Saturday, October 31, 2015

What does Link Deas say about Tom Robinson during the trial in To Kill a Mockingbird?

While Tom Robinson is on the witness stand during his trial, Link Deas stands up and, in attests to Tom's character by declaring Tom has worked for him eight years without any problems.


Mr. Deas is one of the merchants of Maycomb and a decent man who realizes the ridiculousness of Tom's trial. He is so incensed that this hard-working, decent man has been made a scapegoat, and it causes him to stand up and declare, 



I just want the whole lot of you to know one thing right now. That boy's worked for me eight years an' I ain't had a speck o'trouble outa him. Not a speck.



As a businessman, Link Deas has a sense of which citizens of Maycomb are decent people and which ones are not trustworthy or of good character. He is cognizant of the attitudes of the majority of citizens in Maycomb, so he fears Tom will not be treated fairly during the trial. The unfairness of Tom's arrest has already been proven since he was apprehended simply on the word of Bob Ewell, a known drunkard and man of low character who neglects and abuses his own children.


Although he is well-meaning, Mr. Deas disrupts the proceedings of the trial, so Judge Taylor must scold him because he could cause a mistrial. For this reason, the judge has Mr. Deas removed from the courtroom.

Task: The focus of this topic should reveal a clear division between the two main adversaries of the cold war.

The two main adversaries of the Cold War were the United States and the Soviet Union. There was a prolonged period of competition and confrontations between the two countries beginning at the end of World War II.


The United States and Great Britain reached some agreements with the Soviet Union at the end of World War II. One agreement was that the new government in Poland after World War II would have some members of the pre-war government in it. There would also be free elections. After the World War II ended, the new government had very few members of the pre-war government in it, and there was no sign of free elections. Another agreement reached, known as the Declaration of Liberated Europe, was to allow European countries to choose the kind of government they wanted to have. The King of Romania, however, said he was pressured to have a communist government.


The Soviet Union wanted to spread communism. We wanted to prevent it from spreading. This to led to many areas of confrontation with the Soviet Union. The European Recovery Program offered aid to countries that were trying to prevent communism from spreading there. Greece and Turkey were examples of countries that accepted aid and remained noncommunist. The Soviet Union tried to force the Allies out of West Berlin by establishing the Berlin Blockade. All land routes into West Berlin were cut off by the Soviet Union. We responded with the Berlin Airlift, flying supplies over the blockade. The airlift lasted until the blockade ended.


We also opposed the attempt to expand communism into South Korea. When North Korea, unprovoked, invaded South Korea, we went to the United Nations to deal with this invasion. The United Nations, led by the United States, pushed the Soviet-backed North Korea out of South Korea.


The United States and the Soviet Union also clashed over communist-controlled Cuba. We blockaded the Cuban coast when we discovered the Soviet Union was building missile sites and placing missiles in Cuba. This led to an intense two-week crisis known as the Cuban Missile Crisis.


The United States and the Soviet Union competed in other areas also. There was a race to get the first satellite into space. The Soviet Union accomplished that first, but we were the first to land an astronaut on the moon. The two countries also competed in sports. The United States and the Soviet Union had intense competitions in world competitions and in the Olympic games.


The United States and the Soviet Union clearly were on the opposite ends of many issues between 1945-1990.

Why does a balloon get larger when it is heated?

I assume you are referring to a hot-air balloon. These were the first flying machines developed by man and are used these days by tourists and weather scientists, etc. The mechanism of flight of a hot-air balloon is based on buoyancy. Hot air is supplied to a balloon. We do not really heat the balloon, rather we heat the air inside it. Air heats up and since hot air is lighter than ambient cold air, it rises and causes the balloon to expand. The lighter the balloon gets (due to hot air inside), the higher it rises and when we release the hot air, the balloon descends.


Thus, the expansion of balloon, when heated, is caused by thermal expansion of the air inside the "envelope" (that is what ballooners call the balloon). When heat is supplied, air molecules get higher kinetic energy and move rapidly, thus causing an expansion of the air mass and hence the balloon.


Hope this helps.  

Compare Tim O'Brien's short stories "On the Rainy River" and "The Things they Carried."

"The Things they Carried" and "On the Rainy River" are both short stories in Tim O'Brien's novel, also called The Things they Carried. The short story "The Things they Carried" is narrated by O'Brien about what the soldiers in Alpha Company in Vietnam carry as they fight in a senseless war. Much of what they carry is excess physical baggage, such as pantyhose worn as a good luck talisman, chewing gum, and the Bible. They also carry reminders from home, such as the love letters that Lieutenant Jimmy Cross carries from Martha, a girl back home. They carry marijuana to calm their nerves. Finally, they also carry psychological burdens, such as the guilt that Jimmy Cross feels when one of his men, Ted Lavender, is shot and killed. This story can be read on a literal and a symbolic level, as what the men carry stands for the larger burdens they bear.


"On the Rainy River," like "The Things they Carried," can also be read on a literal and symbolic level. Unlike "The Things they Carried," it takes place before (rather than during) the Vietnam War, as the narrator, Tim O'Brien, decides whether to fight in Vietnam or escape to Canada. He is literally on the Rainy River, which separates Minnesota from Canada, while he makes his decision. This story concludes as O'Brien decides to fight in the war, largely out of shame. Like "The Things they Carried," much in this story is symbolic. The river stands for his indecision as he chooses between fighting and escaping to Canada. Like the characters in "The Things they Carried," he also struggles with shame, which motivates his decision to fight in Vietnam. Most importantly, both stories emphasize the senselessness of the war. 

Friday, October 30, 2015

What is anorexia nervosa?


Causes and Symptoms

Anorexia nervosa is an eating disorder characterized by a body
weight at or below 85 percent of normal and an intense fear of weight gain that
leads to restrictive eating to the point of self-starvation. Anorexia nervosa is
typically a physical manifestation of underlying emotional conflicts such as
guilt, anger, and poor self-image and is often characterized by
obsessive-compulsive symptoms about weight and body image. According to the
National Association of Anorexia Nervosa and Associated Disorders, anorexia
nervosa is the third most common chronic condition among adolescents.
Approximately 85 to 90 percent of people with anorexia are female.




Anorexia nervosa often occurs following a successful dieting experience, and
frequent dieting may contribute to the development of the disorder. Dieters may
experience positive feedback regarding weight loss and feel compelled to continue
losing weight.


Although the term “anorexia” means “loss of appetite,” individuals with anorexia
continue to experience hunger but ignore or resist the body’s normal craving for
food. Individuals with anorexia frequently identify specific areas of the body
that they believe are “fat,” despite their emaciated condition. Anorexia is
characterized by extreme body-image distortions. Secrecy and ritual eating habits
may be signs of anorexia nervosa. Sufferers often lie to family and friends to
avoid eating meals and may eat only a set diet at a specific time of day.


Common comorbid conditions in individuals with anorexia nervosa include
obsessive-compulsive disorder, depression,
anxiety
disorders, and social phobia. Many people with anorexia are
high achievers, exhibiting perfectionist or “people-pleasing” personalities. In
addition, a strong correlation exists between anorexia nervosa and athletic
activities that emphasize the physique, such as ballet, figure skating,
gymnastics, cheerleading, and dance. People with anorexia may demonstrate
additional obsessive-compulsive behaviors such as weighing themselves and/or
examining themselves in the mirror several times per day, being overly concerned
with calorie or fat content, exercising compulsively, and maintaining unusually
consistent eating patterns.


Anorexia nervosa is frequently a symptom of depression, and the accompanying weight loss can be seen as a cry for help. Eating disorders tend to run in families, particularly those that equate thinness with success and happiness. The condition may also occur as a result of a traumatic situation such as death, divorce, pregnancy, or sexual abuse.


Symptoms and resulting physical conditions include amenorrhea ,
the abnormal interruption or absence of menstrual discharge, which can occur when
body fat drops below 23 percent. Anorexia nervosa may also be characterized by a
distended abdomen as a result of a buildup of abdominal fluids and the slowing of
the digestive system.


Resulting malnutrition can impair the immune system and cause
anemia or decreased white blood
cell counts. Brain and central nervous system functions may
also be affected, resulting in forgetfulness, attention deficits, and confusion.
Individuals with anorexia frequently experience fatigue, apathy, irritability, and
extreme emotions.


Additional symptoms can include thyroid abnormalities, fainting spells, irregular
heartbeat, brittle nails, hair loss, dry skin, cold hands and feet,
hypotension (low blood pressure), infertility, broken blood
vessels in the face, and the growth of downy body hair called lanugo as the body
attempts to insulate itself because of the loss of natural fat.


The occurrence of eating disorders in adolescents is especially dangerous because
the condition can retard growth and delay or interrupt puberty. Anorexia nervosa
can also result in the erosion of heart muscle, which lowers the heart’s capacity
and can lead to congestive heart failure. Individuals with
anorexia may experience musculoskeletal problems such as muscle spasms, atrophy,
and osteoporosis as a result of potassium and calcium
deficiencies. In extreme cases, patients may also experience organ failure and
cardiac complications that can result in sudden death.




Treatment and Therapy

Treatment of anorexia nervosa generally consists of medical treatment, including
electrolyte balance, and diagnosing and addressing any related health problems,
such as heart problems, depression, and osteoporosis; individual psychotherapy;
and nutrition counseling, as most people with anorexia need to focus away from
weight loss and toward nutritional gain and health.


Research indicates that eating disorders are one of the psychological problems
least likely to be treated, and anorexia nervosa has the highest mortality rate of
all psychosocial problems. The National Institute of Mental Health estimates that
one in ten anorexia cases ends in death from starvation, suicide, or
medical complications such as metabolic collapse, heart attacks, or kidney
failure.


Psychologists play a vital role in the successful treatment of eating disorders and are integral members of the multidisciplinary team that may be required to provide patient care. As part of this treatment, a physician may be called on to rule out medical illnesses and determine that the patient is not in immediate physical danger. A nutritionist may be asked to help assess and improve nutritional intake.


It is frequently necessary first to treat the acute physical symptoms associated
with anorexia nervosa. Patients with severe cases of anorexia—characterized by
weight that is 75 to 80 percent below ideal body weight—benefit from treatment in
a controlled environment that allows medically supervised feeding to achieve a
target rate of weight gain. Less severe cases can be effectively treated on an
outpatient basis.


During the initial phase of supervised feeding, the patient may receive a
low-calorie diet to avoid overwhelming low-functioning organs. Patients who do not
comply with the recommended diet may receive caloric supplements and, in serious
cases, intravenous feeding or nasogastric intubation.


Successful treatment also involves resolution of underlying emotional conflicts
through individual counseling or cognitive behavioral therapy and may also include
use of antidepressants.


Anorexia nervosa is extremely difficult to treat, with a fatality rate of 5 percent to 10 percent within ten years. Nearly half of all sufferers never recover fully from the condition.




Perspective and Prospects

Anorexia is a multifaceted problem that has physical, genetic, emotional, and
cultural components. The lifetime prevalence of anorexia nervosa among adolescents
in the United States is 0.3 percent, and the incidence of anorexia among
adolescent girls has risen each decade since 1930.


Most eating disorders were not recognized as illnesses until the late nineteenth
century. Conditions such as anorexia nervosa gained the attention of medical
professionals during the 1960s and beyond as a result of the media’s obsession
with thinness.


The media are prime contributors to this trend. Television and magazines send
confusing messages to young consumers, such as depicting painfully thin models
promoting high-fat snacks. In 2012, the average fashion model weighed about 23
percent less than the average woman. Of American elementary school girls who read
magazines, nearly 70 percent say that the pictures influence their concept of the
ideal body shape. In addition, the media frequently portray overweight people as
having a lower socioeconomic status and competency than people who are thin.


It appears likely that the incidence of eating disorders will continue to escalate
as the media persist in depicting models with a body image that is significantly
below a normal and healthy body weight.




Bibliography


Broccolo-Philbin,
Anne. “An Obsession with Being Painfully Thin.” Current Health
2
22.5 (1996): 23. Print.



Brumburg, Joan Jacobs.
Fasting Girls: The History of Anorexia Nervosa. Rev. ed.
New York: Vintage Books, 2000. Print.



Costin, Carolyn.
The Eating Disorder Sourcebook. 3rd ed. New York:
McGraw-Hill, 2007. Print.



Dallas, Mary Elizabeth.
"Brain 'Pacemaker' May Help Ease Tough-to-Treat
Anorexia." HealthDay. HealthDay, 7 Mar 2013. Web. 22 May
2013.



Gordon, Richard A.
Eating Disorders: Anatomy of a Social Epidemic. 2nd ed.
Malden: Blackwell Scientific, 2000. Print.



Herpertz-Dahlmann, Beate, et al. "Day-Patient
Treatment after Short Inpatient Care versus Continued Inpatient Treatment in
Adolescents with Anorexia Nervosa (ANDI): A Multicentre, Randomised,
Open-Label, Non-Inferiority Trial." Lancet 383.9924 (2014):
1222–29. Print.



Lucas, Alexander R.
Demystifying Anorexia Nervosa: An Optimistic Guide to
Understanding Healing
. Rev. ed. New York: Oxford UP, 2008.
Print.



Parker, James N., and
Philip M. Parker, eds. The 2002 Official Patient’s Sourcebook on
Binge Eating Disorder
. San Diego: Icon Health, 2002. Print.



Rogge, Timothy, et al. "Anorexia Nervosa."
MedlinePlus. US Natl. Lib. of Medicine, 10 Mar. 2014.
Web. 19 Aug. 2014.



Yager, Joel, et al. "Guideline Watch (August
2012): Practice Guideline for the Treatment of Patients with Eating
Disorders, 3rd Edition." PsychiatryOnline. American
Psychiatric Assoc., Aug. 2012. Web. 19 Aug. 2014.



Zipfel, Stephan, et al. "Focal Psychodynamic
Therapy, Cognitive Behaviour Therapy, and Optimised Treatment as Usual in
Outpatients with Anorexia Nervosa (ANTOP Study): Randomised Controlled
Trial." Lancet 383.9912 (2014): 127–37. Print.

Thursday, October 29, 2015

What is esophagitis?





Related conditions:
Gastroesophageal reflux disease (GERD), Barrett esophagus, heartburn (pyrosis), difficulty swallowing (dysphagia), painful swallowing (odynophagia)






Definition:
Esophagitis is a general condition in which the esophagus, the muscular tube connecting the mouth to the stomach, is inflamed. Different medical conditions are associated with esophagitis, including GERD, a condition in which the stomach contents flow backward into the esophagus, and nonreflux esophagitis. Serious gastrointestinal complications of esophagitis include a narrowing of the esophagus (strictures), ulcers, and in rare cases a risk of esophageal cancer.



Risk factors: Factors that may increase the risk of developing esophagitis include pregnancy, obesity, scleroderma, smoking, alcohol, caffeine, chocolate, fatty or spicy foods, spinal cord injury, and certain medications (such as nonsteroidal anti-inflammatory drugs, or NSAIDs, including aspirin and ibuprofen).



Etiology and the disease process: The etiology of esophagitis differs depending on the cause of the inflammation. In GERD-associated esophagitis, a backflow (reflux) of acidic fluid from the stomach (containing gastric acid, pepsin, and sometimes bile) to the esophagus causes irritation of the epithelium (the cells lining the esophagus). In some instances, a premalignant condition called Barrett esophagus can develop, which can increase the risk of developing esophageal cancer. However, the risk of esophageal cancer in patients with Barrett esophagus is relatively small: less than 1 percent of Barrett esophagus patients a year.


Nonreflux esophagitis may be caused by infection (viral, bacterial, fungal, or parasitic organisms), chemicals (ingestion of a caustic chemical or medication), radiation therapy (physically damaging the lining of the esophagus leading to inflammation and ulceration), or in rare instances immune-mediated disorders (eosinophilic esophagitis).



Incidence: Esophageal reflux symptoms are estimated to occur in up to 60 percent of the general population on a monthly basis with up to 20 percent of people having weekly symptoms. Radiation esophagitis occurs in up to 80 percent of patients receiving radiation therapy to the esophagus.



Symptoms: The most common symptom is heartburn (pyrosis). Other common symptoms of esophagitis include upper abdominal discomfort, nausea, bloating, and fullness. Less common symptoms of esophagitis include dysphagia, odynophagia, cough, hoarseness, wheezing, and vomiting of blood (hematemesis).



Screening and diagnosis: A physician can establish a diagnosis of GERD based on patient history alone. However, if symptoms are severe or do not respond to treatment, the physician may order diagnostic tests designed to determine mucosal injury, amount of reflux, and pathophysiology, including barium x-ray series, endoscopy, an ambulatory acid (pH) probe test, and an esophageal impedance test.


During a barium x-ray series, the patient drinks a barium solution that, through a series of x-rays, provides a picture of the shape and condition of the esophagus, stomach, and upper intestine (duodenum). X-rays can also reveal a hiatal hernia, an esophageal narrowing, or a growth.


During an endoscopy, or an esophagogastroduodenoscopy (EGD), a flexible tube with a light and camera (endoscope) is inserted down the throat and can reveal inflammation of the esophagus or stomach. A biopsy may also be taken during an EGD to test for Barrett esophagus, esophageal cancer, or the presence of a bacterium that may cause peptic ulcers.


An ambulatory acid (pH) probe test can identify when and for how long stomach acid flows back into the esophagus. A flexible tube (catheter) is inserted through the nose into the esophagus to position a probe in the esophagus just above the stomach. The other end of the catheter is attached to a small computer that records acid measurements. The probe remains in place for one or two days while measurements are recorded.


The esophageal impedance test is similar to the ambulatory acid probe test except that it measures whether gas or liquids reflux back into the esophagus.



Treatment and therapy: The goals of treatment are to provide symptom relief, heal ulcerations, and prevent complications. Reflux esophagitis is managed with over-the-counter agents, such as H2-receptor antagonists (cimetidine, ranitidine, famotidine, nizatidine) and with lifestyle changes such as altering eating habits (for example, avoiding alcohol, caffeine, carbonated beverages, chocolate, fatty foods, or overly large meals), ceasing to smoke cigarettes, and sleeping with the head of the bed elevated by about 4 to 6 inches. Proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, esomeprazole, or rabeprazole) are frequently prescribed and appear highly effective at relieving symptoms and healing erosive esophagitis.


Infectious esophagitis is treated with antibiotics, whereas glucocorticoids are effective in patients with immune-mediated esophagitis. Radiation esophagitis treatment involves symptom management (similar to reflux esophagitis) and prevention (radioprotectors, varying treatment doses and schedules). For severe cases, a temporary feeding tube can be inserted into the stomach or surgery may be required to treat the injuries. To treat pain associated with esophagitis, a prescription analgesic can be gargled with and swallowed.



Prognosis, prevention, and outcomes: Though the response to therapy may be different depending on the specific cause of the esophagitis, the disorders that cause esophagitis usually respond to treatment.



Dougherty Jr., Timothy, et al. “Emerging Therapeutic Options for Eosinophilic Esophagitis.” Gastroenterology & Hepatology 10.2 (2014): 106–16. CINAHL Complete. Web. 23 Oct. 2014.


Liacouras, Christopher A., and Jonathan E. Markowitz. Eosinophilic Esophagitis. Totowa: Humana, 2012. Digital file.


Marcel, C. “Eosinophilic Esophagitis and Diet.” CINAHL Nursing Guide (2014). Nursing Reference Center Plus. Web. 23 Oct. 2014.


Parker, Philip, and James Parker. Esophagitis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego: ICON, 2004. Print.


Parkman, Henry, and Robert S. Fisher, eds. The Clinician’s Guide to Acid/Peptic Disorders and Motility Disorders of the Gastrointestinal Tract. Thorofare: SLACK, 2006. Print.


Yamada, T., ed. Textbook of Gastroenterology. 4th ed. Philadelphia: Lippincott, 2003. Print.


Zoler, Mitchel L., and Robert Finn. “Drug Update: Gastroesophageal Reflux Disease.” Family Practice News 32.9 (2002): 25. Print.

Wednesday, October 28, 2015

How does Junior's language make his story relatable to readers that come from different backgrounds? How does this compare to other young adult...

As a young adult living on the Spokane Indian reservation, Junior lives a life that is different from the lives of many in the novel's reading audience.  He is, however, an engaging, sympathetic, and relatable character largely because of his character's use of language.  In the first chapter of the novel, Junior tells the reader that pictures are important for communication because they are more easily interpreted by a wide audience.  Thus, the novel is full of illustrations done by Junior in his effort to communicate his lived experience and his feelings to the reader.  Additionally, Junior uses much humor to cope with the hardships that he faces on the reservation.  The comical tone developed by his use of language allows the reader to relate to Junior and to feel sympathy for his situation as he deals valiantly with being perceived as an outsider in his community.  Few young adult novels tackle issues that are very real on Native American Indian reservations, so Junior as a character who can relate to a more universal audience is crucial in the effort to foster a greater understanding of Native American life and culture.

What is the conflict in the book My Side of the Mountain?

The main conflict in “My Side of the Mountain” is represented by the overriding theme of man versus nature. Sam Gribley is a city kid who runs away from his New York City home to the wilderness of the Catskill Mountains. Although he has read at least one library book on survival skills, he has never used these techniques in the woods and does not appear to have even camped out on his own. He had to learn how to prepare and eat a variety of wild foods. He had to figure out a good “home,” which ended up being a hollowed-out giant hemlock tree. He made his own clothes out of deer hide. He taught himself quite a lot in the year he spent on the mountain.


The case could also be made that the reason Sam went to the woods to begin with was because of a casual challenge by his father. We learn in the second chapter, “In Which I Get Started on This Venture,” that Sam’s father had once run away from home as a youngster in order to catch a ship to Singapore. But he chickened out and came back quickly. He laughed when Sam said he wanted to run away and live on the Gribley land in the Catskills. He said, “Sure, go try it. Every boy should try it.” But obviously, he didn’t think Sam would have the courage to do it. We could say the whole premise of this adventure was the friendly conflict between Sam and his father.


And the case could also be made that this was not only the story of Sam versus nature, but Sam versus civilization. He wanted to be on his own out there. He tried to hide whenever random people entered the woods, because he didn’t want to be found out. This didn’t work. He was found out. But we also get the impression that he may have been missing human contact after six months, even though he was surrounded by his animal “friends.” In the 16th chapter called “In Which Trouble Begins,” Sam decided to go to town on a Sunday, wearing his deerskin clothing. He got strange looks from the townspeople, of course. Soon afterward, newspaper articles appeared about a wild boy living in the woods. Did Sam go to town that day in order to be discovered? Maybe. This incident marked one of the turning points in the book. Sam versus civilization is yet another conflict here.

What is interesting about Hughes's description of the purse of Mrs. Jones in "Thank You, M'am"?


“She was a large woman with a large purse that had everything in it but hammer and nails.”



This is how the story “Thank You, M’am” begins with the introduction of its central character Mrs. Jones. At the very outset of the story, we are told that the “large woman” carries “a large purse that had everything in it but hammer and nails."


Women are quite particular about their choice of purse they buy themselves.To many, a purse defines individual taste and popular trend. Of course, no one carries "hammer and nails" in one’s purse, nor does Mrs. Jones. So, why does the author Langston Hughes mention it?  


By doing so, Hughes suggests that besides carrying money and bills, Mrs. Jones' purse is spacious enough to be used to carry stuff ranging from grocery stuff to newspapers and magazines, from women’s accessories, including comb or mirror, to eatables, from objects she needs at her workplace to articles she buys on her way back home.


One thing is absolutely clear that Mrs. Jones certainly doesn't belong to the class of the sophisticated ladies to whom a purse is a definition of style and taste. She uses the purse solely because she needs to carry things in it. Its large size indicates that it may not be stylish but big enough to take in a lot of things.


The description of the purse also tells us that Mrs. Jones is an ordinary, hard working, middle class woman. She is more bothered about earning a livelihood with dignity rather than about emulating fashionable ladies.


In this way, we see that Hughes’ description of Mrs. Jones’ purse is quite interesting as, with very few words, it offers vital insight into Mrs. Jones character trait. 

What is rabies?


Causes and Symptoms



Rabies is caused by a bullet-shaped virus that attacks warm-blooded animals, especially mammals. The virus can enter many types of mammal cells and cause them to produce and bud off new viruses, but it is particularly adept at attacking nerve cells and glandular cells. This combination enhances the virus’s chance of being transmitted to another host.



The following sequence of events occurs in an untreated human being after being bitten by a rabid animal. The bite introduces large amounts of saliva, which contains abundant rabies virus because of the virus’s efficient growth in salivary glands. The virus enters muscle cells in the vicinity of the bite and replicates there. The new viruses then enter the nerve cells that carry signals from the brain and spinal cord to the muscle cells. They move along these nerve cells to the spinal cord, eventually making their way to the brain. The viruses replicate at certain sites as they ascend the nerve and spinal cord. In the brain, they replicate especially well in the centers that control emotions. Once established in the brain and spinal cord, the virus moves out of these organs along the nerves to most organs of the body. The salivary glands are favored targets in this migration.


As a result of its extensive migrations, the virus is present in many tissues of the body, but the critical ones for the pathology and transmission of the disease are the brain and salivary glands, where the virus reproduces especially well. To understand this relationship between transmission and pathology, consider the dog or other animal that bit the human being described above. A sequence of events similar to that described for the human being has occurred in the animal. The viruses attacking the emotional centers of the animal’s brain initiated the characteristic aggressive state in which it wandered aimlessly, attacking anything it encountered. Viruses attacking the brain also stimulated the production and release of copious amounts of saliva, giving rise to another familiar symptom of rabies: frothing at the mouth. The viruses reproducing in the salivary glands, along with the excessive salivation, assured that an abundance of virus would be chewed into the wound.


The time sequence and pathology of a human victim include an incubation period that may range from ten days to a year; in most victims, however, it is between two and eight weeks. During this time, the virus is replicating in cells at the site of the bite and moving to the central nervous system. As the nervous system begins to be involved, generalized symptoms begin. These include fever, headaches, and nausea and last about a week. Neurologic symptoms then develop, including hyperactivity, seizures, and hallucinations. The throat sometimes becomes so sore and prone to spasms that the patient has trouble swallowing and fears choking while drinking. Another common name for rabies, hydrophobia (literally, fear of water), is based on this aspect of the disease. Paralysis and
coma occur about a week after the onset of the neurologic symptoms, and death follows a few days later. Once the symptoms begin in a human being, the disease is nearly always fatal.


In dogs, a similar sequence of events occurs, though the timing is somewhat different and dogs occasionally recover. The aggressive stage described above is called the furious stage in animals, and the gradual development of paralysis is called the paralytic, or dumb, stage. Both phases may occur in dogs or the furious stage may be bypassed, but death commonly occurs shortly after symptoms begin.


Rabies in wildlife is called sylvatic rabies, and the species of wildlife involved differ according to geographic area. Some species act as the virus’s reservoir and as the source of rabies epidemics in humans or their pets. In arctic regions of North America and Eurasia, arctic foxes and wolves are the most important hosts of sylvatic rabies. Red and gray foxes and skunks play important roles in spreading the disease in various parts of eastern Canada and the United States, as do raccoons. Some investigators believe that weasels and their relatives are important carriers in maintaining the virus in nature in many areas, although they are not particularly important in the direct transfer of the virus to humans.
Bats are common sources of rabies throughout the United States, but especially in the southern part of the country. They play a major role in rabies epidemiology in Mexico and Central and South America, where the disease often occurs in vampire bats.


In 2010, there were 6,153 cases of rabies in animals and only 2 cases of rabies in humans reported in the United States and Puerto Rico. Raccoons (36.5 percent), bats (23.2 percent), skunks (23.5 percent), and foxes (7 percent) were the most commonly infected animals. In 2010 8 percent of rabies reports were for demestic species. Surprisingly, there were more cats than dogs reported with rabies, undoubtedly due to rabies vaccination programs for dogs.


Other mammals, both wild and domestic, are attacked by the virus, but they are not important in transmitting rabies between species or in acting as reservoirs. Examples of these species are grazing and browsing animals such as cattle and deer, which seldom bite other animals and so are not likely to pass the virus to other creatures. Many of these animals die from rabies, however, and the economic and ecological impact of these deaths may be great.


These animals are attacked by the virus in the same manner as are humans and dogs, and they show similar symptoms. Rabid wild animals do not always suffer a furious stage. Raccoons, for example, often skip the furious stage and go directly into the dumb stage. Early in this stage they may lose their fear of humans and appear to be friendly. If left alone, they seldom attack, but humans who approach these “friendly” raccoons may be bitten and exposed to rabies. Many bat species also do not go through the furious stage; a bat suffering from dumb rabies is easily caught and may bite if handled, exposing the handler to rabies. Unlike humans, bats, skunks, raccoons, and other wildlife often survive the symptoms of rabies.


In addition to the disease it causes in humans and their pets, the rabies virus has had other negative impacts on human society. Rabies transmitted to cattle by vampire bats has had a devastating economic effect on the cattle industry in all of Latin America. Rabies in red foxes has occasionally had a detrimental effect on Canada’s fur industry. Wildlife populations in many parts of the world may be periodically decimated by rabies epidemics, which sometimes reduces the population of a species of recreational importance to humans or one critical to the ecological stability of a region.




Treatment and Therapy

Active immunization by vaccination can be used after exposure to rabies because of the relatively long latency period of the virus. If a person has been bitten by a rabid animal, symptoms usually do not appear for two or more weeks. Prompt vaccination after the bite induces the production of antibodies that attack the virus and neutralize it before it reaches the central nervous system. Two other precautions are often taken. The wound is cleaned and treated with antiviral agents, and passive immunity is often produced by injecting antirabies antiserum into the victim.


The rabies inoculations of early immunization series were numerous, extremely painful, and not always successful. Since the early twentieth century, it has been possible to determine whether the attacking animal was rabid and thus whether this painful treatment was necessary. The animal was sacrificed, and its brain was sectioned and stained. Treated in this way, a rabid animal’s brain cells often display Negri bodies, named for the scientist who first described them. They are the sites of production of new virus in the brain cell, and their presence indicates the need for vaccination of the victim. Even though the immunization sequence that was first developed was painful, the certain death that followed the onset of symptoms made immunization imperative if there was any possibility of rabies exposure.


Improved immunization sequences and rabies tests have been developed. Refined and nearly infallible, these immunization sequences require only three inoculations and are no more painful than most shots. Tests using antibodies are more rapid and reliable at detecting the presence of the rabies virus than the test for Negri bodies.


Preexposure immunization, in contrast to the postexposure immunization described above, is used to protect persons who might be exposed to rabies in their normal activities and to protect pets from contracting rabies. Since the overwhelming majority of human cases of rabies come from dog bites, pet vaccination is the most important part of the successful rabies control programs of developed countries. Laws requiring the immunization of pets against rabies and leash laws (which require that pets be controlled and not allowed to wander freely) have been very effective in reducing human rabies in these countries.


Because wildlife may harbor rabies, attempts have been made to control or eliminate the disease by killing (culling) or immunizing wildlife. Neither approach has been particularly successful, and the first is accompanied by troublesome side effects. The purpose of culling members of host species is to reduce the host population below the point that will sustain the rabies virus’s population. This method is based on the idea that each infected host must, on the average, infect at least one other susceptible host before it dies in order for the parasite to persist in the population. The lower the host population, the lower the chance of one host meeting another and thus the lower the probability of an infected host infecting other members of the population. Yet many of the methods of culling (trapping and poisoning, for example) are not species-specific, and members of other species are killed, sometimes in large numbers. Culling has also been ineffective in many cases. It is most successful in small, isolated areas with a low probability of reinvasion.


Instead of reducing the population size of the host, the goal of immunization is to reduce the number of members that are susceptible to rabies by increasing the number that are immune. Oral immunization by scattering bait containing rabies vaccine has shown promising results in reducing rabies in foxes, coyotes, and raccoons.


An argument against immunization of wildlife to control human rabies is based on the success of the control programs in effect and can be stated as follows. Immunization and regulation of pets, preexposure immunization for humans regularly exposed to rabies, and effective postexposure treatment have already minimized the incidence of human rabies in developed nations. Therefore, wildlife immunization is not necessary for the control of human rabies. In developing nations, where human rabies is still a serious disease, all the potential solutions strain the available resources, but the most cost-effective solution would be the one in use in developed countries. There is general agreement, however, that wildlife immunization might be an effective way to increase the population size of a wildlife species that is normally susceptible to rabies, if desirable.


To control vampire bats in Latin America, where rabies carried by vampire bats burdens the cattle industry, culling has been attempted repeatedly, often unsuccessfully, and with serious side effects. For example, other bat species, some of which are important to insect control and the pollination of fruit trees, have been regular victims of indiscriminate attempts at vampire bat control by culling.


A more effective, and less ecologically disruptive, method for the control of vampire bats employs anticoagulants. These chemicals stimulate bleeding in the digestive tract of vampire bats that swallow them, resulting in death. The anticoagulant can be applied directly to the backs of the vampire bats and will spread through the bat population when the bats groom one another at the roosting colony. Alternatively, anticoagulant can be injected into a cow’s rumen, the enlarged first chamber of its four-part stomach. The anticoagulant is then absorbed into the animal’s blood and spread to vampire bats when they feed on the cattle.


In test areas, each method has reduced the number of vampire bat bites in cattle by 90 percent, but each has drawbacks. Direct application to these bats requires extensive netting or trapping, special equipment, and workers skilled in vampire bat identification. The rumen injection technique requires expensive equipment for, and workers experienced in, handling large numbers of cattle. In developing countries, either combination can be difficult to finance.


Education is another important aspect of rabies control. While dogs are the most common source of human rabies, humans occasionally contract the disease after being bitten by a wild animal. In addition, there are potential avenues of transfer other than bites. These include skinning rabid animals, being licked by a rabid animal on broken skin, and breathing air infested with the rabies virus. All these alternative transmission mechanisms are exceptionally infrequent, but there are documented cases of aerial transmission to humans. For example, two men who were not bitten died of rabies contracted while exploring a bat cave in Texas. To be transmitted in this way, the rabies virus must be highly concentrated in the air. These concentrations probably occur only in caves occupied by a large number of bats, and many of them must be carrying the rabies virus.


While educating spelunkers and hunters to these dangers would have a minimal effect on the incidence of rabies, as these transmission mechanisms are so infrequent, such educating could be of the utmost importance to an individual who is spared a rabies infection by the knowledge. Educating people, especially children, to leave animals acting in an unnatural fashion alone would have a somewhat greater effect on rabies incidence. Most wild animals that can be caught or approached closely are sick and may be suffering from dumb or paralytic rabies. They should be avoided and reported to the appropriate authorities, as should any dog or cat that behaves unnaturally. Educating the public about the importance of pet vaccination and pet control is the most important role of education in the regulation of rabies.




Perspective and Prospects

Rabies in humans and its association with attacks by mad dogs have been known for more than two thousand years. Despite the fact that rabies has never caused epidemics accompanied by mass mortality as have smallpox and bubonic plague, its frightful symptoms and ability to turn a loving family pet into a vicious animal have given the disease a terrifying and mysterious aura. As a result, cures and preventions have been sought throughout history.


In the late nineteenth century,
Louis Pasteur and his associates performed a series of experiments in which the rabies virus was isolated from a dog and injected into rabbit brains. Pasteur called this virus a “street” virus because it was isolated directly from dogs in the street. The virus replicated in the rabbit brain and could be transferred into another rabbit’s brain, where it again replicated. Growth of the virus in one of the rabbit brains was called a “passage.” A sequence of such passages resulted in a virus which had a more predictable and shorter incubation period. This virus was called a “fixed” virus because of its fixed incubation period. After a hundred such passages, the virus had lost much of its ability to infect dogs.


Pasteur then developed an immunization sequence that protected dogs from the street virus. He air-dried rabbit spinal cord tissue infected with the fixed virus for varying amounts of time and developed a series of virus solutions, ranging from those that could not infect rabbits through those that could occasionally establish weak infections to those that were maximally infective. He then injected dogs daily for ten days, beginning with the noninfective preparation the first day and increasing the infectivity with each day’s injection until, on the tenth day, he was injecting highly infective virus. Dogs so treated were resistant to experimentally injected street virus.


Pasteur was still refining his immunization system when a boy who had been attacked by a rabid dog was brought to him. Knowing that the latency period of the virus might allow time for the development of immunity before the symptoms appeared, and aware of the almost certain fatal result if nothing was done, Pasteur treated the boy with the sequence that he had used on the dogs. The boy lived, with no apparent side effects, and Pasteur’s treatment became the standard for rabies. The modern treatment sequence is a refinement of Pasteur’s. While the immunization sequence for rabies was not the first to be used successfully—smallpox immunization nearly a century earlier holds that distinction—the possibility of immunization after exposure to diseases with long incubation periods was established by Pasteur’s work.


Considerable work has been done on the epidemiology of rabies. Mathematical and computer models have been developed that attempt to predict the characteristics of the disease spread under different conditions, and thus suggest means of controlling and preventing rabies epidemics. Arguments over the effectiveness of wildlife vaccination are partially based on such models. The usefulness of these models is not restricted to rabies epidemiology but instead contributes to an understanding of epidemiology in general. Thus research on rabies continues to enhance the control and prevention of that terrifying disease and to add to the general knowledge base of medicine as well.




Bibliography:


Bacon, Philip J., ed. Population Dynamics of Rabies in Wildlife. New York: Academic Press, 1985.



Badash, Michelle. "Rabies." Health Library, December 30, 2011.



Baer, George M., ed. The Natural History of Rabies. 2d ed. Boca Raton, Fla.: CRC Press, 1991.



Biddle, Wayne. A Field Guide to Germs. 2d ed. New York: Anchor Books, 2002.



Blanton, Jesse D., et al. “Rabies Surveillance in the United States During 2007.” Journal of the American Veterinary Medical Association 233 (2008): 884-897.



Constantine, Denny G. “Health Precautions for Bat Researchers.” In Ecological and Behavioral Methods for the Study of Bats, edited by Thomas H. Kunz. Washington, D.C.: Smithsonian Institution Press, 1988.



Finley, Don. Mad Dogs: The New Rabies Plague. College Station: Texas A&M University Press, 1998.



Jackson, Alan C., and William H. Wunner, eds. Rabies. Boston: Academic Press, 2002.



Kaplan, Colin, G. S. Turner, and D. A. Warrell. Rabies: The Facts. 2d ed. New York: Oxford University Press, 1986.



Pace, Brian, and Richard M. Glass. “Rabies.” Journal of the American Medical Association 284, no. 8 (August 30, 2000): 1052.



Parker, James N., and Philip M. Parker, eds. The Official Patient’s Sourcebook on Rabies. San Diego, Calif.: Icon Health, 2002.



"Rabies." Centers for Disease Control and Prevention, March 15, 2013.



"Rabies." Mayo Clinic, January 28, 2011.

Tuesday, October 27, 2015

What is whey protein as a dietary supplement?


Overview

Whey is one of the two major classes of protein in milk. The other is casein, the
“curds” of “curds and whey.” Proteins are made of amino acids,
and whey contains high levels of the amino acid cysteine. This is the basis for
many of its proposed uses. It also contains branched-chain amino acids
(BCAAs). However, while there is no question that whey is a
highly digestible and rich protein source, there is no meaningful supporting
evidence that it provides any specific health benefits.




Sources

When milk is converted into cheese, whey is the liquid that is left behind. There is no specific dietary requirement for whey, because the amino acids it contains are present in a wide variety of other foods too.




Therapeutic Doses

A typical dose of whey protein is 20 to 30 grams per day.




Therapeutic Uses

There are no well-documented medicinal uses of whey protein. There is some
evidence that whey can raise levels of glutathione. Glutathione is an antioxidant
that the body manufactures to defend itself against free
radicals. In certain diseases, glutathione levels may fall to
below-normal levels. These conditions include cataracts, human immunodeficiency
virus (HIV) infection, liver disease, diabetes, and various types of cancer. This
reduction of glutathione might in turn contribute to the symptoms or progression
of the disease.


To solve this problem, glutathione supplements have been
recommended, but glutathione is essentially not absorbed when it is taken by
mouth. Whey protein may be a better solution. The body uses cysteine to make
glutathione, and whey is rich in cysteine. Meaningful preliminary evidence
suggests that whey can raise glutathione levels in people with cancer, hepatitis,
or HIV infection. However, while these are promising findings, one essential piece
of evidence is lacking: There is no evidence that this rise in glutathione
produces any meaningful health benefits.


Whey protein has also been proposed as a bodybuilding aid, based partly on its high content of BCAAs. However, there is no more than minimal evidence that whey protein helps accelerate muscle mass development. Furthermore, there is little evidence that whey protein is more effective for this purpose than any other protein. For example, one small double-blind study found evidence that both casein and whey protein were more effective than placebo at promoting muscle growth after exercise, but whey was no more effective than the far less expensive casein. However, a single small study did find ergogenic benefits with whey compared with casein.


One study looked at whether whey protein could help women with HIV build muscle mass. Study participants were divided into three groups: those who undertook a course of resistance exercise (weight lifting), those who took whey, and those who did both. Resistance exercise alone was just as effective as resistance exercise plus whey, while whey alone was not effective.


Whey contains alpha-lactalbumin, a protein that contains high levels of the amino acid tryptophan. Tryptophan is the body’s precursor to serotonin and is thought to affect mental function. In a small double-blind study, the use of alpha-lactalbumin in the evening improved morning alertness, perhaps by enhancing sleep quality. Another small double-blind study found weak evidence that alpha-lactalbumin improved mental function in people sensitive to stress. A third study failed to find that alpha-lactalbumin significantly improved memory in women experiencing premenstrual symptoms.


Weak evidence hints that whey might help prevent cancer or augment the effectiveness of cancer treatment. Infant formula based on predigested (hydrolyzed) whey protein is somewhat less allergenic than standard infant formula; this might reduce symptoms of colic and possibly decrease the risk that the infant will later develop allergies.




Safety Issues

As a constituent of milk, whey protein is presumed to be a safe substance. People with allergies to milk, however, are likely to be allergic to whey (even to partially hydrolyzed forms of whey).




Bibliography


Agin, D., et al. “Effects of Whey Protein and Resistance Exercise on Body Cell Mass, Muscle Strength, and Quality of Life in Women with Human Immunodeficiency Virus” AIDS 15 (2001): 2431-2440.



Borsheim, E., et al. “Effect of an Amino Acid, Protein, and Carbohydrate Mixture on Net Muscle Protein Balance After Resistance Exercise.” International Journal of Sport Nutrition and Exercise Metabolism 14 (2004): 255-271.



Chromiak, J. A., et al. “Effect of a Ten-Week Strength Training Program and Recovery Drink on Body Composition, Muscular Strength and Endurance, and Anaerobic Power and Capacity.” Nutrition 20 (2004): 420-427.



Markus, C. R., et al. “Evening Intake of Alpha-Lactalbumin Increases Plasma Tryptophan Availability and Improves Morning Alertness and Brain Measures of Attention.” American Journal of Clinical Nutrition 81 (2005): 1026-1033.



Marshall, K. “Therapeutic Applications of Whey Protein.” Alternative Medicine Review 9 (2004): 136-156.



Micke, P., et al. “Effects of Long-Term Supplementation with Whey Proteins on Plasma Glutathione Levels of HIV-Infected Patients.” European Journal of Nutrition 41 (2002): 12-18.



Szajewska, H., et al. “Extensively and Partially Hydrolysed Preterm Formulas in the Prevention of Allergic Diseases in Preterm Infants.” Acta Paediatrica 93 (2004): 1159-1165.

True or false: Neutrons are located in shells around the nucleus.

This is false. Neutrons are located in the nucleus which is at the center of the atom.


An atom is made up of three types of subatomic particles:


Protons are positively charged particles that are in the nucleus. The have a mass of approximately one atomic mass unit (amu).


Neutrons are electrically neutral. They also have a mass of approximately one mass unit.


The nucleus contains nearly all of the atom's mass, but makes up a very small part of its volume.


Electrons are located outside the nucleus, in energy levels called shells. Electrons have a very small mass that is approximately zero mass units and have a negative electrical charge. Outer electrons can be lost or gained, forming charged particles called ions.


Electron shells are mathematical functions that describe the energy of electrons. An electron shell's energy level corresponds to its distance from the nucleus. Electrons have more energy when they're at a greater distance from the nucleus.

Monday, October 26, 2015

What is compulsive gambling?


Causes

Problem gambling has a familial component because parents with a gambling addiction tend to socialize their children into the gambling world. Many of these young people, in turn, develop disordered gambling behavior. Neuroscientific and genetic research, which includes research with twins, has also determined that compulsive gambling runs in families and is often a co-occuring disorder with other addictions and/or mental health issues. Cultural components have also been associated with problem gambling.






Risk Factors

Greater numbers of men typically experience gambling addiction, although women are also at risk. People with gambling addictions often have other mental health issues (including personality, mood, and/or anxiety disorders) and other addictive disorders, which increase the challenge in determining what effects were caused by gambling and what were caused by other comorbidities. Problem gamblers often consume alcohol, nonprescription drugs, and tobacco in unhealthy ways, which also contributes to dysfunctional behavior.


Prevailing research suggests that approximately 1 percent of the world’s population experience gambling problems. The disordered gambling figures for adolescents in locations where such research has been completed are much higher, with the implication that gambling-addiction numbers will rise as adolescents age and as increasing means to gamble become available. The growth of online gaming, which includes online gambling, is particularly challenging for local authorities to license, control, or measure. Particular concerns with these web-based services are that young players are difficult to identify and thus cannot be prevented from accessing these sites, even when local laws do not permit children to gamble.




Symptoms

According to the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5), published in 2013 by the American Psychiatric Association (APA), gambling disorder is considered to be an addictive disorder similar to substance use disorder (SUD). As with SUD, gambling disorder affects the brain's reward system in ways similar to the affects of abusing drugs or alcohol. Additionally, problem gamblers report cravings for gambling and getting a "high" as a result of the stimulus of gambling. The previous edition of this manual, the DSM-IV-TR published in 2000, categorized gambling disorder as an impulse control disorder, not an addiction disorder, and labeled the condition "pathological gambling." The DSM-5 not only reclassified problem gambling as an addictive disorder but also renamed it "gambling disorder, which was welcomed by clinicians, researchers, and those suffering from the condition. The word "pathological" has negative connotations, and many feel it reinforced the stigma associated with the problem, thus potentially inhibiting sufferers of gambling disorder from seeking help.


Gambling disorder is defined operationally by the DSM-5 as the presence of at least four of nine criteria that the individual experiences within a twelve-month period. The measures focus on the negative effects of gambling (such as a preoccupation with gambling, using gambling as a way to escape problems, and difficulty cutting back on or stopping gambling despite repeated attempts) and the negative consequences or problems that result from gambling (such as lying to hide the degree of gambling, deteriorating personal and/or professional relationships, loss of educational or employment opportunities as a result of gambling, and financial hardship and increasing debt to cover gambling losses). The DSM-5 also removed the criterion from the DSM-IV-TRthat states that problem gamblers commit illegal acts such as fraud, theft, or forgery. Research has shown that there is a low prevalence of this behavior among problem gamblers, and this stand-alone symptom did not help to distinguish those with gambling disorder from those without.


A person may manifest a gambling addiction for a period of time and then gain some control over his or her behavior, only to relapse and begin the cycle yet again. This is common among other addictive disorders, and this cyclical progression is challenging for the person suffering from this disorder as well as for persons in his or her family and social circles.




Screening and Diagnosis

There are many screening and diagnostic tools to measure or assess problem gambling. Many of these are based on the DSM-5 criteria for measuring gambling disorder. Two common tools are the Brief Biosocial Gambling Screen (BBGS) and the modified NORC diagnostic screen, which also has a self-administered version titled "NODS-SA.." Although often criticized for producing too many false positives, the South Oaks Gambling Screen is often used to assess problem gambling and has also been adapted to assess problem gambling in youth.


Diagnosis typically occurs using the DSM-5 criteria for gambling disorder. The criteria are used by mental health professionals and by insurance companies to reimburse for treatment. Diagnosis typically places the person along a continuum of increasingly disordered behavior. At the lowest levels are people who have never gambled, who do not gamble excessively, or who do not cause harm to themselves or others because of gambling behavior. Gamblers who display symptoms of gambling disorder are diagnosed according to the level of severity. Those with mild severity have displayed four to five of the nine DSM-5 criteria for gambling disorder during the previous twelve months. Those with moderate severity display six to seven criteria, and those with severe symptoms display eight to nine criteria. Individuals with gambling disorder are also referred to as compulsive gamblers, disordered gamblers, excessive gamblers, intemperate gamblers, or problematic gamblers.




Treatment and Therapy

Treatment traditionally involves cognitive and cognitive behavioral therapy (CBT) as well as family therapy, although more recent approaches have focused on pharmacological interventions, especially antidepressants or other drugs that treat the often co-occurring mental health issues such as anxiety and bipolar disorder. The change in classification of problem gambling to now be included as an addiction-based disorder forces insurance companies to cover treatment and medication. Free Gamblers Anonymous groups are found in most urban centers, which is helpful for this client group.


In addition to methodological problems with studies that make it difficult to identify the most promising treatment options, there are conceptual issues. Generally, people with gambling addictions have been considered to be a fairly uniform subject group by researchers; however, there are many differences within the group in terms of comorbidity and other factors, which might influence treatment outcomes. Also, there are many problem gamblers who manage to recover without treatment.


Treatment efforts also have focused on spouses and other family members of problem gamblers. Because the gambling addict negatively affects others with his or her addiction, therapists have suggested that family members could benefit from some intervention.




Prevention

It can be argued that the best prevention for gambling addiction is to avoid gambling, since most people do not realize their propensity for unhealthy and problematic gambling until they have a problem. Generally, government dollars have been spent on treatment rather than on prevention, but there are strong public health arguments that support greater efforts in prevention. Many groups lobby against legalizing gambling in the United States.




Bibliography


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington: American Psychiatric Assoc., 2013. Print.



Denis C., M. Fatséas, and M. Auriacombe. "Analyses Related to the Development of DSM-5 Criteria for Substance Use Related Disorders: An Assessment of Pathological Gambling Criteria." Drug and Alcohol Dependence 122.1–2 (2012): 22–27. PRint



Kaminer, Yifrah, and Oscar G. Bukstein, eds. Adolescent Substance Abuse: Psychiatric Comorbidity and High-Risk Behaviors. New York: Routledge, 2008. Print.



Ladouceur, Robert, and Stella Lachance. Overcoming Pathological Gambling: Therapist Guide. New York: Oxford UP, 2006. Print.



Leeman, Robert F., and Marc N. Potenza. "Similarities and Differences Between Pathological Gambling and Substance Use Disorders: A Focus on Impulsivity and Compulsivity." Psychopharmacology 219.2 (2012): 469–90. Print.



Nathan, Peter E., and Jack M. Gorman, eds. A Guide to Treatments That Work. 3rd ed. New York: Oxford UP, 2007.



Newman, Stephen C., and Angus H. Thompson. “The Association between Pathological Gambling and Attempted Suicide: Findings from a National Survey in Canada.” Canadian Journal of Psychiatry 52.9 (2007): 605–12. Print.



Petry, Nancy M. Pathological Gambling: Etiology, Comorbidity, and Treatment. Washington: American Psychological Association, 2005. Print.



Williams, Robert J., and Rachel A. Volberg. "The Classification Accuracy of Four Problem Gambling Assessment Instruments in Population Research." International Gambling Studies 14.1 (2014): 15–28. Print.



Wong, Irene Lai Kuen. “Internet Gambling: A School-Based Survey among Macau Students.” Social Behavior and Personality 38.3 (2010): 365–72. Print.

What is field experimentation?


Introduction

As an alternative to studying behavior in the sometimes restricted and sterile confines of the laboratory, scientists can turn to field experimentation as a method of finding out how people or other organisms interact with their natural environment. As the term field experimentation implies, genuine science is being conducted; however, the research takes place in the context of the places where the subjects normally live, work, and play. Instead of removing subjects from their normal surroundings and placing them in artificial situations, a field researcher attempts to study behaviors as they occur spontaneously in the real world.






Evolution of Practice

Royce Singleton Jr., Bruce Straits, Margaret Straits, and Ronald McAllister, in their book Approaches to Social Research (1988), make the point that field experimentation procedures were used long before the techniques were recognized by the scientific community. The authors also state there is a consensus that anthropologists—followed shortly thereafter by sociologists—first developed and then legitimized this approach to research. Anthropologist Franz Boas
and sociologist Robert Park
were among the early pioneers of field research during the late nineteenth century and the beginning of the twentieth century. Boas was noted for his research in cultural anthropology. He emphasized the importance of circumventing one’s Western cultural biases by living in another culture for an extended time and acquiring that culture’s perspective. On the other hand, Park, who taught for a number of years at the University of Chicago, was influential in encouraging students to use the city as an alternative laboratory—studying people where they lived.


Field experimentation grew out of a need to seek answers to questions that could not be brought into a laboratory setting. Foreign cultures, complex social relationships, and secretive sects are examples of the phenomena that lend themselves to this method. Laboratory research—research in which phenomena are studied in an artificial setting with rigorous procedures in place to control for outside influences—might be seen as a hindrance to understanding dynamic human behavior. An alternative method needed to be found, and field research filled this vacuum.


Early in its development, field experimentation used data-collection procedures that almost entirely consisted of informal notes. A long narrative describing a sequence of behaviors would not have been uncommon. There has been a gradual move toward the use of more “objective” techniques such as standardized rating scales, behavioral checklists, and structured surveys. These methods were created to quantify better the observations being made. Once the behaviors could be quantified (that is, once specific behaviors could be assigned numbers), they could be subjected to the same statistical analyses used by laboratory experimenters. This improved approach to data collection helped field experimentation methods play a significant role in the social and behavioral sciences.




Advantages

Studying people in their natural environments can yield a number of advantages over more traditional laboratory research methods. For example, it has been found that when subjects are aware that they are being studied, their actions sometimes differ from their actions when they are unaware that they are being observed. This phenomenon is known as the Hawthorne effect. A field study can avoid the Hawthorne effect by enabling the researcher to go “undercover” and study the subjects without their being aware that a study is going on. A field study helps ensure that genuine, rather than contrived, behaviors will emerge.


Another advantage of the field experimentation method is that it lends itself to the study of complex behaviors, such as relationships among family members, that would be too difficult to simulate in a laboratory setting. Another important strength is that the researcher can maintain the interaction between the subject and the setting in which the subject lives or works. Under this set of circumstances, the field study is the method most preferred. In addition, there are some instances in which time does not allow the researcher to bring the phenomena under study into the laboratory. Such instances include those associated with natural disasters or national calamities. For example, a researcher might want to study the psychological reactions of people who have lost their homes in a hurricane. Since it would be imperative to begin collecting data immediately, taking the time to develop a comprehensive survey or to identify and eventually test the important variables in a more controlled setting would jeopardize the data collection of this dynamic, rapidly changing situation.




Disadvantages

Conducting a field experiment does not come without its share of disadvantages. First, there are many topics worthy of study that are too difficult to stage outside the well-controlled confines of a laboratory. Studying memory loss or the processes involved in solving a complex algebra problem are examples of these kinds of topics. Second, some researchers argue that because so many uncontrolled outside influences are present in a field study, it is difficult, if not impossible, to understand causal relationships among the behaviors being studied. Third, field research is particularly susceptible to the biases
of the researcher while the data are being collected. Since data collection is typically less standardized and formal than in other methodologies, it is possible that the researcher may be unaware that observations that support the researcher’s hypothesis may be recorded and given more attention than behaviors that go contrary to the researcher’s beliefs. Some of the research published by anthropologist Margaret Mead during the 1920s, for example, has been called into question for this reason by other researchers who have reached different conclusions.




Techniques

Field experimentation usually entails going into a naturalistic setting to collect data that can be used to generate research questions. The researcher will take such information, begin to organize it, and try to draw some general conclusions from it. This process, referred to as inductive research, occurs when data are first collected and then used to formulate general principles. Thus, field research differs from many other kinds of research methodologies. Field research begins with a broad theory, then sets out to test specific aspects of the theory to see if the data support it.


Field experimentation represents a variety of strategies for studying behavior. One specific technique involves a researcher who goes into the field and chooses to identify herself or himself to the subjects; the researcher also becomes actively involved in the group’s activities. The researcher has become a participant observer. An example of this method would be a person who wanted to study a violent inner-city gang. The researcher might approach the gang’s leadership, then identify himself or herself and give reasons for studying the group. The researcher would also participate in the gang’s meetings and other activities. Perhaps a better approach, in this situation, would be to do everything described except participating in the group’s activities, especially if the gang’s activities were illegal or harmful to others. In that case, the researcher, who revealed his or her true identity to the group yet chose to play a passive, inactive role from a distance, would be considered a “nonparticipant observer.”


An equally important field study technique involves concealing the identity of the researcher from the group that is being studied. In a classic study by John Howard Griffin
described in the book Black Like Me (1962), Griffin colored his skin to take on the appearance of a black man. He then traveled throughout the American South, documenting his experiences, especially those involving race discrimination. This kind of activity is called covert research.


Conducting research in the field does not prevent the researcher from manipulating or altering the environment. In fact, it is a rather common occurrence for the “field” to be contrived. For example, a study on altruism might be designed for field experimentation. A scenario would be designed to discover what kind of person would come to the assistance of someone in need. The “need” could be helping to fix a flat tire or helping a lost child find his or her mother. In either case, since both scenarios occur infrequently in the real world and would be difficult to study, the setting would need to be staged. The ability to stage events opens the possibility of studying a variety of phenomena in a convenient context.




Five Steps of Field Experimentation

Five steps need to be completed in field experimentation. First, an appropriate field must be selected. This is a crucial decision, because the quality of the research hinges on the vitality of the data collected. Second, specific methods and techniques (for example, nonparticipant observation) must be developed to ensure that the behaviors the experimenter wants to observe can occur. In addition, an attempt must be made to eliminate outside influences that might bias the research. Third, the data must be collected. Fourth, the data must be organized, analyzed, and interpreted. The fifth and final step is to report the study within an appropriate format, which might be either a journal article or a book. To show how these steps are implemented and how field experimentation can contribute to scientific knowledge, two examples will be explored in detail.




Cultural Perceptions of Time

In his article “The Pace of Life,” published in American Scientist (1990), Robert Levine attempted to understand how different cultures perceived time. In his opinion, attitudes toward time could affect a society’s pace of life and ultimately might lead to detrimental health problems for its members. Levine chose to collect data from the largest city in six different countries: Japan, Taiwan, Indonesia, Italy, England, and the United States. To gauge the general pace of life, he chose to study three unique indicators: the accuracy of outdoor bank clocks, the average time it took pedestrians to walk a distance of 100 feet (about 30.5 meters), and the time needed for a postal clerk to complete a transaction that entailed selling stamps and returning some change. None of these measures relies on subjective evaluations of the pace of life by the person collecting the data. Levine preferred these particular “objective” measures over a survey approach, which might have required subjects to respond to how they “feel” about the pace of life. He was more interested in direct measures of behavior as indicators of pace.


Standardized techniques were employed while collecting the data to ensure that the pace-of-life indicators would be measured fairly. For example, walking speed would not be measured if it were raining outside. Levine chose a covert approach, since he did not want subjects to be aware that they were in a study, thus eliminating any Hawthorne effect. In addition, both participant and nonparticipant observations were made. Measuring walking speed some distance away from a subject would be an example of nonparticipant observation. On the other hand, the purchasing of stamps on the part of the experimenter was an example of the participant observer technique.


The data were collected primarily by Levine’s students, who visited the countries. The data were then analyzed via basic statistical procedures. The study revealed that Japan had the fastest pace of life of the six countries, scoring the highest on all three measures. The United States came in with the second-fastest pace, followed by England; Indonesia was last, having the slowest walkers and the most inaccurate clocks.


Levine extended this research by looking at associations between the pace of life and both psychological and physical health. He found that the tempo of a society is significantly related to the prevalence of heart disease. In fact, the time-related variables often turned out to be better predictors of heart disease than psychological measures that identify high-energy behaviors in individuals. He concluded that a person who chooses to live in a fast-paced city should take necessary precautions to keep from becoming a time-urgent person. Living in a busy and stressful city can lead to unhealthy behaviors such as smoking and poor eating habits.




Psychological Labels

In another field study, which came to be known as the Rosenhan experiment, David L. Rosenhan studied mental health professionals’ ability to distinguish the “sane” from the “insane.” Rosenhan later published the
research in the article “On Being Sane in Insane Places” in 1973. He sent eight psychologically stable individuals to twelve different mental institutions to find out if they would be admitted as patients. Each “pseudopatient” went to an institution with an assumed name and a false occupation; this was necessary because three of the pseudopatients were psychologists and one was a psychiatrist, and they might be treated differently from other patients. The pseudopatients told the admitting staff that they had been hearing voices that appeared to say the words “hollow,” “empty,” and “thud.” All pseudopatients were admitted and diagnosed as schizophrenic or manic-depressive. From the moment the pseudopatients gained entrance into the institutions, they began to act in a completely normal manner.


Rosenhan’s study used both covert and participant observation techniques to collect the data. Field notes (the recorded behaviors and observations that make up the data of the field study) concerning the behavior of staff members were taken on a daily basis. Although Rosenhan was shocked that all of his assistants (as well as himself) were admitted, he was even more dismayed that the pseudopatients’ “insanity” was never questioned by the staff. When the pseudopatients were observed writing their field notes, the behavior was interpreted by many of the staff members as paranoid and secretive.


The pseudopatients were released from the hospital between seven and fifty-two days later. Field studies, as this example indicates, can be filled with risks. None of the pseudopatients truly expected to be admitted, let alone having to stay an average of nineteen days in the hospital before the mental health professionals declared them well enough to be released. Rosenhan’s study was significant because it underscored the problem of distinguishing the normal from the abnormal with conventional diagnostic procedures. Rosenhan applied the results of this study to the broader issue of psychological labels. He pointed out that categorizing an individual with a particular mental illness can be misleading and in many instances harmful. Rosenhan’s pseudopatients were discharged with the label “ schizophrenia in remission”—that is, according to the mental health workers, they had been relieved of their insanity, although perhaps only temporarily.




Bibliography


Baker, Therese L. Doing Social Research. 3rd ed. New York: McGraw-Hill, 1999. Print.



Berg, Bruce Lawrence. Qualitative Research Methods for the Social Sciences. 7th ed. Boston: Allyn, 2009. Print.



Griffin, John Howard. Black Like Me. New York: New Amer. Lib., 2003. Print.



Levine, Robert V. “The Pace of Life.” American Scientist 78 (1990): 450–59. Print.



Mehl, Matthias R., and Tamlin S. Conner, eds. Handbook of Research Methods for Studying Daily Life. New York: Guilford, 2012. Print.



Reason, Peter, and Hilary Bradbury. Handbook of Action Research: Participative Inquiry and Practice. Thousand Oaks: Sage, 2001. Print.



Reis, Harry T., and Charles M. Judd, eds. Handbook of Research Methods in Social and Personality Psychology. 2nd ed. New York: Cambridge UP, 2014. Print.



Rosenhan, David L. “On Being Sane in Insane Places.” Science 179 (1973): 250–58. Print.



Singleton, Royce, Jr., Bruce C. Straits, M. M. Straits, and Ronald J. McAllister. Approaches to Social Research. 4th ed. New York: Oxford UP, 2005. Print.



Swingle, Paul, ed. Social Psychology in Natural Settings: A Reader in Field Experimentation. New Brunswick: Aldine Transaction, 2007. Print.



Teele, Dawn Langan, ed. Field Experiments and Their Critics: Essays on the Uses and Abuses of Experimentation in the Social Sciences. New Haven: Yale UP, 2014. Print.

Sunday, October 25, 2015

Why did the major say ugly things to the narrator in the short story "In Another Country"?

The major shows courage but he is frustrated with his injury and has little hope of substantially recovering from it. According to the narrator, his hand is like a baby's hand. Adding more frustration to this, the major had been the best fencer in Italy prior to the war. With this injury, presuming it is on his dominant hand, he will never fence at that level again. And perhaps, he will never fence again. Despite these frustrations, the major goes to his rehabilitation with a stoic and sometimes sarcastic discipline. 



The major came very regularly to the hospital. I do not think he ever missed a day, although I am sure he did not believe in the machines. 



The major criticizes the narrator about his grammar and calls him a "stupid impossible disgrace." He also says he is a fool if he wants to be married. The major has no hope of recovering use of his hand, he is disillusioned by the war, and he has just lost his wife to pneumonia. This is why he chastises the narrator about marriage: 



If he is to lose everything, he should not place himself in a position to lose that. He should not place himself in a position to lose. He should find things he cannot lose. 



The major takes out his frustrations and his grief on the narrator. And this is possibly because he knows no other way of venting his anguish. He feels the need to project his feelings somewhere or to someone. 

What is stress reduction?


Indications and Procedures

Stress can exacerbate difficulties in daily functioning, slow recovery from mental or physical problems, and impede immunological functioning. Stress reduction techniques represent a cluster of procedures that share the goal of reducing bodily and emotional tension: drug and physical therapies, exercise, biofeedback training, meditation, hypnosis, psychotherapy, relaxation training, and stress inoculation therapy.


The drugs used in stress reduction are designed to provide overall bodily relaxation, to induce rest, or to decrease the anxious thinking that exacerbates stressful experiences. Sedatives, tranquilizers, benzodiazepines, antihistamines, beta-blockers, and barbiturates are examples of such drugs. Similarly, physical therapies and exercise are recommended for these purposes. Baths (hydrotherapy), massages, and moderate exercise can also be part of a stress reduction program.


Psychotherapy is a common treatment for stress implemented by psychiatrists, psychologists, social workers, psychiatric nurses, and counselors. Not only does it help individuals to sort out their problems mentally but it is also an effective stress management strategy. When individuals analyze their lifestyles and life events, stress-inducing behaviors and life patterns can be explored and targeted for modification.



Biofeedback
training, meditation, hypnosis, and relaxation training all focus on inducing relaxation or altered consciousness by shifting a person’s attention. Biofeedback uses monitoring devices attached to the body to provide visual or aural feedback to the trainee. Such devices include the electromyograph (EMG), which measures muscle tension, and the psychogalvanometer, which measures galvanic skin response (GSR). An EMG involves placing sensors on various muscle groups to record muscular electrical potentials. GSR also relies on sensors, but these sensors record bodily responses caused by sweat gland activity and emotional arousal. The feedback from such devices allows a trainee to learn to control certain bodily processes (for example, muscle tension, brain waves, heart rate, temperature, and blood pressure). Biofeedback training is used to treat headaches, temporomandibular joint (TMJ)
syndrome, high blood pressure, and
tics, and it can also facilitate neuromuscular responses in stroke patients.


Meditation is a focused thinking exercise involving a quiet setting and the repetition of a word or phrase called a mantra. By blocking distracting thoughts and refocusing attention, meditation reduces anxious thinking. It is useful for mild anxiety, minor concentration difficulties, and daily relaxation.


Hypnosis involves the use of suggestion, concentrated attention, and/or drugs to induce a sleeplike state, or trance. Hypnosis can be induced by a hypnotist or via self-hypnosis. Hypnotic states are characterized by increased suggestibility, ability to recall forgotten events, decreased pain sensitivity, and increased vasomotor control. The ability to be hypnotized varies from person to person based on susceptibility to suggestion and psychological needs. Hypnosis is used as a brief therapy targeting such problems as insomnia, pain, panic, and sexual dysfunction. In addition, hypnosis is sometimes used when drugs are contraindicated for anesthetic use, particularly for dental procedures.


Relaxation training involves three primary methods: autogenic training, which involves such techniques as head, heart, and abdominal exercises; progressive relaxation, which involves becoming aware of tension in the various muscle groups by relaxing one group at a time in a specific order; and breathing exercises. Relaxation training is best learned when a therapist trains an individual in person and then the exercises are practiced independently. Relaxation can be practiced several times daily, as well as in response to stressful events. High blood pressure, ulcers, insomnia, asthma, drug and alcohol problems, spastic colitis, tachycardia (rapid heartbeat), pain management, and moderate-to-severe anxiety disorders are treated with relaxation training.


Stress inoculation therapy is a specific type of psychotherapy involving techniques that alter patterns of thinking and acting. It comprises three steps: education about stress and fear reactions, rehearsal of coping behaviors, and application of coping behaviors in stress-provoking situations. It is useful for treating anxiety disorders related to stress.




Uses and Complications

Individuals should not apply stress reduction procedures without proper consultation; medical conditions that might be causing symptoms should be assessed or ruled out first. Biofeedback training for headaches, for example, would be unwarranted until other, more serious causes of headaches had been eliminated from consideration. Similarly, exercise, drug, and physical therapies could actually worsen conditions such as high blood pressure, alcohol and drug problems, and chronic pain if applied incorrectly. For example, where stress or pain is chronic, drug therapies might encourage the development of drug dependence.


Instead, skilled providers should administer these procedures. Training via self-help materials alone or by an unskilled provider may provide no benefit or create difficulties. Poor training could result in frustration, hypervigilance, heightened anxiety, depression, or pain caused by overattention to symptoms or conflicts. In fact, some individuals are prone to these effects even with good training. Therefore, ongoing assessment is necessary. Finally, interpretation of any memories provoked by hypnosis should be done with caution because of the suggestibility that is characteristic of hypnotic states.




Perspective and Prospects

Stress reduction techniques evolved from ancient meditation practices and simpler methods of pain management predating the development of modern anesthetics. The palliative and preventive effects of these techniques have given these procedures a sure hold in future medical practice, while benefits such as decreased absenteeism and increased feelings of wellness in employees have secured these strategies in the workplace. The expanded use of stress reduction procedures in prenatal care and with the elderly is likely.




Bibliography


American Heart Association. "Stress Management." American Heart Association, 2013.



Centers for Disease Control and Prevention. "CDC Features: Coping with Stress." Centers for Disease Control and Prevention, April 16, 2013.



Davis, Martha, Elizabeth Robbins Eshelman, and Matthew McKay. The Relaxation and Stress Reduction Workbook. 6th ed. Oakland, Calif.: New Harbinger, 2008.



Family Doctor. "Stress: How to Cope Better with Life's Challenges." FamilyDoctor.org, November, 2010.



Humphrey, James H. Stress Among Older Adults: Understanding and Coping. Springfield, Ill.: Charles C Thomas, 1992.



Manning, George, Kent Curtis, and Steve McMillen. Stress: Living and Working in a Changing World. 2d ed. Nashville, Tenn.: Savant Learning Systems, Inc., 2011.



National Center for Complementary and Alternative Medicine (NCCAM). "Mindfulness-Based Stress Reduction (MBSR) Information." NIH NCCAM, n.d.



Newton, Tim, with Jocelyn Handy and Stephen Fineman. Managing Stress: Emotion and Power at Work. Newbury Park, Calif.: Sage, 1996.



Pelletier, Kenneth. The Best Alternative Medicine. New York: Fireside, 2002.



Schafer, Walt. Stress Management for Wellness. 4th ed. Belmont, Calif.: Thomson/Wadsworth, 2000.



Seaward, Brian Luke. Managing Stress: Principles and Strategies for Health and Well-Being. 7th ed. Burlington, Mass.: Jones and Bartlett Learning, 2012.



US Department of Health and Human Services. "Manage Stress." HealthFinder.gov, May 28, 2013.

How does the choice of details set the tone of the sermon?

Edwards is remembered for his choice of details, particularly in this classic sermon. His goal was not to tell people about his beliefs; he ...