In The Giver, how does Jonas emotionally and physically go against the community and sameness?

When Jonas starts receiving memories from the Giver, he learns about all of the different sacrifices the community made in order to live according to Sameness. Many of these sacrifices Jonas could accept, such as Climate Control, which is discussed in chapter 11. The community had to give up snow and sunshine in order to be able to control the agricultural periods and eliminate hunger. That's understandable for a twelve year-old boy; but, what is difficult to swallow for Jonas is living without color and preferential choice. Add these sacrifices to Jonas learning that the word release means death and the scales are tipped. Once Jonas sees his father kill a little baby in the name of Sameness, Jonas emotionally revolts and wants to go against the community. 

It is this emotional revolt inside Jonas that motivates him to also physically revolt. The Giver happens to have a plan:

"If you get away if you get beyond, if you get to Elsewhere, it will mean that the community has to bear the burden themselves, of the memories you had been holding for them" (156).

Therefore, Jonas must physically leave and cross over into Elsewhere in order for the memories to flood back into the community. Once Jonas has physically removed himself, and the memories enter the minds of the people, they will certainly feel things emotionally that they have never felt before. In a way, it's almost like he is attacking them emotionally because they will feel love and pain, happiness and sadness, joy and depression all at once. Not only that, they will experience the physical pain that comes with the memories as well. For instance, Jonas physically felt things like a broken leg and sunburns when he received memories.  That means the community would experience these things all at once, which could cause chaos. The Giver explains as follows:

"I have to stay here. . . If I go with you, and together we take away all their protection from the memories, Jonas, the community will be left with no one to help them. They'll be thrown into chaos. They'll destroy themselves. I can't go" (156).

It's a good thing the Giver decides to stay in order to help the people because the memories could attack them both physically and emotionally all at once as Jonas crosses over into Elsewhere.

How is Caliban portrayed when he says "then I love thee" in The Tempest?

Caliban is portrayed sympathetically when complaining to Prospero.

When Prospero landed on the island, he enslaved Caliban through magic.  Although Prospero treats Caliban with nothing but derision, when we first meet Caliban we are more likely to feel sympathetic for him than for Prospero, the vengeful wizard.

Caliban makes it sound as if Prospero tricked him, being nice to him at first so that he would think the wizard was a nice person and then turning on him.  Caliban gives examples of the nice things that Prospero did for him when they first met. 

When thou camest first,
Thou strokedst me and madest much of me, wouldst give me
Water with berries in't, and teach me how
To name the bigger light, and how the less,
That burn by day and night … (Act 1, Scene 2) 

Caliban says that he loved Prospero, and showed him “all the qualities o' the isle,” such as where to get fresh water and food.  He continues by saying that if he hadn’t, he would have been the king of the island, not Prospero.  Prospero doesn’t buy it.  

Thou most lying slave,
Whom stripes may move, not kindness! I have used thee,
Filth as thou art, with human care, and lodged thee
In mine own cell, till thou didst seek to violate
The honour of my child. (Act 1, Scene 2) 

He accuses Caliban of trying to rape Miranda, and says that he deserves nothing more than harshness.  It is better to whip him than be nice to him.  From this point on, we might feel more sympathetic to Prospero and no longer for Caliban.  The comment about Miranda makes Prospero’s harsh treatment of Caliban seem appropriate and justified.

There are two sides to any story.  It seems that at first Prospero and Miranda were nice to Caliban.  He showed them around the island, and they taught him about the world.  Caliban says that they taught him language. Then, at some point, Caliban might have made a move on Miranda.  That was the end of the kindness, and Prospero treated him with scorn and punishment thereafter.

How does Frost use two types of imagery to help the reader understand the speaker's feeling about his job?

I think by "two types of imagery" you may mean that the poem is symbolic and somewhat allegorical, in that the description and details of apple picking actually can be seen to stand for something else. Analysis of this poem by many critics has suggested that the speaker in the poem might be the poet himself (Frost) and that the chore of apple picking, and the tiredness and somewhat sad frustration indicated at the end of a large amount of work may be compared to the author's feeling about the work of being a poet.

The poem's imagery is very descriptive of the actual work and experience of apple picking and there are many sensual details which support this idea. But the language also works symbolically to describe a lifetime of work writing poetry, as opposed to a short season of work harvesting apples.

Although this poem was written when Frost was a relatively young man (he was thirty-nine when it was published), it imagines a poet further along in his career who wonders if the work, in the end, is worth the labor. The line "I am overtired / Of the great harvest I myself desired" suggests that a life of writing poetry can be exhausting, perhaps mentally and emotionally, and possibly on a practical level, since many poets cannot make their living (which "harvest" is a reference to) from writing poetry alone. Many prolific poets worked at other jobs; for example, Robert Burns worked as a distillery inspector, and Wallace Stevens worked for an insurance company. Frost is not yet at the point where he can have a lifelong perspective, but it speaks to his wisdom and perception that he imagines what this might feel like in the years ahead, and imagines this as an experience to which other poets might relate.

How does Abigail react to Tituba's change in heart in The Crucible?

When Tituba suddenly confesses to working with the Devil, naming two other women in the town as witches, Abigail seems to quickly realize that she has an opportunity to also be seen as "God's instrument" to "discover the Devil's agents," as Mr. Hale calls Tituba.  She cries out that she wants God's light, that she "danced for the Devil," that she goes back to Jesus, and she immediately names the two women Tituba just named as well as one more: Bridget Bishop.  

In confirming the women Parris's slave just named as witches, Abigail appears to confirm the veracity of Tituba's words, and she gives weight to her own claim that Bishop is a witch as well.  In the remainder of the scene, Abigail proceeds to name three more women as witches.  She capitalizes on Tituba's confession to redirect attention toward herself and exploit Tituba's accusations in order to be able to make her own.

What is kidney transplantation?

Indications and Procedures

Transplantation of a human kidney from a donor to a recipient has been used since the middle of the twentieth century to improve the quality and length of life for people with renal failure. While hemodialysis—or the use of an artificial kidney machine, as it is commonly known—can be used satisfactorily for years, transplantation is often the ultimate goal because it can return the patient to a near-normal life.

The kidneys play a pivotal role in maintaining a stable internal environment by controlling fluid levels, excreting waste products, and regulating the blood concentration of acids and bases and of ions such as sodium and potassium. The kidneys are also responsible for regulating blood pressure by secreting substances that constrict the blood vessels. Clearly, the derangement of such complex functions, as occurs in renal disease, is life-threatening.

There are many reasons for renal failure, but the most frequent are inherited disorders, severe infections, toxic substances, allergic reactions, diabetes mellitus, and hypertension. The latter two, which are common illnesses in the United States, result in renal damage because of long-term injury to the blood vessels. The symptoms of minimally or nonfunctioning kidneys reflect an accumulation of toxic waste products and dramatic changes in the chemical composition of the blood. Every system is affected until coma and death ensue. The process of hemodialysis is used intermittently to cleanse the blood and maintain life. Transplantation in the otherwise healthy person, however, is preferred.

An extraordinary amount of cooperation and preparation is necessary for successful kidney transplantation. The donor organ may come from a living blood relative or from a cadaver within minutes of death. The organ is removed and maintained at low temperature in a special preservative solution for up to forty-eight hours. A suitable recipient is located through a national registry that can rapidly pair a cadaver organ to a waiting patient. The chosen candidate is immediately prepared for surgery, and through an abdominal incision, the kidney is placed in the abdomen and connected to the blood supply by its artery and vein. The ureter, the urine-collecting duct, is attached to the bladder. The recipient’s own diseased kidneys may or may not be removed; their presence does not interfere with the transplanted organ. Within hours, the newly transplanted organ begins to form urine.

Uses and Complications

All transplanted organs and tissues face both immediate and long-term rejection by the recipient’s
immune system. Recognizing the donated kidney as foreign, or “nonself,” the immune system attacks it both physically and chemically. The injury can be so severe as to result in the organ’s death and the need for its surgical removal. In an attempt to prevent this reaction, certain steps are taken both before and after transplantation surgery.

Matching a donor and recipient involves careful selection that must minimize the physiological differences that exist between people. The blood types (the ABO and Rh systems) should be the same. Gene sequences on the sixth chromosome that code for immune system components are also matched as closely as possible in a process known as human leukocyte antigen (HLA) compatibility. Living, first-degree relatives, such as parents or siblings, often provide the best survival rates because of the genetic similarities between donor and recipient. The loss of one kidney in a healthy individual does not appear to affect the body.

The excellent success rates that have been achieved—over 80 percent—are attributable both to preoperative matching and to immunosuppression, which is begun shortly before surgery and continued for many months afterward. Potent drugs are used to inhibit the recipient’s immune system, thereby protecting the new kidney from attack and significantly reducing rejection. Eventually, the drugs are tapered off and stopped, having allowed the body time to adjust to the foreign tissue and the kidney time to heal.

As can be expected in a procedure as difficult as kidney transplantation, the risks and complications are many. In the immediate postoperative period, hemorrhaging from the attached renal artery or vein, leakage from the ureter, organ malfunction, and immediate rejection can occur. Often, difficulties begin weeks or even months later, because of both rejection damage to the kidney and side effects related to severe immunosuppression. Immunosuppression leaves the body prey to bacterial, viral, and fungal infections, as well as cancer. Sometimes, a vicious cycle begins, in which life-threatening infections require the discontinuation of the immunosuppressive drugs, and the probability of organ rejection and irreparable kidney damage is heightened. Continual patient monitoring is absolutely essential to maintain the delicate balance between the risks and benefits involved in this procedure.

Perspective and Prospects

Prior to 1962, when immunosuppressive drugs were unavailable and matching could only be based on blood type, kidney transplantation was an experimental procedure usually involving the organ of a living, first-degree relative. In the following decades, an extraordinary surge in information about the immune system and the genes that control the rejection response, as well as the discovery of powerful drugs, made transplantation a successful alternative for patients supported by hemodialysis. It also significantly increased the donor pool of organs by allowing unrelated cadaver kidneys to be used. It is in both areas, more precise matching and the development of less toxic postoperative drugs, that research continues. Contributions made in this field are readily used for research in all other organ transplantation as well.

Bibliography

American Kidney Fund. http://www.kidneyfund.org.

Brezis, M., et al. “Renal Transplantation.” In Brenner and Rector’s The Kidney, edited by Barry M. Brenner and Floyd C. Rector, Jr. 6th ed. Philadelphia: W. B. Saunders, 1999.

Carpenter, C., and M. Lazarus. “Dialysis and Transplantation in Renal Failure.” In Harrison’s Principles of Internal Medicine, edited by Dennis L. Kasper et al. 16th ed. New York: McGraw-Hill, 2005.

Danovitch, Gabriel, ed. Handbook of Kidney Transplantation. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2010.

Hoogland, E. R. Pieter, et al. "Improvements in Kidney Transplantation from Donors after Cardiac Death." Clinical Transplantation 27, no. 3 (May/June, 2013): E295–301.

"Kidney Transplant." Health Library, November 26, 2012.

"Kidney Transplant." MedlinePlus, June 13, 2011.

National Kidney Foundation. http://www.kidney.org.

Schrier, Robert W., ed. Diseases of the Kidney and Urinary Tract. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007.

In The Giver, why might minor rule breaking, such as riding a bicycle before the age of nine, be tolerated in the otherwise strict community?

The rule against bicycles is broken because it is a minor rule and breaking it is tradition.

Rules that are broken for everyone are unspoken rules of their own.  This is part of community conformity, which is fundamental to Sameness.  Traditions generated by minor rule-breaking turn into rules when they are codified by the committee.

The rule against children under nine riding bicycles is the one Jonas says is always broken.  Older siblings teach their younger siblings how to ride so that when they get the bike, they can ride it.

It was one of the few rules that was not taken very seriously and was almost always broken. The children all received their bicycles at Nine; they were not allowed to ride bicycles before then. But almost always, the older brothers and sisters had secretly taught the younger ones. (Ch. 2) 

You can see why the community would not mind this rule being broken.  One, it adds to efficiency.  Once the nine year olds get their bicycles, they can use them immediately.  Two, it is tradition.  Older brothers and sisters all teach their siblings to ride.  Breaking the rule is an unwritten rule.  Finally, allowing the rule to stand even though it is continually broken reinforces the idea that it is very hard to change a rule, so that no one will attempt to change rules willy-nilly.

Rules were very hard to change. Sometimes, if it was a very important rule--unlike the one governing the age for bicycles—it would have to go, eventually, to The Receiver for a decision. The Receiver was the most important Elder. (Ch. 2)

Jonas comments that the community will never change the rules against bicycles, because it is not considered an important enough rule to bother the Receiver with.  Instead, they will “simply fret and argue about it themselves for years, until the citizens forgot that it had ever gone to them for study.”  While they are fretting, the citizens develop their own unwritten rule about bicycles and the rule change is not really needed.

What is pigmentation?

Structure and Functions

One of the most apparent human characteristics is the color of a person’s skin. Five pigments play major roles: melanin, melanoid, carotene, hemoglobin, and oxyhemoglobin. Melanin occurs in the greatest variation and is the most important of the five; in large amounts, it can mask the effects of the other pigments.

Melanocytes are cells that convert tyrosine, an amino acid, into the black pigment called "melanin." The rate of production is controlled by a hormone called "melanocyte-stimulating hormone (MSH)," which is released by the anterior pituitary gland. About a thousand melanocytes occur on each square millimeter of the body (with the exception of the head and the forearms, which have twice as many). Interestingly, all human races vary greatly in color but tend to have the same number of melanocytes, which inherit different abilities to make melanin.

When humans are compared, an uninterrupted array of shades of skin color is found. Traits that show such continuous variation are thought to be controlled by several sets of genes (polygenetic inheritance). Thus, several sets of genes were believed to control the amount of pigmentation. In 2005, researchers at Pennsylvania State University found two variant expressions of a single gene that may be responsible for the observed distribution of human skin color.

Melanocytes convert tyrosine into
melanin by several chemical steps that involve the key enzyme tyrosinase. A functional tyrosinase molecule consists of different amino acids (the building blocks of proteins) and copper. Traces of copper are in the normal human diet and provide the amounts needed for the enzymes.

Tyrosine, the molecule that is converted to melanin, is one of twenty amino acids occurring in biological systems that chain together in various ways to make up different proteins. Eight of these amino acids are essential—that is, they must be present in the diet. The remaining twelve amino acids can be made by chemical modification of the others. Tyrosine is not an essential amino acid. Ample amounts of tyrosine occur in all meats and in most dairy products. If it is not taken into the body in sufficient amounts, however, it will be made from other amino acids. Either way, tyrosine is delivered to the melanocytes and changed into melanin. This product, with its high molecular weight, functions to protect the skin from excessive ultraviolet (UV) radiation.

UV radiation is an invisible part of the sun’s radiation having wavelengths from one hundred to four hundred nanometers. Humans can see the colors of the spectrum from red through violet. Wavelengths of radiation that are slightly longer than red (infrared) cannot be seen but are detected by the body as heat. Wavelengths that are shorter than violet, such as UV, cannot be seen or felt. Nevertheless, UV radiation penetrates the body. In moderation, UV light is valuable for humans because the body uses its energy to synthesize vitamin D. Vitamin D allows the intestinal absorption of calcium to be used for skeletal growth and for nerve and muscle function.

UV radiation poses several risks. A sunburn involves UV radiation damage to epidermal skin cells, which release chemicals that dilate blood vessels, causing redness. Swelling and blistering may occur. When large numbers of cells are destroyed, the skin speeds up production of new cells, which forces the burned cells to peel off. UV radiation also can change the skin’s collagen, a protein that holds tissues together in much the same way that concrete is reinforced by steel rods. The changes in the collagen, possibly by causing cross-linkage between fibers, can permanently wrinkle the skin. Finally, many researchers agree that UV light may also inhibit the immune response by damaging Langerhans cells in the epidermis. When damaged, these large cells lose their ability to alert the other cells of the immune system to infection. The most serious danger is that UV radiation may alter the genetic code within cells, causing cancer.

Melanin protects the cells of the body by blocking and absorbing UV light. People who have more melanin by heredity are not at as high a risk as those who are lighter. (This is not to say that dark-skinned people should not protect themselves from the sun.) In all cases, exposure to UV radiation immediately causes the skin to darken by causing oxygen to combine with the melanin that is already present. Exposure also increases the rate of melanin production and speeds its distribution to other cells, producing more darkening.

Melanocytes are found at the bottom of the outer layer of the skin, which is called the "epidermis." They are also at the base of the shafts of hairs and in the eye, producing coloration of the iris and in the black membrane of the eye behind the retina. The pigment-producing melanocytes in the skin are found at the base of the epidermis among cube-shaped skin cells that cannot make pigment. About thirty-six of these epidermal cells occur for each melanocyte. Melanocytes have long extensions that reach out to protect the regular skin cells. Furthermore, melanin can also be transferred to epidermal cells. Skin color is also influenced by the distribution and size of the pigment granules in the melanocytes. Very dark skin tends to have single, large granules. Lighter skin tends to have clusters of two to four smaller granules.

On a larger scale, small uneven clusters of pigment are called "freckles." These spots of melanin show mostly in lighter-skinned people, are controlled by heredity, and appear with sun exposure to the skin. Because of this uneven distribution of melanin, other cells among the freckles are not protected and can easily be sunburned.

Moles (nevi) are larger, dark spots of melanin that tend to increase as a person ages. Two types occur: the pigment can be deposited into the dermis (intradermal nevi) or can be found between the dermis and the epidermis (junctional nevi). The first type of mole tends to be elevated and have hair growing from it. The second tends to be flat and very dark.

Large amounts of melanin in
hair will cause it to be black. Lesser amounts make it brown, and still less causes it to be blond. White or gray hair has no melanin. Yet a separate gene for a reddish, iron-containing pigment can be inherited. If two of these recessive genes are present, then the hair will be red. Depending on the amount of melanin that is also present, such people range from almost purely red hair to a strawberry blond color to a reddish-brown (auburn). Larger amounts of melanin will cover the red pigment completely.

Lack of melanin in the iris of the eye will scatter light and cause the eye to reflect blue. Larger amounts cause the eye color to be darker. The pigment in the iris serves to block radiation that could sunburn the retina. In 1992, investigators at Boston College found that eye sensitivity increases when the amount of melanin is greater.

Melanin breaks down as it moves toward the outer layers of the epidermis, forming a chemical called "melanoid" in the process. Melanoid can be seen as a yellow color in the thick (calloused) skin of the palms of the hands and the soles of feet.

Carotene is a yellow-to-orange pigment that tends to accumulate in the layer of fat under the skin. This pigment is also responsible for the color of carrots, yellow vegetables, and the yellows in autumn leaves. When taken into the body, carotene is stored in the liver and converted into vitamin A, which is used in vision. Females usually store more carotene than males because of their higher percentages of fat. Asian peoples tend to have combinations of low melanin and higher carotene that produce a yellowish skin hue.

Hemoglobin and oxyhemoglobin are pigments that are found inside red blood cells. Hemoglobin is dark red but looks bluish through the skin. If hemoglobin combines with oxygen, it is called "oxyhemoglobin." Oxyhemoglobin is bright red. Skin color from this pigment varies with the amount of blood that is circulated at the surface of the dermis, the relative amounts of hemoglobin and oxyhemoglobin that are present, and the densities of other pigments. Hemoglobin and oxyhemoglobin affect the color of light-skinned people more than of darker people. The skin of lighter people generally looks reddish, with oxygen-poor veins appearing blue.

Rapid change of hair color, from dark pigmented to gray or white, is impossible because of the slow growth rate of hair. Melanin is deposited into the hair shaft at the root. The hairs grow outward at a rate of about thirteen millimeters a month. Hence, a loss of pigment production would take a long time to show. The myth of rapid change may be based on diseases that cause all the pigmented hair to fall out overnight, leaving only white hairs.

Disorders and Diseases

Pigmentation can be abnormal and associated with disease. Excess
adrenocorticotropic hormone (ACTH) can increase melanin. ACTH contains several hormones, including MSH. Addison disease involves the overproduction of ACTH. Also, certain injuries such as burns, chemical irritations, or some infections may cause an increase in pigmentation, as can pregnancy. Injuries in which melanocytes are destroyed may result in scar tissue that lacks pigmentation. An excessive intake of carotene can cause light skin to turn orange, a condition called "carotenemia."

Skin cancer
has increased over time. In the late twentieth century, the rate doubled every decade from the 1960s to the 1990s. The
ozone layer, a thin layer of gas molecules consisting of three oxygen atoms, was being depleted by chemicals such as refrigerants that were released into the atmosphere. This layer protects life on the planet from the full shower of
ultraviolet radiation that comes from the sun. In 2013, according to the World Health Organization, some two to three million skin cancers were being diagnosed annually. Any changes in the skin, such as a mole that changes in color or begins to grow, should be shown to a doctor. Although moles and other abnormalities in pigmentation are not usually dangerous, some may develop into melanomas.

Researchers have been trying to discover if it is possible to tan safely. Attempts have been made to develop better creams to block UV radiation. Skin cancer is less common among dark-skinned people; it has been reasoned that if melanin could be put into a skin cream, lighter-skinned people could have more of this natural protection. Unfortunately, many sources of melanin are expensive.

Presently, the best way to avoid skin cancer is to avoid the sunlight, especially when and where the light is most intense—at midday, near the equator, during the summer at other latitudes, at high altitudes, and in highly reflective environments such as sand or snow. Additional protection can be found by using a sunscreen lotion with a high sun-protection factor (SPF) of at least 15. SPF 15 permits fifteen times longer exposure before burning (compared to using no sunscreen), and SPF 30 is thought to protect even the fairest skins. The American Academy of Dermatology recommends using SPF 30 or higher.

Nevertheless, even with frequent applications of sunscreens, people may be putting themselves at risk of melanoma, the most serious skin cancer. Specifically, deoxyribonucleic acid (DNA) absorbs and can be directly damaged by the 280 and 315 nanometer range of UV radiation, and it was formerly assumed that this range, called UVB, was the only one about which people had to worry. Sunscreens were initially developed to block only UVB, the “burning rays.” Data collected by Richard B. Setlow and his colleagues at Brookhaven National Laboratory in 1993, however, indicated that longer wavelengths, including some visible light and UVA (315–400 nanometers), can also damage DNA. Setlow suggested that melanin itself absorbs this energy, setting off chemical reactions that produce chemicals that then damage the melanocytes. This process may be the cause of melanoma. The current consensus is that people should protect themselves from all sunlight, using a broad-spectrum sunscreen lotion that protects against both UVA and UVB. The same risks apply to tanning salons.

Most melanomas are skin cancers. They can also be found inside the eye, as a black spot on the white of the eye, on the iris, or in the center of the field of vision. Treatment of such growths with radiation or surgical removal of the tumor are options. Removal of the entire eye may be necessary. Preventive measures include sunglasses that filter UV light. According to the American Academy of Ophthalmology, sunglasses should block 99 to 100 percent of UV radiation. Most manufacturers label their sunglasses.

In 1991, a controlled study was done in which injections of synthetic MSH were tested. The goal was to help prevent sunburn and skin cancer in high-risk individuals who tan poorly. Those receiving MSH showed significant tanning compared to those who received injections of a placebo. Some mild side effects occurred in the MSH group, including some brief flushing and vague stomach discomfort after the injection.

There are several irregularities of pigmentation. If the tyrosinase enzyme is missing, a person will produce no melanin. This condition is inherited among all races, and such a person is called an "albino" (Greek for “white”). Actually, the lack of melanin allows hemoglobin to determine the skin color. In some types of albinism, an affected individual produces reduced amounts of melanin, resulting in an appearance that is only slightly lighter than that found in the individual's family and ethnic community. All albinos have less protection from the sun and, in addition to the risks to the skin, have poor vision because of light reflections off the back of the eye that normally would be absorbed by pigment. With no pigment in the iris, they are also more likely to suffer damage to their retinal cells, resulting in blindness.

Especially in lighter-skinned people, a lack of hemoglobin (anemia) will cause paleness. If a person’s body circulates more blood into the dermis, the skin will appear more reddish or flushed. This could signal that the body is attempting to cool itself or that a person is embarrassed. If the body is cold or emotionally shocked, it may reduce circulation of blood to the surface of the dermis and the individual will appear pale. Lack of normal sunlight can cause a person to slow the production of melanin. A person who is exercising by swimming in cold water may not circulate blood as quickly as it is needed, and the increase of hemoglobin may turn that person blue, a tone that is noticeable in people with both large and small amounts of melanin.

Perspective and Prospects

Scientists believe that the first humans probably had their origin in Africa and were darkly pigmented. As people migrated to the higher latitudes, where the radiation from the sun was less direct, having less pigment may have been adaptive. Less melanin would allow these people to synthesize needed vitamin D where there was less direct sunlight and less UV light. Before individuals began to migrate over long distances, populations were neatly distributed with darker skins near the equator and lighter skins in northern Europe. Inuits are an interesting exception: they have dark skin and live in a northern latitude. Their diet, however, has traditionally included fish livers with sufficient vitamin D.

The possibility of danger from the sun and other radiation is only a recent discovery. Ultraviolet radiation was discovered in 1801. By 1927, H. J. Muller showed in the laboratory that x-rays cause changes in the genetic code of fruit flies that can be inherited. Such changes, called "mutations," can be harmful. Further investigations showed that UV light, while not as dangerous as x-rays, can also cause mutations. The likelihood of mutation in an organism is proportional to the dose of radiation that is received; spacing out the exposure makes no difference.

Attempts to classify races by description of skin color have given little return. Paul Broca (1824–80) developed an elaborate table of twenty colors for cross-matching with the eyes and twenty-four colors for cross-matching with the skin. The color of the skin, however, is extremely difficult to judge: the color itself changes with environmental and physiological conditions, the ability of observers varies, and the lighting conditions under which comparisons are made can make a difference in the results.

To avoid some of these problems, studies have been performed with a device that measures the reflection of various wavelengths by the skin. In 1992, a study of members of the Jirel population in Nepal showed that the reflections from measurements of upper arm skin using three different wavelengths varied as if the reflective properties were controlled by only a single set of genes. Evidently, the use of various wavelengths gives little additional information about color differences.

Bibliography

A.D.A.M. Medical Encyclopedia. "Skin - Abnormally Dark or Light." MedlinePlus, May 13, 2011.

"Albinism." Mayo Foundation for Medical Education and Research, April 2, 2011.

Balter, Michael. "Zebrafish Researchers Hook Gene for Human Skin Color." Science 310, no. 5755 (December 16, 2005): 1754–55.

Freinkel, Ruth K., and David T. Woodley, eds. Biology of the Skin. New York: Parthenon, 2001.

Greeley, Alexandra. “Dodging the Rays.” FDA Consumer 27 (July/August, 1993): 30–33.

Greener, Mark. “Gene for Red Hair Could Shed Light on Skin Pigmentation.” Dermatology Times 20, no. 12 (December, 1999): 19.

Guttman, Cheryl. “Pigmentation Disorders Common in Asians.” Dermatology Times 20, no. 8 (August, 1999): 24.

"Health Effects of UV Radiation." World Health Organization, 2013.

Levine, Norman, ed. Pigmentation and Pigmentary Disorders. Boca Raton, Fla.: CRC Press, 1993.

Schalock, Peter C., ed. "Overview of Skin Pigment." Merck Manual of Home Health Handbook, January, 2013.

Turkington, Carol, and Jeffrey S. Dover. The Encyclopedia of Skin and Skin Disorders. 3d ed. New York: Facts On File, 2007.

"UV Radiation." United States Environmental Protection Agency, June, 2010.

Weedon, David. Skin Pathology. 3d ed. New York: Churchill Livingstone/Elsevier, 2010.

Why do you think the economic and the political turmoil in Europe may have made some people more willing to pass anti-immigration laws in the...

Europe experienced a great deal of economic and political turmoil in the early 1900s. This impacted our country as restrictive immigration laws were passed in the 1920s.

After World War I ended, there was a good deal of concern that the Soviet Union was trying to spread its communist system to our country. People pointed to a large number of strikes after World War I as an example of this. They believed the Soviet Union and the communists were trying to start a revolution to bring communism to the United States. This was known as the Red Scare. The conviction of Sacco and Vanzetti on murder charges added to this growing fear. These men were Italian immigrants and called themselves anarchists. Additionally, many of the immigrants who came to this country left Europe because of economic issues. These immigrants often took low paying jobs causing Americans to believe these immigrants were taking jobs away from them and keeping wages low.

As a result of these concerns, the United States passed two restrictive immigration laws in the 1920s. The Emergency Quota Act of 1921 limited immigration to three percent of a country’s population that was living in our country in 1910. In 1924, the National Origins Act lowered the percentage from three percent to two percent and changed the base year to 1890. These laws were aimed at immigrants from South and East Europe. Many of the immigrants from South and East Europe were perceived as being different from the immigrants from North and West Europe in terms of culture, language, and political viewpoints.

Americans were fearful that their way of life was under attack and that their economic security was in jeopardy from immigrants coming from South and East Europe due to the difficult economic conditions there and the political turmoil that also existed in these areas of Europe. These concerns led to very restrictive immigration laws, aimed at limiting immigration from parts of Europe, to be passed in the 1920s.

What is sleep?

Structure and Functions

All multicellular animals cycle through daily fluctuations in biological activity known as circadian rhythms, with the alternation of sleep and wakefulness being the most obvious example. In humans, a polycyclic sleep/wake cycle—several periods of sleep and arousal during a twenty-four-hour period—becomes evident in the fetus during the latter stages of pregnancy. As children progress from infancy through childhood, they gradually settle into a mainly diurnal pattern, with one long period of sleep during the day. A complex interaction of several external and internal events determines the timing and duration of sleep.

The key exogenous factor that influences sleep is light. In the absence of the alternation of day and night, people will usually develop a sleep/wake cycle that is a little longer (from a few minutes to an hour) than a twenty-four-hour day. Two neurological structures detect light and synchronize the body’s sleep/wake cycle with the presence or absence of light. The pineal gland
is a photosensitive endocrine gland centrally located in the brain that secretes the hormone melatonin, which causes drowsiness. When darkness increases, the pineal gland steps up production of melatonin; levels of melatonin decline as light increases. Melatonin levels also affect the structure of the brain that plays the key role in regulating circadian rhythms, the suprachiasmatic
nucleus
of the hypothalamus (SCN). The SCN serves as the body’s primary biological clock, containing cells that will pulse in rhythmic activity in the absence of light. The activity of these cells, however, is influenced by output from the pineal gland and also from the eye’s retinal cells, providing two avenues by which light can affect the SCN. Light causes the SCN to alter levels of Tim, a protein which, when it interacts with two other proteins known as Per and Clock, will induce sleepiness at high levels. Levels of Tim, in turn, will increase activity in certain cells of the SCN. Thus, light serves as the zeitgeber (time-giver) for the sleep/wake cycle by changing the activity of the pineal gland and SCN, thereby altering levels of sleep-inducing chemicals.

Although damage to the pineal gland and SCN will significantly disrupt the quality and quantity of sleep, periods of sleep will still occur. That observation, in addition to the fact that animals will develop sleep/wake cycles in the absence of light changes, points to other, internal mechanisms that control sleep and arousal. One of these mechanisms is body temperature. Body temperature fluctuates from approximately 98 degrees Fahrenheit (36.7 degrees Celsius) to 99 degrees Fahrenheit (37.2 degrees Celsius) during the day. Rising body temperature is associated with arousal; declining body temperature is correlated with drowsiness. Vigorously rubbing the hands together can increase blood flow to the hands, dropping the blood supply to the brain, thereby decreasing the temperature of the brain and making it easier to fall asleep. While blood flow has an impact on the level of alertness, it is the flow of several neurotransmitters—chemicals that bridge the synaptic gap between one neuron (nerve cell) and another—that play the crucial role in regulating sleep and
arousal.

Neurotransmitters generally have excitatory or inhibitory effects on arousal, but their impact on sleep is dependent on the neurological structures that they affect. Overall, more neurotransmitters appear to facilitate arousal rather than sleepiness. Acetylcholine and glutamate are the primary neurotransmitters for learning, so it is not surprising that they mediate the brain’s alertness to external stimuli. The pontomesencephalon portion of the reticular formation—the brain’s major arousal system—releases these two neurotransmitters, which activate regions of the brain from top (the cortex) to bottom (the medulla). Acetylcholine is also released by excitatory basal forebrain cells that have direct connections with the thalamus, the brain’s center for the integration and processing of sensory information. Close to the bottom of the brain in the pons is the locus coeruleus, which promotes wakefulness and helps to consolidate memories. Norepinephrine, the neurotransmitter that is involved in the display of active emotions such as fear or anger, is released from this structure and arouses many areas of the brain. Between the locus coeruleus and the basal forebrain is the hypothalamus, which influences many aspects of motivation and emotion, particularly through its regulation of the pituitary gland, the master gland of the endocrine system. Anterior cells of the hypothalamus release histamine, which, like acetylcholine, has widespread arousing effects on the brain. Taking antihistamine drugs to subdue the symptoms of allergies and colds will militate against those arousing effects. Lateral cells of the hypothalamus produce orexin, a neurotransmitter that is necessary for staying awake, especially as the day transpires.

Three neurotransmitters promote the induction and maintenance of sleep; two of them exert their effects via the basal forebrain. Gamma-aminobutyric acid (GABA), the brain’s primary inhibitory neurotransmitter, is released by inhibitory cells in the basal forebrain and dampens arousal in the cortex and thalamus. Adenosine decreases activity in the acetylcholine-producing cells of the basal forebrain, thereby inhibiting arousal. Caffeine derives its stimulating effects by blocking adenosine receptors. Moderate levels of serotonin have a calming effect and can facilitate the induction of sleep. However, serotonin (and norepinephrine) can decrease the quantity of REM sleep. Other chemicals, such as prostaglandins, work in conjunction with these three neurotransmitters to promote the induction and maintenance of sleep.

The interplay of various levels of neurotransmitters and hormones effect changes in the electrical activity of the brain. Recordings of the electrical potentials of brain cells made with an electroencephalograph (EEG) have resulted in the identification of four succeeding distinct patterns of brain wave activity that occur in approximately ninety-minute cycles. Prior to falling asleep, a person manifests mostly alpha EEG readings—high amplitude (top-to-bottom distance), medium wavelength (peak-to-peak distance) brain wave activity—characteristic of an alert, relaxed state. When a person slips into the first stage of sleep, a theta EEG pattern—low amplitude, short wavelengths—predominates. As sleep progresses, brief periods of very short wavelengths (sleep spindles) and bursts of high amplitude waves (K-complexes) punctuate the theta EEG pattern, marking the appearance of stage 2 sleep. Eventually, high amplitude and long wavelength brain activity—a delta EEG record—becomes more prevalent and stage 3 sleep is evident. Finally, delta EEG waves predominate
as the person settles into stage 4 sleep. The individual will then cycle back through the third and second stages before reaching stage 1 sleep again, completing the ninety-minute biorhythm. The second period of stage 1 sleep is usually accompanied by the first appearance of rapid eye movement (REM) sleep in humans (many species lack the eye movements), a phenomenon in which brain activity is high but many signs of physiological arousal, such as muscle tension, are low. The time spent in each stage varies, depending on how long the person has been sleeping: stages 3 and 4 predominate during the first half of a sleep period, while stages 1 and 2 predominate (stage 4 sleep is often absent) during the second half.

Differences in sleep stage characteristics and their associated phenomena have led some researchers to distinguish between two basic types of sleep: S-sleep (more neural synchrony, similar activity in diverse brain regions), which combines stages 3 and 4, and D-sleep (more neural desynchrony, diverse brain regions active at different times), which combines stages 1 and 2. S-sleep is characterized by many signs of a deeper physical rest: lower body temperature, generally lower autonomic arousal, difficult arousal. Moreover, sleep loss and physical injuries or deprivations tend to increase the percentage of S-sleep over D-sleep. In contrast, more signs of psychological restoration are associated with D-sleep: increased cortical blood flow and more vivid and prevalent dreams, especially during REM sleep. Additionally, deprivation of REM sleep tends to impair memory and increase irritability more so than deprivation of S-sleep. Because the distinctions between S-sleep and D-sleep are not always clear-cut—for example, S-sleep is essential for some types of memory formation—some researchers prefer to distinguish between REM sleep and non-REM (NREM) sleep.

Disorders and Diseases

Species vary in the amount of sleep that they require during a day, ranging from approximately two hours for a horse to twenty hours for a bat. Humans begin life averaging around sixteen hours of sleep a day as babies, progress to needing about half that much through most of adolescence and adulthood, and then typically get six to seven hours of sleep a day in later adulthood (partially due to age-related decreases in melatonin). No matter what the species or the age of the individual, problems with both the quantity and quality of sleep impair physical and psychological well-being.

Poor quantity of sleep, resulting in feeling tired during waking hours, is the primary characteristic of the most common class of sleep disorders known as insomnias. Insomnias may be characterized by difficulty initially falling asleep (onset), problems in staying asleep (maintenance), or inability to fall back asleep when waking up early (termination). Termination and maintenance insomnia become more likely as people leave early adulthood. Rising body temperature is a factor in both onset and termination insomnia; breathing problems often induce maintenance insomnia.

Trouble breathing, leading to a drop of oxygen in the blood and frequent awakenings, is the main symptom of sleep apnea. Apnea can be caused by many factors, including obstructions of airway passages (often the result of obesity), the use of drugs (such as alcohol and tranquilizers, which relax breathing muscles), or deterioration of areas in the brain that control breathing (the pre-Botzinger complex of the medulla). Left untreated by surgery or breathing aids, apnea can result in numerous health problems, such as loss of cells in multiple areas of the brain, memory deficiencies, heart problems, and diabetes.

Insomnias and apnea, as well as numerous other sleep disorders, can also lead to poor quality of sleep. In particular, depressed amount of REM sleep is a common problem associated with sleep dysfunctions. Neurological depressants, such as alcohol and tranquilizers, have commonly been used to treat insomnia. Unfortunately, such drugs can lead to iatrogenic (caused by medical treatment) insomnia in which a drug initially facilitates sleep but then tolerance develops, in which an increasing amount of the drug is needed to induce its primary effects, and insomnia recurs. Moreover, neurological depressants typically suppress REM sleep, further exacerbating the insomniac’s condition.

In stress-induced insomnia, EEG records reveal that brain activity drifts in a twilight zone between sleep and wakefulness, with minimal REM sleep. People suffering from significant reactions to trauma, such as in post-traumatic stress disorder (PTSD), frequently reexperience their traumatic encounters in nightmares that are so vivid and horrifying that they are unable to stay asleep during REM periods. In contrast, it is the sleep partners of individuals with REM behavior disorder who have problems staying asleep, as the person with the dysfunction thrashes wildly about, perhaps acting out her or his dreams.

Overactive motor activity is also the primary symptom of two NREM disorders: restless leg syndrome, which is characterized by twitching and high muscle tension of the legs, and myoclonus, which involves body twitching, particularly of the arms and legs, while asleep. The extreme overactive muscle sleep disorder, however, is sleepwalking. Sleepwalking normally occurs in stage 4 sleep and is more common in children and adolescents. What sleepwalking is to motor activity, night terrors (extremely terrifying dreams) are to psychological activity. As with sleepwalking, night terrors are more common in children and adolescents and occur during stage 4 sleep. Sleeptalking is not restricted to any particular age-group or sleep stage.

Narcolepsy is a sleep dysfunction in which the main problem is evident during waking hours rather than during the sleep period. The four primary symptoms of narcolepsy are intense periods of sleepiness, cataplexy (muscle weakness), hypnogogic imagery (dreamlike hallucinations while slipping into sleep), and sleep paralysis

(muscle immobility while moving into and out of sleep periods). Because most of the symptoms are associated with REM sleep, narcolepsy has been interpreted as a wakeful experience of REM-like sleep. Low levels of orexin have been implicated as a cause of this disorder.

Perspective and Prospects

In his book The Promise of Sleep (1999), William C. Dement, one of the foremost researchers of sleep, describes the breakthrough research in the early 1950s that gave birth to the modern era of sleep understanding. Dement, working with Nathaniel Kleitman and Eugene Aserinsky, conducted the first research to measure simultaneously the electrical activity of the eyes and brain while people were sleeping. The results of their work led to the identification of four distinct stages of sleep, the discovery of a ninety-minute sleep cycle, and the detection of REM sleep. REM sleep was later found to correspond with a discovery by Michel Jouvet called paradoxical sleep, so named because animals in this type of sleep manifest high brain activity but relaxed postural muscles. Dement and Kleitman also discovered that people awakened from REM sleep were usually dreaming. These discoveries of the 1950s opened up new avenues of research, from empirical studies of dreaming to the interrelationship between sleep and health, and led to the development of better methods to diagnosis and treat sleep disorders.

By the mid-twentieth century, benzodiazepines (tranquilizers, such as Halcion, Valium, and Xanax), which facilitate the action of GABA and adenosine, became the primary treatment for diverse kinds of sleep disorders. Such side effects such as REM suppression, increased likelihood of apnea, and drowsiness during waking hours, however, prompted researchers to search for alternatives to these highly addictive drugs. Safer alternatives for insomnia were developed in the late twentieth century as nonbenzodiazepine, GABA-facilitating sleep aids (such as Ambien, Lunesta, and Sonata) became more popular. Rozerem, a melatonin receptor stimulant, offered physicians a new approach to treating insomnia in the twenty-first century. While chemicals, such as dopaminergic agents (Sinemet) for restless leg disorder and stimulants (Ritalin) for narcolepsy, can be useful in treating various sleep disorders, for the person suffering from insomnia the best advice is often to avoid the chemicals—such as
alcohol, caffeine, and nicotine—that will interfere with the natural mechanisms designed to promote sleep.

In July 2013, researchers at the Veterans Administration Medical Center in Mississippi published a study showing that sleep apnea treatment, specifically continuous positive airway pressor, or CPAP, helps alleviate symptoms of post-traumatic stress disorder.

Bibliography

Dement, William C., and Christopher Vaughan. The Promise of Sleep: A Pioneer in Sleep Medicine Explores the Vital Connection Between Health, Happiness, and a Good Night’s Sleep. New York: Delacorte Press, 1999.

Hirshkowitz, Max, Patricia B. Smith, and William C. Dement. Sleep Disorders for Dummies. Hoboken, N.J.: For Dummies, 2004.

Jacobs, Gregg D. Say Goodnight to Insomnia. London: Rodale, 2009.

Kryger, Meir H., Thomas Roth, and William C. Dement, eds. Principles and Practice of Sleep Medicine. 4th ed. New York: Saunders/Elsevier, 2005.

"Sleep Apnea May Boost Risk of Sudden Cardiac Death." MedlinePlus. June 11, 2013.

Preidt, Robert. "Poor Sleep May Worsen Heart Woes in Women, Study Finds." MedlinePlus. June 7, 2013.

Preidt, Robert. "Sleep Apnea Treatment Eases Nightmares in Vets with PTSD: Study." MedlinePlus. July 17, 2013.

In Sonnet 31 by Sir Philip Sidney, what does the last line reveal about Astrophel's view on love?

Astrophel and Stella is a series of sonnets by Sir Philip Sidney, each of which expounds upon a different element or emotion of Astrophel’s unrequited love for Stella. In Sonnet 31, Astrophel is addressing the moon, wondering whether Eros, even in the heavens, “his sharp arrows tries.” And if there is love on the astral plane, Astrophel further wonders whether it is the same as on Earth, and asks several rhetorical questions of the moon, comparing his own situation to the hypothetical circumstances of love in the skies. “Is constant love deem’d there but want of wit? / Are beauties there as proud as here they be?” he asks. In his final question, he asks of the moon, “Do they call virtue there ungratefulness?” This indicates that in Astrophel’s own experience with Stella, he has been labeled ungrateful by his love for demonstrating virtue.

We can assume that Astrophel’s view on love is dejected and somewhat bitter—he is feeling hopeless in his situation with Stella; his endless love for her is being ridiculed. He believes Stella is being proud in her rejection of him, and that she is taking advantage of his doting without any concern for his own deeply invested feelings for her. And so he turns to the moon, seeking solace in a companion to whom he can assign, and with whom he can share, his own feelings. Thus by asking the moon about the nature of love among heavenly bodies, he is revealing the nature of his own relationship with Stella, and revealing as well his despondence as his virtue, his dedication, and his loyalty are regarded with derision and turned against him in his quest for Stella’s love.

What is vitamin B6? What are its therapeutic uses?

Overview

Vitamin B6 plays a major role in making proteins, hormones, and neurotransmitters—chemicals that carry signals between nerve cells. Because mild deficiency of vitamin B6 is common, this is one vitamin that is probably worth taking as insurance. However, there is little evidence that taking vitamin B6 above nutritional needs offers benefits in the treatment of any particular illnesses, except, possibly, nausea of pregnancy (morning sickness).

Requirements and Sources

Vitamin B6 requirements increase with age. The official U.S. and Canadian recommendations for daily intake are as follows:

Infants aged 0 to 6 months (0.1 mg) and 7 to 12 months (0.3 mg); children aged 1 to 3 years (0.5 mg), 4 to 8 years (0.6 mg), and 9 to 13 years (1.0 mg); males aged 14 years to fifty years (1.3 mg); females aged 14 to 18 years (1.2 mg); women aged 19 to fifty years (1.3 mg); pregnant women (1.9 mg); and nursing women (2.0 mg).

Severe deficiencies of vitamin B6 are rare, but mild deficiencies are extremely common. In a survey of 11,658 adults, 71 percent of men and 90 percent of women were found to have diets deficient in B6. Vitamin B6 is the most commonly deficient water-soluble vitamin in the elderly, and children often do not get enough B6. In addition, evidence has been presented that current recommended daily intakes should be increased.

Vitamin B6 deficiency might be worsened by use of hydralazine (for high blood pressure), penicillamine (used for rheumatoid arthritis and certain rare diseases), theophylline (an older drug for asthma), monoamine oxidase (MAO) inhibitors, and the antituberculosis drug isoniazid (INH), all of which are thought to interfere with B6 to some degree. Good sources of B6 include nutritional (torula) yeast, brewer’s yeast, sunflower seeds, wheat germ, soybeans, walnuts, lentils, lima beans, buckwheat flour, bananas, and avocados.

Therapeutic Dosages

One study found that 30 milligrams (mg) of vitamin B6 daily was effective for symptoms of morning sickness. While far above nutritional needs, this dosage should be safe. However, for the treatment of other conditions, B6 has been recommended at doses as high as 300 mg daily. There are potential risks at this level of vitamin B6 intake.

Therapeutic Uses

The results of a large double-blind, placebo-controlled study suggest that vitamin B6 at a dose of 30 mg daily may be helpful for treating nausea in pregnancy (morning sickness). Vitamin B6 has been proposed for numerous other uses, but without much, if any, scientific substantiation. For example, the two most famous uses of vitamin B6, carpal tunnel syndrome and premenstrual syndrome (PMS), have no reliable supporting evidence, and the best-designed studies found this vitamin ineffective for either of these purposes.

Higher intake of vitamin B6 reduces the level in the blood of homocysteine, a substance that might accelerate cardiovascular diseases, such as heart disease, strokes, and related conditions. However, there is no meaningful evidence that reducing homocysteine is beneficial, and considerable evidence that it is not.

A series of studies suggests that vitamin B6 may be helpful for the treatment of tardive dyskinesia (TD). In the first study, a four-week, double-blind crossover trial of fifteen people, treatment with vitamin B6 significantly improved TD symptoms compared with placebo. Benefits were seen beginning at one week of treatment. The subsequent follow-up study tested the benefits of vitamin B6 used over a period of twenty-six weeks in fifty people with tardive dyskinesia, and once again the supplement proved more effective than placebo.

For the following other conditions, current evidence for benefit with vitamin B6 remains incomplete or contradictory: allergy to monosodium glutamate (MSG), asthma, depression, diabetes of pregnancy, human immunodeficiency virus (HIV) infection, photosensitivity, preventing kidney stones, schizophrenia, seborrheic dermatitis, tardive dyskinesia and other side effects of antipsychotic drugs, and vertigo.

Despite some claims in the media, vitamin B6 has not shown benefit for enhancing mental function. Research investigating the benefits of B6 in combination with folate and vitamin B12 as a potential treatment for cognitive decline due to Alzheimer’s disease has also shown disappointing results.

One study failed to find B6 at a dose of 50 mg daily helpful for rheumatoid arthritis, despite a general B6 deficiency seen in people with this condition. Vitamin B6, alone or in combination with magnesium, showed some early promise for the treatment of autism, but the best-designed studies failed to find it effective.

Additionally, current evidence suggests that vitamin B6 is not effective for treating diabetic neuropathy or eczema, or for helping control the side effects of oral contraceptives.

Scientific Evidence

Nausea and vomiting: Morning sickness. Vitamin B6 supplements have been used for years by conventional physicians as a treatment for morning sickness. In 1995, a large double-blind study validated this use. A total of 342 pregnant women were given placebo or 30 mg of vitamin B6 daily. Subjects then graded their symptoms by noting the severity of their nausea and recording the number of vomiting episodes. The women in the B6 group experienced significantly less nausea than those in the placebo group, suggesting that regular use of B6 can be helpful for morning sickness. However, vomiting episodes were not significantly reduced.

At least three studies have compared vitamin B6 to ginger for the treatment of morning sickness. Two studies found them to be equally beneficial, while the other found ginger to be somewhat better. However, because ginger is not an established treatment for this condition, these studies alone do not provide any additional evidence in favor of B6.

Chemotherapy-induced nausea and vomiting. Researchers also investigated whether vitamin B6 can reduce the nausea and vomiting that often accompanies chemotherapy. A total of 142 women with ovarian cancer who were undergoing chemotherapy were randomized into three groups: acupuncture plus B6 injection into the P6 acupuncture point (located on the inside of the forearm, about two inches above the wrist crease), acupuncture alone, or B6 alone. Those that received both acupuncture and B6 experienced less nausea and vomiting compared with the other two groups.

Premenstrual syndrome
. A properly designed double-blind study of 120 women found no benefit of vitamin B6 for premenstrual syndrome (PMS). In this study, three prescription drugs were compared against vitamin B6 (pyridoxine, at 300 mg daily) and placebo. All study participants received three months of treatment and three months of placebo. Vitamin B6 proved to be no better than placebo.

Approximately a dozen other double-blind studies have investigated the effectiveness of vitamin B6 for PMS, but none were well designed; overall, the evidence for any benefit is weak at best. Some books on natural medicine report that the negative results in some of these studies were due to insufficient B6 dosage, but in reality there was no clear link between dosage and effectiveness.

However, preliminary evidence suggests that the combination of B6 and magnesium might be more effective than either treatment alone.

Autism. One double-blind, placebo-controlled crossover study found indications that very high doses of vitamin B6 may produce beneficial effects in the treatment of autism. However, this study was small and poorly designed; furthermore, it used a dose of vitamin B6 so high that it could cause toxicity.

It has been suggested that combining magnesium with vitamin B6 could offer additional benefits, such as reducing side effects or allowing a reduced dose of the vitamin. However, the two reasonably well-designed studies using combined vitamin B6 and magnesium have failed to find benefits. Therefore, it is not possible at present to recommend vitamin B6 with or without magnesium as a treatment for autism.

Asthma
. A double-blind study of seventy-six children with asthma found significant benefit from vitamin B6 after the second month of usage. Children in the vitamin B6 group were able to reduce their doses of asthma medication (bronchodilators and steroids). However, a recent double-blind study of thirty-one adults who used either inhaled or oral steroids did not show any benefit. The dosages of B6 used in these studies were quite high, in the range of 200 to 300 mg daily. Because of the risk of nerve injury, it is not advisable to take this much B6 without medical supervision.

Safety Issues

The safe upper levels for daily intake of vitamin B6 are as follows:

Children aged 1 to 3 years (30 mg), 4 to 8 years (40 mg), 9 to 13 years (60 mg), and 14 to 18 years (18 mg); adults (100 mg); pregnant girls (80 mg); and pregnant women (100 mg).

At higher dosages, especially above 2 g daily, there is a very real risk of nerve damage. Nerve-related symptoms have even been reported at doses as low as 200 mg. (This is a bit ironic, given that B6 deficiency also causes nerve problems.) In some cases, very high doses of vitamin B6 can cause or worsen acne symptoms.

In addition, doses of vitamin B6 over 5 mg may interfere with the effects of the drug levodopa when it is taken alone. However, vitamin B6 does not impair the effectiveness of drugs containing levodopa and carbidopa. Maximum safe dosages for individuals with severe liver or kidney disease have not been established.

Important Interactions

People who are taking isoniazid (INH), penicillamine, hydralazine, theophylline, or MAO inhibitors may need extra vitamin B6, but they should take only nutritional doses. Higher doses of B6 might interfere with the action of the drug. People who are taking levodopa without carbidopa for Parkinson’s disease should not take more than 5 mg of vitamin B6 daily, except on medical advice. In addition, B6 might reduce the side effects for people taking antipsychotic medications.

Bibliography

Aisen, P. S., et al. “High-Dose B Vitamin Supplementation and Cognitive Decline in Alzheimer Disease.” JAMA: The Journal of the American Medical Association 300, no. 15 (2008): 1774-1783.

Chiang, E. P., et al. “Pyridoxine Supplementation Corrects Vitamin B6 Deficiency but Does Not Improve Inflammation in Patients with Rheumatoid Arthritis.” Arthritis Research and Therapy 7 (2005): R1404-1411.

Ensiyeh, J., and M. A. Sakineh. “Comparing Ginger and Vitamin B6 for the Treatment of Nausea and Vomiting in Pregnancy.” Midwifery 25, no. 6 (2009): 649-653.

Huang, S. C., et al. “Vitamin B6 Supplementation Improves Pro-Inflammatory Responses in Patients with Rheumatoid Arthritis.” European Journal of Clinical Nutrition 64, no. 9 (2010): 1007-1013.

Lerner, V., et al. “Vitamin B6 Treatment for Tardive Dyskinesia.” Journal of Clinical Psychiatry 68 (2007): 1648-1654.

_______. “Vitamin B6 Treatment in Acute Neuroleptic-Induced Akathisia.” Journal of Clinical Psychiatry 65 (2004): 550-1554.

Malouf, R., and E. J. Grimley. “The Effect of Vitamin B6 on Cognition.” Cochrane Database of Systematic Reviews 4 (2003): CD004393.

Miodownik, C., et al. “Vitamin B6 Add-on Therapy in Treatment of Schizophrenic Patients with Psychotic Symptoms and Movement Disorders.” Harefuah 142 (2003): 592-566, 647.

Schwammenthal, Y., and D. Tanne. “Homocysteine, B-Vitamin Supplementation, and Stroke Prevention: From Observational to Interventional Trials.” Lancet Neurology 3 (2004): 493-495.

Smith, C., et al. “A Randomized Controlled Trial of Ginger to Treat Nausea and Vomiting in Pregnancy.” Obstetrics and Gynecology 103 (2004): 639-645.

Sripramote, M., and N. Lekhyananda. “A Randomized Comparison of Ginger and Vitamin B6 in the Treatment of Nausea and Vomiting of Pregnancy.” Journal of the Medical Association of Thailand 86 (2003): 846-853.

You, Q., et al. “Vitamin B6 Points PC6 Injection During Acupuncture Can Relieve Nausea and Vomiting in Patients with Ovarian Cancer.” International Journal of Gynecological Cancer 19 (2009): 567-771.

Why were black people enslaved?

When considering the subject of slavery, it's important to remember that many groups of people have been enslaved by others over the course of history, sometimes by people of their own race. In the United States, Africans were initially brought to the territories to serve as slaves to white land owners and eventually their descendants were also enslaved until the practice was ended following the American Civil War.

As for why Africans and African-Americans were enslaved, the answer is difficult and complicated. In general, the practice of slavery is based on the belief that one group of people is superior to or more valuable than another. As such, the more valuable group felt that they had the right to enslave the inferior group. From the founding of the British colonies into the 18th and early 19th centuries, white people believed that they were superior to people of other races and were more deserving of control over the land and power over other people. For that reason, the use of African slaves as forced laborers was considered to be justifiable because they were believed to be inferior to whites.

In the US, the use of slaves was largely an economic decision that was justified by white superiority. A considerable portion of the American economy was built on slave labor, which is why it was able to grow so quickly.

What are some crimes and evil practices/beliefs of Theodore Roosevelt?

So far as I am aware, no one ever credibly accused Theodore Roosevelt of committing any acts that were actually illegal.  As to his beliefs, “evil” is a very strong term.  However, Roosevelt did hold a variety of beliefs that many people today would abhor.

Roosevelt believed in the idea of “big stick diplomacy.”  He felt that the United States should use its military might to get its way in international affairs.  He did not think that the US needed to worry much about morality or the feelings of people in other countries.  This is, for example, why he used military force to prevent the government of Colombia from putting down a rebellion in Panama, which was then part of Colombia.  He wanted the rebels to win because they would give the US better terms for the land where Roosevelt wanted to build the Panama Canal.   Today, many people would say that it is wrong to believe that the US should use its power to take whatever it wants.

Roosevelt was also racist by any modern use of the term.  He did not think that Native Americans or African Americans were really equal to white people.  Moreover, like many Americans at the time, he believed that many people that we would call “white” today were racially inferior.  He believed that many of the “New Immigrants” from places like Italy and Poland were racially inferior to people from places like England and Germany.  Today, we typically think that people who believe things like this are, at best misguided and might even be evil.

Finally, Roosevelt believed strongly in the idea of eugenics.  This belief went hand in hand with his belief that certain kinds of white people were better than others.  He wanted the “good” white people to have more children.  He wanted to force criminals and other undesirable people to be sterilized or to be forbidden from having children.  Today, we think that this is a terrible idea.  We think it is wrong to argue that poor people or people who are not very smart should not have children because we do not want them to pass their genes on to future generations.

While I think it is stretching things to say that these are evil beliefs, they are certainly beliefs that most people today would reject.

Give a critical analysis of the poem "Phenomenal Woman" by Maya Angelou.

To critically examine Angelou's poem "Phenomenal Woman," let us first look at the structure. The poem is written in free verse, with an irregular rhyme scheme. It does have a clear rhythmic ebb and flow to it when read aloud. This rhythm, paired with the way the lines of the poem look on the page, is suggestive of the curves of the female form, thus allowing the structure of the poem to emphasize the theme of natural feminine allure. 

Angelou uses repetition throughout the poem to bind it together poetically, as well as to emphasize her main point. The rhythm created by the repetitions in lines like:

"The reach of my arms,
The span of my hips,
The stride of my steps,
The curl of my lips" (lines 6-9)

serve the purpose of listing the narrator's feminine attributes in a predictable way throughout the poem, but also create the rhythm and sway that evokes a curvy woman swinging her hips as she strolls down a street. 

Angelou also uses repetition in the final four lines of each stanza:

"I'm a woman
Phenomenally
Phenomenal woman,
That's me."

This chorus acts a repetition of her thesis for the poem: that her power, beauty and grace come from her inherent femininity, rather than an external trait granted by society.

Examining Angelou's word choice, one cannot escape her decision to use the word "phenomenal." According to dictionary.com, the word can have several meanings. The first and most obvious is "highly extraordinary; exceptional" and this fits right in with what Angelou is saying in the poem. Her narrator is an exceptional woman, who intrigues both men and women, but is also exceptional because she is a woman, embodying the Platonic ideal of what being a woman means and is. 

However, phenomenal directly relates to phenomenon, which means "a fact, occurrence, or circumstance observed or observable." This definition injects some irony into the poem. The narrator tries time and again to demonstrate her innate womanliness and its power, by indicating things like the "arch of [her] back" or "sun of [her] smile" (lines 38-9). To her, female beauty and power are a clear phenomenon, observable by the senses. But the men "say they still can't see" (line 36). To them, this beauty and power is a mysterious force, unknowable even when they are directly shown it. 

Most readings of the poem correctly identify the themes of confidence in oneself and inner beauty that Angelou emphasizes in the poem. However, a deeper look, as shown above, will also reveal the celebration and reverence of the feminine that Angelou gives to her narrator. 

Do you think the breakup of Pangea led to the extinction of some dinosaurs? What makes you think that?

Generally speaking, the extinction of the dinosaurs was catastrophically finalized by the Chicxulub impact and the subsequent worldwide ecological changes. However, some data suggests that certain dinosaur populations were decreasing in diversity prior to the impact. We should also be conscious of the fact that our data does not necessarily represent a true cross-section of life during the Mesozoic, due to a variety of factors skewing the fossil record and our access to it. Nevertheless, it would be fair to say that events related to continental rifting may have influenced extinctions; not necessarily because dinosaurs were falling into volcanoes, but because of ecological changes tied to the rifting process.

The breakup of Pangea was a long-term and complicated process that was not particularly different from the rifting we see today in places like East Africa. There are at least two significant effects that rifting produces; climate change as a result of previously connected land masses becoming geographically distinct, and climate change as a result of volcanic events tied to the movement of the plates.

One way in which changing the size and shape of land masses influences climate has to do with rainfall; large land masses tend to have arid interiors simply due to rain developing over the ocean and not being able to sustain itself over hundreds of miles of land. There were almost certainly changes in ocean and air currents as well, leading to different weather patterns in different regions depending upon the interaction of these factors.

In terms of tectonic events, volcanism can release a lot of carbon dioxide, a greenhouse gas, which can alter the local as well as global temperatures, and all related ecological factors. This and other gases can also blanket certain areas, rendering the air unbreathable, let alone covering them with lava. The Deccan Traps are an example of this. 

Thus, the breakup of Pangea could have contributed to dinosaur extinctions by:

• generally reducing the amount of land available to an animal


• changing the local and global climate


• rendering certain regions uninhabitable due to volcanic events

In the sermon Sinners in the Hands of an Angry God, what does Edwards mean when he says, “The bow of God’s wrath is bent, and the arrow made...

Throughout this sermon, one of the major points that Jonathan Edwards makes over and over again is that God is angry at all people and that all people deserve for God to be angry at them.  Edwards emphasizes that God could (and perhaps should) destroy everyone and send them all to Hell, and that only his mercy prevents him from doing so. This is the meaning of the quote that you have placed in your question.

Here is the whole quote, part of which you cite:

The bow of God's wrath is bent, and the arrow made ready on the string, and Justice bends the arrow at your heart, and strains the bow, and it is nothing but the mere pleasure of God, and that of an angry God, without any promise or obligation at all, that keeps the arrow one moment from being made drunk with your blood.

When Edwards talks about “the bow of God’s wrath” he is using a metaphor.  He is saying that God’s anger is very dangerous.  It is like a weapon that can kill you.  Then, when he says that it “is bent, and the arrow made ready on the string,” he is saying that God is ready to let his anger kill you.  When an arrow is on the string of the bow and the bow is bent, the archer is ready to shoot.  He has put the arrow up against the string and has pulled back.  As soon as he lets go, the arrow will fly at its target.  This is like having a round in the chamber of a gun with the safety off and the shooter’s finger on the trigger.  In other words, this is a very dangerous situation.  The person that Edwards addresses is literally a moment away from death and damnation.

By using this metaphor, and by emphasizing that God is very angry at people, Edwards meant to frighten people and also to make them grateful.  He wanted them to be afraid when they realized that they deserved to be killed and damned.  He also wanted them to be grateful to God for not punishing them in the way they deserved.  This is what this quote means and why Edwards uses it.

Why did Germany postpone its invasion of Britain ?

Hitler was uneasy about the consequences of a cross-channel invasion of Britain, something that had not been done successfully since William of Normandy did it in 1066.  The blitzkrieg was more designed for the open spaces of Poland and France than the probable urban fighting of London that an invasion would ultimately require.  He allowed his Air Commander Goering to try to force Britain to capitulate due to bombing, but Britain stubbornly held out--the Battle of Britain was a propaganda victory for Britain as it brought them more American sympathy and demonstrated that Britain could withstand German attack.  The Luftwaffe also lost experienced pilots over Britain.  Hitler did not have the patience to invade Britain, as in the summer of 1941 he turned his attention to invading the Soviet Union, which he looked at as the ultimate prize in the war, as the Soviet land could be used to feed the German state and provide estates for loyal Nazis.  

Analyze the theme of power in Julius Caesar.

The whole play is essentially a major power struggle. It begins soon after Caesar’s defeat of Pompey, one third of the triumvirate that ruled Rome. A number of tribunes worry at Caesar’s growing popularity and power. Cassius seems jealous, mocking Caesar’s physical weaknesses and conspiring with Brutus to get rid of him.

In spite of his friendship with Caesar, Brutus succumbs to Cassius’s manipulations. Though Cassius seems driven by greed and a desire for power (Brutus later accuses Cassius of having “an itching palm; / To sell and mart your offices for gold”), Brutus seems genuinely concerned about the Republic of Rome.

Brutus believes that power corrupts: “He would be crown'd: / How that might change his nature, there's the question.” He thinks the balance of power in Rome is so essential to its well-being, he decides to help assassinate Caesar for the greater good.

Caesar may very well desire absolute power. Antony offers Caesar the crown three times, which he refuses. However, Casca describes him as being “very loath to lay his fingers off it.” In the senate, he declares how uniquely consistent he is:

Yet in the number I do know but one
That unassailable holds on his rank,
Unshaked of motion: and that I am he…

Brutus’s good intentions are marred by his ignorance about power plays. His idealism overwhelms his wisdom. The other conspirators or not as principled as he is, and Antony, whom he allows to live, quickly turns the crowd against Brutus in a manipulative speech at Caesar’s funeral. Antony and Cassius know how to play the game, but Brutus does not.

In the end, Brutus and Cassius kill themselves. Even years after their suicides, the never ending game continues to be played by Antony and Octavius Caesar, as is portrayed in another Shakespeare play Antony and Cleopatra.

Suggest why the noble gases such as neon and argon do not exist as molecules.

Electrons and Stability

The stability of an atom is related to the number and arrangement of its electrons. Atoms with completely filled valence shells tend to be more stable. The valence shell of an atom is its outermost shell. Atoms form compounds such as molecules or ionic salts in order to fill their valence shells with electrons. 

Noble Gases

Noble gas atoms are located in column 18 of the periodic table. The valence shells of these atoms are already completely filled. Therefore, they are already stable and do not need to form compounds in order to fill their valence shells.

Helium and neon never form molecules because their shells are completely filled and they have very high ionization energies. Ionization energy is the amount of energy needed to remove an electron from an atom. The high ionization energies of helium and argon prevent these atoms from forming ions. Some of the other heavier noble gases, such as krypton and argon, will occasionally form molecules.

What are the poetic devices used in Maya Angelou's poem "Caged Bird"?

Maya Angelou uses a myriad of poetic devices in "Caged Bird," including metaphor, rhyme, imagery, alliteration, personification, and repetition.

In the poem, Angelou employs these poetic devices to contrast a free bird with a bird who is confined to a cage; the two different birds serve as metaphors for people free from oppression and people who are oppressed by society, respectively. Considering Angelou's personal history and the themes of her autobiographies, the caged bird, more explicitly, is a metaphor for African Americans who experienced racism and discrimination through slavery and Jim Crow laws in the U.S. Like the caged bird in the poem, African Americans were physically confined or restricted due to slavery and segregation, but they still vocally demanded their freedom.

In addition to using metaphor, Angelou utilizes repetition to reinforce the idea that African Americans cried out for freedom from oppression even in the bleakest of times when their oppressors did not want to "hear" them. Angelou repeats the third and fifth (final) stanzas, with the caged bird singing for freedom: 

The caged bird sings/with fearful trill/of things unknown/but longed for still/and his tune is heard/on the distant hill/for the caged bird/sings of freedom.

In the above quotation, note the end rhyme in the second, fourth, and sixth lines with "trill," "still," and "hill." We also find end rhyme as well as alliteration in the second stanza of the poem, when Angelou describes how the caged bird is physically confined. In the second stanza, the caged bird is in "his narrow cage" and "can seldom see through/his bars of rage" ("seldom see" forms the alliteration, while "cage" and "rage" form the end rhyme).

Finally, there is vivid imagery in the first stanza when the free bird "dips his wing/in the orange sun rays" and personification and alliteration in the fourth stanza when the caged bird's "shadow shouts on a nightmare scream." In this example from the fourth stanza, note the repetition of the consonant "s" and giving the caged bird's shadow the human quality of shouting, which emphasizes the bird's nightmarish existence living in confinement.

What was the significance of the aristocratic revolution in France?

The aristocratic revolution was the first stage of the French revolution. In 1787, the country had the largest population in Europe. Feeding and supporting this population, along with extravagant spending by the noble or aristocratic class, resulted in a large deficit. In order to address this issue, the controller of finances at the time, Charles Alexander de Colonne, proposed raising taxes on the rich, also known as the bourgeoisie or aristocrats.  The idea is similar to current debates surrounding taxation of the rich in American society today. Some argue that the wealthier classes should pay more taxes in order to support the growing population of the underclass and to lessen the burden of the deficit. You can think of the 1% as the aristocracy and the 99% as the third estate.

The aristocrats refused to pay higher taxes and this led to the aristocratic revolt. The aristocracy included members of the parliament and of the courts, so the country came to a standstill. This was in 1788, also the year of a terrible harvest, so the country was going hungry. Again, we can see parallels in the current state of affairs in the United States. The wealthy are refusing to pay higher taxes, the ruling officials have come to a standstill, and the poor masses of people are seeing their situation decline.

In response to this aristocratic refusal to pay higher taxes, an assembly was convened which included this group along with the clergy and the common people, known as the third estate. This convention was to determine the future of the country, but the aristocracy wanted to have their votes count as equal to those of the common people that outnumbered them. This was denied and the aristocratic revolt crystallized.

The new assembly was formed at the same that the food shortage was getting worse and the peasants were pressing for reforms. The reforms that resulted from the revolution included the Declaration of the Rights of Man and the dissolution of the feudal system that created such great divisions between the aristocracy and the rest of the population in the first place.

So the importance of the aristocratic revolution is that it led the peasants, in combination with the food shortage and the spread of Enlightenment ideals, to revolt against the upper classes. The refusal of the aristocrats to pay higher taxes or recognize the voice of the lower classes in the National Assembly is what is considered as the aristocratic revolt. This sparked the revolt of the peasants and the French Revolution, resulting in the reforms that shaped the trajectory of European governance for the following centuries.

What is shopping/spending addiction?

Causes

The causes of shopping and spending addiction are debated. German psychiatrist Emil Kraepelin was the first medical expert to describe the condition in 1915; he called it oniomania (from two Greek words meaning “to sell” and “insanity”). Eugen Bleuler, a Swiss expert on schizophrenia, defined shopping addiction in 1924 as an impulse-control disorder in the same category as kleptomania and pyromania.

The vast majority of persons with the disorder also meet the
Diagnostic and Statistical Manual of Mental Disorders
(DSM) criteria for anxiety or mood disorders, eating disorders, substance abuse disorders, and axis II disorders (personality disorders). Obsessive-compulsive, borderline, and narcissistic personality disorders in particular have been associated with compulsive buying disorder (CBD). An estimated 40 percent of people with CBD also hoard, which is an obsessive-compulsive behavior in which the affected individual acquires and cannot or will not dispose of possessions. Because of these extensive overlaps, some observers question whether compulsive spending is a separate mental disorder or simply a secondary feature of other disorders. Furthermore, there is no evidence of a genetic factor in shopping or spending addiction.

Some experts regard CBD’s underlying cause as poor ability to tolerate anger, sadness, boredom, or other negative feelings. Others believe that a search for personal identity through purchasing prestigious brand-name products is the underlying cause. Other causes that have been suggested include early childhood deprivation, leading to compensating in adult life by purchasing special items; a need for excitement and stimulation; seeking approval by purchasing clothing or other items owned by one’s peers; social isolation and loneliness; perfectionism (needing to dress or look perfect); and a feeling of inner emptiness.

Risk Factors

Risk factors for CBD include being female; being in one’s late teenage years through early twenties; living in a developed country with a market-based economy; and a family history of substance abuse or mood disorders. It is estimated that about 6 percent of the general population are compulsive shoppers.

The disorder also has been reported and studied by psychiatrists in France, Canada, the United Kingdom, Germany, and Brazil. The rate is expected to increase worldwide because of widespread access to the Internet and online shopping, the easy availability of credit cards, and advertising that encourages the purchase of consumer goods as a way to increase self-esteem and social acceptance.

Symptoms

The symptoms of CBD include excessive time spent shopping and excessive spending, in most cases leading to impaired cognitive, social, and occupational functioning. Spending beyond the person’s means (beyond available income) usually creates tension in interpersonal relationships and financial and legal difficulties; these difficulties may include bankruptcy, ruined credit, or prosecution for shoplifting, check forgery, or embezzlement.

The person typically displays anxiety or emotional distress regarding the shopping and spending behavior. Denial is relatively uncommon; most affected persons acknowledge that their shopping behavior is problematic. Research also suggests that CBD is associated with diminished self-regulation of inappropriate and disruptive actions, poor risk adjustment, and deficits in spatial working memory.

Some psychiatrists identify four distinct phases or stages in an episode of compulsive shopping: anticipation, in which the person develops an urge to buy a specific item or to go on a shopping trip; preparation, in which the person decides which stores to go to, how to get there, what to wear, and even which credit cards to use; the actual shopping, which some persons describe as exciting or even sexually arousing; and the act of purchase, which is often followed by feelings of disappointment or anxiety over one’s loss of self-control. Compulsive shopping is a solitary behavior in most cases, although some persons with CBD report that they go shopping with a friend or partner who shares the addiction.

The most common items purchased by both men and women are clothing, shoes, compact discs (CDs), and household items. Women with CBD often purchase jewelry and cosmetics, while men typically splurge on hardware, electronic gadgets, or automotive equipment. In most cases the individual items purchased are not expensive; however, persons with CBD often buy in quantity, such as eight or ten CDs instead of one. Researchers report that the average cost of a compulsive buying spree is between $100 and $150 (in US dollars).

Screening and Diagnosis

There are no standardized diagnostic criteria for shopping and spending addiction. An earlier edition of the DSM (DSM-III-R) classified CBD as an impulse-control disorder not otherwise specified, while neither the DSM-IV nor the DSM-5 mentions it at all. Proposed diagnostic criteria for the disorder considered (but ultimately rejected) for the DSM-5 included intense preoccupation with shopping or spending, significant impairment in functioning, and shopping or spending that does not occur as part of a manic episode.

Several questionnaires and “screeners” for shopping addiction have been developed since the late 1980s. The oldest English-language instrument is the compulsive buying measurement scale (CBMS; 1988), which measures four dimensions of compulsive buying: the urge to spend, guilt after making the purchase, a general tendency to spend money freely, and a troubled family environment. In 1990, a German version of the CBMS, known as the Hohenheimer Kaufsuchttest or Hohenheim shopping addiction test, was published and used in several European studies.

The Minnesota impulsive disorder interview (MIDI; 1994), includes a subsection intended to diagnose compulsive buying, although no data have been published regarding its reliability or validity. The Yale-Brown obsessive-compulsive scale (Y-BOCS) was modified in 1996 to develop a ten-item scale called the Y-BOCS shopping version, or Y-BOCS-SV. In 2005 an English-language screener called the "compulsive buying scale" was introduced and rated for validity and reliability.

In some cases affected persons will screen themselves for the disorder through an online shopaholics self-test, by reading a book on the disorder, or by completing the fifteen-question assessment tool of Debtors Anonymous (DA), and will then seek professional help after admitting to themselves that they have a problem.

Treatment and Therapy

A number of different treatments for CBD have been tried. Antidepressant medications, particularly the selective serotonin reuptake inhibitors, have been used but appear to be relatively ineffective, as does psychodynamic psychotherapy. Group therapy and a twelve-step program such as DA are helpful to some persons with CBD, as are simplicity study circles—small groups that meet to redefine the good life, to encourage self-reflection, and to help people make such changes as turning away from shopping or other forms of social competition.

Some compulsive shoppers also benefit from bibliotherapy (reading self-help books) or from bibliotherapy combined with cognitive-behavioral therapy (CBT). In some cases financial counseling is a useful adjunct to CBT. One expert in CBD offers patients five points of advice: they should not rely on antidepressants or other medications to treat CBD,; they should acknowledge that they have the disorder; they should destroy all credit cards and checkbooks; they should go shopping only with friends or companions who do not have CBD; and they should find activities other than shopping to fill leisure time.

Researchers are also investigating the therapeutic possibilities of mindfulness, motivational interviewing, dialectical behavior therapy, and acceptance and commitment therapy for compulsive buying. The Stopping Overshopping model, a hybrid of all of these approaches and CBT, was developed in 2005, and preliminary trial results of the twelve-week group program reductions in the amounts of time and money spent, the numbers of episodes experienced, and overall measures six months after the intervention.

Prevention

Prevention of CBD is difficult because shopping and spending addiction is often rooted in the affected person’s family of origin—which means that the behavior typically develops before the person recognizes that he or she is at risk for a behavioral addiction and may already suffer from an eating disorder or other impulse control disorder. Adolescents are particularly susceptible; however, there is no single family structure or characteristic that is useful in predicting the likelihood that a specific family member will develop CBD. Possible preventive strategies include parental oversight of teenagers’ spending habits and early training in the responsible use of income, whether the money comes from allowances or part-time employment.

Bibliography

Adee, Sally. “Possessed by Possessions.” New Scientist 221.2962 (2014): 44. Academic Search Complete. Web. 28 Oct. 2015.

Albrecht, Ulrike, et al. “Diagnostic Instruments for Behavioural Addictions: An Overview.” GMS Psycho-Social Medicine 4 (2007): 1–11. Print.

Benson, April L. To Buy or Not to Buy: Why We Overshop and How to Stop. Boston: Trumpeter, 2008. Print.

Benson, April Lane, et al. “Stopping Overshopping: A Preliminary Randomized Controlled Trial of Group Therapy for Compulsive Buying Disorder.” Journal of Groups in Addiction & Recovery 9.2 (2014): 97–125. Academic Search Complete. Web. 28 Oct. 2015.

Black, Donald W. “Compulsive Buying Disorder: A Review of the Evidence.” CNS Spectrums 12.2 (2007): 124–32. Print.

Coombs, Robert H., ed. Handbook of Addictive Disorders: A Practical Guide to Diagnosis and Treatment. Hoboken: Wiley, 2004. Print.

Mueller, Astrid, et al. “Latent Profile Analysis and Comorbidity in a Sample of Individuals with Compulsive Buying Disorder.” Psychiatry Research 178.2 (2010): 348–53. Print.