As a teacher, how can you deal with a lack of parental involvement?

I definitely understand your concern.  I would like to make a small point about parental involvement.  Parental involvement is a double-edged sword.  While it can be great to have, it can also be a source of frustration.  Parental involvement could lead to dozens and dozens of parents or families trying to micromanage you, your classroom, and your students.  That could be detrimental to the classroom environment that you are trying to create.  

So, what to do about a lack of parental involvement?  There are two choices in my opinion, and they are polar opposites of each other.  The first is to do nothing and make the best of it.  Your students are your priority.  A teacher could spend a large amount of time trying to get parents involved and have little to no success.  The problem is that the time spent on the parents takes away from time that could have been spent on students and class time.  

If a teacher wants to get parents more involved, though, there is a variety of things that a teacher could try to do.  Personal phone calls home once per semester is one thing that I do.  I make sure that every family of a student that I teach gets a phone call from me.  And for that phone call, no matter what, I make it a positive phone call.  I tell the parents something good about having their child in my class.  Email works too, but it doesn't work as well as a phone call.  Everybody gets email these days.  It's more rare to get a phone call.  A colleague of mine foregoes the phone call and sends a hand written card to each family.  She gets great feedback about those.  Think about it.  How often do people get real letters in the mail anymore? 

You could design homework assignments that require a small bit of parental involvement.  My masters thesis was on this very topic, and the research suggests that those types of homework assignments improve student learning as well.  For example, in a business math class, a part of an assignment might be to ask their parents how they use the current class topic in their weekly life.  

Another way to perhaps increase parental involvement would be to host an open house.  It's best done on the school level, but you could make it work within a single classroom.  Tie it in with some kind of project that the students complete.  My school's art teacher does this once per semester.  She hosts a student art show near the end of the semester, and parents come to see the work that their child has done during the course.  

In Martel's Life of Pi, what evidence shows how religion helps Pi survive his ordeal at sea?

Pi is a very spiritual and religious teenager. He converts to Hinduism, Islam and Christianity! It is no surprise, then, that he would turn to God during the biggest trial of his life. Pi is also very intellectual and reasonable; so, he draws upon everything in his life to help him to survive. In chapter 49, for example, he's been on the lifeboat for almost three days and he realizes how thirsty he is. He analyzes his situation based on what he remembers of Christ's crucifixion, as follows:

"Christ on the Cross died of suffocation, but His only complaint was of thirst. If thirst can be so taxing that even God Incarnate complains about it, imagine the effect on a regular human" (135).

Remembering this information helps him to assess his situation, which also motivates him to find water quickly, which saves his life by providing needed hydration.

In chapter 53, Pi believes that it is a miracle that he has survived so far. He takes his belief and applies it to his current information as follows:

"Now I will turn miracle into routine. The amazing will be seen every day. I will put in all the hard work necessary. Yes, so long as God is with me, I will not die. Amen" (148).

He combines his belief in miracles with a prayer that shows gratitude, humility, and faith that he is not alone. Not feeling alone is one critical factor that helps Pi continue fighting for survival. This is a far better way to approach his situation because he could sit down and cry or give up. 

Another example of when Pi uses prayer and faith to help him to survive is when he prays aloud, "God, give me the time" (150) to help him finish building a raft, thereby securing himself safety, before Richard Parker spots him. Fortunately, his prayer is granted and he is given enough time to finish the raft. Later, in chapter 63, during a long and lonely night at sea, Pi remembers the great Vishnu of Hinduism and then says a Muslim prayer to comfort him. These prayers help him to regain control of his psyche and faith to continue living. Also in chapter 63, Pi lists everything he does each day and prayers are on it five times, just as it directs in Islam.

Finally, in chapter 74, Pi goes into more detail about his faith in God and how it helps him through his ordeal at sea. He practices any ritual that he can think of from his three main religions, such as Mass, Communion, pujas, and devotions to Allah. He says that all of these things help to bring him comfort, but they also help him to let go of pain and to trust in and love God. In an effort not to lose his faith in and love for God, he also practices being grateful for everything that he has. For example, he would touch his pants, for example, and say, "This is God's attire!" Then he would point the boat and say, "This is God's ark!" These actions and words of affirmation hold his faith in God strong and then he would "go on loving" and surviving (209).

What is the state-trait anxiety inventory (STAI)?

Introduction

The State-Trait Anxiety Inventory (STAI) is a very widely used measure of anxiety. It was developed by American psychologist Charles Spielberger, who first produced it in collaboration with Richard L. Gorsuch, Robert Lushene, Peter R. Vagg, and Gerald A. Jacobs in 1970. It is copyrighted by Consulting Psychologists Press.

The State-Trait Anxiety Inventory consists of twenty items about a person’s feelings of anxiousness (such as “I am presently worrying over possible misfortunes”) that are answered on a four-point scale ranging from 1 (“Not at all”) to 4 (“Very much so”). Some of the items are worded positively (“I feel calm”); others are worded negatively (“I am tense”). The positive items are reverse-scored, so that higher scores indicate more anxiety. The inventory has two forms: state form and trait form. In the state form (also called Y-1), the items are about the respondent’s feelings in specific situations; in the trait form (also called Y-2), the items are about the respondent’s general feelings overall. The STAI has cut-off scores; a score over this point indicates clinically relevant anxiety symptoms. Form Y is the second revision of the STAI; the first was called Form X.

The STAI has been revised so that it can be used with many different kinds of people. Test forms include a children’s version with twenty items that the child rates on a three-point scale, a short version with only six items, and a version for parents to complete about their children with the usual twenty items and six additional items. There are versions in many different languages, including Arabic, Amharic, Chinese, Czech, Dutch, French, German, Hindi, Italian, Japanese, Norwegian, Polish, Portuguese, Spanish, and Thai.

Uses

The STAI has clinical uses: It can be administered before and after therapy or before and after medication for anxiety disorders. For example, in one report, a woman had distressing a vocal tic, which meant that she involuntarily made repeated sounds and words and coughed. A vocal tic is similar to stuttering. She received therapy that included awareness training, a review of situations and of how inconvenient the habit was, relaxation training, the learning of competing responses, and social support. The therapist measured whether she improved by videotaping her and counting the number of vocal tics and having her complete the STAI to measure her anxiety. She improved in having fewer vocal tics and less anxiety.

The STAI is widely used in research with both adults and children. In a citation analysis of six commonly used measures of anxiety, it ranked first. It is so widely used because it is a reliable and valid research instrument. One type of reliability is test-retest reliability, which means that people typically describe themselves the same way on the STAI from one time to another. Another type of reliability is internal consistency, which means that all the STAI questions are measuring the same thing. In terms of validity, the STAI is correlated with other measures of anxiety. Also, people who describe themselves as anxious or who are diagnosed with anxiety disorders score higher on the STAI than people who describe themselves as calm or who are not diagnosed with anxiety disorders. For research purposes, questionnaires must be reliable and valid to be useful, and the STAI meets both criteria.

An example of a research project using the STAI with adults was a study of 147 cancer patients (mean age 57.6 years). They completed the STAI and interviews before and after discussions with their cancer physician. Patients who did not like their physician’s communication style had higher anxiety following the discussion. Further, after the discussion, patients’ anxiety levels remained low, even among those patients with unfavorable examination results, when the patients liked their physician’s communication style.

An example of a research project using the STAI with children is a study of ninety children with spina bifida who attended a one-week summer camp. They completed the STAI before and after camp. By the end of the camp, their anxiety was lower than it had been at the beginning.

Bibliography

Antony, Martin M., and Murray B. Stein, eds. Oxford Handbook of Anxiety and Related Disorders. New York: Oxford UP, 2009. Print.

Briery, Brandon G., and Brian Rabian. “Psychosocial Changes Associated with Participation in a Pediatric Summer Camp.” Journal of Pediatric Psychology 24.2 (1999): 183–190. Print.

Carducci, Bernardo J. The Psychology of Personality: Viewpoints, Research, and Applications. Malden: Wiley, 2009. Print.

Fuata, Patricia, and Rosalyn A. Griffiths. “Cognitive Behavioural Treatment of a Vocal Tic.” Behavior Change 9.1 (1992): 14–18. This article describes how the State-Trait Anxiety Inventory might be used in a clinical situation.

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

McDowell, Ian. Measuring Health: A Guide to Rating Scales and Questionnaires. 3d ed. New York: Oxford UP, 2006. Print.

Stein, Dan J., Eric Hollander, and Barbara Olasov Rothbaum. Textbook of Anxiety Disorders. 2nd ed. Washington, DC: Amer. Psychiatric, 2010. Print.

Takayama, Tomoko, Yoshihiko Yamazaki, and Noriyuki Katsumata. “Relationship Between Outpatients’ Perceptions of Physicians’ Communication Styles and Patients’ Anxiety Levels in a Japanese Oncology Setting.” Social Science and Medicine 53.10 (2001): 1335–50. Print.

What is group B streptococcal infection?

Definition

Group B streptococcal (GBS) disease is a bacterial
infection. These bacteria live in the gastrointestinal and
genitourinary tracts and are found in the vaginal or rectal areas of 10 to 35
percent of all healthy adult women.

GBS can cause illness in newborns, pregnant women, the elderly, and adults with
other chronic medical conditions, such as diabetes or liver disease. In newborns, GBS is the most common cause of bacteremia or
septicemia (blood infection) and meningitis
(infection of the fluid and lining surrounding the brain). GBS in pregnant women
and their fetuses and newborns are discussed here.

Causes

GBS is caused by the bacterium
Streptococcus agalactiae. Not all fetuses and babies who are exposed to the bacterium will become infected, but those who have become infected with GBS got the infection in one of three ways: before birth, during delivery, and after birth. Before birth, bacteria in the vagina spread up the birth canal into the uterus and infect the amniotic fluid surrounding the fetus. The fetus becomes infected by ingesting the infected fluid. During delivery, the fetus can become infected by contact with bacteria in the birth canal; after birth, the newborn can be infected through physical contact with the mother.

Risk Factors

Factors that increase the risk of a baby contracting GBS are the mother having
already had a baby with GBS disease, the presence of GBS bacteria in the current
pregnancy, the mother having a urinary tract infection caused by GBS,
going through labor or experiencing a rupture of the membranes before thirty-seven
weeks gestation, experiencing a rupture of the membranes for eighteen hours or
more before delivery, and the mother having a fever during labor.

Symptoms

In pregnant women, GBS infections can cause endometritis, amnionitis, and septic abortion. In newborns, two forms of infection occur: early-onset and late-onset. Early-onset GBS disease usually causes illness within the first twenty-four hours of life. However, illness can occur up to six days after birth. Late-onset disease usually occurs at three to four weeks of age; it can occur any time from seven days to three months of age. Symptoms of both kinds of GBS include breathing problems, not eating well, irritability, extreme drowsiness, unstable temperature (low or high), and weakness or listlessness (in late-onset disease).

Screening and Diagnosis

GBS can be diagnosed in a pregnant woman at a doctor’s office. Testing for GBS should be done about one month before the baby is due. The doctor swabs the pregnant woman’s vagina and rectum and sends these samples to a laboratory to test for GBS. Test results are available in twenty-four to forty-eight hours. The doctor may also order blood tests.

Treatment and Therapy

Women who test positive for GBS or who are at high risk may receive intravenous
antibiotics during labor and delivery. Penicillin or
ampicillin is usually used. Women who are allergic to penicillin or ampicillin may
be given clindamycin or erythromycin instead. It is generally not recommended that
women take antibiotics before labor to prevent GBS (unless GBS is identified in
the urine). Studies have shown that antibiotics are not effective at earlier
stages.

If the doctor suspects strep B infection in the newborn, the newborn might be kept in the hospital for observation by staff. If the baby is diagnosed with GBS, he or she will be treated with intravenous antibiotics for ten days. Even with the existence of screening tests and antibiotic treatment, some babies can still get GBS disease.

Prevention and Outcomes

Methods to prevent GBS include screening pregnant women at thirty-five to thirty-seven weeks into the pregnancy and giving antibiotics during labor and delivery to women who are carriers of GBS bacteria, who have previously had an infant with invasive GBS disease, who have GBS bacterium in the present pregnancy, who go into labor or have a rupture of the membranes before the fetus has reached an estimated gestational age of thirty-seven weeks, who have a rupture of membranes for eighteen hours or more before delivery, who have a fever during labor, or who have a urinary tract infection with GBS. Another option is to give antibiotics (usually penicillin) to newborns who were exposed to the bacterium. No vaccine exists for the disease.

Bibliography

Centers for Disease Control and Prevention. “Provisional Recommendations for the Prevention of Perinatal Group B Streptococcal Disease.” Available at http://www.cdc.gov/groupbstrep/guidelines/provisional-recs.htm.

Cunningham, F. Gary, et al., eds. Williams Obstetrics. 23d ed. New York: McGraw-Hill, 2010.

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

Phares, C. R., et al. “Epidemiology of Invasive Group B Streptococcal Disease in the United States, 1999-2005.” Journal of the American Medical Association 299, no. 17 (2008): 2056-2065.

Remington, Jack S., et al., eds. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia: Saunders/Elsevier, 2006.

Wilson, Michael, Brian Henderson, and Rod McNab. Bacterial Disease Mechanisms: An Introduction to Cellular Microbiology. New York: Cambridge University Press, 2002.

How do you find the current and voltage in the circuit shown on the attached image?

This problem involves the current and voltage distribution in parallel and series circuits, as well as the equivalent resistance of these circuits.

Notice that in the circuit on the attached image, the 30 ` ` and `6 Omega` resistors are connected in parallel, and the `15 Omega` resistor is connected to them in series. We can calculate the equivalent resistance of this network:

The equivalent resistance of the resistors `R_1` and `R_2` is determined by...

This problem involves the current and voltage distribution in parallel and series circuits, as well as the equivalent resistance of these circuits.

Notice that in the circuit on the attached image, the 30 ` ` and `6 Omega` resistors are connected in parallel, and the `15 Omega` resistor is connected to them in series. We can calculate the equivalent resistance of this network:

The equivalent resistance of the resistors `R_1` and `R_2` is determined by the formula

`1/R = 1/R_1 + 1/R_2`

so the equivalent resistance of `30 Omega` and `6 Omega` resistors will be the reciprocal of

`1/30 + 1/6 = 6/30 = 1/5` , or `5 Omega` .

Since the `15 Omega` resistor is connected in series, the equivalent resistance of the whole circuit will be the sum of `15 Omega` and `5 Omega` : 15 + 5 = 20 `Omega` .

Now that we know the resistance of the circuit, we can calculate the current in this circuit, supplied by the 120 V battery:

`I = 120/20 = 6 A` .

This current I will flow through the battery, as well as through the 15 `Omega` resistor. The voltage drop on this resistor is determined by the Ohm's Law:

`V = 6A * 15 Omega = 90 V` .

The voltage drop on the `30 Omega` and  `6 Omega` resistors is the same (because they are connected in parallel) and equal to the remaining voltage: 120 V - 90 V = 30V.

The total current I = 6 A splits among these two resistors in a way such that the current is inversely proportional to the resistance (this, again, follows from the Ohm's Law and the fact that the voltage is the same.) So, since one resistance is 5 times greater than the other, the current through `30 Omega` resistor is 5 times less than the current through `6 Omega` resistor. Since the total current is 6 A, the former current is 1 A and the latter current is 5 A.

To summarize,

for `15 Omega ` resistor, I = 6A and V = 90V;

for `30 Omega` resistor, I = 1A and V = 30V;

for `6 Omega` resistor, I = 5A and V = 30V.

What is intervention? |

Brief Intervention

There is no universally accepted classification of addiction and substance abuse intervention. However, it is useful to begin with a distinction between brief (sometimes called simple) intervention and formal or structured intervention. This second category can be subdivided into direct and indirect interventions. Although structured interventions were introduced in the 1960s as a method of moving alcoholics into treatment, these intervention models have been increasingly used in treating such behavioral problems as sexual addiction, gambling or shopping addiction, and video gaming addiction.

The term brief intervention is sometimes used to include informal attempts by family members or friends to confront the addict or to coax him or her into getting help, but it is more often applied to short, one-on-one counseling sessions between the addict and his or her physician, psychotherapist, social worker, or religious leader in a setting familiar to the addict. Brief interventions in primary care settings are considered to be most appropriate for persons who are not dealing with an immediate legal or social crisis caused by the addiction, are not intoxicated or high at the time of the office visit, and do not have a coexisting major psychiatric disorder. Brief interventions in emergency departments or trauma centers may be helpful, but only with patients who are open to counseling after an alcohol- or drug-related accident or injury.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) have published pamphlets for physicians, psychotherapists, and other helping professionals on conducting brief interventions. Possible settings for such interventions include prenatal care, primary care, emergency care, and college health centers.

The first step in a brief intervention is screening the patient for alcohol or drug use. NIDA has drawn up a “screener” called ASSIST that can be filled out by the patient in the doctor’s office on paper or on a computer. After the screener is scored, the doctor then discusses the results with the patient, giving personalized advice according to the patient’s likelihood of developing a substance use disorder. NIDA recommends referring high-risk patients to an addiction specialist for further evaluation and treatment, counseling moderate-risk patients to lower their drug or alcohol intake, and advising low-risk patients to continue to be responsible and moderate in their use of alcohol.

After the initial brief intervention, the primary care physician then schedules follow-up visits with ongoing support. Office handouts and other printed educational materials are often given to a patient as part of a brief intervention.

Structured Intervention

Structured interventions have become increasingly familiar to the general public through such media as reality television shows, popular magazines, social media, and personal memoirs. In a structured intervention, the addicted person is confronted in one of two ways: directly by concerned family members, friends, and possibly employers or religious leaders or indirectly through a professional interventionist’s work with the addict’s family.

The first type of structured intervention is known as the Johnson model; the second type is variously known as the invitational or family systems model. In actual practice, however, a structured intervention may incorporate features of both the Johnson and the family systems models. The reason for the overlap is that structured interventions are highly individualized; that is, they are tailored to the addict’s age, gender, occupation, drug or addictive behavior of choice, living situation, and extended family structure or friendship network.

The goal of a structured intervention is to persuade the addict to enter treatment at once. Plans include transportation to the treatment center and caring for the addict’s children, pets, and residence to lower his or her resistance to accepting treatment.

Johnson Model

The Johnson model is named for Vernon Johnson (1920–1999), an Episcopal priest and recovering alcoholic who pioneered the use of structured interventions in alcohol rehabilitation in the 1960s. In the Johnson model, also known as the confrontational or direct model of intervention, those closest to the addict form a team that will confront him or her under the guidance of a trained interventionist. Johnson believed that a confrontational approach is necessary to break through the addict’s denial and other psychological defenses.

Members of the team have a pre-intervention meeting in which they learn about the disease model of addiction, decide on treatment options for the addict, and prepare letters or statements in which they describe the effect of the addict’s substance abuse (or behavioral addiction) on their lives. They also may prepare a list of the addict’s behaviors that they will no longer tolerate, along with specific consequences if the behaviors continue. The statements are written in a straightforward but caring tone that avoids judgmental expressions or accusations.

The actual intervention is usually a surprise to the addict, who may be told that he or she is being taken to lunch or to some other get-together but is instead confronted by the interventionist, family members, and other concerned persons. Following an introductory explanation by the interventionist, the members of the team take turns reading their prepared statements. At the end, the addict is offered the option of immediate treatment.

Family Systems Model

The family systems model of intervention, also known as the indirect or invitational model, focuses on the addict’s family rather than the addict alone. The theory underlying this model is that changes in the family system—the behavior patterns and interactions of family members—will affect the addict also and will reduce the severity of his or her self-destructive behaviors. A common form of this type of structured intervention is to hold an educational workshop for family members, to which the addict is invited; however, the workshop takes place as scheduled even if the addict refuses to attend.

The workshop, which typically lasts for two days, is led by a professional interventionist and includes discussion of intergenerational patterns of addiction and enabling as well as the biological and medical dimensions of addiction. Each family member is helped to understand his or her role within the family system and how his or her behavior may have enabled the addict. The participants may be asked to read some educational materials before the workshop. During the workshop, the various treatment options—including codependency treatment for family members—are explained. If the addict has chosen to attend, treatment is offered to him or her at the end of the workshop.

The general atmosphere of a family systems intervention differs from that of the direct model in that it is nonconfrontational. Interventionists who use this model usually maintain contact and follow-up with the family for as long as one year after the intervention.

Professional Interventionists

While structured interventions can be led by an addict’s friend or family member, the chances of success are low because the addict has already had considerable practice in manipulating those close to him or her. Most treatment centers recommend consulting a professional interventionist when brief interventions have failed and when a structured intervention is necessary.

A professional interventionist—who may be a physician, psychotherapist, social worker, nurse, psychologist, or member of the clergy—is a person who has completed training programs and field supervision approved by the Association of Interventionist Specialist Certification Board. After two years of experience in the field, the interventionist may be licensed as a board-certified interventionist, level one. Level-two interventionists have had an additional three years of field experience and have completed an oral or written examination. Lists of certified interventionists can be obtained from treatment centers, community mental health centers, or the Association of Intervention Specialists.

Bibliography

Johnson, Vernon. Intervention: How to Help Someone Who Doesn’t Want Help: A Step-by-step Guide for Families and Friends of Chemically Dependent Persons. Minneapolis: Johnson Inst., 1986. Print.

Morgan, Oliver J., and Cheryl H. Litzke, eds. Family Intervention in Substance Abuse. New York: Haworth, 2008. Print.

Recovery Connection. Intervention: A Free Resource for Addicts, Friends, and Family. Pompano Beach: Recovery Connection, 2010. PDF file.

Substance Abuse and Mental Health Services Administration. Brief Interventions and Brief Therapies for Substance Abuse. Washington, DC: SAMHSA, 2012. PDF file.

Write a hypothesis test for each parameter. State the conclusion for each hypothesis test in brief paragraph form. The data to use is in the...

We are told that in a sample of 47 18-23 year-olds 37 are registered to vote, while the remaining 10 are not registered. Assuming that we are interested in the percentage of this age group who are registered to vote, the population proportion p is the percentage of 18-23 year old people who are registered to vote.

(1) We can create a confidence interval using this sample -- the sample size is adequate. (Typically we would want n>30.)

The point estimate we use is `hat(p)=37/47~~.7872 ` . Then for the confidence interval we add/subtract the margin of error given by the product of the confidence factor and the standard error. Assuming a 95% confidence we have:

`.7872 - 1.96sqrt((.7872 * .2128)/47)<p<.7872+1.96sqrt((.7872 * .2128)/47) `

`"or" .6701<p<.9042`

Thus we can say with 95% certainty that the population proportion lies in this interval.

(2) In order to run an hypothesis test, we need a null hypothesis. Since you have not provided this, I will provide an example so that you can redo with the correct given information.

Suppose that you are told that only 60% of people in the age range from 18 to 23 are registered to vote.

Further suppose that you believe the proportion is higher.

The null hypothesis is that p=.6, while the alternative hypothesis is that p>.6

The alternative test will be our claim.

This is a one-tailed test, so the critical value is 1.645. A test value greater than this lies in the critical region.

The test value is computed by taking the difference of the observed value from the sample and the expected value from the null hypothesis divided by the standard error:

` "tv"=(.7872 - .6)/sqrt((.6 * .4)/47)~~2.62`

 Since this value is greater than the critical value we reject the null hypothesis. Also, the p-value method gives p approximately .004 which is less than the alpha of .05 so we reject the null.

We conclude that there is sufficient evidence to support the claim that p>.6

What are fluids and electrolytes?

Structure and Functions

Humans live in a wide variety of environmental conditions. Some days are hot and wet, others are cold and dry, and most are somewhere between. At the same time, as foods and liquid are taken in, the body is exposed to a variety of chemical substances over a wide range of concentrations. Amid these widely changing circumstances, the internal environment, to which the body’s cells are exposed, remains essentially unchanged. This regulation of the internal environment, which is called homeostasis, is necessary for the correct functioning of the body. Essentially, all the organs and tissues of the body play roles in the homeostatic processes, and the main control mechanism operates through the movement of body fluids.

There are several different body fluids, but they are all solutions of solutes in water. The identity of the solutes and their concentrations differentiates one body fluid from another. Among the solutes, two categories exist. Some solutes dissociate into electrically charged particles when they dissolve and are thus called electrolytes. Others remain as neutral particles dissolved in the water and are nonelectrolytes. Both types of solutes play important roles in the correct physiological functioning of the body, but it is the electrolytes that draw the most attention. This is the case because the fluids and the electrolytes are interdependent and because imbalances of these factors are associated with a vast array of illnesses.

Although subject to some variation with age, gender, and physical condition, the body is composed of about 60 percent water by weight. For purposes of classification, this water is considered to be present in compartments. It is important to recognize that this terminology is conceptual only and does not refer to the existence of any real, separate, water-containing compartments in the body. Approximately twenty-five cubic decimeters of water are contained within the body’s cells; this is the intracellular fluid. Most of the remaining fluid, about twelve cubic decimeters, is termed extracellular and exists in the regions exterior to cells. The
extracellular fluid is further subdivided into the categories of interstitial fluid, which surrounds the cells; intravascular fluid, which is located within the blood vessels; and transcellular fluid, which includes the fluid found in the spinal column, the region of the lungs, the area surrounding the heart, the sinuses, and the eyes, along with sweat and digestive secretions. These subcategories are listed in order of the amount of fluid present. Of all these types, only the intravascular fluid is directly affected when a person drinks or eliminates fluid. Alterations in the other regions occur in response to that change, however, and there is a continual dynamic exchange of fluid among all compartments. The balance of conditions created by this exchange determines the state of health of the individual.

The solutes that are electrolytes generate positively charged ions called cations and negatively charged ions called anions. The amount of positive charge present in a solution is always equal to the amount of negative charge. The major cations present are hydrogen, sodium, potassium, calcium, and magnesium. The most important anions are chloride, hydrogen carbonate, hydrogen phosphate, sulfate, and those derived from organic acids such as acetic acid. Several other ions of both types are present at very low levels. The nonelectrolytes present include urea, creatinine, bilirubin, and glucose. All these solutes are involved with particular biological changes in the body, so their presence at the correct concentration is vital.

The fluid and its solutes move within the body by means of several transport mechanisms, some of which move solutes through the fluid and some of which move either water or the solutes from one side of a cell membrane to the other. The mechanisms available are diffusion, active transport, filtration, and osmosis. Diffusion is the movement of particles through a solution from a region in which the concentration of the particles is high to a region in which it is lower. The energy that drives this motion is thermal energy, and the transport rate is increased by increasing the temperature, which increases the concentration difference from point to point and is faster for smaller particles. Cell walls are a barrier to this type of transport unless the solute particles are small enough to pass through pores in the wall or are soluble in the cell wall itself. Active transport provides another means of moving solutes across cell walls. The energy for such movement is provided by a series of chemical reactions involving adenosine triphosphate. The movement of sodium out of and potassium into cells, as well as the transport of amino acids into cells,
occurs in this manner. Filtration is a means by which both water and some solutes are transported through a porous membrane. The solutes transported are those that are small enough to pass through the pores in the membrane. The driving force for filtration is provided by a difference in pressure on the two sides of the membrane, and the motion occurs from the high-pressure side to the low-pressure side. The pressure in this case results from gravity and from the pumping action of the heart. Osmosis is a process by which water is moved across a semipermeable membrane as the result of the influence of a different type of pressure. When two solutions of different concentrations of solute particles are separated by a semipermeable membrane, an osmotic pressure develops that acts as the driving force to move water from the side of the membrane where the concentration of solute particles is lower to the side where the solute particle concentration is higher.

A solute’s concentration in the body fluid has a great effect on the transport of materials and thus on the body’s health. Concentrations in body fluids are expressed in several ways. Electrolyte concentration is often expressed in terms of milliequivalents of solute per cubic decimeter of solution. This is a measure of the amount of change, positive or negative, provided by that solute. A solution with twice the number of milliequivalents per cubic decimeter will have twice the concentration of change. This also measures the solute’s combining power, because one milliequivalent of cations will chemically combine with one milliequivalent of anions. Osmolality, osmolarity, and tonicity refer to a solution’s ability to provide an osmotic pressure. Osmolality and osmolarity are proportional to the number of particles of solute present in the solution. When solutions of different osmolalities or osmolarities are separated by a semipermeable membrane, there will be a flow of solvent across the membrane. Isotonic solutions have equal osmotic effects. Tonicity is a way of comparing the osmotic potential of solutions by referring to one as being hypotonic, isotonic, or hypertonic to the other.

Disorders and Diseases

There are two ways to approach thinking about the health role of body fluids and electrolytes. One is to consider one particular fluid component, such as sodium, that is out of balance and proceed to trace possible causes of the imbalance and appropriate treatment modes. It must be noted, however, that there are many possible illnesses that could cause any particular imbalance. The second approach is to consider a representative number of specific diseases and to look at their effect on the fluid and electrolyte balance and how such effects may be treated.

The first of these two approaches is adopted here because it highlights the fluids and electrolytes themselves rather than the diseases. Two imbalances will be considered as examples of the types of effects seen. First to be considered is the volume of fluid itself. Second, the balance of calcium will be given attention because of the connection of calcium deficiency with the bone brittleness that often occurs during aging.

Volume imbalance that is larger than the system’s normal regulatory ability to control may occur in either the intracellular or extracellular fluid or both and may be in the direction of too little fluid (dehydration) or too much (overhydration). Both of these effects may result from a number of underlying illnesses, but each is, by itself, life-threatening and requires direct treatment. Often, this treatment precedes the diagnosis of the root cause.

The body apparently senses fluid volume imbalance with receptors near the heart, and several coping responses are triggered. Dehydration can be the result of vomiting, diarrhea, excessive perspiration, or blood loss. In such cases, the body’s responses are in the direction of maintaining the flow of blood to vital organs. Vessels at the extremities are constricted, and those in the regions of the vital organs are dilated. Kidney function is greatly slowed, the reabsorption of sodium is increased, and the production of urine is markedly decreased, ensuring water retention. Centers in the hypothalamus respond and cause the individual to become thirsty. Thus, the body acts to protect its most important functions while at the same time stimulating actions from the individual that will bring additional fluid volume into the system. The manner in which the individual responds to being thirsty will determine other bodily changes. If plain water is used to quench the thirst, the extracellular fluid becomes less concentrated in electrolytes than is the intracellular fluid, causing an
osmotic pressure imbalance that the body regulates by transporting more water into the cells, producing overhydration there and aggravating the original dehydration in the extracellular fluid. Notice that this means that drinking large amounts of water can, strange though it may seem, cause dehydration. If saltwater is ingested, the reverse occurs, with a resulting dehydration of the cells that in turn triggers extreme thirst but few cardiovascular problems. Proper volume replacement thus requires that the water brought into the system be of the same electrolyte concentration as the cellular fluids—that is, that they be isotonic. In that case, the osmotic pressure remains balanced and the fluid volumes in both of the major compartments can be built up.

Overhydration is a less common occurrence that is usually associated with cardiovascular disease, severe malnutrition and kidney disease, or surgical stress. When the heart is not able to act as an effective pump, a back pressure builds in the circulatory system that causes fluid to be filtered through the walls of the vessels and that results in the accumulation of fluid in the interstitial regions around the heart and lungs. A decrease in proteins in the bloodstream, resulting from either malnutrition or kidney malfunction, lowers the osmotic pressure in the blood and causes water retention in the interstitial spaces. Accumulation of excess fluid in the interstitial spaces is called edema. This same end condition also arises when the kidney excessively filters fluid from the bloodstream into the interstitial spaces. The treatment of overhydration takes the form of fluid intake restriction, restriction of dietary sodium, and the use of diuretic therapy to stimulate urine production.

Calcium, much of which comes from milk and milk products, is the fifth most abundant ion in the body and is involved with the formation of the mineral component of teeth and bones, the contraction of muscles, proper blood clotting, and the maintenance of cell wall permeability. Calcium is added to extracellular fluid as a result of the intestinal absorption of dietary calcium and bone resorption. It is lost from the extracellular fluid via secretion into the intestinal tract, urinary excretion, and deposition in bone. The maintenance of a proper calcium level mainly depends on processes occurring in the intestinal tract. Only a very small part of the body’s total calcium is in fluids. Both hypocalcemia and hypercalcemia, the shortage and the overabundance of calcium in the fluids, may occur. Unlike the case of water shortage or excess, however, there are few direct visual consequences of a calcium imbalance; one must rely on laboratory testing of the fluid and on indirect physical assessment.

Hypocalcemia in the blood is associated with reduced intake, increased loss, or altered regulation, as in hypoparathyroidism. Bone, a living material, continually absorbs and desorbs calcium. The parathyroid gland secretes a hormone that regulates bone resorption and thus can raise the calcium level in the extracellular fluid at the expense of decreasing the amount of bone. Obviously, this cannot be a long-term mechanism to provide calcium. The same hormone also regulates the absorption of calcium from the intestines and the kidneys. Vitamin D is an essential, although indirect, factor in permitting the absorption of calcium from the intestine. A deficiency of this vitamin is a major cause of hypocalcemia. When the calcium level in the extracellular fluid falls below normal, the nervous system becomes increasingly excited. If the level continues to fall, the nerve fibers begin to discharge spontaneously, passing impulses to the peripheral skeletal muscles,
where they cause a contractive spasm. Often, this is first seen in a contracting of the fingers. Generalized muscular spasming can be lethal if the calcium imbalance is not corrected quickly. Immediate calcium deficiency is treated with the administration of either oral or intravenous calcium compounds, with vitamin D therapy, and with the inclusion of foods of high calcium content in the diet. In the longer term, treatment of the underlying illness is necessary.

The opposite imbalance, hypercalcemia, can occur as a result of an excessive intake of calcium supplements and vitamin D, in conjunction with a high-calcium diet. Calcium excess is also associated with some tumors and with kidney or glandular diseases. It has also been found to be caused by prolonged immobility, in which case the bones resorb because of the lack of bone stress. This latter effect has been of major concern in the space program. Too high a level of calcium in the intercellular fluid causes a depression of the nervous system and a slowing of reflexes. Lack of appetite and constipation are also common results. At very high levels, calcium salts may precipitate in the blood system, an effect that can be rapidly lethal. Again, in the long term, the underlying cause of the imbalance must be corrected, but treatments do exist for more immediate alleviation. As long as the kidneys are functioning correctly, intravenous treatment with saline serves as a means of flushing out excess calcium. Calcium also
can be bound to phosphate that is delivered intravenously, but there is a risk of causing soft tissue precipitation of the calcium phosphate compound. Dietary control is used, at times in concert with steroid therapy, to counter high calcium levels. If resorption is the cause of the excess, there are therapies, both chemical and physical, that are effective in increasing bone deposition.

Perspective and Prospects

From the earliest times, those concerned with the treatment of illnesses have had their attention drawn to the fluids present in or exuded by the human body. The color, smell, and texture of fluids being given off by a sick or injured person provided clues to the nature of the illness or injury. Bleeding was commonly practiced as a means of venting the illness so that health could be restored. Lancing of ulcerative conditions was also practiced by early healers. These early attempts at understanding and of treatment have been greatly refined, and the search for better understanding and improved treatment modes continues.

This concern with fluids and electrolytes is easy to understand. The fluids and their components constitute both the external and the internal environment for all the body’s tissues and cells. Any abnormality in the cells or tissues is reflected in a variation from normal conditions in the fluids. All major illnesses and many minor ones have associated with them a fluid and electrolyte disorder. Fluids are more readily accessible for study than are tissues from deep within the body; hence, a considerable effort has been directed at measuring fluid constituents and interpreting the findings. The testing of fluids has evolved from highly labor intensive measurements of a few components to highly automated testing procedures applied to dozens of components. The reliability and precision of the measurements continue to increase, and the scope of measurements continues to expand.

Not all that is to be known about fluids and electrolytes, however, depends on laboratory testing. Some knowledge can be collected from close observation of the patient. Although the resulting measurements are not precise, they are nevertheless important because they are much more immediately available. Physical symptoms that carry information about fluids and electrolytes include the following: sudden weight gain or loss; changes in abdominal girth; changes in either the intake or output of fluids; body temperature; depth of respiration; heart rate; blood pressure; skin moisture, color, and temperature; the skin’s ability to relax to normal after being pinched; the swelling of tissue; the condition of the tongue; the appearance of visible veins; reflexive responses; apparent mental state; and thirst. Each of these observations, and more, is readily available to one who is monitoring the health of an individual.

As is the case with most testing and data-gathering situations, interpreting the test and observation results is the critical step. Any one measure, by itself, points to a vast array of possible illnesses. Only by considering the whole and recognizing the existence of patterns in the information can a health professional narrow the possibilities. It is this recognition of patterns that develops with education and experience, and it is this step that relies on judgment that makes medicine an art as well as a science.

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What is the climax of William Saroyan’s story “The Summer of the Beautiful White Horse”?

The story reaches its climactic moment when one morning while riding “the beautiful white horse,” Mourad and Aram accidentally run into John Byro. Byro is none other than the owner of the horse.

Byro instantly recognizes the horse to be his. The speciality of this scene is that each of the three persons - Byro, Mourad and Aram - present there knows that the horse belongs to Byro, yet no one admits so.

It’s clear to Byro that these boys had brought his horse. Still, instead of claiming his horse outright and accusing the boys of stealing it, he handles the situation with appreciable subtlety. He knows that Mourad and Aram belong to the Garoghlanian tribe, which is famous for their unwavering adherence to the virtue of honesty. He is sure that the boys couldn’t have stolen his horse for monetary gain, and that they would return his horse. So, he leaves only saying,

“Tooth for tooth, he said. I would swear it is my horse if I didn’t know your parents. The fame of your family for honesty is well known to me. Yet the horse is the twin of my horse. A suspicious man would believe his eyes instead of his heart. Good day, my young friends.”

Mourad, too, exhibits unexpected cool and confidence during the encounter. Not even the slightest trace of fear or shock can be seen in his face or manner. Neither does he try to slip away nor give excuses. Instead, he reacts in a most confident and unperturbed manner, as if the horse really belonged to him.  

How could he display such ease of manner when confronting the person whose horse he had brought without permission? It’s only because Mourad hadn’t had the intention to keep the horse forever or sell it for money. He was only passionate about horses, and after a couple of months, he was going to return it to Byro. That’s why neither Mourad nor Aram ever felt guilty about stealing the horse.

Earlier, we had heard Aram say, 

“If you were crazy about horses the way my cousin Mourad and I were, it wasn’t stealing. It wouldn’t become stealing until we offered to sell the horse, which of course, I knew we would never do.”

So, we see that the author William Saroyan constructs the climactic scene with great subtlety. Byro is absolutely certain that no member of Garoghlanian tribe could take to stealing or dishonest practices. So, he leaves without taking offense. Mourad and Aram, on the other hand, feel no scruples about stumbling upon Byro because they were going to return it to him.

What is social media addiction?

Background

The rise in popularity of social media websites, such as Facebook and Twitter, has spawned an age of social media consumption that is difficult to quantify. Rather than point to specific numbers or trends in everyday use, perhaps a better way of considering the effect of social media on society is to consider that two professional journals now chronicle the ongoing relationship with social media. The new journals are the Journal of Social Media and the Journal of Cyberpsychology and Behavior, both of which are relevant to studies of the effects of social media on human behavior.

Facebook, for example, has changed the way that people communicate and maintain social relationships, both in productive and nonproductive ways. Twitter has become a global vehicle through which people collect, report, and share the news of the moment. Communicating with other people has become easier and more immediate, while the boundaries, rules, and language that govern this communication have become more convoluted. As a result, research aimed at how and why people find themselves using social media (and technology in general) is on the rise. For instance, psychologist Julia Hormes hypothesizes that the unpredictable updates on social media platforms and self-disclosures inherent in the process both activate the brain's reward circuitry, reinforcing the behaviors. Other research has suggested that people use social media for a sense of belonging, much as they would join social groups in the real world.

Furthermore, features of one’s personality that predict heavy (or limited) social media use are under investigation. For instance, poor emotion regulation, impulsivity, alcohol abuse, and Internet addiction were associated with social media dependence among young adults in one 2014 study. The merits of what widely interconnected, online relationships mean for face-to-face communication, intimacy, and privacy have become the objects of study as well.

The Human Relationship with Technology

Social media researcher Sherry Turkle has been exploring the interaction of human relationships and technology for decades. Her work has developed a collective understanding of how human beings interface with a technological society. Her seminal works applying self and interpersonal theories to social media relationships were predictive and formative. Turkle has shown that technological advances have made it virtually impossible to isolate oneself from complex interpersonal relationships.

Additionally, technology has done as much to challenge self-representation as it has challenged interpersonal relationships; for instance, many Facebook users report feeling anxiety in trying to manage their self-representation to varying audiences of friends, family, and professional connections on the site. Social media sites also encourage attention-seeking behaviors. In so doing, the ways in which one’s real life aligns with one’s virtual life are telling and have become useful fodder for ongoing research.

Psychological Addiction? Loneliness, Anxiety, Shyness

Because of the long-held assumption that social media helps to foster meaningful, online relationships, and because of the ease through which one can build a relationship with someone previously unknown to them, three psychological concerns in particular are now being studied: loneliness, anxiety, and shyness. No consensus exists on how these factors intersect with one’s proclivity for social media use (or for social media addiction), though there are a few interesting points to highlight.

First, research has revealed mixed findings regarding people who self-identify as “lonely” and people who self-identify as “anxious.” Some research has indicated that lonely people prefer face-to-face interaction (they find that social media lacks intimacy), whereas anxious people prefer electronic modes of communication. As such, loneliness could be better understood as something self-representational (with concerns hovering around issues of the self rather than of a specific fear of others or of socializing with others). According to a University of Wisconsin–Milwaukee meta-analysis of loneliness and Facebook use, lonelier people spend more time on the site despite not feeling their loneliness lessen while using it. Anxious people prefer social media because of the anonymity involved, making it easier to rationalize possible disapproval while having more control over how the other person experiences them. Studies have also suggested that those with low self-esteem are particularly vulnerable to dysfunctional social media usage, as they repeatedly seek the rewards of self-disclosure but often turn off their social media contacts with negative sharing.

Second, shyness is not something that inhibits social media usage despite the likelihood that shy people will experience the same minimal amount of social contact online as they would otherwise. Despite reported difficulty maintaining online relationships, shy people report heightened satisfaction in their virtual worlds. This is likely because they are spending a greater amount of time seeking, surveying, and considering positive social encounters while online. Additionally, social media provide a rather safe and secure outlet for heightened social interaction.

Third, the issue of locus of control has come under scrutiny as it relates to potential social media addiction. Specifically, research has examined closely the types of reinforcements experienced by heavy social media users. People are less likely to become addicted to social media if they feel that they have control over their own lives (both online and off), whereas people are more likely to be addicted to social media if they feel as though others have greater control over them (both online and off).

Turkle’s analysis of the Internet (and social media) as seductive is especially relevant here, particularly when one considers the fluid nature of a person’s experience of social media. That is, a person can update, alter, change, or redefine his or her online identity in the click of a button.

Bibliography

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Chak, Katherine M., and Louis Leung. “Shyness and Locus of Control as Predictors of Internet Addiction and Internet Use.” Cyberpsychology and Behavior 7.5 (2004): 559–70. Print.

Chia-Yi, Mba, and Feng-Yang Kuo. “A Study of Internet Addiction through the Lens of the Interpersonal Theory.” Cyberpsychology and Behavior 10.6 (2007): 799–804. Print.

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Hormes, Julia M., Brianna Kearns, and C. Alix Timko. “Craving Facebook? Behavioral Addiction to Online Social Networking and Its Association with Emotion Regulation Deficits.” Addiction 109.12 (2014): 2079–88. Academic Search Complete. Web. 28 Oct. 2015.

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What is carpal tunnel syndrome?

Causes and Symptoms

The carpal tunnel is a narrow passage of ligament and bones that contains the median nerve and tendons. Carpal tunnel syndrome, also known as median nerve palsy, is caused by the transverse carpal ligament compressing the median nerve. This nerve passes through the carpal tunnel alongside nine tendons attached to the muscles that enable the hand to close and the wrist to flex. The tendons have a lubricating lining called the synovium, which normally allows the tendons to glide back and forth smoothly through the tunnel during wrist and hand movements. The median nerve is the softest component within the tunnel and becomes compressed when the tendons are stressed and become swollen. Median nerve compression most often results when the synovium becomes thick and sticky as a result of the wear and tear of aging or repeatedly performing stressful motions with the hands while holding them in the same position for extended periods. The carpal tunnel is smaller in some people than in others, predisposing them to carpal tunnel syndrome. Entrapment of the median nerve is less commonly caused by rheumatoid arthritis, diabetes mellitus, poor thyroid gland or pituitary function, excessive fluid retention during pregnancy or menopause, medications, vitamin B6 or B12 deficiency, or bone protruding in the tunnel from previous dislocations or fractures of the wrist.

Initial symptoms of carpal tunnel syndrome include tingling and numbness in the hands, often beginning in the thumb and index and middle fingers, that causes the hand to feel as though it were asleep and shooting pain from the thenar region radiating as far up as the neck. Later symptoms include burning pain from the wrist to the fingers, changes in touch or temperature sensation, clumsiness in the hands, and muscle weakness creating an inability to grasp, pinch, and perform other thumb functions. Swelling of the hands and forearms and changes in sweat gland functioning in the hands may also be noted. Symptoms can be intermittent or constant and often progress to the point of regularly awakening the patient at night. Temporary relief is sometimes available by elevating, massaging, and shaking the hand. Although very treatable if diagnosed early, carpal tunnel syndrome can escalate into persistent pain, which can become so crippling that workplace duties and such simple tasks as holding a cup, writing, and buttoning a shirt are compromised. Carpal tunnel syndrome usually occurs in adults and is more common in women than in men.

A clinical examination for confirmation of median nerve impingement includes wrist examination, an X-ray for previous injury and arthritis, and assessment of swelling and sensitivity to touch or pinpricks. Tapping of the median nerve (Tinel’s test) will cause tingling or shocklike sensations in the fingers. Holding the wrist in a flexed position for several minutes with the heel of the hands touching for several minutes (Phalen’s test) will result in tingling or numbness in the hands. Nerve conduction tests, which measure nerve transmission speed by electrodes placed on the skin, and electromyogram evaluation, which notes muscle function abnormalities, may also assist in a diagnosis. Ultrasound identifies whether motion of the median nerve is impeded.

Treatment and Therapy

Early diagnosis and the taking of appropriate preventive measures, such as ergonomic modifications in the way that upper extremity movements are performed, often reduce the risk of developing advanced carpal tunnel syndrome. The need to compensate for weak muscles with an inappropriate wrist position can be reduced by maintaining a neutral (straight) wrist position instead of a flexed, extended, or twisted wrist position; utilizing the entire hand and all the fingers to grasp and lift objects, instead of gripping solely with the thumb and index finger; minimizing repetitive movements; allowing the upper extremities regular rest periods; using power tools, instead of hand tools; alternating work activities; switching hands; reducing movement speed; and stretching and using strengthening exercises for the hand, wrist, and arm. Keeping the hands warm to maintain good blood circulation and avoiding smoke-filled environments, which reduce peripheral blood flow, are also recommended.

Treatment generally begins with splinting of the wrist and medication, but surgery may be required if symptoms do not subside within six months. Both nocturnal splints and job-specific occupational splints can effectively keep the wrist in a neutral position, thus avoiding the extreme wrist flexion or extension that narrows the carpal tunnel. Wrist supports lying on the desk in front of a computer keyboard are often helpful, but the benefit of strapping on wrist splints while typing is controversial because disuse atrophy may result, potentially creating a muscle imbalance. Aspirin and other oral nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce swelling and inflammation, relieving some nerve pressure. Corticosteroids and cortisone-like medications injected directly into the carpal tunnel can help confirm diagnosis if the symptoms are relieved. Diuretics and vitamin supplementation may also be beneficial. Vitamin B6 has shown promise in reducing the symptoms of carpal tunnel syndrome. Exercises can be performed, under the guidance of a physical or
occupational therapist, to stretch and strengthen the wrists. Acupuncture and chiropractic may benefit some who suffer from carpal tunnel syndrome; however, their effectiveness has not been supported. Pain reduction and improved grip strength have been documented among patients who practice yoga.

If initial symptoms do not subside, pain increases, or the risk of permanent nerve and muscle damage exists, then surgery may be necessary, with subsequent rehabilitation and ergonomic counseling with a physical or occupational therapist. Carpal tunnel release is one of the most common surgical procedures in the United States. It is often recommended for individuals who experience carpal tunnel symptoms for more than six months. This outpatient surgical procedure involves dividing the transverse ligament to open the carpal tunnel to relieve pressure and remove thickened synovial tissue. Endoscopic surgery using a fiber-optic camera allows the surgeon to visualize and cut the carpal ligament. This procedure results in faster recovery and minimizes postoperative discomfort and scarring. Though most patients who have carpal tunnel surgery recover completely, recovery can take months.

Perspective and Prospects

The historic roots of carpal tunnel syndrome can be traced back to the 1860s, when meatpackers complained of pain and loss of hand function, which physicians initially attributed to reduced circulation. Modern occupations that require repetitive motions for extended periods—such as typing on a computer keyboard, construction and assembly-line work, and jackhammer operation—have caused a dramatic rise in cumulative trauma disorders such as carpal tunnel syndrome, while other workplace injuries have leveled off.

Bibliography:

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What are birth's effects on physical development?

Introduction

Birth represents the culmination of an involved journey from a single-celled fertilized egg to a newborn baby. Normal, uncomplicated childbirth does not have any significant physical impact on the development of the baby. Neurological or physical abnormalities following a smooth delivery are most likely attributable to disruptions during prenatal development. Prenatal disruptions may be chromosomal, environmental, or some combination of the two and are studied in the field of teratology. Although the second and third trimesters of pregnancy are important, the first trimester of prenatal development is often considered most sensitive to disruptions. Disturbances during prenatal development can produce fetal death or severe abnormalities, such as deformed or missing limbs, cerebral palsy, or intellectual disabilities, as well as more subtle complications such as mood disorders or learning disabilities that may not manifest until later stages of development.

Most pregnancies in industrialized countries progress smoothly. When a mother experiences birth complications, however, the baby is at increased risk for adverse physical and neurological outcomes. Some of the more serious birth complications include anoxia, premature delivery, low birth weight, and contact with maternal genital herpes lesions at birth. In developing countries, babies may be at greater risk for physical or neurological damage due to a lack of medical facilities or trained medical personnel. As a result, birth complications can lead to fetal, and sometimes maternal, death; physical abnormalities such as paralysis or cerebral palsy; or neurological abnormalities such as intellectual disability or schizophrenia.

Stages of Labor

“Labor” is the term used to describe the process of the birth of the baby. Labor has three stages and begins when the cervix dilates. The cervix is the opening in the women’s vagina through which the baby passes. A common misconception is that labor begins with the onset of uterine contractions, but these are often present several hours before dilation. The duration of labor depends on a number of factors, the most important being the mother’s previous birth experience. On average, first-time mothers experience longer labors (eight to fourteen hours) than mothers who have given birth previously (three to eight hours).

The first stage of labor is the longest and most uncomfortable for the mother. It officially begins when the uterine contractions occur within fifteen-minute intervals and ends when the cervix is fully dilated so that the fetus can pass through. The second stage of labor represents the actual delivery of the baby. In vaginal childbirth (as opposed to cesarean section), the baby is pushed out through the expanding cervix, and average delivery time ranges from thirty to forty minutes. The third stage of labor takes about ten minutes and involves expulsion of the afterbirth, which comprises the placenta and other membranes. A physician will typically examine the afterbirth to ensure that all of it has been expelled. If not, the physician may scrape the uterus to remove the remaining portions and prevent infection.

The birth process is thought to be stressful on the baby but also adaptive. The contractions of the uterus during labor help push the baby out but may also restrict the oxygen supply to the fetus. This decrease of oxygen, called anoxia, can cause brain damage or fetal death if it persists beyond four minutes. In response to contractions during labor and the subsequent oxygen restriction, the fetus secretes hormones that increase blood flow to the brain and ensure that the baby will breathe on its own when it finally enters the extrauterine environment.

Childbirth Positions and Settings

There are considerable cultural variations in the childbirth process. For some cultures, childbirth is a communal occasion, while for others, it takes place in isolation. In most non-Western societies, childbirth takes place in a vertical position, such as squatting or sitting; in Western societies the mother is often placed on her back or side.

In the United States before the 1800s, the birth of a child took place at home, where the expectant mother was surrounded by family, relatives, and friends. In contrast, a modern setting is most likely to be a hospital. A majority of the births in the United States (98.8 percent in 2010) occur in a hospital setting. This percentage is lower in some European countries, where home births attended by midwives are more common.

Childbirth in a hospital setting is thought to have both advantages and disadvantages. The hospital setting is perceived to be less comfortable, less likely to allow extensive mother-baby contact at birth, and more likely to perform unnecessary medical interventions for issues that could be resolved without the risk of surgery. However, this setting is the most appropriate for older mothers and mothers who are likely to experience birth complications. Freestanding birth centers are thought to be more flexible, less likely to use unnecessary medical procedures, and more likely to encourage early contact between parents and the baby. Some developmental psychologists argue that the first twelve hours following birth are a critical period in the bonding experience between mother and baby. Without such initial contact, some developmental psychologists argue that the baby’s development will be suboptimal. The research in this area is inconclusive.

Home births are more frequent in Europe and developing countries than in North America. Advantages include a familiar environment and a setting that is in a position to promote parent-infant contact. Advocates of this setting indicate that the benefits of early attachment to the caregiver and the comfort level of the mother during the birth process outweigh any possible risks of being away from a hospital setting in the event of an emergency. If complications occur, however, the mother and baby must be transported to the hospital, jeopardizing the physical health of the baby by delaying what could be critical intervention.

In 2010, a midwife attended approximately 8 percent of US births in any of the described settings. A midwife is an individual experienced in the process of childbirth who assists with the delivery of the baby and provides emotional as well as educational support to the expectant mother. Midwives are common in many countries around the world, assisting pregnant women not only through birth but also through all stages of pregnancy.

Methods of Delivery

There are three types of delivery: natural, medicated, and cesarean. Natural childbirth avoids medication and requires education of the expectant mother to reduce fear and anxiety during childbirth, which are thought to increase the duration of labor and, as a result, the possibility of fetal complications. Prepared childbirth (the Lamaze method) was developed by French obstetrician Ferdinand Lamaze and is a type of natural childbirth. It includes not only education about childbirth but also training in special breathing techniques to control pushing in the final stages of labor. Other natural childbirth techniques, such as the Bradley method, have been developed, but these are usually variations of the Lamaze method.

Medicated childbirth uses a nonsurgical approach to expedite the delivery of the baby and to decrease the mother’s pain. Expectant mothers are commonly given oxytocics, synthetic hormones that expedite the birth process by stimulating uterine contractions. The American Academy of Pediatrics recommends the least possible use of medication such as tranquilizers or pain medications due to potential adverse impact on the newborn baby. Although it is difficult to predict the precise effects of medication on the fetus, it is customary to use minimal medicinal therapy. A general anesthetic such as Demerol is sometimes given to relieve the mother’s muscle tension and anxiety. This medication passes through the placenta and can lead to detrimental changes in the fetus, such as decreases in heart rate, muscle tone, breathing, and general attentiveness. One commonly used alternative is an epidural block, which has fewer side effects on the fetus than intravenous or oral medications. An epidural block entails the insertion of a needle into the spinal canal of the mother and the introduction of local anesthesia to numb the woman’s body from the waist down. A cesarean section commonly involves epidural analgesia so that the expectant mother can remain alert to greet her newborn baby.

A cesarean delivery is a surgical birth. The physician makes an incision in the mother’s abdomen and surgically removes the baby from her uterus. The indications for a cesarean section include previous cesarean births, abnormal labor, the presentation of the baby in breech position (buttocks first), and infant distress due to oxygen deprivation. In addition, a cesarean section might be necessary if there is serious maternal illness such as diabetes, premature separation of the placenta from the uterus (placenta abruptio), or maternal infection with genital herpes. Cesarean births require extra recovery time for the mother. Babies tend to be less alert and have greater breathing difficulties following cesarean delivery. However, there does not appear to be any significant lasting deleterious impact with cesarean delivery.

Baby’s Physical Appearance

At the time of birth, the baby is covered with protective grease called the vernix caeosa. This covering serves to protect the baby’s skin during birth. At birth the baby appears bluish in color (from oxygen deprivation) and may have a misshapen head, a flattened nose, and bruises. These characteristics are related to passage through the birth canal. The head is large compared to the rest of the body, and it has spaces between the skull bones (fontanelles) that allow it to contort slightly to fit through the birth canal. The fontanelles will close shortly after birth.

There are times during natural childbirth when a physician uses forceps or a vacuum extractor to deliver the baby. Forceps are a tonglike device used to pull the baby out of the mother’s birth canal. A vacuum extractor is a suction device that attaches to the baby’s head and pulls the baby out through the birth canal. Both forceps and vacuum extraction can contribute to transient bruises and misshapen features at birth.

Assessment of the Baby

There are two widely used methods of assessing the baby’s physical and neurological status following birth. The Apgar test
assesses the baby’s vital functions within sixty seconds of birth and again five minutes after birth by looking at heart rate, respiratory effort, reflex irritability, muscle tone, and color. A low score suggests possible physical or neurological abnormalities. A more thorough assessment may be conducted using the Brazelton Neonatal Behavior Assessment Scale (NBAS), which is administered a few days after birth. Areas assessed by the NBAS include reflex and respiratory responses and the infant’s capacity to respond to stimuli in an interactive process. For the NBAS, the baby is manipulated from sleep to wakefulness to crying and then back down to a quiet state. The baby’s coping and adaptive strategies are thus examined, and the baby’s physical and central nervous system functioning can be assessed.

Birth Complications

Although most births progress smoothly, some involve complications that can have a profound impact on the physical and neurological development of the baby. Premature birth is a significant risk factor for physical and neurological abnormalities. A baby’s physical status may be classified along two dimensions: birth weight and the length of time spent in the mother’s womb. A normal birth usually occurs between thirty-seven and forty-two weeks of pregnancy, and the baby averages 7.5 pounds. A fetus that is born prior to the twentieth week of pregnancy or weighs less than 1 pound will die. This type of birth is called a miscarriage. A fetus delivered between the twentieth and twenty-eighth week of pregnancy and weighing between 1 and 2 pounds is called immature. With the advancement of medical practices, it is possible for babies that are born as early as four months prematurely and weighing only 1.5 pounds to survive. A baby born between the twenty-ninth and thirty-sixth week of pregnancy and weighing between 2 and 5.5 pounds is termed premature. Both immature and premature births predispose a baby to a variety of adverse outcomes, ranging from death to severe physical and mental disabilities.

Low birth weight is another complication that predisposes a baby to adverse physical and neurological outcomes. Complications of low-birth-weight babies include greater incidences of intellectual disability, cerebral palsy, and general intellectual and gross motor delay. Babies weighing less than two pounds at birth are at risk for the most severe outcomes should they survive beyond infancy. Research indicates that nearly a quarter of these children experience intellectual disabilities, vision problems, and hearing difficulties. Babies weighing less than three pounds at birth continue to have a smaller physical stature and a significantly higher incidence of various illnesses throughout childhood. There is a clear relationship between premature birth, low birth weight, and adverse physical and neurological outcomes. A baby delivered prematurely is commonly a low-birth-weight baby. Both of these complications increase the baby’s risk for fetal death, physical abnormalities such as paralysis or cerebral palsy, and neurological abnormalities such as intellectual disability or schizophrenia.

Anoxia is another birth complication that is cause for particular concern. A cesarean section is performed when the fetus is at risk for prolonged oxygen deprivation. Newly born babies can tolerate oxygen deprivation for as long as four minutes, after which it can cause severe brain damage. There are several causes of anoxia. In many cases, the condition may occur as a result of constriction of the umbilical cord. This is common in a breech birth, in which the baby’s buttocks present for delivery rather than the baby’s head. A second cause of anoxia is premature separation of the placenta from the uterus, which interrupts the supply of oxygen to the fetus. Sedation given to the mother during childbirth is another risk factor for anoxia. Sedation crosses the placenta and interferes with the baby’s impetus to breathe. Anoxia may also occur as a result of airway obstruction from mucus inhaled during the birth process. This problem is typically alleviated through suctioning of the newborn’s airway at birth.

Bibliography

Berk, Laura E. Infants, Children, and Adolescents. 7th ed. Boston: Allyn, 2012. Print.

Johnson, Robert V. Mayo Clinic Complete Book of Pregnancy and Baby’s First Year. New York: Morrow, 1994. Print.

Kail, Robert V., and John C. Cavanaugh. Human Development: A Life-Span View. 6th ed. Belmont: Wadsworth, 2013. Print.

Lansky, Vicki. Complete Pregnancy and Baby Book. Lincolnwood: Publications Intl., 1996. Print.

Lefrançois, Guy R. The Lifespan. 6th ed. Belmont: Wadsworth, 1999. Print.

Moore, Keith L., T. V. N. Persaud, and Mark G. Torchia. Before We Are Born: Essentials of Embryology and Birth Defects. 8th ed. Philadelphia: Saunders, 2013. Print.

Moore, Keith L., T. V. N. Persaud, and Mark G. Torchia. The Developing Human: Clinically Oriented Embryology. 9th ed. Philadelphia: Saunders, 2013. Print.

Santrock, John W. Life-Span Development. 14th ed. New York: McGraw, 2013. Print.

Sydsjö, Gunilla. "Long-Term Consequences of Non-Optimal Birth Characteristics." Supp. to American Journal of Reproductive Immunology 66.1 (2011): 81–87. Web. 20 Feb. 2014.

Van Hus, Janeline W. P., et al. "Comparing Two Motor Assessment Tools to Evaluate Neurobehavioral Intervention Effects in Infants with Very Low Birth Weight at 1 Year." Physical Therapy 93.11 (2013): 1475–83. Print.

The mass of a toy spoon is 7.5 grams and it's volume is 3.2 ml. What is the density of the toy spoon?

The density of a substance is the ratio of its mass to its volume. In other words,

density = mass of a substance / volume of the substance = M / V

where M is the mass of the substance and V is its volume.

In this case, the mass of the toy spoon is 7.5 g and hence M = 7.5 g.

The volume of the toy spoon is 3.2 ml and hence V...

The density of a substance is the ratio of its mass to its volume. In other words,

density = mass of a substance / volume of the substance = M / V

where M is the mass of the substance and V is its volume.

In this case, the mass of the toy spoon is 7.5 g and hence M = 7.5 g.

The volume of the toy spoon is 3.2 ml and hence V = 3.2 ml.

Thus, the density of the spoon can be calculated as:

density = M / V = 7.5 g / 3.2 ml = 2.344 g/ml or 2.3 g/ml (rounded off)

Thus, the density of the toy spoon is about 2.3 g/ml. We can also write the density as 2.3 kg/l or 2344 kg/m^3. 

Note that the toy spoon is 2.344 times heavier than the water (which has a density of about 1000 kg/m^3).

Hope this helps. 

How do the issues of due process and just cause affect employers' disciplinary actions?

How due process and just cause have an impact on the discipline of employees is mostly a matter of context and a matter of perception.  There is no one definitive answer to this question, so I will address a few different contexts for you.

First, if there is a collective bargaining agreement, it is quite likely that due process and just cause will be built into that agreement, such that grievances can be filed over disciplinary actions and an employer is required to have just cause for any disciplinary action. I have never seen a collective bargaining agreement in which these were not present.

Second, absent a collective bargaining agreement, if there is an employment contract of any sort, these may or may not be part of that contract. Employee contracts can contain a myriad of provisions, some allowing termination without due process or just cause, while others might contain provisions for one, the other, or both.

Third, to what degree any of this matters is largely a function of what state has jurisdiction over the situation. Some states are called "at will" states, which means that employees, absent some sort of contract, can be fired for no reason at all, as long as it is not for an unlawful reason, for example, race discrimination or pregnancy.  A few states have some worker protection built in, although I am not aware of any state that guarantees workers due process.

Fourth, it is quite important to understand that due process is guaranteed to us by government. There is no guarantee of due process in a private employment situation. That is simply not an entitlement of the American worker, unless that person is working for the government. 

Fifth, similarly, just cause is not an entitlement.  It is not an entitlement under the Constitution nor an entitlement in private employment. It is something that is valued by employees, but that by no means makes it a requirement.

Finally, in spite of the fact that they have no entitlement, employees who perceive disciplinary actions to be lacking in due process and just cause are likely to become disaffected employees very quickly, as will any workmates who have this perception, too.  Without either, we perceive the workplace to be quite unfair, and this is very bad for motivation and productivity. A wise employer will build in at least a modicum of due process and not act without good cause, lest the perception of unfairness permeate the workplace to the employer's detriment. 

So, it is important to consider collective bargaining agreements, other contracts, and what state has jurisdiction over the matter.  It is important to remember that absent a contract of some sort, neither is an entitlement.  Nevertheless, the perception of fairness is an important part of effective management, and some due process should be built in to discipline, and no disciplinary action should be occurring arbitrarily.