How does Sidi mock Baroka in her conversation with him?

When Sidi enters Baroka's palace, he is in the middle of wrestling a younger man, and she mentions that his house seems empty. Baroka responds by asking Sidi if Ailatu, his favorite wife, is around, and Sidi tells him that she is not. Baroka says that Ailatu will be back and mentions to Sidi that he offended Ailatu after she hurt him while plucking his armpit hairs out. Sidi mocks Barokaby saying that...

When Sidi enters Baroka's palace, he is in the middle of wrestling a younger man, and she mentions that his house seems empty. Baroka responds by asking Sidi if Ailatu, his favorite wife, is around, and Sidi tells him that she is not. Baroka says that Ailatu will be back and mentions to Sidi that he offended Ailatu after she hurt him while plucking his armpit hairs out. Sidi mocks Baroka by saying that Ailatu must have been dissatisfied with him for some reason, suggesting that he was not able to perform sexually. Baroka wisely controls his temper and refers to himself as a "humorless old ram." Sidi then comments that she thinks the other wrestler will win. Baroka asks Sidi if that is her wish and she mocks him by saying, "If the tortoise cannot tumble it does not mean that he can stand" (Soyinka 42). Sidi then tiptoes behind his back and makes funny gestures at him. Sidi continues to mock Baroka by mentioning that he is old enough to be her father and disrespects his character. She indirectly mocks him by commenting on his age and "open-handedness," and even brings up an embarrassing story about how Baroka has acquired a taste for ground corn and pepper because he is too cheap to pay for snuff. As Sidi continues to tell Baroka the story of her suitor, which incidentally happens to be him, she mentions that once upon a time he used to be fertile and please his wife. She also says that he is too tired anymore and cannot produce offspring. At this point in the play, Baroka realizes that Sadiku has told Sidi about his impotence, and he begins to play along in order to deceive Sidi.

What is Streptococcus? |

Definition

Streptococcus is a genus of gram-positive cocci, or bacteria, with a thick peptidoglycan layer in their cell walls (gram-positive) that appear under the microscope as chains of two or more spherical cells (cocci). The streptococci can grow in low concentrations of oxygen or without oxygen and are distinguished from bacteria in the genus Staphylococcus in the laboratory by the production of the enzyme catalase by staph species.

The streptococci are classified in a number of ways, including by the identity of molecules on the cell surface and by the presence and variety of hemolysin, or enzyme, that lyse red blood cells. Alpha-hemolytic species lyse red blood cells and oxidize hemoglobin to leave an opaque green residue on blood agar petri dishes. Beta-hemolytic species leave a transparent halo around colonies on blood agar petri dishes. Gamma-hemolytic species exhibit neither of these traits.

Natural Habitat and Features

Streptococci are a part of the normal microbiota of humans and other mammals.
Some streptococci can cause infectious diseases. The progression from latency to
infectious disease is not well understood, but scientists have investigated the
possibility that virus-induced genetic changes in streptococcal species are
responsible for the sudden appearance of “flesh-eating” disease, or
necrotizing
fasciitis.

Pathogenicity and Clinical Significance

S. pyogenes is a notable member of the beta-hemolytic
streptococci. Pyogenes is an opportunistic pathogen widely distributed in humans. It causes acute bacterial pharyngitis,
commonly known as strep throat, and infections of the skin and circulatory
system. These bacteria are able to evade the human immune system
though various means. That is, the cells are covered in hyaluronic acid, which is
a component of human connective tissue and, therefore, non-immunogenic; and a
series of proteins, M proteins, prevents the engulfment of bacterial cells by
immune cells. Two toxins that destroy immune cells also cause beta-hemolysis of
red blood cells.

Pyogenes strains that produce erythrogenic exotoxins, the
extracellular proteins responsible for the scarlet fever rash, may produce one of
three varieties. Exposure to one variety does not induce immunity to the others,
so a person may have recurring infection. These toxins are not encoded on the
bacterial chromosome, but on plasmids. Prompt antibiotic therapy of
strep throat has reduced the incidence of scarlet
fever.

Acute rheumatic fever and acute glomerulonephritis are also consequences of
untreated strep throat. The symptoms of rheumatic fever occur about three to
four weeks following strep throat and include pains in the joints and long-term
damage to the heart, likely because of an autoimmune response. Glomerulonephritis
is swelling of the kidneys following strep throat or a streptococcal skin
infection.

Streptococcal impetigo is a localized skin infection caused by
pyogenes. Erysipelas is an acute infection of the
skin with fever. Strains that express the enzyme streptokinase may dissolve a
blood clot to penetrate to deeper tissue. Infection of deep muscle and fat tissue, the lungs, and blood can
be life-threatening. Necrotizing fasciitis (infection of muscle and fat tissue)
kills about 20 percent of infected persons, and streptococcal toxic shock syndrome
(an infection causing low blood pressure and shock and injury to the kidneys,
liver, and lungs) kills up to 60 percent of infected persons.

Another beta-hemolytic species, agalactiae, is the major cause
of meningitis, pneumonia, and infections of the
bloodstream in newborns. The female genital tract is the natural habitat for
agalactiae, with 25 to 35 percent of the female population
being carriers. Newborns are infected at birth or during their stay in a hospital
nursery. Antibiotic therapy of pregnant women who carry
agalactiae prevents transmission to their fetuses at
birth.

Most human cases of bacterial pneumonia are caused by alpha-hemolytic
pneumoniae. This species grows as pairs of cocci coated in a
thick carbohydrate capsule. Colonies on blood agar petri dishes are surrounded by
transparent agar and a mucoid appearance. Pneumoniae is an
inhabitant of the upper respiratory tract of up to 70 percent of the population.
In immunocompromised hosts, such as many elderly persons, and in those with a
viral
infection, this strain causes pneumonia. The infection in the
lungs results in fluid retention and difficulty in breathing. Recovery follows
after five to six days, even without antibiotic treatment. An increase of
circulating antibodies accompanies a decrease in the severity of the
symptoms. Penicillin or erythromycin hastens recovery, while a few persons with
pneumococcal-pneumonia, primarily the elderly, die even though they are being
treated with antibiotics.

Spinal meningitis caused by pneumoniae had been the second
leading cause of bacterial meningitis. This changed when a glycoconjugate
vaccine was added to the infant immunization schedule in the United States and
other countries.

Mutans, mitis, and sanguinis are alpha-hemolytic streptococci that are normal inhabitants of the human mouth. Mutans and mitis are found in dental plaque. S. mutans produces dextran from sucrose. Dextran is the sticky component of dental plaque that allows many bacterial species to stick to tooth surfaces. When bacteria grow on the teeth, they produce acid that contributes to the creation of cavities. Non-hemolytic species, also called gamma-hemolytic streptococci, are not human pathogens.

Drug Susceptibility

Streptococcal
infections are treated primarily with antibiotics. Widespread
incidence of resistance has not occurred to the extent that it has in the
staphylococcal species. Multiply resistant strains have been documented, though.
The treatment of strep throat has become more difficult because of
antibiotic
resistance of non-strep bacteria in the throat. Other
bacteria can destroy penicillin and other beta-lactam antibiotics and, thus,
shield sensitive pyogenes from their effect.

Bibliography

Brachman, Philip S., and Elias Abrutyn, eds. Bacterial Infections of Humans: Epidemiology and Control. 4th ed. New York: Springer, 2009. A college-level introduction that focuses on the mechanisms of pathogenicity.

Parker, James N., and Philip M. Parker, eds. The Official Patient’s Sourcebook on “Streptococcus pneumoniae” Infections. San Diego, Calif.: Icon Health, 2002. Draws from public, academic, government, and peer-reviewed research to provide a wide-ranging handbook for patients with pneumonia infections.

Tortora, Gerard J., Berdell R. Funke, and Christine L. Case. Microbiology: An Introduction. 10th ed. San Francisco: Benjamin Cummings, 2010. A great reference for those interested in exploring the microbial world. Provides readers with an appreciation of the pathogenicity and usefulness of microorganisms.

What is immunodeficiency? |

Definition

The
immune system defends the body against infections.
The impairment or absence of the immune system results in immune deficiencies, or
immunodeficiencies, which increase susceptibility to infectious diseases and rare
cancers. A normal, healthy immune system confers lifelong protective immunity
against harmful toxins, viruses, fungi, bacteria, parasites, and cancer cells.
Immune deficiencies predispose a person to persistent and unusual infections,
slower healing, and increased incidences of rare cancers. Persons who have
immunodeficiency are considered immunocompromised.

For the immunocompromised person, opportunistic infections, especially if left undiagnosed or untreated, increase morbidity and mortality; these infections are typically harmless to a person with a healthy immune system. Because of complex and intertwined regulatory systems in the body, immunodeficiencies that affect either parts of the innate or acquired immune systems can easily lead to serious health complications, even when other parts of the immune system function normally.

Immunocompromised persons often have repeated infections that become serious.
Some immunodeficiencies will shorten a person’s life, while others, if properly
treated, will mainly affect a person’s short- or long-term quality of life.

A sore throat or head cold may lead to pneumonia. Severe burns are always
associated with complications because the injured skin has lost its mechanical
integrity and immune defense properties. Persons with acquired immunodeficiency
syndrome (AIDS) are especially susceptible to opportunistic
infections and can become critically ill from simple, normally nonthreatening
infections.

Medical procedures too are associated with an increased risk of infections.
Other complications might present themselves as autoimmune
disorders, slowed growth, increased risk of cancer, and
damage to lungs, the heart, the nervous system, and the digestive tract.

Congenital and Acquired Immunodeficiencies

Congenital (primary) immunodeficiency (CI) is evident at birth and generally results from genetic defects or disorders. These disorders are relatively rare and are classified based on the immune component that is affected, including B cells, T cells, B and T cells, NK cells, phagocytes, and complement proteins.

Acquired (secondary) immunodeficiency (AI) develops later in life and usually is the result of an infectious process, a complication of another condition or disease, or the use of certain drugs during treatment for another condition. AIs are more common than CIs. Malnutrition, some types of cancer, and infections are the most common causes for AIs. Typical infections that can result in AI are cytomegalovirus, lupus, chronic hepatitis, measles, chickenpox, tuberculosis, German measles (rubella), infectious mononucleosis (Epstein-Barr virus), and certain bacterial and fungal infections.

Certain types of drugs, such as anticonvulsants, immunosuppressants, corticosteroids, some monoclonal antibodies, and chemotherapy drugs, can cause an AI. For example, for tissue or organ transplantation, immunosuppressants are used to prevent organ rejection by intentionally suppressing the immune system. Similarly, immunosuppressants are used to reduce inflammation, as in the case of rheumatoid arthritis. In addition, radiation therapy and some chemotherapy drugs, which are given to treat cancer, destroy the cells of the immune system. Immunosuppressants repress the body’s ability to attack infections and, sometimes, to destroy cancer cells. During and sometimes beyond drug treatment, the chance of infection increases.

AI is common among severely sick, hospitalized, and older persons. Almost every
lengthy acute disorder or infection can potentially lead to an immunodeficiency.
In diabetes, white blood cells malfunction because of high
sugar levels in the blood, leading in some cases to AI. The best-known severe AI
is AIDS, which is caused by human immunodeficiency virus (HIV)
infection.

Prevention and Treatment

Treatments exist for preventing and treating infections, for boosting the immune system, and for treating underlying causes. Some immunodeficiencies can be prevented, to a certain extent. These include AIDS, cancer, and diabetes. The risk for HIV infection (and AIDS) can be lessened by avoiding the sharing of drug-injection needles and by practicing safer sex. Decreased use of immunosuppressants by persons with cancer might restore the normal function of the immune system after a successful treatment. In the case of diabetes, balanced blood sugar levels can improve the function of white blood cells and can, consequently, help to prevent infections.

The type of immunodeficiency determines preventive and treatment strategies.
Common prevention strategies include eating only cooked food, drinking bottled
water, taking one’s regular medications, proper vaccination, avoiding exposure to
other infectious people, and observing good personal hygiene. Infections can be
managed with antibiotics or with the treatment of symptoms.

Immunoglobulin, gamma interferon, and growth factors therapy can help boost the
immune system. To properly balance the complex immune regulation systems in the
body, immune-related treatments should be applied with careful knowledge of the
deficiency. In severe combined immunodeficiency syndrome (commonly known as
bubble-boy syndrome), stem cell transplantation can offer a permanent cure of this
life-threatening condition.

Impact

The impact of immunodeficiencies lies in the incidence and prognosis of many infectious diseases, which strongly affect the young, the ill, and the elderly with often devastating outcomes. More research is needed to quantify the impact of infectious disease on immunodeficiencies. Better understanding of the clinical indicators of immune competence may lead to improvements in the prevention, treatment, management, and outcome of infectious diseases and their affect on immunocompromised persons.

Bibliography

Al-Muhsen, S. Z. “Gastrointestinal and Hepatic Manifestations of Primary Immune Deficiency Diseases.” Saudi Journal of Gastroenterology 16 (2010):66-74.

Blaese, R. Michael, and Jerry A. Winkelstein. Patient and Family Handbook for Primary Immunodeficiency Diseases. 4th ed. Towson, Md.: Immune Deficiency Foundation, 2007.

De Bakker, P. I., and A. Telenti. “Infectious Diseases Not Immune to Genome-Wide Association.” Nature Genetics 42 (2010): 731-732.

Morimoto, Y., and J. M. Routes. “Immunodeficiency Overview.” Primary Care: Clinics in Office Practice 35 (2008): 159-173.

Sompayrac, Lauren M. How the Immune System Works. 3d ed. Hoboken, N.J.: Wiley-Blackwell, 2008.

Strugnell, R. A., and O. L. Wijburg. “The Role of Secretory Antibodies in Infection Immunity.” Nature Reviews Microbiology 8 (2010): 656-667.

Tolan, Robert W., Jr. “Infections in the Immunocompromised Host.” Available at http://emedicine.medscape.com/article/973120-overview.

What is fatal familial insomnia?

Definition

Fatal familial insomnia (FFI) is a rare, genetic prion disease transmitted as an autosomal dominant
trait. The responsible mutation causes prions (proteins found extensively in
the body) to assume abnormal shapes and thereby become pathogenic. A nongenetic
form of the disease, sporadic fatal insomnia, also exists.

Causes

The cause of FFI has been identified as a mutation at codon 178 of the prion-protein gene (PRNP) on chromosome 20. Disease characteristics, such as duration, are determined by a polymorphism at codon 129 of the PRNP gene.

Risk Factors

Each offspring of an affected parent has a 50 percent risk of inheriting the mutant gene, which is highly penetrant; as far as is known, those persons who inherit the gene will express the disease. Sporadic cases have no known risk factors.

Symptoms

Insomnia is the hallmark of this disease, although it is not
invariably present in the earliest stages. Symptoms are best understood in the
context of the histopathology of FFI, primarily involving degeneration and loss of
neurons in the thalamus. The thalamus has a crucial integrative function in the
brain, relaying all manner of sensory information to the cerebral cortex. A role
for the thalamus in regulating autonomic functions and key circadian
rhythms is consistent with prominent FFI symptoms.
Twenty-four-hour circadian patterns comprise not only the sleep-wake cycle but
also the normal ebb and flow of hormone secretions.

Other symptoms include severely impaired motor functions, uncoordinated and jerky muscle movements, and difficulty in speaking and swallowing. The autonomic dysregulation also manifests as fever and sweating. Affected persons are often described as inattentive, restless, and unable to concentrate. Cognition may also be affected.

Secretion of adrenocortical hormones is increased. These hormones are involved in the body’s stress reaction, and those affected experience chronic stress. The insomnia that characterizes this disease is progressive and untreatable, leading to the ultimate absence of any sleep patterns or responses.

The first reported case, in 1986, was that of a fifty-three-year-old man. The onset of FFI is most often in middle to late adulthood, although it has been reported in some patients in their early twenties. The duration of the disease, from less than one year to several years, largely depends on genetic factors.

Screening and Diagnosis

Neither careful clinical examination nor standard tests of sleep responses can
identify carriers of the FFI mutation before symptoms become
apparent. Findings of routine laboratory tests are generally normal.
Positron
emission tomography, however, which can measure the brain’s
consumption of glucose, has shown thalamic changes in an asymptomatic gene
carrier. Postmortem examination confirms the diagnosis.

Treatment and Therapy

Palliative
treatment has been the only reported treatment. Attempts to
alter the disease course with medications have been unsuccessful. Fatal familial
insomnia is considered untreatable.

Prevention and Outcomes

There is no known way to prevent the disease in a carrier. Prenatal diagnosis is theoretically possible.

Bibliography

Bosque, Patrick J., and Kenneth L. Tyler. “Prions and Prion Diseases of the Central Nervous System (Transmissible Neurodegenerative Diseases).” In Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, edited by Gerald L. Mandell, John F. Bennett, and Raphael Dolin. 7th ed. New York: Churchill Livingstone/Elsevier, 2010.

Brown, David R., ed. Neurodegeneration and Prion Disease. New York: Springer, 2005.

Max, Daniel T. The Family That Couldn’t Sleep: A Medical Mystery. New York: Random House, 2007.

_______. “The Secrets of Sleep.” National Geographic, May, 2010, pp. 74-93.

Prusiner, Stanley B. “The Prion Diseases.” Scientific American 272, no. 1 (January, 1995): 48-57.

_______, ed. Prion Biology and Diseases. 2d ed. Cold Spring Harbor, N.Y.: Cold Spring Harbor Laboratory Press, 2004.

Rowland, Lewis P., and Timothy A. Pedley, eds. Merritt’s Textbook of Neurology. 12th ed. Philadelphia: Lippincott Williams & Wilkins, 2010.

What is the Stanford prison experiment?

Introduction

In 1971, a prison was constructed in the basement of Stanford University’s psychology building. The makeshift prison was to provide a realistic setting for examining the effects of simulated confinement on prisoners and guards. The Stanford prison experiment, designed and led by Philip Zimbardo, a renowned psychologist and professor emeritus at Stanford University, is a case study that demonstrates how the power of a situation can transform those who are generally regarded as good people into authoritarians and sadists. It highlighted the ability of human nature’s dark side to emerge under certain circumstances.

Truly a classic study in psychology, the Stanford prison experiment is one of the best known and most widely cited experiments in the discipline. The investigation has been discussed in most introductory psychology courses since the early 1970s. Videos or still photos of the experiment have been featured in television documentaries and news magazines, are shown to students in undergraduate classes, and appear on the Internet. The study, along with Stanley Milgram’s obedience to authority experiment, has become widely known outside the realm of psychology.

Prison Simulation

To bring realism to the experiment, the study began with televised, dramatized arrests of the student participants by the Palo Alto Police Department. Arrests were followed by a real-life booking process: handcuffing, fingerprinting, and photographing (mug shots), as well as the conducting of strip searches and the assignment of numbers to the detainees, which gave the students a new identity. The study even involved fictitious parole board hearings, administered by an actual former prison inmate, in which students pled for their release. The experiment ended abruptly and unexpectedly after six days instead of the scheduled fourteen because of the emotional suffering of the prisoners and the escalating abusiveness of the guards, which took the form of sleep deprivation, sexual humiliation, physical abuse, solitary confinement, incessant prisoner counts, and mindless activities. Half of the student prisoners had to be released from the study because of psychological strain.

Participants

Before being selected for the study, participants were thoroughly assessed for mental illness, medical disabilities, and personality or character problems. The participants were twenty-four healthy undergraduates with no hint of severe emotional problems or predilections toward violence or any other untoward behaviors. Not only were the experiment guards and prisoners free of significant emotional problems as they began the experience, they were also randomly assigned, by a coin toss, to their respective roles for a two-week study of authority and social influence. Yet, the behaviors of the inmates and guards in the ersatz prison belied their scores on the personality tests.

Transformations

The students became guards and inmates through a simple change of uniform. The prison-based conversion was facilitated by two complementary processes: deindividualization and dehumanization. Deindividualization allowed the guards to hide behind uniforms, badges, ranks, and titles. The detention officers in the experiment donned mirrored sunglasses, wore khaki uniforms, carried batons and whistles, and insisted on being addressed as “Mr. Corrections Officer,” all of which fueled the sadistic behaviors they directed toward the inmates.

When the student-guards entered the basement of Stanford University’s psychology building, they not only put on a new set of clothes but also assumed the mantle of authority. In the experiment, the inmates wore flimsy gowns, which were undignified and demeaning. They were forced to cover their hair with nylon stocking caps, which further eroded their identities. Inmates were stamped with insulting names as part of a ritualized depersonalization and demoralization process. They were punished by the guards’ ordering them to sleep on the floor; having them perform exhausting exercises and mindless, repetitive activities; restricting their use of the bathroom facilities; locking them in a solitary confinement closet; and forcing them to engage in simulated homoerotic behaviors. The research participant-inmates were no longer individual students, but a collective caricature of prison dwellers.

The student-inmates became abjectly submissive young men whose dialogues and interactions were scripted by the surroundings that dictated their behaviors, self-perceptions, and even their thoughts about others in the situation. The roles ossified as the research unfolded and eventually unraveled. The experiment showed that even a brief period of confinement in a contrived prison environment can precipitate short-term mental health problems in a sample of seemingly healthy young men.

In the experiment, Zimbardo maintained enough distance from the guards and gave them loose rules of engagement with prisoners (keep order, permit no one to escape, and commit no acts of violence) so that they enumerated their own set of regulations, which were applied arbitrarily and often with the sole intention of controlling and tormenting the inmates. In addition, the tacit approval of the abuse by the warden and prison superintendent (Zimbardo) most certainly encouraged more abuse. In submerging himself in the role of prison superintendent/principal investigator, Zimbardo lost his perspective and reasonable judgment. He wore dark glasses while running the prison, and he was blind to the escalating abuse even though he reviewed the audio and videotapes that recorded each day of confinement.

The bystander effect operated in the experiment as the “good” guards permitted the most sadistic ones to define appropriate actions. Not wanting to be chastened by fellow guards, the more humanitarian ones did nothing while the dominant ones meted out their punishments and degradations. Therefore, the silence of the good guards allowed the bad ones to act with impunity. The guards who were exceptionally physically imposing and harsh, particularly during the night shift, created a natural hierarchy of leaders and followers, setting the stage and atmosphere for the guards to imitate and revel in the sadistic treatment of inmates.

The guards at Stanford University prison probably feared losing face in front of their compatriots, being superseded by a superior officer or alpha guard, or offering unwanted assistance. As the situation was highly ambiguous, the guards monitored and mimicked the reactions of others in the prison; their motivation was to ascertain and follow acceptable standards of behavior. As no one lodged complaints about inmate mistreatment at the prison facility, the abuse continued and escalated. The inaction of others, especially the leadership, led the “good” guards to conclude that the situation must be acceptable, which is an example of pluralistic ignorance and social proof.

Conditions in the Stanford University prison acutely deteriorated following an escape attempt and an uprising of the prisoners in protest of their shoddy treatment and harsh conditions. The uprising was followed by more mistreatment and violence against the inmates. The prison guards and leadership took precautions to thwart future outbreaks of dissension, which they believed demanded stricter rules and a further crackdown on inmates’ rights and privileges, thus beginning the slippery slide down the slope of abuse and mistreatment. Echoing the times, some of the inmates organized a group to present their demands and rally for justice; one went on a hunger strike. These activities were to no real avail and served mostly to justify the progressively harsher treatment issued by the guards.

Termination of the Study

At Stanford University prison, Christina Maslach, a young assistant professor from the University of California, Berkeley, was helping Zimbardo with the student prisoners. After listening to her complaints about the cruelty of the study, he terminated the research and debriefed the participants to educate them about the experience and to forestall future mental health problems.

Later Studies

Decades after the original study, Thomas Carnahan and Sam McFarland tested to see if the researchers investigated whether students who selectively volunteer for a study of prison life might possess characteristics that predispose them to act abusively. To recruit subjects for the study, the investigators posted a newspaper advertisement that was virtually identical to the one used in the Stanford prison experiment. One advertisement included the term “prison life” while the other did not. Those who volunteered for the “prison study” scored significantly higher on measures of aggressiveness and authoritarianism, which are directly related to the propensity toward aggressive abuse, and lower on empathy and altruism, which are inversely related to the propensity toward aggressive abuse. These results challenge the conclusions of the Stanford prison experiment, which suggested that behavior is determined entirely by the situation rather the person in the situation or the interaction between the person and the situation.

Bibliography

Banuazizi, Ali, and Siamak Movahedi. “Interpersonal Dynamics in a Simulated Prison: A Methodological Analysis.” American Psychologist 30.10 (1975): 152–60. Print.

Carnahan, Thomas, and Sam McFarland. “Revisiting the Stanford Prison Experience: Could Participant Self-Selection Have Led to Cruelty?” Personality and Social Psychology Bulletin 33.5 (2007): 603–14. Print.

Drury, Scott, et al. “Philip G. Zimbardo on His Career and the Stanford Prison Experiment’s Fortieth Anniversary.” History of Psychology 15.2 (2012): 161–70. America: History and Life. Web. 1 July 2014.

Haney, C., W. C. Banks, and Philip G. Zimbardo. “Interpersonal Dynamics in a Simulated Prison.” International Journal of Criminology and Penology 1.1 (1973): 69–97. Print.

Haney, C., W. C. Banks, and Philip G. Zimbardo. “Study of Prisoner and Guards in a Simulated Prison.” Naval Research Reviews 9.2 (1973): 1–17. Print.

Haslam, S. Alexander, and Stephen. D. Reicher. “Contesting the ‘Nature’ of Conformity: What Milgram and Zimbardo’s Studies Really Show.” Plos Biology 10.11 (2012): 1–4. Academic Search Alumni Edition. Web. 1 July 2014.

Haslam, S. Alexander, and Stephen D. Reicher. “When Prisoners Take Over the Prison: A Social Psychology of Resistance.” Personality and Social Psychology Review 16.2 (2012): 154–79. Academic Search Alumni Edition. Web. 1 July 2014.

Zimbardo, Philip G. The Lucifer Effect: Understating How Good People Turn Evil. New York: Random, 2007. Print.

What are the best study tips you have, and is there any website for help?

Study tips can vary according to what grade you are and the subject you are studying, but the following tips should be a good place to start. Keep in mind that different people learn best in different ways so if a suggestion does not work for you keep trying different ones until you find one that does. You can also adjust these suggestions to better fit your needs.

Before class:

1. If you know what chapter you will be covering in class, read it. You don’t need to worry too much about detail and definitely do not stress over things you don't understand. The idea is to familiarize yourself with the material. Write down questions you have and parts that were unclear so that you can ask about it when your teacher/professor is going over the material in class. Going over the material before class (even if all you have time for is to skim it quickly) will help you feel more confident since it won’t all look so new.

During class:

1. Most students find it helpful to take notes during class, even if the material can be found in the book or if notes are already provided. Taking notes helps you focus on the class instead of daydreaming or focusing on other things going on around you.

2. One study tip many people do not use is to record the class so you can listen to later. A lot of educators are okay with students bringing a voice recorder to use during class. But please make sure to get permission first. Then you can play the recording at home while you go over your notes.

After class:

Here is where the sky is the limit and you will have to try different tactics to see what works for you.

1. You can highlight important parts of your book/notebook while you read.

2. Make notecards that you can carry with you anywhere and take advantage of little chunks of time you can throughout the day.

3. Read your notes our loud (auditory learners find this very helpful).

4. To make sure you actually understand the material (instead of just mindlessly reading it) pretend you need to explain it to someone and see if you can do it. Better yet, find someone (classmate, sibling, parent) and try to explain it to them).

5. Students don’t often realize how willing their teachers/professors are to help. Write down your questions and approach your teacher either early before class or right after class and see when they would be available to help. Many are willing to come early and/or stay late to accommodate students.

In general, one of the best “tips” anyone can give you is for you to work your hardest to keep up with the material. The best study tip in the world cannot give you extra time if you are trying to cram the night before a test. Going over the material every day after class and approaching your teacher/professor for help as soon as possible will make the night before a test more like a review than a torture session.

When you are at home and find yourself “stuck” you can always try to reach out to a classmate or come to to ask questions.

How do mental health issues affect the workplace?

Introduction

The National Institute of Mental Health reported that in 2012 an estimated 18.6 percent of all US adults age eighteen and older had some form of mental illness (besides substance abuse or developmental disorders). The World Health Organization also estimated that in 2010, 13.6 percent of all disability adjusted life years (DALYs) worldwide were caused by mental and behavioral disorders. According to many employers, mental illness is the condition with the highest indirect cost to their companies. Substance use disorder, bipolar disorders, major depression (major depressive disorder), obsessive-compulsive disorder, and schizophrenia, coupled with anxiety, stress, and nonmajor depression, present a growing problem in the workforce. These disorders may lead to productivity loss, employee turnover, and long-term disability in employees. Depression is often reported as the mental health disorder that has the greatest effect in the workplace, leading to approximately 200 million days of lost work annually in the United States, according to 2001 and 2003 reports cited by the Centers for Disease Control and Prevention in 2013.

Globalization has resulted in workers in the United States and other developed nations losing their jobs due to downsizing, outsourcing, and factory closings; those who remain employed experience increased workloads, pressure to perform, and uncertainty about their futures. In economic downturns, falling purchasing power and the decreased demand for goods can lead to a rise in drug and alcohol abuse as well as in stress and domestic violence, according to the International Labor Organization.

Historically, employers have viewed mental health disorders in applicants and workers in a negative manner. The stigma attached to mental illness has affected both hiring and retention of individuals perceived to have mental health issues. By the twenty-first century, however, efforts at educating employers regarding mental health issues have ameliorated some of the stigma associated with mental illness and allowed workers with mental illnesses to receive appropriate treatment. In addition, companies have altered their hiring practices to comply with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination against people with disabilities, including psychiatric disabilities, in employment and other activities. Studies have shown that employees either entering or returning to the workplace after successful treatment for mental health issues are as productive as their coworkers.

To provide a healthful workplace and decrease employee turnover, many companies have begun educating employees and managers to recognize the signs and symptoms of mental health disorders, enabling them to identity early indications of problems and to refer individuals to the appropriate course of treatment. Many companies have also found that providing an environment conducive to good mental health in employees enhances productivity and product quality.

Recognizing Signs of Mental Health Disorders

Employers are encouraged to consider hiring individuals with managed mental health disorders.Research has shown that employees with select psychiatric disorders can be stable, functional, and productive employees. Understanding the pathology of mental illness can assist managers in providing an environment that encourages success for employees. When employers are aware of mental health disorders affecting employees, accommodations can be made to better meet their needs.

Both managers and employees should be educated to recognize the early signs of mental health disorders. Early recognition of signs indicating a problem in an employee will lead to early intervention, prompt referral for treatment, and better outcomes of therapy. Employees may also be able to recognize their developing problems if mental health education has been provided in the workplace. Education also creates the opportunity to remove the stigma surrounding mental health issues and encourages both managers and employees to feel comfortable acknowledging a need for assistance.

The most visible sign of a potential mental health issue with an employee is absenteeism. If an employee calls in sick several times a month for a few days at a time, this should alert the individual’s supervisor to a potential problem. Employees who exhibit sadness, irritability, or make inappropriate comments should also be observed carefully. Employees may also complain of burnout or their frustration with assigned tasks and, in extreme cases, may even make comments about violence or suicide. General poor health—including high blood pressure, skin rashes, sleeping disorders, and frequent infections—is often associated with mental health disorders. Lethargy, abnormally slow movements, or periods of hyperactivity may indicate substance abuse, and slurred speech, confusion, clumsiness, and the smell of alcohol on the breath may indicate alcohol abuse.

Changes in work performance are often noted in mental health disorders. Decreased productivity and work output, and increased errors and accidents are indicators that should be carefully evaluated. An inability to prioritize work, poor decision making, and a loss of commitment and motivation are also signs that an employee may have a problem. If staff in an area demonstrate a poor attitude or there is a high rate of turnover, it may indicate a problem with the supervisor or the workplace environment.

Poor relationships at work with colleagues or clients may also be an indication that an employee is experiencing difficulties. Visible tension or conflicts, an increase in actions requiring discipline, or avoidance of an employee by colleagues are also warning signs for employers. Social support from colleagues is important to mental health and work productivity.

Although absenteeism, changes in work performance, and deteriorating relationships may indicate a problem with an individual, the diagnosis of a mental health disorder must be made by a mental health professional. Educating individuals about warning signs of a potential issue is the first step in determining if an employee or manager needs professional intervention.

Common Psychiatric Conditions

Many employees with diagnosed psychiatric conditions are capable of working and being productive members of society when given the opportunity. Understanding the definition of common mental health disorders is important for managers of employees with a diagnosed condition, and managers are encouraged to research known diagnoses in more depth to increase understanding of a specific disease.

Bipolar disorders, also known as manic-depressive disorders, cause changes in mood, function, and energy levels. Manic phases with hyperactivity, lack of impulse control, and irritability, alternating with depressive phases of sad, anxious, or hopeless moods are the hallmarks of bipolar disorders. Often the disease is not recognized in a timely manner, but when diagnosed, the disease is treatable, and patients can lead full and productive lives.

Major depression is a disorder that interferes with the ability to carry on a normal life and should not be confused with mild episodes of sadness or a blue mood. Depressive disorders are evidenced by persistent sadness, feelings of hopelessness, decreased energy levels, thoughts of death or suicide, loss of interest in pleasurable activities or work, difficulty concentrating, or trouble making decisions. Depression may be treated with psychotherapy and medication, and individuals are capable of leading a productive life after intervention.

Substance use disorder remains a growing problem in the workplace. A compulsion to drink; being unable to limit drinking; the development of withdrawal symptoms such as nausea, sweating, and anxiety; and an increasing need for greater amounts of alcohol all indicate a problem. The
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013; DSM-5) eliminates the distinction between drug abuse and drug dependence. Prior to DSM-5 drug abuse was defined as repeated use of harmful agents but did not include tolerance or compulsive use. Drug dependence was also known as addiction and implied an inability to do without an agent. Substance use disorders and other mental health conditions often occur together. Behavioral therapies and medication may be used to treat addictions, and positive responses may occur with continued support and the individual’s commitment to staying sober.

An individual with obsessive-compulsive disorder, an anxiety disorder, has unwanted thoughts or demonstrates repetitive behaviors such as hand washing or counting in attempt to control unwanted thoughts. Medication, psychotherapy, and self-help groups may be effective in managing this disorder.

Schizophrenia is a severe and disabling disorder that, according to DSM-5, may cause individuals to hear voices, hallucinate, suffer delusions, or exhibit disorganized speech. Depending on the type of schizophrenia, individuals may also experience paranoia, or withdraw. Antipsychotic medications and long-term psychosocial interventions may allow the individual to manage the chronic disorder, but recovery does not occur. Entry into the workforce for more complex mental disorders is possible in a carefully selected and managed setting.

Anxiety, stress, and nonmajor depression may be evident in individuals who are in the workplace. Stressors such as life events (divorce, death, or other loss) may lead to nonmajor depressions and anxiety disorders such as post-traumatic stress disorder (PTSD). Cognitive behavioral therapy and medications may be used to treat anxiety disorders.

Hiring an individual with a diagnosed mental health disorder requires a commitment to providing accommodations based on the needs of the individual. There may be funding available to assist companies in providing a job opportunity for individuals entering or returning to the workforce after therapy for mental illness.

Intervention Programs

The most commonly implemented intervention program related to mental health in the workplace is the Employee Assistance Program (EAP), offered by 77 percent of companies in the United States, according to the Society for Human Resource Management in 2013. The EAP provides a confidential resource for employees to seek help with mental health issues and is a nonthreatening option for managers to suggest to employees. Although the EAP was originally designed to assist with drug and alcohol use disorders, its programs have expanded to cover a variety of issues, including depression, stress management, marital problems, or legal and financial problems. Many plans also allow limited care for employees’ family members. The program is conducted by an outside third party, and confidentiality is assured.

Many employers have implemented disease management programs for mental illness. Disease management programs generally assign a case manager to monitor the care of an employee undergoing therapy to be sure that timely and appropriate care is provided. An additional focus of disease management programs is to facilitate the employee’s reentry into the workplace.

Supporting Employees with Mental Health Problems

Individuals with mental health disorders benefit from work during their treatment and recovery. Having a purposeful and supportive place to go on a daily basis provides structure and financial security to individuals experiencing mental illness. Often job-related health benefits are needed to pay for therapy and medications that lead to recovery. Colleagues and friends are an important part of recovery. Individuals receiving care may share their issues and concerns with coworkers.

If the workplace provides education about good mental health, employees have a foundation from which to support the colleague with a mental health issue. Some more formal work reentry programs allow a therapist to come to the workplace and provide an orientation to coworkers to ease the employee’s return. This program must be conducted without violating patient confidentiality and with the individual’s written, legal permission. Recovery is more likely in a supportive environment, and a workplace that is accepting and supportive is important.

Promoting Good Mental Health

Employers have a responsibility to create a work environment that promotes good mental health. An assessment of physical conditions, such as lighting, temperature, cleanliness, and noise level, may indicate that the physical environment needs attention. A safe and secure work environment is the first step in promoting good mental health in the workplace.

Managers are also critical to a positive work experience, leading to a less stressful and healthy workplace. Providing management training for newly promoted supervisors and ongoing education for all managers is important. Understanding how to manage and motivate employees to achieve their potential in a positive and supportive manner may contribute to good employee mental health. Measuring employee morale and satisfaction in the workplace is also important to track measures that affect good mental health and to determine if managers are meeting the needs of their employees.

Some companies provide screening programs to detect mental health risk factors in employees. Mental health screenings must be confidential and should be interpreted by a mental health professional. Employees may feel threatened by the findings of a mental health screening and its relationship to continued employment or advancement within the company. Some mental health screening questionnaires allow individuals to self-evaluate using a set of indicators, and if the individual crosses a certain threshold of response, the person is advised to seek additional assistance from a mental health professional. These are similar to cancer or heart disease screening questionnaires, which are used to refer individuals who possibly have problems to their doctors. Most general health screening questionnaires include some mental-health-related questions. Many employers also have pre-employment drug testing or, depending on the industry, may have a policy of ongoing, random drug testing. In some instances, this may be a deterrent to substance abuse in the workplace.

Companies should provide education that assists individuals in learning how to deal with stress, anxiety, and substance use disorders both in and out of the workplace. Learning stress relief measures, such as meditation, guided imagery, and relaxation, helps employees deal with day-to-day issues. Learned coping mechanisms may also improve employees’ personal lives, leading to less stress at home and improved performance at work. It may also lead to less reliance on drugs and alcohol as coping mechanisms. Educating employees may also be effective in preventing the development of drug or substance use disorders.

Proactive measures designed to enhance employee health contribute to positive mental health and may decrease behaviorally related mental health disorders. Wellness programs such as smoking cessation, weight loss, and grief recovery programs are used to enhance employee health and self-esteem. Allowing community agencies or twelve-step programs such as Alcoholics Anonymous to use meeting space at a company is a way to provide cost-effective intervention programs. Educational programs such as on-site literacy programs, high school completion programs, and special training or college courses all contribute to a positive self-image and may inhibit development of some mental health disorders.

Companies should provide their employees with health insurance with equivalent coverage of physical and mental health problems. If employees have access to inpatient or outpatient care, those with recognized signs of mental health issues may be referred for care more easily.

Bibliography

Dunnagan, T., M. Peterson, and G. Haynes. “Mental Health Issues in the Workplace: A Case for a New Managerial Approach.” Journal of Occupational & Environmental Medicine 43.12 (2001): 1073–1080. Print.

Harder, Henry George, and Thomas Geisen. Disability Management and Workplace Integration: International Research Findings. Farnham: Gower, 2011. Digital file.

Kawada, T., and S. Suzuki. “Physical Symptoms and Psychological Health Status by the Type of Job.” Work 31.4 (2008): 397–403. Print.

Kessler, R. C., et al. “Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers.” American Journal of Psychiatry 163 (2006): 1561–1568. Print.

Langlieb, A. M., and J. P. Kahn. “How Much Does Quality Mental Health Care Profit Employers?” Journal of Occupational and Environmental Medicine 47.11 (2005): 1099–1109. Print.

National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. "Workplace Health Promotion: Depression" Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 23 Oct. 2013. Web. 15 July 2014.

National Institute of Mental Health. "Any Mental Illness (AMI) among Adults." National Institute of Mental Health. NIH, n.d. Web. 15 July 2014.

Partnership for Workplace Mental Health, American Psychiatric Foundation. Partnership for Workplace Mental Health. Partnership for Workplace Mental Health, American Psychiatric Foundation, 2014. Web. 15 July 2014. http://www.workplacementalhealth.org/

Schultz, Izabela Z., and E. Sally Rogers. Work Accommodation and Retention in Mental Health. New York: Springer, 2011. Digital file.

Thomas, Jay C., and Michel Hersen, eds. Handbook of Mental Health in the Workplace. Thousand Oaks: Sage, 2002. Print.

What is naloxone? |

Uses

Naloxone is a pure opioid antagonist that completely displaces narcotics from the opioid receptor sites in the brain's central nervous system. Naloxone is the treatment of choice for emergencies involving opioid overdose and intoxication. It is most often administered intravenously because of the need for a rapid onset of activity, but nasal Naloxone is also effective in reversing the effects of an overdose . Naloxone’s effects are usually seen within two minutes of administration and last for thirty to forty-five minutes. Because opiates have a longer half-life than Naloxone, repeat doses of naloxone may be necessary if complete reversal of opioid intoxication is not achieved.

Naloxone combined with narcotic analgesic Buprenorphine, with the brand name Suboxone, is also used to treat opiate addiction. Suboxone is available through specially licensed physicians as a facet of long-term maintenance therapy for opioid addiction, usually in an outpatient, office-based setting. In rare instances, naloxone may be used postoperatively to reverse the effects of anesthesia.

Naloxone/Narcan distribution programs have been implemented in cities worldwide to provide naloxone to opioid abusers and their acquaintances to be used in the case of an overdose. From 2014–2015, there was a significant increase in the number of first responders in cities and towns throughout the United States who began carrying Narcan. These programs are critical components of harm reduction methodology and in reducing morbidity and mortality associated with opioid abuse.

Precautions

Naloxone may cause increased heart rate, elevated blood pressure, and pulmonary edema, but these adverse effects do not usually warrant avoiding its use, given the life-threatening nature of opioid overdose. However, naloxone does precipitate immediate withdrawal symptoms in opioid-dependent persons.

Bibliography

Bazazi, A. R., et al. “Preventing Opiate Overdose Deaths: Examining Objections To Take-Home Naloxone.” Journal of Health Care for the Poor and Underserved 21.4 (2010): 1108–13. Print.

Dawson, Andrew H. “Naloxone, Naltrexone, and Nalmefene.” Medical Toxicology. Ed. Richard C. Dart. 3rd ed. Philadelphia: Wolters, 2004. Print.

Fukuda, Kasuhiko. “Opioids.” Miller’s Anesthesia. Eds. Ronald D. Miller, et al. 7th ed. Orlando: Churchill, 2009. Print.

Hedrich, Dagmar, and Richard Hartnoll. "Harm Reduction Interventions." Textbook of Addiction Treatment: International Perspectives. Eds. Nady el-Guebaly, et al. Milan: Springer, 2015. 1291–313. Print.

Mintzer, Ira L., et al. “Treating Opioid Addiction with Buprenorphine-Naloxone in Community-Based Primary Care Settings.” Annals of Family Medicine 5 (2007): 146–50. Print.

Sporer, Karl A., and Alex H. Kral. “Prescription Naloxone: A Novel Approach to Heroin Overdose Prevention.” Annals of Emergency Medicine 49.2 (2007): 17–77. Print.

What is embolism? |

Causes and Symptoms

An embolism is a mass of undissolved matter traveling in the vascular or lymphatic system. Although an embolism can be solid, liquid, or gaseous, the majority of emboli are solid. Likewise, emboli may consist of air bubbles, bits of tissue, globules of fat, tumor
cells, or many other materials. The majority of emboli, however, are blood clots (thrombi) that originate in one portion of the body, break loose and travel, and eventually lodge in another part of the body. Where the traveling blood clot lodges will determine what kind of damage is done.

If the thrombus starts in the veins of the legs, it may break loose, travel up the veins of the leg and abdomen, pass through the right side of the heart, and lodge in the arteries in the lungs. This condition, called a pulmonary embolism, is often fatal. If the embolism is small, it may cause only shortness of breath and chest pain. If it is even smaller, the embolism may produce no symptoms at all.

If a blood clot forms in the chambers of the heart, breaks loose, and eventually lodges in an artery in the brain, then the patient will experience a stroke. If a clot breaks loose and lodges in an artery in the leg, then the patient will experience pain, coldness, or numbness in that leg. A blood clot that lodges in the coronary arteries, the arteries that feed the heart muscle, may cause a heart attack.

Treatment and Therapy

Treatment will vary depending on what system has been affected by the embolus. If the clot lodges in the lungs, then the patient will likely be placed on a blood-thinning drug such as heparin. In severe cases, thrombolytic drugs, which dissolve clots, may be used. If the clot lodges in a coronary artery, then open-heart surgery may be performed to bypass the occluded artery. If the clot lodges in the leg, a surgeon may remove the clot from the artery. This procedure is possible only when the clot is discovered early, when it has not yet formed a strong attachment to the vessel wall. Another approach to this problem may be to bypass the occluded artery using an artificial artery or a graft.

Perspective and Prospects

The prevention and treatment of emboli are constantly improving. Venous thrombosis, the most common cause of pulmonary emboli, is becoming easier to diagnose thanks to major advances in ultrasound imaging. Also, magnetic resonance imaging (MRI) is being used to make the identification of emboli in the lungs more accurate and safer. Procedures for imaging the chambers of the heart, a common spot where emboli form, are improving as well, making prevention easier.

Bibliography

A.D.A.M. Medical Encyclopedia. "Blood Clots." MedlinePlus, June 5, 2012.

Bick, Roger L. Disorders of Thrombosis and Hemostasis: Clinical and Laboratory Practice. 3d ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Kroll, Michael H. Manual of Coagulation Disorders. Malden, Mass.: Blackwell Science, 2001.

MedlinePlus. "Pulmonary Embolism." MedlinePlus, May 16, 2013.

National Center on Birth Defects and Developmental Disabilities, Division of Blood Disorders. "Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)—Blood Clot Forming in a Vein." Centers for Disease Control and Prevention, September 25, 2012.

Verstrate, Marc, Valentin Fuster, and Eric Topol, eds. Cardiovascular Thrombosis: Thrombocardiology and Thromboneurology. 2d ed. Philadelphia: Lippincott-Raven, 1998.

Virchow, Rudolf L. K. Thrombosis and Emboli. Translated by Axel C. Matzdorff and William R. Bell. Canton, Mass.: Science History, 1998.

What is mammography? |

Cancers diagnosed: Breast cancer

Why performed: In the United States, the most frequently occurring cancer for women is breast cancer. By age eighty, approximately one of every nine women will develop this cancer. Mammography allows for the screening and early detection of breast-tissue abnormalities. Statistics indicate that use of mammography can result in detection of breast cancer one to two years before it can be detected by breast self-examination. Early detection of breast cancer improves the chances for successful treatment of this form of cancer.

Patient preparation: The patient should shower or bathe prior to the mammogram and should not use deodorant, body lotions, sunscreens, creams, powders, or perfume on the chest or underarms, as they may cause “artifacts” (false images) to appear on the X-ray image.

Steps of the procedure: Patients who have breast implants should mention that fact when making the mammogram appointment. Both the technologist who performs the mammogram and the radiologist who interprets the mammogram must have experience in working with implants.

Prior to undergoing mammography, the patient will be asked if she has undergone any type of breast surgery, as this may affect the way in which the X-ray films are interpreted. She will then be asked to remove all clothing and jewelry from the waist up. The patient will be given a short gown and asked to put it on so that it opens in the front.

The procedure begins with the radiologic technologist placing one of the breasts on a platform and lowering a plastic plate onto the breast until it is flattened as much as possible. This allows for the successful X-ray visualization of as much breast tissue as possible. The technologist then positions the X-ray machine, stands behind a protective barrier, and takes the image. A front-view X ray (from the upper surface down) and a side-view X ray of the breast will be taken. Next, the technologist repeats this procedure with the other breast. While the patient may feel uncomfortable when the breast is being flattened, this discomfort is short in duration.

After the procedure: The patient will be asked to wait while the X-ray films are developed and then viewed by a radiologist to make sure that none of the images need to be retaken. Once this has been confirmed, the patient will be allowed to redress and use deodorant.

The patient should ask how long it will take to get the results of the mammography and whether those results will be sent to the patient as well as to the doctor. She may also want to ask where the “films” will be stored, so that they can be retrieved if the patient moves out of the area and needs to have future mammograms performed at another location. This is important because the new radiologist may use those earlier images as a reference to determine if there have been any changes in breast tissue over time.

Risks: Mammography uses low-dose radiation and is considered to be very safe. Patients who are pregnant or think they may be pregnant, however, should not have a mammogram. A pregnant woman should not be exposed to X rays because of the possible risk to the fetus.

The safety and reliability of mammograms are mandated by a federal law called the Mammography Quality Standards Act (MQSA). This law requires that all mammography facilities in the United States meet stringent quality standards, including those for the medical physicist, who tests the mammography equipment; the technologist, who takes the mammogram; and the radiologist, who interprets the mammogram. The facilities must also maintain certification by the Food and Drug Administration (FDA) and undergo an annual inspection.

Results: A normal result means that the X-ray films revealed no obvious signs of breast cancer. In certain instances, however, breast cancer may still be present. This false negative result is more common for those women with breast tissue that is more dense, as is typical for younger women. The more dense the breast tissue, the more difficult it is to visualize abnormal spots on the X-ray image.

An abnormal result means that something has been identified that needs to be looked at more closely. The abnormality may be an unusual-looking area of breast tissue or a type of cyst or lump. Even the presence of a lump, however, does not necessarily indicate cancer. A lump can be either benign (noncancerous) or malignant (cancerous). Therefore, additional testing such as a diagnostic mammogram, ultrasound, or biopsy may be required to determine if the abnormality is the result of breast cancer. The most common type of biopsy is known as a needle biopsy. This procedure consists of inserting a small-gauge needle into the area in question and removing a small tissue sample. That sample is then sent to a laboratory for determination if any cancerous cells are present. An abnormality that is interpreted as breast cancer when none is present is called a false positive result. Like the false negative result, it is more common for younger women. It is also more common for those women who have a family history of breast cancer, have had a previous breast biopsy, or are taking estrogen.

The American College of Radiology (ACR) has established a system for uniform reporting of mammogram results called the Breast Imaging Reporting and Database System (BI-RADS) that consists of seven categories. Radiologists and physicians use it to help determine appropriate patient care.

Bhale, Aparna Narendra, and Manish Ratnakar Joshi. "Enhancement of Screen Film Mammogram up to a Level of Digital Mammogram: Experimental Analysis." Intl. Journ. of Image & Graphics 13.2 (2013): 1–14. Print.

DeShazer, Mary K. Mammographies: The Cultural Discourses of Breast Cancer Narratives. Ann Arbor: U of Michigan P, 2013. Print.

Lanyi, M. Mammography: Diagnosis and Pathological Analysis. New York: Springer, 2003. Print.

Pisano, E. D., C. Gatsonis, E. Hendrick, et al. “Diagnostic Performance of Digital Versus Film Mammography for Breast-Cancer Screening.” New England Journal of Medicine 353 (2005): 1773–783. Print.

Qasee, A., et al. “Screening Mammography for Women Forty to Forty-nine Years of Age: A Clinical Practice Guideline from the American College of Physicians.” Annals of Internal Medicine 146.7 (2007): 511–15. Print.

Whitman, Gary J., and Tamara Miner Haygood. Digital Mammography: A Practical Approach. Cambridge: Cambridge UP, 2012. Print.

What role does agriculture play in the book of Genesis?

Many of the people depicted in Genesis are farmers and sheepherders, from the very beginning. Adam and Eve lived in a garden, after all. 

When Adam and Eve were evicted from the garden, they had two sons, Cain and Abel, who were involved in agriculture. We see this from the offerings they made to God. Cain offered grain and Abel offered up one of his animals. 

Later on, Abram and Lot had to part ways...

Many of the people depicted in Genesis are farmers and sheepherders, from the very beginning. Adam and Eve lived in a garden, after all. 

When Adam and Eve were evicted from the garden, they had two sons, Cain and Abel, who were involved in agriculture. We see this from the offerings they made to God. Cain offered grain and Abel offered up one of his animals. 

Later on, Abram and Lot had to part ways because the land they were living on was not sufficient to support the herds each man had. Animal sacrifice was hugely important in the entire Old Testament, beginning with Abel. In order to be able to support a large family and to be able to offer appropriate sacrifices to God, people needed large herds. 

There are more incidents with the size of herds, such as when Laban tricked Jacob into marrying his older daughter, Leah. Jacob had to wait another seven years for Rachel and he ended up taking a large part of Laban's flock because he tricked Laban. 

The story of Joseph and the Coat of Many Colors also ends up being about agriculture. Joseph is rescued from prison because the Pharaoh has a dream that ends up being about an upcoming famine. Joseph suggests storing up grain during the seven good years that were to take place so that they would have food for the seven bad years. 

The agricultural life is one of uncertainty. Farmers are never sure what will happen next, whether it is too much rain or not enough. Animals can prosper or they can get sick and die. It is probable that the unpredictability of agricultural conditions contributed to people's desires to know God. Agriculture created both the desire and the means, through sacrifice, for worshiping God. 

What is a cognitive bias?

Cognitive biases are judgment errors that people commit due to irrational thought processes. Despite the fact that they often produce unfavorable consequences, cognitive biases are considered psychologically satisfying and convenient. Cognitive biases are often difficult to overcome because they help people simplify the world around them.

What Is Cognitive Bias?

In the most general sense, cognitive bias is the product of simplified and unsound mental processes that people use to understand the complexities of the world. These erroneous judgments can arise from numerous causes, such as limited exposure to the facts of certain situations, overreliance on past precedents, overconfidence in the future, and the relentless pursuit of self-interest. People employ cognitive biases when they ignore facts that are present, see facts that are not there, or blindly discredit new evidence in favor of long-held beliefs.

A scientific example of this involves an observer using the visual clarity of an object to determine its distance from himself. To humans, blurrier objects naturally seem farther away, while clearer objects appear closer. However, the numerous factors that contribute to dynamic visibility on Earth or in the atmosphere can change from moment to moment, deceiving observers into establishing false beliefs about the true distance of objects. This can cause people to form cognitive biases about how to judge an object's distance.

This scenario is a model of how all cognitive biases work; they begin as seemingly logical and rational arguments used to understand new concepts. But the biases fail as sound reasoning when people refuse to adapt them to account for new information. This would necessitate a degree of psychological discomfort in the observer and is therefore generally avoided. If the observer refuses to alter his view that blurry objects must be farther away, even when corrected by the facts, he is preserving a cognitive bias.

The object-observer example is a type of information bias, one of two broad categories of cognitive biases. An information bias results from reliance on
heuristics
, or quickly acquired but inaccurate judgments based on insufficient facts. The other category is known as ego bias, which refers to seemingly sound judgments that are actually based only on emotions such as fear and anger, desires to succumb to peer pressure, and unfounded beliefs that information or advice from others must be correct.

Depending on the situation, the effects of holding cognitive biases vary. Adhering to the cognitive bias about the clarity of distant objects involves relatively low stakes, incorrect though it may be. Other cognitive biases, however, can yield more profound results, as in the case of politicians who ignore inconvenient facts and make important decisions based on their inaccurate judgments. The difference between these two examples demonstrates the great number and diversity of cognitive biases that humans can hold.

Common Cognitive Biases

A common cognitive bias is the affect heuristic, in which people's current moods or emotional states dictate how they perceive the world. If a hungry person were quickly shown the words rake, cake, and take, the person would remember seeing cake and forget the other words because appetite has been substituted for intellect. Another common bias is confirmation bias. This involves people taking in only those facts and opinions that support their established viewpoints and ignoring all evidence to the contrary. As a result of these confirmation biases, people perpetuate their reliance on potentially untrue claims, which can form the basis of prejudice.

In the bandwagon effect, people become more likely to take up particular views as the popularity of these views increase within society. This cognitive bias can also be called
groupthink
, a herd mentality in which individuals are less likely to express dissent for fear of social rejection. As a result, potentially better ideas are not considered. An example of a cognitive bias created for self-interest is the choice-supportive bias. This occurs when people become prone to ascribing only positive aspects to the decisions they make while ignoring the negative aspects. For example, a woman may downplay the fact that her recently acquired dog occasionally bites people but become angry when other dogs bite her. The choice-supportive bias has produced the woman's double standard.

The clustering illusion bias can have particularly damaging effects on gamblers. Winning money on slot machines or roulette wheels is based entirely on chance. But for people under the influence of the clustering illusion, several consecutive wins on certain machines or wheel colors makes them believe that the machine or color will continue yielding success. The gamblers then risk losing large sums of money due to unsound judgment.

Some cognitive biases involve selective memory distorting people's perceptions of the truth. A common such bias is the tendency to focus on negative experiences while ignoring positive ones. When reflecting on a recently given speech, a person may obsess over a single mistake in pronunciation and forget that the rest of the speech was received well. Somewhat related to selective memory is personalizing, a bias in which people view themselves as personally responsible for all actions around them, particularly the moods of others. These people believe they have brought on the anger or irritation of others without examining possible alternative causes for these emotions.

These examples represent a small number of the cognitive biases that can affect people's judgment in many areas of life. Some of these biases, such as personalization, result in only mildly intrusive mental stresses. Others, such as the bandwagon effect and clustering illusion, can lead to compromises in decision making, which can produce negative consequences and financial losses. People can only eliminate cognitive biases by analyzing and accepting facts.

Bibliography

Baer, Drake, and Lubin, Gus. "58 Cognitive Biases that Screw up Everything We Do." Business Insider. Business Insider Inc. 18 Jun. 2014. Web. 27 Jan. 2015. http://www.businessinsider.com/cognitive-biases-2014-6#

Boyes, Alice. "50 Common Cognitive Distortions." Psychology Today. Sussex Publishers LLC. 17 Jan. 2013. Web. 27 Jan. 2015. https://www.psychologytoday.com/blog/in-practice/201301/50-common-cognitive-distortions

"Groupthink." Merriam-Webster. Merriam-Webster, Incorporated. Web. 28 Jan. 2015. http://www.merriam-webster.com/dictionary/groupthink

Taylor, Jim. "Cognitive Biases Are Bad for Business." Psychology Today. Sussex Publishers LLC. 20 May 2013. Web. 27 Jan. 2015. https://www.psychologytoday.com/blog/the-power-prime/201305/cognitive-biases-are-bad-business

"What Are Cognitive Biases?" Central Intelligence Agency. Central Intelligence Agency. Web. 27 Jan. 2015. https://www.cia.gov/library/center-for-the-study-of-intelligence/csi-publications/books-and-monographs/psychology-of-intelligence-analysis/art12.html

What is a transvestic disorder?

Introduction

As defined in psychology, transvestism (formerly termed "transvestic fetishism") is poorly understood by the public, who often confuse it with homosexuality and transsexualism. Homosexuals are either men or women sexually attracted to individuals of their own gender, while transsexualism
is when either men or women feel or express discomfort with their biological gender and persistently identify themselves as being, or wishing to be, another gender. Transvestites may be heterosexual or homosexual, male or female; however, most research has been conducted with heterosexual male transvestites. Transvestic disorder is typically not diagnosed if there are gender identity issues. In rare cases, individuals with transvestic disorder may develop gender dysphoria, a sense of discomfort with their biological sex. Such individuals sometimes develop a desire to live permanently as women.

The garments that constitute cross-dressing are culturally determined. A Scottish man wearing a kilt is not cross-dressing, even though kilts resemble feminine skirts in other cultures. Also, the mere act of cross-dressing does not necessarily indicate transvestism or any sexual disorder. Male cross-dressing is actually common in some societies and is frequently portrayed in entertainment. Some films such as Tootsie (1982), Victor Victoria (also 1982), and Mrs. Doubtfire (1993) and television shows such as M.A.S.H., Boy Meets World, and Boston Legal have featured cross-dressing. Many comedians have used cross-dressing in their acts, including Milton Berle and Dana Carvey. Some men, such as RuPaul, have made a career out of appearing in “drag.” These individuals, called “drag queens,” cross-dress as performance art. Historically, the Roman emperors Caligula and Nero cross-dressed, and cross-dressing was common on the stage in Shakespearean theater. Men play all the female roles in kabuki, a traditional type of Japanese theater. Although Caligula and Nero’s reasons for cross-dressing are unclear, most examples discussed here would not indicate transvestic disorder. Actors playing roles or comedians seeking laughs are not transvestites because their motives for cross-dressing are external and not normally associated with sexual arousal. Similarly, drag queens or male homosexuals dressing as females at a costume party are not cross-dressing for sexual arousal.

Details and Possible Causes

Transvestism is a
paraphilia, a condition in which intense sexual urges and fantasies center on behaviors or objects other than those seen in typical sexual activities. Other paraphilias include exhibitionism and voyeurism. For a paraphilia, such as transvestism, to be considered a paraphilic disorder, the deviant fantasies, urges, or behaviors must be persistent (occur over a period of at least six months) and disruptive (cause significant distress, interpersonal difficulty, or employment disruption).

According to Frederick L. Whitam, cross-cultural research has shown that when not cross-dressed, heterosexual male individuals exhibiting transvestism appear typically masculine in behavior, whereas the behavior of homosexual male transvestites tends to be more feminine and performative overall. Many heterosexual male transvestites are married and have children, and they cross-dress only in private. Sexual masochism, the sexual pleasure derived from personal suffering, submission, or humiliation, as in bondage, is an associated feature in some transvestites. It is also possible for transvestism to present with fetishism (arousal from objects such as shoes or leather) or with autogynephilia (arousal from visualization of oneself as female).

The urge to cross-dress typically appears in late childhood or early adolescence. Some researchers suggest a biological predisposition for this disorder, but most explanations have involved learned experiences. Many transvestites report experiencing difficult family issues, such as an uncomfortable father-son relationship. Some transvestites report being praised as children for looking “cute” in female clothing, while others were forced to wear such clothing as punishment. Certainly, many male transvestites masturbated during adolescence while either wearing female garments or with such garments nearby. Because orgasm is a strong reinforcer, associating masturbation with opposite-gender clothing can produce classically conditioned arousal to such clothing.

Cross-dressing increases in frequency for transvestites when they are stressed, and it seems to calm them. The sexual arousal aspect also decreases as many transvestites age, without lessening the cross-dressing urge. Cross-dressing apparently helps some individuals escape the strictures of the traditional male role. Therefore, more than just sexual arousal may be involved. Other than a tendency toward introversion and inhibition in relationships, the personality profiles for transvestites and nontransvestites are typically indistinguishable.

Treatment Issues

Unlike many paraphilias, transvestic disorder has little potential to cause physical harm to the individual or others. However, transvestites often feel guilty about their behavior, and it can damage their sexual relationships, especially if spouses or romantic partners disapprove; couples therapy is often recommend for that reason. In addition, cross-dressing is illegal in some jurisdictions, and cross-dressers appearing in public may face legal risks.

Historically, most therapies used with transvestites have been based on learning model explanations for transvestic disorder. Some therapists have claimed success by strengthening the individual’s confidence and adequacy in male sex roles. In the past, relatively unsuccessful attempts to pair cross-dressing with electrical shock in aversive conditioning procedures were made. Covert sensitization, in which the individual first imagines engaging in the desired behavior of cross-dressing, then vividly visualizes humiliating outcomes for doing so, was more successful. The negative visualization countered the reinforcing arousal of cross-dressing with a punishing emotional state, thus decreasing sexual excitement.

More modern therapies for transvestic disorder adopt a cognitive behavioral perspective and include harm reduction, acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and functional analytic psychotherapy (FAP). Harm reduction seeks to reduce the frequency, intensity, and effects of undesired behaviors. ACT helps the patient cope with the underlying distress that triggers the unwanted thoughts or behaviors. DBT and FAP both take an interpersonal approach, focus on identifying the patient's underlying emotional state (strengths and vulnerabilities), and then help the patient find personally acceptable alternatives to the undesired thoughts and behaviors. Little data is available on the efficacy of these therapies, however.

Pharmaceutical treatments may include antiandrogen agents to reduce testosterone levels, antianxiety and antidepressant medications, which may be best suited to those with concomitant mood disorders or other conditions.

Bibliography

Bloom, Amy. Normal: Transsexual CEOs, Crossdressing Cops, and Hermaphrodites with Attitude. New York: Random, 2002. Print.

Bradford, John M. W., and A. G. Ahmed, eds. Sexual Deviation: Assessment and Treatment. Philadelphia: Elsevier, June 2014. Digital file.

Bullough, Vern L., and Bonnie Bullough. Cross Dressing, Sex, and Gender. Philadelphia: U of Pennsylvania P, 1996. Print.

Newring, Kirk A. B., Jennifer Wheeler, and Crissa Draper. "Transvestic Fetishism: Assessment and Treatment." Sexual Deviance: Theory, Assessment, and Treatment. 2nd ed. Ed. D. Richard Laws and William T. O'Donohue. New York: Guilford, 2008. 285–304. Print.

Rudd, Peggy J. My Husband Wears My Clothes: Crossdressing from the Perspective of a Wife. 2nd ed. Katy: PM, 1999. Print.

Stryker, Susan, and Stephen Whittle, eds. The Transgender Studies Reader 2. New York: Routledge, 2013. Print.

Suthrell, Charlotte A. Unzipping Gender: Sex, Cross-Dressing, and Culture. New York: Berg, 2004. Print.

Whitam, Frederick L. "A Cross-Cultural Perspective on Homosexuality, Transvestism, and Trans-Sexualism." Variant Sexuality. Ed. Glenn Wilson. New York: Routledge, 2014. 176–201. Digital file.