In Romeo and Juliet, how does the ring that the nurse gives to Romeo represent a symbol?

The ring symbolises Juliet's overwhelming love and commitment to her first and only love, Romeo. It becomes more than just that, however, if one considers the turgid circumstances in which the two lovers find themselves. Their families have been lifelong enemies and the two lovers' current situation is that 'new mutiny' implies that old hatreds have flared up again, creating a disturbance in the beautiful and peaceful city of Verona.

What makes the situation much, much worse, though, is that Romeo has killed Juliet's cousin, Tybalt, in a duel when he avenged his friend, Mercutio, who had been killed by Tybalt. Prince Escalus has banished Romeo permanently, at the risk of the young lover forfeiting his life if he should be discovered in Verona.

The two lovers had, before these unfortunate developments, agreed to get married secretly with Friar Laurence conducting the ceremony. The nurse has just heard about the tragic events which have resulted in Romeo's sanction. She informs Juliet of the circumstances and the young girl is overwhelmingly distraught, so much so that she even considers committing suicide:

for Romeo is exiled:
He made you for a highway to my bed;
But I, a maid, die maiden-widowed.
Come, cords, come, nurse; I'll to my wedding-bed;
And death, not Romeo, take my maidenhead!

The nurse, however, tells her that she will speak to Romeo and urge him to secretly visit Juliet. It is then that Juliet presents her with the ring:

O, find him! give this ring to my true knight,
And bid him come to take his last farewell.

Against this backdrop, Juliet's token of love becomes almost sacrificial. She is saying, by presenting this ring to him, that she is prepared to risk everything, even her life, to be with him. She shows her unconditional allegiance to her love, Romeo, who should in fact, now more than ever, be her lifelong enemy.

When Romeo receives the ring, his spirits too, are revived for he had also felt suicidal. The ring to him symbolises some hope for happiness for he now knows that Juliet is still his and that, irrespective of the devastating circumstances they find themselves in, they will still have, and possibly be with, each other. He declares:

How well my comfort is revived by this!

He bids friar Laurence goodbye, saying:

But that a joy past joy calls out on me,
It were a grief, so brief to part with thee: Farewell.

What is qualitative research?

Introduction

Qualitative methodology is a type of scientific inquiry that emphasizes the qualities or essences of the phenomenon under study. This type of research relies on nonnumerical data, such as words and images. For example, Rosemarie Rizzo Parse in Qualitative Inquiry: The Path of Sciencing (2001) defined qualitative research as “the systematic study of phenomena with rigorous adherence to a design, the data of which comprises oral, written, or artistic descriptions of human experiences, and for which there are no digital findings.”

Historical Foundations

Qualitative research grew out of naturalistic inquiries conducted in the disciplines of sociology, anthropology, and linguistics, but is now readily applied across the social sciences. This methodological approach has been used to investigate research questions in psychology and has been widely used in the fields of anthropology, sociology, nursing, social work, administration, community services, management, education, and medicine.

Qualitative methods have been used to investigate research questions ill-suited to quantitative methods, provide rich descriptions of particularly complex or multidimensional phenomena, give voice to traditionally marginalized groups, serve as an initial exploration toward the development of theories or quantitative measures, illuminate the diverse perspectives and experiences of several people experiencing a similar event, and connect research to applied practice.

Features of Qualitative Research

Qualitative investigations contain several common features that distinguish them from other types of scientific inquiry. For example, in Qualitative Research and Evaluation Methods(3d ed., 2002), Michael Quinn Patton has outlined ten primary characteristics of qualitative research: naturalistic inquiry, inductive analysis, holistic perspective, qualitative data, personal contact and insight, dynamic systems, unique case orientation, context sensitivity, empathic neutrality, and design flexibility. Psychology’s interest in qualitative approaches has grown in the twenty-first century. Several events have occurred that are examples of the emergence of qualitative methods in psychology. Psychology journals (such as the Journal of Counseling Psychology) have published special issues devoted to qualitative methods. There has also been an increased appreciation for how qualitative methods can be used to bridge the science-practice gap within the field of psychology. Researchers have also expressed a growing understanding of how such methods are congruent with the paradigms that characterize the helping professions. Psychological researchers have also increasingly begun using mixed models. Common qualitative approaches include phenomenology, case study, and grounded theory.

Phenomenology

Phenomenology seeks to describe the meaning individuals give their life experiences and is based on the philosophy that observable, measurable, duplicable (that is, quantitative) approaches to psychological inquiry are prone to missing, or even altogether eliminating, the most important phenomenon under study, human experience. It concerns itself not with explanation and control but rather with understanding and description. According to Paul F. Colaizzi in his essay “Psychological Research as the Phenomenologist Views It,” in Existential-Phenomenological Alternatives for Psychology (1978), it is “a refusal to tell the phenomenon what it is, but a respectful listening to what the phenomenon speaks of itself.”

There is no single phenomenological method, but most approaches fall under one of two major methodological umbrellas: hermeneutic or empirical. Hermeneutic phenomenological approaches are concerned with analyzing and understanding written narratives to understand and describe human experience. The goal is to produce a rich, deep description of a phenomenon as it emerges within a text, which can be done by analyzing the life texts, or written experience, of participants, or by studying previously written historical or literary narratives. The researcher works to overcome personal assumptions to understand and describe the phenomenon itself, as viewed in context from the text’s perspective. Phenomenology seeks to explore and describe the unique meaning assigned to experience by persons who have lived through a common phenomenon. Phenomenology also provides a flexible step-by-step process for data analysis, the result of which is a description of the essence of participants’ experience in terms of both their common and unique experiences.

Case Study

Case study research has a long and rich history, especially within the disciplines of medicine, law, business, and the social sciences. Yet, this form of qualitative research was not conceptualized as a specific approach until the late 1970s and 1980s. The emphasis of case study research is on understanding phenomena from a specific case or cases within a bounded system. According to Patton, the primary function of case study research is “to gather comprehensive, systematic, and in-depth information about each case of interest.” Robert E. Stake suggests that there are three different types of case studies. The primary investigation into one specific case is known as an intrinsic case study. In an instrumental case study, researchers study a particular case as a means to better understanding a specific issue. A collective case study involves the use of numerous cases to understand a particular phenomenon.

Case study research differs from other qualitative methods in several ways. It seeks to determine and describe the prevailing processes of the phenomena under investigation. Another key characteristic of case study research is that it makes a comparison of all the data sources, such as interviews, documents, and observations, within a contextual and historical framework. Case study research also attempts to integrate empirical data with theory. According to Sharan B. Merriam in Case Study Research in Education: A Qualitative Approach (1988), this approach to research also focuses on “thick” descriptions of the phenomena being studied; case study research uses “complete, literal description of the incident or entity being investigated.” In addition, case study procedures engage the researcher in examining the data from the onset of the investigation.

Several basic assumptions are innate to case study research. First, a case may be chosen because it is unique and therefore is of interest. Second, the phenomenon under study is bound to a specific system, consisting of complex and interrelated elements. Third, an emphasis should be placed on understanding the intrinsic particulars of a phenomenon. Fourth, the research process is influenced by the perceptions of the researcher. Moreover, through careful comparative analysis of the data, and theory, a greater understanding of the phenomenon can be obtained.

Grounded Theory

Grounded theory is a major qualitative tradition. Sociologists Barney G. Glasser and Anselm L. Strauss introduced this qualitative tradition in Discovery of Grounded Theory: Strategies for Qualitative Research (1967). The goal of grounded theory is to discover and develop comprehensive theories. It is a general methodology for theory development that comes from systematically gathered and analyzed data. The emphasis of grounded theory is on theory generation (developing theory from data) rather than on theory confirmation, or hypothesis testing. As a result, researchers have the freedom to modify procedures (for example, sampling changes) and methods (for example, reworking interview protocols) in accordance with the data.

Several basic assumptions are unique to grounded theory. The social phenomenon under study is seen as both complex and repeatedly adapting to the environment. Through a systematic approach, researchers can understand, predict, and control human behavior. Grounded theory also recognizes that the research process is subjective in nature and views the researcher as an active participant. Theory emerges through careful comparative analysis of the data.

Evaluative Criteria

The criteria that should be used to evaluate qualitative research have been the cause of great debate among many qualitative researchers. Several researchers have attempted to evaluate qualitative research in terms of internal validity, external validity, reliability, and objectivity, which have traditionally been used in quantitative approaches. Kelly J. Devers states, in his 1999 article on qualitative research, that these criteria largely evolved out of the positivistic paradigm, which judged the scientific method suitable for researching all forms of knowledge (natural and social) and defined what that method should entail. Yet, qualitative research is based in postpositivistic philosophy, which proposes “reality is dynamic, contextual, and socially constructed.” The differences in philosophical perspectives lead to a split between many quantitative and qualitative researchers.

During the late 1970s and mid-1980s, several qualitative researchers started challenging the positivistic criteria that had been used to evaluate qualitative research and began calling for a new set of criteria. Out of this dialogue came several diverse sets of evaluative criteria. Among these new advances were the criteria set forth by Norman Lincoln and Yvonna Guba: credibility, transferability, dependability, and confirmability. Credibility refers to the degree to which the results of a study have merit and accurately represent the experienced reality of its participants. Transferability is the qualitative counterpart of the quantitative concept of external validity or generalizability. It refers to the degree to which findings can be generalized or transferred to people, settings, and times similar to those found in the original study. Dependability is the qualitative counterpart to quantitative reliability. Dependable investigations can be relied on to accurately and impartially report the findings that emerged. Confirmability refers to the degree to which the results of the investigation can be objectively corroborated by the obtained data.

Bibliography

Bamberg, Paul M., Jean E. Rhodes, and Lucy Yardley, eds. Qualitative Research in Psychology: Expanding Perspectives in Methodology and Design. Washington, DC: Amer. Psychological Assn., 2003. Print.

Creswell, John W. Qualitative Inquiry and Research Design: Choosing Among the Five Traditions. Thousand Oaks: Sage, 1998. Print.

Creswell, John W. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Thousand Oaks: Sage, 2002. Print.

Denzin, Norman K., and Lincoln Yvonna, eds. Handbook of Qualitative Research. Thousand Oaks: Sage, 2000. Print.

Devers, Kelly J. “How Will We Know ’Good’ Qualitative Research When We See It? Beginning the Dialogue in Health Services Research.” Health Services Research 34 (1999): 1153–88. Print.

Forrester, Michael A., ed. Doing Qualitative Research in Psychology. Thousand Oaks: Sage, 2010. Print.

Frost, Nollaig. Qualitative Research Methods in Psychology: Combining Core Approaches. Maidenhead: Open UP, 2011. Print.

Glasser, Barney G., and Anselm L. Strauss. The Discovery of Grounded Theory: Strategies for Qualitative Research. New York: Aldine de Gruyter, 1967. Print.

Patton, Michael Quinn. Qualitative Research and Evaluation Methods. 3rd ed. Thousand Oaks: Sage, 2002. Print.

Willig, Carla. Introducing Qualitative Research in Psychology. 3rd ed. New York: McGraw, 2013. Print.

What is veterinary medicine?

Science and Profession

Animals become sick, get injured, or fail to perform as well as they should, just
as humans do. Humans, however, have developed a much more sophisticated medical
expertise about themselves than they have about the wide variety of other animals.
The basics of this medical knowledge apply to other animals, but the physiological
differences of each of the many kinds of animal species preclude the application
of human medical care. Much of veterinary knowledge has traditionally been
concerned with a few common species, such as cats, dogs, cattle, sheep, goats,
swine, horses, and some birds. Other species are receiving increasing attention,
however, and their medical needs are becoming more widely acknowledged and better
understood.

Most of the medical fields concerned with human health apply to veterinary health
practice as well, including anatomy, anesthesiology and pharmacology,
biochemistry, cardiovascular medicine, cell biology, dental medicine, dermatology,
disease pathology, emergency and critical care, endocrinology, epidemiology,
gastroenterology, genetics, geriatric medicine, hematology, immunology, internal
medicine, microbiology, nephrology and renal medicine, neurology, obstetrics,
oncology, ophthalmology, orthopedics, osteopathic medicine, otorhinolaryngology,
physiology, psychiatry, surgery, and urology. There has been much progress in the
veterinary applications of these fields. There has also been considerable progress
in the application of the expertise, techniques, and equipment used in these
fields to an increasingly wide variety of animal species. This development is
attributable to both an improved knowledge of and interest in these other species
and a growing ethical concern for this wider range of species.

Not only have humans become more knowledgeable about how to care for less common
domestic and wild animals, it has also become more acceptable to do so. As a
result, veterinarians have become involved with a much wider range
of employment opportunities in government, business, universities, and zoological
parks, although most are still in private practice and dealing with farm
livestock, horses, cats, and dogs. In addition, veterinarians are also working in
a wider range of locations, including clinics, research laboratories, farms,
zoological parks, and the wild. There are also more employment opportunities for
veterinary
technicians, paraprofessionals who assist the veterinarian or
who carry out certain veterinary duties when the veterinarian is not
available.

Veterinary medicine is both a distinct medical field and an extension of human
medical fields. It deals with species quite different from humans, the degree of
difference ranging from slight (such as with primates) to great (such as with
birds, reptiles, amphibians, and fish). While medical doctors deals with only one
species, veterinarians are concerned with a multitude of species. Therefore,
medical doctors tend to specialize in a particular field, while veterinarians tend
to specialize in particular kinds of animals. There are some similarities and many
differences between human medicine and veterinary medicine, with one common ground
being zoonoses, those diseases that can be transmitted between
humans and other animals. These degrees of similarity and difference among species
are a primary concern for the veterinarian and are one of the things that make
veterinary medicine such an interesting subject.

Most veterinarians perform routine clinical work, both in the office and in the
field, dealing with farm livestock, domestic pets, and racing horses and dogs.
However, some are involved in other kinds of work. Veterinarians may work with
exotic pets; exotic livestock, such as on ostrich or alligator farms; zoological
park and aquarium animals; or laboratory animals. They may maintain healthy game
herds and flocks, such as deer and turkeys; translocate wild animals from one area
to another; work with teams doing scientific research that involves animals; help
with efforts to save endangered species, either in the wild
or in captivity; work with beached porpoises, whales, and other sea mammals; or
advise government agencies concerned with animal-welfare issues.

In addition to treating sick and injured animals, veterinary medicine involves advising on preventive measures, making routine observations of individual animals or groups of animals, evaluating herd management, assessing environmental and housing conditions, assisting with births, and performing necropsies. Veterinarians working with laboratory animals, zoological park animals, native game species, or endangered species may also provide advice on reducing stress; assisting with propagation strategies, including various artificial propagation techniques; tranquilization; translocation techniques; the gathering of tissue samples; and other animal-welfare matters.

The control of epidemic diseases in farm livestock or native wildlife is also
carried out by veterinarians. Diseases that may be introduced by imported animals,
particularly exotic species, are of interest as well. For example, parrots
imported for the pet trade are capable of transmitting diseases that could affect
poultry, as are migrating native bird species. Imported exotic hoofstock can
introduce diseases that could affect farm livestock, as could the importation of
farm livestock from already infested areas.

For these reasons, species similar to those on farms and ranches, usually birds and hoofstock, are subjected to medical quarantines and other medical restrictions. The transfer of animals or animal products from one country to another by private citizens is strictly controlled. Diseases that can be passed to humans by animals, particularly those sold as pets, are closely monitored. Another problem involving both medical doctors and veterinarians is those diseases that can be passed from native wild animals to humans, either directly or through other host species, such as insects.

Veterinarians working in the field on medical problems involving native wildlife, imported exotic species, or endangered species are often on their own, working at remote sites and frequently carrying their clinics on their backs. Improvisation, creativity, and adventure are typically part of their practice.

In summary, while the application of veterinary medicine involves the same kinds of medical fields as those used in human medicine, the methods, techniques, equipment, medicines, and treatments are different. The degree of difference depends on the species and the area of operation, which ranges from urban clinics to rural farms to the wilds of remote wilderness areas.

Diagnostic and Treatment Techniques

Most medical fields are much better developed for use with humans than with animals, because humans know so much more about themselves than they do about the other animal species. Humans constitute only one of innumerable species—one that has been studied in depth for quite some time. Unlike human medicine, veterinary medicine is concerned with many animal species, each of which has its own physiological parameters. In addition, different categories of animals—mammals, birds, reptiles, amphibians, or fish—have significantly different body systems. These different categories and species have to be treated differently when determining whether an animal is normal and healthy and when prescribing treatment for a sick animal.

The best-understood groups of animals are the ones that have been of concern to
the veterinary profession for the longest period of time, namely farm livestock
and pets. More recently, other groups have received attention, including animals
in zoological parks, laboratory animals, native wildlife, and endangered species.
As ethical concerns have extended beyond the human race, more concern has been
shown for the health of all animal species. There remains much to learn about the
many species that are not dealt with on a regular basis by veterinarians.

The diagnosis and treatment of an illness or injury depend on the kind of animal
being examined. Since the animal cannot tell its owner or the veterinarian what is
wrong, it is up to the veterinarian to discover this information. The diagnosis is
therefore particularly important. First, the veterinarian must analyze any
abnormality. On a clinical level, this means a general physical examination, a
special examination of the suspect system or organ, a special examination of the
problem area, and a medical history, as well as laboratory tests and a comparison
with peer performance standards. Second, if applicable, the veterinarian must
analyze the pattern of occurrence of the abnormality in the herd; this process
includes an epidemiological examination and an evaluation of general management,
environmental factors, time of year, nutritional status, and genetics. The
veterinarian then categorizes and defines the abnormality, prescribes a treatment,
follows up on the treatment, and advises the owner on prevention.

The first step in providing care is knowing when an animal is sick. An injury is easier to detect, but it may still be difficult to determine the extent of the injury. Lack of performance may or may not be a medical problem. It is easier to determine when an illness is present in animals with which humans are very familiar, such as pets, horses, or livestock. It becomes more difficult with other mammals and birds, and especially with fish, reptiles, and amphibians.

The species of the animal being evaluated must be known, along with the
physiological parameters for that species. The medical history of the
individual—and, if applicable, the other individuals with which it is associated,
such as a herd—is also necessary. A clinical examination is then used to determine
the current medical situation, supplemented by a laboratory examination and an
epidemiological examination. These examinations include consideration of past
diseases and treatments, nutrition, behavior, general appearance, skin condition,
voice, eating habits, defecation and urination, posture, and gait; the inspection
of specific body regions; a physical examination, including taking the animal's
temperature and pulse; consideration of environmental factors, such as housing,
source of water supply, sanitation, and chemical contaminants; and laboratory
tests on specimen samples from the animal and the environment.

Based on this information, a diagnosis is made and a treatment is prescribed. The
diagnosis should provide information on the disease or injury, the etiology of the
disease, and the clinical manifestation—that is, the severity or extensiveness—of
the disease. The treatment may involve additional care, surgery, medication, a
change in diet, or a change in the animal’s environment.

Follow-up on the treatment may also be necessary, as well as continued monitoring
and reexamination. Medicines can have side effects, and multiple medicines can
have synergistic effects. Another problem is that animals tend to care for
themselves by licking, pulling at bandages, and other behaviors that can undo what
the veterinarian has done. Also, animals are not able to say whether they are
feeling better, although this can often be determined by observing the animal’s
return to normal behavior.

Preventive health care is as important for animals as it is for humans. This type
of care may involve vaccination shots, pills, proper nutrition,
dental care, reduction of stress, exercise, sanitation and proper housing, the
quarantine of exotic species, or simply observation of behavior.

Low performance may be a medical problem, but is difficult to detect because the
problem tends to be a subclinical disease. The performance of livestock and racing
animals may require the attention of veterinarians. The efficient performance of
livestock is economically important to the farmer, and an assessment of a herd’s
productivity is usually done by comparing its performance with a standard that is
based on known performances of peer herds. Productivity can have several meanings,
including reproductive efficiency, the amount of milk or meat produced per animal
or per hectare, calf survival rate, longevity, and acceptability or quality of the
milk or meat at market. Low performance might be caused by a number of factors,
such as inadequate nutrition, poor genetic inheritance, improper housing, stress,
lack of herd-management expertise, subclinical diseases, physiological
abnormalities, or anatomical problems.

Although some veterinarians specialize in a particular medical field, for the most
part, a veterinarian has to be familiar with all medical fields in order to treat
an animal. While these fields are basically the same whether one is treating a
human or an animal, veterinary medicine is complicated by the fact that each
species has different body structures and physiological parameters. Also,
different equipment and techniques are necessary in applying these medical fields
to animals. For example, the principles of anesthesiology are well understood, but
applying anesthesia to a human is not the same as applying it to a dog, a horse,
or an elephant. The gases and doses used, the equipment needed, and the procedures
performed must be tailored to the particular kind of animal being treated.

Most veterinary work is carried out in the clinic, particularly small-animal practice, which usually involves cats, dogs, and other common pets. Large-animal practice, typically involving farm livestock and horses, is often done at specially designed on-site areas at a farm or ranch. Veterinary schools have both small-animal and large-animal clinics. While small animals are easily handled, large animals need pens, squeeze cages, tilting tables (able to tilt from a vertical position, in which the animal is strapped onto it, to a horizontal position), and other equipment to restrain them during the examination. Large-animal veterinarians working on a farm or ranch also use veterinary vehicles that are stocked with whatever the veterinarian normally needs. In rural areas, the animals requiring care tend to be too far away from the clinic for veterinarians to repeatedly return to the clinic for supplies while making rounds, so their vehicles are specially adapted as mobile clinics, either by the veterinarians themselves or by commercial companies.

Perspective and Prospects

Animal
domestication developed around 8000 BCE. With humankind’s
increasing dependency on domestic animals, it became necessary to care for their
medical needs. The Code of Hammurabi, a legal code from
Babylonia that dates to the eighteenth century BCE, mentions payments to animal
doctors if they successfully care for an animal and punishment if they are not
successful. Papyri from ancient Egypt contain the oldest known veterinary
prescriptions (ca. 1900 BCE). The first veterinarian known by name was from India
(ca. 1800 BCE). It was also in India that the first known animal hospitals were
established, around 250 BCE. The Aztecs of ancient America also had animal doctors
for the large royal animal collections. Ancient civilizations treated diseases
with herbs and rituals; some surgical procedures were performed, and some injuries
were treated. Medical instruments were crude, and care was based on magic and
folklore. This was not unusual during a time when medicine, science, and religion
were integrated into one limited body of knowledge. The fact that an effort was
made to care for animals indicates their importance to these early societies.

While medical knowledge increased in ancient China and Greece, veterinary
knowledge did not. In the Roman and medieval periods, practitioners simply
compiled and transcribed what had already been done. Nevertheless, the advances
made in medical knowledge—for example, the determination that diseases have
natural rather than divine causes—would affect veterinary medicine as well.

The Renaissance brought about a renewed interest in many areas of study, including
veterinary medicine. In particular, there was concern about farm livestock and
horses because of their increasing economic importance to society. In addition,
much of the medical research conducted during this time was done with animals.
Advances in veterinary medicine at first coincided with those in medicine in
general but were eventually made for their own sake. The first short-lived
veterinary schools appeared in Spain around 1490, and the first modern ones
appeared in Europe during the eighteenth century. It was not until the nineteenth
century, however, that methodological observation and examination became the
foundation for diagnoses and veterinary medicine passed from the common
practitioner to the academic or professional practitioner.

One significant effect of the growth of veterinary medicine and its acceptance by the general public has been the concept of animal rights, which has increased the provision of medical care to pets, exotic animals, and native wildlife. At the same time, veterinary knowledge has been extended to amphibians, reptiles, and fish, as well as to a larger array of birds and mammals.

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Ballard, Bonnie, and
Ryan Cheek, eds. Exotic Animal Medicine for the Veterinary
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Wallach, Joel D., and
William J. Boever. Diseases of Exotic Animals: Medical and Surgical
Management. Philadelphia: Saunders, 1983. Print.

What is virtual reality as an alternative therapy?

Introduction

After World War II, computer scientists and engineers developed technology, such as flight simulators, that provided an early foundation for virtual reality through digitization, real-time graphics, and interactive and pointing devices. By the early 1980s, medical and computer science professionals collaborated to integrate their specialties. Some medical professionals incorporated virtual reality as a tool to learn and practice medical procedures, especially surgery, by manipulating virtual organs. Virtual reality underwent a transition from laboratories to hospitals. Physicians reported that virtual reality eased the pain that burn patients felt by distracting them and making them unaware of the real world through immersion in alternative environments such as snowy landscapes, which convinced patients that they felt coolness.

Another foundation for modern virtual reality was the computer program ELIZA. Created in 1966 by Joseph Weizenbaum, ELIZA was not strictly a virtual reality environment but an early form of computer-simulated psychotherapy. Although ELIZA was a grammar program that used only text, it seemed to engage the user in Rogerian therapy. By the early 1990s, virtual reality had expanded to creating both visual and auditory environments.

Virtual reality techniques were appropriated for psychological applications by the early 1990s to influence people’s perceptions and psychological processes. Computer hardware and software were developed to simulate specific situations for therapeutic sessions. This technology enabled phobic patients to interact safely with situations that arouse fear. Phobic patients often prefer virtual reality therapy because they can encounter their fears in private instead of in public situations. In 1998, CyberPsychology and Behavior: The Leading Psychology Journal for Internet, Multimedia, and Virtual Reality Research began providing a centralized forum to advance virtual reality as a therapeutic tool. Software improvements enabled the creation of more virtual environments to meet therapeutic demands. Although there was significant interest in virtual reality therapy early in the twenty-first century, by 2005 much of that enthusiasm had cooled, although there has been renewed interest in using virtual reality platforms such as Second Life, Multiverse, and Active Worlds to address psychological issues.

Therapies

Six types of virtual reality therapies have been tested. All rely on convincing people that they are experiencing an environment by making it realistic to their senses of sight, hearing, and touch. The desktop method involves interacting with images on a computer screen by using pointing devices. Projected virtual reality casts the patient’s image into an artificial setting. Cave virtual reality displays images on the walls of a small room, allowing several people to participate in therapy simultaneously. Telepresence delivers a setting from another place on a video screen that the patient observes. Augmented virtual reality uses objects that enhance the setting for specific therapies. Immersive virtual reality is used most frequently and includes aspects of other virtual reality types. In contrast to two-dimensional computer images, virtual reality creates a three-dimensional environment composed of computer graphics. People believe they are immersed in and participating in the simulation. This illusion is enabled by devices that participants wear that aid them to interact with and manipulate the virtual setting. A head-mounted visor has a stereoscopic optical display. The scenery is adjusted by motion-tracking sensors attached to people’s heads and limbs, and the experience seems more realistic because graphics respond convincingly to movement. Additional sensors in datagloves improve the illusion by suggesting that the participant is interacting with items located in the virtual world and navigating through the setting.

Treatment

Many psychologists have been skeptical as to whether virtual reality can be advantageous for therapeutic use. Many professionals consider the expense associated with equipment and operation of some types of virtual reality therapy to be prohibitive. In addition, they consider virtual reality at worst to be an irrelevant technology more suitable for entertainment than therapy and at best to be an experimental therapy requiring additional research. Gradually, the benefits of virtual reality have secured the approval of some mental health practitioners, many of whom admit to being surprised at patients’ successful improvement due to virtual reality exposure (VRE) therapy. Virtual reality therapy has been used to address a variety of potential psychological problems and other difficulties, including phobias, post-traumatic stress disorder, autistic spectrum disorders, and addictive behaviors. It has been used in the area of cognitive assessment and for self-improvement in the area of weight management.

Phobias

Virtual reality’s most frequent psychological application is treatment for phobias. VRE therapy parallels traditional therapy in which a patient’s exposure to a situation or object stimulus that arouses acute fear and anxiety is gradually increased. Such exposure is either in vivo (actually experienced by the patient) or in vitro (imagined by the patient). The degree of exposure is deliberately increased over time. Individuals become conditioned and desensitized, learn not to panic, and develop more receptive attitudes.

Virtual reality creates a safe, private environment in which patients can confront their fears without being publicly embarrassed or risking physical harm. Compared with most real settings and props, such as airplanes and animals, that are necessary for conventional phobia therapy, virtual reality is inexpensive and more controllable. Multiple stimuli can be presented. Specific stimuli can be isolated, and distractions can be eliminated. Virtual reality also allows therapists to develop settings not easily located in their communities.

Patients can face frightening situations and objects virtually that they could not initially handle in person. These virtual depictions of dangerous settings are more realistic than most patients would imagine. Virtual reality enables people to overcome the limitations of their imagination and memory. Active interaction with anxiety-arousing stimuli causes patients to feel more in control, confident, and capable than undergoing more passive observational and listening therapies. Virtual reality allows people in remote places to experience settings and fears that are not available to them in their immediate surroundings.

Virtual reality has proven effective in countering acrophobia (fear of heights), claustrophobia (fear of enclosed spaces), agoraphobia (fear of open spaces), arachnophobia (fear of spiders), and aerophobia (fear of flying). Patients with social phobias such as fear of public speaking can practice skills with virtual reality to interact more comfortably with people. Research teams are also considering the possibilities of patients and therapists being immersed in virtual reality settings together.

Post-Traumatic Stress Disorder

Chronic post-traumatic stress disorder (PTSD) has been addressed through the use of virtual reality. At the Georgia Institute of Technology’s College of Computing, a group of Vietnam veterans with PTSD were treated using virtual reality therapy. During virtual reality sessions, therapists encouraged veterans to narrate their military experiences. The veterans were asked to repeat their stories many times to bolster their memories. Although many veterans were reticent to share their stories in traditional therapy, virtual reality freed them to become more talkative and physical as they interacted with virtual comrades and enemies in a setting that included combat sounds.

Such experiences helped the veterans deal with guilt about such things as being the sole survivor of an attack. Although their PTSD was not eliminated, many veterans experienced a lessening of problems after they revisited their memories via virtual reality. Veterans’ hospitals have incorporated virtual reality equipment into therapy treating chronic anxiety disorders.

The Weill Cornell Medical Center in New York City has used virtual reality to address a variety of PTSD situations, including among veterans of the Persian Gulf and Iraq wars. Virtual reality therapy has also helped survivors of the terrorist attacks on the World Trade Towers on September 11, 2001. The treatment includes virtual exposure to the towers before, during, and after their collapse for individuals who experienced the attacks from within the towers and from afar. All treatment is under the guidance of a therapist who makes sure the patient does not become overwhelmed by the experience.

Autistic Spectrum Disorders

Through virtual reality worlds such as Second Life, individuals can seek out others for social interaction. In Second Life, users create an avatar that is a representative of themselves and use that avatar to interact with the virtual environment and other avatars in that virtual environment. Self-help groups are not uncommon in Second Life. Through virtual reality, individuals with autistic spectrum disorders can reach out to others with similar concerns and problems. Geographically diverse individuals can interact and help each other. For example, a young man with Asperger syndrome established Naughty Auties, a resource center for individuals with autistic spectrum disorders, in Second Life. However, seeking help in the unregulated environment of virtual reality carries significant risk in that the avatars’ real identities are unknown, as is the veracity of their statements. Despite this drawback, virtual reality, which does not have the same pressures as real-life social interactions, seems to provide an optimum place for individuals to practice social interactions in a variety of virtual settings without the risk of failing in the real world. Research is just beginning in this area, but some results have been promising.

Addictive Behaviors and Self-Improvement

Virtual reality has been used to deal with addictive behaviors such as smoking. In virtual reality environments, patients can practice coping skills when confronted with virtual simulations of situations and stimuli that trigger their addictive behaviors. The virtual environment seems to provide the right balance of believability of stimuli without the risk of real-life failure. Virtual reality also has been used therapeutically for patients’ self-improvement.

Eating disorders have been successfully treated with virtual reality methods that often supplement traditional forms of therapy. The virtual-reality-based experiential cognitive treatment of obesity and binge-eating disorders assists people to modify their flawed body perceptions. Improved body awareness obtained through an integration of virtual environments and traditional cognitive behavioral and visual-motor therapies results in awareness of latent feelings, decreased problematic eating, and displays of more normal social behavior.

Research has also confirmed that virtual reality can be used to make exercising more enjoyable. Similar to watching television or listening to music while exercising, virtual reality can provide a distraction. Instead of biking in the gym, virtual reality can allow the individual to bike through the English countryside or on the course for the Tour de France.

Measurement, Neuroscience, and Education

Virtual reality environments allow patients who are unable to function in normal settings to respond to stimuli presented in real time. Neuroscientists can then gauge individuals’ cognitive abilities. Virtual reality has proven effective in rehabilitating some individuals who are cognitively impaired because of brain injuries or diseases such as Alzheimer’s. Patients are tested with virtual reality scenarios that researchers can control and adjust as needed to assess how well individuals function.

Virtual settings offer people with neurological impairments the opportunity to interact with an environment to which they would otherwise lack physical access to enrich their sensory and motor skills. Virtual reality classrooms have been designed to evaluate and measure the cognitive abilities of children who possibly have attention-deficit hyperactivity disorder (ADHD). Most cognitive researchers consider virtual reality tests less biased than traditional tools and do not consider its lack of realism, comparable to that of a photograph, problematic. Virtual reality has proven beneficial in working with children with a variety of reading disabilities and delays. School districts have used virtual reality games that engage students with a story line to increase reading scores. Virtual reality has also been used to successfully teach other subjects.

Side Effects and Risks

Virtual reality is limited by its costs, complexity, technology, and reliability, as well as the technical proficiency of users. Time delays, noise, and distortions (particularly in body image sessions) can impede therapy, although technological advances will continue to address these issues. To improve techniques, virtual reality researchers have begun investigating human-computer interaction with clinical tests. They are interested in how people perceive and accept or reject computer-generated worlds as a mental health treatment method. Researchers evaluate whether virtual reality therapy is more time- and cost-effective than traditional techniques.

Some patients may experience simulation sickness, which is a form of motion sickness, and nausea. Careful design of virtual scenarios and screening of patients can minimize such adverse reactions. Some people’s neck muscles are too weak to support heavy virtual reality helmets, and many claustrophobic patients are reluctant to wear the bulky helmets. Some users experience depth perception problems. Sometimes virtual reality confuses patients, and virtual experiences replace real experiences in memories. Migraines and seizures are also a possibility. Despite these risks, many patients, however, seem receptive to virtual reality techniques.

Although virtual reality does present many opportunities for treatment and growth, the unregulated environment of many virtual reality worlds, such as Second Life, Multiverse, and Active Worlds, presents many opportunities for the development and expression of pathologies. This particular negative aspect of virtual reality has received little research attention, although warnings abound. In virtual reality, just as in the online environment in general, where the usual social constraints on behavior are often lacking, individuals can behave in very pathological ways, and far from practicing positive social interactions, individuals may find themselves engaging in relationships that mirror the negative patterns they follow in real life or that exhibit an even higher degree of pathology. Behaviors such as stalking, emotional abuse, and manipulation are all possible. Vulnerable and needy individuals may lose sight of where reality ends and virtual reality begins. Their online relationships and interactions can become more real to them than their real-life relationships and interactions.

In the virtual environment, people engage in all sorts of behavior that they would not otherwise engage in. They have virtual sex with strangers and sell their virtual bodies. In a recent divorce case in England, the husband was engaging in virtual sex with prostitutes in Second Life. His wife cited his online behavior as a cause for divorce. The virtual world also offers a multitude of opportunities to find others who share a person’s pathologies and thereby can confirm these negative beliefs and reinforce them.

Bibliography

Baumann, Stephen, and Michael A. Sayette. “Smoking Cues in a Virtual World Provoke Craving in Cigarette Smokers.” Psychology of Addictive Behaviors 20.4 (2006): 484–489. Print.

McLay, Robert N. At War with PTSD: Battling Post-Traumatic Stress Disorder with Virtual Reality. Baltimore: Johns Hopkins UP, 2012. Print.

Mühlberger, Andreas, Heinrich H. Bülthoff, Georg Wiedemann, and Paul Pauli. “Virtual Reality for the Psychophysiological Assessment of Phobic Fear: Responses During Virtual Tunnel Driving.” Psychological Assessment 19.3 (2007): 340–346. Print.

North, Max M., Sarah M. North, and Joseph R. Coble. Virtual Reality Therapy: An Innovative Paradigm. Colorado Springs: IPI, 1996. Print.

Riener, Robert, and Mattias Harders. Virtual Reality in Medicine. London: Springer, 2012. Digital file.

Riva, Giuseppe, Brenda K. Wiederhold, and Enrico Molinari, eds. Virtual Environments in Clinical Psychology and Neuroscience: Methods and Techniques in Advanced Patient-Therapist Interaction. Amsterdam: IOS, 1998. Print.

Rothbaum, Barbara O., and Larry F. Hodges. Virtually Better: Therapist Manual for Fear of Flying. Atlanta: Virtually Better, 1997. Print.

Villani, D., F. Riva, and G. Riva. “New Technologies for Relaxation: The Role of Presence.” International Journal of Stress Management 14.3 (2007): 260–274. Print.

Wiederhold, B. K., and G. Riva. Annual Review of Cybertherapy and Telemedicine 2012: Advanced Technologies in the Behavioral, Social and Neurosciences. Amsterdam: IOS, 2012. Digital file.

What caused the becalmed ship?

A lack of wind and breeze caused Kit's ship, the Dolphin, to move along the river at a very slow pace.  The journey took nine days in all as the boat sailed on "the forty-three mile voyage."  After passing Saybrook, the breeze faded away as the "sails sagged limp and soundless, and the Dolphin rolled sickeningly in midstream."  Goodwife Cruff and her husband were already suspicious of Kit.  The slowness of their journey made them even more suspicious of her.  The couple "considered the becalmed ship" to be Kit's fault.  It is implied in the story that they suspected her of being a witch, which was a grave crime in that time.  

The word "becalm" describes when a lack of wind causes a ship to be still.  This word accurately described the situation of the Dolphin on the river for most of those nine days.  On the last day, a breeze came and it took the ship to Wethersfield.

In "The Story of an Hour," which sentence or ensemble of sentences would best describe the fact that, back then, when the husband was happy, the...

Taken as an illustration of marriage in the late 19th century, this story shows that a husband's happiness clearly does not correspond to his wife's happiness. In fact, it argues that the woman's happiness is often suppressed. 

But for the sake of argument, consider some sentences that suggest a loving marriage. 

Louise's grief does suggest a connection to her husband. 

She wept at once, with sudden, wild abandonment, in her sister's arms. 

When Louise's grief subsides and her feelings and thoughts turn towards her newly discovered freedom, she does reflect upon her marriage to Brently. She considers how he always "looked" upon her with love: 

She knew that she would weep again when she saw the kind, tender hands folded in death; the face that had never looked save with love upon her, fixed and gray and dead. 

He "looked" upon her with love. Note, that the narrator does not say that he spoke to her with love, nor did he necessarily treat her with love and respect. Simply looking upon her with love shows a kind of objectification. 

Considering her new independence, Louise considers her love for Brently: 

And yet she had loved him—sometimes. 

These sentences show Louise's natural reaction to the death of an important person in her life. And in this story, they are the most favorable comments upon the notion that Louise's happiness corresponded to her husband's own happiness. But they are hardly convincing. And the rest of the story clearly shows that Louise's happiness was not based upon her husband's happiness. In fact, the story argues the opposite point. Louise was unhappy. Her husband ruled over her and this was characteristic of many marriages during this period. This story argues that a husband's happiness simply does not imply the wife's happiness. The story argues that women were dependent upon their husbands. And this dependence was a culturally inscribed role. As a result, the wife's happiness was overlooked and deemed unimportant. With Brently gone, Louise actually begins to understand happiness for the first time: 

There would be no powerful will bending hers in that blind persistence with which men and women believe they have a right to impose a private will upon a fellow-creature. 

What is cervical cancer?

Related conditions:
Squamous intraepithelial lesion (SIL), dysplasia, human papillomavirus (HPV) infection

Definition:

Cervical cancer is a slow-growing cancer of the female reproductive organs. The two primary types of cervical cancer are squamous cell carcinoma and adenocarcinoma. Classified by microscopic examination, squamous cell carcinoma accounts for 90 percent of diagnosed cases. The majority of the remaining cases are classified as adenocarcinoma, a cancer that develops from the mucus-producing gland cells in the endocervix. Additionally, a very small minority of cervical cancer cases demonstrate characteristics of both types and are therefore classified as adenosquamous or mixed carcinomas.

Risk factors: The most significant risk factor for developing cervical cancer is infection with high-risk types of human papillomavirus (HPV). HPV is sexually transmitted, and certain sexual behaviors can increase the risk of infection: sex at an early age, multiple sexual partners (directly or indirectly through a partner who has multiple sexual partners), and sex with an uncircumcised partner. Although use of condoms does not eliminate the potential for HPV infection because any skin-to-skin contact can be sufficient to transmit the virus, condoms nonetheless do provide limited protection. Studies have identified the following additional risk factors:

• Obesity/low-fiber diet





• Smoking





• Concomitant infection with another sexually transmitted disease such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), or chlamydia





• Long-term oral contraceptive use





• Multiple full-term pregnancies





• In utero exposure to diethylstilbestrol (DES, a hormone prescribed from 1940 to 1971 for some pregnant patients considered at high risk for miscarriage)





• Family history of cervical cancer

Etiology and the disease process: Human papillomavirus (HPV) is a group of more than one hundred distinct viruses, with approximately forty strains capable of infecting the genital tract. Researchers have classified fifteen HPV types as high risk for cancer development, with a nearly two-thirds prevalence of types 16 and 18 in cervical cancer samples. In the vast majority of cases, HPV infection is spontaneously cleared by a healthy immune system. In a minority of cases, however, the virus can remain latent for years before eventually converting normal cervical cells to cancerous ones. Because only a small percentage of women infected with HPV progress to cervical cancer, lifestyle and immune system competence are believed to play a vital role in the progression of the disease.

Incidence: Cancer of the cervix is second only to breast cancer in prevalence among women worldwide. Nearly 500,000 new cases are diagnosed each year, with a greater than 80 percent occurrence in developing countries.

Age-standardized incidence rates fall in the 15 per 100,000 range for most first-world countries. In the United States, more than 11,000 new cases are diagnosed each year, with nearly 4,000 deaths annually.

Symptoms: Early cervical cancer does not generally produce any distinguishable signs or symptoms. Abnormalities found in screening tests are the most common and effective method for detecting the presence of precancerous and cancerous cervical cells. As untreated disease progresses, symptoms may include unusual vaginal bleeding (after intercourse, between periods, postmenopausal); watery, bloody, and foul-smelling vaginal discharge; pelvic pain; or pain during intercourse.

Screening and diagnosis: Extensive cervical screening programs designed to detect early, precancerous cervical changes are well established in most developed countries. Exfoliative cytology (Pap test) is the primary component of these programs, although molecular HPV deoxyribonucleic acid (DNA) testing is also commonly incorporated. Colposcopy is a second-level diagnostic procedure used as a follow-up to abnormal screening results.

Named after the physician who developed the procedure (Papanikolaou), exfoliative cytology, or Pap test, is a screening procedure involving the collection and microscopic evaluation of cervical cells. During a routine pelvic examination, cervical cells are collected by broom, brush, spatula, or other means. These cells are either smeared directly onto a microscope slide (as in the traditional, “dry” Pap smear) or transferred into a liquid medium to concentrate the cells for subsequent transfer onto a slide. This new liquid-based cytology has demonstrated greater test sensitivity because more cells can be analyzed.

The HPV DNA test is a molecular analysis of a cervical sample to determine the presence of HPV and its type. This test is used in conjunction with an abnormal Pap test as an additional diagnostic tool.

A colposcopy is a pelvic examination in which a light source and binocular microscope are used to enable a direct magnified inspection of the patient’s cervix, vagina, and vulva. Application of a weak acetic acid solution also serves to highlight any suspicious abnormalities.

Following abnormal screening results, additional tests may be ordered to confirm diagnosis and determine how far the cancer has spread (staging):

• Biopsy: Analysis of a small section of tissue collected from the cervix





• Proctoscopy: Visual inspection of the rectum for the presence of cancer





• Imaging (such as X ray, magnetic resonance imaging, computed tomography, positron emission tomography): Patient/organ appropriate imaging to inspect for cancer spread (metastasis)

Cervical cancer is staged based on tumor size, invasive nature, and degree of metastasis (spread to lymph nodes/organs). Cervical cancer is staged with the International Federation of Gynecology and Obstetrics (FIGO) system:

• Stage 0: Carcinoma in situ; superficial cancer is detected in the cervical lining.





• Stage I: Cancer has invaded the cervix but has not spread.





• Stage IA: Microscopic amounts of cancer cells are present.





• Stage IA1: Cancer invasion is less than 3 millimeters (mm) deep and less than 7 mm wide.





• Stage IA2: Cancer invasion is between 3 and 5 mm deep and less than 7 mm wide.





• Stage IB: Cancer is greater than 5 mm deep and greater than 7 mm wide.





• Stage IB1: Cancer is visible but less than 4 centimeters (cm).





• Stage IB2: Cancer is visible and greater than 4 cm.





• Stage II: Cancer has spread beyond the cervix but is contained within the pelvis.





• Stage IIA: Cancer has spread to the upper part of the vagina.





• Stage IIB: Cancer has spread to the parametrial tissue (next to the cervix).





• Stage III: Cancer has spread to the lower part of the vagina or the pelvic wall.





• Stage IIIA: Cancer has spread to the lower third of the vagina.





• Stage IIIB: Cancer has spread to the pelvic wall or blocks urine flow.





• Stage IV: Cancer has spread to nearby organs.





• Stage IVA: Cancer has spread to the bladder or rectum.





• Stage IVB: Cancer has spread to more distant organs.

Treatment and therapy: Treatment of cervical cancer largely depends on disease stage. The three treatment options are surgery, radiation, and chemotherapy.

Surgical removal is used primarily for nonmetastatic lesions. Cryosurgery uses a metal probe cooled with liquid nitrogen to freeze cancerous cells. Laser surgery uses a laser to burn (vaporize) cancerous cells. In conization, a thin, heated wire (LEEP, or loop electrosurgical excision procedure) or surgical/laser knife (cold knife cone biopsy) removes the affected tissue. Rarely used as a sole treatment, conization aids in diagnosis before additional surgery or alternative treatment. In a hysterectomy, the degree of the removal of uterine tissue (simple vs. radical) depends on the stage and patient circumstances.

Radiation employs high-energy X rays to kill cancer cells, either externally (external beam radiation) or internally via a radioactive capsule (brachytherapy).

Chemotherapy uses anticancer drugs (such as cisplatin, paclitaxel, topotecan, ifosfamide, or fluorouracil) taken orally or intravenously to treat metastasized cancer.

Prognosis, prevention, and outcomes: Early detection through effective screening programs offers a high probability for complete cancer eradication. Continued adherence to annual cervical screening and healthy habits is integral to continued remission.

A new vaccine, Gardasil, approved by the Food and Drug Administration offers protection against the most dangerous, high-risk HPV types 16 and 18. It also protects against types 6 and 11, which cause genital warts. For greatest efficacy, the vaccine should be administered before the patient has become sexually active. The Federal Advisory Committee on Immunization Practices (ACIP) recommends vaccination for girls aged eleven and twelve. The committee also recommends that nonvaccinated women from age thirteen to twenty-six receive catch-up vaccinations. Although the American Cancer Society (ASC) agrees with the initial vaccination protocol, it recommends catch-up vaccinations for young women aged thirteen to eighteen only. ACS recommends that older women discuss the potential benefit of the vaccination with regard to their personal risk factors for previous exposure to HPV.

Devita, Vincent T., Jr., Samuel Hellman, and Steven A. Rosenberg, eds. Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2005.

Saslow, D., et al. “American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors.” CA: A Cancer Journal for Clinicians 57 (2007): 7-28.

Stewart, Bernard W., and Paul Kleihues, eds. World Cancer Report. Lyon, France: IARC Press, 2003.