Saturday 30 November 2013

In the play Hamlet, King Hamlet (the father of Prince Hamlet) and Claudius are brothers. If that is so, then why are there so few examples of how...

King Hamlet, the father of Prince Hamlet, only appears briefly in Shakespeare's play, in the form of a ghost urging his son to take revenge on Claudius for his murder. The reason that there are not many examples of the differences between the two brothers is that King Hamlet has been murdered before the play starts and therefore is not a central character. We don't receive much characterization to attribute to Kind Hamlet.


Prince Hamlet,...

King Hamlet, the father of Prince Hamlet, only appears briefly in Shakespeare's play, in the form of a ghost urging his son to take revenge on Claudius for his murder. The reason that there are not many examples of the differences between the two brothers is that King Hamlet has been murdered before the play starts and therefore is not a central character. We don't receive much characterization to attribute to Kind Hamlet.


Prince Hamlet, in certain ways, idealized his father and Shakespeare may have intended to suggest that King Hamlet was an ideal ruler and Claudius a bad one. First, Claudius poisoned his brother, which is a morally wrong act. The marriage to Gertrude, despite Hamlet's protestations, may actually have been a moral act, a way of taking care of his brother's widow. Although it may have been intended to suggest adultery before King Hamlet's death. Hamlet points out the difference between her current and former husband to Gertrude in the following lines:



See what a grace was seated on [King Hamlet's] brow;


... Look you now, what follows;


Here is your husband [Claudius]; like a mildew'd ear ...



King Hamlet appears to have been widely respected and loved both by his subjects and by foreign kings. Claudius' dealings tend to be more duplicitous and he may be perceived as a less powerful warrior, as is seen in Fortinbras' attempt to reclaim lands from Denmark after the death of King Hamlet. 

What is automaticity? |


Introduction

Psychologists have found it useful to classify many aspects of human mental and motor performance as either “automatic” or “controlled.” Automatic processes are those that are carried out with ease, often requiring little or no attention. They can usually also be performed simultaneously with other tasks. Controlled processes, on the other hand, are more difficult and typically require a person’s full attention. Because they require so much attention, it is difficult to do anything else at the same time. Research on automaticity has outlined the conditions under which each type of processing can develop, as well as the conditions under which each works best.







Development

To illustrate automaticity and its development, consider the task of driving an automobile. Driving really involves many tasks, such as steering, looking out for traffic and pedestrians, obeying traffic lights and signs, changing speed, starting and stopping as traffic changes, and perhaps even discussing directions with a passenger. When first learning to drive, most people have difficulty doing all these things at once. When they see a stop sign, for example, they may have to decide consciously and deliberately which pedal to push to stop the car. For novice drivers, holding a conversation while driving is also difficult; if they pay attention to their driving, they will not hear what their passenger says, but if they listen and respond to their passenger, they may be endangering themselves and others. After some experience, however, the same person may be able to stop at a stop sign, check for oncoming traffic, and then proceed safely, all while holding up his or her end of a conversation.


What has changed to make reacting to a stop sign so much easier? Psychologists describe this phenomenon by saying that for a novice driver, the act of stopping at a stop sign is controlled, but through practice, it becomes automatic. Another activity in which this change occurs is reading, which is initially very difficult. With practice, however, a skilled reader no longer has to think about reading as a deliberate act. Instead, when the reader points his or her eyes at a printed page, he or she recognizes the words automatically.




Role of Mapping

Walter Schneider and Richard Shiffrin have done extensive research on how and under what conditions a process changes from controlled to automatic. The shift is a gradual one; to put it another way, automaticity is a matter of degree. From the examples above, it is clear that practice is a key ingredient in automaticity. Schneider and Shiffrin's research has highlighted the relevance of both the type and the degree of practice. They have described two kinds of practice: practice with consistent mapping, which promotes automaticity; and practice with varied mapping, which does not. The term “mapping” here refers to the relationship between stimulus and response, specifically which response is mapped onto each stimulus. Varied mapping refers to a situation in which a stimulus should sometimes be responded to and sometimes be ignored.


To return to the driving example, the difference between consistent and varied mapping can be illustrated by the difference between a stop sign and a yield sign. A stop sign involves consistent mapping, because the only response one should ever make to a stop sign is to stop; the sign never calls for any other response. Such is the hallmark of consistent mapping: there is only ever one response to make to a certain stimulus, and the stimulus never appears under circumstances in which it should be ignored, so that particular response is always (consistently) mapped to that particular stimulus. As a result of always stopping at stop signs, the response becomes automatic and can be executed without a pause in a conversation between the driver and a passenger. A yield sign, on the other hand, involves varied mapping, as its presence calls on the driver to make a decision in response to current conditions. If no traffic is coming, the yield sign means that the driver should continue without stopping; if there is other traffic coming, however, it means that the driver should stop.


To promote automatic processing, large amounts of practice with consistent mapping are needed. The mental or physical act thus practiced becomes automatic: easy to perform, even in conjunction with other activities, but very difficult to change, in part because it calls so little attention to itself. Automaticity has costs as well as benefits. One such cost is the large amount of practice required to develop automaticity. The inflexibility of automatic processes can also lead to inappropriate responses if the situation changes. As an example, imagine the difficulties faced by drivers in Sweden in the 1960s, when the nation switched from driving on the left side of the road to driving on the right. Drivers setting off to work on the morning after the change might well have found themselves driving on the (now) wrong side of the road. This is an extreme example, but any time that flexibility of response is required, controlled processes, though somewhat slower, may be better. Where flexibility is not a problem and quick response is needed, automaticity should be encouraged.




Dual-Task Methodology

Much of the research conducted on the development of automaticity has involved a letter-search task, in which a subject is seated before a computer monitor and told to look for a letter (or several different letters). The subject starts the task and begins seeing a series of letters on the screen. Whenever one of the items the subject is looking for appears, he or she must press a key on the computer keyboard. Usually subjects do many such trials, divided into two types. In some trials, they always search for the same letters, such as P and C; this is consistent mapping, because the stimulus and the expected response are always the same. In another series of trials, however, the letters they are searching for change every few trials. This is varied mapping. Note that if the letters P and C were used for the consistently mapped condition, they never appear as distractors (nontargets) in the varied mapping condition. The only time the subject sees them is when they are targets.


To test for the development of automaticity, a common approach is to employ a dual-task methodology. After considerable training at the task described above, typically twenty to thirty hours, a second task is added that the subject must perform at the same time. One task that has often been used is a category-search task, in which the subject is shown words as well as letters and must decide whether each word fits into a certain category (for example, “pieces of furniture”) while continuing to search for the letters. The typical finding is that subjects who are searching for the consistently mapped letters (P and C, in this example) will show little change in their reaction time, that is, the time between seeing the letter and responding to it. They will continue to make rapid, accurate responses to the letter-search task while also doing well at the category-search task. On the other hand, subjects who practiced the letter-search task with different letters, and thus experienced varied mapping, will suddenly become slower and less accurate, and they will do poorly in the category-search task as well. Just as the novice driver has to think about what to do when approaching a stop sign and will pause in a conversation, so the subject searching for varied targets will find sharing two tasks difficult.


One interesting example of the degree to which a task may become automatic was given by the concert pianist Charles Rosen. When practicing for a performance of a piano concerto that he knew well, he found that he became bored, so he began to read light novels while practicing. Reading is a relatively automatic task, which he could apparently combine easily with the (at least partially) automatic task of playing a well-practiced piece of music.




Role of Drilling

Upon examining many skills, it becomes evident that at least some aspects of most, if not all, of them are (and probably must be) automatic. Driving consists of many component skills—some automatic, such as steering and braking at stop signs, and some controlled, such as choosing at which corner to turn. The same is true in other areas as well. One reason for drills during sports practices is to increase automaticity so that responses are quick and reliable. In baseball, a base runner who had to stop to plan how to slide into base would have a short career. In education, a teacher must be able to recall the multiplication tables quickly and accurately to use them easily at each step in multiplying two three-digit numbers.


One practical issue raised by research on automaticity is the degree to which drilling is necessary in educational practice. At one time, educational practice relied heavily on large amounts of drilling. More recently, drilling has been seen as boring and irrelevant to education, promoting memorization rather than understanding. The truth is that drilling, or repetitive practice, is absolutely essential to gaining many of the fundamental skills necessary for deeper and more nuanced learning. Without enough drilling in algebra, for example, students find that their first course in calculus is mostly spent trying to figure out the algebra of the equations, with an accompanying reduction in understanding of the new material. Further research will provide more information about the optimum amount of drilling: enough so that the skill being practiced can be easily integrated into more complex tasks, but not so much that students are discouraged through boredom.




Evolution of Automaticity Study

In
The Principles of Psychology
(1890), William James, who was a principal founder of American psychology, described the fact that some mental acts are so easy that one hardly notices them, while others require careful thought and attention. It is exactly this distinction that finds modern expression in the distinction between automatic and controlled processes. It was not until the 1970s that experimental psychologists, including Schneider and Shiffrin, developed ways to study automatic processes and especially the acquisition of these processes.


The development of cognitive psychology, beginning in the 1950s, has shown the benefit to psychology of studying complex psychological processes by trying to identify and study their various components. By focusing on one part of the overall task at a time, more adequate experimental control can be gained and each component skill can more easily be studied. By knowing the conditions under which automaticity develops and using approaches such as dual-task methodology to help measure it, those parts of a complex task that are best performed automatically can be isolated. That isolation can lead to improvements in learning, because aspects of a complex skill that can be performed automatically can be subject to drilling. It also can help improve understanding of complex mental processes, such as reading, which can lead to the discovery of ways to help new learners understand what is required for mastery.




Contribution to Attention Studies

The study of automaticity has added to the general study of phenomena of attention. Fully automatic processes, such as well-trained letter searches in a Schneider and Shiffrin experiment or braking at a stop sign, seem to require almost no attention at all. A popular view of attention is the “resource” approach, suggested by Daniel Kahneman, which treats attention as a limited resource that can be assigned fairly flexibly. When a task to which one is paying attention is fairly easy (that is, uses few attentional resources), it can often be performed at the same time as another task. If a task requires considerable attentional resources, however, one is unable to perform another task at the same time. For example, driving in a thunderstorm or on icy roads makes conversation difficult for the driver, who will probably not even respond if a passenger tries to start a conversation. In this case, the driver must attend and respond in a controlled manner to many aspects of driving that are usually automatic. Thus, the concepts of automatic and controlled processes fit well with one of the major approaches to the study of attention.




Bibliography


Bargh, John A., et al. "Automaticity in Social-Cognitive Processes." Trends in Cognitive Sciences 16.12 (2012): 593–605. Print.



Charlton, Samuel G., and Nicola J. Starkey. "Driving on Familiar Roads: Automaticity and Inattention Blindness." Transportation Research: Part F 19 (2013): 121–33. Print.



D'Angelo, Maria C., et al. "Implementing Flexibility in Automaticity: Evidence from Context-Specific Implicit Sequence Learning." Consciousness and Cognition 22.1 (2013): 64–81. Print.



Kahneman, Daniel. Attention and Effort. Englewood Cliffs: Prentice, 1973. Print.



Schneider, Walter. “Training High-Performance Skills: Fallacies and Guidelines.” Human Factors 27.3 (1985): 285–300. Print.



Smyth, Mary M., et al. Cognition in Action. 2nd ed. Hillsdale: Erlbaum, 1994. Print.



Solso, Robert L. Cognitive Psychology. 8th ed. Boston: Pearson, 2008. Print.



Teachman, Bethany A., et al. "Automaticity in Anxiety Disorders and Major Depressive Disorder." Clinical Psychology Review 32.6 (2012): 575–603. Print.



Wickens, Christopher D., et al. Engineering Psychology and Human Performance. 4th ed. Boston: Pearson, 2013. Print.



Wyer, Robert S., ed. The Automaticity of Everyday Life. Mahwah: Erlbaum, 1997. Print.

What are phytochemicals? |


Protective Role and Abundance

People who eat a diet rich in fresh fruits, vegetables, and whole grains obtain some protection from various diseases because of the phytochemicals that the plants contain. Phytochemicals are not traditional nutrients, such as proteins, carbohydrates, or fats; nor are they vitamins or minerals. Instead, they are substances that plants produce to protect against environmental stresses, such as attack by fungi and other organisms, or to attract animal pollinators or seed dispersers. Many phytochemicals are plant pigments, giving fruits and vegetables their animal-luring colors. There are thousands of phytochemicals, and plant species vary widely in the kinds and amounts that they contain.



Many phytochemicals have antioxidant properties, meaning that they help protect cells from oxidative damage, which has been implicated in cancer, diabetes, heart disease, strokes, and other disorders. Some phytochemicals function in humans in ways similar to the female hormone estrogen.


Although diets rich in plant-based foods have been shown to result in lower incidences of a number of diseases, scientists have had difficulty pinpointing which of the many different phytochemicals are protective. It may be that the interaction of a variety of naturally occurring phytochemicals, rather than any particular ones, is the significant factor in promoting health.




Some Major Kinds

One important group of phytochemicals, the carotenoids, includes many antioxidants. Of the numerous health claims that have been made for these plant pigments, one of the few to be substantiated is that increased consumption of lutein, a carotenoid found in green leafy vegetables such as collards, kale, spinach, and broccoli, is associated with a lowered risk for macular degeneration, an eye disease associated with advanced age.


Flavonoids, pigments that belong to a major class of phytochemicals called polyphenols, are abundant in vegetables, fruits such as blueberries and raspberries, and beverages such as tea, red wine, and fruit juices. Some flavonoids, including the widely occurring group anthocyanins, have antioxidant properties. Flavonoids called isoflavones are plant estrogens plentiful in soy products.




Perspective and Prospects

The discovery that phytochemicals are important to human health was not made until late in the twentieth century, and research is still being done. Scientists do not advise taking dietary supplements of particular phytochemicals; rather, they recommend a diet high in a variety of fruits, vegetables, and whole grains. Taking concentrated forms of phytochemicals might be harmful over the long term.




Bibliography


American Institute for Cancer Research, ed. Nutrition and Cancer Prevention: New Insights into the Role of Phytochemicals. New York: Kluwer Academic/Plenum, 2001. Advances in Experimental Medicine and Biology 492.



Bao, Yongping, and Roger Fenwick, eds. Phytochemicals in Health and Disease. New York: Marcel Dekker, 2004.



Meskin, Mark S., Wayne R. Bidlack, Audra J. Davies, Douglas S. Lewis, and R. Keith Randolph, eds. Phytochemicals: Mechanisms of Action. Boca Raton, Fla.: CRC Press, 2004.



Meskin, Mark S., Wayne R. Bidlack, Audra J. Davies, and Stanley T. Omaye, eds. Phytochemicals in Nutrition and Health. Boca Raton, Fla.: CRC Press, 2002.



Meskin, Mark S., Wayne R. Bidlack, and R. Keith Randolph, eds. Phytochemicals: Nutrient-Gene Interactions. Boca Raton, Fla.: CRC Press/Taylor & Francis, 2006.



"Phytochemicals." American Cancer Society, January 17, 2013.



"Phytochemicals and Cardiovascular Disease." American Heart Association, May 1, 2013.



Webb, Denise. “Phytonutrients: The Hidden Keys to Disease Prevention, Good Health.” Environmental Nutrition 26, no. 1 (January, 2003): 1–6.

Friday 29 November 2013

What are complementary and alternative mental health treatments?


Overview

People with psychological problems, including mood, anxiety, eating, sleep, and sexual disorders, seek complementary and alternative medicine (CAM) treatments. In some cases, they rely on these treatments in lieu of extant therapies; in other cases, they use CAM treatments along with traditional therapies.


CAM treatments for mental illness are remarkably diverse in scope. One 2002 review listed more than twenty widely used CAM techniques for mental health. These techniques include aromatherapy, acupuncture, herbal remedies, biofeedback, meditation, yoga, homeopathy, and creative arts (music, art, and dance) therapies. The research evidence for these and other CAM techniques varies in quality and quantity.




Popular Use of CAM

Studies demonstrate that substantial proportions of persons with mental disorders,
in the United States use one or more CAM remedies. One large population-based
survey conducted in 1997 and 1998 revealed that 22.4 percent of Americans with
major depression used one or more CAM therapies. The corresponding
proportions of Americans with panic disorder (a condition marked by
sudden surges of extreme anxiety), generalized anxiety disorder (a
condition marked by high levels of nervousness across many situations), and either
mania or psychosis (conditions often marked by a loss of contact with reality)
were 32.0, 20.5, and 22.3 percent respectively. Persons with major depression and
those with panic disorder were significantly more likely to use CAM treatments
than other persons in the general population.


The study also found that people with mental disorders who used CAM treatments were as likely as those without mental disorders to seek conventional mental health treatments, such as psychotherapy and psychotropic medication. This information is important because certain herbal remedies can interfere with the effects of some widely used medications.


The results of another U.S. study from the same time period yielded higher
percentages than did the 1997/1998 study. The study’s investigative team found
that 53.6 percent of persons with major depression had obtained CAM therapies in
the year before the study; the corresponding number for persons with panic attacks
was 56.7 percent. Among the most widely used CAM therapies (the percentage in
parentheses refers to the proportion of people with major depression and panic
attacks, respectively, using these therapies) were spiritual healing (10.5 and
9.9), energy healing (5.4 and 2.8), herbal remedies (4.3 and 3.3), megavitamins
(3.4 and 3.6), aromatherapy (3.7 and 2.6), and hypnosis (1.8
and 3.0). Most people with major depression (63.9 percent) and with panic attacks
(51.9 percent) who used CAM treatments also obtained conventional treatments.
These latter percentages indicate, however, that large minorities of persons with
mental disorders use CAM treatments in an alternative rather than complementary
fashion. The data are worrisome given that a number of the CAM treatments used by
respondents, such as energy therapies, megavitamins, and aromatherapy, are not
empirically supported for the treatment of either mood or anxiety disorders.


Later systematic survey data on CAM use among persons with mental disorders is lacking. Nevertheless, the data from the late 1990s study suggest that CAM use is prevalent among people with psychological problems, at least in the United States. As a consequence, it is essential to ascertain whether CAM treatments are effective for psychological problems and whether any could be harmful. The sections that follow briefly examine the scientific evidence concerning four commonly used CAM treatments for mental illness: acupuncture, herbal remedies, yoga and meditation, and creative arts therapies.




Treatments and Techniques


Acupuncture. Several investigators have examined the efficacy of
acupuncture for clinical depression. A few early studies
suggested that acupuncture may alleviate the symptoms of depression, but most of
these studies were not conducted in a double-blind fashion and, therefore, may
have been influenced by the expectations of treatment providers or patients, or
both.


The most methodologically rigorous study, published in 2006, randomly assigned 151
persons with major depression to one of three “conditions” lasting eight weeks:
traditional
Chinese medicine acupuncture (condition 1), a sham
acupuncture condition involving needles inserted into the “wrong” areas (condition
2), and a wait-list control condition (condition 3). The results revealed that
both conditions (1) and (2) outperformed (3), but that (1) and (2) did not differ
significantly from each other. Moreover, the effects of both genuine and sham
acupuncture on depressive symptoms were relatively weak. These findings raise
questions concerning the efficacy of acupuncture for depression and suggest that
the effects of acupuncture on mood may be attributable to nonspecific influences,
such as placebo effects; that is, improvement was caused by the mere expectation
of improvement.



Herbal remedies. Although numerous herbal remedies are available
for treating psychological problems, perhaps the two best known are St. John’s
wort (Hypericum perforatum) and kava (Piper
methysticum
). Following the passage of the Dietary Supplement Health and
Education Act by the U.S. Congress in 1994, these and other
herbal remedies for mood have not been regulated by the U.S. Food and Drug
Administration. Therefore, mental health consumers in the
United States take them at their own risk.


The data on the efficacy of St. John’s wort for mood disorders have
been inconsistent. A 2005 meta-analysis (quantitative review) revealed that St.
John’s wort exerted positive effects relative to a placebo among persons with mild
to moderate depression. Nevertheless, the analysis also indicated that St. John’s
wort may be largely or entirely ineffective relative to placebo for persons with
major depression and for those with prolonged depression. The study also found no
evidence that St. John’s wort is more effective than standard antidepressants, such as the selective serotonin reuptake
inhibitors Prozac and Paxil.


A 2010 randomized-controlled trial of 189 persons suggested that St. John’s wort may be more effective than placebo among persons with atypical depression, namely, among those persons who exhibit “reversed” features, such as overeating and oversleeping. Overall, the findings for St. John’s wort point to potential positive effects on mild to moderate depression, and perhaps atypical depression, but offer little or no support for its use for severe depression.


Moreover, persons who take St. John’s wort should be certain to inform their physicians, because the remedy can interfere with the effects of other medications. For example, St. John’s wort can impede the effectiveness of chemotherapy medications and those used to treat human immunodeficiency virus infection. Evidence also exists that St. John’s wort can interfere with the effects of birth control pills, anticoagulants (blood thinners), and antidepressants.



Kava is an herbal remedy that has been used medicinally in
the South Pacific to reduce anxiety. The practice of using kava as an anxiolytic
has spread to other regions. A 2009 study revealed that kava is more effective
than placebo for generalized anxiety. Other evidence suggests that kava is not
more effective than buspirone, an antianxiety agent.


Kava has been deemed unsafe because of its potential to create toxic liver reactions. Researchers have been assessing the efficacy of an aqueous extract of kava to create a mixture that reduces the toxicity of the herb. Further inquiry is required to ascertain this extract’s safety and efficacy.



Meditation. Meditation comprises a heterogeneous
array of self-control techniques, stemming largely from Buddhist and Hindu
traditions and designed to enhance awareness and attention. A 2010 review of more
than sixty studies (spanning thirty-five years) examined the effects of meditation
techniques on a host of mental health difficulties, including mood, anxiety, and
sleeping problems.


Although several of the studies in the review reported negative findings, most yielded preliminary evidence that various forms of meditation exert beneficial effects across a variety of psychological outcome variables. However, the overall quality of the research was limited, rendering any conclusions tentative. For example, many of the studies neglected to include control groups or included control groups of questionable adequacy. In addition, few of the studies incorporated adequate safeguards against client or therapist expectancy effects. In addition, it remains unclear whether meditation exerts positive effects above and beyond simpler interventions, such as relaxation.



Yoga. Yoga consists of a variety of physical
and psychological techniques designed to heighten awareness. Hatha yoga,
which originated in India but has substantially influenced Western forms of yoga,
comprises postures (such as bending and balancing the body), breathing exercises,
and meditation. A 2005 review of five randomized-controlled trials concluded that
yoga shows some promise as an intervention for depression. Researchers also
revealed that the studies varied considerably in the severity of the depression
and nature of the yoga intervention delivered, and often omitted crucial
methodological details.


As a consequence, the literature precludes strong conclusions regarding yoga’s potential effectiveness for depression. Moreover, it remains unclear if any beneficial effects of yoga on depression, anxiety, or other psychological difficulties are attributable to yoga per se or to the relaxation or exercise associated with it.



Creative arts therapies. Creative arts therapies encompass a plethora of CAM treatments and are used in various guises to enhance mental health and to improve creativity, productivity, and interpersonal relations. Such therapies include those of art, music, dance, and poetry.


A 1997 review showed that most of the research on the effects of creative arts therapies on mental disorders has been limited in quality and quantity, and few studies have controlled for placebo effects or the nonspecific effects of attention from mental health professionals. Moreover, most investigations of creative arts therapies demonstrate short-term elevating effects on mood rather than improvements in the core features of mental disorders such as schizophrenia, autism, or major depression.


Of all creative arts therapies, music therapy has been perhaps the most
extensively investigated. A 2006 review of three studies of music therapy for
autism spectrum disorders yielded mixed results. They found positive effects of
music therapy on the communicative and gestural deficits of autism, but no
significant effects on its behavioral deficits. Still, the small sample sizes (the
total number of participants across all three investigations was only twenty-four)
and the paucity of long-term follow-up studies make it impossible to draw clear,
strong inferences. A 2008 review of five studies of music therapy on depression
revealed low rates of dropout and positive results in four of the studies.
Nevertheless, as the study’s authors noted, the substantial variations in the
populations studied, the nature of the interventions, and the outcome measures
administered again render any conclusions tentative.




Conclusions

Survey data demonstrate that large percentages, and perhaps majorities, of people with mental health problems, including mood and anxiety disorders, seek CAM therapies. These findings are troubling, given that most CAM therapies have been insufficiently investigated for such problems. However, preliminary evidence suggests that certain CAM therapies, including some herbal remedies (such as St. John’s wort and kava), meditation, yoga, and music therapy, hold promise for certain psychological difficulties. Still, even these interventions must be regarded as only promising, and all require additional research before they can be regarded as empirically supported and, in the case of herbal remedies, safe for widespread public consumption.


A variety of other widely used CAM methods, including homeopathy,
chiropractic, energy therapies, chelation
therapy, and craniosacral therapy, are not empirically
supported for mental health problems. Therefore, they should not be used in lieu
of treatments of established effectiveness.


Mental health consumers should be aware that a host of factors may contribute to
erroneous beliefs in the effectiveness of certain CAM treatments for psychological
problems. In particular, many emotional difficulties, such as depression, panic
disorder, and sleep, sexual, and eating disorders, often wax and wane in severity
over relatively short time periods. As a consequence, persons with mental health
problems may mistakenly attribute naturally occurring improvement in their
symptoms to CAM interventions. In addition, the placebo
effect can generate improvement that is independent of the
ingredients of the CAM treatments themselves. For these and other reasons, one
should rely on controlled studies, rather than subjective judgments or anecdotes,
to ascertain whether these treatments are effective.




Bibliography


Hughes, Brian M. “How Should Clinical Psychologists Approach Complementary and Alternative Medicine? Empirical, Epistemological, and Ethical Considerations.” Clinical Psychology Review 28 (2008): 657-675. A critical review of how clinical psychologists should evaluate CAM practices, including ethical, empirical, and epistemological perspectives on CAM.



Kessler, Ronald C., et al. “The Use of Complementary and Alternative Therapies to Treat Anxiety and Depression in the United States.” American Journal of Psychiatry 158 (2001): 289-294. A comprehensive survey of CAM treatments for anxiety and depression, including data on how many participants used CAM treatments in lieu of conventional therapies and the perceived helpfulness of these treatments.



Sarris, Jerome. “Kava and St. John’s Wort: Current Evidence for Use in Mood and Anxiety Disorders.” Journal of Alternative and Complementary Medicine 15 (2009): 827-836. A helpful summary of research on the efficacy of kava and St. John’s wort on anxiety and depression, respectively.

Thursday 28 November 2013

How are the Industrial Revolution in Great Britain and the Civil War in the United States connected?

At the time of the Civil War, 1861-1865, the price of cotton was at an all-time high. There was an explosion of textile factories in England during the Industrial Revolution, and the increasingly large British empire gave British manufacturers a larger and larger market. In Manchester, England alone, the number of cotton mills rose from 2 in 1790 to 66 in 1821. Much of the raw cotton in British mills came from the United States,...

At the time of the Civil War, 1861-1865, the price of cotton was at an all-time high. There was an explosion of textile factories in England during the Industrial Revolution, and the increasingly large British empire gave British manufacturers a larger and larger market. In Manchester, England alone, the number of cotton mills rose from 2 in 1790 to 66 in 1821. Much of the raw cotton in British mills came from the United States, specifically the south. In fact, by 1860, the south provided 75% of the world's cotton supply, and it was shipped from ports such as New Orleans, Savannah, Charleston, and Houston. 


The south relied on "King Cotton" as a form of diplomacy during the Civil War. They thought that cotton would allow the Confederacy to be economically independent during the war and that England would ally itself with the Confederacy. However, there was a strong abolitionist lobby in England that made the alliance between the Confederacy and England untenable. In addition, the Union blockade of the Confederacy largely prevented the shipment of their cotton during the war.



How do I find quotations in "The Slave Dancer" regarding the friendship between Ras and Jessie?

In the book, The Slave Dancer by Paula Fox, there are several insightful quotations about the friendship between Ras and Jessie.


When looking for a quote, it helps to have a solid understanding of the book. For example, it helps to know where certain events or relationships occur in the book. In this specific instance, Ras and Jessie’s friendship develops slowly and is primarily prevalent after they are trapped for multiple days in the ship...

In the book, The Slave Dancer by Paula Fox, there are several insightful quotations about the friendship between Ras and Jessie.


When looking for a quote, it helps to have a solid understanding of the book. For example, it helps to know where certain events or relationships occur in the book. In this specific instance, Ras and Jessie’s friendship develops slowly and is primarily prevalent after they are trapped for multiple days in the ship (chapter: “Ben Stout’s Mistake”).


Additionally, if you have an electronic copy of the book, you can also search the book to find specific words. Although searching the name “Jessie” would turn up dozens of responses, Ras is not as prominent. Thus, it would be beneficial to search for “Ras” and see if any of the results discuss Ras and Jessie’s friendship.


After knowing this, it is easier to find quotes about their friendship.  Here are a few quotes about their friendship to help you get started:



“Ras and I ate until the food ran down our chins and we were covered with grease. He pointed at me and laughed. I drew my finger along his chin, showing him the ham fat that had collected on his cheeks. He laughed harder.”



And:



“He [Ras] was gone in an instant. Daniel and I were alone.


I felt such a hollowness then . . .”



And:



“I knew that some part of my memory was always looking for Ras. Once, in Boston, I thought I really saw him, and I ran after a tall slender young black man walking along in front of me. But it was not he.”



Thus, it can be challenging to find quotations. However, by knowing the context, reading the book, and even searching for a word or phrase in an electronic copy, we can find great quotations! 

What is shigellosis? |


Causes and Symptoms


Shigellosis accounts for half of the cases of bloody diarrhea in developing countries and a smaller portion of diarrheal illness in the United States. As of 2009, the World Health Organization reported 120 million cases and estimated that 1.1 million people die of the infection annually. Named after Kiyoshi Shiga, a Japanese scientist who performed much of the original research about it in the aftermath of an 1896 epidemic, Shigella is a gram-negative bacillus. The four species that cause shigellosis are S. dysenteriae, S. flexnerii, S. sonnei, and S. boydii.



The severity of shigellosis is quite variable, ranging from mild diarrhea to death. The more severe illness, dysentery, is characterized by abdominal cramps, tenesmus (a painful urge to defecate), and a bloody, mucus-filled diarrhea. Most victims of this severe illness are children, with those under age five years being particularly at risk with fatality rates around 25 percent. Poverty, malnutrition, poor hygiene, and overcrowding are associated with this serious disease, which is almost never seen in industrialized countries except in travelers who have visited an endemic area of the world. Shigella dysenteriae type 1 is responsible for most of these severe cases.


The pathogenicity (or disease-causing mechanism) of shigellosis is the invasion of the intestinal lining by the bacteria, causing inflammation and ulceration of the intestinal wall. Although Shigella
bacteria also produce a toxin, the role of this toxin in the infection is less clear and remains a research topic of much interest. In contrast to some other intestinal infections such as cholera, shigellosis produces a relatively small fluid volume loss, making dehydration less problematic. Victims also suffer from fever, malaise, and decreased appetite. Transmission of the Shigella bacteria is from person to person; there is no animal reservoir.




Treatment and Therapy

The diagnosis of shigellosis is made by the growth of Shigella in a stool culture. Antibiotic treatment is helpful, but resistance to many antibiotics is increasing. Quinolones, such as ciprofloxacin, are the treatment of choice for adults. Children are often treated with a cephalosporin or a variety of other agents. Azithromycin has been used successfully for multidrug resistant cases. Research continues on a possible vaccine.




Bibliography


Alam, N. H. “Treatment of Infectious Diarrhea in Children.” Pediatric Drugs 5, no. 3 (2003): 151–165.



Bhattacharya, S. K. “An Evaluation of Current Shigellosis Treatment.” Expert Opinion on Pharmacotherapy 4, no. 8 (August, 2003): 1315–1320.



Humes, H. David, et al., eds. Kelley’s Essentials of Internal Medicine. 2d ed. Philadelphia: Lippincott Williams & Wilkins, 2001.



Kabir, Iqbal, et al. “Increased Height Gain of Children Fed a High-Protein Diet During Convalescence from Shigellosis.” Journal of Nutrition 128, no. 10 (October, 1998): 1688–1691.



Vorvick, Linda J. "Shigellosis." MedlinePlus, May 30, 2012.



World Health Organization. "Initiative for Vaccine Research (IVR): Diarrhoeal Diseases (Updated February 2009)." World Health Organization, February, 2009.

Wednesday 27 November 2013

What is fatigue? How does it affect cancer patients?




Risk factors: In the setting of cancer, fatigue may be caused by the type of cancer and its stage, chemotherapy or radiation therapy, stress, anemia, depression, chronic pain, lack of sleep, lack of proper nutrition, nausea and vomiting, infections, dehydration and electrolyte imbalance, and weight loss.



Etiology and the disease process: The causes of fatigue in patients with cancer are not clearly understood and appear to be multiple. Fatigue can be one of the first symptoms of the presence of cancer and can also be an indication of disease progression. The disease of cancer itself can cause fatigue, primarily through the release of cytokines, which are thought to induce fatigue, the increased need of cancer cells to maintain their high rate of metabolism, and the alteration of hormone levels. The stress of having cancer also can be the cause of fatigue. Treatments can lead to fatigue as the body tries to deal with the insult of cytotoxins or radiation and tries to rebuild cells after treatment. Many biological therapies (those that attempt to strengthen the patient’s immune system to fight cancer) have flu–like symptoms, including fatigue, as side effects. Medication used as supportive care (for example, to treat depression or vomiting) can cause fatigue. Another cause of fatigue is lack of sleep, which may be caused by pain, emotional issues, depression, and anxiety. Poor nutrition, caused by lack of interest in food or an inability to eat because of mucositis, diarrhea, nausea, or vomiting, has been implicated in fatigue. Surgery for cancer may be the cause of fatigue, which often lessens as the patient recuperates and heals. One way that cancer can cause fatigue is by spreading to bone marrow, where it destroys red blood cell production and leads to anemia, the most commonly reported cause of fatigue. Both chemotherapy and radiation therapy can destroy bone marrow and cause anemia.



Incidence: Depending on the type of cancer and its treatment, approximately 14 to 96 percent of patients with cancer report feeling mentally and physically fatigued during the course of treatment while 19 to 82 percent of patients report cancer-related fatigue following treatment, according to the National Cancer Institute's 2014 estimates.



Symptoms: Fatigue is manifested by extreme tiredness and inability to perform normal daily functions. Fatigue can then lead to other symptoms, such as depression or poor nutrition (if the patient is unable to shop for groceries or cook). Because of the nature of cancer-related fatigue and its interactions with risk factors and other conditions, it is difficult to pinpoint a single symptom. Common symptoms, however, can include dizziness, confusion, inability to think clearly, loss of balance, being bedridden for more than one day, and worsening conditions (for example, increased vomiting, pain, or depression).



Screening and diagnosis: Because of the complex nature of cancer-related fatigue and its many presumptive causes, it is necessary to carefully rule out causes before effective treatment can occur. It is imperative to understand the pattern of fatigue, including when it started, how long it lasted, and how it changed the patient’s daily activity pattern. If fatigue was reported only after radiation therapy, for example, depression and other medications could be ruled out as the cause. The kind of cancer and its stage is important to know, as are known treatment-related symptoms. The side effects of chemotherapeutic agents or other medications may be instructive in determining the cause of fatigue. The health care provider should understand the patient’s sleep patterns before starting treatment for cancer as well as during treatment for cancer. It is important to know if the patient’s eating habits have changed. Patients should be screened for depression, as this is a common cause of fatigue. Patients may be depressed because of their cancer or because they fear losing their jobs, are having financial difficulties, or are upset about their inability to perform their normal daily activities.


Anemia, which is a common cause of fatigue, can be determined through blood tests. Depression scores can be determined through the use of various screens. No staging is available, however, for grading cancer-related fatigue.



Treatment and therapy: To be treated properly, the source of fatigue whether is it physical, emotional, or psychological must be determined. Because anemia is the most common cause of fatigue, blood tests generally are done to check for low red blood cell counts, low hemoglobin concentration, or both. Anemia can be corrected by blood transfusions. After a focused review, in 2010 the US Food and Drug Administration approved a new risk management program and demanded updated warnings and revised dosing instructions for the use of erythropoiesis-stimulating agents (ESAs) in the treatment of anemia as these agents were found to decrease survival and/or augment the chance of tumor development or reappearance in patients with several types of cancer.


Fatigue due to lack of sleep, depression, or poor nutrition generally can be helped by administration of supportive care, such as drugs, or correction of an underlying cause, such as the inability to shop for and prepare food.


Patients may be able to help themselves by being aware of what causes their fatigue. It may be important to schedule regular naps or limit the number of visitors. It is important to save energy for important tasks and to ask for help with other tasks. Energy levels may be maintained by scheduling regular eating times, including healthy snacks, limiting caffeine and alcohol, and drinking increased amounts of fluids. Some patients report that mild to moderate exercise also helps fight cancer-related fatigue, allows for a better frame of mind, and increases the ability to sleep at night. Exercise can include aerobic or resistance training. Relief of cancer-related fatigue may also come from practicing yoga or meditation. Research suggests that psychosocial interventions, such as group or individual therapy, education, stress management, or support groups, also have a positive effect on cancer-related fatigue.



Prognosis, prevention, and outcomes: Because cancer-related fatigue is often caused by many overlapping factors, it is difficult to predict which patients will be most affected. Fatigue may subside once treatments are completed and the patient’s bone marrow has recovered. Fatigue may increase as the cancer stage progresses and the cancer spreads in the body.



Bower, Julienne E., and Donald M. Lamkin. "Inflammation and Cancer-Related Fatigue: Mechanisms, Contributing Factors, and Treatment Implications." Brain, Behavior, and Immunity 30 (2013): S48–S57. Print.


"Fatigue." National Cancer Institute. Natl. Cancer Inst., 28 Aug. 2014. Web. 10 Sept. 2014.


Hofman, Maarten, et al. “Cancer-Related Fatigue: The Scale of the Problem.” Oncologist 12 (2007): 4–10. Print.


Minton, Ollie, et al. "Cancer-Related Fatigue and Its Impact on Functioning." Cancer 119.S11 (2013): 2124–30. Print.


Morrow, Gary R. “Cancer-Related Fatigue: Causes, Consequences, and Management.” Oncologist 12 (2007): 1–3. Print.


Ryan, Julie L., et al. “Mechanisms of Cancer-Related Fatigue.” Oncologist 12 (2007): 22–34. Print.


Weis, Joachim, and Markus Horneber. Cancer-Related Fatigue. New York: Springer Healthcare, 2014. Print.

Tuesday 26 November 2013

Identify three events in the play that had a significant impact on the lives of Romeo and Juliet, and explain why each event had a role in their...

There are several events that take place during Romeo and Juliet which have a direct effect on the ultimate fate of the two young lovers. The three most important are their initial meeting, the fight that breaks out in Act III, Scene 1, and the plot of Friar Laurence to have Juliet fake her death.


Obviously, the meeting between the son and daughter of Montague and Capulet is important. They fall instantly in love and...

There are several events that take place during Romeo and Juliet which have a direct effect on the ultimate fate of the two young lovers. The three most important are their initial meeting, the fight that breaks out in Act III, Scene 1, and the plot of Friar Laurence to have Juliet fake her death.


Obviously, the meeting between the son and daughter of Montague and Capulet is important. They fall instantly in love and even after they find out each other's identity they continue their ill-fated relationship. As the Prologue indicates, they are "star-crossed" and so the audience already knows that their lives are doomed.


Act III is the turning point of the play. Romeo and Juliet have just been married, but since the play is a tragedy, there must be a plot twist which turns the play toward conflict and death. In Scene 1, despite the warnings of Benvolio, Mercutio remains in the street and encounters the Capulet men led by Tybalt. When Romeo enters the scene Mercutio and Tybalt are given an excuse to fight as Romeo, who has just married Tybalt's cousin Juliet, backs down. Mercutio cannot tolerate the supposed cowardice and challenges Tybalt himself. When Romeo attempts to break up the fight, Mercutio is killed. In revenge, Romeo kills Tybalt, remarking that he is "fortune's fool." Indeed he is, as the event leads to his banishment. Because Romeo is banished, he never receives word of the Friar's plot for Juliet to fake her death. When he is mistakenly told that she is dead, he buys poison in order to commit suicide inside the Capulet tomb next to Juliet.


Friar Laurence's plan for Juliet to fake her death is important because it lands the girl in the tomb where she and Romeo will kill themselves. The Friar believes that if Juliet takes a potion which will make her look dead, she can avoid the arranged marriage with Count Paris. The Friar will send a note to Romeo and the two will eventually be reunited. Unfortunately, the note is never delivered to Romeo and when Balthasar arrives in Mantua, he tells Romeo that Juliet is dead. Romeo buys poison from a poor apothecary and goes to the tomb. Even though he comments that Juliet still looks very much alive he drinks the poison. When Juliet awakens, she is distraught by seeing Romeo's dead body and so kills herself with Romeo's dagger.


What are the number of Muslims involved in the crusades?

The Crusades occurred over a period of about two centuries and there is some debate about which events deserve to be included as part of the Crusades. Due to these factors and the general imprecision of historical records in the Midlde Ages, the precise number of people involved on each side of the various conflicts is disputed. That said, we do have some approximate numbers; it is believed that somewhere between 1 million and 9...

The Crusades occurred over a period of about two centuries and there is some debate about which events deserve to be included as part of the Crusades. Due to these factors and the general imprecision of historical records in the Midlde Ages, the precise number of people involved on each side of the various conflicts is disputed.

That said, we do have some approximate numbers; it is believed that somewhere between 1 million and 9 million people died on all sides during the total of all the Crusades. Deaths appear to have been about evenly split between the Christian and Muslim factions, and army sizes also appear to have been comparable. Casualty rates in the Crusades were extraordinarily high (probably due to the religious fanaticism and quasi-genocidal intent motivating them), so as many as 50% to 75% of soldiers deployed died. This means that the total number of soldiers on both sides was somewhere between 1.25 million and 18 million. Thus, the number of Muslim soldiers in particular was probably somewhere between 500,000 and 9 million.

World population at that time was about 300 million, of which probably 50 million in the Middle East; but all soldiers were men (only half of people are), and there were also 10 generations during the Crusades; so somewhere between 0.2% and 4% of all Muslim men alive during the Crusades were soldiers involved in the Crusades. This is comparable to the proportion of men who are part of modern military forces (about 2% of men in the US are in the military, along with a much smaller proportion of women).

Monday 25 November 2013

What is computed tomography (CT) scanning?


Indications and Procedures


Computed tomography (CT) scanning collects X-ray data and uses a computer to produce three-dimensional images, called tomograms, of body cross sections, or slices. The noninvasiveness of CT scanning yields easy and safe body part analysis based on varying tissue opacity to X-rays. Bone absorbs X-rays well and appears white. Air absorbs them poorly, so the lungs are dark. Fat, blood, and muscle absorb X-rays to varying extents, yielding different shades of gray. Tumors and blood clots, for example, appear as areas of abnormal shades in normal tissue.



CT scanning is used to analyze disorders of the brain (brain CT) and most body parts (body CT), yielding tomograms that are hundreds of times more definitive than conventional X-rays. For example, conventional abdominal X-rays show bones and faintly outline the liver, kidneys, and stomach. Tomograms clearly depict all abdominal organs and large blood vessels.


Physicians call CT scanning the most valuable diagnostic method because, without it, the symptoms that patients describe may not be identified clearly as minor, serious, or life-threatening. For example, a subjective description of repeated headache does not reveal whether the cause is tension, stroke, or brain cancer. Before CT scanning, an accurate diagnosis often required complex or dangerous identification methods.


A CT patient changes into a hospital gown, removes any metal possessions, and lays on a table that can be raised, lowered, or tilted. During a scan, the patient enters a doughnut-shaped scanner that holds an X-ray source, detectors, and computer hookups. In brain CT, the patient’s head is in the scanner. Some CT patients have experienced claustrophobia, which can be prevented with faster scanner speeds and less-enclosed scanners. A patient who must stay still for an extended time may be given a sedative. If small anomalies are foreseen, then contrast materials are given before or during the procedure. These materials include barium salts and iodine, X-ray blockers that allow better visualization of specific tissues. Subjects may take the materials orally, by enema, or intravenously.


The CT scanner generates a continuous, narrow X-ray beam while moving in a circle around the patient’s head or body. The beam is monitored by X-ray detectors sited around the aperture through which the patient passes. Slices are produced as the scanner circles the head or body. Between slices, the table moves through the scanner. Slices become tomograms seen on a cathode-ray tube (CRT) and are stored in a computer. The procedure used to take twenty to forty minutes in a standard scanner. However, in the newer spiral CT, which is now standard in most hospitals, a patient is scanned rapidly as the X-ray tube rotates in a spiral. There are no gaps, as with slices, and tissue-volume tomograms are produced. A simple spiral scan is completed while the patient holds his or her breath, aiding the detection of small lesions and decreasing scan artifacts. Spiral CT, twenty times faster than standard CT, is useful in all patients, from restless children to the critically ill.




Uses and Complications

CT scanning detects organ abnormalities, and a major use is in diagnosing and treating brain disease. Even the earliest scanners could distinguish tumors from clots, aiding in the diagnosis of cancer, stroke, and certain birth defects. Furthermore, brain CT saves lives as physicians avoid risky methods requiring opening of the brain for pretreatment diagnosis. In addition, postsurgical scans can find recurrences or metastases.


Body CT allows for better damage appraisal of broken bones than does conventional X-ray analysis. Another use of body spiral CT is in the diagnosis of pulmonary
embolism; it is safer than using pulmonary angiography, which maneuvers a catheter from the heart to the pulmonary artery. CT scans can also guide surgery, biopsy, and abscess drainage and can help fine-tune radiation therapy. Speed and excellent soft tissue elucidation make CT scanning invaluable for trauma detection in emergency rooms.


There are few side effects to CT scanning. Preparation for a scan may be mildly uncomfortable, but it is rarely dangerous. Before body CT, subjects often fast, take enemas to clear the bowels, and receive contrast materials through enemas or IVs. If contrast materials are used, then physicians must be told of allergies, especially to iodine. Contrast materials—enhancers of specific tissue CT—may cause hot flashes. Barium enemas for lower gastrointestinal tract scans cause full feelings and urges to defecate.




Perspective and Prospects

British engineer Godfrey Hounsfield and American physicist Allan Cormack won the 1979 Nobel Prize in Physiology or Medicine for the theory and development of computed tomography. CT scanning was first used in 1972, after Hounsfeld made a brain scanner holding an X-ray generator, a scanner rotated around a circular chamber, a computer, and a CRT. The patient laid on a gurney, head in the scanner, and emitter detectors rotated 1 degree at a time for 180 degrees. At each position, 160 readings entered the computer, so 28,800 readings were processed.


CT scanning is essential to radiology, which began in 1885 after Wilhelm Conrad Röntgen discovered X-rays. The rays soon became medical aids, and for years broad X-ray beams were sent through body parts to exit onto film, yielding conventional X-ray images. Bones absorb X-rays well, appearing white, and conventional images can show bone fractures and give some soft tissue data. However, soft tissue evaluation is poor, the tissues superimpose, and estimating their condition is difficult. CT scans allow convenient, noninvasive analysis.


CT scans and stereotaxic neurosurgery, later joined, have improved diagnosis and treatment. For example, the implantation of electrodes in a brain can be monitored using CT, enhancing accuracy. Similar techniques are used in breast biopsy. Current progress in CT scans includes thinner slices, spiral scans, and fast-operating standard scanners. Because complex scans expose patients to more radiation than do conventional X-rays, fast scans are preferred to minimize patient risk.




Bibliography


"CT Scans." MedlinePlus, June 12, 2013.



Durham, Deborah L. Rad Tech’s Guide to CT: Imaging Procedures, Patient Care, and Safety. Malden, Mass.: Blackwell Scientific, 2002.



Hsieh, Jiang. Computed Tomography: Principles, Design, Artifacts, and Recent Advances. 2d ed. Bellingham, Wash.: SPIE Press, 2009.



Kalender, Willi A. Computed Tomography: Fundamentals, System Technology, Image Quality, Applications. 3rd ed. Weinheim, Germany: Wiley VCH, 2009.



McCoy, Krisha, and Brian Randall. "CT Scan (General)." Health Library, Nov. 26, 2012.



"Radiation-Emitting Products: Full-Body CT Scans – What You Need to Know." US Food and Drug Administration, Apr. 6, 2010.



Slone, Richard M., et al., eds. Body CT: A Practical Approach. New York: McGraw-Hill, 2000.

What is glycolysis? |


Structure and Functions

Glycolysis is the first step in the process that cells use to extract energy from food molecules. Although energy can be extracted from most types of food molecule, glycolysis is usually considered to begin with glucose. In fact, the term “glycolysis” actually means the splitting (lysis) of glucose (glyco). This is a good description for the process, since the glucose molecule is split into two halves. The glucose molecule consists of a backbone of six carbon atoms to which are attached, in various ways, twelve hydrogen atoms and six oxygen atoms. The glucose molecule is inherently stable and unlikely to split spontaneously at any appreciable rate.



When the energy is extracted from a glucose molecule, it is stored, for the short term, in a much less stable molecule called adenosine triphosphate (ATP). The ATP molecule consists of a complex organic molecule (adenosine) to which are attached three simple phosphate groups (see figure).


ATP consists of a five-carbon sugar called ribose, linked on one side to the nitrogenous base adenine and on the other side to a linear chain of phosphate groups. The molecule formed by the attachment of adenine to ribose is called adenosine, and the linkage of three phosphates generates adenosine triphosphate. The first phosphate is attached to the ribose sugar by means of a chemical bond whose energy is no greater than those bonds found anywhere else in the molecule. While the first phosphate is attached by what one could call a “normal” chemical bond, the second and third phosphates are attached by high-energy bonds. These are chemical bonds that require a considerable amount of energy to create. Thus ATP is an ideal energy storage molecule that provides readily available energy for the biosynthetic reactions of the cell and other energy-requiring processes.


When one of the high-energy bonds of ATP is broken, a large amount of energy is released. Usually, only the bond holding the last phosphate is broken, producing a molecule of adenosine diphosphate (ADP) and a free phosphate group. The phosphate group is only split from ATP at the precise moment when energy is required by some other process in the cell. This breaking of ATP provides the energy to drive cellular processes. The processes include activities such as the synthesis of molecules, the movement of molecules, and the contraction of muscle. The third phosphate can be reattached to ADP using energy released from glycolysis, or by other components of cellular respiration. The production of ATP can be diagrammed as follows: “energy from glycolysis + ADP + phosphate → ATP.” Similarly, the breakdown of ATP can be diagrammed as “ATP → ADP + phosphate + usable energy.” With this understanding of how ATP works, one can look at how it is generated in the cell by glycolysis.


The first step in the production of energy from sugar is really an energy-consuming process. Since glucose is inherently a stable molecule, it must be activated before it will split. It is activated by attaching a phosphate group to each end of the six-carbon backbone. These phosphate groups are supplied by ATP. Therefore, glycolysis begins by using the energy from two ATP molecules. The atoms of the glucose molecule are also rearranged during the activation process so that it is changed into a very similar sugar, fructose. A fructose molecule with a phosphate group on either end is called fructose 1,6-diphosphate. Thus one can summarize the activation process as “glucose + 2 ATP → fructose 1,6-diphosphate + 2 ADP.”


Fructose 1,6-diphosphate is a much more reactive molecule and can be readily split by an enzyme called aldolase into two three-carbon compounds called dihydroxyacetone phosphate (DHAP) and glyceraldehyde 3-phosphate (G3P). DHAP is converted into G3P by an enzyme called triose phosphate isomerase, which makes G3P the starting point for all the following steps of glycolysis. Each G3P undergoes several reactions, but only the more consequential reactions will be mentioned. G3P undergoes an oxidation reaction, catalyzed by an enzyme called glyceraldehyde 3-phosphate dehydrogenase. Oxidation reactions involve the loss of high-energy electrons. Electrons are highly energetic and have a negative electrical charge. They are picked up and carried by molecules specially designed for this purpose.


These energy-carrying molecules are called nicotinamide adenine dinucleotide (NAD). Biologists have agreed on a conventional notation for this molecule to allow the reader to know whether the molecule is carrying electrons or is empty. Since the empty molecule has a net positive charge, it is denoted as NAD+. When full, it holds a pair of electrons. One electron would neutralize the positive charge, while two result in a negative charge. The negative charge attracts one of the many hydrogen ions (H+) in the cell. Thus when carrying electrons the molecule is denoted NADH. G3P surrenders two high-energy electrons to NAD+. The G3P molecule also picks up a free phosphate group at the end opposite from where one is already attached to form 1,3-bisphosphoglycerate. One can summarize the reaction as “2 Glyceraldehyde 3-phosphate + 2 NAD+ + 2 inorganic phosphates → ? 2 1,3-bisphosphoglycerate + NADH + H+.” The following reactions merely transfer the energy in these chemical bonds to high-energy bonds by transferring these phosphate groups to ADP molecules to produce ATP. Since each G3P eventually produces two ATPs, and two G3Ps are produced from each original glucose molecule, glycolysis produces four ATP molecules all together. However since two ATPs were used to activate the glucose, the cell has a net gain of two ATP molecules for each glucose molecule used.


The rearrangement of the atoms leaves them in a form called pyruvate. Pyruvate still contains much energy locked up in its chemical bonds. In most of the cells of the body and most of the time, pyruvate will be further broken down and all of its energy released. This further breakdown of pyruvate requires oxygen and is beyond the scope of this topic. It should be pointed out, however, that the complete breakdown of two molecules of pyruvate can produce more than thirty additional ATP molecules. With the addition of oxygen, the end products are the simple molecules of carbon dioxide and water.


The oxidative pathways that completely break down pyruvate are limited by the lack of oxygen in very active muscles. The ability to deal with electrons from NADH is also drastically reduced. Glycolysis can continue even in the absence of oxygen, but the electrons produced by glycolysis must be dealt with.


There is a very limited amount of NAD+ in each cell. NAD+ is designed to hold electrons briefly, while they are transferred to some other system. In the absence of oxygen, the electrons are transferred to pyruvate. Since pyruvate cannot be broken down without oxygen, there is an ample supply. Transferring electrons from NADH to pyruvate allows the empty NAD+ to pick up more electrons produced by glycolysis. Therefore, glycolysis can continue producing two ATP molecules from each glucose molecule used. While two ATPs per glucose molecule is a small amount compared to the more than thirty ATPs produced by oxidative metabolism, it is better than none at all.


The process of generating energy (ATPs) in the absence of oxygen is referred to as fermentation. Most people are familiar with the fermentation of grapes to produce wine. Yeast has the enzymes to transfer electrons from NADH to a derivative of pyruvate and to convert the resulting molecule into alcohol and carbon dioxide. No further energy is obtained from this process. Alcohol still contains much of the energy that was in glucose. Humans and other mammals have different enzymes than yeast cells. These enzymes transfer the electrons from NADH to pyruvate, producing lactate.




Glycolysis and Muscle Activity

When yeast is fermented anaerobically (without oxygen), it will continue producing alcohol until it poisons itself. Most yeast cannot tolerate more than about 12 percent alcohol, the concentration found in most wine. The lactate produced by fermentation in humans is also poisonous. People, however, do not respire completely anaerobically. The two ATPs produced per glucose molecule used are simply not enough to supply the energy needs of most human cells. Muscle cells have to be somewhat of an exception. There are times when one asks the muscle cells to use energy much faster than one can supply them with oxygen. One may consider a muscle working under various levels of physical activity and examine its oxygen requirements and waste products.


At rest, a muscle requires very little ATP energy. For an individual sitting on the couch watching television, energy demands are minimal. The lungs inhale and exhale slowly and take in enough oxygen to keep its concentration in the blood high. A relatively slow heart rate can pump enough of this oxygen-rich blood to the muscles to supply their very minimal needs. As soon as one uses a muscle, however, its ATP consumption increases dramatically. Even if an individual simply walks as far as the refrigerator, large quantities of ATP are required to cause the leg muscles to contract. Muscle cells maintain a constant level of ATP so that, as soon as one asks a muscle to contract, it can do so. The ATP that is broken down is almost instantly regenerated from an additional energy store peculiar to muscle cells. Creatine phosphate is a molecule similar to ATP, in that the phosphate group is attached by a high-energy bond. There is more creatine phosphate in muscle cells than ATP. As soon as ATP is broken down, phosphates, and their high-energy bonds, are transferred from
creatine phosphate. Within the first few seconds of activity, the ATP concentration in a muscle cell remains almost constant, but the creatine phosphate level begins to drop.


As soon as the creatine phosphate concentration drops, the aerobic (oxygen-requiring) respiratory processes speed up. These processes break down glucose all the way to carbon dioxide and water and release plenty of ATP. This ATP can then be used for muscle contraction. If the muscle has now stopped contracting, the new ATP produced will be used to rebuild the store of creatine phosphate.


Within the first minute or so of muscle contraction, the use of oxygen can be quite high. The circulatory system has not yet responded to this increased oxygen demand. Muscle tissue, however, has a reserve of oxygen. The red color of most mammalian muscles is attributable to the presence of myoglobin, which is similar to hemoglobin in that it has a strong affinity for oxygen. The myoglobin stores oxygen directly in the muscle, so that the muscle can operate aerobically while the circulatory and respiratory systems adjust to the increased oxygen demand.


At low or moderate muscle activity, the carbon dioxide produced by aerobic respiration in muscles will trigger an increase in the activity of both the circulatory and the respiratory systems. The increased demand for oxygen by the muscles is supplied by an increased blood flow. Jogging around a track or participating in aerobic exercises would be considered low to moderate muscular activity. Respiration rate and pulse rate both increase with jogging. This increase in oxygen supply to the muscles provides all that they need. The level of creatine phosphate will be lower than that in resting muscles, but it will soon be replenished when the activity is stopped. The muscle cells have a good supply of food molecules in the form of glycogen. Glycogen is simply a long string of glucose molecules connected together for convenient storage. At a rate of activity such as that created by jogging, the glycogen supply can last for hours. Even after it is used up, glycogen stored in the liver can be broken down to glucose and carried
to the muscles by the blood. An individual will probably want to stop jogging before his or her muscles will want to quit.


High levels of muscular activity pose a different set of problems. After more than about a minute of vigorous exercise, the muscles begin to use ATP faster than oxygen can be supplied to regenerate it. The additional ATP is supplied by lactic acid fermentation. Glucose is only broken down as far as pyruvate, then converted to lactate by the addition of electrons from NADH. Lactate begins to accumulate in the muscle tissue. Since the body is still using large amounts of ATP but not taking in enough oxygen, it is said to enter a state of oxygen debt. When the muscular activity ends, the oxygen debt is repaid.


One can use an example of someone running to catch a bus, sprinting for fifty yards at full speed. That is not enough time for the circulation and lungs to respond to the increased demand for oxygen. The muscles have made up the difference between supply and demand with lactic acid fermentation. The individual now sits down in the bus and pants—to repay his or her oxygen debt.


Some of the oxygen will go to replenish the store in muscle myoglobin. Some of it will be used in oxidative metabolism in the muscle to replenish the reserves of creatine phosphate. The rest will be used to deal with the accumulated lactate. The lactate is not all dealt with in the muscle where it was produced. Being a small molecule, it easily enters the bloodstream. In muscles throughout the body, it can be converted back to pyruvate. Pyruvate can then reenter the oxidative pathway and be used to generate ATP, with the use of oxygen. The lactate, then, is being used as a food molecule to supply the needs of resting muscle. Much of the lactate is metabolized in the liver. Some of it will be metabolized with oxygen to produce the energy to convert the rest of it back to glucose. The glucose can then be circulated in the blood or stored in the liver or muscles as glycogen. A minimal amount of lactate is excreted in the urine or in sweat.


If the subject of the preceding example kept running at full speed, having missed the bus and run all the way to the office, lactate would build up in the muscles and in the blood. If the office was far enough away, the subject would eventually reach the point of exhaustion and stop running. At that point, the level of lactate in the leg muscles would be high enough to inhibit the enzymes of glycolysis. Glycolysis would slow down so that lactate would not become any more concentrated. The muscles’ supply of creatine phosphate would be almost exhausted, but the ATP supply would be only slightly lower than in a resting muscle. The body is protected from damaging itself: Too much lactate would lower the pH to dangerous levels, and the absolute lack of ATP causes muscles to lock, as in rigor mortis. The body’s self-protection mechanisms force one to stop before either of these conditions exists. Once the subject stops running, and pants long enough, he or she can continue. The additional oxygen taken in by increased respiration will have metabolized a sufficient amount of lactate to allow the muscles to start working again.


In cases where an individual has an inherited deficiency of particular enzymes of glycolysis, the consequences for muscle tissue are rather dire. Muscles, which depend heavily on glycolysis when operating under conditions of oxygen debt, fail to perform well if any of the glycolytic enzymes are defective. Symptoms include frequent muscle cramps, easy fatigability, and evidence of heavy muscle damage after strenuous exertion.




Glycolysis and Red Blood Cell Function

Red blood cells are the oxygen-ferrying units of the bloodstream and are filled with an iron-containing protein called hemoglobin. Hemoglobin binds oxygen tightly when oxygen concentrations are high and releases oxygen when oxygen concentrations are low. To perform their task successfully, red blood cells must maintain the health and functionality of their hemoglobin stores, and glycolysis helps them do that. In red blood cells, approximately 90 to 95 percent of the glucose that enters the cell is metabolized to lactate by means of glycolysis and lactate dehydrogenase. The ATP generated by glycolysis is used to bring charged atoms into the cell such as calcium, potassium, and others. The NADH generated by glycolysis is also used to maintain the iron found in hemoglobin in a state that allows it to bind oxygen. Glycolysis is also used to form the metabolite 2,3-DPG (2,3-Diphosphoglycerate). 2,3-DPG binds to hemoglobin and forces it to release oxygen more readily when oxygen concentrations are low. Thus 2,3-DPG aids hemoglobin delivery of oxygen to the tissues.


Abnormalities in the enzymes that catalyze the reactions of glycolysis are inherited. Individuals who inherit two copies of a gene that encodes a mutant form of a glycolytic enzyme experience uncontrolled destruction of red blood cells (hemolysis). The red blood cell destruction that results from defects in glycolytic enzymes is chronic and not ameliorated by drugs. An enlarged spleen is a typical symptom of glycolytic enzyme abnormalities, as the spleen tends to fill with dying red blood cells. The red blood cell destruction can be so severe that blood transfusions might be necessary. Removal of the spleen reduces red blood cell destruction.




Insulin, Diabetes, and Glycolysis

Glycolysis is heavily regulated by the hormones insulin and glucagon. Insulin, a hormone made and released by the beta cells of the pancreatic islets, stimulates the insertion of the GLUT4 glucose transporter into the membranes of cells. People with type 1 diabetes mellitus, who are incapable of making sufficient quantities of insulin, tend to have very high blood sugar readings, since their cells cannot receive the signal to insert the glucose transporter into their membranes and take up glucose from the blood. This prevents the removal of glucose from the blood, and in type 1 diabetics the blood glucose level climbs to abnormally high levels. GLUT4 allows the uptake of glucose without the input of energy. Therefore, glycolysis occurs as fast as the cells can take up glucose.


Insulin also stimulates the synthesis of a metabolite called fructose 2,6-bisphosphate. Fructose 2,6-bisphosphate is a potent activator of phosphofructokinase, and activation of this enzyme ensures the activation of glycolysis. Insulin also activates the expression of genes that encode the protein involved in glycolysis. During uncontrolled diabetes, reduced glucose transport in muscle inhibits muscle cell glycolysis. In liver cells, reduced glycolytic gene expression and attenuation of the levels of fructose 2,6-bisphosphate reduce glycolysis. This contributes to the voluntary muscle weakness, liver dysfunction, and heart problems that are sometimes observed in diabetics.




Glycolysis and Cancer

The uptake of glucose and its degradation by glycolysis occurs ten times faster in tumor cells than in nontumor cells. This phenomenon, called the Warburg effect, seems to benefit tumor cells, since they lack an extensive capillary network to feed them oxygen and must rely on anaerobic glycolysis to generate ATP.


Oxygen-poor conditions also induce the synthesis of a protein called hypoxia-inducible factor (HIF). HIF is a transcription factor that helps turn on the expression of specific genes that help cells survive oxygen-poor conditions. The synthesis of at least eight glycolytic enzymes are activated by HIF. These fundamental observations of cancer cells have shown that glycolytic enzymes are excellent potential drug targets for anticancer agents.




Perspective and Prospects

Cellular respiration is the process by which organisms harvest usable energy in the form of ATP molecules from food molecules. Lactic acid fermentation is the form of respiration used by human muscles when oxygen is in limited supply. Glycolysis is the energy-producing component of lactic acid fermentation, which is much less efficient than aerobic cellular respiration. Fermentation harvests only two molecules of ATP for every glucose molecule used, while aerobic respiration produces a yield of more than thirty molecules of ATP. Most forms of life will resort to fermentation only when oxygen is absent or in short supply. While higher forms of life such as humans can obtain energy by fermentation for short periods, they incur an oxygen debt that must eventually be repaid. The yield of two molecules of ATP for each glucose molecule used is simply not enough to sustain their high demand for energy.


Nevertheless, lactic acid fermentation is an important source of ATP for humans during strenuous physical exercise. Even though it is an inefficient use of glucose, it can provide enough ATP for a short burst of activity. After the activity is over, the lactate produced must be dealt with, which usually requires the use of oxygen.


Most popular exercise programs focus on aerobic activity. Aerobic exercises do not place stress on muscles to the point where the blood cannot supply enough oxygen. These exercises are designed to improve the efficiency of the oxygen delivery system so that there is less need for anaerobic metabolism. Training programs in general attempt to tune the body so that the need for lactic acid fermentation is reduced. They concentrate on improving the delivery of oxygen to the muscles, storing oxygen in the muscles, or increasing the efficiency of muscular contraction.


Insulin signaling activates glycolysis whereas another pancreatic peptide hormone, glucagon, inhibits glycolysis. Diabetics can suffer from inadequate glycolytic activity in particular organs, which can result in organ dysfunction. Expression of mutant forms of various glycolytic enzymes or supporting enzymes in transgenic mice has elucidated the link between abnormalities in glycolysis and the pathology of diabetes mellitus.


In the 1920s the German biochemist Otto Warburg demonstrated that cancer cells voraciously take up glucose and metabolize to lactate. Glycolysis is very active in cancer cells and helps them flourish under low-oxygen conditions. The development of new glycolytic inhibitors may constitute a new class of anticancer drugs that have wide-ranging therapeutic applications.




Bibliography


Alberts, Bruce, et al. Essential Cell Biology. 3d ed. New York: Garland Science, 2010.



Campbell, Neil A., et al. Biology: Concepts and Connections. 6th ed. San Francisco: Pearson/Benjamin Cummings, 2009.



Fox, Stuart Ira. Human Physiology. 13th ed. Boston: McGraw-Hill, 2013.



Nelson, David L., and Michael A. Cox. Lehninger Principles of Biochemistry. 5th ed. New York: W. H. Freeman, 2009.



Sackheim, George I., and Dennis D. Lehman. Chemistry for the Health Sciences. 8th ed. Upper Saddle River, N.J.: Pearson/Prentice Hall, 2009.



Shephard, Roy J. Biochemistry of Physical Activity. Springfield, Ill.: Charles C Thomas, 1984.



Wu, Chaodong, et al. “Regulation of Glycolysis: The Role of Insulin.” Experimental Gerontology 40 (2005): 894–899.

Sunday 24 November 2013

What is neonatal sepsis? |


Definition

Neonatal sepsis, a bacterial infection in the blood that
may become a serious condition, is sometimes found in infants during the first
month of life.










Causes

Neonatal sepsis is caused when the fetus or baby is exposed to bacteria.
Early-onset sepsis that develops within the first week of birth comes from the
pregnant woman (through the placenta or from passing through the birth canal).
Late-onset sepsis that develops one week after birth comes from the caregiving
environment. Intrapartum antibiotics have prevented early-onset bacterial
sepsis.


Some factors related to a woman’s pregnancy or health also add to the chance
that the fetus or newborn can get this condition. These factors include labor
complications resulting in traumatic or premature delivery, the breaking of the
woman’s “water” more than eighteen hours before giving birth, a fever or other
infection while in labor, and the long-term need for a catheter while pregnant.




Risk Factors

In addition to the foregoing risk factors, the following increase a fetus’s or a newborn’s chance of developing neonatal sepsis: the baby is born more than three weeks before the due date (it is premature); the woman goes into labor more than three weeks before the due date; the fetus is in distress before being born; the newborn has a low birth weight; the fetus has a bowel movement before being born and the uterus contains fetal stool; and the amniotic fluid that surrounds the baby has a bad smell or the baby has a bad smell at birth. Newborn boys are at greater risk for neonatal sepsis than are newborn girls.




Symptoms

In most cases, symptoms are present within twenty-four hours of birth. In
almost all cases, they will be present within forty-eight hours of birth. The
following symptoms are not necessarily caused by neonatal sepsis; they may be
caused by other, less serious health conditions. However, one should consult a
doctor if the baby displays any of the following: a fever or frequent changes in
temperature; poor feeding from breast or bottle; decreased or absent urination or
a bloated abdomen; vomiting of yellowish material; diarrhea; extreme redness
around the belly button; skin rashes; unexplained high or low blood sugar;
difficulty waking or unusual sleepiness; jaundiced or overly pale skin; abnormally
slow or fast heartbeat; rapid breathing; difficult breathing; periods of no
breathing (apnea); bruising or bleeding; seizures; and cool, clammy skin.




Screening and Diagnosis

A doctor will ask about the baby’s symptoms and medical history and will
perform a physical exam. Tests may include a complete blood
count; cultures of the blood, urine, cerebrospinal
fluid, and skin lesions; and X rays of the chest or
abdomen.




Treatment and Therapy

One should consult the doctor about the best treatment plan. Treatment depends
on the severity of the condition and may last two to twenty-one days. In general,
neonates suspected of having sepsis are hospitalized for a minimum
of two days to wait for culture results. A well-appearing infant may be monitored
without antibiotics. The infant is sent home when cultures are
negative. Culture-proven sepsis is treated for seven to twenty-one days, depending
on the location of the infection.


The baby may also need to receive antibiotic medication, fluids, glucose, and electrolytes intravenously,or to receive oxygen to help with ventilation (breathing).




Prevention and Outcomes

To reduce the chance that a fetus or newborn will get neonatal sepsis, the doctor may prescribe antibiotics near the due date for women who have given birth to a baby with neonatal sepsis. The antibiotics will kill dangerous bacteria in the birth canal. The doctor also may test the woman for the bacteria before the due date and prescribe antibiotics, and he or she may recommend breast-feeding, which can help prevent sepsis in some infants.




Bibliography


Behrman, Richard E., Robert M. Kliegman, and Hal B. Jenson, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders/Elsevier, 2007.



EBSCO Publishing. DynaMed: Neonatal Sepsis. Availablethrough http://www.ebscohost.com/dynamed.



Herbst, A., and K. Källén. “Time Between Membrane Rupture and Delivery and Septicemia in Term Neonates.” Obstetrics and Gynecology 110, no. 3 (September, 2007): 612-618.



Martin, Richard J., Avroy A. Fanaroff, and Michele C. Walsh, eds. Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 2 vols. 8th ed. Philadelphia: Mosby/Elsevier, 2006.



Merenstein, Gerald B., and Sandra L. Gardner, eds. Merenstein and Gardner’s Handbook of Neonatal Intensive Care. 7th ed. Maryland Heights, Mo.: Mosby/Elsevier, 2011.

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