What are existing and continuing threats to the security of e-commerce? What are examples of ways to thwart these threats?

As e-commerce continues to proliferate and become an essential part of the economy, we are seeing a rise in electronic crimes.

The first major area of concern is identity theft. A key to any business transaction is being able to verify the identity of both parties to an electronic transaction. As various forms of malware including keyloggers are increasingly being used to steal password and other identity data, businesses are responding with more secure forms of identity verification. Perhaps the most secure is using a combination of biometric identification with some form of password protection.

A second security issue is phishing, a process by which scammers send out emails or create fake websites that appear to be associated with your business but which actually are not. For these, the best solution is consumer education and employee training. Some anti-virus software can also evaluate the safety of websites and warn users if a website appears to have a bad certificate or some other red flag.

What is collectivism?

Introduction

The construct of collectivism is traditionally compared with individualism when considered in the literature of social psychology. The dual constructs are powerful in their ability to identify general differences in cultural perspective or worldview. The danger that accompanies the constructs is the tendency to overgeneralize. Nevertheless, when painting with a broad sweep, the two categories provide a helpful model for understanding foundational differences in cultural groups.

Social psychologists attempt to both define and measure collectivism but are not unified in what they propose. A definition developed by Harry C. Triandis describes collectivism as a “social pattern consisting of closely linked individuals who see themselves as parts of one or more collectives (family, co-workers, tribe, nation).” A definition that includes a functional aspect identifies collectivism as being a cultural syndrome of norms, values, and a way to engage in the world that is embedded in practices, artifacts, and institutions. In collectivism, members give priority to the goals of the collective rather than personal goals. Norms and duties of the collective motivate members, and value is placed on connection with members of the group. Countries known for their highly collectivist natures are Pakistan, Venezuela, Colombia, Peru, Taiwan, Thailand, Japan, and China.

Individualism and Collectivism

In contrast to collectivism, individualism gives priority to personal goals and to values that serve the self such as personal distinction, achievement, and independence. The individual is the most basic unit. Countries that represent individualistic societies include Canada, Great Britain, Belgium, France, the Scandinavian countries, and the Netherlands. The majority group in the United States represents individualism.

Several contrasts between individualism and collectivism can be drawn relative to the functioning and perception of group members. Collectivism values the public self. Achievement includes cooperation for the benefit of the in-group. Individualism places importance on the private self, personal achievement, competition, and power. Collectivism values obedience, in-group harmony, and a few close relationships. Individualism values pleasure and freedom and is more likely to represent many casual relationships. Collectivism stresses saving face for both self and others, and favors people who are modest and self-effacing. Individualism emphasizes saving one’s own face and favors people who are self-assured.

Diverse Groups and Collectivism

Although the majority population in the United States tends to represent individualism, diverse cultural groups are more likely to have a collective worldview. Within such groups, high priority is placed on loyalty to family and culture.

Many immigrants come from countries with collectivist narratives for self and family. A primary component of such collectivist narratives is the internalized obligation to help extended family members, regardless of whether there was a strong relationship with the member. Depending on the ethnic group, this sense of family obligation and support often continues to exist as an enduring psychosocial feature.

In Middle Eastern societies, the development of an individual identity that separates one from the family or ethnic community is not valued or encouraged. The enhancement of family honor and status is a primary goal. Family members are expected to control their individual behavior because it reflects on the family’s reputation.

In Asian cultures, the group often takes precedence over the needs of the individual. The activities of the individual may be more directly related to the status and wealth of the family as a whole, rather than to the advancement of the individual. This group focus tends to emphasize dependency and respect for authority rather than independence and egalitarian relationships more common in northern European countries.

American Indians view the focus on the solitary individual to the exclusion of the group as meaningless. They question the concentration on the individual in Western philosophy, law, and the religious thinking of modern society. For the American Indian, concepts about religion and spirituality have a communal rather than an individual basis. Because all things are perceived as interconnected, relationships among people are critically important. Indian tribes would view individuals without loyalty to anyone else as people who are exceedingly dangerous. Relationships within the family and clan are valued so highly that banishment, refusal of the tribe to recognize the wrongdoer as a member, has traditionally served as punishment for heinous crimes.

Collectivism and the Family Unit

In collectivist cultures, marriages link families rather than individuals and may be arranged. Group boundaries are explicit, and great value is placed on shared activities, solidarity, and family/group loyalty. In contrast, individualist cultures reflect relationships that are loosely connected and autonomous, with flexible boundaries. Relationship goals include personal fulfillment and romance as important components in the pursuit of life.

Collectivist cultures have traditionally viewed marriage as a vehicle for maintaining social order and for forming links between families rather than as a means of fulfilling personal desires. In traditional Hindu societies, marriage is one of the most important events in a person’s life and is perceived as a social and cultural duty. Individualist cultures follow a love-based approach to marriage, which values feelings of personal compatibility and mutual attraction, rather than a duty to meet the needs of family or society.

As diverse families are served by mental health professionals, they are often placed within the Western value systems of psychology and counseling, in which individuation is expected to place boundaries on cohesion and individual goals. On one commonly used family scale, families identified as unbalanced have the following characteristics: high dependence, very high togetherness, very high closeness, high loyalty, and mainly shared activities.

Research and Application

Collectivism appears to be a variable associated with romantic partner preferences. Although universal values for a core group of dispositional features have been identified in research, cultural differences exist. Adults in collectivist cultures such as China and India tend to value “practical” characteristics(such as being a good housekeeper) and demographic similarity (such as sharing the same religion or caste) in a potential spouse more than do adults from individualist cultures. This would seem consistent with cultures that have a history of arranged marriage.

Individuals from collectivist cultures tend to view chastity as a relatively important attribute in a potential mate, whereas it appears to be a dispensable or even undesirable trait for men and women in many Western countries. An overview of research finds that young adults in collectivist cultures are more likely to disapprove of premarital sex as compared with young adults from individualist cultures, who typically hold more permissive attitudes.

Low-income families are more likely than higher-income families to have a collective worldview relative to financial style and spending practices. Individuals from groups reflecting a collective worldview value helping family members, friends, or neighbors when assistance is needed. Consequently, money is more often shared than used to better the individual in purchasing houses, furthering education, or investments. Mental health professionals and financial advisers from European American, middle-class groups may view this as being irresponsible.

Conclusion

Cultural competence refers to the expertise and information needed by those who work with diverse populations. Culture is defined as the behavior, patterns, beliefs, and all other products of a particular group of people that are passed on from generation to generation. If members of diverse populations do try to implement practices that are in conflict with strengths of their own cultural group, members of the helping profession may actually cause harm to the family because they encourage a “cultural clash” that negatively affects family life. Mental health workers and agencies should carefully assess their cultural competence.

Proponents of the collectivist worldview argue that the Western emphasis on individualism devalues the role that groups play in the survival of human beings and may undermine the basic need for relatedness. Comparison of collectivist and individualist cultures reveal that individualistic cultures have higher rates of suicide, drug abuse, crime, divorce, and mental disorders.

All individuals incorporate both individualism and collectivism in their patterns of living. When comparing the two, the focus is more one of preference and degree. Some of the more common contrasts between individualism and collectivism involve self-descriptions and contextual information. In collectivism, the social group is incorporated into self-descriptions, context is used to describe the self, and contextual information is used for decision making. A balance between collectivism and individualism may be the optimal position. Either in its extremity will result in undesirable consequences. The point of agreement is the need to have both a positive sense of self and a sense of connectedness to others.

Bibliography

Al-Deen, N. “Understanding Arab Americans: A Matter of Diversities.” In Cross-Communications and Aging in the U.S. Mahwah, N.J.: Lawrence Erlbaum, 1991. Provides comprehensive information on the values of Arab Americans. Illustrates their collective identity in a number of characteristics.

Kagitcibasi, C. Family, Self, and Human Development Across Cultures. Mahwah, N.J.: Lawrence Erlbaum, 2007. Focuses on diversity of cultures in areas such as human development. Notes the tendency of developmental psychology to use individualism as its standard and identifies the disadvantages of this approach.

Khallad, Y. “Mate Selection in Jordan: Effects of Sex, Socio-economic Status, and Culture.” Journal of Social and Personal Relationships 22 (April 1, 2005): 155-168. Examines mate preferences of individuals from a collectivist culture in the Middle East to note the strength of the traditional social values.

McAuliffe, Garrett, et al., eds. Culturally Alert Counseling. Thousand Oaks, Calif.: Sage Publications, 2008. Provides an excellent background for mental health professionals working with diverse groups. The influence of varying worldviews is obvious.

McGoldrick, M., et al., eds. Ethnicity and Family Therapy. 3d ed. New York: Guilford Press, 2005. Almost all cultural groups are included, making the distinctions between collectivism and individualism evident.

Reis, H. T., and S. K. Sprecher, eds. Encyclopedia of Human Relationships. Thousand Oaks, Calif.: Sage Publications, 2009. A three-volume set that provides a vast amount of information about how people think, feel, and act toward others with whom they have relationships. Includes an article on the effect of collectivism on relationships.

Robins, Kikanza Nuri, et al. Cultural Proficiency Instructions: A Guide for People Who Teach. 2d ed. Thousand Oaks, Calif.: Sage Publications, 2006. Written for educational institutions, but its principles apply for mental health institutions.

Skogrand, L., D. Hatch, and A. Singh. Strengths and Challenges of New Immigrant Families: Implications for Research, Policy, Education, and Service. Lanham, Md.: Lexington Books, 2008. Interviews of many families from diverse cultural backgrounds provided data to make culturally relevant provisions in mental health policies and service. Includes differences relative to collectivistic and individualistic worldviews.

Thomas, Anita Jones, and Sara Schwarzbaum Thomas. Culture and Identity: Life Stories for Counselors and Therapists. Thousand Oaks, Calif.: Sage Publications, 2006. Each chapter describes the experience of individuals from diverse cultures who are attempting to navigate the many challenges of developing a cultural identity. A number of cultures are considered, helping the reader understand the importance of cultural identity within the larger framework of human development. Various activities are suggested as a means to apply the cultural setting to the mental health practitioner.

Triandis, H. C. Individualism and Collectivism: New Directions in Social Psychology. Boulder, Colo.: Westview Press, 1995. One of only a few sources that provides scholarly theoretical information on the distinctive aspects of collectivism.

What is the relationship between dogs and infectious disease?

Definition

Dogs were the first animal species to become domesticated. Fossil evidence
from fourteen thousand years ago shows that dogs lived among humans as a species
physically distinct from their wolf ancestors. Genetic sequencing suggests dogs
split from wolves as long as 100,000 years ago, perhaps because they began to live
in close contact with humans. However, dogs remain close relatives to wolves; some
scholars argue that dogs are simply a subspecies because dogs and wolves (and coyotes and dingoes) interbreed and produce fertile offspring. As
canines, dogs belong to a group of social carnivores and
scavengers. In practice, however, dogs, even feral dogs, are not effective
hunters, depending instead on human provisioning and garbage.

Physically and behaviorally, dogs resemble juvenile wolves, a development
called neotony. Juvenile features and behavior probably make them more appealing
to humans and more amenable to human lifestyles.

Natural History and Risk Factors

Dogs have adapted to the ecological niche of human society. They are so well adapted to humans that they understand human signals, such as pointing, gaze direction, and tapping, better than humans’ closest primate relatives. These adaptations support and attest to the intimate nature of the human-dog bond. Although cultural norms and the role assigned to dogs vary, dogs worldwide still share homes, meals and sleeping spaces with humans. Given this, it is surprising that dogs do not form a great public health risk.

Globally, dogs remain the primary transmitters of rabies. They
are the primary transmitters of Echinococcus granulosus and,
along with cats and wild species, are sources of visceral and ocular larval
migrans. Dogs can be one source of infection with Leptospira, and
they reportedly occasionally transmit other bacterial and
protozoan
diseases.

Rabies

Recognition of the role dogs play in the transmission of rabies, a nearly 100
percent fatal form of encephalitis, is ancient. A
four-thousand-year-old Eshnunna civil code sets fines for the owners of
“mad-dogs”; that is, dogs with rabies. Early scholars described a venom, then
called a virus, in the saliva of rabid dogs that they believed transmitted the
disease. Rabies is actually a collection of viruses, with strains propagating best
in a single mammalian species. There are dog strains, fox strains, raccoon
strains, bat strains, and others; all can cause disease in any mammal. Although
eradicated in developed nations, dog rabies has long been a major threat to
humans.

Dog rabies became an epizootic and epidemic threat when humans began to live in cities and keep dogs as pets. Abandoned pets then became feral and depended on garbage to survive. Feeding at single sites brought dogs into close contact, allowing for efficient transmission of rabies.

Prevention of dog-rabies epizootics and human exposures can be achieved through the control of strays, licensing and leash laws, and vaccinations of susceptible dogs. These measures have eradicated dog strain rabies from the United States, Japan, and Europe.

Cystic Echinococcus

Dogs are the natural host for the tapeworm E.
granulosus and one of the natural hosts for E.
multicularis. The worms mature in the dog’s small intestines, shedding
eggs that drop to the ground. Herbivores (especially sheep and goats, but also
wild animals and bovines) ingest the eggs, and dogs are reinfected when they eat
uncooked organ meats containing larval cysts. Humans can be infected if they
ingest water or soil contaminated by dog feces or if they do not practice
appropriate hygiene when handling dogs. The highest prevalence of infection with
E. granulosus occurs in pastoral societies, particularly in
sub-Saharan Africa.

Ingested eggs develop into larvae that migrate to organs such as the liver,
lung, and brain, where they form cysts. Cysts may not cause disease
unless they are large or if they rupture. Cystic Echinococcus is
debilitating but rarely fatal. Prevention includes hygiene, keeping dogs from
eating uncooked offal from abattoirs, and regular deworming of dogs.

E. multicularis is a similar tapeworm that uses wild canines, especially the red fox, as its definitive host. Dogs and cats also serve as hosts and can transmit the parasite to humans. E. multicularis most often causes alveolar echinococcosis when cysts develop in the host’s lungs.

Nematode Zoonoses

Dogs are natural hosts for a number of roundworms,
including
Toxocara canis and the Ancylostomatoidea, or hookworms. Humans have their own set of roundworm parasites,
and often people assume dogs are a source; for the most part, dog roundworms do
not develop into adult roundworms in humans.

T. canis larvae migrate in human tissues, most often in children,
causing abdominal pain, respiratory signs, and allergy-like syndromes called visceral larval migrans. Occasionally, the larvae cause granulomatous
lesions (ocular larval migrans) in the retinas of the eyes, which can limit vision
and cause blindness. These diseases result from the ingestion of soil contaminated
with T. canis eggs. Ancylostomatoidea roundworms comprise the
group called hookworms and attach to the intestinal wall. These parasites cause
anemia in both dogs and humans. Species of canine hookworms
cannot mature in human organs and instead cause skin lesions and, rarely,
enteritis.

Bacterial Zoonoses

Dogs are one of many reservoir hosts for
Leptospira, a spirochete bacteria. There are several pathogenic serovars of Leptospira, some of which can cause disease in humans and dogs. Rodents are the major reservoir. Infective bacteria are excreted with urine into standing water. Leptospira causes a flulike illness that can lead to liver and kidney failure.

Dogs have been the source of a variety of bacterial diseases in humans, including brucellosis, campylobacteriosis, salmonellosis, yersiniosis, and Helicobacter infections. Dogs may bring humans into contact with ticks and fleas, which can result in the transmission of vector-borne diseases such as Lyme disease, ehrlichiosis, and spotted fever group rickettsiosis. In addition, dogbites can occasionally become infected, most commonly with Staphylococcus, Streptococcus, Corynebacterium, and Bacteroides spp.

Protozoan Zoonoses

Dogs are reservoir hosts for leishmaniasis. The disease, spread by
sandflies, is caused by single-celled parasites. Skin lesions, disfigurement, and
a rare, potentially fatal visceral syndrome called kala-azar may result.

Impact

Rabies kills about fifty-five thousand people every year around the world, and most of these infections are transmitted by dogs. The other diseases transmitted by dogs are not well documented and cause few fatalities. In developed nations, where dogs are controlled and receive veterinary care, public health concerns are limited. Indeed, there is evidence that owning a pet has salutary benefits, such as encouraging owners to exercise and helping to lower stress.

Bibliography

Krauss, Hartmut, et al. Zoonoses: Infectious Diseases Transmissible from Animals to Humans. 3d ed. Washington, D.C.: ASM Press, 2003. Explores the myriad infections introduced by human-animal contact.

Macpherson, Calum N. L., et al., eds. Dogs, Zoonoses, and Public Health. New York: CABI, 2000. A comprehensive survey of all potential zoonoses transmitted by dogs.

Morgan, Marina, and John Palmer. “Dog Bites.” British Medical Journal 334 (2007): 413-417. A journal article on infections caused by dog bites.

Serpell, James, ed. The Domestic Dog: Its Evolution, Behaviour, and Interactions with People. 1995. Reprint. New York: Cambridge University Press, 2002. Explores the history and evolution of the domestic dog and its relationship with peoples around the world.

World Health Organization. “WHO Expert Consultation on Rabies: First Report.” Technical Report Series 931. Geneva: Author, 2004. Experts’ consensus with summaries of experience on controlling rabies. Emphasis on controlling dog populations and on mass vaccination administration.

What is bubonic plague?

Definition

Bubonic plague is a severe bacterial infection characterized by acute, local, necrotizing lymphadenitis (infection of the lymph glands). Bacteremia rapidly follows, then spreads to the spleen, liver, and other organs. Bubonic plague is the most common form of plague and has a mortality rate of 50 to 90 percent if not treated. If treated promptly and appropriately, the mortality rate is 5 to 15 percent.

Bubonic plague is one of the oldest diseases known and has been one of the most devastating in human history. It is widely regarded as a disease of mainly historical importance because it is now rare in developed countries and affects mainly poor and remote populations. However, reports of incidence have increased once again.

In Madagascar, Peru, and the Democratic Republic of the Congo, bubonic plague is a significant health concern. Adding to the new incidence rate is the discovery of antibiotic-resistant strains of the plague bacterium. The Centers for Disease Control and Prevention reports that as of 2015, an average of seven human cases develop each year in the United States, with the highest incidence occurring in the southwestern states of New Mexico, Arizona, and Colorado. According to the American Society of Tropical Medicine and Hygiene, between 2000 and 2009, more than 20,000 cases of humans infected with the plague were reported worldwide, with the following countries having the highest incidences (in order of most reported cases): DRC, Madagascar, Zambia, Uganda, Mozambique, Tanzania, China, Peru, Malawi, Indonesia, the United States, and Vietnam. The World Health Organization WHO) concedes that official data on the plague do not truly reflect incidence of plague, mainly because of a reluctance to report plague cases but also because of inadequate surveillance capabilities.

Causes

Bubonic plague is caused by the bacterium Yersinia pestis (formerly called Pasteurella pestis). Alexandre Yersin isolated the bacterium (germ) that causes plague. (The bacterium was named Y. pestis for Yersin.) He developed a treatment (an antiserum) to combat the disease and was the first to suggest that fleas and rats may have spread plague in the epidemic of 1894. Y. pestis is a nonmotile, non-acid-fast, non-spore-forming, gram-negative coccobacillus (bacterium) measuring 1.5 by 0.75 microns. The bacterium can be killed in less than ten minutes with sunlight, high temperatures, desiccation, ordinary disinfectants, and preparations containing chlorine.

Y. pestis is primarily an internal parasite of wild rodents. It is transmitted by rat fleas from wild rodents to domestic rats (Rattus norvegicus and especially R. rattus)
and then to humans (or directly from wild rodent to human). Y.
pestis reproduces rapidly in the wild rodent, which may then be
overcome with sepsis. A vector transmits it to a human from the wild
rodent. The vector is usually a rat flea of the species Xenopsylla cheopis, X. ramesis, or X.
nubica, although thirty different flea species have been identified as
carriers of plague; other vectors include ticks and
human
lice.

The vector takes a blood meal from the rodent, sucking up large amounts of Y. pestis bacteria, which then establish a colony in the stomachs and esophagi of some of these fleas. As a result, the flea cannot fit blood into its stomach and thus becomes extremely hungry. This extreme hunger drives the flea into intense blood-sucking (hematophagia). To avoid starvation, it will seek a blood meal from any nearby host, such as a human, rather than seek out a preferred rodent. This “blocked” flea will suck voraciously until it involuntarily regurgitates some of the blood it is sucking and some of the bacilli. As the flea feeds, it also defecates and thus excretes bacilli onto the human skin. The person scratches at the flea bite and thus deposits Y. pestis into his or her bloodstream.

As soon as a rodent that is infected with plague dies, its fleas leave for living hosts, humans often being the only nearby alternative. Under optimal conditions, vector fleas can live for six weeks, but they probably can transmit plague for about two weeks only. X. cheopis, the flea species most likely to transmit plague, flourishes in a dry, warm environment of about 60° to 77° Fahrenheit (20° to 25° Celsius). Bubonic plague can persist in relatively small rodent populations from which occasional human epidemics then arise.

Y. pestis probably evolved from the Central Asiatic plateau, the swathe of desert that reaches across Central Asia, the Middle East, and North Africa. It is rich with rodents and fleas that harbor and transmit plague. It is possible that these animals transferred Y. pestis from Central Asia to North Africa and subsequently to Central Africa.

The human flea (Pulex irritans) may be a transmitter of plague in some areas of Africa. However, human-to-human transmission of bubonic plague is uncommon because Y. pestis rarely produces in humans the level of sepsis needed for a flea to become blocked and thereby become a vector for bubonic plague.

Transmission can also occur when a person inhales plague-infected organisms
that have been released into the air. The inhalation form of the plague can be
aerosolized and used in acts of bioterrorism.

Risk Factors

The main risk factor for bubonic plague is contact with rodents carrying infected fleas. This may occur through occupational or environmental exposure to rats, ferrets, rabbits, squirrels, marmots, gerbils, birds, prairie dogs, bobcats, and coyotes. More than two hundred different rodents and other species can serve as hosts. Recent flea bites and scratches or bites from infected domestic cats are also risk factors.

Risk factors may be heightened by environmental and cultural conditions. For example, the Alur ethnic group in the West Nile region store grain and livestock in the same structure where people sleep because of the possibility of theft. This, coupled with the cultural practice of gathering and sleeping in the home of a deceased for three or four days (as dictated by the belief that the deceased spirit lingers and should be recognized by surviving relatives and friends), may increase the risk of contracting plague. An unusually prolonged drought is another risk factor because it may force field rodents to seek food in buildings. Poverty, poor sanitation, and poor food-storage practices are also risk factors. Late diagnosis is a risk factor for the spread of bubonic plague because it limits the effectiveness of control measures.

Symptoms

The classic symptom of bubonic plague appears usually one to six days after exposure as a smooth and painful lymph gland swelling known as a bubo. A bubo is most commonly found in the groin but is also found in the armpits and neck. A bubo usually occurs at the site of the initial flea bite or scratch. Pain may occur at the site before the bubo appears. If the infected person survives, the bubo usually suppurates in one to two weeks because of secondary infection with pyogenic bacteria. It may then burst and leave a deep ulcer. Other symptoms of bubonic plague are malaise (a general ill feeling), myalgia (muscle aches and pain), high fever, chills, severe headache, nausea, vomiting, seizures, and prostration. Petechiae (purplish spots caused by small hemorrhages); ecchymoses (purple discoloration from ruptured blood vessels); bleeding into the tissues, which turns the tissue black; and bleeding from the gastrointestinal tract may also present. In its mild form, however, bubonic plague may not even confine a person to bed.

If left untreated, bubonic plague can became septicemic or pneumonic plague, which affect the blood stream and the lungs, respectively. In addition to the other symptoms of bubonic plague, shock may occur with septicemic plague or pneumonic plague. Pneumonic plague is characterized by respiratory symptoms such as cough, chest pain, thin or bloody mucus excretions, shortness of breath, and even respiratory failure. When someone has pneumonic plague, the disease can also transmit directly to another human through airborne droplets.

Screening and Diagnosis

A doctor will ask the patient about symptoms and medical history and will perform a physical examination. Diagnostic tests may include blood and urine samples, sputum samples, a chest X ray, a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan, and a bronchoscopy, in which a thin scope is used to look into the lungs. Laboratory confirmation includes cultures from samples of blood, sputum, and fluid from the bubo. Cultures require more than forty-eight hours to produce definitive results. If plague infection is discovered, an infectious disease specialist should be contacted for assistance.

Treatment and Therapy

One should immediately treat suspected bubonic plague with antibiotics and then initiate confirmatory laboratory work. Without prompt treatment, Y. pestis can multiply in the bloodstream or spread to the lungs so rapidly that it may lead to the more serious pneumonic plague. Persons with bubonic plague are often hospitalized and placed in isolation, however.

The standard treatment for bubonic plague is intramuscular streptomycin (1 gram twice daily for ten days). Less severe cases can be treated with 500 milligrams (mg) of oral tetracycline, four times daily. Chloramphenicol is a suitable alternative and is administered in divided doses of 50 mg per kilogram per day, either parenterally or, if tolerated, orally for ten days. Gentamycin is the preferred antibiotic for treatment during pregnancy because it is safe, because it can be administered either intravenously or intramuscularly, and because its concentrations in the blood can be monitored.

The three most effective drugs have potentially serious adverse events associated with use during pregnancy: streptomycin may be ototoxic and nephrotoxic to the fetus, tetracycline has an adverse effect on the developing teeth and bones of the fetus, and chloramphenicol carries a risk, albeit low, of gray baby syndrome or bone-marrow suppression. Sulfonamides have been used extensively in plague treatment; however, some studies have shown higher mortality, increased complications, and longer duration of fever with its use compared with treatment with streptomycin, tetracycline, or chloramphenicol.

Prevention and Outcomes

Killed bacteria began to be used in plague vaccines in 1896. However, the vaccine licensed for use in the United States was a whole-cell bacterial vaccine, inactivated with formaldehyde and preserved in phenol. The primary series consisted of three doses: the first dose at the initial visit, the second dose one to three months later, and the third dose five or six months later. Booster doses could be given at six-month intervals if exposure continued. Common side effects included mild pain, erythema (redness), and induration (hardening) at the injection site. Fever, headache, and malaise were more common and more severe following repeated doses. Rare side effects included difficulty in breathing or swallowing; hives; itching, especially of soles or palms; reddening of skin, especially around ears; swelling of eyes, face, or inside of nose; and unusual, sudden, and severe tiredness or weakness. The plague vaccine was not very effective, however.

In 2000, the United States began working with Great Britain and Canada in sharing information about plague vaccine. In 2005, the three countries agreed to pool their resources to create a vaccine that combines the existing vaccine for the bubonic plague with a new kind of protection from the pneumonic plague. As of 2015, no plague vaccine was available to the public. In 2008, researchers from the Institut Pasteur in Paris used the less virulent ancestor to Y. pestis, Y. pseudotuberculosis, to try to develop a potentially safer, more efficient, and less expensive live oral vaccine. As of 2015, their efforts to create a stable, safe live vaccine remained ongoing.

Because human plague is rare in most parts of the world, there is no need to vaccinate anyone other than those at particularly high risk of exposure—namely, laboratory and field personnel working with or in proximity to Y. pestis. This intramuscular vaccine is not indicated for most travelers to countries reporting cases, particularly those traveling only to urban areas with modern hotel accommodations.

If a person is diagnosed with plague, most countries require that a governmental health agency be notified. Particularly if pneumonic plague is suspected, the person is kept in strict isolation until the disease is controlled with antibiotics. It is imperative that those who have been in close contact with an infected person be traced, identified, and evaluated. Infected persons might also be put under observation or given preventive antibiotic therapy (with a tetracycline, chloramphenicol, or one of the effective sulfonamides), depending on the degree and timing of contact. Antibiotics can also be given for a brief period to people who have been exposed to the bites of potentially infected rodent fleas or who have handled an animal known to be infected. People who must be present in an area where a plague outbreak is occurring can protect themselves for two to three weeks by taking antibiotics.

Many cities, especially in the United States, have instituted rodent-control programs because rodents also carry rabies and other deadly diseases. In rural areas, eliminating wild-rodent harborage and food sources and clearing brush, rock piles, and junk puts distance between rodents and the home. Ridding pet dogs and cats of fleas regularly prevents the fleas from jumping to other pets. Applying insect repellents, if available, to clothing and skin to prevent flea bites is advisable, as is wearing gloves when handling potentially infected animals. Keeping floors clean and occasionally pouring boiling water on a dirt floor and not sleeping on it is helpful.

In Africa, plague control is often reactive, not proactive, because of a lack of resources for surveillance. Plague control that targets rodents in Africa has focused on trapping, burning homes, and dusting homes and rodent burrows with powdered insecticide or other poisons such as dichloro-diphenyl-trichloroethane (DDT) powder followed by anticoagulant bait. Many countries employ rigorous disinfection routines for ships, docks, and aircraft because transportation of infected rodents aboard transcontinental vehicles has led to earlier pandemics.

Bibliography

Bahmanyar, M., and D. C. Cavanaugh. Plague Manual. Geneva: World Health Organization, 1999.

Borchert, Jeff N., Jeff J. Mach, and Timothy J. Linder. “Invasive Rats and Bubonic Plague in Northwest Uganda.” In Managing Vertebrate Invasive Species, edited by G. W. Witmer, W. C. Pitt, and K. A. Fagerstone. Fort Collins, Colo.: National Wildlife Research Center, 2007.

Cook, Gordon C., and Alimuddin I. Zumla, eds. Manson’s Tropical Diseases. 22d ed. Philadelphia: Saunders/Elsevier, 2009.

"Fast Facts on Plague in the 21st Century." ASTMH. Amer. Soc. of Tropical Medicine & Hygiene, n.d. Web. 29 Dec. 2015.

Findlay, John, and Drew Shrewsbury. A History of Bubonic Plague in the British Isles. New York: Cambridge University Press, 2005.

Jong, Elaine C., and Russell McMullen, eds. Travel and Tropical Medicine Manual. 4th ed. Philadelphia: Saunders/Elsevier, 2008.

Mandell, Gerald L., John E. Bennett, and Raphael Dolin, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. New York: Churchill Livingstone/Elsevier, 2010.

Marquardt, William C., ed. Biology of Disease Vectors. 2d ed. New York: Academic Press/Elsevier, 2005.

National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD). "Plague: Frequently Asked Questions." CDC. Centers for Disease Control and Prevention, 14 Sept. 2015. Web. 29 Dec. 2015.

What is hearing loss?

Causes and Symptoms

The causes of hearing loss vary, although three major factors enhance the progression of loss as one ages: exposure to noise, previous middle-ear disease, and vascular disease. There are basically two types of hearing loss, conductive hearing loss and sensorineural hearing loss. Conductive hearing loss
results from interference with sound vibration through the external and middle ear. In other words, the sound cannot get to the inner ear. In some types of conductive hearing loss, if the sound amplitude is increased enough, then the person may be able to hear. Possible reasons for conductive hearing loss include impacted or large amounts of cerumen (wax) in the ear, foreign bodies (such as soap, food, or insects) in the ear canal, otitis media (middle-ear infection), rheumatoid arthritis, and otosclerosis, in which the stapes becomes fixed to the oval window of the cochlea. Sensorineural hearing loss is caused by damage to the inner ear, the auditory nerve, or the brain.

Earwax buildup is a common and treatable cause of conductive hearing loss. There have been reports that as much as 25 percent of nursing home residents have impacted cerumen. Older adults can be taught how to remove the wax on their own. Cerumenex (by prescription only) and Debrox (sold without a prescription) can be used as directed, followed by lavage to remove the wax and residual medication. Some health care providers recommend the instillation of mineral oil into the ear canal twenty-four hours before removal to help soften the wax, followed by lavage with one part hydrogen peroxide to three parts water at room temperature.

Sensorineural hearing loss
means the presence of disease anywhere from the organ of Corti to the brain. The result is loss of hearing high tones, for it is the hair
cells in the basal curvature of the organ of Corti that are sensitive to high tones. Presbycusis is sensorineural hearing loss caused by aging
of the inner ear. The onset of presbycusis may begin anytime from the third to the sixth decade of life, depending on type. Presbycusis affects more than 50 percent of individuals over age sixty-five. Older adults suffering from these disturbances show distinct and differing audiograms, which are used clinically to diagnose types of impairment. The standard type of presbycusis with hearing loss at high Hertz is often associated with sensory and neural presbycusis. There are four types of presbycusis: sensory, neural, metabolic, and cochlear conductive.

The elderly first start to lose hearing in the high-frequency range. High-frequency consonants and sibilants become more difficult to recognize—for example, f, g, l, t, s, ch, sh, and th. In presbycusis, high-frequency sounds become unintelligible. Understanding spoken words depends largely on the clear perception of high-frequency consonants rather than low-frequency vowel sounds. This is why words starting with the above letters or combinations become unintelligible. Many times, older adults have both conductive and sensorineural frequency losses. The precise cause of the defect requires help from a specialist and the use of sophisticated audiometric testing.

The sound waves that travel through the ear have two main characteristics, frequency and amplitude. Frequency is related to the pitch of a sound and is measured by the number of vibrations or cycles per second. The higher the vibration frequency, the higher the perceived pitch of the sound. Hertz (Hz) is the unit of measurement to denote cycles per second. Amplitude is related to the loudness of a sound. The greater the intensity with which a sound strikes the eardrum, the louder the tone. The unit of measurement of intensity of sound is decibels (dB).

Among the offenders to hearing are radio headphones, lawn mowers, diesel trucks, heavy machinery, and loud music. A single very loud noise can damage the middle ear. An eardrum can be broken by sounds reaching 160 decibels to 1,000 Hertz. Also, continuous noise of more than 80 to 85 decibels can cause harm to hearing. Normal conversation is measured at 60 decibels. A noisy restaurant, a vacuum cleaner, an electric shaver, and a screaming child can reach decibels between 80 and 85 decibels. Louder everyday noises include a blow-dryer (100 decibels), a subway train (100 decibels), and a car horn (110 decibels). Anyone exposed to noise in the 80 decibel range should wear hearing protection.

Another common hearing problem is tinnitus
(ringing in the ears). Medications such as aspirin, aminoglycoside antibiotics, and diuretics can cause toxic effects to the hair cells of the organ of Corti, thereby resulting in sensorineural hearing loss. Tinnitus, an internal noise generated within the hearing system, occurs in many types of hearing disorders at all ages, but it is reported more frequently in the elderly. Tinnitus affects seven million people, of which 10 to 37 percent are elderly, and that number is growing. The ringing sound is generally high pitched with sensorineural loss and low pitched with conductive hearing loss. However, tinnitus may be present with or without hearing loss. Some types of tinnitus do not usually awaken people out of sleep nor do they interfere with leisure activities. Older adults can attempt to alleviate the condition through biofeedback or by disguising the sound. Soft radio music and other distracting sounds may offer some comfort.

Treatment and Therapy

There are many treatments for hearing loss and, depending on the type of loss, some treatments work better than others. For example, with conductive hearing loss, if the cause is excessive earwax buildup, then the results can be remarkable when the wax is removed. For both types of hearing loss, conductive and sensorineural, simple measures can be used to facilitate better communication.

One technique that can help in communicating with someone with hearing loss is facing the person when speaking, so that he or she can see one’s face and lips. Using simple, short sentences or phrases and speaking slowly in a low voice can be helpful. Loudness is not helpful and can be irritating, whereas a low voice enables people to hear lower frequencies, which usually can be heard more easily.

Although hearing aids
may help certain types of hearing loss, many people do not like to use them. A person wearing such a device for the first time needs to go through an adjustment period, and some older adults do not give themselves enough time to get used to the hearing aid. Some hearing aids have been known to cause irritation to the external ear. Also, the increased humidity within the external auditory canal may cause infectious otitis externa.

There are basically three kinds of hearing aids: the body type, the behind-the-ear-type, and in-the-ear type. The body type resembles a handheld amplifier with a wire that attaches to an earpiece. The behind-the-ear type is worn behind and in the ear. A person with poor eyesight and rheumatoid arthritis would probably benefit from the body type or behind-the-ear type. These types are easier to see and handle because of their larger size. The in-the-ear devices are small and cosmetically more acceptable, but they are more difficult to manipulate. The selection often depends on the wearer’s personal preference, vision capabilities, and manual dexterity.

It takes time to adjust to using a hearing aid. Sounds and voices are made louder, not clearer. The wearer must become accustomed to the background noise. Often, the user must be encouraged to continue using the hearing aid during this adjustment period. The greatest satisfaction is achieved with hearing aids if hearing loss is between 55 and 80 decibels. There is only partial benefit if the loss is greater than 80 decibels.

Perspective and Prospects

Hearing is regarded by some to be the most important of the five senses. It is imperative for people to protect their hearing for as long as they can. In today’s world, where excessive noises are bombarding eardrums everyday, people need to protect themselves.

Hearing loss occurs when hair cells in the ear are damaged or destroyed by excessively loud noise or moderately loud noise for prolonged periods of time. Hearing loss usually occurs gradually and without pain. Over time, sounds become muffled and higher frequency sounds become hard to distinguish. Normal conversation occurs around 60 decibels. Anything higher than 60 decibels for extended periods of time may lead to hearing loss. According to the Ear Institute in Los Angeles, about 30 percent of hearing loss is due to exposure to loud sounds.

There are ways to reduce excessive noise levels in the environment. First, the time exposed to loud noises should be limited. This can be accomplished by removing the sound or decreasing the volume. The popular audio products now on the market can pose a risk to hearing. Most people are not aware of the potential dangers of listening to music at high volumes. A person listening to music by wearing earphones should not be heard by the person standing next to them. Similarly, a loud device such as a vacuum cleaner should be operated for no more than ten minutes at a time, with a five-minute break between uses.

It is interesting to note that hearing loss results from both loudness and time exposure. For example, a one-time gunshot noise near the ear can be just as damaging as extended exposure to loud music at 120 decibels for fifteen minutes or more. Anyone working in an environment that reaches noise levels of more than 85 decibels for extended periods of time should wear protective devices. Earplugs and hearing protection devices are needed for construction workers, traffic personnel, musicians, disc jockeys, air traffic personnel, nightclub employees and patrons, or anyone exposed to loud noises.

Scientists are conducting research to discover whether damaged hair cells of the ear are capable of rebuilding their structure over a forty-eight-hour period (the time that it takes for hearing to return after a temporary loss). Researchers speculate that permanent hearing loss may occur when self-repair mechanisms are compromised.

Scientists are studying blood flow in the cochlear section of the ear to evaluate how drugs may affect hair cells. Researchers are also examining blood flow to the cochlea when people are exposed to conversational sound and loud sounds. It seems that when a person is exposed to loud sounds, the blood flow in the cochlea drops. Drugs that are used to treat blood flow problems, such as in peripheral vascular disease, may show a benefit to maintaining blood flow to the cochlea. These and other drug therapies may show promising results in helping people with hearing loss. Finally, with a reduction in harmful noise, hearing loss will decrease.

Bibliography

Carmen, Richard, ed. The Consumer Handbook on Hearing Loss and Hearing Aids: A Bridge to Healing. 3d rev. ed. Sedona, Ariz.: Auricle Ink, 2009.

Carson-DeWitt, Rosalyn. "Hearing Loss." Health Library, September 10, 2012.

Craine, Michael. Hear Well Again: A Step by Step Program to Better Hearing. Chapel Hill, N.C.: Professional Press, 1999.

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What is forensic pathology?

Science and Profession

Forensic medicine probably is best known to most people because of the work of forensic pathologists, principally for the autopsies that they perform as coroners and medical examiners. Other experts, however, also are key participants in the field. They include anthropologists, histologists, odontologists, psychiatrists, serologists, toxicologists, police officers, and specialists in trace evidence. Except for the forensic psychiatrist, who is called on to determine the sanity of an accused individual and thus that person’s fitness to stand trial, the above-listed specialists generally do not become involved in the work of forensic medicine until a death has occurred that obviously is other than from natural causes.

In the United States, a forensic pathologist is a medical doctor who typically will spend three to four years preparing in that field after graduating from medical school and two or so years beyond that before being certified by the American Society of Clinical Pathologists. Other forensic specialties generally require a four-year college degree as well as specialized training after that.

Forensic medicine is not a crowded field. Indeed, there is a shortage of trained and qualified people, because most such jobs are in the public sector, where salaries are good but not as high as similar skills and knowledge will command in the private sector. Those who choose careers in forensic medicine, however, find the work more exciting, intellectually challenging, and personally satisfying than most private-sector jobs.

Duties and Investigative Techniques

As a general rule, the coroner, supported to a greater or lesser extent by one or more of the specialists listed above, will become involved in a death when a person dies by suspected criminal or other violent means, by suicide, suddenly when in apparent good health, or in any suspicious or unusual manner. In such a case, the coroner typically is charged by law with determining the cause, mode, and manner of death, with each of those terms having a specific meaning. The physical cause of death is a purely medical determination. Legal considerations, on the other hand, are broader and more inclusive.

Both medical and legal aspects, however, are so interrelated that they cannot be separated. For example, to determine the physical cause of death, it would be sufficient to show a penetrating wound to the heart. To determine the mode of death, however, it would be necessary to establish whether the wound was caused by a bullet or a sharp instrument. An autopsy would reveal the mode of death. The next question is legal: What was the manner of death? In other words, how was the wound inflicted? Was it self-inflicted? If it was, was it intentional (suicide) or accidental? If it was inflicted by another person, was it an accident or was it homicide? Investigation of the scene where the injury was sustained, examination of the evidence found there, and statements of witnesses would furnish information as to the circumstances of the incident.

The actual autopsy involves the dissection and examination of a dead body—surgery performed postmortem. It begins with what is called a gross examination—that is, a visual examination with the naked eye, first externally and then internally. For the internal examination, a Y-shaped incision is made beginning at each shoulder, running down to and meeting just below the sternum or breastbone and continuing as a single cut down to the lower portion of the abdomen just above the genital area. Rib cutters are used to expose the thoracic area. The internal organs are removed and examined. Fluids are drawn for laboratory tests, and tissue samples are taken for microscopic examination. Access to the brain is gained by using a small powersaw to remove the top part of the skull. The third portion of the autopsy involves the toxicological examination of body fluids, including blood, urine, and the vitreous humor of the eye. After examination, the body is restored, and the incisions are carefully sewn.

Perspective and Prospects

Probably the first well-known person to be the subject of a postmortem examination was Julius Caesar. A physician named Antisius determined that of the twenty-three wounds that Caesar sustained, the one that perforated the thorax was the cause of death. The sixth-century Justinian Code of the Byzantine Empire required the opinion of a physician in certain circumstances and often is credited as the first recognition of the correlation of law and medicine in effecting legal justice. By the sixteenth century in England, investigations were being made by a representative of the king, who had the title of Custos Placitorum Coronae (guardian of the decrees of the crown), from which comes the word “coroner.” It is believed that William Penn appointed the first coroner in the American colonies. In the nineteenth century, forensic medicine became established as a distinct specialty and has continued to mature into the advanced and sophisticated field that it is today.

The capabilities of and advances in forensic medicine traditionally are tied to those of science in general and applicable medical specialties. They set the pace for the development of forensic medicine. The future should prove no different. The advances in overall knowledge of deoxyribonucleic acid (DNA), the development of scanning electron microscopy, improvements in spectrographic analysis, and advances in computer graphics capabilities, for example, occurred outside the field of forensic medicine and subsequently were adopted by it.

Bibliography

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Pollanen, Michael. "Forensic Pathology and the Miscarriage of Justice." Forensic Science, Medicine & Pathology 8, no. 3 (September 2012): 285–289.

Schuliar, Yves, and Peter Knudsen. "Role of Forensic Pathologists in Mass Disasters." Forensic Science, Medicine & Pathology 8, no. 2 (June 2012): 164–173.

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In Three Men in a Boat by Jerome K. Jerome, what happens to the three friends at Datchet when they are looking for a hotel?

This story is recounted by the narrator in Chapter XII, as a memory from a past river trip. The same three friends had landed at Datchet at 10 p.m. and had wanted to find a place to stay overnight. But the first inn they came to didn’t have honeysuckle growing around it (as J. would have preferred); and at the second one, Harris didn’t like the looks of the man who was leaning against the front door. They continued on, and soon found out that these were the only inns in Datchet. They turned around and went back, only to learn that both inns were now quite full of guests. Based on local advice, they then moved on to a beershop, to a grocer’s, and to an old woman who rented rooms. All were full. The men were despondent. Harris sat down and said he would not go any farther.

“At that moment an angel came by in the disguise of a small boy,” J. says. The boy led them to his mother’s small cottage. She fed them fairly decently. George and J. slept in one small bed, and Harris slept in the young boy’s bed, all uncomfortably. They had learned their lesson about being picky about inns, J. concludes. “We were not so uppish about what sort of hotel we would have, next time we went to Datchet.