In what way is a flea sucking a dog's blood similar to commensalism?

A flea sucking a dog's blood isn't exactly commensalism, but there is something in common here--both are symbiotic relationships. When two organisms live alongside one another, they may establish a symbiotic relationship. When a flea sucks a dog's blood, this is an example of a parasitic symbiotic relationship. Parasites like fleas and worms thrive on the energy provided by a host organism while offering no benefits to the host and, more often than not, causing some amount of harm. Commensalism, on the other hand, is a relationship between two organisms that share a space without either being harmed. In fact, one of these organisms benefits from the relationship without any detriment to the other. An example of a commensal relationship would be that between a clown fish and an anemone. Anemones tend to sting organisms that come swimming or floating by, but clown fish are able to coat themselves in a protective slime. When a clown fish lives inside the tendrils of an anemone, it is protected from potential predators who don't want to be stung. The anemone is not harmed or helped by this relationship.

What is the significance of the images of the flamingos and the river-horse in the poem "The Slave's Dream"?

Dreams are manifestations of man’s deep-seated desires, fears and other emotions. The yearning for liberty is the strongest and deepest feeling of a slave. Finding it impossible to be realized in reality, he takes refuge to dreams. Though unreal and illusory, they offer him a platform to fulfill his desires.

Whatever the slave sees in the dream reflects his pining for freedom. Flamingos and river-horse are among many other images that he associates with the idea of liberty. The poet says,

Before him, like a blood-red flag,
  The bright flamingoes flew;
From morn till night he followed their flight,
  O'er plains where the tamarind grew,

He sees “bright flamingoes” fly “from morn till night.” Riding on his horse, he follows them throughout the day till he reaches the ocean shore.

A flying bird is a stereotypical image of freedom. Thus, flamingos, in the poem, symbolize liberty. Like them, the slave wants to move unrestrictedly; though in reality his movement is restricted and confined.

In the next stanza, the poet says,

At night he heard the lion roar,
  And the hyena scream,
And the river-horse, as he crushed the reeds
  Beside some hidden stream;

River-horse is another name for hippopotamus, a mammal indigenous to Africa. They are semi-aquatic creatures that mostly inhabit water bodies including rivers, lakes and mangrove swamps. They spend the day mostly in water or mud, and come out for grazing grasses after sunset.

In his dream, the slave hears the movement of the river-horse “beside some hidden stream” “as he crushed the reeds.” Unlike the slave, a river-horse is independent and self-determining. It moves freely in water and on land.

What’s common between the flamingos and the river-horse is that both of them move unrestrictedly and freely. The flamingos have the whole sky as their abode, while the river-horse moves at liberty in water and on land.

So, we see that the images of flamingos and water horse contribute to the thematic structure of the poem, and underscore the slave’s desperate craving for freedom.

How did Macbeth kill King Duncan?

Macbeth murders King Duncan in his sleep by stabbing him with a dagger. Duncan, having just survived a revolt and an invasion, is celebrating at Macbeth's palace. Macbeth has been told by the witches that he is to be king. Goaded and encouraged by his wife, and after some soul-searching, Macbeth eventually decides to hurry the process along by murdering the king. His wife gets the king's guards drunk, and after they pass out, Macbeth commits the deed. Lady Macbeth then takes the murder weapon and smears Duncan's blood on the guards, to make it appear that they were guilty of the murder. Macbeth then murders the guards, claiming that he did so in a fit of rage after Macduff discovers the king's body in his chamber. With this act, the first in a series of evil deeds he commits throughout the play, Macbeth becomes king. 

What is a good intro for a synthesis essay that is on the death penalty?

In a synthesis essay, you must come up with an argument. In your case, this might be an argument for or against the death penalty. This argument should be part of your thesis statement. But also note that a good synthesis essay demonstrates the writer's ability to show how different secondary sources support your claim and thesis statement. Think of a synthesis as a way of combining your ideas and the supporting information of the secondary sources. Imagine that you/writer are presenting your claim/thesis in a room with the authors of those secondary sources. So, your paper would read like a dialogue between your ideas and theirs. The idea with a synthesis is to combine different things. The result (conclusion) will summarize how your ideas did combine with the other sources in a logical, persuasive way. 

The intro should introduce how you are going to do this. State how you will show that sources support your argument. For example, if you are arguing that the death penalty is too absolute and barbaric, an introduction might sound something like this: 

In this essay, I argue that the enforcement of the death penalty is barbaric, does not deter crime, and makes the exoneration of wrongly convicted people an impossibility. I will support these claims with statistics and evidence that prove that the cons far outweigh any pros of the death penalty. 

You might then take a few sentences (or more) to elaborate a bit on how you will prove each point. Then you get into the bulk of the essay. (Check out the link below for essay feedback.) 

What is non-Hodgkin lymphoma?

Risk factors: Some known and potential risk factors for non-Hodgkin
lymphoma include age (over forty years); gender (more common in men); a
compromised immune system (such as from immunosuppressant treatments or acquired
immunodeficiency syndrome, AIDS); autoimmune or chronic inflammatory conditions,
such as rheumatoid arthritis and Sjögren
syndrome; chronic infection, such as with Epstein-Barr
virus (increases risk of Burkitt
lymphoma),
Helicobacter pylori
,
and hepatitis C
virus; radiation exposure; and chemical exposure (such as to
certain solvents, pesticides, herbicides and fertilizers).

Despite the list of known and suspected risk factors for non-Hodgkin lymphoma, most people diagnosed have no known risk factors, and many who have risk factors never develop the disease.

Etiology and the disease process: For most patients, the exact cause
of non-Hodgkin lymphoma is unknown. One suspected cause is the activation of
certain abnormal genes that allow uncontrollable lymphocyte division and growth.
This uncontrolled growth causes lymph nodes and other lymphatic tissues to swell.
Because lymphatic tissue is in various locations throughout the body, non-Hodgkin
lymphoma can start almost anywhere and tends to be widespread, although
slower-growing types may be confined to one place. Typically, non-Hodgkin lymphoma
begins in the lymph nodes and spreads to other parts of the lymphatic system.
Occasionally, non-Hodgkin lymphoma also invades organs outside the lymphatic
system, including the stomach, brain, and lungs.

Incidence: Non-Hodgkin lymphoma is the fifth most common type of
cancer among adults and the sixth leading cause of cancer deaths in the United
States. According to the National Cancer Institute, in 2014, an estimated 70,800
non-Hodgkin lymphoma cases were diagnosed and 18,990 deaths were attributed to
non-Hodgkin lymphoma.

Non-Hodgkin lymphoma occurs in all age groups, but the risk of developing the disease increases with age (95 percent of cases occur in adults age forty and older). Some subtypes are more common in certain age groups. In children, non-Hodgkin lymphoma is most commonly diagnosed between the ages of seven and eleven, and some types of non-Hodgkin lymphoma are among the most common childhood cancers.

Symptoms: Symptoms vary depending on the area of the body in which the tumor originated and the areas to which the cancer has spread. Swollen, painless lymph nodes in the neck, underarms, stomach, or groin are commonly the only sign of non-Hodgkin lymphoma in early stages.

Generalized symptoms include fever, unexplained weight loss, fatigue, excessive sweating, night sweats, chills, easy bruising, itchiness, and unusual infections.

Tumors in the stomach can cause pain and swelling, which can lead to loss of appetite, constipation, nausea, and vomiting. Tumors in the thymus or chest lymph nodes can cause coughing and shortness of breath. Lymphoma of the brain can cause headaches, personality changes, and seizures.

Screening and diagnosis: Many tests are used to diagnose non-Hodgkin lymphoma and assess the spread of the disease. Diagnosis begins with a medical history and physical examination, which commonly focuses on the lymph nodes, liver, and spleen. Blood and urine tests may be performed to help rule out infections and other diseases that cause swollen nodes.

An excisional biopsy is the best way to definitively diagnose lymphoma and
determine the subtype.

Lymph node biopsy from the neck, armpits, or groin is most common. Bone marrow biopsy may be performed to establish whether the disease has spread.

Imaging tests such as X-rays, magnetic resonance imaging, and computed
tomography scanning may be used to detect the presence of non-Hodgkin lymphoma,
determine the size of tumors, and determine the extent to which the cancer has
spread.

Staging helps to determine treatment. A system commonly used to stage
non-Hodgkin lymphoma is a modified Ann Arbor staging system. This system
classifies lymphoma into four stages:

• Stage I: Lymphoma is limited to a single region, usually one lymph node or one lymph node region in the body.





• Stage II: Lymphoma involves two or more lymph node regions on the same
  side of the diaphragm.





• Stage III: Lymphoma has spread to lymph node regions on both sides of the
  diaphragm.





• Stage IV: Widespread disease has affected one or more nonlymphatic
  organs.

A lettering system is commonly used in combination with the stage to indicate
the presence of symptoms. An “E” indicates involvement of organs outside the lymph
system; a “B” indicates the presence of weight loss, night sweats, or unexplained
fever; an “A” indicates the absence of symptoms; and an "S" indicates the
involvement of the spleen.

Treatment and therapy: Treatment of non-Hodgkin lymphoma depends on the type and stage of the disease, symptoms, and the patient’s age and overall medical condition. Three main treatments are used: chemotherapy, radiation therapy (RT), and immunotherapy (also called biological therapy). Surgery is rarely used to treat the disease but may be used to relieve problems caused by non-Hodgkin lymphoma, such as bowel obstruction and spinal cord compression.

Chemotherapy is the primary treatment for non-Hodgkin lymphoma. It may be used
alone or in combination with other treatments. Intermediate- and high-grade
lymphomas and advanced low-grade lymphomas are commonly treated with multiple
agents; single-drug therapy may be used for early-stage, low-grade disease. The
exact medications, routes, doses, and duration of treatment depend on the stage
and type of lymphoma. A common chemotherapy regimen for the initial treatment of
non-Hodgkin lymphoma includes cyclophosphamide, doxorubicin, vincristine, and
prednisone. Patients are usually treated on an outpatient basis unless problems
arise.

Radiation therapy is used to kill or shrink cancer cells. In some cases of Stage I and II non-Hodgkin lymphoma, curative treatment with radiation therapy is possible. Sometimes, radiation therapy is used with chemotherapy to treat intermediate-grade tumors or tumors in specific sites, such as the brain. However, it is typically ineffective against more advanced lymphomas. Radiation therapy may also be used to ease symptoms.

Immunotherapy is an evolving treatment in which substances naturally made by
the immune system are used to kill lymphoma cells or slow their growth.
Investigational immunotherapies for non-Hodgkin lymphoma include monoclonal
antibodies and interferons. Rituximab is a monoclonal antibody approved by the US Food and Drug
Administration for the treatment of B-cell non-Hodgkin lymphoma. It is commonly
used in combination with chemotherapy. Some forms of radioimmunotherapy, in which
monoclonal antibodies are attached to radioactive substances, are also used to
treat non-Hodgkin lymphoma. Examples include ibritumomab and tositumomab. Because
of their life-threatening side effects, these drugs are used only after other
treatments have failed.

If non-Hodgkin lymphoma recurs, treatment with high-dose chemotherapy, total-body or total-lymph node irradiation, or bone marrow or stem cell transplantation may be necessary.

Prognosis, prevention, and outcomes: The one-year relative survival
rate for non-Hodgkin lymphoma is 81 percent; five-year, 63 percent; and ten-year,
49 percent. Rates vary depending on the person, type of lymphoma, and stage of
disease. As with most other cancers, the earlier the diagnosis, the greater the
chances for successful treatment. However, 70 percent to 80 percent of patients
with aggressive lymphomas achieve complete remission with treatment. Typically,
the type of tissue involved is a better prognostic predictor than cancer
stage.

The International Prognostic Index (IPI) is used to help predict lymphoma growth and patient response to treatment. Based on patient age, cancer stage and spread, patient function, and lactate dehydrogenase levels, the IPI is mainly used in patients with aggressive lymphomas.

Low-grade non-Hodgkin lymphomas tend to be advanced when diagnosed. Although
they usually respond well to treatment, they may also recur. High-grade
non-Hodgkin lymphomas sometimes require intensive chemotherapy. These lymphomas
are often curable (some have 60 to 80 percent cure rates). However, if the cancer
does not respond to chemotherapy, the disease can cause death.

Because most people who have non-Hodgkin lymphoma have no known risk factors
and the cause of the cancer is unknown, prevention is elusive.

Adler, E. M.
Living with Lymphoma: A Patient’s Guide. Baltimore:
Johns Hopkins UP, 2005. Print.

American Cancer
Society and National Comprehensive Cancer Network. Non-Hodgkin’s
Lymphoma Treatment Guidelines for Patients. Atlanta: Author,
2005. Print.

Holman, Peter, Jodi
Garrett, and William Jansen. One Hundred Questions and Answers About
Lymphoma. Sudbury: Jones and Bartlett, 2004. Print.

Niederhuber, John E., et al.
Abeloff's Clinical Oncology. 5th ed. Philadelphia:
Saunders, 2013. Print.

Quesenberry, Peter J., and Jorge J.
Castillo, eds. Non-Hodgkin Lymphoma: Prognostic Factors and
Targets. New York: Humana, 2013. Print.

Rich, Robert R., ed. Clinical
Immunology: Principles and Practice. 4th ed. London: Elsevier,
2013. Print.

What is hope, and how does it affect mental health?

Introduction

For centuries, people have contemplated the meaning of hope. Because hope is an abstract idea, definitions have varied according to diverse factors, including cultural, spiritual, and psychological needs to secure what people believe hope represents. The essence of hope frequently reflects wishes for accomplishments or objects that fulfill people or help them achieve behaviors compatible with societal demands. Secular and religious literature has depicted hope mostly with positive attributes, although some portrayals, such as the Pandora myth, hint of hope’s ambiguities. Hope is often equated with resilience, while hopelessness is associated with despair. Until the mid-twentieth century, many psychology researchers resisted studying hope scientifically because they considered it difficult to define and quantify.

Hope Theories

In 1959, Karl Menninger spoke about the need for psychiatrists to study and incorporate hope in therapy during his presidential presentation at an American Psychiatric Association meeting. Jerome Frank emphasized the importance of hope for effective psychotherapy in a 1968 International Journal of Psychiatry article. Hope theory research, representing positive psychology, emerged throughout the latter half of the twentieth century. Erik H. Erikson hypothesized that hope, which he said started forming at birth, was essential for development of cognition. Ezra Stotland wrote The Psychology of Hope (1969), exploring his premise that people’s expectations to meet valued goals influenced their experiences with hope.

By the 1980’s, Sara Staats had stated that hope involved both emotion and cognition. At the University of Kansas, C. R. Snyder began developing a hope theory to assist his patients in recognizing ways to pursue their goals. In the 1990’s, he outlined three components of hope. First, people identify goals, representing daily activities or more complicated endeavors. Next, people use their cognition skills to recognize pathways they can follow in pursuit of goals. Third, people need agency, demonstrating the motivation and perseverance required to engage in pathways, for goal resolution. All three cognitive elements are essential to Snyder’s hope theory.

Obstacles, including negative emotions, attitudes, and experiences, affect whether people believe they can complete goals. People with high hope often pursue several goals simultaneously, express confidence in their abilities, and excel in school, athletics, or work. Hope also aids people to cope with such medical concerns as cancer. Imbalanced hope theory components can frustrate people who are unsure how to attain their goals or lack sufficient motivation. Although hope can empower people, psychology professionals recognize the absence of hope can impair mental health and result in depression.

In the early twenty-first century, research in hope theory has considered topics such as the positive or negative impact of unexpected events on hope. Emotions produced when people react to emergencies or other traumatic occurrences can motivate them to achieve goals such as fleeing danger or assisting injured people.

Measuring Hope

Mental health professionals use hope measurement to provide patients effective therapy that enhances existing hope or counters helplessness. In the April, 1975, Journal of Clinical Psychology, Richard Erickson, Robin Post, and Albert Paige introduced their Hope Scale, inspired by Stotland’s scholarship. In this scale, people use a seven-point scale to respond to twenty goal statements. They also assign numerical values from one to one hundred to rate how attainable they perceive each goal to be.

During the 1980’s, Staats developed the Expected Balance Scale (EBS) to evaluate adults’ emotion-based hope with responses to a list of eighteen items, equally divided between negative and positive statements. Staats and Marjorie Stassen measured cognitive aspects with the Hope Index, which included sixteen items that people ranked in four categories: hope for themselves, hope for others, wishes, and expectations.

In the 1990’s, Snyder developed several hope measurement tests. The Adult Dispositional Hope Scale consists of twelve statements to assess pathways and agency. The Children’s Hope Scale (CHS), with six items quantified by a six-point scale, is for children age seven through sixteen. Snyder’s Domain Specific Hope Scale focuses on relationship goals or other precise concerns. His Young Children’s Hope Scale (YCHS) evaluated children age five to seven.

Other hope tests for adults include the Miller Hope Scale, created by nurses Judith Miller and M. J. Powers; the thirty-two item Herth Hope Index, designed by A. K. Herth; and the Nowotny Hope Scale, established by Mary Nowotny to assess hope in people enduring stress. Some psychologists observed patients’ actions pursuing goals to measure hope. In the June, 1974, Archives of General Psychiatry, Louis Gottschalk described evaluating verbal samples for hope. Mary Vance devised the Narrative Hope scale in the 1990’s to examine stories for references to pathways and agency. Hope measurement scales were frequently translated into Asian or European languages and adapted for compatibility with distinct cultures, such as a Norwegian version of the Herth Hope Index.

Bibliography

Lopez, Shane J., C. R. Snyder, and Jennifer Teramoto Pedrotti. “Hope: Many Definitions, Many Measures.” In Positive Psychological Assessment: A Handbook of Models and Measures, edited by Lopez and Snyder. Washington, D.C.: American Psychological Association, 2003. Summarizes hope theory developments and researchers’ efforts to quantify hope. Diagram, tables, appendixes, bibliography.

Reading, Anthony. Hope and Despair: How Perceptions of the Future Shape Human Behavior. Baltimore: Johns Hopkins University Press, 2004. Psychiatrist Reading discusses cognitive, emotional, and physiological processes associated with hope and hopelessness. Figures, endnotes, bibliography.

Snyder, C. R., ed. Handbook of Hope: Theory, Measures, and Applications. San Diego, Calif.: Academic Press, 2000. Comprehensive source addresses gender, age, and ethnicity factors and how hope helps people recovery from injuries and helps relieve pain.

Snyder, C. R., Diane McDermott, William Cook, and Michael A. Rapoff. Hope for the Journey: Helping Children Through Good Times and Bad. Boulder, Colo.: Westview Press, 1997. Stresses storytelling’s role in hope development. Discusses parents’ and teachers’ responsibilities. Appendices suggest children’s literature with hope themes and provide a story version of the YCHS.

Snyder, C. R., Kevin L. Rand, and David R. Sigmon. “Hope Theory: A Member of the Positive Psychology Family.” In Handbook of Positive Psychology, edited by Snyder and Shane J. Lopez. 2d ed. New York: Oxford University Press, 2005. Compares hope theory with optimism, self-efficacy, self-esteem, and problem-solving theories. Includes three measurement scales.

What is bone marrow transplantation?

Indications and Procedures

Bone marrow
transplantation is used when the immune and blood-forming systems of the body are malfunctioning or have been severely damaged. Without adequate white blood cells, a person will soon die from infection. Transplantation
is an attempt to cure or arrest diseases such as leukemia, cancer, and sickle cell disease and conditions such as brain
tumors and hereditary diseases. Bone marrow transplantation is used when all other methods of treatment have failed. The procedure is usually performed on patients who are younger than fifty years old, with the greatest success rates found in children.

Before the procedure can be performed, a suitable donor must be found. The donor can be the patient (autologous transplantation) or someone else (allogeneic transplantation). Once the donor is identified, the bone marrow is harvested. This procedure is usually done under general anesthesia and takes one to two hours. A needle is inserted in the hip, and marrow is sucked out from different locations in the pelvic bone. Approximately 1 to 3 pints of marrow are taken. The donor usually stays overnight in the hospital and may be sore for one or two weeks following the operation.

The marrow, which contains the stem cells necessary to reestablish the blood-producing and immune systems of the patient, is processed and stored until the patient is prepared for the transplantation. During the hospital stay, the patient is kept in a sterile room to prevent infection. If the surgery is being performed on a cancer patient, the patient receives extensive chemotherapy and/or radiation before the donor marrow is transplanted; this action destroys any cancer cells in the patient, as well as his or her immune system.

The patient then receives the bone marrow transplantation in a manner similar to a blood transfusion: The donor cells are introduced through the veins and into the bloodstream. Until the transplanted cells begin to function (usually two to four weeks), the patient receives blood and platelet transfusions, as well as antibiotics to fight infection. The patient is usually discharged from the hospital in a month but must take antibiotics and antiviral medications for six months to two years after the transplantation because the recovery of the immune system is slow.

Uses and Complications

Bone marrow transplantation is a risky procedure with a success rate that ranges from 10 to 90 percent. One of the greatest obstacles is finding a suitable donor. The best possible match is between siblings, but even here the probability of a correct match is only 25 percent. Unrelated donor and patient matches made with marrow from donor banks increase the risk of a mismatch.

Finding a suitable donor is imperative because of the risk of graft-versus-host disease
(GVHD). GVHD occurs when the donor cells recognize the host’s body as foreign and react against it. This reaction may occur within a hundred or more days after the transplant and can vary in severity from a mild rash to the fatal destruction of tissue and organs. For correctly matched donors and recipients, the risk of life-threatening GVHD is 10 to 20 percent. For mismatched donors and recipients, the risk rises to 80 percent. In some cases, especially with leukemia and cancerous blood diseases, patients who suffer mild GVHD have an improved chance of survival because part of GVHD is a graft-versus-leukemia (GVL) effect. In these cases, the transplanted immune system acts against any remaining leukemia cells.

When the patient does not have a condition that damages the bone marrow, transplantation can be performed with his or her own marrow. After marrow has been collected from the patient, radiation and/or chemotherapy can be used to destroy the remaining immune system. Autologous transplantation eliminates the need to find a compatible donor and the risk of GVHD. This method can be used for treating solid tumors and has shown promise in curing brain tumors that were once considered fatal, with a success rate of 20 percent.

In April 2013 scientists at the Abramson Cancer Center of the University of Pennsylvania published a study of 300,000 bone marrow translplant recipients. According to the study, transplant recipients are at increased risk for suicide and accadential death.

Perspective and Prospects

Research on bone marrow transplantation began in the early 1950s, with the first successful transplantations performed on children in 1968. By the 1990s, more than five thousand bone marrow transplantations were being performed worldwide every year. The development of drugs that work to suppress the immune system has increased the chances for survival for these patients.

Several areas of research promise even better results in the future. A growing understanding of disease at the genetic level offers the possibility of separating unhealthy bone marrow cells from healthy ones. Methods of growing cells outside the body for use in transplantation are being developed. Progress has also been made in increasing the donor pool. National and international programs actively seek potential donors. Healthy people may begin storing their own bone marrow for a possible need in the future.

Perhaps one of the most promising potential sources of donor bone marrow is umbilical cord blood, which is rich in stem cells. Transplants using umbilical cord blood were first used in 1989 and have proven very successful. If established, umbilical cord blood banks could greatly increase the quantity of available donor marrow.

Bibliography

"After-transplant problems that may show up later." cancer.org, October 24, 2012.

Blood and Marrow Transplant Information Network. http://www.bmtinfonet.org.

Bolwell, Brian J., ed. Current Controversies in Bone Marrow Transplantation. Totowa, N.J.: Humana Press, 2000.

Marget, Madeline. Life’s Blood. New York: Simon & Schuster, 1992.

Marshak, Daniel R., David Gottlieb, and Richard L. Gardner, eds. Stem Cell Biology. Cold Spring Harbor, N.Y.: Cold Spring Harbor Laboratory Press, 2002.

National Research Council. Stem Cells and the Future of Regenerative Medicine. Washington, D.C.: National Academy Press, 2002.

Stewart, Susan K. Autologous Stem Cell Transplants: A Handbook for Patients. Highland Park, Ill.: Blood and Marrow Transplant Information Network, 2000.

Seaman, Andrew M. "Suicide, accidents linked to bone marrow transplant." Medline Plus, April 12, 2013.

Swerdlow, Joel L. “A New Kind of Kinship.” National Geographic 180, no. 3 (September, 1991): 64-92.

"The transplant process." cancer.org, October 24, 2012.

U.S. Department of Health and Human Services, National Institutes of Health. Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation. Rev. ed. Bethesda, Md.: Author, 1994.

What is instinct theory?

Introduction

When instinct theory was incorporated into the new scientific psychology of the late nineteenth century, it was already centuries old. In its earliest form, instinct theory specified that a creature’s essential nature was already established at birth and that its actions would largely be directed by that nature. A modern restatement of this notion would be that, at birth, creatures are already programmed, as computers are, and that they must operate according to their programs. Charles Darwin’s theory of evolution through
natural selection, first published in 1859, led to great controversy in the late nineteenth and early twentieth centuries. It also fostered speculation that if humans were evolved from earlier forms and were therefore more closely related to other animals than had once been believed, humans might have instincts, or inherited behaviors, that other animals were observed to have. In 1908, William McDougall
, one of the main early instinct theorists, suggested a list of human instincts that included such varied behaviors as repulsion, curiosity, self-abasement, and gregariousness. Many researchers came up with their own lists of human instincts; by the 1920s, more than two thousand had been suggested.

A computer program can be printed out and studied, but an instinct in the original sense cannot so easily be made explicit. At best, it can be inferred from the behavior of an animal or person after other explanations for that behavior have been discounted; at worst, it is simply assumed from observing behavior. That a person has, for example, an instinct of argumentativeness could be assumed from the person’s arguing; arguing is then “explained” by declaring that it comes from an instinct of argumentativeness. Such circular reasoning is unacceptable in scientific analysis, but it is very common in some early scientific (and many modern popular) discussions of instinct.

Variations in Theory

As is often the case with ideas that have long been believed by both scientists and the general public, instinct theory has separated into several theories. The earliest form was accepted by Aristotle, the ancient Greek philosopher and scientist. He stated in his
Politics
that “a social instinct is implanted in all men by nature” and that “a man would be thought a coward if he had no more courage than a courageous woman, and a woman would be thought loquacious if she imposed no more restraint on her conversation than the good man.” The first statement declares an inherent quality of people; the second, inherent qualities of men and women. Very likely, Aristotle’s beliefs were based on careful observation of people around him—a good beginning, but not a sufficient basis for making factual comments about people in general.

Aristotle’s views were those of a scientist of his day. Centuries later, a scientist would not hold such views, but a layperson very well might. Over the many centuries since Aristotle expressed his views on instinct theory, “popular” versions of it have been more influential than the cautious versions offered by later scientists.

Historic Misinterpretations

Modern science reaches conclusions based, to the greatest extent possible, on evidence gathered and interpreted along lines suggested by theories. Traditional instinct theory is especially weak in suggesting such lines; usually it put early psychologists in the position of trying to support the idea that instinct had caused a behavior by demonstrating that nothing else had caused it. Rather than supporting one possibility, they were attempting to deny dozens of others. Even worse, they were forcing thought into an “either-or” pattern rather than allowing for the possibility that a behavior may be based on inherited influences interacting with learned ones.

For example, to try to evaluate the possibility that people are instinctively afraid of snakes, one might first find a number of people who are afraid of snakes and then attempt to establish that those people had never had an experience that might have caused them to learn their fear, such as being startled or harmed by a snake or even being told that snakes are dangerous. Such a task is all but impossible, almost guaranteeing that a researcher will conclude that there are several ways that the fear could have been learned, so an instinct explanation can be discounted. The fact that people who fear snakes can learn not to fear them can be offered as further evidence that they had learned their original fear—not a particularly compelling argument, but a good enough approach for a researcher who wants to discount instinct.

When behaviorism
became the predominant theoretical stance of psychology in the 1920s, the problems with instinct as an explanation of motivation
were “resolved” simply by sidestepping them. Instincts were discarded as unscientific, replaced by concepts such as needs, drives, and motives. Dropping the term “instinct” from the vocabulary of psychology did not eliminate the behaviors it had originally labeled, either for lower animals or for people, but it did separate even further the popular views of instinct from the scientific ones.

Reemergence of Human Nature Research

Instinct theory’s purpose in psychology’s infancy was the same as it had once been in the distant past: to explain the motivations of a variety of species, from the simplest creatures up to humans. Unfortunately, it had also served other purposes in the past, purposes that often proved unwelcome to early behavioral scientists. To declare people superior to other animals, or men superior to women, or almost any target group better or worse than another was not a goal of psychology.

Worse than the heritage of centuries of misuse of the concept of instinct was the accumulation of evidence that instincts, defined at the time as completely unlearned behaviors, were limited to simple creatures and were virtually nonexistent in people. Psychology and related sciences all but eliminated instinct as a motivational concept for decades. However, they could not avoid bringing back similar notions; the term “instinct” was gone, but what it tried to explain was not. For example, in the 1940s, social psychologists working to find alternatives to the belief that aggression is instinctive in humans proposed that frustration (goal blocking) is a major cause of aggression. When pressed to explain why frustration led to aggression, many indicated that this is simply part of human nature. Some years later, it was demonstrated that the presence of some sort of weapon during a frustrating experience enhanced the likelihood of aggression, apparently through a “triggering effect.” Instinct as a concept was not invoked, but these ideas came very close.

Even closer was the work of another group of scientists, ethologists, in their explanations of some animal behaviors. Evaluating what might be thought a good example of instinct in its earliest definition, a duckling following its mother, they demonstrated that experience with a moving, quacking object is necessary. In other words, learning, albeit learning that was limited to a very brief period in the duckling’s development, led to the behavior. Many other seemingly strong examples of instinct were demonstrated to be a consequence of some inner predisposition interacting with environmental circumstances. A new, more useful rethinking of the ancient concept of instinct had begun.

Instinctive Influences

A 1961 article by Keller and Marian Breland suggested that instinct should still be a part of psychology, despite its period of disgrace. While training performing animals, they had witnessed a phenomenon they termed “instinctive drift.” (Although other terms, such as “species-specific behavior,” were at that time preferred to “instinct,” the Brelands stated their preference for the original label.) Instinctive drift refers to the tendency of a creature’s trained behavior to move in the direction of inherited predispositions.

When the Brelands tried to teach pigs to place coins in a piggy bank, they found that although the pigs could easily be taught to pick up coins and run toward the bank, they could not be stopped from repeatedly dropping and rooting at them. Raccoons could be taught to drop coins in a container but could not be stopped from “dipping” the coins in and rubbing them together, a drift toward the instinctive washing of food. Several other species presented similar problems to their would-be trainers, all related to what the Brelands willingly called instinct.

Preparedness is another example of an instinct/learning relationship. Through conditioning, any creature can be taught to associate some previously neutral stimulus with a behavior. Dogs in Ivan Petrovich Pavlov’s laboratory at the beginning of the twentieth century readily learned to salivate at the sound of a bell, a signal that food would appear immediately. While some stimuli can easily serve as signals for a particular species, others cannot. It seems clear that animals are prepared by nature for some sorts of learning but not for others. Rats can readily be trained to press a lever (a bar in a Skinner box) to obtain food, and pigeons can readily be trained to peck at something to do so, but there are some behaviors that they simply cannot learn to serve that purpose.

Conditioned taste aversion
is yet another example of an instinctive influence that has been well documented by modern psychology. In people and other animals, nausea following the taste of food very consistently leads to that taste becoming aversive. The taste/nausea combination is specific; electric shock following a taste does not cause the taste to become aversive, nor does a visual stimulus followed by nausea cause the sight to become aversive. Researchers theorize that the ability to learn to detect and avoid tainted food has survival value, so it has become instinctive.

Limitations and Misuse of Theory

In popular use, belief in instincts has confused and hurt people more than it has enlightened or helped them. Instinct theory often imposes a rigid either-or form on people’s thinking about human motivation. That is, people are encouraged by the notion of instinct to wonder if some behavior, such as aggression, is either inherent in people or learned from experience. Once one’s thoughts are cast into such a mold, one is less likely to consider the strong likelihood that a behavior has multiple bases, which may be different from one person to the next. Instead of looking for the many possible reasons for human aggression, some related to inherent qualities and some related to learned qualities, one looks for a single cause. Intently focusing on one possibility to the exclusion of all others often blinds people to the very fact that they are doing so. Searching for “the” answer, they fail to recognize that their method of searching has locked their thinking onto a counterproductive track.

Instinct theory has been invoked to grant humans special status, above that of other animals. Generally, this argument states that humans can reason and rationally control their actions, while lower animals are guided solely by instincts. At best, this argument has been used to claim that humans are especially loved by their God. At worst, the idea that lower animals are supposedly guided only by instinct was used by philosopher René Descartes to claim that animals were essentially automatons, incapable of actually feeling pain, and that therefore they could be vivisected without anesthesia.

Instinct theory has also been used to support the claim that some people are more worthy than other people. Those with fewer “base instincts,” or even those who by their rationality have overcome their instincts, are supposedly superior. Acceptance of such ideas has led to very real errors of judgment and considerable human suffering. For example, over many centuries, across much of the world, it was believed that women, simply by virtue of being female, were not capable of sufficiently clear thinking to justify providing them with a formal education, allowing them to own property, or letting them hold elected office or vote. Anthropologist Margaret Mead, in her 1942 book And Keep Your Powder Dry: An Anthropologist Looks at America, reports a reversal of the claim that women inherently lack some important quality. Young women in her classes, when told the then-prevailing view that people had no instincts and therefore they had no maternal instinct, became very upset, according to Mead, believing that they lacked something essential. Many minority racial or ethnic groups have suffered in similar fashion from claims that, by their unalterable nature, they are incapable of behaving at levels comparable to those in the majority.

Instinct theory has been used to suggest the absolute inevitability of many undesirable behaviors, sometimes as a way of excusing them. The ideas that philandering is part of a man’s nature or that gossiping is part of a woman’s are patently foolish uses of the concept of instinct.

Bibliography

Barrett, Deirdre. Supernormal Stimuli: How Primal Urges Overran Their Evolutionary Purpose. New York: Norton, 2010. Print.

Bering, Jesse. The Belief Instinct: The Psychology of Souls, Destiny, and the Meaning of Life. New York: Norton, 2011. Print.

Birney, Robert Charles, and Richard C. Teevan, eds. Instinct: An Enduring Problem in Psychology. Princeton: Van Nostrand, 1961. Print.

Breland, Keller, and Marian Breland. “The Misbehavior of Organisms.” American Psychologist 16.11 (1961): 681–84. Print.

Cofer, Charles Norval, and M. H. Appley. Motivation: Theory and Research. New York: Wiley, 1967. Print.

Hilgard, Ernest Ropiequet. Psychology in America: A Historical Survey. San Diego: Harcourt, 1987. Print.

Pinker, Steven. The Language Instinct: How the Mind Creates Language. New York: Harper, 2007. Print.

Portegys, Thomas E. "Discrimination Learning Guided by Instinct." International Journal of Hybrid Intelligent Systems 10.3 (2013): 129–36. Print.

Spink, Amanda. Information Behavior: An Evolutionary Instinct. Heidelberg: Springer, 2010. Print.

Sun, L. The Fairness Instinct: The Robin Hood Mentality and Our Biological Nature. Amherst: Prometheus, 2013. Print.

Wallenstein, Gene V. The Pleasure Instinct: Why We Crave Adventure, Chocolate, Pheromones, and Music. Hoboken: Wiley, 2009. Print.

Watson, John B. Behaviorism. New York: Norton, 1925. Print.

Weiten, Wayne. Psychology: Themes and Variations. 9th ed. Belmont: Wadsworth, 2013. Print.

What is resveratrol as a dietary supplement?

Overview

The French diet is high in saturated fat and cholesterol, yet France has one of the world’s lowest rates of heart disease. One theory for this apparent discrepancy is that another major player in the French diet, red wine, protects the arteries of the heart. Another possibility, perhaps even more likely, is that cutting down on saturated fat is less helpful than previously thought.

Resveratrol is a natural antioxidant found in red wine. Antioxidants protect cells in the body from damage by free radicals, naturally occurring but harmful substances that are thought to play a role in cardiovascular disease. Resveratrol is also a phytoestrogen, a substance that mimics some of the effects of estrogen, while blocking others. Soy, another phytoestrogen, is thought to help prevent heart disease and cancer, and resveratrol might have similar effects. However, none of these potential benefits of resveratrol have been documented in any meaningful way, and there is some evidence that resveratrol taken by mouth is broken down by the liver before it enters the bloodstream.

Sources

Resveratrol is not an essential nutrient. It is found in red wine, red grape skins and seeds, and purple grape juice. Peanuts also contain a small amount of resveratrol. Resveratrol supplements are available too.

Therapeutic Dosages

Because no clinical studies have been undertaken to look at the effects of resveratrol, the optimal therapeutic dosage has not been established. Based on animal studies, a reasonable therapeutic dosage might be about 500 milligrams daily.

Therapeutic Uses

Preliminary evidence, such as the results of test-tube studies, suggests that resveratrol may help prevent heart disease and cancer. However, not all studies have been favorable. Furthermore, there is some evidence that resveratrol is immediately broken down by the human liver and therefore does not enter the bloodstream at any significant level. In any case, only double-blind studies can prove a treatment effective, and none have been reported with resveratrol.

Safety Issues

Resveratrol, which has a chemical structure similar to that of the synthetic estrogenic hormone diethylstilbestrol, has estrogenic effects. According to one study, resveratrol might stimulate the growth of breast cancer cells. For this reason, resveratrol should be avoided by women who have had breast cancer or are at high risk of developing it. Maximum safe dosages for children, pregnant or nursing women, or those with severe liver or kidney disease have not been determined.

Bibliography

El Attar, T. M., and A. S. Virji. “Modulating Effect of Resveratrol and Quercetin on Oral Cancer Cell Growth and Proliferation.” Anticancer Drugs 10 (1999): 187-193.

Fulda, S. “Resveratrol and Derivatives for the Prevention and Treatment of Cancer.” Drug Discovery Today 15 (2010): 757-765.

Gullett, N. P., et al. “Cancer Prevention with Natural Compounds.” Seminars in Oncology 37 (2010): 25-281.

Mgbonyebi, O. P., J. Russo, and I. H. Russo. “Antiproliferative Effect of Synthetic Resveratrol on Human Breast Epithelial Cells.” International Journal of Oncology 12 (1998): 865-869.

Walle, T., et al. “High Absorption but Very Low Bioavailability of Oral Resveratrol in Humans.” Drug Metabolism and Disposition 32 (2004): 1377-1382.

What do Miss Caroline's interactions with Burris Ewell suggest about Miss Caroline and the Ewells in To Kill a Mockingbird by Harper Lee?

Miss Caroline officially meets Burris Ewell in chapter three of To Kill a Mockingbird. As she's walking by him, Miss Caroline spots a louse crawling out of Burris's hair. She screams in horror, but is calmed down by Little Chuck Little who assures her that cooties are nothing to be afraid of. Burris shows no sign of alarm, finds the bug, and squishes it between his fingers. The interchange that follows between teacher and student shows they are from completely different sides of the tracks.

First, Miss Caroline asks Burris to spell his first name because all she has is his last name "Ewell" in her roll book, but Burris doesn't know how to spell his name. She then tells him to go home and wash his hair before returning the next day. She even reads a recipe to him about how to get rid of lice. Scout describes him as the filthiest person she's ever seen. He stands up and declares that she isn't sending him home, he's leaving on his own volition. The class then explains to her the Ewells only come on the first day of school and don't come back till the next year. Miss Caroline is also deeply affected by the revelation that Burris has no mother. Burris disrespectfully yells the following before leaving the school:

"Ain't no snot-nosed slut of a schoolteacher ever born c'n make me do nothin'! You ain't makin' me go nowhere, missus. You just remember that, you ain't makin' me go nowhere!" (28).

Once Miss Caroline is sufficiently crying, Burris leaves.

The differences between Miss Caroline and Burris Ewell are almost innumerable. Miss Caroline is tender-hearted, educated, and probably doesn't know what it means to suffer or go hungry. She also probably grew up with two parents who nurtured her and gave her everything she needed in life. Miss Caroline has never been spoken to by anyone in such a disrespectful manner, either. She is a young, naïve, and inexperienced girl.

Burris, on the other hand, is a wild, uneducated, disrespectful boy who hasn't been taught manners, hygiene, or how to obey anyone from the community. He's probably been taught the world owes him a living and he is beholden to no one. Sadly, Burris goes home with an empty stomach and to no one but siblings because his father is probably out drunk somewhere. The Ewells, as Atticus puts it, are the biggest disgrace of Maycomb county.

`1, 5, 9, 13...` Use mathematical induction to find a formula for the sum of the first n terms of the sequence.

`1,5,9,13,......`

Now let's denote the first term` ` of the above sequence by `a_1` and k'th term by `a_k` and let's write down the first few sums of the sequence.

`S_1=1`

`S_2=1+5=6=(2(1+5))/2=(2(a_1+a_2))/2`

`S_3=1+5+9=15=(3(1+9))/2=(3(a_1+a_3))/2`

`S_4=1+5+9+13=28=(4(1+13))/2=(4(a_1+a_4))/2`

From the above sequence it appears that the formula for the sum of the k terms is,

`S_k=(k(1+a_k))/2`

Now the difference between the consecutive terms of the series is 4, so we can write down ,

`a_k=1+(k-1)4=1+4k-4=4k-3`

`a_(k+1)=4(k+1)-3=4k+4-3=4k+1`

`S_k=(k(1+4k-3))/2=(k(4k-2))/2`

`S_k=k(2k-1)`

Now we can verify that it is valid for n=1,

Plug in k=1 to verify,

`S_1=1(2*1-1)=1`

Let's assume that the formula is valid for n=k and now we have to show that it is valid for n=k+1

`S_(k+1)=1+5+9+13........+a_k+a_(k+1)`

`S_(k+1)=S_k+a_(k+1)`

`S_(k+1)=k(2k-1)+4k+1`

`S_(k+1)=2k^2-k+4k+1`

`S_(k+1)=2k^2+3k+1`

`S_(k+1)=2k^2+2k+k+1`

`S_(k+1)=2k(k+1)+1(k+1)`

`S_(k+1)=(k+1)(2k+1)`

`S_(k+1)=(k+1)[2(k+1)-1]`

So the formula is valid for n=k+1 also, 

So the formula can be written as ,

`S_n=n(2n-1)`

What is Annie Sullivan's greatest fear regarding Peter Fagan?

Peter Fagan is actually not mentioned in Helen Keller's autobiography, The Story of My Life, as the autobiography was actually published in 1903, whereas Helen did not meet Peter until 1916, when she was in her 30s. Instead, novelist Rosie Sultan wrote a historical fictional novel titled Helen Keller in Love, published in 2013, detailing Helen's lost love story, which she, along with many other writers and reporters, pieced together based on archived letters and newspaper articles.

Helen met Peter at the age of 35 when her teacher, Anne Sullivan, became infected with tuberculosis. Peter was a 29-year-old unemployed journalist sent by Anne's husband to Helen to be her secretary. According to Sultan, confirmed by an article titled "Helen Keller, 87, Dies: Triumph Out of Tragedy," printed in The New York Times on June 2, 1968, Helen and Peter had taken out a marriage license and planed to elope. However, both Miss Sullivan and Helen's mother broke up the affair because their was a standard belief that women with disabilities should not marry. In addition, Helen's mother objected strongly to Peter's Socialist beliefs.

Miss Sullivan in particular, also a woman with disabilities, couldn't help but relate Helen's love affair to her own marital situation. Though she married, she and her husband were separated, and he was a manipulator, frequently asking her for money. Miss Sullivan saw how easy it is for a woman with disabilities to be taken advantage of, and her greatest fear was that Helen would likewise be taken advantage of.

Why do we pass more urine in winter?

Our body requires water for a number of processes and this demand is satisfied by drinking more and more water, as per the needs of our body. However, not all the consumed water is used and part of it may have to be discarded. There are a number of ways to do that. Urination is one way for our body to discard the excess water and wastes from the body. The other common excess water outlet is sweat. 

In the summer months, when the temperature is high, we sweat a lot and lose a lot of water that way. However, in winter, temperatures are lower and we hardly sweat at all. All the excess water still has to be discarded. In absence of sweating, urination becomes the dominant pathway for water loss and to compensate for absence of sweating, we have to use the washroom more often. 

Hence, we pass more urine during the winter.

Hope this helps. 

How does Harper Lee uses the symbol of the mockingbird to communicate meaning and theme?

In Chapter 10 of To Kill a Mockingbird, Jem and Scout are practicing with their air-rifles, and Atticus, their father, tells them to shoot cans instead of practicing on birds. However, if they have to shoot birds, he tells them to shoot bluejays, but says that "it's a sin to shoot mockingbirds." Scout is confused about what Atticus means, and she asks Miss Maudie, who says:

“Mockingbirds don’t do one thing but make music for us to enjoy. They don’t eat up people’s gardens, don’t nest in corncribs, they don’t do one thing but sing their hearts out for us. That’s why it’s a sin to kill a mockingbird" (page 93; page numbers vary by edition).

Miss Maudie means that mockingbirds are the essence of innocence. They don't prey on anything, and their main purpose is to create beautiful music for people to enjoy. Miss Maudie reiterates that it's wrong to kill anything so innocent.

The mockingbird is a symbol for characters in the book. For example, Boo Radley is a harmless man who largely isolates himself inside his house. The townspeople, including initially Jem and Scout, believe he is creepy and perhaps evil, but in reality, he is harmless and entirely innocent. In that way, he is similar to a mockingbird. Tom Robinson, the African-American man who Atticus defends against charges of rape, is also innocent. He is only targeted because of his race, while in reality, he is an honest, well-meaning man. He is also like a mockingbird, and the theme of the book is that it is sinful to target such innocent people simply because they are in weak positions in society, much as the mockingbird is an easy target for shooting. 

`(4x - 1)^3 - 2(4x - 1)^4` Use the Binomial Theorem to expand and simplify the expression.

You need first to factorize `(4x-1)^3` , such that:

`(4x-1)^3 - 2(4x-1)^4 = (4x-1)^3(1 - 2(4x-1))`

`(4x-1)^3 - 2(4x-1)^4 = (4x-1)^3(1 - 8x + 2) `

`(4x-1)^3 - 2(4x-1)^4 = (4x-1)^3(3-8x)` 

You need to use the binomial formula, such that:

`(x+y)^n = sum_(k=0)^n ((n),(k)) x^(n-k) y^k`

You need to replace 4x for x, 1 for y and 3 for n, such that:

`(4x-1)^3 = 3C0 (4x)^3 +3C1 (4x)^2*(-1)^1+3C2 (4x)*(-1)^2 + 3C3 (-1)^3`

By definition, nC0 = nCn = 1, hence `3C0 = 3C3 = 1.`

By definition nC1 = nC(n-1) = n, hence `3C1= 3C2 = 3.`

`(4x-1)^3 = 64x^3 - 48x^2 + 12x - 1`

Replacing the binomial expansion `64x^3 - 48x^2 + 12x - 1` for `(4x-1)^3`  yields:

`(4x-1)^3(3-8x) = (64x^3 - 48x^2 + 12x - 1)(3-8x)`

`(4x-1)^3(3-8x) = (192x^3 - 512x^4 - 144x^2 + 384x^3 + 36x - 96x^2 - 3 + 8x)`

Grouping the like terms yields:

`(4x-1)^3(3-8x) = (- 512x^4 + 576x^3 - 240x^2  + 44x - 3)`

Hence, expanding and simplifying the expression yields `(4x-1)^3 - 2(4x-1)^4 = (- 512x^4 + 576x^3 - 240x^2  + 44x - 3).`

What is the general setting of Act II of Macbeth?

Act II takes place mostly inside Macbeth's castle, generally in the hallways but also in a few different rooms there. The last scene in this act (Scene 4) takes place just outside the castle.

Let's take a closer look:

Scene 1 takes place at night, inside the castle, while the king is in bed. Macbeth talks with Fleance and Banquo in the hall and then sees the vision of the dagger.

Macbeth commits the murder, and then Scene 2 involves him talking with his wife about which rooms their different guests are sleeping in (Macbeth and his wife are still out in the hall). Lady Macbeth goes into one of the bedrooms for a moment to plant the daggers there to frame the guests for the murder, and then she comes back out into the hall to her husband. Finally, she leads him into their bedroom so he can wash up.

In Scene 3, the action mostly takes place in the hallway again, with Macduff briefly going into the king's bedroom, finding him dead, and coming back out into the hall. Of course, on discovering what's happened, a lot of the other characters go into that bedroom to see for themselves, then exit the bedroom. That's when Lady Macbeth faints and is taken away from the hallway.

Scene 4, as I mentioned, is the only one in the act that takes place outside the castle. This is when Ross, the old man, and Macduff all discuss what's occurred, and how creepy things have been happening ever since the murder.

What is childbirth?

Process and Effects

In humans, pregnancy lasts an average of forty weeks, counting from the first day of the woman’s last menstrual cycle. Actually, ovulation, and therefore conception and the start of pregnancy, does not normally occur until about two weeks after the beginning of the last menstrual period, but because there is no good external indicator of the time of ovulation, obstetricians and other health care providers typically count the weeks of pregnancy using the easily observed last period of menstrual bleeding as a reference point. Because of the uncertainty about the actual time of ovulation and conception, the calculated due date for an infant’s birth may be inaccurate by as much as two weeks in either direction.

There is incomplete understanding of the processes that determine the timing and initiation of childbirth. Near the end of pregnancy, the uterus undergoes changes that prepare it for the birth process: The cervix softens and becomes stretchy, the cells in the uterus acquire characteristics that enable them to contract in a coordinated fashion, and the uterus becomes more responsive to hormones that cause contractions.

A number of substances are involved in the preparation of the uterus for birth, including the hormones
estrogen and progesterone (produced within the placenta), the hormone relaxin (from the maternal ovary and/or uterus), and
prostaglandins (produced within the uterus). The fetus participates in this preparation, since it provides precursors necessary for the uterine synthesis of estrogens. In addition, the amnion and chorion (the placenta and umbilical cord), two membranes surrounding the fetus, are capable of producing prostaglandins that assist in the preparation of the uterus.

Once labor begins, the hormone oxytocin (from the maternal pituitary gland) and uterine prostaglandins cause uterine contractions. It is not known what triggers the onset of labor or how the preparatory hormones and prostaglandins work together. However, a 2009 study indicated that labor may be triggered by elevated levels of placental corticotrophin-release hormone (CRH), which promotes the production of a steroid hormone called DHEAS by the fetal adrenal gland. The placenta is then thought to convert the steroid hormone into estriol, and the increasing imbalance between estriol and estradiol (both estrogens) may be responsible for inducing labor. Typically, estradiol blocks estriol's actions, but as the imbalance between these two estrogens increases, estriol is able to activate proteins in the uterine muscles, which then produce prostaglandins that promote muscle cell contraction.

In humans, the onset of labor is indicated by one or more of three signs: the beginning of regular, rhythmic uterine contractions; the rupture of the amniotic membrane, a painless event that is usually accompanied by the leakage of clear fluid from the vagina; and the expulsion of a slightly bloody mucus plug from the cervix, which is an indication that the cervix is beginning to dilate. These signs may appear in any order, or occasionally one sign may be absent or unnoticed. For example, the amniotic membrane may fail to rupture spontaneously; in this case, the attendant will usually pierce the membrane to facilitate the birth.

Uterine contractions are the most prominent indication of labor, which is divided into three stages. In the first stage of labor, the contractions have the effect of dilating the cervix from its initial size of only a few millimeters to full dilation of 10 centimeters, large enough to permit the passage of the fetus. When the first stage of labor starts, the contractions may be up to twenty minutes apart, with each contraction of relatively short duration. As the first stage progresses, the contractions become longer and closer together, so that by the end of the first stage there may be only a minute between contractions. There is no downward movement of the fetus during the first stage of labor, but the contractions do force the fetus against the cervix, and this force is important in causing cervical dilation. This first stage lasts for an average of eleven hours in women giving birth for the first time, but up to twenty hours is considered normal. The average length of the first stage of labor in women who have previously delivered is reduced to seven hours, with a norm of up to fourteen hours.

In the second stage of labor, the fetus moves downward through the fully dilated cervix and then into the vagina as a result of the force exerted by the continuing uterine contractions. Voluntary contractions of the abdominal muscles by the mother can help shorten this stage of labor by applying additional force, but in the absence of voluntary contractions (as with an anesthetized mother), the uterine contractions are usually sufficient to cause delivery. In approximately 96 percent of human births, the fetus is situated so that the head is downward and thus is first to pass through the birth canal. Because the vagina does not lie in the same line as the cervix and uterus, the head of the fetus must flex and rotate as the fetus progresses downward past the mother’s pelvic bones. The final barrier to the birth of the fetus is the soft tissue surrounding the vaginal opening; once the head of the fetus passes through and stretches this opening, the rest of the body usually slips out readily. The average duration of this second stage of labor in women delivering for the first time is slightly more than one hour; the average duration is shortened to twenty-four minutes in women who have previously delivered. Most women agree that the
actual birth of the child during the second stage is less uncomfortable than the strong uterine contractions that occur at the very end of the first stage of labor, when the cervix is dilating the last centimeter or so.

Most infants begin to take regular, deep breaths immediately upon delivery. These breaths serve to inflate the lungs with air for the first time. The infant now becomes dependent on breathing to supply oxygen to the blood, whereas oxygen had been supplied to the fetal blood by circulation through the placenta.

Following delivery of the infant, the mother enters the third stage of labor, during which continued uterine contractions serve to reduce the size of the uterus and expel the placenta. The placenta usually separates from the uterus and is expelled five to fifteen minutes after the birth of the infant.

Uterine contractions do not end with the delivery of the placenta; they continue, with decreasing frequency and intensity, for as long as six weeks following childbirth. These later contractions, known as afterpains, serve to reduce bleeding from the site of placental attachment and to return the uterus and cervix to their prepregnancy condition.

Another significant process that occurs in the mother’s body following delivery is the onset of milk production. During pregnancy, the breasts are prepared for later milk production by a number of hormones, but actual milk production does not begin until about the second day after delivery. It appears that the decrease in progesterone levels caused by the removal of the placenta at birth allows milk production to commence.

Most obstetrical attendants agree that the ideal childbirth situation is a labor and delivery with a minimum of medical intervention. If all goes well, the role of the attendant will be primarily that of a support person. Most women are admitted to a hospital or birthing center during the first stage of labor. The mother’s blood pressure and temperature will be checked frequently. In addition, the strength and timing of contractions will be assessed either by a hand placed lightly on the abdomen or by an electronic monitor that detects uterine activity through a sensor belt placed around the abdomen. The fetal heart rate will be measured with a stethoscope or by this same electronic monitor placed on the mother’s abdomen. Fetal well-being may also be monitored by an electrode placed on the scalp of the fetus through the cervix. This scalp pH probe indicates whether the fetus is tolerating labor well or is in distress. Cervical dilation can be assessed by a vaginal examination: The attendant will insert one or more fingers into the cervix to determine its state of dilation. It is also important that the attendant provide emotional support and reassurance to the mother throughout the delivery.

During the second stage of labor, the attendant will monitor the progress of the fetus through the birth canal. By inserting a hand into the vagina and feeling for the fetal skull bones, the attendant can determine the exact placement of the fetus within the birth canal. As the infant’s head appears at the vaginal opening, an incision called an
episiotomy is usually performed to prevent accidental tearing of these tissues. Many physicians believe that episiotomy should be done to prevent possible vaginal tearing, since a planned incision is easier to repair than an accidental tear. Another advantage of episiotomy is that it tends to speed the expulsion of the infant, which may be an advantage to both the mother and the child at this stage. The episiotomy incision is made after the injection of a local anesthetic to numb the area, and the incision is stitched closed following the delivery of the placenta.

Once the infant’s head has emerged from the vagina, the attendant uses a suction device to clear the infant’s nose and mouth of fluid. As the rest of the infant emerges, the attendant supports the body; a quick examination is conducted at this time to determine whether the infant has any major health problems. The umbilical cord that joins the infant to the placenta is usually cut within a few minutes after birth. When the placenta is delivered, the attendant will examine it for completeness and then will perform a thorough examination of the mother and child to ensure that all is well.

Complications and Disorders

If the labor and delivery do not progress normally, the attendant has available a number of medical interventions that will promote the safety of both the mother and the baby. For example, labor may be induced by administration of oxytocin through an intravenous catheter. Such induction is performed if the amniotic membrane ruptures without the spontaneous onset of uterine contractions, if the pregnancy progresses well beyond the due date, or in response to maternal indicators such as hypertension. The induction of labor has been found to be safe, but careful monitoring of the progress of labor is required.

Another fairly common procedure is the use of forceps to assist delivery. These tonglike instruments have two large loops that are placed on the sides of the fetal head when the head is in the birth canal. Forceps are not used to pull the fetus from the birth canal; instead, they are used to guide the fetus through the birth canal and to assist in the downward movement of the fetus during contractions. The use of forceps can help to speed the second stage of labor, and injury to the fetus or the mother is minimal when the forceps are not applied until the fetal head is well within the birth canal, as is the convention. Some type of anesthesia is always used with a forceps delivery. In some areas, vacuum extraction of the fetus is preferred. As the name implies, vacuum extraction makes use of a suction cup on the end of a vacuum hose; the suction cup is affixed to the fetal scalp.

Many women require some type of pain relief during labor, although this need can be reduced by thorough education and preparedness during the pregnancy. A wide range of pain-reducing drugs (analgesics), sedatives, and tranquilizers is available for use during the first stage of labor. These are typically administered by injection; they work at the level of the brain to alter the perception of pain and to promote relaxation. The goal is to use the minimum drug dose that allows the woman to be comfortable. The main danger is that these drugs reach the fetus through the placental circulation; side effects in the infant, which can persist for many hours after delivery, may include depressed respiration, irregular heart rhythm or rate, and sleepiness accompanied by poor suckling response.

Anesthetics that numb pain-carrying nerves in the mother may also be used during the first and second stages of labor. Two routes of delivery are in common use: epidural and spinal, both of which involve the injection of anesthetic drugs into or near the membranes around the mother’s spinal cord. The epidural route of injection places the anesthetic in a space that lies outside the spinal cord membranes; with spinal anesthesia, the injection is made slightly deeper into the membranous layers. An advantage of both methods is that the mother remains awake during the delivery and can assist by pushing during the second stage.

Although the disadvantages of both anesthetics, and especially of epidurals, have been downplayed, these procedures do impose restrictions on the mother. Once an epidural has been given, for example, a woman must stay in bed because it will be difficult for her to move her legs; some hospitals do offer “mobile epidurals,” which use a type of drug that blocks the pain while still allowing the woman to walk around, but these are the exception. Because walking helps to stimulate labor, the use of epidurals can be counterproductive. The use of epidurals is also associated with a prolongation of the second stage of labor and with increased need for forceps to assist delivery. Headaches, backaches, low blood pressure, nausea, and other side effects may result in the mother following the use of anesthetics. Moreover, contrary to past evidence, recent studies have suggested that the drugs in epidurals do cross the placenta to the baby, causing health risks.

General anesthesia refers to the use of drugs that induce sleep; they may be administered by inhalation or by injection. Because of profound side effects in both the mother and child, most physicians use general anesthesia only in an emergency situation requiring an immediate cesarean section.

Cesarean section refers to the delivery of the fetus through an incision made in the mother’s abdominal and uterine walls. (The name derives from an unsubstantiated legend that Julius Caesar was delivered in this way.) Cesarean deliveries may be planned in advance, as when a physician notes that the fetus is in a difficult-to-deliver position, such as breech (buttocks downward) or transverse (sideways). Multiple fetuses may also be delivered by cesarean section in order to spare the mother and her infants excessive stress. Alternatively, cesarean delivery may be performed as an emergency measure, perhaps after labor has started. As fetal monitoring techniques have improved, problems are noted more quickly and with greater frequency, leading to a larger number of cesarean sections. One indication of the need for emergency cesarean delivery is fetal distress, a condition characterized by an abnormal fetal heart rate and rhythm. Fetal distress is thought to be an indication of reduced blood flow to the placenta, which may be life-threatening to the fetus. Cesarean section may be performed using spinal or epidural anesthesia, as well as general anesthesia. A woman who delivers one child by cesarean section does not necessarily require a cesarean for later deliveries; each pregnancy is evaluated separately. Attempted vaginal births after cesareans (AVBACs) are still being done but are decreasing in frequency due to increased likelihood of problems.

Perspective and Prospects

Prior to 1800, most women were attended during childbirth by female midwives. In some areas, a midwife was provided a salary by the town or region; her contract might stipulate that she provide services to all women regardless of financial or social status. In other areas, midwives worked for fees paid by the clients. Midwives of this time had little, if any, formal training and learned about birth practices from other women. Because birth was considered a natural event requiring little intervention on the part of the attendant, the midwife’s medical role was limited and the few doctors available were consulted only in difficult cases. Although birth statistics were not kept at the time, anecdotal accounts from the diaries of midwives and doctors suggest that the births were most often successful, with rare cases of maternal or infant deaths.

The nineteenth century saw a gradual shift away from the use of midwives to a preference for formally trained male doctors. This shift was made possible by the establishment of medical schools that provided scientific training in obstetrics. Because these schools were generally closed to women, only men received this training and had access to the instruments and anesthesia that were coming into use.

Maternity hospitals came into being during the nineteenth century but were at first used primarily by poor or unmarried women. Women of higher social status still preferred to deliver their children in the privacy of their homes. Indeed, home birth was safer than hospital birth, since the building of hospitals had outpaced the knowledge of how to sanitize them. Rates of infection and maternal and infant death were higher in hospitals than in homes.

By the 1930s, the situation had reversed: Hospital births had become safer than home births, because sanitation and surgical procedures had improved. There followed an increasing trend for women to enter hospitals for delivery, so that the percentage of women giving birth in hospitals increased from about 25 percent in 1930 to almost 100 percent by 1960. In the same period, maternal and infant mortality showed a dramatic reduction. The shift to hospital birth had coincided with an interventionist philosophy: Most women were anesthetized during delivery, and forceps deliveries and episiotomy became more common.

By the 1960s, the older idea of “natural” childbirth—that is, a birth that encourages active labor and the use of drug-free types of pain relief with as little medical intervention as possible—had regained popularity. This change in attitude was brought about in part by recognition that analgesic and anesthetic drugs often had profound effects on the infant and often prevented strong mother-infant bonding in the immediate hours after delivery.

It was also brought about by the Lamaze method of childbirth, conceived by French doctor Fernand Lamaze and introduced to the United States with Marjorie Karmel’s book Thank You, Dr. Lamaze (1959). In this method, women learn controlled breathing techniques to relax and to cope with contractions during labor. A labor coach, who is often the baby’s father, helps to initiate and facilitate these techniques. Because natural childbirth must be learned, usually through childbirth classes offered in hospitals during the last trimester of pregnancy, it is also called prepared childbirth. As an extension of natural childbirth, the LeBoyer method has been proposed, allowing for delivery to take place underwater, so that the fetus is expelled from the fluid-filled amniotic sac into a warm, peaceful, fluid-filled environment, allowing for an easier transition to extrauterine life.

By the latter part of the twentieth century, a compromise between the more radical approaches of the past seemed to have been reached, with common practice in obstetrics being to allow the birth to proceed naturally when possible, but with the advantage of having refined drugs, diagnostics, and surgical techniques available if needed. The midwife has been reinstated as a specially trained advanced practice nurse (certified nurse midwife) who provides comprehensive health care to pregnant and nonpregnant women, and who conducts deliveries under a variety of settings, collaborating with physician colleagues as necessary for medically complicated labor and birth.

Bibliography

Ammer, Christine. The New A to Z of Women’s Health: A Concise Encyclopedia. 6th ed. New York: Checkmark Books, 2009.

Beckmann, Charles R. B., et al., eds. Obstetrics and Gynecology. 7th ed. Baltimore: Lippincott Williams & Wilkins, 2013.

Creasy, Robert K., et al., eds. Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practice. 6th ed. Philadelphia: W. B. Saunders, 2008.

Cunningham, F. Gary, et al., eds. Williams Obstetrics. 23d ed. New York: McGraw-Hill, 2010.

DeCherney, Alan, et al., eds. Current Diagnosis & Treatment: Obstetrics & Gynecology. 11th ed. New York: McGraw Hill, 2012.

Klaus, Marshall H., John H. Kennell, and Phyllis H. Klaus. Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth. 2d ed. Reading, Mass.: Perseus, 2002.

Klein, M. C., et al. “Why Do Women Go Along with This Stuff?” Birth 33, no. 3 (September, 2006): 245–250.

"Labor and Birth." US Department of Health and Human Services Office on Women's Health, September 27, 2010.

Lees, Christoph, and Grainne McCarten. Pregnancy and Birth: Your Questions Answered. Rev. ed. New York: DK, 2012.

Quilligan, Edward J., and Frederick P. Zuspan, eds. Current Therapy in Obstetrics and Gynecology. 5th ed. Philadelphia: W. B. Saunders, 2000.

Simkin, Penny, et al. Pregnancy, Childbirth, and the Newborn: The Complete Guide. 4th ed. Minnetonka, Minn.: Meadowbrook Press, 2010.

How can I summarize the privatized businesses/ franchises in the world of Snow Crash? What part of the book can I find the most information about...

Your question is an understandable question.  Understanding the government system, the franchises, and business of Snow Crash makes up a major part of the book.  The best place to look is the opening chapters.  That's where you learn that Hiro is a pizza delivery guy for the most powerful government/business/franchise in the area.  That's right, a private business is equivalent to a governmental power.  The United States as you know it now doesn't exist.  Most of the ruling and governing power is handled by private corporations.  As a business expands, it does so with franchises.  That's fairly regular sounding business, but the franchise is also a branch of that "country" (business).  That's why "Mr. Lee's Greater Hong Kong" exists in Los Angeles as a separate country with its own laws.  Hiro delivers pizzas for the Mafia.  His pizza delivery car is actually considered sovereign territory, because it belongs to that business/country/franchise.  I know that I keep using a lot of slashes, and that is because a business operates very much like its own country.  It expands its ruling power through franchises.  

The economic structure of the world is touched upon throughout the book, but the opening few chapters give the most amount of detail in shortest amount of text.  For example.  

But franchise nations prefer to have their own security force. You can bet that Metazania and New South Africa handle their own security; that's the only reason people become citizens, so they can get drafted. Obviously, Nova Sicilia has its own security, too. Narcolombia doesn't need security because people are scared just to drive past the franchise at less than a hundred miles an hour (Y.T. always snags a nifty power boost in neighborhoods thick with Narcolombia consulates), and Mr. Lee's Greater Hong Kong, the grandaddy of all FOQNEs, handles it in a typically Hong Kong way, with robots.

What is prescription drug addiction?

Causes

When used as prescribed, prescription drugs can help to improve the quality of life for people with chronic pain or chronic health conditions, such as attention deficit hyperactivity disorder (ADHD), narcolepsy, anxiety, or sleep disorders. However, when used long term, some prescription drugs can lead to drug abuse and addiction.

Most people take prescription medications as they are prescribed, but according to the National Institute on Drug Abuse, a growing number of people are taking prescription medications for nonmedical reasons, and such abuse can lead to addiction. It is unclear why prescription drug abuse is on the rise. One theory is that prescription medications have become more accessible. More drugs are being prescribed than ever before, and pharmacies on the Internet have made it easy for people to obtain prescription drugs, even without a prescription. Some people also mistakenly believe that because prescription medications are prescribed for medical reasons, they are safer alternatives to street drugs.

Opioids. When used as prescribed, opioids are intended to treat pain in persons with chronic health conditions such as cancer, back pain, arthritis, muscle or bone pain, diabetic neuropathy, phantom limb pain, and pain caused by injuries that are slow to heal. Opioids also are used to treat severe short-term pain from surgical procedures, injuries, or painful medical conditions, such as shingles.

Opioids block the nerve receptors in the body that cause a person to perceive pain. They also affect the regions of the brain that perceive pleasure, which results in an initial feeling of euphoria followed by a calm, drowsy feeling. As a result, many people use them to feel good or to get high, to relieve stress, or to relax in social situations.

Central nervous system (CNS) depressants. CNS depressants, which are used to treat anxiety disorders, sleep disorders, muscle tension, and seizure disorders, slow brain function and produce a calm, drowsy effect. They are often used to get high, to relieve stress, to relax in social situations, or to counteract the effects of other drugs, such as stimulants.

Stimulants. Stimulant medications, which are used for the treatment of ADHD or narcolepsy, increase alertness, energy, and attention. When taken as prescribed, stimulant medications slowly increase the production of dopamine—a neurotransmitter that is responsible for feelings of pleasure—in the brain. However, when taken in higher than normal doses or by routes other than oral, they can cause a rapid increase in dopamine, which results in a feeling of euphoria. Stimulant medications are often used to get high or to decrease appetite.

Risk Factors

Risk factors for prescription drug addiction may include a genetic predisposition to addiction, but people who are not genetically predisposed to addiction can still become addicted. Other factors contribute to prescription drug addiction, including early onset of drug abuse (teenage years or early twenties); addictions to other substances, either past or present; peer pressure; and easy access to prescription drugs.

Symptoms

Symptoms of prescription drug addiction will depend, somewhat, on the type of drug to which the person is addicted. However, symptoms that are common to all prescription drug addictions include taking a higher dose of the medication than what the doctor prescribed or taking the medication more frequently than called for by the prescription. People who are addicted to prescription drugs may find themselves calling the doctor’s office more frequently for refills or asking the physician to prescribe higher doses.

Opioids. In addition to increasing the medication’s dose and frequency without permission from the doctor, opioid addicts have the following symptoms from use: constipation, excessive sleeping, depression, confusion, slurred speech, poor coordination, itching, tiny pupils, paranoia, excessive sweating, poor judgment, low blood pressure, and shallow breathing.

CNS depressants. Symptoms of addiction to CNS depressants may include drowsiness or excessive sleeping, slurred speech, depression, confusion, unsteady gait, lack of coordination, impaired memory, poor judgment, slowed breathing, low blood pressure, and involuntary rapid eye movements.

Stimulants. A person who is addicted to stimulant medications may experience weight loss, staying awake for long periods of time, irritability, mood swings, excessive energy, poor judgment, bloodshot eyes, high blood pressure, rapid or irregular heartbeat, dangerously high body temperatures, anxiety, paranoia, and seizures.

People who are addicted to prescription drugs may do things that they would not do otherwise. For example, to get more drugs or money to buy more drugs, people who are addicted to prescription medications might seek prescriptions from more than one doctor (a practice known as doctor shopping), steal money or items that they can sell for money, forge prescriptions, or engage in prostitution for money.

When people who are addicted to prescription drugs run out of drugs and are unable to get more, they may experience withdrawal symptoms. Symptoms of opioid withdrawal include fever, chills, shaking, stomach cramps, nausea or vomiting, diarrhea, muscle aches, increased sensitivity to pain, insomnia, watery eyes, runny nose, irritability, and panic. Symptoms of CNS depressant withdrawal include anxiety, insomnia, tremors, weakness, delirium, and seizures. Symptoms of stimulant withdrawal include intense cravings, irritability, headaches, nausea, vomiting, mood swings, anxiety, depression, increased appetite, fatigue, shaking, sweating, insomnia, and confusion.

Prescription drug addiction can lead to a number of complications, especially when the drugs are taken in large doses or combined with alcohol or other drugs. Opioids can increase a person’s risk of choking. They also can slow breathing. If taken in large doses or used in combination with alcohol, antihistamines, barbiturates, or benzodiazepines, opioids can lead to respiratory depression, a life-threatening condition that can slow a person’s breathing to a point where breathing may actually stop.

CNS depressants can cause memory problems and can also affect body temperature. If taken in large doses or used in combination with other substances that may cause drowsiness, such as alcohol, opioids, antihistamines, and some over-the-counter cold medications, CNS depressants can lead to respiratory depression, coma, and death.

Stimulant medications can cause increased blood pressure, irregular heart rate, increased body temperature, and a decrease in appetite, which can lead to malnutrition. In large doses, they can cause seizures, paranoia, or hallucinations, and stroke. If taken with certain over-the-counter cold medications, stimulant medications may raise blood pressure to a dangerously high level. They also may cause irregular heart rhythms.

Addiction to prescription medications may have other consequences, in addition to physical complications. For example, driving while under the influence can lead to a motor vehicle accident or arrest. Prescription drug addiction can also have an adverse effect on school or work performance.

Screening and Diagnosis

Physicians are in a unique position not only to screen patients for prescription drug abuse but also to help them recognize when they have a problem, to set recovery goals, and to seek treatment. Diagnosis of prescription drug addiction is usually based on the patient’s symptoms and medical history.

Health care providers may screen patients by asking about past or present substance use or abuse, and by asking about current medication use, including the dosage, frequency, reason for use, and for what period of time the person has been taking the medication. Blood and urine tests also may be used to determine what prescription medications a patient has been taking and to track treatment progress.

Pharmacists can help screen patients for prescription drug addiction by checking prescriptions closely to see if they may have been forged or modified and by watching for multiple prescriptions from different doctors. Pharmacists also can alert nearby pharmacies when fraud or doctor shopping has been detected.

Treatment and Therapy

Prescription drug addiction is a treatable condition. The type of treatment will depend on the type of drug to which the person is addicted and on the needs of the individual. Successful treatment programs are usually a combination of detoxification, counseling, and, in some cases, medications. Many people go through more than one round of treatment before they are able to fully recover from their addiction.

Opioids. Initial treatment for opioid addiction may include medications to help alleviate the symptoms of withdrawal. Methadone and buprenorphine, both synthetic opioids, are the most commonly used drugs to treat symptoms of opioid withdrawal. Both are highly regulated drugs that are usually prescribed to people who are enrolled in a treatment program for opioid addiction.

Methadone and buprenorphine ease withdrawal symptoms and relieve cravings. Methadone has been used for decades to treat opioid addiction. Buprenorphine was approved by the US Food and Drug Administration for the treatment of opioid dependence in 2002. Patients will need medical supervision during treatment for opioid withdrawal.

Counseling following treatment for opioid withdrawal symptoms can help patients learn to function without drugs, handle drug cravings, and avoid people and situations that could lead to relapse. Support groups and twelve-step programs such as Narcotics Anonymous can help with the treatment of opioid addiction and with the adjustment to a new, drug-free lifestyle.

CNS depressants. People who are addicted to CNS depressants should not abruptly stop taking the medication because withdrawal from CNS depressants can be life-threatening. Instead, the medication dose must be gradually tapered until it is safe to stop taking the drug altogether. Patients will need medical supervision during treatment for withdrawal from CNS depressants. After the patient has been successfully weaned from the drug, cognitive-behavioral therapy can help the recovering addict to increase his or her coping skills, thereby eliminating the perceived need for the drug.

People who are addicted to CNS depressants often have coaddictions, such as alcoholism, so approaches to treatment must address all addictions. Support groups and twelve-step programs such as Narcotics Anonymous also can help with the treatment of addiction to CNS depressants.

Stimulants. There are no medications to help alleviate withdrawal symptoms in patients who are addicted to prescription stimulants. One approach is to slowly decrease the dosage until the patient has been weaned. Patients will need medical supervision during treatment for withdrawal from stimulant medications. Once the patient has stopped taking the medication, behavioral therapy is often used to help patients recognize risky situations, avoid drug use, and more effectively cope with problems.

Another treatment that has been proven effective for stimulant addiction is contingency management. During contingency management, patients are given vouchers for drug-free urine tests. The vouchers can be exchanged for rewards that promote healthy living. Support groups and twelve-step programs such as Narcotics Anonymous also can help with the treatment of prescription stimulant addiction.

Prevention

Most people who take prescription medications as prescribed do not become addicted. There are some steps that people can take to decrease their risk of addiction, including the following:

• Ask if the medication being prescribed is addictive and if there are any alternative medications.

• Follow the directions on the medication label without exception.

• Avoid increasing a medication dose without discussing it with the health care provider who prescribed the medication.

• Avoid taking medication that was prescribed for someone else.

Parents too can take steps to help ensure that their children do not become addicted to prescription drugs. Preventive steps include keeping prescription medications in a locked cabinet; discussing with children the dangers of prescription medications, including the dangers of sharing medications with others; and properly disposing of prescription medications.

Pharmacists can help prevent prescription drug addiction by giving patients clear information about how medications should be taken and by providing information about potential side effects or drug interactions. Prescribers can help to prevent prescription drug addiction by noting increases in the amount of drug a patient needs to get the same therapeutic effect and by tracking frequent requests for refills.

Bibliography

Fishbain, D. A., et al. “What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review.” Pain Medicine 9.4 (2008): 444–59. Print.

Lewis, Todd F. "Prescription Drug Addiction." Treatment Strategies for Substance and Process Addictions. 127–47. Alexandria: American Counseling Association, 2015. PsycINFO. Web. 2 Nov. 2015.

McCabe, S. E., C. J. Teter, and C. J. Boyd. “Medical Use, Illicit Use, and Diversion of Abusable Prescription Drugs.” Journal of American College Health 54.5 (2006): 269–78. Print.

National Institute on Drug Abuse. “Prescription and Over-the-Counter Medications.” June 2009. Web. 30 Oct. 2015. http://www.nida.nih.gov/infofacts/PainMed.html.

National Institute on Drug Abuse. “Prescription Drugs: Abuse and Addiction.” Oct. 2011. Web. 30 Oct. 2015. http://www.nida.nih.gov/researchreports/prescription/prescription6.html.

Waters, Rosa. Prescription Painkillers: Oxycontin, Percocet, Vicodin, and Other Addictive Analgesics. Broomall: Mason Crest, 2015. Print.