What is ironic about John's proclamation that he is going to a "brave new world" in Brave New World?

The statement is ironic because the phrase "brave new world" comes from Shakespeare, but the society John is talking about has banned Shakespeare.

John has read Shakespeare, unlike the rest of the society. They feel that books other than nonfiction are not valuable.  That includes Shakespeare. We are told that “all books published before A.F. 15O” have been suppressed. This is part of the “campaign against the Past” (Ch. 3). However, since John is a...

The statement is ironic because the phrase "brave new world" comes from Shakespeare, but the society John is talking about has banned Shakespeare.

John has read Shakespeare, unlike the rest of the society. They feel that books other than nonfiction are not valuable.  That includes Shakespeare. We are told that “all books published before A.F. 15O” have been suppressed. This is part of the “campaign against the Past” (Ch. 3). However, since John is a savage, he has lived a completely different life. Popé brought him The Complete Works of William Shakespeare, which had been found in one of the chests of Antelope Kiva.

John’s mother tells him the book is uncivilized, but that he can practice reading on it. John does not have the best life, and he is drawn to the beauty of Shakespeare. The book helps John get in touch with his emotions.

Since he begins to experience and understand the world through the lens of Shakespeare, it kind of makes sense that John’s reaction to Lenina is an allusion to Miranda’s reaction to Alonso and Antonio in The Tempest.

The flush suddenly deepened; he was thinking of Lenina, of an angel in bottle-green viscose, lustrous with youth and skin food, plump, benevolently smiling. His voice faltered. "O brave new world," he began, then suddenly interrupted himself; the blood had left his cheeks; he was as pale as paper. (Ch. 8)

John can’t wait to see the world Lenina came from. Bernard is not impressed. He asks him to see the rest of the world before he makes a judgement. This is because Bernard knows that the world they are going back to is not a fantasy.

There are a couple of reasons that John’s reaction is ironic. Irony refers to a statement that is contradictory. There is dramatic irony with this statement, because John has no idea what this new world is like. Dramatic irony is when the reader knows something a character does not. He judges the new world by Lenina. She is beautiful, so the world she came from should be beautiful. It must be full of beautiful people. The fact that he quotes Shakespeare to praise a world that has banned Shakespeare is ironic.

The statement is also ironic because it is an expression of John’s situation. Like Miranda, he has been isolated from the rest of the world. Miranda was trapped on an island, and John was trapped in the reservation. In each case, the character is going to be leaving their isolation. Miranda might have hated the world she came to. We don't know, because the play ends. Alonso and Antonio did betray her father. John is not going to like the world he is going into either.

What is the ionic and chemical formula for copper sulfate?

Copper sulfate commonly refers to copper (II) sulfate or cupric sulfate. This chemical compound is made up of two ions- a copper (II) ion and sulfate ion. Copper (II) ion or cupric ion is denoted by Cu2+ and sulfate ion has an ionic formula of SO4^2-. The overall ionic formula of copper (II) sulfate is CuSO4.

The chemical formula of an ionic compound contains the cation first, followed by the anion. Both cations and anions...

Copper sulfate commonly refers to copper (II) sulfate or cupric sulfate. This chemical compound is made up of two ions- a copper (II) ion and sulfate ion. Copper (II) ion or cupric ion is denoted by Cu2+ and sulfate ion has an ionic formula of SO4^2-. The overall ionic formula of copper (II) sulfate is CuSO4.

The chemical formula of an ionic compound contains the cation first, followed by the anion. Both cations and anions are followed by the number of atoms of each ion. Using these guidelines, the chemical formula of copper (II) sulfate can be written as CuSO4. We can similarly write the chemical formula of copper (I) sulfate or cuprous sulfate as Cu2SO4. 

Generally, ionic equations and chemical equations are used for chemical reactions, when two or more chemical compounds react with each other, rather than for individual chemical compounds.

Hope this helps. 

How can we compare the works of Renoir and Fragonard?

The works of Jean-Honoré Fragonard and Pierre-Auguste Renoir can be compared along the lines of content and style, though both worked during different periods. Fragonard was a painter whose work exemplified the decorative, aristocratic Rococo style of the mid-1700s. Renoir was an Impressionist painter who worked during the mid-1800s. 

Both painters created works that featured people enjoying leisure activities, though there was a difference in who was depicted by each artist. Fragonard, like most Rococo painters, focused on members of the aristocracy in a fête galante, or scenes that showed members of French high society engaged in outdoor entertainments.

A characteristic example is Fragonard's 1766 work The Swing, in which a high-society lady is being pushed and pulled in a swing by an old bishop while her young lover watches and admires her. The scene takes place in lush surroundings. The young lady kicks off her pink slipper which flies toward a Classical statue of Cupid. The figure in the statue parallels her position by being seated. The cherubic love god also holds a finger to his lips, as though to hush her squeals of delight. The presence of the love god, as well as the reclining lover and the lush surrounds, all allude to sex. The "glowing pastel colors and soft light" also contribute to "the theme's sensuality" (Kleiner 770).

Renoir often depicted people in Parisian clubs and cafés. Good examples include Dance at Le Moulin de la Galette and Luncheon of the Boating Party. Now, it is working-class people gathered in festive atmospheres. Like Fragonard, Renoir works with pastels, but prefers dappled light to Fragonard's soft mists. Figures are also less clearly defined, and idealized surroundings are abandoned in favor of depictions of actual places. Finally, figures in the paintings are positioned more naturally and are featured doing real things. For example, in Dance at Le Moulin de la Galette, a man on the right side of the canvas picks his teeth. On the left, a man who appears to be bored stiffly dances with a young woman. Such figures sharply contrast with the reclining figure in The Swing, who implausibly fixes his lover with a wondrous gaze, and is lying in a very awkward position in an uncomfortable-looking bush.

In sum, both artists are similar in that they focused on leisure scenes. However, Fragonard, like most Rococo painters, only depicted members of the aristocracy, while Renoir painted members of the working class. The depiction of leisure was very important during both periods. In Fragonard's time, leisure time was evidence of one's wealth. In Renoir's, industrialization and set work schedules allowed people both the time and money to drink in bars and dance in nightclubs.

In terms of style, both depicted aspects of nature, particularly the presence of vegetation. While Fragonard presented lush, idealized natural scenes, Renoir provided more realistic impressions. Both, too, were concerned with depictions of light, and with the ways in which color could be used to demonstrate the vivacity and sensuality of figures.

Reference: Kleiner, Fred S. Gardner's Art Through the Ages: A Global History, Fifteenth Edition. Boston: Cengage Learning, 2016. Print.

What is the relationship between families and behavioral addictions?

Scope of the Issue

While behavioral addictions are well accepted as serious mental and behavioral health problems, this historically was not the case. Mental health and even substance abuse specialists were slow to recognize the addictive properties in these behaviors for several reasons. First, the behaviors, such as shopping, were often engaged in routinely with no signs of addiction in most people. The activities themselves are usually ordinary, everyday, and common. There is nothing inherently addictive about them.

Second, some behavioral addictions that are not as ordinary (for example, pornography) occur privately, often hidden from public view. Performed in secret, people who are addicted are unseen and unchallenged. Others simply were unaware of the problem. Third, there was a general lack of awareness that such activities could become truly addicting in the same way that alcohol, cocaine, or prescription pain or anti-anxiety medications could become addicting. Among specialists, occasional disagreement still exists about whether behavioral addictions are true addictions.

With increased recognition of the underlying characteristics of behavioral addiction has come more accurate reporting and intervention. Physicians and other health care providers, educational and workplace personnel, friends, and families are now more likely to express concern and acknowledge a serious problem. While varying sources estimate the prevalence of behavioral addictions differently, most addiction specialists conservatively assume that one in ten families has a behaviorally addicted family member. Some specialists believe the prevalence is as high as one family in three.

Families and Causes

It is established that chemical addictions run in families. That is, having one family member addicted to chemicals increases the likelihood, fourfold, that a first-order relative—a parent or sibling—will develop a chemical addiction at some time in his or her life. Behavioral addictions also run in families, though it is unclear just how much more likely it is that a second family member will develop a behavioral addiction when a first-order relation is addicted to a specific behavior.

The actual connections between one behaviorally addicted family member and a similar addiction in another family member are complex and far from fully delineated. Similarly, how particular family climates promote (or discourage) behavioral addiction is also far from being fully understood. Still, the existence of connections is indisputable.

The first, and most fundamental, connection is family-shared biology and genetics. The response in the brain’s pleasure centers tends to be similar in genetically related persons. The enjoyment the video-gaming addict gets will be similar among his or her family members even if the particular source of enjoyment (such as addictive catalog shopping rather than video gaming) is different. The intensity of the reward and its recurrent allure will be similar. However, family genes do not cause addiction.

As many as three-quarters of families with a behaviorally addicted family member do not have a second addicted member. The genetic contribution lies in the degree of likelihood that each family member shares for developing addiction, not that they will develop the addiction. The strength of the tendency to become addicted is largely shared though the outcomes (being addicted to gambling as a primary force in one’s life or merely enjoying gambling as a pastime) are not necessarily the same. One is not “doomed” to addiction if a sibling or parent has become addicted.

A second connection lies in what family members are exposed to and learn to imitate. A straightforward example would be how children learn to copy their parents. If a single mother has a relational addiction in which she serially and incessantly dates men regardless of the psychological health of these relationships, her children will gradually learn that their value and sense of safety, security, and meaning is dependent on being in a relationship. Though it could take years for the addictive properties of this behavior to develop in her children, the chances that they eventually will are multiplied.

The woman’s children see and experience the emotional anxiety and panic that their mother feels when she lacks an active, current dating relationship. Even if they do not have the language to describe what their mother is doing, they notice their mother’s pattern and learn how to ensure they are part of a relationship—any relationship. Even if the children come to understand the self-destructive pattern their mother is enduring (and putting her children through), they learn that having a relationship, even a bad one, prevents feelings of insecurity and insignificance that they believe are sure to come if they are not in a relationship. Their addictive pattern of incessant serial dating thus begins.

Families and Continuation

Though behavioral addictions are pathological, maladaptive, and harmful to the addicted persons and their families, the addictions persist because the families’ way of functioning, how it achieves or fails to achieve what it sets out to do, has accommodated the addictive disease. As much as the family may want the addiction to stop and as much suffering as the addicted member causes, the family responds as a unit (or system, in the jargon of family therapy) in ways that end up supporting the addictive behaviors. Thus, the behaviors continue.

While this dynamic seems contrary to the well-being of the family and its members, it demonstrates the powerful emotional need within families to hold together for their survival—that no members can be lost. Families achieve this through maintaining a psychic balance, what social psychology describes as homeostasis: the drive within a family to keep itself going, regardless of the existence of harmful and hurtful family patterns (such as abuse, neglect, and addiction).

As the family realizes there is a problematic behavior (for example, one member’s addiction to food) it responds initially with efforts to correct the problem. Usually, however, families cannot control a member’s addictive behaviors. As the family experiences repetitive failures, its emotional life becomes threatened, and though members do not consciously and explicitly coordinate their response, they react to the addict in ways that dysfunctionally balances the emotional energy within the family. Members become preoccupied with the addict’s food consumption, where he or she is getting the food, where it is hidden, and how much is consumed, for example. This preoccupation involves everyone in the family with the well-intentioned, but unsuccessful, goal of getting the addict to eat normally.

Often, the addiction, known to all, is spoken openly by no one. It becomes this family’s “public secret.” As a secret, it cannot be effectively addressed. The addict reacts, in turn, to the heightened concern and scrutiny, and because the addiction must be fed, he or she reacts against the family’s efforts to help.

These reactions take a variety of predictable forms: angry denial of the problem, in which family members are intimidated and told to mind their own business; avoidance of family encounters and generally being less visible, often in the guise of being too busy to participate in family activities, like meals, and spending large blocks of time at work, school, or in one’s room; and helpless proclamations of guilt and shame while vowing to get help or promising to try harder.

This setting involves many negative emotions, including blame, that surface and resurface. Questions are asked by the addict and by family members: Who really cares? Who is really selfish? Who really understands the addict? Who among us will take a stand? The emotional disconnection within the family grows.

Families and Treatment

Just as families are typically central to the successful treatment of chemical and substance abuse, they are usually central to successful treatment of behavioral addiction. First, open acknowledgement of the problem—that it has reached the stage of addiction—allows the addiction to be treated.

In the early stages of treatment, or recovery, families are often confronted by the behaviorally addicted member’s denial that there is a problem, that the problem is as bad as members say, that the addict can control it, or that the behavior is anyone else’s business. Addicted video gamers, for example, will likely argue the benefits to their many hours of compulsive playing: It relieves stress for them. They enjoy it. They have friends online who play as much as they do and they enjoy their companionship. They are not bothering anyone else.

In such a case, family members must be supportive but honest in confronting both the addict and themselves, addressing how they have unintentionally enabled the addiction to continue. Family members need to recognize and openly declare what they used to do that allowed the addiction to continue and that they will no longer support the behavior. Members too should seek help, because it is inherently difficult to disengage from a loved one in trouble. Family members should assume a position of full support for helping the addict get help and of zero support for anything the addict does that does not promote recovery.

Bibliography

American Academy of Child and Adolescent Psychiatry. “Facts for Families.” Washington, DC: AACAP, 2011. Print.

Bradshaw, John. On the Family: A New Way of Creating Solid Self-Esteem. Deerfield Beach, FL: Health Communications, 1996. Print.

"Family Behavior Therapy." National Institute on Drug Abuse. NIH, Dec. 2012. Web. 29 Oct. 2015.

Hayes, Steven, and Michael Levin. Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions. Oakland, CA: New Harbinger, 2010. Print.

Sadock, B. J., and V. A. Sadock, eds. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. Philadelphia: Lippincott, 2000. Print.

What is fetal surgery? |

Indications and Procedures

As early as the 1960s, some unborn infants suffering from progressive anemia caused by antibodies that drew away their strength were saved by receiving blood transfusions in utero. These early procedures marked the beginnings of invasive medical intervention in dealing with fetal problems.

Not until the technical advances of the 1970s and beyond, however, was it possible to observe human fetuses in the uterus. With the development of ultrasound imaging, it became possible to examine in considerable detail the size, growth, and contour of fetuses. The use of ultrasound enabled physicians to assess with considerable accuracy the age of fetuses, their probable date of birth, and a number of congenital abnormalities, such as spina bifida.

Laparoscopes with diameters of less than 0.1 inch make it possible to examine the fetal stomach. The use of lasers and tiny instruments guided by computers has allowed methods of fetal surgery that were inconceivable in the mid-twentieth century. These instruments greatly reduce blood loss in all types of surgery, including fetal surgery, and greatly improve the prognosis in such procedures. They are used to repair ruptured membranes in fetuses, to install shunts to relieve blockages, and, with the laser excision of placental vessels, to equalize osmotic pressure in twin-twin transfusion
syndrome.

It has become possible for obstetricians to observe all significant fetal organs. Whereas physicians earlier could barely hear the beat of the fetal heart, they now can monitor all four of its chambers in the unborn to detect defects early, and, in some cases, to repair them surgically. Ultrasound enables physicians to observe fetal movement within the uterus and to monitor fetal breathing and swallowing.

Because physicians can now gather specific information about the fetus and its health, abnormalities and life-threatening physical problems can be detected several months prior to delivery. Whereas neonatologists have regularly encountered such problems as intestinal and urinary tract obstructions, heart defects, protrusions of the wall of the stomach into the thorax (diaphragmatic hernia) or into the esophageal region (hiatal hernia), swelling of the kidney (hydronephrosis), tumors (sacrococcygeal teratomas), hydrocephalus (water on the brain), and defects of the chromosomes shortly after the birth of a child, it is now possible to detect and, in some cases, to treat these defects surgically in utero.

In cases where fetal surgery appears to offer the most reasonable solution to a difficult problem, the mother may be sent to one of the few centers in the United States where this highly specialized and controversial form of surgery is performed regularly. With the development of sophisticated computer-operated instrumentation, surgeons geographically distant from their patients can perform highly specialized surgery on them. Eventually, such surgery will likely be performed without uprooting mothers.

The current success rate of fetal surgery is not encouraging, although some remarkable outcomes have occurred through its use. Fetal surgical procedures often result in miscarriages and sometimes in the death of both the mother and the fetus.

Two conditions that frequently require fetal surgery are obstructions in the urinary tract that, if untreated until birth, may lead to kidney failure, and hydrocephalus, in which cerebral swelling makes it difficult or impossible for brain cerebrospinal fluid to circulate. Both conditions, which occur in 1 of every 5,000 to 10,000 births, require immediate attention to prevent long-term problems or death. Stents can overcome blockages. Instruments have been developed to drain fluid from the brain in instances of hydrocephalus.

When surgery is performed to allow fetal lungs to develop normally, the fetus, attached to the mother through the umbilical cord, exists in the most protective environment it is ever likely to know. If corrections are made in the uterus, then the fetal lungs are in the safest possible environment for becoming stronger before they are forced to function on their own.

In cases of obstructive urinopathy (obstruction of the urinary tract), surgery may help injured kidneys to recover and develop. Hypotonic urine found in fetal samples indicates that normal kidney function might be restored and suggests that surgery may permit the affected kidneys to gain strength within the uterus. On the other hand, the presence of isotonic urine in fetal samples indicates kidneys that are too badly compromised to regain normal function. Treatments currently available offer no solution to this problem.

One of the more routine procedures connected with pregnancy is amniocentesis, testing for chromosomal abnormalities through the analysis of amniotic fluid drawn through the abdominal wall of the mother and of blood drawn from the umbilical cord. This procedure is not without risks to mothers and fetuses. It is commonly used, however, because the benefits derived from it are generally thought to outweigh the risks.

Nevertheless, amniocentesis remains a controversial procedure, and major ethical questions surround its use. If the test reveals a chromosomal abnormality, the parents are left with the decision of whether to seek a therapeutic abortion to terminate the pregnancy, which in many jurisdictions would be considered a realistic option. With many such abnormalities, however, the fetus might be delivered alive and, although significantly handicapped, have a life expectancy of many years.

Fetal surgery is indicated when physicians are convinced that a fetus will not survive long enough to be delivered or when it appears certain that the newborn will be unable to survive long after its birth. For example, if it appears through ultrasound that a fetus suffers from a severe kind of congenital diaphragmatic hernia in which the liver is in the chest, then it is obvious that the development of the lungs will be seriously compromised without surgical intervention. Fetal surgery becomes a stopgap measure in such cases to lessen the severity of the problem so that the fetus can grow to term and be delivered, after which corrective surgery outside the uterus can be undertaken. This procedure involves substantial risk, however, because the liver can be destroyed in the process of trying to restore it to its normal position below the diaphragm.

Sometimes ultrasound reveals noncancerous sacrococcygeal tumors. Such tumors, if untreated, can become large enough in a fetus to put a strain on the heart sufficient to cause heart failure. This severely compromises the survival of the fetus. Guided by ultrasound imagery, surgeons can cut off the blood supply to such tumors and starve them before they do irreparable damage to the fetus. When this procedure is used, the destroyed tumor can be removed surgically after birth.

Another growing use of fetal surgery is in cases where spina bifida, usually identified through ultrasound around the sixteenth week of pregnancy, is present. This congenital defect involves a malformation in the vertebral arch, in which the neural tube connected to the brain and the spine is exposed. When this condition is diagnosed and treated early in the development of the fetus, considerable spinal cord function can be preserved. This makes postnatal treatment more effective than it would be were the condition not discovered until after delivery.

There are essentially two major forms of fetal surgery. The more drastic of these involves performing a cesarean section, after which the fetus is carefully removed from the uterus and treated. It is then returned to the uterus, which is closed with sutures. The umbilical cord is not cut, so that the fetus is still receiving oxygen and need not breathe on its own before its lungs have developed sufficiently. This procedure is indicated when some congenital defect, possibly a teratoma (tumor), blocks the airway. Clearing the fetal airway enables the baby to breathe independently upon delivery. The other form of fetal surgery is done without removing the fetus from the uterus and is made possible by the use of laparoscopes and other specialized instruments. This is the preferred method if a choice is offered.

Uses and Complications

As fetal surgery becomes more significant and more common in the treatment and elimination of many threatening prenatal conditions, numerous complications, both ethical and physical, necessarily arise. Any surgery involves risk, and in fetal surgery a dual risk exists: risk to the fetus and risk to the mother. Therefore, physicians who perform fetal surgery have simultaneously as patients both prospective mothers and fetuses. Because fetuses cannot speak for themselves or make their own decisions, fetal surgeons often find themselves in an ethical quagmire. Most physicians hesitate to recommend fetal surgery except in such extreme cases that fetal death or severe disability without such surgery seems inevitable.

Sometimes wrenching decisions must be made about whether to save the life of the mother or the life of the fetus. Questions also arise about whether to allow a fetus to come to term if it is obvious that it will suffer from birth defects that will either severely limit the length of its life or adversely compromise its quality of life, which in some cases may involve a normal life span. Many notable people who suffered from severe birth defects have made significant contributions to society and have led productive and rewarding lives.

One of the more significant uses of fetal surgery is in the treatment of twin-twin transfusion syndrome. In the United States, this syndrome occurs in about one thousand pregnancies each year. Twin-twin transfusion syndrome results in a pair of twins being of unequal size in the fetal state because of abnormal circulation of amniotic fluid between them within the placenta that they share. The larger of the two is surrounded by considerably more amniotic fluid than the smaller one. This disproportion can result in the death of one or both of the fetuses. Attempts can be made to equalize the amniotic fluid by inserting a hollow needle through the mother’s abdomen and drawing out excess fluid, a procedure that can threaten the viability of one or both of the fetuses.

Another more sophisticated treatment of twin-twin transfusion syndrome involves inserting a fetoscope into the uterus and using heat from a laser to seal off the blood vessels between the fetuses. This treatment is directed toward separating the circulation between the twins, which accounts for the condition. Regardless of which treatment is employed, the mortality rate is currently quite high in such cases, and premature delivery is a virtual certainty in them. Without intervention, however, these fetuses inevitably die in the uterus.

One of the greatest complications of fetal surgery is premature delivery. Fetuses were once thought to be viable only in the seventh month and beyond. Now the means are available to make survival outside the uterus possible earlier than that, although extraordinary care, attention, and equipment are required for extended periods following the delivery of a baby short of seven months and hospitalization in the neonatal intensive care unit (NICU) may continue for many months following such a birth.

When fetal surgery is performed, the mother is routinely medicated with drugs that will both reduce her pain and substantially decrease the possibility of miscarriage or premature delivery. As the field grows and becomes increasingly sophisticated, many of the current problems that it poses will surely be overcome.

Perspective and Prospects

The development of highly specialized instruments, including fiber-optic telescopes and instruments specially designed to enter the uterus through minute incisions, has made possible the field of fetal surgery. Obstetrical surgeons can now correct life-threatening defects and malformations through the smallest, least invasive of openings while the fetus remains within the protection of the mother’s body. This procedure, referred to as fetoscopic surgery, is the method preferred whenever it is possible because it reduces substantially the danger of bringing about premature labor at a time when the fetus cannot breathe on its own.

Because fetal surgery is in its infancy, relatively few surgeons specialize in it and the full range of its uses and promises has yet to be explored. The two major centers in the United States that have pioneered development in this field are the Children’s Hospital in Philadelphia and the University of California Hospital in San Francisco.

Considerable research in fetal surgery is being conducted at both of these institutions and in laboratories and hospitals throughout the country. It is a matter of time before improved technology will exist to eradicate some of the major barriers to more extensive fetal surgery. Surgery of all kinds is becoming less invasive, which reduces considerably the shock that it delivers to patients’ bodies, including blood loss and recovery time. Noninvasive fetal surgery is particularly important to ensure the physical welfare of both the fetus and the mother.

Bibliography

Barron, S. L., and D. F. Roberts, eds. Issues in Fetal Medicine: Proceedings of the Twenty-ninth Annual Symposium of the Galton Institute, London, 1992. New York: St. Martin’s Press, 1995.

Dickens, Bernard M., and Rebecca J. Cook. "Legal and Ethical Issues in Fetal Surgery." International Journal of Gynecology & Obstetrics 115, no. 1 (October, 2011): 80–83.

Harrison, Michael, et al. The Unborn Patient: The Art and Science of Fetal Therapy. 3d ed. Philadelphia: W. B. Saunders, 2001.

Hartmann, Katherine E., et al. "Evidence to Inform Decisions About Maternal-Fetal Surgery." Obstetrics & Gynecology 117, no. 5 (May, 2011): 1191–1204.

O’Neill, J. A., Jr. “The Fetus as a Patient.” Annals of Surgery 213 (1991): 277-278.

Wise, Barbara, et al., eds. Nursing Care of the General Pediatric Surgical Patient. Gaithersburg, Md.: Aspen, 2000.

Vrecenak, Jesse, and Alan Flake. "Fetal Surgical Intervention: Progress and Perspectives." Pediatric Surgery International 29, no. 5 (May, 2013): 407–417.

What is dentistry? |

Science and Profession

The practice of dentistry is a specialized area of medicine that treats the diseases of the teeth and their surrounding tissues in the oral cavity. Dental education normally takes four years to complete, with predental training preceding it. Prior to entering a dental school, students are usually required to have a bachelor’s degree. This degree should have major emphasis in biology or chemistry. Predental courses are concentrated in both inorganic and organic chemistry. The biology courses can cover such subjects as comparative anatomy, histology, physiology, and microbiology. Other courses that can help students to prepare for both dental school and the future practice of dentistry are English, speech skills, physics, and computer technology. Upon entering dental school, students are faced with two distinct parts of their education: didactics and techniques.

The didactic courses offered in dental schools are required to achieve knowledge of the human body, most particularly the head and neck. Some of the courses required are human anatomy, physiology, biochemistry, microbiology, general and oral histology and pathology, dental anatomy, pharmacology, anesthesiology, and radiology. One course specific to dental school is occlusion, which emphasizes the structure of the temporomandibular joint and its accompanying neurology and musculature.

In addition, students must know the properties of the materials used in the practice of dentistry. The physical properties of metals, acrylic plastics, gypsum plasters, impression materials, porcelains, glass ionomers, dental composites, sealant resins, and other substances must be thoroughly understood to determine the proper restorations for diseased tissues in the mouth. Knowledge of resistance to wear by chewing forces, thermal conductivity, and corrosion and staining by mouth fluids and foods is important. Information concerning the materials used in dental treatment in terms of resistance to recurrent decay, possible toxicity, or irritation to the hard and soft tissues of the oral cavity is also necessary.

The technical phase of dental education addresses the practical use of this didactic knowledge in treating diseases of the mouth. Students are trained to operate on diseased teeth and to prepare the teeth to receive restorations that will function as biomechanical prostheses in, or adjacent to, living tissue. An understanding of anatomy, physiology, and pathology is necessary for successful restoration of the teeth. During this course of study, students are required to construct fillings, cast-gold crowns and inlays, fixed and removable dentures, porcelain crowns and inlays, and other restorations on mannequins, plastic models, or extracted teeth. These activities are undertaken prior to working on patients. Through practice and repetition of these techniques, dental students soon become aware of the importance of mastering this phase of the education prior to their application in a clinical environment.

The clinical phase of dental education integrates the didactic and technical instruction that has taken place throughout the first years of professional study. Students learn to treat patients under the close supervision of their instructors. The treatment of patients in all the specialties of dentistry is required of students before they receive the degree for general dentistry. Some students may opt for extra training in one of several specialties. To become a specialist, postgraduate education is required. This education commonly encompasses two years of study but is sometimes longer.

Upon graduation, students receive their professional degrees. Before they can legally practice dentistry in the United States, however, they must successfully pass an examination offered by the board of dental examiners in their chosen state. National exams in didactics are offered during dental school, and most states accept them as part of their state examination. The technical portion of the exam may only be taken after the student has received a doctorate from an accredited college or university. The emphasis regarding techniques may vary from state to state. Many states allow reciprocity, which means that a student who has passed the examination in one state may become licensed to practice in another. In states that do not accept reciprocity, the student must pass the practical examination of that state prior to obtaining a license. There have been attempts to make reciprocity universal among all states, but several states insist on governing the quality of their dental health care.

Dental education can be quite expensive. After a dentist receives a license to practice, the cost of equipping an office must also be borne. A dental office must have dental chairs, office and reception room furniture, a dental laboratory, a sterilizing room, x-ray units, instruments, and various supplies. Because of these expenses, new dentists often initially practice as an associate or partner of an established dentist, as an employee of a dental clinic, in the military or Public Health Service, or in state institutions. Some dentists enjoy the academic atmosphere of dental schools and return to become part-time or full-time educators.

Diagnostic and Treatment Techniques

The practice of dentistry is quite different in modern times compared to the past. While some techniques and materials are still in use, there have been improvements in materials and instruments because of expanded knowledge in many scientific fields. This knowledge has increased to such an extent that dentistry has divided into several specialties. While the general dentist uses all disciplines of dentistry to treat patients, complex problems often require referral and the expertise of a specialist.

The general dentist is involved primarily in the treatment of caries or tooth decay and the replacement of missing teeth. Bacterial acids that dissolve the enamel and dentin of teeth cause caries. A diseased or damaged tooth must be prepared mechanically by the removal of the decayed material using a dental drill and tough, sharp bits called burs. The amount of damage and the position of the tooth in the mouth determine the type of restoration. In the posterior or back teeth, initial cavities may be restored with bonded composite resins. In addition to removing the decayed tooth structure, the dentist must take into consideration the closeness of the dental pulp, the chewing forces of the opposing teeth, and the aesthetics of the finished restoration. In the anterior or front teeth, aesthetic restorative materials are used to fill small cavities. In this case also, the size and position of the defect determine the choice of restorative material.

When the amount of tooth destruction caused by decay becomes too large for conservative filling materials, the remaining tooth structure must be reinforced by the use of cast metal or porcelain restorations. The tooth is prepared for the specific restoration, and accurate impressions are taken of the prepared teeth. The crown or inlay is fabricated on hard plaster models reproduced from the impressions and then cemented into place on the tooth. This process is also used for fixed partial dentures, or bridges, which are used to replace one or more missing teeth. Two or more teeth are prepared on either end of the space of missing teeth to support the span. The bridge is constructed with metal and porcelain as a single unit. It is then cemented on the prepared abutment teeth.

The health of the supporting tissues of the teeth, the periodontium, is necessary for the long-term retention of any mechanical restoration. When teeth become loose in the jaws because of periodontal disease, or pyorrhea, the restoration of these teeth often depends on the treatment by a periodontist, the specialist in this field. Periodontists treat the diseased tissues by scraping off harmful deposits on the roots of the teeth and by removing the diseased soft tissue and bone through curettage, surgery, or both techniques. Some newer techniques of grafting the patient’s bone with sterile freeze-dried bone, implanting stainless steel pins, or using other artificial materials show great promise.

If the tooth decay reaches the dental pulp and infects it, there are two choices of treatment: removal of the tooth or endodontic therapy, commonly known as root canal treatment. If the tooth is well supported by a healthy periodontium, it is better to save the tooth by endodontics. The basic procedure of a root canal is to enter the tooth through the chewing surface on teeth toward the rear of the mouth or the inside surface or lingual aspect of teeth in the front of the mouth. Files, reamers, and broaches to the tip of the root remove diseased or decaying (necrotic) material of the dental pulp. The now-empty canal is filled by cementing a point that fits into it. Although the tooth is now nonvital, meaning that it has lost its blood supply and nerve, it can remain in the mouth for many years and provide good service.

The maintenance of the health of the primary dentition, or baby teeth, is very important. These deciduous teeth, although lost during childhood and adolescence, are important not only to the dental health of the child but to the permanent teeth as well. The deciduous teeth act as guides and spacers for the correct placement of adult teeth when they erupt. A pediodontist, who specializes in the practice of dentistry for children, must have a good knowledge of the specific mechanics of children’s mouths in treating primary teeth. This specialist must also have a thorough foundation in the treatment of congenital diseases. The pediodontist prepares the way for dental treatment by an adult dentist and often assists an orthodontist by doing some preliminary straightening of teeth.

An orthodontist treats malocclusions, or ill-fitting teeth (so-called bad bites) with mechanical appliances that reposition the teeth into an occlusion that is closer to ideal. These appliances, known commonly as braces, move the teeth through the bone of the jaws until the opposing teeth occlude in a balanced bite. The side benefit of this treatment is that the teeth become properly positioned for an attractive smile and easier cleaning.

Sometimes the teeth or their supporting tissues become so diseased that there is no alternative but to remove them. A general dentist often does routine extractions of these diseased teeth. If the patient has complications beyond the training of a general dentist or is medically compromised by systemic illness, an oral surgeon, with specialized training, is typically consulted. This specialist not only removes teeth under difficult conditions but also is trained to remove tumors of the oral cavity, treat fractures of the jaws, and perform the surgical placement of dental implants.

Although the total loss of teeth is becoming rarer, there are still many patients who are without teeth. Often, they have been wearing complete, removable dentures that, over a period of time, have caused the loss or resorption of underlying bone. Prosthodontists are specialists trained to construct fixed and removable dentures for difficult cases. The increased success of titanium implants in the jaws and the appliances connected to them have aided prosthodontists in treating the complex cases. They also construct appliances to replace tissues and structures lost from cancer surgery of the oral cavity and congenital deformities such as cleft palate.

Perspective and Prospects

In the past, dentistry only treated pain caused by a diseased tooth; the usual mode of treatment was extraction. Today, the prevention of disease, the retention of teeth, and the restoration of the dentition are the treatment goals of dentists.

The development of composite resins has successfully addressed many aesthetic problems associated with restorations. Although metal fillings of silver amalgam (actually a mixture of silver, lead, and mercury) and cast-gold restorations were often the treatments of choice in the past, composite fillings have become the treatment of choice. Plastic composite materials that are chemically bonded to the enamel and dentin of teeth are more aesthetically pleasing than metals. They have also shown great promise for longevity. There is still some concern about the resistance of these materials to chewing forces and leakage of the bonding to the tooth, but the techniques and materials are improving.

Dental porcelains improved greatly in the last half of the twentieth century. Although porcelain fused to metal crowns is often the material of choice, in certain cases crowns, inlays, and fixed bridges of a newer type of porcelain are being used. Thin veneers of porcelain are also used to restore front teeth that are congenitally or chemically stained. The result is cosmetically more appealing. Through a similar bonding process of composites, these veneers on the front surfaces of the teeth offer maximum aesthetics with minimum destruction of tooth structure.

While implantation of metals into the jawbones to support dentures and other prosthetic appliances is not new, the recent use of titanium implants and precision techniques promises long-term retention. Special drills are used to prepare the implant site, and titanium cylinders are either threaded into the bone or pushed into the jaw. The implant is covered by the gum tissue and allowed to heal for six to eight months, so that the process of osseointegration (joining of bone and metal) can occur. The bone will actually fuse to the pure metal, anchoring the implant for an eventual prosthetic appliance.

Laser technology is an exciting field has yielded some important applications in dentistry. Lasers have been used in gum surgery. Some theorists believe that if the enamel surface of the teeth were to be fused, it would be highly resistant to decay. The heat generated by lasers is a concern, but steps are being taken to control this problem. One of the most promising uses of lasers is in the specialty of endodontics. A thin laser fiber-optic probe advanced down the root canal, preparing and sterilizing the canal prior to filling, vaporizes diseased or degenerating pulp.

Computer science is also being integrated into the treatment phase of dentistry. For example, after scanning a patient’s mouth, projected results of treatment can be displayed on a computer screen. In addition, restorations can be developed using the concept of computer-aided design/computer-aided manufacturing (CAD/CAM). A computer scans a prepared tooth for a crown or inlay. The restoration is then designed for a three-dimensional model on the screen. After the model restoration has been chosen, the computer transfers the data to a computer-activated milling machine in the dental laboratory, and a restoration is reproduced in a ceramic or composite resin material in the designed image. The restoration is then cemented into the prepared tooth. Furthermore, techniques are being developed toward a less invasive way than x-rays of assessing dental health, including optical coherence tomography.

Such improvements in techniques and materials have advanced dentistry into a new era in providing treatment for patients. The basic fundamentals of treatment of the teeth and their surrounding tissues must be maintained, however, in view of the peculiar anatomy and physiology of the teeth.

Bibliography

Artemis, Nadine. Holistic Dental Care: The Complete Guide to Healthy Teeth and Gums. Berkeley: North Atlantic, 2013.

Bird, Doni L., and Debbie S. Robinson. Modern Dental Assisting. 11th ed. St. Louis: Elsevier, 2015. Print.

Darby, Michelle L. Mosby's Comprehensive Review of Dental Hygiene. 7th ed. St. Louis: Mosby, 2011. Print.

Foster, Malcolm S. Protecting Our Children’s Teeth: A Guide to Quality Dental Care from Infancy through Age Twelve. New York: Insight, 1992. Print.

Gluck, George M., and William M. Morganstein. Jong’s Community Dental Health. 5th ed. St. Louis: Mosby, 2003. Print.

Heymann, Harald O., Edward J. Swift Jr., and Andre V. Ritter. Sturdevant's Art and Science of Operative Dentistry. 6th ed. St. Louis: Elsevier, 2012.

Kendall, Bonnie L. Opportunities in Dental Care Careers. Ed. Blythe Camenson. New York: McGraw, 2006. Print.

Moss, Stephen J. Growing Up Cavity Free: A Parent’s Guide to Prevention. New York: Edition Q, 1994. Print.

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

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

Ring, Malvin E. Dentistry: An Illustrated History. New York: Abrams, 1985. Print.

Smith, Rebecca W. The Columbia University School of Dental and Oral Surgery’s Guide to Family Dental Care. New York: Norton, 1997. Print.

"What Is Laser Dentistry?" Academy of General Dentistry, Jan. 2012. Print.

Your Dental Health: A Guide for Patients and Families. Farmington: Connecticut Consumer Health Information Network, Univ. of Connecticut Health Center, 2008. Print.

In The Loved One by Evelyn Waugh, how does Dennis Barlow demonstrate the theme that death is artificial in America ?

The Loved One by Evelyn Waugh is a satirical novel that targets what Waugh considers the inanity and superficiality of American life. The targets of his satire include Hollywood, the mortuary industry, and journalism. In each case, he shows that under a facade of moral seriousness lies corruption, acquisitiveness, or stupidity. 

The most biting satire in the book is reserved for the operation of The Happier Hunting Ground, a pet cemetery that is seen through the...

The Loved One by Evelyn Waugh is a satirical novel that targets what Waugh considers the inanity and superficiality of American life. The targets of his satire include Hollywood, the mortuary industry, and journalism. In each case, he shows that under a facade of moral seriousness lies corruption, acquisitiveness, or stupidity. 

The most biting satire in the book is reserved for the operation of The Happier Hunting Ground, a pet cemetery that is seen through the eyes of Dennis Barlow, a cynical Englishman, whose poetry is just as much a facade as the ornate funerals given to the pampered pets of the Hollywood elite. 

The artificial nature of death is shown in the way corpses are made to look almost alive through the use of cosmetics, sanitizing the experience of death. Death is also sugar-coated through sentimentality and ritual. By blending pet and human deaths and refracting the experience of human mortuary services through animal ones which hold up a mirror to them, Waugh shows that death has been sugar-coated and made almost unreal and overly pretty in the American tradition. As a devout Catholic himself, Waugh is implicitly suggesting that the saccharine cliches of commercialized funerary homes have replaced a more profound religious understanding of death.

The most biting critique occurs when Dennis arranges for Joyboy to receive the following annual message:

Your little Aimee is wagging her tail in heaven tonight, thinking of you.

This sort of anodyne reminder of the anniversary of a death stands in opposition to the profound ritual of the All Souls' liturgy commemorating the faithful departed. 

What is salmonella infection? |

Causes and Symptoms

Salmonella are a group of bacteria that can cause gastrointestinal infections, blood infections, and various local infections. All types of salmonella can be carried in the gastrointestinal tract without symptoms after recovery from infection.

The clinical disease caused by salmonella depends on the type of bacteria, the amount of organisms ingested, and the age and immune status of the person infected. Infection with salmonella can take place with the ingestion of one or 100 million organisms. Increasing the dosage of bacteria decreases the incubation period and increases the severity of the resulting disease. After ingestion, the bacteria adhere to and invade the gastrointestinal tract. In the wall of the intestinal tract, salmonella survive and multiply in immune cells and then enter the bloodstream, where they proceed to any area of the body. Young infants and people with immune deficiencies and hemolytic anemia are at increased risk for severe and complicated infections.

One specific type of serious illness caused by salmonella is enteric or typhoid fever. Typhoid fever is rare in the United States, causing an estimated 5,700 cases per year, primarily in people who acquired it in other countries. This disease is caused by the Typhi variety of the Salmonella enterica bacterium. Symptoms during the first week of illness include progressively increasing fever with associated headache, muscle aches, abdominal pains, and lethargy. In the second week, the heart rate decreases, the liver and spleen enlarge, small red bumps form on the trunk, and the patient enters into a stupor. During the third to fourth week, intestinal hemorrhage and perforation are common. The fever begins to remit in the fifth to sixth week of illness. Diarrhea usually starts in the first week and resolves within six weeks. Without treatment, death can occur from gastrointestinal hemorrhage and perforation. Infants tend to have much more severe disease than older children.

Salmonellosis caused by nontyphoid salmonella is more common in the United States, causing about forty thousand reported cases per year; the number of unreported cases is thought to be far higher. The major reservoir of nontyphoid salmonella is the gastrointestinal tract of many animals, including mammals, reptiles, birds, and insects, although plants may also become contaminated. Farm animals and pet reptiles commonly carry salmonella. Some antibiotic resistance is caused by the use of antibiotics in animal feeds. Contaminated eggs and milk products are common sources of human infection.

Gastroenteritis
is the most common disease caused by nontyphoid salmonella. The incubation period for this disease is about one day, with a range from six hours to three days. Symptoms include nausea, vomiting, and abdominal pain. Diarrhea typically contains blood and mucus. Usually, symptoms disappear in less than a week in healthy children, but in young infants and in children with immune deficiencies, symptoms may persist for several weeks.

Bacteremia can occur in 1 to 5 percent of patients with salmonella gastroenteritis. Bacteremia is generally associated with fever, chills, and toxicity in the older child but may be asymptomatic in the infant. Children with an increased risk of bacteremia include those with acquired immunodeficiency syndrome (AIDS) or other immune deficiencies and hemolytic anemias such as sickle cell anemia.

Bacteremia can lead to infection of almost any organ. Children with sickle cell anemia are more prone to bone infections and meningitis. Salmonella may localize to areas of the body that have received trauma or that contain damaged tissue or a foreign body. Meningitis, inflammation of the covering of the spine and brain, is primarily seen as a complication of bacteremia in infants. Patients who have persistent bacteremia should also be evaluated for heart infection.

The diagnosis of a salmonella infection is best made by culturing stool and blood samples. With enteric fever, it is important to culture multiple sites multiple times. Antibiotic susceptibility testing must be performed routinely to guide therapy. Other bacterial causes of gastroenteritis can be confused with salmonella infection.

Treatment and Therapy

Treatment for gastroenteritis usually does not require antibiotics. Antibiotics do not speed the resolution of disease but instead lead to prolonged excretion of salmonella. Therapy is primarily focused on the correction of fluid and salt imbalances and on general supportive care. If the patient has indications of sepsis, shock, or chills, however, then antibiotics should be administered. Infants under three months of age and children with immune deficiencies should also be treated with antibiotics. Ampicillin is usually used as the initial treatment in uncomplicated cases, and third-generation cephalosporin antibiotics are used in severe and complicated cases. About 20 percent of nontyphoid salmonella in the United States is resistant to ampicillin as well as to other antibiotics. Antibiotic treatment should last ten days to two weeks in children with bacteremia and four to six weeks in children with bone infection or meningitis. Local infections may require surgical drainage.

Typhoid fever is treated for a minimum of two weeks. It is important to perform susceptibility testing for the possibility of resistance so that proper antibiotic therapy can be chosen. Chronic carriers of Salmonella enterica Typhi should be treated with antibiotics. If eradication is unsuccessful, surgical assessment of the biliary tract should be sought.

Prevention of the spread of salmonella requires a number of public health procedures. Hand washing is critical to the prevention of transmission. Persons who are carriers of salmonella should be excluded from food preparation and child-care settings. Hospitalized infants and children should be isolated. Proper sewage disposal, water purification, and chlorination are essential public health measures. In developing countries, the promotion of prolonged breast-feeding also reduces the infection rate.

There are two typhoid vaccines commercially available in the United States. The first is an oral, live attenuated vaccine that requires four doses given over a period of one week and a booster every five years. The second is a parenteral capsular polysaccharide vaccine given as a single intramuscular injection and a booster every two years. The vaccines are 50 to 80 percent protective. The live attenuated vaccine should not be given to patients who are pregnant, taking antibiotics, or immunocompromised, such as persons with the Human immunodeficiency virus (HIV).

Perspective and Prospects

Salmonella was identified as the cause of typhoid fever in 1880 and was first cultured in 1884. Since 1920, improvements in sanitation, water supplies, and sewage disposal have resulted in a marked decrease of typhoid fever in the United States. However, it is still a problem in the developing world, where it affects over 20 million people per year.

Recent research is focused on public health. Measures to decrease food contamination such as improved cleanliness, decreased use of antibiotics in animal feeds, and food irradiation are being evaluated and used to decrease transmission to humans. Research into alternate vaccines with fewer side effects and improved immune response is also being performed.

Nontyphoid salmonella causes as many as half a million infections per year in the United States. One-third of these infections are in children less than five years of age, and 40 percent are in adults over thirty years of age.

Bibliography

Aaron, Shara. "Salmonellosis." Health Library, November 26, 2012.

Beers, Mark H., et al., eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, N.J.: Merck Research Laboratories, 2006.

Bellenir, Karen, and Peter D. Dresser, eds. Contagious and Noncontagious Infectious Diseases Sourcebook. Detroit, Mich.: Omnigraphics, 1996.

Biddle, Wayne. A Field Guide to Germs. 3d ed. New York: Anchor Books, 2010.

Cliver, Dean O., and Hans P. Riemann, eds. Foodborne Diseases. 2d ed. San Diego, Calif.: Academic Press, 2002.

Jay, James M., Martin J. Loessner, and David A. Golden. Modern Food Microbiology. 7th ed. New York: Springer, 2005.

Leon, Warren, and Caroline Smith DeWaal. Is Our Food Safe? A Consumer’s Guide to Protecting Your Health and the Environment. New York: Crown, 2002.

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

"Salmonella." Centers for Disease Control and Prevention, May 22, 2013.

"Salmonellosis." National Institute of Allergy and Infectious Diseases, November 16, 2011.

In Wilfred Owen's poem Dulce Et Decorum Est, what poetic techniques are used?

Wilfred Owen was a major war poet, writing about his experiences during World War I. He died days before Armistice Day, the ending of that brutal, bloody war. Unlike today's "surgical strikes," World War I was fought in trenches. Seventeen million soldiers and civilians died between 1914 and 1918. 

Owen's poetry reflects the horror of that war and Dulce et Decorum Est is part of that representation. The poem begins and ends with a major irony. "Dulce et decorum est" is Latin, meaning "sweet and beautiful it is." What follows this title is anything but sweet and beautiful. In describing what happened to a victim of gassing, the poem states:

If in some smothering dreams, you too could pace
Behind the wagon that we flung him in,
And watch the white eyes writhing in his face,
His hanging face, like a devil’s sick of sin;
If you could hear, at every jolt, the blood
Come gargling from the froth-corrupted lungs,
Obscene as cancer, bitter as the cud
Of vile, incurable sores on innocent tongues,—

There is nothing sweet and beautiful about this. 

The irony continues in the last four lines of the poem, stating that if we were to truly understand the horror of war, we would not be telling children, particularly British school boys of the early 20th century and their descendants, the old Latin saying, "Dulce et decorum est pro patria mori," which means, "sweet and beautiful it is to die for one's country." People choose to go to war and die for their countries, but that process is ugly and profane. 

A second major poetic device Owen uses is simile. Owen's challenge as a writer is to portray the level of horror he felt during this situation to readers who had never been in a trench, never been shot at, never been subject to gas, never watched friends die in agony. Simile offers him a chance to compare what he saw in war with horrible things people experience in everyday life, such as a devil, cancer, and bitter cud (cud is something to be chewed on for awhile; cows chew on cud). 

Finally, like many poets, Owen uses the sound of words as a means of unifying the poem. Rhyme and assonance make the poem hold together, since words that share sounds feel like they belong with each other. The rhyme scheme is a, b, a, b, which means that every other line rhymes. The verses vary in length but this rhyme scheme is carried through the poem. 

Assonance is the use of the same vowel sound across words. Here is an example of the use of the short /u/; words with this sound are italicized:

Gas! GAS! Quick, boys!—An ecstasy of fumbling
Fitting the clumsy helmets just in time,
But someone still was yelling out and stumbling

The sound /m/ in this passage is an example of consonance, the use of the same consonant sound, even if this does not occur at the beginning of the word (which would be alliteration). 

It is almost impossible to relate how terrible war is to experience; yet Owen makes a mighty effort to persuade his readers that war is not glorious or something to be romanticized. 

What is nephritis? |

Causes and Symptoms

Nephritis means any inflammatory responses of the kidney, whether the cause is infectious or immunological. Generally, it involves mainly the glomeruli, where the initial formation of urine takes place. The term is therefore equivalent in meaning to glomerulonephritis. Pathological changes may also occur in the interstitium (the extravascular, extracellular domain in which the tubules are embedded) and affect tubular functions. This condition, referred to as tubulointerstitial nephritis, is associated with localized cellular infiltrates and the accumulation of fluid.

The classic cause of acute glomerulonephritis is an infection in the throat or of the skin by a nephritogenic strain of Group A streptococci. The clinical presentation can be dramatic and can be associated not only with a sore throat but also with headaches, shortness of breath, and swelling of the ankles. Physical examination may find hypertension, rales in the lungs, peripheral pitting edema, and changes in the retinal vessels. In the chronic form, the onset is usually insidious; an infection may have been forgotten or ignored, without specific complaints except for some ankle edema, tiredness, and perhaps pallor. The physical findings for chronic glomerulonephritis are similar to but less striking than in the acute form.

The diagnosis in each type of nephritis is presumed on the basis of urinalysis, with a finding of blood (hematuria) in the acute form; proteinuria (actually mainly albuminuria, although globulins may also be present); and a decreased glomerular filtration rate. Diagnosis is established on the basis of renal biopsy with examination by both light and electron microscopy. Throat cultures and streptococcal group determination are appropriate if an infection is suspected.

Both conditions may be followed by the development of nephrotic syndrome, which is characterized by major losses of albumin in the urine, decreased serum albumin concentrations (hypoalbuminemia), the retention of water and of sodium and chloride ions, and massive edema and ascites (fluid leakage from blood vessels into the abdomen). Nephrotic syndrome may also appear without any history or evidence of a preceding episode of acute glomerulonephritis. On renal biopsy, essentially no changes or only minimal changes may be noted on inspection by light microscopy (minimal change disease), although characteristic changes are found with electron microscopy affecting particularly the foot processes (podocytes) of the glomeruli.

Acute glomerulonephritis resolves spontaneously and rapidly in about 95 percent of cases, without detectable residual damage to kidney functions. Apart from control of hypertension, no specific treatment is available. The edema is rarely sufficient to warrant the use of diuretics. Antibiotics are not indicated unless there is evidence of an infection. Patients can be considered to be cured but should nonetheless be followed in the event of a reappearance of symptoms or manifestations.

In nonresolving acute glomerulonephritis and in chronic glomerulonephritis, there can be progression of damage to the glomeruli so that the number of functioning glomeruli (normally, about one million in each kidney) diminishes. This process may be gradual or may occur as a part of acute exacerbations that subside but leave the patient with diminished renal functions. As a result, glomerular filtration is decreased and the accumulation of metabolic end-products, particularly urea, occurs in the blood and tissue fluids. Abnormalities of acid-base regulation appear with decreased blood pH (acidemia), decreased serum bicarbonate concentration, and increased potassium concentration. Generally, a significant anemia exists, and renal blood flow is decreased so that the metabolic activities of the renal tubule
cells are affected. Renal insufficiency is established, and dietary control is instituted, with decreased intakes of protein and potassium. Paradoxically, with decreased glomerular function, proteinuria decreases, serum albumin increases, and edema decreases or disappears.

Unfortunately, the progression of glomerular dysfunction continues, and dietary measures provide insufficient control of metabolic abnormalities. Resort is then made to hemodialysis or peritoneal dialysis to control the metabolic abnormalities and lift dietary restrictions to some degree while the patient awaits kidney transplantation. During this waiting period, stimulants of the bone marrow, such as erythropoietin, are administered in the expectation of maintaining the red cell count and the hematocrit at a satisfactory level. Transplants will require the use of immunosuppressive agents to prevent rejection unless an identical twin is the donor.

Other diseases in which glomerular damage can occur include diabetes mellitus, amyloidosis, systemic
lupus erythematosus (SLE), Wegener’sgranulomatosis, Goodpasture’s syndrome, syphilis, and human immunodeficiency virus (HIV) infection. Common problems associated with glomerular damage of any etiology are hypertension, strokes, heart failure, pulmonary edema, arteriolar vasoconstriction and sclerosis, impaired vision from exudates, pericarditis, and pericardial effusions.

Treatment and Therapy

Acute glomerulonephritis is characterized by the disappearance of signs and symptoms, or at least their marked reduction, in most patients. In 90 to 95 percent of cases, there is no progression and no recurrence. In some patients, the problems may reappear after apparent complete remission, while in others the disease progresses, often to nephrotic syndrome. This phase, too, disappears as the disease worsens, reaching the stage where hemodialysis or peritoneal dialysis becomes necessary. A renal biopsy can aid in determining the appropriate treatment. For example, if the biopsy confirms that poststreptococcal nephritis is present, then no specific treatment is available. If progressive glomerulonephritis is the diagnosis, then steroids may be indicated.

Hemodialysis depends on an arteriovenous shunt being created, usually in the forearm, so that the patient’s blood can pass through a dialysis
machine, which functions in a manner similar to glomeruli. Usually, several sessions, two or three times per week for several hours at a time, are required. Peritoneal dialysis involves the introduction of large amounts of fluid into the peritoneal cavity and its withdrawal after adequate exchanges with body fluids across the peritoneal surfaces have occurred. Hemodialysis requires going to a hospital or specialized facility, while pertoneal dialysis can be performed at home. Both procedures require careful and frequent monitoring of the patient’s acid-base, electrolyte, and metabolic statuses.

While arrangements can usually be made for local dialysis, patients on dialysis lose a significant degree of mobility and independence. This independence can be regained to a considerable degree through kidney transplantation.
Kidneys may be obtained from cadavers, unrelated living donors, and related living donors, such as identical twins. Except with the latter group, rejection phenomena may occur. Infections can occur with the use of immunosuppressive agents. Rarely, malignancies can be introduced with transplanted kidneys.

A low protein intake is recommended in the later stages of glomerulonephritis because too high a protein intake may accelerate the progression of the disease. Lack of control of water intake may lead to edema. Anemia is common in the later stages and may require the administration of erythropoietin.

In the nephrotic phase and in minimal change disease, control of edema is sought through one or more of the following measures: salt restriction, diuretics, intravenous (IV) administration of concentrated human serum albumin, corticosteroids (such as prednisone, which is more likely to be effective in minimal change disease), and other immunosuppressive agents. Nephrotic syndrome may occur in the presence of other underlying diseases, such as lupus, diabetes mellitus, HIV infection, syphilis, amyloidosis, and microvascular angiopathies. Specific treatments should be used when applicable.

Perspective and Prospects

The monograph Reports of Medical Cases by Richard Bright, published in 1827, marks the first clear description of nephritis through clinical findings (edema), laboratory assessment (proteinuria), and gross structural changes in the kidneys at postmortem. For many years, nephritis was referred to as Bright’s disease. Apart from the measurement of blood constituents such as urea and creatinine, functional assessment was limited until the development, by Donald D. Van Slyke, of the clearance concept, defined as the amount of a given substance excreted in the urine per unit time relative to its concentration in plasma or blood. Van Slyke focused on the clearance of urea, while P. B. Rehberg in Denmark proposed that the clearance of creatinine could be used as a measure of the glomerular filtration rate. Glomerular fluid had been shown by Newton Richards to have the same composition as an ultrafiltrate of plasma. Accordingly, if creatinine was neither secreted nor reabsorbed by the tubules, then its clearance would be equivalent to the glomerular filtration rate.

The assumptions with respect to creatinine were shown to be incorrect, and inulin, a polyfructoside studied by Homer Smith, was found to be a reliable and correct indicator for measuring the glomerular filtration rate. Smith and his collaborators systematized and advanced knowledge of the kidney as a whole organ in a quantitative manner. Detailed understanding of the components of the whole organ progressed rapidly with the discovery of the significance of countercirculation in establishing the solute concentration gradient from cortex to medulla reported by H. Wirz and B. Hargitay. Functions of limited segments of the tubules (and later of individual cells) have provided additional important information on transport and metabolic processes in the kidneys.

On the clinical side, the introduction of renal biopsies and of hemodialysis (and later peritoneal dialysis) by way of an arteriovenous shunt made for more accurate diagnoses and longer life expectancies for patients with chronic renal disease. Further encouragement was provided by the development of techniques for successful renal transplants, first from identical twins, then from living donors and cadavers. Problems of rejection remain. Another major challenge is to find the means of delaying or arresting the progression of chronic renal disease before dialysis and transplants become necessary.

A study published in the Journal of Epidemiology and Community Health in May 2013 reported that half of over 1,100 adults treated for stroke in Boston, Massachusetts between 1999 and 2004 lived in close proximity to a major roadway. According to researchers, there is evidence that air pollution caused by traffic can cause harm to the arteries that supply blood to the kidneys.

Bibliography

Brenner, Barry M. “Retarding the Progression of Renal Disease.” Kidney International 64 (2003): 370-378.

_______, ed. Brenner and Rector’s The Kidney. 8th ed. Philadelphia: Saunders/Elsevier, 2008.

Cameron, J. Stewart, and Richard J. Glassock, eds. The Nephrotic Syndrome. New York: Marcel Dekker, 1988.

D’Amico, G., and C. Bazzi. “Pathophysiology of Proteinuria.” Kidney International 63 (2003): 809-825.

Eddy, A. A., and J. M. Symons. “Nephrotic Syndrome in Children.” The Lancet 362 (2003): 629-639.

Hricik, D. E., M. Chung-Park, and J. R. Sedor. “Glomerulonephritis.” New England Journal of Medicine 339 (1998): 888-899.

Lue, Shih-Ho. "Residential Proximity to Major Roadways and Renal function."  Journal of Epidemiology and Community Health. 10.1136 (2012). Print.

What is botulism? |

Causes and Symptoms

Clostridium botulinum is a bacillus that produces spores. Both bacteria and spores can be found in the intestines of humans and other animals as well as in contaminated soil and water. The spores are highly resistant to heat and can survive boiling and other measures employed to kill bacteria and destroy toxins for safe food preparation. Under appropriate anaerobic conditions (those lacking oxygen), the spores germinate into the toxin-producing vegetative bacilli. The exotoxin is a protein synthesized within the bacteria and released only after the death and lysis (disintegration) of the bacteria. When ingested, the toxin resists the acid and enzymes of the stomach by creating complexes with other bacterial proteins. This allows the toxin to reach the intestines, where it is absorbed into the bloodstream and carried to nerve endings. The toxin is bound and internalized into the presynaptic nerve
endings, preventing release of the neurotransmitter acetylcholine. The binding is irreversible, and recovery can occur only after nerve endings regenerate.

Human illness is caused by toxin ingestion or the entry of toxin-producing bacteria into the host. Improper processing of food, especially home canning, can result in the germination of contaminating spores, with subsequent toxin production. Food poisoning
occurs when toxin-containing food is ingested, unless it has has been heated sufficiently to denature the protein toxin.

The symptoms of descending paralysis usually begin twelve to thirty-six hours after ingestion. Blurred vision, slurred speech, and difficulty swallowing are followed by labored breathing and weakness of the upper and then the lower extremities. Spores may also contaminate a wound and then germinate and form toxin within the host, producing symptoms similar to food poisoning. Botulism is diagnosed by identification of the toxin and/or bacteria in the patient’s serum, stool, or wound, or in ingested food. The specific type of botulinum toxin is verified using the mouse neutralization test.

Treatment and Therapy

The outcome of botulism has improved with the development of critical care and supportive measures. Intubation and mechanical ventilation is vitally important until neuromuscular control of breathing is regained. Specific treatment with botulism antitoxin may be used in severe or progressive cases. Because this antitoxin is of equine origin, however, a high incidence of hypersensitivity reactions (9 to 20 percent) occurs in human patients.

Perspective and Prospects

In 1820, a German named Justinus Kerner first noted the association between sausage consumption and paralytic disease. The term botulism is derived from botulus, the Latin word for “sausage.” Wound botulism was first recognized in 1943. Infant botulism, which is caused by swallowed spores rather than preformed toxin, was first noted in 1976. The most common form of human botulism in the United States, infant botulism can be contracted from exposure to honey, but most cases seem to be related to spores found in soil and dust.

Despite these insights, however, the epidemiology of many botulism cases remains obscure. A diagnostic test more rapid and widely available than the mouse neutralization test, which takes forty-eight hours, is needed. Antitoxin, perhaps from deoxyribonucleic acid (DNA) hybridization technology, would improve therapy over the scarce and dangerous equine product.

Bibliography:

Brachman, Philip S., and Elias Abrutyn, eds. Bacterial Infections of Humans: Epidemiology and Control. 4th ed. New York: Springer, 2009.

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

MedlinePlus. "Botulism." MedlinePlus, Apr. 23, 2013.

Pommerville, Jeffery C. Alcamo’s Fundamentals of Microbiology. 9th ed. Sudbury, Mass.: Jones, 2010.

Wood, Debra. "Botulism." Health Library, Nov. 11, 2012.

What impact did the character Napoleon from the book Animal Farm have on the other characters? What was his impact on the plot of the story?

Napoleon is an interesting character because he is one of the smartest pigs on the farm. In fact, at first we don't see too much of an impact from him, especially with regards to the initial conflict and subsequent rebellion by the farm animals. It is only after the rebellion that he steps up to take a leadership role over the other animals. In the book, he is described as fierce-looking, with a reputation for...

Napoleon is an interesting character because he is one of the smartest pigs on the farm. In fact, at first we don't see too much of an impact from him, especially with regards to the initial conflict and subsequent rebellion by the farm animals. It is only after the rebellion that he steps up to take a leadership role over the other animals. In the book, he is described as fierce-looking, with a reputation for getting his way. The other animals know that he will eventually get what he wants, so they don't put up too much of a fight. In this way, he has a powerful effect on them; one might say that he has a manipulative effect on them.

Everything that Napoleon doesn't want to deal with, he finds a sneaky, yet effective, solution for and bides his time until he is able to solve the problem for himself. He does this by raising dogs in order to chase Snowball off of the farm. He never has to speak for himself, because Squealer does it for him. In this way, he can avoid taking responsibility. Napoleon also does away with public meetings in order to avoid protests, and he appoints himself as the head of every single committee, so there's no disagreement. Because of this, he effectively succeeds in silencing the other characters. 

In order to appear more powerful, he spends most of his time separated from the others, surrounded by a pack of dogs which serve as his protectors. This gives him the image of being all-powerful, mysterious, and not someone that you want to mess with. He changes the story by forcing a few of the other animals to make false claims in public. Essentially, he rewrites history to suit his own needs. Just like Stalin, he claims to be doing it all for the good of everyone, but he is really just motivated by power and greed. 

How do people cope with terminal illness?

Introduction

A terminal illness cannot be cured and, therefore, is recognized by the person dying as a catastrophic threat to the self, to the individual’s relationships, and to the body. In terms of the model of coping proposed by Richard Lazarus and Susan Folkman,
death
is the perceived threat or stressor causing stress and is evaluated by primary appraisal; the response or coping strategy depends on the person’s secondary appraisal of available physical, psychological, social, and spiritual resources. The relationship between the perception of threat and the coping response is dynamic in that it changes over time. For example, the threat of death varies with physical or psychological deterioration and calls for changing strategies during the period of dying.

Anxiety and fear are typical of any crisis; however, when faced with the overwhelming crisis that death poses, a dying person is flooded with death anxiety or mortal fear of dying. Two classic views of death anxiety are Freudian and existential. Sigmund Freud
believed that it was impossible to imagine one’s own death and that “death anxiety” is really fear of something else, whereas the existentialists believe that awareness of mortality is a basic condition of human existence and is the source of death anxiety. In 1996, Adrian Tomer and Grafton Eliason offered a contemporary “regrets” model, where death anxiety is a function of how much one regrets not having accomplished what one had hoped to accomplish in light of the time left. A major criticism of their work is that achievement takes precedence over social relationships and other sources of meaning. In 2000, Robert J. Kastenbaum proposed an edge theory, where the response to extreme danger is distinct from the ordinary awareness of mortality. He suggested that death anxiety is the consequence of a heightened awareness of potential disaster at the edge of what is otherwise known to be relatively safe.

Thanatology, the study of death and dying, focuses on the needs of the terminally ill and their survivors. Some thanatologists distinguish between fear of the process of dying and fear of the unknown at death. For example, the Collett-Lester Scale, established in 1994, operationalizes these ideas by offering four subscales: death of self, death of others, dying of self, and dying of others. A major problem with studies of death anxiety is that researchers typically employ self-report questionnaires that measure conscious attitudes. In general, the construct validity of questionnaires is reduced when anxiety is confounded with unconscious denial or when death is confounded with dying.

Hospice and Palliative Care

From the beginning of the twentieth century until the 1970s, Americans with terminal illnesses usually died in hospitals. Medical treatment focused on pathology; control of pain with narcotics was limited, as most physicians were worried about consequent drug addiction. Efforts to save lives were machine-intensive and often painful. The psychological, social, and spiritual needs of the person were not as important as the heroic effort to preserve life at any cost. When Dame Cicely Saunders, a British nurse and physician, opened St. Christopher’s Hospice in London in 1967, she introduced holistic reforms that treated both the dying person and his or her family and included regular administrations of morphine for the amelioration of pain. It was discovered that control of pain is better when dosing at regular intervals and that the total dosage may be less than if drugs are offered only in response to severe, acute pain. Saunders was a profound inspiration to the international hospice movement, as well as to the new field of palliative medicine. (The goal of palliative care is to relieve pain and symptoms and is different from traditional, curative care.)

Initially, hospices were based in hospitals; however, toward the end of the twentieth century, home-based care became common. A full-service program provides an interdisciplinary team of a physician, social worker, registered nurse, and pastor or counselor; round-the-clock care is available. Furthermore, after death, support services are offered to grieving families. In the United States, the National Hospice Reimbursement Act of 1983 offered financial support for full-service hospice care. A local hospice is an important coping resource for someone who chooses to forgo traditional medical treatment. It offers a means for preserving some control of the environment, as well as for maintaining personal dignity. Most important, a peaceful, pain-free death is possible.

Stages of Dying

About the time that the international hospice movement was gaining momentum, an important book titled On Death and Dying (1969) was published in America by the psychiatrist Elisabeth Kübler-Ross. She presented transcripts of interviews with dying patients who were struggling with common end-of-life concerns. What gripped American readers was her call for the treatment of dying people as human beings and her compelling, intellectual analysis of dying as a sequence of five stages: denial and isolation, anger, bargaining, depression, and acceptance. However, according to Robert J. Kastenbaum, there is no real empirical verification of her stage theory. Specifically, dying need not involve all stages and may not proceed in the sequence described by Kübler-Ross. Therapists point out that depression and anxiety are ever present but change in intensity—sometimes manageable, sometimes overwhelming. Although theoreticians argue about the scientific status of Kübler-Ross’s stage theory, clinicians use her ideas to tailor therapeutic regimens depending on the current needs of their patients. One way to evaluate current status is in terms of how the patient is coping with various threats and challenges posed by dying.

The “stages” of dying may be thought of as emotion-focused coping behaviors for responding to death, a stressor that cannot be changed. In contrast, problem-focused coping behaviors are appropriate when an aspect of the stressor can be changed. When a dying mother is too weak to care for a child, she copes with the problem of her weakness by arranging for child care. When a husband is worried about the financial security of his wife, he draws up a will.

Denial is usually the first response to the shocking news of terminal illness. Denial of one’s impending death is a way of coping with the threat of losing one’s self and key relationships. The loss of one’s self is characterized by the loss of what one values as personally defining. For example, death implies the ultimate loss of strength or of the capacity for meaningful work and ushers in a radical, unwanted change of self-concept. However, denial allows an acceptance of the facts at a slower, more manageable rate and is a way to cope emotionally with death anxiety.

Anger is a common venting response once denial is no longer consuming. (Other venting strategies include crying, yelling, sarcasm, and recklessness.) The private or public expression of anger is evidence that the person has moved beyond complete denial toward the recognition of death as a real threat.

Bargaining with fate or some higher power is a futile but common coping strategy, whereby the person tries desperately to restore body integrity and self-concept. The efforts are sometimes heroic, as when a person has accepted that he or she is dying but tries to maintain some version of prior meaningful activities. The scope is limited and the places may change, but relationships and activities critical to self-concept continue for as long as possible.

Depression is marked by sorrow, grief for current and future losses, and diminished pleasure. It is different from the anxiety that arises when a person fears that what is necessary for an intact self is jeopardized; in contrast, depression occurs when the dying person is certain that he or she has lost what is necessary. Depression is the most common psychological problem in palliative-care settings. However, when ordinary depression becomes major, the treatable condition is often unrecognized and patients suffer needless emotional pain. Minor depression, an expected coping behavior, may be adaptive, whereas major depression is maladaptive and requires medical intervention.

Acceptance of a terminal condition is viewed by many clinicians as a desired end-state because the possibility of a peaceful death comes with acceptance. The person has not given up emotionally but has reached a point of choosing not to struggle for survival. Therapists of various kinds interpret acceptance in the light of a particular worldview or theoretical paradigm. For example, the transpersonal counselor sees acceptance as evidence of an intrapsychic transformation of the self to a higher level of consciousness.

Other Coping Strategies

Dying presents many threats and challenges, including psychological and spiritual distress, pain, exhaustion, loss of independence, loss of dignity, and abandonment. In addition to depression and anxiety, guilt is a response to believing that one must have been a bad person to deserve such a fate or that one risked one’s health in a way that brought on the illness. Sometimes people feel guilty because of anger and sarcasm vented on hapless family members, friends, helpers, or a higher power. Thoughts of suicide may occur when depression is severe enough or if the pain is intolerable. Not all people suffer all these assaults, but each requires a strategy for coping.

It is not uncommon for friends and relatives to pull away from the dying person because of their own anxiety and discomfort. Witnessing the physical and emotional distress of a valued person poses a threat to successful, day-to-day management of mortal fears; one way to cope is by ignoring the dying. Unfortunately, physical or emotional distancing causes dreadful isolation and a sense of abandonment just when social support is most critically needed. The terminally ill in such a predicament may cope by turning to a pastoral counselor, therapist, self-help group, or local hospice.

Each type of therapist has a different focus. A psychoanalyst might encourage frank discussions of fears and anxieties. A cognitive behavioral therapist might focus on changing maladaptive behavior by modifying negative thought patterns. A humanistic-existentialist might encourage a life review to help consolidate the patient’s perceptions of the meaning of life and as a way to say “good-bye.” A transpersonal counselor might focus on facilitating a meaningful transformation of self in preparation for death. A primary goal of therapy of any kind with dying patients is to promote physical and psychological comfort. Often, the therapist is an advocate acting as a liaison between the patient and the hospice, hospital, family, or friends. The therapist may provide helpful psychoeducational interventions, such as alleviating distress about an upcoming medical procedure by informing the patient about the rationale for the procedure, the steps involved, the predictable side effects, and the prognosis or forecast for the outcome. When the therapist also educates the family, the quality of their support is enhanced, thereby improving the well-being of the patient.

Self-Help Groups

Self-help groups provide significant mutual support to the terminally ill and to those in mourning. They are available in professional and nonprofessional settings. They are usually composed of peers who are in a similar plight and who, therefore, are familiar with the depression, anxiety, and guilt associated with dying. Access to a new, primary group counteracts common feelings of alienation and victimization by offering the opportunity for meaningful social support and information. Mutual disclosure reduces feelings of isolation and abandonment by building a community of peers. Sharing successful strategies for coping with secondary losses triggered by terminal illness restores hope. (For example, group members may know how to cope with the disfigurement of mastectomy or with confinement to a wheelchair.) Group participants also encourage one another to be active partners in their own medical care. Unreliable patterns of communication and reluctance to talk about dying are common outside the group; however, group members talk to one another openly, thereby reducing the dismay associated with patronizing exchanges with doctors and nurses or the silence of family and friends.

Religious and Spiritual Coping

Psychologists emphasize the ways in which adversity may be conquered or controlled, but not every stressor is controllable. Certainly, dying brings into sharp relief the fact that humans are ultimately powerless in the face of death. At the end of life, people often turn to religion or spirituality for answers as to the purpose of their lives, the reasons for suffering, the destination of their souls, the nature of the afterlife—whether a life everlasting exists. Coping theorists may reduce the function of religion to “terror management,” but others believe that the experience of the sacred cannot be understood empirically and that religion is more than an elaborate coping mechanism.

The psychologist of religion Kenneth I. Pargament studied the relationship between religion and coping. He defined religion functionally in terms of a search for significance in the light of the sacred. He described a typical Christian belief system involving the event (in this case, death), the person, and the sacred. Core beliefs are that God is benevolent, the world is just or fair, and the person is good. Dying jeopardizes the balance of this belief system; to cope, people turn to religious reframing as a way of conserving the significance or value of their core beliefs. For example, people facing a seemingly pointless death reframe its significance—death becomes an opportunity for spiritual growth or enlightenment; this preserves the beliefs that the person is good and that God is benevolent. Others reframe the nature of the person as being sinful; otherwise, why does suffering exist? The result is that belief in a just world is preserved. Some reframe their beliefs regarding the sacred and consider God as punishing. However, several researchers have found that only a small proportion of people attribute their suffering to a vengeful, punishing God. Another way to reframe the nature of God is to reconsider his omnipotence. People may conclude that a loving God is constrained by forces in nature. This reframed belief preserves the idea that God is good.

Dying is not always the occasion for spiritual crisis; people of deep Christian faith find solace in their relationship with God or with their understanding of the transcendent. The psychiatrist Harold G. Koenig reports in The Healing Power of Faith (1999) that faith, prayer, meditation, and congregational support mitigate fear, hopelessness, and the experience of pain. For people committed to a Christian religious or spiritual belief system, God or spirit is a source of peace and hope while dying.

Bibliography

Balk, David E. Dealing with Dying, Death, and Grief During Adolescence. New York: Routledge, 2014. Print.

Cook, Alicia Skinner, and Kevin Ann Oltjenbruns. Dying and Grieving: Life Span and Family Perspectives. 2nd ed. Fort Worth: Harcourt Brace, 1998. Print.

Kastenbaum, Robert J. Death, Society, and Human Experience. 11th ed. Boston: Pearson, 2014. Print.

Kessler, David. The Needs of the Dying: A Guide for Bringing Hope, Comfort, and Love to Life’s Final Chapter. New York: Harper, 2007. Print.

Kübler-Ross, Elisabeth. On Death and Dying. 1969. Reprint. New York: Routledge, 2009. Print.

Lair, George S. Counseling the Terminally Ill: Sharing the Journey. Washington, DC: Taylor & Francis, 1996. Print.

Miller, Glen E. Living Thoughtfully, Dying Well: A Doctor Explains How to Make Death a Natural Part of Life. Harisonburg: Herald, 2014. Print.

Pargament, Kenneth I. The Psychology of Religion and Coping: Theory, Research, and Practice. New York: Guilford, 2001. Print.