What does Harper Lee's To Kill a Mockingbird teach us about how people deal with issues of race and class?

Harper Lee portrays how various members of Maycomb's community deal with race and social class issues differently. There are characters throughout the novel who are openly prejudiced towards African Americans and individuals from lower social classes. Unapologetic racists like Mrs. Dubose and members of the Old Sarum bunch proudly oppose Atticus' decision to defend Tom Robinson. They do not care about what other people think and are not ashamed of their prejudiced beliefs. They wantonly voice their opinions in hopes of restricting African Americans' rights. Aunt Alexandra also openly displays her contempt for individuals from lower social classes by not allowing Scout or Jem to associate with them.

Harper Lee also displays how morally upright individuals like Atticus proudly stand up for what is right in the face of adversity. Atticus opposes the prejudiced beliefs of Maycomb and refuses to give into the community's threats. Atticus risks his reputation in order to do what is right and courageously defends Tom. He also teaches his children the importance of treating people equally regardless of their family background or social class.

Lee also depicts how certain individuals choose to quietly support prejudiced views. Miss Gates and Mrs. Merriweather do not blatantly express their prejudiced views but make inconspicuous comments that depict their beliefs. Harper Lee also illuminates how individuals quietly oppose Maycomb's prejudice. Characters such as Miss Maudie, Judge Taylor, and Heck Tate keep their opinions to themselves and privately support Atticus' cause. They are aware of the prejudiced feelings throughout town and do not want to draw attention to their opposing views.

Harper Lee shows her audience that individuals deal with race and social class issues in various ways. Some people proudly support their views and take action, while others choose to hide their feelings. Every individual has an opinion, and it is the way in which they express their opinions which makes them different.

What is folic acid? |

Cancers treated or prevented:
Colorectal cancer, breast cancer

Delivery routes: Natural dietary sources, fortified foods, oral supplements

How this substance works: Folate is an essential cofactor in the de novo synthesis of purines and thymidylate and therefore plays a role in DNA synthesis, replication, stability, and repair. Evidence suggests that folate deficiency can lead to DNA damage and is associated with macrocytic anemia, neural tube defects, and cancer. In 1998, the US Food and Drug Administration (FDA) began requiring the fortification of all flour and cereal grains with folic acid. These products are thus a major source of folic acid in the US population. Large epidemiological studies that followed subjects for many years have found that higher dietary intake of folate and folic acid supplementation decreased the risk of colon and breast cancer. A possible explanation for its protective effect is that folate prevents DNA damage that may lead to the development of cancer.

Side effects: Research results on the benefits of folate in preventing cancer are inconsistent. Despite population studies showing positive effects of higher folate intake, studies in animals and humans also have shown that folic acid supplementation increased the risk of breast cancer and the development of colon polyps. These mixed results suggest that folate has a dual role in the development of cancer. In normal tissues, folate appears to suppress the development of cancer, presumably by preventing mutations. Once early lesions or tumors have developed, however, folate appears to promote their progression in colorectal and breast cancers. In these cases, folic acid may provide a source of nucleotides for rapidly proliferating tissues, including tumors. Indeed, antifolate drugs are sometimes used in the treatment of cancer. Thus, the timing, dose, and form of folate appear to be critical in whether this substance prevents or actually promotes certain types of cancers. For these reasons, the National Institutes of Health (NIH) do not currently recommend folic acid supplements to reduce the risk of cancer.

Bibliography

Amer. Cancer Soc. "Folic Acid." Cancer.org. ACS, 7 Mar. 2011. Web. 22 Oct. 2014.

Ebbing, M., et al. "Cancer Incidence and Mortality after Treatment with Folic Acid and Vitamin B12." JAMA 302.19 (2009): 2119–2126. PubMed.gov. Web. 22 Oct. 2014.

Health Library. "Folate." Health Library.

MedlinePlus. "Folic Acid." MedlinePlus. US NLM/NIH, 16 Sept. 2014. Web. 22 Oct. 2014.

US Natl. Insts. of Health Office of Dietary Supplements. "Folate: Dietary Supplement Fact Sheet." Natl. Insts. of Health Office of Dietary Supplements. NIH/ODS, 14 Dec. 2012. Web. 22 Oct. 2014.

Vollset, S. E., et al. "Effects of Folic Acid Supplementation on Overall and Site-Specific Cancer Incidence During the Randomised Trials: Meta-Analyses of Data on 50,000 Individuals." Lancet 381.9871 (2013): 1029–1036. PubMed.gov. Web. 22 Oct. 2014.

What does the conch's fate in Lord Of The Flies symbolize?

The destruction of the conch symbolizes the end of rules and of order. It had always been a symbol of civilized behaviour and became a token that there existed some form of order on the island. It was the instrument which summoned all the boys to meetings where behavioural norms and other important aspects to ensure the boys' survival on the island were discussed. Furthermore, it was a guarantee that the rules of decency and respect would be adhered to, for the one who had the conch also had the right to speak.

The conch, in being used to summon meetings, also made it possible for the boys to socialize and discuss their concerns as well as their fears but also to consider a means to make themselves noticeable so that they could be rescued. It became a source of comfort for especially the younger and weaker boys, such as the littluns and Piggy who would otherwise not have been listened to. In this sense, it gave them power.

For these reasons, the conch became the most powerful object on the island. Its deep, booming sound created an awareness amongst the boys that something important was about to happen. It is ironic, though, that such an unsophisticated object could attain such a great measure of significance. Further irony lies in the fact that, because it was so simple and natural, it would fit in better in a savage environment, rather than one in which it became a device to maintain civilized order, and, therefore, be an emblem of sophistication. 

Once the conch was destroyed, everything fell apart almost from the moment of its destruction. Its annihilation indicates a dramatic turning-point in the novel. It was obliterated as the following extract from chapter 11 illustrates:

...the conch exploded into a thousand white fragments and ceased to exist.

It is no coincidence that Piggy died at the same time as the conch. He was the one who thought rationally and who insisted on an adherence to the rules. He believed that they would only survive and be rescued if they maintained control.

Although there had been a move away from civilized order, specifically by Jack and his hunters, who called themselves savages, painted their faces and formed a tribe, their bloodlust and savagery truly came to the fore once the conch was gone. It being out of the way meant that there was nothing to hold them back. They were then able to practice their malice without any restraint, and this is exactly what they did. Jack gleefully and remorselessly celebrated the conch's destruction:

Suddenly Jack bounded out from the tribe and began screaming wildly. “See? See? That’s what you’ll get! I meant that! There isn’t a tribe for you any more! The conch is gone—”  

Once the conch was no more, nothing was sacred to Jack and his tribe. We read in chapter twelve that they purposefully set out to hunt Ralph, flush him out, and kill him. Ralph was nothing more than an object to appease their savagery - he had become much the same as the pigs that they had so gleefully hunted. It was fortunate that the naval officer found Ralph before Jack and his tribe reached him. The officer's arrival meant the return of civilization, the restoration of order and the end of savagery.

How does Atticus explain the mob's actions to Scout?

Atticus explains to Jem and Scout that mobs are made up of ordinary people. He tells Jem that he will understand this more someday when he grows up. He emphasizes several times that everyone in the mob who went to the jail is a human being.

Scout has trouble grasping this concept. She is upset with the men, and especially with Mr. Cunningham. She vows to beat up young Walter Cunningham the next time she...

Atticus explains to Jem and Scout that mobs are made up of ordinary people. He tells Jem that he will understand this more someday when he grows up. He emphasizes several times that everyone in the mob who went to the jail is a human being.

Scout has trouble grasping this concept. She is upset with the men, and especially with Mr. Cunningham. She vows to beat up young Walter Cunningham the next time she sees him at school. Atticus warns Scout not to touch Walter. He tells her that she should not hold a grudge against Mr. Cunningham:

"Mr. Cunningham was part of a mob last night, but he was still a man. Every mob in every little Southern town is always made up of people you know—doesn't say much for them, does it?" (To Kill a Mockingbird, Chapter 16).

Atticus understands that despite the men being angry, they were still just a group of people. He reminds Scout that she had helped Mr. Cunningham stand in his shoes. He also suggests that the police be made up of children.

What is screening for cancer?

Cancers diagnosed: The most common cancer screenings detect breast, cervical, colorectal, and prostate cancer. Some require a blood test, while others require more extensive screening procedures.

Why performed: The purpose of screening tests is to allow early identification of cancer and prevent the progression of any existing cancer. Screening and early detection can save human lives, minimize the trauma of cancer illness, and conserve limited health care resources spent on costly cancer therapies.

People participate in screenings for various reasons. Sometimes they see screening as a preventive measure, and sometimes they undergo screening because they are at high risk for a cancer. Often health-conscious people participate in routine cancer screenings, and their health insurance pays the bill. Medicare (health insurance for older adults and the disabled) Part B covers certain key preventive cancer screening tests such as colorectal screening, mammograms, Pap smears and pelvic examinations, and prostate cancer screenings within certain parameters.

Screening for cancer offers many advantages for the public. Screening can save the life of someone who may have died without early intervention. When cancer is discovered, treatment can be started immediately and decrease the possibility of radical surgery or therapy. Early intervention also results in lower health care costs. A primary advantage is that the person who receives negative (benign) results has peace of mind that, at that point in time, cancer is not present. This is reassuring for anyone but especially for someone with a family history of cancer or who has other high risks for cancer.

However, the disadvantage of screening is that some false negatives may occur so the person does not believe there is a problem even when symptoms surface. Conversely, “false positives” can cause undue anxiety until further tests confirm there is no cancer. Sometimes the screening finds a cancer that is not treatable or is so advanced that the screening does not alter the negative outcome for the person. Another disadvantage is that borderline reports from cancer screenings can result in excessive testing and associated costs.

Breast self-exam (BSE): Breast cancer can be detected through several screening tests. One is palpation of the breast tissue through a monthly breast self-examination (BSE). Palpation is a noninvasive way to examine and screen for abnormalities in the breast such as cysts, lumps, or thickening. The patient can be taught to do an examination of her breasts each month and note visual or palpable changes in the breasts.

Patient preparation. The patient should stand unclothed from the waist up and view her breasts in a mirror. The best time to complete an examination is a few days after the completion of the menses, when swelling and tenderness are lessened.

Steps of the procedure. A breast self-examination is a five-step process:

• The woman observes her breasts in the mirror, with her hands on her hips, for any visual changes in color, shape, and size. She looks for dimpling, swelling, or puckering of the skin as well as changes in the nipples or redness or rash on the breast.





• She raises her arms over her head and observes the same as above.





• She gently squeezes the nipples and observes for any liquid or discharge. (None should be present unless the woman is breast-feeding.)





• She lies down and examines each breast with the opposite hand in a circular pattern, starting at the nipple and working outward. She palpates all breast tissue from the collarbone to the abdomen and from the armpit to the cleavage area.





• She palpates the breast again in a sitting or standing position in the same pattern. Some women find that the examination is best completed when the skin is wet and slippery, such as in the shower.

After the procedure. The woman should record any observation and the date of each examination in a journal to be sure that it is completed monthly, preferably after the menses. This simple screening can detect early changes in the woman’s breasts.

Risks. None.

Results. The woman makes an appointment with her health care provider if abnormalities are noted. She should schedule her annual examination with the health care provider, which includes a clinical breast exam (CBE).

Mammograms: A screening mammogram uses x-rays to detect breast cancer. Mammography offers a noninvasive way to screen the breasts for cancer. A screening mammogram is useful when a woman has no history of problems with her breasts. Two x-ray views are taken of each breast. Scheduling the mammogram a week after the menses can decrease the patient’s discomfort, as hormonal soreness or tenderness is less at that time. An annual screening mammogram is recommended primarily for women over the age of forty. A screening mammogram can detect suspicious areas that may be breast cancer long before a mass can be palpated.

Patient preparation. The patient should avoid use of powders, deodorant, or lotion before the mammogram, since particles from these products can be viewed as abnormalities on the x-ray. The patient completes paperwork such as her history, last menses, risk factors, childbearing, surgeries, implants, birth control, hormone therapy, or any problems. The patient undresses from the waist up and wears an examination gown into the x-ray room. The patient can expect the x-rays to take about a half hour.

Steps of the procedure. The patient stands in front of the x-ray machine. A radiology technician exposes one breast at a time and places it on a film holder; the breast is compressed for a few seconds between the holder and a plastic paddle to take the x-ray. Good compression is necessary for accurate x-rays. Next the patient moves her side toward the machine, and the breast is compressed from the side. The x-ray is repeated.

After the procedure. A radiologist reads the x-ray either immediately or at a later time, depending on the facility’s availability to the radiologist.

Risks. The risk of radiation exposure through a screening mammogram is considered minimal. Most authorities agree that the benefit of screening for breast cancer outweighs the risk of low-dose radiation.

Results. Screening mammograms do not detect breast cancer 100 percent accurately. A normal result means that the mammogram detects no abnormalities, though a cancer can be hidden in dense breast tissue. Screening mammograms may be read as borderline, which may suggest that further testing (such as a diagnostic mammogram, ultrasound, or biopsy) is indicated to confirm the diagnosis of breast cancer.

Pap smear: The Pap smear is a screening test to detect changes in the cervix that may lead to cervical cancer in women. Early detection can increase the chance of successful treatment. All women need this screening examination, including sexually active women over the age of eighteen and those at risk for cervical cancer, such as women who had a previous abnormal pap smear. This test is usually performed during the woman’s annual gynecological exam.

Patient preparation. The woman should avoid douching or using any vaginal medications within forty-eight hours of the test. For accurate results, she should avoid intercourse within twenty-four hours of the screening. Optimal time for a Pap smear is at midcycle of the menses; a Pap smear cannot be performed during the menses. The woman should empty her bladder before the test to decrease discomfort.

Steps of the procedure. The Pap smear does not take long to perform. The patient lies on her back with her knees bent and her feet slightly apart. The health care provider will lubricate a speculum (an instrument that holds the walls of the vagina apart) and place it into the vagina. The patient will feel pressure as the provider swabs the cervix for a sample to examine. The sample is swabbed on a glass slide and sprayed with preservative. The slide is sent to the lab for microscopic examination for abnormal cells.

After the procedure. There are usually no side effects of this test. The lab results will be sent to the patient.

Risks. One risk is a false positive, which would lead to further testing, or a false negative, which might cause the person to ignore other warning signs of cervical cancer.

Results. Results are categorized as negative if no abnormal cells are seen. The patient usually receives a written notification of the results. Patients need to seek further testing from their health care provider for abnormalities.

Fecal occult blood, sigmoidoscopy, colonscopy: Colon cancer is the third leading cause of cancer death in the United States. The first screening test for colon cancer is the fecal occult blood sample. This test detects blood in the stool. The next screening is a sigmoidoscopy or colonoscopy. Regular rectal and colon screening is advised in persons over fifty years of age and in those at high risk. This includes a fecal test annually, a sigmoidoscopy every five years, and a colonoscopy every ten years after age fifty-five.

Patient preparation. Certain medications (aspirin and aspirin products, ibuprofen products, iron tablets, and vitamin supplements) should be avoided for a week before screening. Prescribed medications can usually be taken, but the physician should be consulted. A sigmoidoscopy or colonoscopy requires preparation of the bowel. The exact preparation used may vary by provider preference, but these preparations usually include a diet of clear liquids for twenty-four hours prior to the test as well as a liquid laxative about two to four hours before the examination.

Steps of the procedure. Both a sigmoidoscopy and colonoscopy require the insertion of a rigid or flexible tube that contains a lens and a light into the colon. The provider can visualize the rectum, lower colon (or sigmoid colon), or upper colon.

After the procedure. Patients may need someone to drive them home after this test, especially if they have sedation. The patient can experience some soreness and mild cramping due to the air that was injected into the colon for the test, but this condition improves as the air is passed. No other aftercare is required.

Risks. A slight risk of bleeding is possible, especially when the patient has decreased clotting capacity. A perforated (torn) colon is a serious but rare complication following a sigmoidoscopy or colonoscopy.

Results. A normal result is one where the colon walls are smooth and without polyps, inflammation, or tumors. An abnormal result would be present when the colon shows precancerous polyps or tumors. A biopsy and surgical removal of the polyps or tumors would be scheduled.

Digital rectal exam (DRE) and prostate-specific antigen (PSA) blood test: Prostate cancer is the second leading cause of death in men. By the age of fifty, men should have screening tests for prostate cancer; in high-risk men, screening should start at the age of forty-five. The main screening tests for prostate cancer are digital rectal exam (DRE) and the prostate-specific antigen (PSA) blood test. The prostate is the male reproductive organ located under the bladder and in front of the rectum.

Patient preparation. No special preparation is required.

Steps of the procedure. For the digital rectal exam, the patient is dressed in an examination gown and placed in a relaxed position (such as lying on his side or resting over an exam table) with the rectum accessible. The doctor inserts a well-lubricated, gloved finger into the rectum and feels the size of the prostate.

After the procedure. No residual patient discomfort occurs.

Risks. None.

Results. If abnormal results are reported from either the digital rectal exam or prostate-specific antigen test, the patient will need further testing to confirm a cancer diagnosis.

“Cancer Screening Overview: What Is Cancer Screening?” National Cancer Institute. Natl. Inst. of Health, 2 July 2014. Web. 22 January 2015.

Elit, Laurie. Cervical Cancer: Screening Methods, Risk Factors and Treatment Options. New York: Nova Biomedical, 2014. Print.

Finkel, Madelon L. Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening. Westport: Praeger, 2005. Print.

Miller, Anthony B., ed. Advances in Cancer Screening. Boston: Kluwer, 1996. Print.

Querna, Elizabeth. “Breast Cancer Screening: What Is the Best Way to Find Out If You Have the Disease?” US News & World Report 9 Sept. 2004. Print.

Scholefield, John, and Cathy Eng. Colorectal Cancer: Diagnosis and Clinical Management. Hoboken: Wiley, 2014. Print.

What were two major events of the Civil Rights Movement that had the most lasting impact on the United States?

There were many events in the Civil Rights Movement that had a great impact on the United States. One of those events was the Montgomery Bus Boycott. African-Americans in Montgomery were protesting the arrest of Rosa Parks. Rosa Parks was arrested for not giving up her seat in the section of the bus reserved for African-Americans. African-Americans refused to ride the buses until the segregation law was changed. This boycott lasted 381 days. This event...

There were many events in the Civil Rights Movement that had a great impact on the United States. One of those events was the Montgomery Bus Boycott. African-Americans in Montgomery were protesting the arrest of Rosa Parks. Rosa Parks was arrested for not giving up her seat in the section of the bus reserved for African-Americans. African-Americans refused to ride the buses until the segregation law was changed. This boycott lasted 381 days. This event was significant because it showed African-Americans were determined to bring about changes in the South regarding segregation, no matter how long it took or how inconvenient it was for them. Eventually, the Civil Rights Act of 1963 was passed ending segregation in public places.

Another major event was the Selma March on Bloody Sunday. This march was supposed to be a peaceful march from Selma to Birmingham to protest the lack of African-Americans that were registered to vote in Selma. When the police responded by attacking the peaceful marchers, this was captured on film and shown across the country. This led to nationwide demands for change. Another march was held two weeks later, with federal protection. This event helped lead to the passage of Voting Rights Act. This law made voting restrictions, such as poll taxes and literacy tests, illegal. It also allowed for federal workers to register voters.

There were many critical events that have had a lasting effect in our country from the Civil Right Movement. These were two of these important events.

1. What is the effect that Tim O’Brien has had on contemporary literature? 2. What significant events in Tim O’Brien’s life helped shape him...

Tim O'Brien grew up in Minnesota and fought in the Vietnam War from 1969 to 1970. His battalion was sent to the area where the My Lai Massacre had taken place the year before, though he was not aware of this fact at the time. His works have had an impact on contemporary literature by providing a literary account of the war in Vietnam, drawing on his own experiences. His works have also brought together fiction and reality in a manner that he refers to as "story-truth." He believes that "story-truth," or the emotional truth that can come from fictionalizing true events, is often truer than what actually occurred.

The narrator of The Things They Carried is Tim O'Brien, which can increase the reader's sense  that the story is accurate in its details about the war. It can also, however, lead the reader to question whether O'Brien's account of the war is biased and more personal than general. In other words, he may just be writing from his own perspective, rather than from a general perspective about the war.

In his story, the soldiers carry necessary items, such as pocket knives, dog tags, Kool-Aid, C rations, and lighters. They also carry unexpected items of personal interest that are remembrances of home, such as photographs of their girlfriends, comic books, and the New Testament. These items are more for psychological comfort than physical necessity. Some soldiers also tote other items to help them cope with the war, including dope. The reader might identify with carrying items of comfort and remembrances of home.

The book is still relevant today, as the United States is fighting wars abroad that ask people to decide whether they believe in our foreign entanglements and whether a sense of duty is by itself compelling enough to make people fight in wars. The book also deals with American misunderstanding of foreign affairs and wars, which is still relevant today.

What is fragile X syndrome?

Causes and Symptoms

Fragile X syndrome is caused by a change in a gene located on the long arm of the X chromosome. It is a sex-linked inherited
disease, transmitted from parent to child, with boys being affected much more often and more severely than girls. The prevalence of the disorder is estimated to be 1 in 4,000 males and 1 in 6 to 8,000 females worldwide.

While symptoms and their severity vary widely, common physical features of fragile X syndrome include a long, thin face, a prominent jaw and ears, a broad nose, a high palate, large testicles (macroorchidism) in males, and large hands with loose finger joints. Physical features are more subtle in females. Nonphysical features include a range of intellectual and learning disabilities, with the majority of affected males demonstrating a range from low-normal intelligence to severe intellectual disability. More recent research has found that the intelligence quotients (IQs) of males with fragile X syndrome appear to decline throughout childhood. Associated behavioral symptoms include unusual speech patterns, problems with attention span, hyperactivity, motor delays, and occasional autistic-type behaviors, such as poor eye contact, hand-biting, or hand-flapping.

Treatment and Therapy

While there is no cure for fragile X syndrome, a number of possible interventions can address various symptoms. Medications can be administered to assist with attention span and hyperactivity, as well as with aggressive behavior. Schools can provide children with assistance in speech, physical therapy, and vocational planning. Early childhood special education services for children prior to school age can provide necessary early intervention that may prove most helpful if indeed the rate of learning for children with fragile X syndrome slows with age. Genetic counseling is advised for families who carry the gene.

Perspective and Prospects

In 1969, the discovery was made of a break or fragile site on the long arm of the X chromosome. It was not until the 1980s, however, that consistent diagnoses of fragile X syndrome were made. In 1991, the responsible gene was sequenced and named the FMR-1 gene. Cytogenetic and deoxyribonucleic acid (DNA) testing are now available to identify affected persons.

Bibliography:

Alan, Rick, and Rimas Lukas. "Fragile X Syndrome." Health Library, Oct. 11, 2012.

"Facts about Fragile X Syndrome." Centers for Disease Control and Prevention, Apr. 15, 2013.

"Fragile X Syndrome." MedlinePlus, May 13, 2013.

Hagerman, Randi Jensen, and Paul J. Henssen. Fragile X Syndrome: Diagnosis, Treatment, and Research. 3d ed. Baltimore: Johns Hopkins University Press, 2002.

Maxson, Linda, and Charles Daugherty. 3d ed. Genetics: A Human Perspective. Dubuque, Iowa: Wm. C. Brown, 1992.

Moore, Keith L., and T. V. N. Persaud. The Developing Human: Clinically Oriented Embryology. 9th ed. Philadelphia: Saunders/Elsevier, 2013.

National Fragile X Foundation. Fragile X–Associated Disorders (FXD). 3d ed. Walnut Creek, Calif.: National Fragile X Foundation, Sept. 2009.

Parker, James N., and Philip M. Parker, eds. The Official Parent’s Sourcebook on Fragile X Syndrome. Rev. ed. San Diego, Calif.: Icon Health, 2005.

Sherwood, Lauralee. Human Physiology: From Cells to Systems. 8th ed. Pacific Grove, Calif.: Brooks/Cole/Cengage Learning, 2013.

Webb, Jayne Dixon, ed. Children with Fragile X Syndrome: A Parents’ Guide. Bethesda, Md.: Woodbine House, 2000.

"What is Fragile X?" FRAXA Research Foundation, 2013.

What was the exact date of Sir Charles Baskerville's death in The Hound of the Baskervilles?

In chapter two of The Hound of the Baskervilles, by Sir Arthur Conan Doyle, Dr. Mortimer presents a news article for Mr. Holmes to read. The article is from the Devon County Chronicle, and Mortimer describes the article as having been published on the 14th of June, a "few days" after the death of Sir Charles Baskerville. One might interpret a "few days" to imply that Sir Baskerville died on perhaps the 11th or 12th...

In chapter two of The Hound of the Baskervilles, by Sir Arthur Conan Doyle, Dr. Mortimer presents a news article for Mr. Holmes to read. The article is from the Devon County Chronicle, and Mortimer describes the article as having been published on the 14th of June, a "few days" after the death of Sir Charles Baskerville. One might interpret a "few days" to imply that Sir Baskerville died on perhaps the 11th or 12th of June, but reading on, we discover that he is believed to have died on the night of the 4th of June.

The news article says that Sir Charles Baskerville, on the 4th of June, announced that he intended to travel to London the next day. While his butler prepared his luggage, Sir Baskerville went on his usual nightly walk. At midnight, the butler began to worry and went outdoors to search for his master. He finds the body of Sir Baskerville at the end of the Alley of the estate. If the butler set off at precisely midnight and found the body of Sir Baskerville soon after, we can infer that Baskerville had died late in the night of the 4th of June. 

What is septic shock? |

Definition

Septic shock is acute cardiovascular collapse precipitated by a complex
interaction between biochemical agents in the bloodstream and the body’s
immune
system as it attempts to respond to infectious agents.
Arterial hypotension persists despite adequate fluid resuscitation.
The circulatory system is unable to meet the metabolic demands of cells: delivery
of oxygen and nutrients and removal of waste products. Pumping and circulation
fail, leading to reduced tissue perfusion and organ dysfunction. Mortality
approaches 40 to 70 percent.

Causes

Infectious agents such as gram-positive and gram-negative bacteria, viruses, fungi, and yeast trigger an exaggerated immune inflammatory response. The lipopolysaccharide (LPS) shell on gram-negative bacteria is an extremely strong stimulator of systemic inflammation.

Risk Factors

Substantive risk factors include a compromised immune system, thermal burns,
malnutrition, extremes of age, chronic medical conditions, use of invasive medical
devices, hospitalization, steroid administration, and urinary tract, respiratory,
or abdominal infection. Recent research has demonstrated polymorphisms, mutations,
and dysregulation of cellular receptors that negatively affect the body’s
recognition of and response to pathogens.

Symptoms

Infection is heralded by fever, tachycardia, tachypnea, and
abnormal white blood cell count. Respiratory distress or frank respiratory failure
ensues. Myocardial depression, decreased cardiac output, and vasodilation lead to
hypotension refractory and fluid resuscitation and may require vasopressor and
hydrocortisone support. Peripheral pulses and capillary refill are diminished. A
procoagulant state develops in an attempt to prevent the dissemination of
pathogens, leading to coagulopathy and dermal petechiae and purpura. Renal and
gastrointestinal function diminishes.

Screening and Diagnosis

Diagnosis is incumbent on history, physical examination, clinical signs and symptoms, hematologic labs (blood culture, complete blood count, differential, immature to total neutrophil ratio, and serum lactate), acute-phase reactants and biomarkers (interleukin-6, adrenomedullin, C-reactive protein, and procalcitonin), and radiological evaluation of suspected source sites.

Treatment and Therapy

Elimination of the infection source is vital to survival. Culture and sensitivity testing of infected sites to identify the causative organism allows selection of definitive antimicrobial therapy. Until culture results are known empiric antibiotic therapy is required. Antibiotics should be administered within an hour of a diagnosis of sepsis. Newer microarray testing is allowing earlier identification of pathogens, leading to better definitive antibiotic therapy. Cardiovascular support includes adequate ventilation and oxygenation, vasopressor support, corticosteroids, and adequate hematologic parameters (platelets, red blood cells).

Prevention and Outcomes

Adequate nutrition, management of chronic illness, good handwashing technique,
aseptic
technique for sterile procedures, the avoidance of trauma or
exposure to infectious agents, and the removal of unnecessary tubes and catheters
in institutionalized and hospitalized persons reduces the incidence of infection
and thus lowers the risk of an exaggerated inflammatory response and shock
state.

Bibliography

Dellinger, R. Phillip, et al. “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008.” Critical Care Medicine 36 (2008): 296-327.

Evans, Timothy, and Mitchell P. Fink, eds. Mechanisms of Organ Dysfunction in Critical Illness. New York: Springer, 2002.

Klein, Deborah G. “Shock and Sepsis.” In Introduction to Critical Care Nursing, edited by Mary Lou Sole, Deborah G. Klein, and Marthe J. Moseley. 5th ed. St. Louis, Mo.: Saunders/Elsevier, 2009.

“Septic Shock.” MedlinePlus. Natl. Lib. of Medicine, 8 Feb. 2014. Web. 29 Dec. 2015.

Tissari, Päivi, et al. “Accurate and Rapid Identification of Bacterial Species from Positive Blood Cultures with a DNA-based Microarray Platform.” The Lancet 375 (January, 2010): 224-230.

What are personality interviewing strategies for assessment?

Introduction

The assessment of personality is an activity that occurs frequently and can be very important. On an informal level, people make decisions about someone’s personality based on their experiences with that person. If they have had positive experiences, they might say the person has a “nice personality.” Although these informal assessments have significant implications for friendships among people, more formal personality assessments may have a far-reaching impact on a person’s life. Formal personality assessments are commonly used in making employment decisions and decisions about the status of people’s mental health. Interview strategies used to assess personality usually are seen as either structured or unstructured. Interview questions are influenced by the theoretical orientation of the interviewer.

Fred Kerlinger’s discussion of the use of interviews in Foundations of Behavioral Research (1986) goes beyond using interviews to assess personality. In personality research, the interview is used to obtain information about the person’s thoughts, beliefs, behavior, and feelings to determine how they combine into what is called personality, as well as how they are influenced by or influence other life events. From the research perspective, the personality interview is an in-depth study of all facets of a person’s psychological and behavioral makeup.

Structured and Unstructured Interviews

Personality interviews may be placed on a continuum from highly structured at one extreme to highly unstructured at the other. In actuality, few interviews occupy extreme positions. Most interviews are designed to elicit as much useful information as possible from the person being interviewed. Therefore, there is a propensity to prefer one style over the other, although there is no rigid adherence to this tendency. Both structured and unstructured (or standardized and unstandardized) interviews are used in psychology to assess a number of things, including personality. As an approach to assessment, personality interview strategies must conform to expectations of reliability (the quality of delivering the same basic results after each of several interview sessions), validity (the quality of assessing the content that the interviewer intends to assess), and objectivity (the quality of being free of bias or prejudice).

Structured interviews are designed to obtain specific information about the person being interviewed. In the most highly structured type of interview, a list of questions is presented in its entirety to every person completing the interview. The questions are always presented in the same way and in the same order. The interviewer is not allowed the flexibility to pursue topics of interest; however, the structured interview is actually conducted with somewhat more flexibility in most applied settings. The interviewer is given a list of topics about which information is desired. In gathering the information, the interviewer is free to vary the order of the topics and is able to request elaboration of specific points as needed. This flexibility increases the likelihood that the desired information will be obtained, because the interviewer can vary the order of the interview to put the interviewee at ease while still covering all topics. Structured interviews are sometimes called "standardized interviews" because the interview topics and procedures are established in advance. Another name for the structured interview is the "directive interview" because the interviewee is directed into areas that interest the interviewer.

Unlike structured interviews, unstructured interviews, also called "nondirective" or "unstandardized" interviews, place control of the interview with the interviewee. Instead of asking “How many people are in your family?,” for example, interviewers using unstructured approaches use open-ended questions such as “Tell me about your family.” By using the open-ended question, the interviewer has the opportunity to learn more about the person’s family than with the structured interview. The unstructured interview may produce considerable information yet does not ensure that all topics are covered, as in the structured interview.

Regardless of the type of interview used, the interviewer is charged with observing and interpreting interviewee behavior. Changes in body posture, eye contact, and length of time between question and response are all suggestive of different emotional reactions to the interview. It is up to the interviewer to determine the accuracy of what is being reported by looking for patterns of consistency and inconsistency in the person’s behavior. Some determination must be made about whether the person is trying to minimize certain facets of his or her personality to save face or, conversely, is exaggerating facets for their inherent shock value. It is important for the interviewer to test various hypotheses about why the interviewee answers in a certain way if an accurate assessment of personality is to take place.

Obstacles

A number of common obstacles must be overcome in an interview. One of these is resistance, or the interviewee’s reluctance to talk about certain topics, perhaps because the topics are too painful or embarrassing. Resistance may be overcome by allowing the interviewee time to become more comfortable with the interviewer and time to broach the difficult topics in his or her own way. Other complications of the interview are interruptions from other people, distracting settings, and the interviewer’s emotional reactions to the person being interviewed.

Another approach to personality interviewing is the use of a computer-administered interview. When a computer is used to administer the interview, a branching program is used. Answering “yes” or “no” to a question may lead to additional questions on that topic or to entirely new topics. Some people have found that computerized interviewing leads to more complete answers. This may be especially true when the subject matter is intimate and potentially embarrassing.

Use in Clinical Settings

Typically, personality interviews are used in clinical settings or to make employment decisions; they are usually used in conjunction with formal psychological testing. Occasionally, they are used for research purposes; however, the training necessary to develop a skilled interviewer and the expense involved in the interview process usually limit the settings in which they are used to those where they are particularly significant.

In clinical settings, interviews are used for two reasons. First, they are used to gather information about the client or patient’s life and about the reason the person is seeking services. Second, the interview is the vehicle for intervention in most forms of psychotherapy. Gary Groth-Marnat discusses the role of the interview within the larger context of psychological assessment in his Handbook of Psychological Assessment (2003). In clinical settings, the interview is used to gather intake information (the intake interview) and to establish the person’s current emotional and cognitive state (the mental status examination). The intake interview is sometimes known as the initial interview, and it is the first significant contact with the interviewee. The purpose of the intake interview is to determine why the person has sought psychological services. This involves determining the person’s symptoms or chief complaint.

Once this information is obtained, the interviewer tries to learn more about the person’s life. In addition to asking about specific areas of one’s life—for example, educational experience and relationship history—the interviewer begins to assess the personality of the interviewee. The personality assessment requires careful observation and integration of both verbal and nonverbal behavior. The interviewer must be aware of how the person reacts to different questions or topics. Some people will always try to please the interviewer, while others may appear nervous, sad, or angry at different times during the interview. Integrating all this information helps the interviewer understand the personality and circumstances of the person being interviewed.

Mental Status Examination

The mental status examination is an extension and elaboration of information
necessary to understand the personality of the interviewee. Although some of the
information included in the mental status examination is acquired through direct
questioning, much of it is learned through careful listening and observation of the
person during the intake interview. Kaplan and Sadock's Comprehensive Textbook
of Psychiatry (2009) provides a detailed description of the mental status
examination. Typically, this examination includes information in the following areas:
physical appearance and how the person is dressed; attitude toward the interviewer and
others; any unusual motor behavior or movements; oddities of speech and language,
including accents, speech impediments, and unusual words; disturbances in thought
content and process such as delusional beliefs or difficulties expressing thoughts;
perceptual problems in the form of hallucinations or illusions; changes in cognition,
which may include memory impairments and other intellectual changes; disturbances in
orientation and sensorium, which refers to the person’s knowledge of who and where he or
she is, as well as to a determination of the level of alertness; the current affective
or emotional state; and the degree of insight into the person’s current
circumstances.

Each aspect of the mental status examination contributes information that helps in the understanding of a person’s personality. Information obtained through this part of the interview is also valuable in the diagnosis of psychological disorders. Certain deviations from the norm that may be revealed by the mental status examination are associated with disorders such as anxiety, depression, schizophrenia, and personality disorders. Thus, the intake interview and the mental status examination used together provide the foundation for understanding a person’s personality and psychological disorders.

Use in Employment Settings

Personality interviewing is also an integral part of employment interviews. One important area in which personality interviews are used to help make employment decisions is in the selection of law-enforcement officers. The goals of the interview are twofold. First, it is used to identify those candidates who, because of their personality, are likely to make good or effective police officers. These are people with good coping skills, well-developed intellectual abilities, and good observational abilities. Second, the personality interview is used to identify candidates who are likely to make poor law-enforcement officers. In the area of law enforcement, it is crucial to consider liability issues and the protection of the public in making hiring decisions. Personality interviews provide information that can help to improve the quality of the hiring decisions and ultimately the quality of law-enforcement agencies.

Personality interviewing is also used in other employment settings. The interview is a significant part of the application process; used either informally or formally, it yields important information about the applicant’s motivation and suitability for the position. Information from the interview helps an employer decide whether the applicant’s personality will mesh or clash with coworkers, will convey the appropriate image for the position, or will satisfy other considerations salient to the job. As in clinical settings, the use of the personality interview in employment decisions is frequently combined with formal psychological testing. In both employment and clinical uses, it is important to note areas of similarity and difference between the interview and the testing.

Role in Therapeutic Process

The use of interviewing, in various guises, has been central to psychological investigations of personality as well as to psychotherapeutic approaches to helping patients or clients. Sigmund Freud called one of the central aspects of psychoanalytic interviewing “free association”—a highly unstructured effort to obtain information that is as uncensored as possible. The interviewee is told to talk about whatever comes to mind without concern for its relevance or appropriateness. Following this uncensored revelation by the interviewee, the interviewer eventually makes interpretations about personality and unconscious conflicts. Although personality interviewing and free association remain hallmarks of psychoanalysis, the interview has also been important to others in psychology and psychotherapy.

Carl R. Rogers, the founder of
person-centered therapy (or nondirective therapy), considered the interview critical to the therapeutic process. He and his followers believed that, without controlling the direction of the interview, they could learn more about the person that would be useful in resolving the person’s problems. Rogerian psychologists are firm believers in the nondirective approach because it allows the client to discover, independent of someone else’s opinion, the solution to the problem.

Behavioral psychologists, as exemplified by Kenneth P. Morganstern, place their emphasis on a person’s observable behavior. Personality is not defined as something a person has but rather as the perceptions of other people based on the person’s behavior. Thus, personality interviewing from a behavioral perspective focuses heavily on observations of the person’s behavior in different situations. Many behavioral psychologists believe that a person’s personality is modifiable if his or her prior learning experiences can be identified and if it is possible to ensure that specifiable consequences can follow behaviors that the client is trying to change.

Many psychologists, including Groth-Marnat, believe that computers are likely to be used more frequently to administer interviews. Assessment interviews will be more important in determining accountability for treatment decisions and therefore are likely to become more structured. As interviews become increasingly structured, it is also likely that they will represent an integration of different theoretical positions rather than the parallel interview styles that have been developing among psychologists adhering to different theories.

Bibliography

Cormer, Sherry, Paula S. Nurius, and Cynthia J. Osborn. Interviewing and Change Strategies for Helpers. 7th ed. Belmont: Brooks/Cole, 2013. Print.

Groth-Marnat, Gary. Handbook of Psychological Assessment. 5th ed. New York: Wiley, 2009. Print.

Kerlinger, Fred N., and Howard B. Lee. Foundations of Behavioral Research. 4th ed. Belmont: Wadsworth, 2000. Print.

Kirschenbaum, Howard. The Life and Work of Carl Rogers. Alexandria: Amer. Counseling Assn., 2009. Print.

Morrison, James. The First Interview. 4th ed. New York: Guilford, 2014. Print.

Pheister, Maria. "Psychiatric Interviewing: What to Do, What Not to Do." International Handbook of Psychiatry: A Concise Guide for Medical Students, Residents, and Medical Practitioners. Ed. Laura Weiss Roberts, Joseph B. Layde, and Richard Balon. Hackensack: World Scientific, 2013. 78–101. Print.

Sadock, Benjamin J., Virginia Sadock, and Pedro Ruiz, eds. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincott, 2009. Print.

Did the participants in the White House staff meeting think the evidence was clear and convincing that the North Vietnamese attacked the American...

There are a few ways to look at this question. There is evidence that suggests some people didn’t believe an attack had occurred. There is also evidence to suggest people may have believed an attack occurred. I will share both viewpoints and then let you decide.

There would be a reason why some people believed an attack had occurred. The intelligence report that was presented at the meeting omitted many of the communications that would...

There are a few ways to look at this question. There is evidence that suggests some people didn’t believe an attack had occurred. There is also evidence to suggest people may have believed an attack occurred. I will share both viewpoints and then let you decide.

There would be a reason why some people believed an attack had occurred. The intelligence report that was presented at the meeting omitted many of the communications that would have cast doubts about this event occurring. There was no mention of US actions in the Gulf of Tonkin. There also was no mention that we may have mistaken the sonar pings they detected as actually hitting the rudder of their ship instead of hitting North Vietnamese submarines. Thus, it is possible people may have believed there was clear evidence we were attacked by North Vietnam because they didn't have all the necessary information.

Some information could lead one to conclude no attack occurred. President Johnson privately had doubts that these attacks occurred. He felt the sailors might have been shooting at nothing. If the President had these views, it is reasonable to believe other people shared these thoughts. Additionally, some of the people involved in the military also had doubts about these attacks occurring. These concerns were communicated with the Secretary of Defense.

Based on this information, it is now your turn to decide.

What further comic complication does Shakespeare suggest at the end of Act III in Taming of the Shrew?

The main event at the end of Act III is the marriage between Petruchio and Katharine. Petruchio makes the wedding day as humiliating as possible. First, he turns up late, making his bride and her father wonder if he will come at all. Katharine is so upset at the embarrassment that she weeps. Then Petruchio arrives in a ridiculous getup riding on his servant, who is dressed as a horse. Everyone stands aghast:

Gentles, methinks...

The main event at the end of Act III is the marriage between Petruchio and Katharine. Petruchio makes the wedding day as humiliating as possible. First, he turns up late, making his bride and her father wonder if he will come at all. Katharine is so upset at the embarrassment that she weeps. Then Petruchio arrives in a ridiculous getup riding on his servant, who is dressed as a horse. Everyone stands aghast:

Gentles, methinks you frown:
And wherefore gaze this goodly company,
As if they saw some wondrous monument,
Some comet or unusual prodigy?

Gremio reports events of the actual wedding. Petruchio swore in church, startling the priest into dropping his book, and then struck the priest as he bent over to pick it up. He continued to misbehave, kissing Kate so loudly “That at the parting all the church did echo.” Petruchio then insists on leaving immediately after the wedding service. He takes Kate by force, pretending that he does it to protect her.

Humor comes at Kate’s expense from Petruchio’s completely inappropriate behavior at the wedding. What will follow is the tumultuous (and possibly comedic) marriage between the fiery Kate and the wild Petruchio. Also suggested is Lucentio’s elopement with Bianca.

What is the legacy of the Cold War today?

The Cold War continues to affect the world, and the United States, in many different ways.  Let us examine a number of the ways in which it still affects us.  (Please note that, because there are so many possibly legacies of the Cold War, you should consult your textbook and/or class notes if your teacher expects you to give a certain, specific answer.)

1.       Because of the Cold War, communism has almost completely disappeared from...

The Cold War continues to affect the world, and the United States, in many different ways.  Let us examine a number of the ways in which it still affects us.  (Please note that, because there are so many possibly legacies of the Cold War, you should consult your textbook and/or class notes if your teacher expects you to give a certain, specific answer.)

1.       Because of the Cold War, communism has almost completely disappeared from the world.  Early in the Cold War, there were many communist countries in the world.  All of Eastern Europe was communist.  China and North Korea were communist.  However, as time went by the pressures of the Cold War destroyed communism in most places.  Today, communism only exists in a few small countries (I do not count China, which is communist in name only).


2.       Largely because of the Cold War, the communist countries built up their military power but neglected their civilian economies.  The communist countries tried hard to keep up with the West in military terms but were not strong enough economically to do that and to still produce large quantities of high-quality consumer goods.  Because of this, their economies were relatively weak and remain weak to this day.  Almost all ex-communist countries are rather poor today, partly because of the effects of the Cold War.


3.       Because of the Cold War, we have large arsenals of nuclear weapons in the US and the former Soviet Union.  During the Cold War, the two superpowers engaged in an arms race, each trying to have enough nuclear weapons to destroy the other.  Those arsenals still exist today, costing us money and causing us to worry that some of the nuclear material might fall into the hands of terrorists.


4.       In the United States, the Cold War helped to cause discord between liberals and conservatives.  During the Cold War, and particularly during the Vietnam War, liberals and conservatives disagreed sharply over how aggressive the US should be in fighting communism abroad.  Disputes over foreign policy helped bring about a situation in which conservatives thought liberals were un-American and liberals thought conservatives were imperialistic warmongers.  This helped get us to the where we are today with a huge gulf between liberal and conservatives.


5.       In part because of the Cold War, the US became the world’s only real superpower.  The US was the unquestioned leader of the West during the Cold War.  After it “defeated” the Soviet Union in the Cold War, it was left as the preeminent power in the world.  This has meant that the US expects to have influence all around the world and people all around the world expect the US to help solve their problems.

All of these things, and more, can be seen as legacies of the Cold War today.

What is gaming addiction? |

Causes

Gaming addiction can have several underlying causes. In general, gaming addictions are triggered and cultivated when unmet (or partially met) social and psychological needs are fulfilled by playing games. It is believed that one of the primary functions of playing games is to rehearse real-life situations and circumstances to develop behavioral responses without risk. Reasons for excessive gaming can include stress release, relaxation, anxiety reduction, escapism, autonomy, social interaction, and competence and self-esteem development.

Gaming addiction is considered to be similar to pathological gambling in that it begins as rewarding entertainment. Video gaming, like gambling, activates the brain’s reward pathways (and releases dopamine). Another consideration in the cause of video game addiction is the genre of the game. The massively multiplayer online role-playing games (MMORPGs) have a significant mixture of social interaction and open-ended game play that has drawn considerable attention for being addictive. The interactive nature of video games and the increasing potential for realistic depictions of environments that allow for complex social interactions increase the potential that they become salient to the person playing the game.

Risk Factors

Research indicates that adolescent and young adult males are predominant users of video games and also show a greater incidence of dependency. Gaming can elicit a cognitive and affective state known as flow, which is characterized by a rewarding, focused sense of control and a loss of sense of time and place. Data demonstrate that pathological gaming can persist over time and is not a “phase.” Impulsivity, absence of empathy, low social competence, and inability to regulate emotion are correlated with pathological gaming, although experts differ on the causal relationship of these factors in gaming development. (The factors also may be in response to problematic gaming.)

Addictive or pathological patterns of gaming also appear to predict mental health issues such as depression, anxiety, and social phobias; however, the role of these effects in developing and maintaining gaming problems is unclear. Youth who play games more than thirty hours per week are more likely to develop gaming addiction than are those who game less than twenty hours per week. Games such as MMORPGs, which involve identifying with a gaming character or avatar, are much more likely to become addictive. Open-ended games or those that regularly add content to be mastered, also pose a risk of addiction. Persons with a history of addictions (such as substance abuse and gambling) and persons with extended periods of unstructured time are also considered to be at risk for gaming addiction.

Symptoms

Symptoms for gaming addiction, which range from psychological and social to physiological, include excessive game-binging (gaming for more than six to eight hours at a time with little or no interruption), gaming late into the night, a decreased interest in school or occupational pursuits, anger or frustration when denied access to gaming (for example, when the computer server is not working, when access to a game is denied, or when disengaging), being preoccupied with the next gaming session, downplaying the prevalence or effects of video gaming, a distorted perception of time while gaming, difficulty abstaining from gaming, increased spending on games and gaming platforms and equipment, and feelings of distress when unable to play. Relational symptoms include lying to others about how much time is spent gaming, decreased time spent with family and friends, increased preference given to fellow gamers in their social relationships, and decreased interest in marital and romantic relationships.

Other issues, such as sleeping difficulties or a significant change in sleep habits, dry or red eyes, weight gain, lack of attention to personal hygiene and eating habits, and soreness to the back, neck, hands, or wrists (such as carpal tunnel syndrome), can be symptomatic of pathological gaming. The use of substances such as stimulants (for example, caffeine) to aid in staying awake and alert also may indicate a gaming addiction.

Screening and Diagnosis

Several screening tools have been developed to study gaming addiction, none of which are considered gold standards. These screening tools use measures similar to those used to determine pathological gambling and substance abuse. The gaming addiction scale for adolescents is a Likert scale based on a series of questions that deal with what are suggested to be the core components of gaming addiction. These components include salience, tolerance, mood modification, withdrawal, relapse, conflict, and consequences or problems. Another screening tool is the problematic video game playing scale (PVP). The PVP is a nine-item forced-choice questionnaire that addresses issues related to symptoms of excessive gaming.

The
Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV-TR), published in 2000 by the American Psychiatric Association (APA), does not list video game addiction as an addiction. The APA will reconsider this listing if sufficient data warrants its inclusion in future DSM revisions. In general, proponents of including gaming addiction in the DSM are concerned about the medical, educational, and social well-being of children who spend excessive time gaming. The DSM-5, published in 2013, listed internet gaming disorder in the section of the manual that discusses conditions requiring further clinical research for consideration of inclusion as a formal disorder.

Given that gaming addiction is not in the DSM, it is not considered a clinical diagnosis. Gaming addiction can be considered comorbid, however, with mood disorders, anxiety disorders, or antisocial disorders. Diagnosis of gaming addiction should consider common addiction criteria, such as tolerance, psychological or physiological withdrawal with gaming abstinence, a progressive increase in time spent gaming, and a cycle of abstinence followed by relapse.

Treatment and Therapy

The most commonly used treatments are individual psychotherapy and psychoeducation about the effects of gaming consumption. Interpersonal therapy and cognitive-behavioral therapy are commonly employed to treat comorbid psychological issues. In addition, support groups (such as Online Gamers Anonymous) and group therapy can be effective in treating gaming addiction, provided these groups consider matters of access, coping skills, relapse prevention, and recovery.

Online communities for recovery also exist, although computer access and availability and the anonymous nature of this interface, which allows for viewing pornography, can be problematic. To address this, the use of filtering software to monitor use and prevent access to sexually explicit material is commonly regarded as a first-order behavioral or environmental intervention. Pharmacotherapy for gaming addiction or related diagnosis (such as anxiety disorder or mood disorder) should also be considered for severe cases.

South Korea has experienced a concerning increase in cases of internet gaming addiction, which has been evidenced by several deaths and murders linked to gaming addiction as well as the government's attempts to combat the addiction. In 2011, for example, the government passed a law that blocked youths under the age of sixteen from logging in to gaming websites between midnight and 6:00 a.m. Additionally, the country became the first to open treatment centers dedicated to helping people recover from gaming addictions as far back as the early 2000s. These centers focus on social interaction, outdoor activities, and hobbies such as arts and crafts.

Prevention

Prevention of gaming addictions is best achieved by avoiding the regular use of video games. Refraining from extended play of video games, especially MMORPGs and those that are open-ended, also is recommended.

Bibliography

Block, Jerald J. “Issues for DSM-V: Internet Addiction.” American Journal of Psychiatry 165.3 (2008): 306–7. Print.

Clark, Neils, and Scott P. Shavaun. Game Addiction: The Experience and the Effects. London: McFarland, 2009. Print.

Gentile, Douglas A., et al. “Pathological Videogame Use among Youths: A Two-Year Longitudinal Study.” Pediatrics 127 (2011): 319–29. Print.

Grüsser, S. M., R. Thalemann, and M. Griffiths. “Excessive Computer Game Playing: Evidence for Addiction and Aggression?” Cyberpsychology and Behavior 10 (2007): 290–92. Print.

Johnson, Nicola F. The Multiplicities of Internet Addiction: The Misrecognition of Leisure and Learning. Burlington: Ashgate, 2009. Print.

Robinson, Melia. "Korea's Internet Addiction Crisis Is Getting Worse, as Teens Spend up to 88 Hours a Week Gaming." Business Insider. Business Insider, 25 Mar. 2015. Web. 29 Oct. 2015.

Skoric, M. M., L. L. Teo, and R. L. Neo. “Children and Video Games: Addiction, Engagement, and Scholastic Achievement.” Cyberpsychology and Behavior 12.5 (2009): 567–72. Print.

What is healing? |

The Healing Process

The human body is not able to reproduce injured parts during the healing process. Most injured tissue in the body is replaced with collagen, a white protein known as scar tissue. Body areas capable of reproducing, or regenerating, include the outer layer of skin and the inner layers of the intestines.

The human body is involved in a continuous process of self-healing. The outer layer of the skin is constantly rubbed off, yet the body is able to replace (regenerate) new skin to take its place. Another body area capable of regeneration is the innermost layer of the intestine. All other types of tissue, however, such as muscle, fat, blood vessels, or even bones, must rely on other ways to heal when injured. How quickly the body heals depends on many factors, but the process is a predictable one. The healing process includes three phases: the acute inflammatory phase, the repair or regeneration phase, and the remodeling phase.

The first phase of healing, the immediate inflammatory phase, includes the first three or four days after the injury. This process, carried out by vascular, chemical, and cellular events, leads to the repair of tissue, to regeneration, or to scar tissue formation. If the hand is sliced open by a piece of broken glass, the first healing response would be a temporary decrease in blood flow, known as vasoconstriction, or narrowing of the blood vessels at the injury site to prevent the person from bleeding to death. With extensive vessel damage, however, the body is unable to close off enough vessels, and life-threatening hemorrhaging may occur.

The blood begins to seal the broken vessels by coagulation, also known as blood clot formation. The next step is activation of the chemicals needed in the healing process, which is possible only after the blood vessel diameter increases in a process called vasodilation. During vasodilation, the blood flow is slowed and the blood becomes thicker, resulting in swelling. At this point, a buildup or accumulation of fluid results from the seeping of plasma, the fluid portion of the blood, through the vessel walls. This seeping or leakage results from the difference in pressure within the vessel and outside its walls, as well as in the increased permeability of blood vessel walls during the inflammatory process. The amount of swelling at the injury site depends on the amount of seeping, which in turn depends on how much tissue damage has occurred.

Because the blood flow is slower, the concentration of red blood cells and white blood cells is increased. The white blood cells line up and adhere to the inside walls of small blood vessels, known as venules. These white blood cells then pass through the venule walls and are chemically attracted to the injury site over the next several hours. A specialized connective tissue cell, known as a mast cell, is also sent to the injury site. Mast cells contain heparin and histamine. Heparin prolongs the clotting time of blood by temporarily preventing coagulation, while histamine causes dilation of the capillaries. During this earliest phase, both heparin and histamine are important factors, since their actions allow other specialized cells to move into the injured area. The amount of bleeding and fluid buildup at the injury site depends on the extent of damage and how easily materials can cross the walls of intact vessels.
Both of these conditions influence the healing process.

The second phase of healing can be called the repair or regeneration phase. For tissue capable of regeneration, this phase involves the restoration of destroyed or missing tissue. For other types of tissue, this second phase would entail the repair process. The healing of a deep cut in the hand would not be considered regeneration, since the body is not able to remake all the different layers of skin and muscle injured. This healing phase would extend forward from the previously described inflammatory phase. During this phase, the cut is naturally cleaned through the body’s ability to remove cellular waste, the help of the red blood cells, and the formation of a blood clot.

Two types of healing can occur. Primary healing, or healing by primary intention, could take place in the hand laceration example, since the edges are even and close together. If this injury resulted in a large piece of tissue being removed, then the body would fill the gap with scar tissue. The replacement of tissue with scar tissue is an example of secondary healing, or healing by secondary intention. A torn muscle would be an example of secondary healing if it is allowed to heal on its own by the formation of scar tissue within the muscle.

No matter which type of healing occurs, several factors regulate how quickly and how completely this process takes place. Because blood vessels and cells are deprived of oxygen and die from the injury, this new cellular waste or debris must be cleaned from the area before repair or regeneration can take place. This tissue death promotes the formation of new capillary buds on the walls of the intact vessels. As these mature, the injury site is newly supplied with oxygenated blood and the healing process continues into the third phase.

The third phase of healing, known as the remodeling phase, includes the laying down of young scar tissue that increases in strength over the next year. Although the healing process has no distinct time frame, it is believed that three to six weeks are needed for the production of scar tissue. There must be a balance between the toughness and the elasticity of the scar. The amount of stress placed on a newly formed scar will determine the tensile strength of the collagen content. If stress or strain is placed on this forming scar tissue too early, the healing process will take longer. A desirable outcome would be a scar of adequate collagen content through the development of sufficient mature collagen fibers of proper tensile strength. Adequate tensile strength is also affected by how long inflammation is present.

If an injury site has inflammation that lasts up to one month, it is considered a subacute inflammation. When it lasts for months or years, it is then called chronic inflammation. Chronic inflammation is a condition in which small traumas happen repeatedly; it is often seen in overuse injuries. Because this type of injury lasts longer, different types of chemicals try to initiate complete healing. The role of some of these special chemicals is not completely understood.

The healing of a broken bone, similar in many ways to the healing of the skin, is somewhat easier to understand. The first phase shows the same acute inflammation that lasts about four days, involving clotting blood, dead bone

cells, and soft tissue damage around the injury site. The second phase, the repair and regeneration phase, differs slightly when a bone is broken, since the blood clot (hematoma) becomes granulated and builds between the two bone ends. The bone produces a specialized cell that turns into a soft or hard fibrous callus, matures into cartilage, and finally becomes bone with a firmly woven network of cells.

The beginning soft callus is a network of unorganized bone that forms at the two broken edges and is later absorbed and replaced by a hard callus. With appropriate care, a broken bone will develop a new network in the center and eventually become primary bone. The amount of oxygen available in the area determines this development. It is important to keep in mind that when the injury is severe enough to break a bone, then the blood supply is interrupted, lowering the amount of oxygen that is available. Low oxygen could result in the formation of only fibrous tissue or cartilage. Strong, healthy bone results when oxygen and the correct amount of compression are available. The third phase, the remodeling phase, describes the time when the callus has been reabsorbed and special intersecting bone fibers cover the broken area. It may take many years for this entire process to be completed, until the bone has regained its normal shape and ability to withstand stresses.

Disorders and Treatment

Any of the three stages of healing can be delayed or prevented. The three main causes for failed healing are poor blood supply, poor immobilization, or infection.

The healing process within the body can be seriously hampered if the blood supply is poor, since the delivery of nutrients, chemicals, hormones, and specialized building materials to the injury site is hampered. It is extremely important that oxygen levels are adequate for proper healing. If the blood supply is not sufficient, then the tissue may die, especially in broken bone fragments. Fortunately, most tissues of the body have a good blood supply, as demonstrated by the amount of bleeding that takes place when the skin and underlying tissues are injured.

The second condition that interferes with healing is excessive movement because the body part was not immobilized. For the scar tissue or even new bone to become well organized, the two edges of the injured tissue must be kept close together.

The third reason for poor healing is infection. Although the body has many defenses against infection, foreign material can slow healing. If this infectious material invades the space between the two bone ends of a fracture, the necessary building materials may not reach the site. Infection invading the hand tissue cut by the glass could prevent the edges from healing together because of pus, scab formation, or the interference of germs.

There are many different types of injuries, and several steps must be taken in caring for each type. Soft tissues, the first line of defense against injuries, can be used to describe all tissues other than bone. Soft tissue injuries are classified as either closed or open. In a closed wound, the damage lies below the surface of the skin and the skin remains intact. A sprained ankle or a bruised knee are classified as closed wounds. In an open wound, the skin or mucous membranes, such as the lining of the mouth, are broken or torn.

There are four types of open soft tissue injuries; each has specific characteristics and heals differently. The first type is an abrasion, in which part of the outer layer of the skin and some underlying tissue is rubbed or scraped off. A common injury of this type is a scraped knee resulting from a fall on the sidewalk. The second type, a laceration, results from a sharp object cutting the skin, such as the previous example of a piece of glass cutting the skin either superficially or very deeply. The third type, an avulsion, results when a piece of skin or even an entire fingertip is torn off or left loosely hanging by a small flap of skin. It is important that this flap not be removed since a physician can sometimes reattach the part. The last type of soft tissue injury is the puncture wound, which results when a sharp object penetrates the skin and into a body part. Such an injury could be a stab from a knife or an ice pick, a splinter stuck in the foot, or even a bullet shot into the leg. The initial management is the same for all four types of injury.

Management of open wounds must include the control of bleeding, infection prevention, and immobilization. Two of the above injuries, an avulsion and a puncture wound, require additional special care. In the case of an avulsed body part, the amputated part should be saved; wrapped in a dry, sterile piece of gauze; and placed in a plastic bag. If this bag is kept in something cool, such as a bucket of ice, the possibility of reattachment is increased. An impaled object remaining in a puncture wound should never be removed but held in place, all movement restricted until medical care can be given.

Several medical treatments can aid in promoting the healing process, as can commonsense first aid measures taken immediately after an injury occurs. For example, with a glass cut to the hand one should immediately stop the bleeding by placing a sterile piece of gauze, or a very clean cloth, directly over the laceration. By adding direct pressure over the gauze, the circulation is reduced. If the cut is deep, if the bleeding cannot be controlled, or if a piece of glass remains in the wound, then it is advisable to seek medical attention. A physician would then thoroughly clean the injury site and stitch the two edges together. Immobilizing the two flaps of skin together by sewing them will allow the first two phases of healing to progress. By having the wound inspected and cleaned by medical personnel, the risk of infection is reduced. A small injury can be cared for at home, but infection must be prevented through proper cleansing. Even soap and water, along with a bandage or dressing, will help ward off infections.

Perspective and Prospects

Many strategies to improve the healing of human tissue have evolved over time—from ancient times, when healers packed mud on the top of sores to draw out the infection, to modern alternative medicines. Every person, at one time or another, receives a cut, scrape, bump, or bruise. Therefore, there is much interest in speeding up the healing process.

Renewed interests in nontraditional approaches to medicine explore the healing powers locked within the human body. The use of homeopathy, acupuncture, and acupressure are examples of alternatives to antibiotics and standard first aid measures to help an injury heal. Holistic health care, hypnosis, and osteopathic medicine offer other areas of exploration. The practice of Chinese medicine includes the use of herbs, crystals, massage, and meditation to allow healing to proceed quickly but through natural means. Even the use of aromatherapy—treatment through the inhalation of specific smells—has gained a foothold in the medical world. The manipulations done by chiropractic doctors offer other possibilities. Some seek cures in nature, from sources below the sea or deep in the forest. Yet, many untapped resources remain. The continuing research in genetics offers vast possibilities, and the link between mental attitude and the immune system presents a rich area for further exploration. Even innovations as simple as a special glue, used to replace sutures or staples for closing wounds, would have an important influence on the future of the healing process.

Bibliography

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Woodham, Anne, and David Peters. The DK Natural Health Encyclopedia of Natural Healing. 2d ed. New York: DK, 2000.

What is vitamin B6? What are its therapeutic uses?

Overview

Vitamin B6 plays a major role in making proteins, hormones, and neurotransmitters—chemicals that carry signals between nerve cells. Because mild deficiency of vitamin B6 is common, this is one vitamin that is probably worth taking as insurance. However, there is little evidence that taking vitamin B6 above nutritional needs offers benefits in the treatment of any particular illnesses, except, possibly, nausea of pregnancy (morning sickness).

Requirements and Sources

Vitamin B6 requirements increase with age. The official U.S. and Canadian recommendations for daily intake are as follows:

Infants aged 0 to 6 months (0.1 mg) and 7 to 12 months (0.3 mg); children aged 1 to 3 years (0.5 mg), 4 to 8 years (0.6 mg), and 9 to 13 years (1.0 mg); males aged 14 years to fifty years (1.3 mg); females aged 14 to 18 years (1.2 mg); women aged 19 to fifty years (1.3 mg); pregnant women (1.9 mg); and nursing women (2.0 mg).

Severe deficiencies of vitamin B6 are rare, but mild deficiencies are extremely common. In a survey of 11,658 adults, 71 percent of men and 90 percent of women were found to have diets deficient in B6. Vitamin B6 is the most commonly deficient water-soluble vitamin in the elderly, and children often do not get enough B6. In addition, evidence has been presented that current recommended daily intakes should be increased.

Vitamin B6 deficiency might be worsened by use of hydralazine (for high blood pressure), penicillamine (used for rheumatoid arthritis and certain rare diseases), theophylline (an older drug for asthma), monoamine oxidase (MAO) inhibitors, and the antituberculosis drug isoniazid (INH), all of which are thought to interfere with B6 to some degree. Good sources of B6 include nutritional (torula) yeast, brewer’s yeast, sunflower seeds, wheat germ, soybeans, walnuts, lentils, lima beans, buckwheat flour, bananas, and avocados.

Therapeutic Dosages

One study found that 30 milligrams (mg) of vitamin B6 daily was effective for symptoms of morning sickness. While far above nutritional needs, this dosage should be safe. However, for the treatment of other conditions, B6 has been recommended at doses as high as 300 mg daily. There are potential risks at this level of vitamin B6 intake.

Therapeutic Uses

The results of a large double-blind, placebo-controlled study suggest that vitamin B6 at a dose of 30 mg daily may be helpful for treating nausea in pregnancy (morning sickness). Vitamin B6 has been proposed for numerous other uses, but without much, if any, scientific substantiation. For example, the two most famous uses of vitamin B6, carpal tunnel syndrome and premenstrual syndrome (PMS), have no reliable supporting evidence, and the best-designed studies found this vitamin ineffective for either of these purposes.

Higher intake of vitamin B6 reduces the level in the blood of homocysteine, a substance that might accelerate cardiovascular diseases, such as heart disease, strokes, and related conditions. However, there is no meaningful evidence that reducing homocysteine is beneficial, and considerable evidence that it is not.

A series of studies suggests that vitamin B6 may be helpful for the treatment of tardive dyskinesia (TD). In the first study, a four-week, double-blind crossover trial of fifteen people, treatment with vitamin B6 significantly improved TD symptoms compared with placebo. Benefits were seen beginning at one week of treatment. The subsequent follow-up study tested the benefits of vitamin B6 used over a period of twenty-six weeks in fifty people with tardive dyskinesia, and once again the supplement proved more effective than placebo.

For the following other conditions, current evidence for benefit with vitamin B6 remains incomplete or contradictory: allergy to monosodium glutamate (MSG), asthma, depression, diabetes of pregnancy, human immunodeficiency virus (HIV) infection, photosensitivity, preventing kidney stones, schizophrenia, seborrheic dermatitis, tardive dyskinesia and other side effects of antipsychotic drugs, and vertigo.

Despite some claims in the media, vitamin B6 has not shown benefit for enhancing mental function. Research investigating the benefits of B6 in combination with folate and vitamin B12 as a potential treatment for cognitive decline due to Alzheimer’s disease has also shown disappointing results.

One study failed to find B6 at a dose of 50 mg daily helpful for rheumatoid arthritis, despite a general B6 deficiency seen in people with this condition. Vitamin B6, alone or in combination with magnesium, showed some early promise for the treatment of autism, but the best-designed studies failed to find it effective.

Additionally, current evidence suggests that vitamin B6 is not effective for treating diabetic neuropathy or eczema, or for helping control the side effects of oral contraceptives.

Scientific Evidence

Nausea and vomiting: Morning sickness. Vitamin B6 supplements have been used for years by conventional physicians as a treatment for morning sickness. In 1995, a large double-blind study validated this use. A total of 342 pregnant women were given placebo or 30 mg of vitamin B6 daily. Subjects then graded their symptoms by noting the severity of their nausea and recording the number of vomiting episodes. The women in the B6 group experienced significantly less nausea than those in the placebo group, suggesting that regular use of B6 can be helpful for morning sickness. However, vomiting episodes were not significantly reduced.

At least three studies have compared vitamin B6 to ginger for the treatment of morning sickness. Two studies found them to be equally beneficial, while the other found ginger to be somewhat better. However, because ginger is not an established treatment for this condition, these studies alone do not provide any additional evidence in favor of B6.

Chemotherapy-induced nausea and vomiting. Researchers also investigated whether vitamin B6 can reduce the nausea and vomiting that often accompanies chemotherapy. A total of 142 women with ovarian cancer who were undergoing chemotherapy were randomized into three groups: acupuncture plus B6 injection into the P6 acupuncture point (located on the inside of the forearm, about two inches above the wrist crease), acupuncture alone, or B6 alone. Those that received both acupuncture and B6 experienced less nausea and vomiting compared with the other two groups.

Premenstrual syndrome
. A properly designed double-blind study of 120 women found no benefit of vitamin B6 for premenstrual syndrome (PMS). In this study, three prescription drugs were compared against vitamin B6 (pyridoxine, at 300 mg daily) and placebo. All study participants received three months of treatment and three months of placebo. Vitamin B6 proved to be no better than placebo.

Approximately a dozen other double-blind studies have investigated the effectiveness of vitamin B6 for PMS, but none were well designed; overall, the evidence for any benefit is weak at best. Some books on natural medicine report that the negative results in some of these studies were due to insufficient B6 dosage, but in reality there was no clear link between dosage and effectiveness.

However, preliminary evidence suggests that the combination of B6 and magnesium might be more effective than either treatment alone.

Autism. One double-blind, placebo-controlled crossover study found indications that very high doses of vitamin B6 may produce beneficial effects in the treatment of autism. However, this study was small and poorly designed; furthermore, it used a dose of vitamin B6 so high that it could cause toxicity.

It has been suggested that combining magnesium with vitamin B6 could offer additional benefits, such as reducing side effects or allowing a reduced dose of the vitamin. However, the two reasonably well-designed studies using combined vitamin B6 and magnesium have failed to find benefits. Therefore, it is not possible at present to recommend vitamin B6 with or without magnesium as a treatment for autism.

Asthma
. A double-blind study of seventy-six children with asthma found significant benefit from vitamin B6 after the second month of usage. Children in the vitamin B6 group were able to reduce their doses of asthma medication (bronchodilators and steroids). However, a recent double-blind study of thirty-one adults who used either inhaled or oral steroids did not show any benefit. The dosages of B6 used in these studies were quite high, in the range of 200 to 300 mg daily. Because of the risk of nerve injury, it is not advisable to take this much B6 without medical supervision.

Safety Issues

The safe upper levels for daily intake of vitamin B6 are as follows:

Children aged 1 to 3 years (30 mg), 4 to 8 years (40 mg), 9 to 13 years (60 mg), and 14 to 18 years (18 mg); adults (100 mg); pregnant girls (80 mg); and pregnant women (100 mg).

At higher dosages, especially above 2 g daily, there is a very real risk of nerve damage. Nerve-related symptoms have even been reported at doses as low as 200 mg. (This is a bit ironic, given that B6 deficiency also causes nerve problems.) In some cases, very high doses of vitamin B6 can cause or worsen acne symptoms.

In addition, doses of vitamin B6 over 5 mg may interfere with the effects of the drug levodopa when it is taken alone. However, vitamin B6 does not impair the effectiveness of drugs containing levodopa and carbidopa. Maximum safe dosages for individuals with severe liver or kidney disease have not been established.

Important Interactions

People who are taking isoniazid (INH), penicillamine, hydralazine, theophylline, or MAO inhibitors may need extra vitamin B6, but they should take only nutritional doses. Higher doses of B6 might interfere with the action of the drug. People who are taking levodopa without carbidopa for Parkinson’s disease should not take more than 5 mg of vitamin B6 daily, except on medical advice. In addition, B6 might reduce the side effects for people taking antipsychotic medications.

Bibliography

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Chiang, E. P., et al. “Pyridoxine Supplementation Corrects Vitamin B6 Deficiency but Does Not Improve Inflammation in Patients with Rheumatoid Arthritis.” Arthritis Research and Therapy 7 (2005): R1404-1411.

Ensiyeh, J., and M. A. Sakineh. “Comparing Ginger and Vitamin B6 for the Treatment of Nausea and Vomiting in Pregnancy.” Midwifery 25, no. 6 (2009): 649-653.

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Lerner, V., et al. “Vitamin B6 Treatment for Tardive Dyskinesia.” Journal of Clinical Psychiatry 68 (2007): 1648-1654.

_______. “Vitamin B6 Treatment in Acute Neuroleptic-Induced Akathisia.” Journal of Clinical Psychiatry 65 (2004): 550-1554.

Malouf, R., and E. J. Grimley. “The Effect of Vitamin B6 on Cognition.” Cochrane Database of Systematic Reviews 4 (2003): CD004393.

Miodownik, C., et al. “Vitamin B6 Add-on Therapy in Treatment of Schizophrenic Patients with Psychotic Symptoms and Movement Disorders.” Harefuah 142 (2003): 592-566, 647.

Schwammenthal, Y., and D. Tanne. “Homocysteine, B-Vitamin Supplementation, and Stroke Prevention: From Observational to Interventional Trials.” Lancet Neurology 3 (2004): 493-495.

Smith, C., et al. “A Randomized Controlled Trial of Ginger to Treat Nausea and Vomiting in Pregnancy.” Obstetrics and Gynecology 103 (2004): 639-645.

Sripramote, M., and N. Lekhyananda. “A Randomized Comparison of Ginger and Vitamin B6 in the Treatment of Nausea and Vomiting of Pregnancy.” Journal of the Medical Association of Thailand 86 (2003): 846-853.

You, Q., et al. “Vitamin B6 Points PC6 Injection During Acupuncture Can Relieve Nausea and Vomiting in Patients with Ovarian Cancer.” International Journal of Gynecological Cancer 19 (2009): 567-771.