What are airborne illness and disease?

Definition

Airborne diseases

are those diseases transmitted by contaminated droplets in the air.
Common types of airborne disease include the common cold,
the flu (influenza), chickenpox (varicella), and
tuberculosis.

Exposure

Cold and flu. Both the common cold and the flu are highly contagious. They can be spread from person to person when an infected person coughs or sneezes. People can also catch a common cold or the flu by touching an contaminated object (a fomite) that contains the live virus and by then touching their eyes, nose, or their mouth. Other methods of transmission include kissing and sharing food or drinks.

There are certain risk factors that may cause a person to be more susceptible to a cold or flu. Those risk factors include age (young children and adults age sixty-five years and older are more susceptible), a compromised immune system caused by illness or treatment of an illness (such as human immunodeficiency virus [HIV] infection or chemotherapy), living in a residential care facility, or working in health care.

Chickenpox. Chickenpox is also highly contagious and can be spread from person to person when an infected person coughs or sneezes. One of the main symptoms of chickenpox is a rash that eventually blisters. Touching an open blister that is leaking fluid can also lead to the spread of the disease.

As with the cold or flu, there are certain risk factors that may cause a person to be more susceptible to chickenpox. Risk factors for increased susceptibility to chickenpox include not having had chickenpox in the past, not being given the chickenpox vaccine, and spending a lot of time around children.

Tuberculosis. Although tuberculosis is a contagious disease, it does not spread as easily as the common cold, the flu, or chickenpox. It can still be spread from person to person when an infected person coughs or sneezes, but it is most commonly spread when people spend a lot of time together in close quarters, such the home or office. Tuberculosis is not spread by handshaking, kissing, or sharing food or drinks.

In addition to living with or working with someone who has tuberculosis, there are other risk factors that may make someone more susceptible to contracting the disease, including the following: having a compromised immunity, living in a region where there are high rates of tuberculosis, age (sixty-five years and older), long-term drug or alcohol use, living in a residential care facility, and working in health care.

People who are at high risk for contracting tuberculosis, or those who think they may have been exposed to the disease, should be tested for tuberculosis. The following persons should be periodically tested for tuberculosis infection: health care workers, people with HIV or other immune system disorders, people who live in areas with high rates of infection, people who live in residential care facilities, persons who have symptoms of active tuberculosis, people who live or work in correctional facilities, injection-drug users, and persons who have lived with or who have spent much time with someone who has active tuberculosis.

Prevention

Cold. There is currently no vaccination for the prevention of the common cold. The best method of preventing the common cold is frequent handwashing, particularly before eating or preparing food.

Another way to help prevent the common cold is to periodically clean with antibacterial wipes all shared surfaces, such as telephones, computer keyboards, refrigerator handles, doorknobs, and toys. A third method for preventing the common cold is to teach children to drink from their own drinking glass, rather than sharing. A fourth method of common cold prevention is to avoid close contact with people who have a cold or other respiratory tract infection.

Flu. The best way to prevent the flu is to get a flu shot
(influenza
vaccination). In the fall of 2010, the flu vaccine began
protecting against the most common types of flu viruses, seasonal influenza and
the H1N1 virus (swine flu). The Centers for Disease Control and
Prevention (CDC) recommends that all persons age six months and older be
vaccinated, although there are some exceptions. The following people should not
get a flu vaccine without consulting a physician: persons who are allergic to
eggs, who have had a previous allergic reaction to the flu vaccine, who have
Guillain-Barré
syndrome, or who are already sick and who have a fever.
Vaccination is recommended after illness, however.

In addition to vaccination, there are other steps to help prevent the spread of influenza, including frequent handwashing, using a tissue to cover the nose or mouth when coughing or sneezing, periodically cleaning shared surfaces, avoiding close contact with people who have symptoms of a cold or flu, not sharing drinking glasses, and not going to work when sick.

Chickenpox. The best method for preventing chickenpox is the
varicella (chickenpox) vaccine. The CDC recommends that all children and adults
who do not have evidence of immunity to varicella be vaccinated. Evidence of
immunity, according to the CDC, includes documentation of either of the following:
two doses of varicella vaccine, blood tests that show immunity, laboratory
confirmation of prior varicella disease, a diagnosis of chickenpox or verification
of a history of chickenpox from a qualified health care provider, or a diagnosis
of herpes zoster (shingles) or verification of a history of herpes zoster
(shingles) from a qualified health care provider.

Some people are given the chickenpox vaccine after exposure to help prevent them from contracting the disease. According to the CDC, the chickenpox vaccine is not recommended for the following people: those allergic to gelatin, those who have a moderate or serious illness, pregnant women, persons with compromised immune systems because of illness or treatment of illness, persons who have received blood or blood products three to eleven months before considering vaccination, and persons with a family history of immune deficiency.

Tuberculosis. Although a vaccine has been developed for the
prevention of tuberculosis, that vaccine is not commonly used in the United
States. The tuberculosis vaccine, which is known as the Bacille
Calmette-Guérin vaccine, does not always protect against tuberculosis and could
cause a false-positive result in people who are later tested for tuberculosis.

Preventing the spread of tuberculosis is still possible without the vaccine. For example, persons who are infected with tuberculosis can be treated before their disease becomes active. This involves regular testing of people who may be at risk. For persons who test positive for tuberculosis infection, medications that can be prescribed by doctors to help prevent active disease. Other methods of preventing the spread of tuberculosis include covering the nose and mouth with a tissue when coughing or sneezing, opening windows to ventilate rooms if the weather permits, avoiding the workplace when sick, wearing a mask around others, and avoiding close contact with family members for the first few weeks of treatment.

Symptoms

Cold. Symptoms of the common cold begin from one and three days after exposure, and may include runny or stuffy nose, coughing, sneezing, congestion, sore throat, fatigue, and a general feeling of being unwell.

Flu. Flu symptoms are much like symptoms of the common cold, but are more severe. In addition to cold symptoms, persons who have the flu will also experience fever and chills, headache or body aches; other persons, particularly children, also may experience nausea and vomiting. There are potential complications that are related to the common cold or flu. Complications may include ear infection (particularly in small children), sinus infection, bronchitis, and pneumonia.

Chickenpox. The main symptom of chickenpox is a skin rash, mostly
on the face, scalp, chest, and back. The rash eventually blisters, then dries up
and crusts over. Some people may also experience fever, headache, sore throat, and
a general feeling of being unwell.

As with the cold and flu, some people do experience complications that are
related to chickenpox. Complications may include pneumonia, skin infection, and,
in rare cases, encephalitis (infection of the brain). Another complication
of chickenpox may occur many years after a person has the disease. This
complication is shingles, an infection that is characterized by a painful rash. It
is usually seen in older adults and is caused by the same virus that causes
chickenpox.

Tuberculosis. Many people who contract tuberculosis have no symptoms. Persons who are asymptomatic have latent TB (tuberculosis) infection and cannot spread the disease to others unless their disease becomes active.

When tuberculosis bacteria begin actively multiplying in the body, the person who is infected is said to have active TB disease. Symptoms of active TB include a persistent cough (sometimes coughing up blood), chest pain when breathing or coughing, fever, chills, night sweats, fatigue, loss of appetite, and weight loss. People with active TB are contagious and can spread the disease to others.

Complications from tuberculosis can be serious or even fatal. Tuberculosis
complications may include lung damage, joint damage, damage to other organs,
meningitis, and death.

Treatment

Cold. There is no cure for the common cold. Cold “treatments” are designed not to cure the cold but to relieve symptoms. Over-the-counter (OTC) drugs that can help to relieve cold symptoms include nasal sprays, decongestants, and cough medicines. These medications are not recommended for children under the age of two years unless okayed by a physician. People who have the common cold should rest and drink plenty of fluids.

Flu. As with the common cold, the “cure” for the flu is rest, liquids, and symptom relief. OTC decongestants and cough syrups can be used to relieve nasal congestion and cough. OTC pain relievers, such as Tylenol or Advil, can help to relieve headache, body aches, and sore throat.

Some fever can be beneficial because it helps the body fight the virus, so many doctors recommend that fever not be treated unless it is above 102° Fahrenheit, although an exception can be made if the fever is causing a great deal of discomfort. Fever in infants under three months of age can be a sign of a serious infection, so one should seek immediate medical attention.

In some cases, a physician may prescribe antiviral medications, which are also used for symptom reduction rather than as a cure for the flu. Antiviral medications are generally only given to people who are at increased risk of flu complications, such as young children, the elderly, pregnant women, people who are in the hospital, and people who suffer from certain chronic medical conditions.

Antibiotics will not cure the common cold or the flu. They also will not relieve cold or flu symptoms because antibiotics are used to treat bacterial infections, and both the common cold and the flu are viruses.

Chickenpox. Most healthy people do not require medical treatment for chickenpox, but some doctors may prescribe an antihistamine to help relieve itching. Oatmeal baths or calamine lotion can also help to prevent itching.

People who have other health problems or who may be considered at high risk for
complications of chickenpox, may be given antiviral medications or immunoglobulin
treatment. These treatments are intended to lessen the severity of the disease
and, therefore, to prevent complications. OTC pain medications, such as Tylenol or
Advil, can be given to reduce fever, but people with chickenpox should not be
given aspirin because aspirin can cause a serious medical condition called
Reye’s
syndrome.

Tuberculosis. Prescribed medication can prevent TB from becoming active. It can also help cure active TB.

Impact

According to the National Institutes of Health, the United States experiences
more than 1 billion cases of the common cold each year. The World Health
Organization (WHO) estimates that there are between 3 and 5 million cases of
severe influenza illness each year during seasonal epidemics, resulting in between
250,000 and 500,000 deaths. CDC statistics show that during an average flu season,
5 to 20 percent of the U.S. population will get the flu and more than 200,000 will
be hospitalized because of complications of the flu. Since the last decades of the
twentieth century,deaths from influenza in the United States have ranged from a
low of 3,000 to a high of 49,000 persons.

According to the CDC, before the varicella vaccine was developed in 1995, around 4 million cases of chickenpox were reported each year in the United States. Also, there was an average of 10,600 hospitalizations and 100 to 150 deaths. From 1995 to 2005, the incidence of chickenpox declined 90 percent overall. In 2002, hospitalizations from chickenpox had decreased 88 percent from the years 1994 and 1995. Death rates dropped 66 percent between 1990 and 2001.

WHO estimates that one-third of the world’s population is infected with tuberculosis at any given time, and that 5 to 10 percent of those who are infected will develop active TB. In 2009, about 1.7 million people died from tuberculosis.

Bibliography

Centers for Disease Control and Prevention. “Basic TB Facts.” Available at http://www.cdc.gov/tb/topic/basics. A tuberculosis fact sheet that includes information about how tuberculosis is spread and discusses the difference between latent TB and TB disease.

_______. “Seasonal Flu: What to Do if You Get Sick.” Available at http://www.cdc.gov/flu/whattodo.htm. Discusses influenza diagnosis, symptoms, medical treatment, recovery, and emergency warning signs.

Mason, Robert J., et al., eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia: Saunders/Elsevier, 2010. Details basic anatomy, physiology, pharmacology, pathology, and immunology of the lungs.

Mayo Foundation for Medical Education and Research. “Chickenpox.” Available at http://www.mayoclinic.com/health/chickenpox/DS00053. A detailed description of chickenpox that includes a definition of chickenpox, symptoms, risk factors, complications, prevention, and treatment.

_______. “Common Cold.” Available at http://www.mayoclinic.com/health/common-cold/DS00056. A detailed description of the common cold that includes a definition of the common cold, symptoms, risk factors, complications, prevention, and treatment.

_______. “Tuberculosis.” Available at http://www.mayoclinic.com/health/tuberculosis/DS00372. A detailed description of tuberculosis that includes a definition of tuberculosis, symptoms, risk factors, complications, prevention, and treatment.

MedlinePlus. “Chickenpox.” Available at http://www.nlm.nih.gov/medlineplus/ency/article/001592.htm. An overview of chickenpox, including causes, symptoms, diagnosis, treatment, prevention, prognosis, and possible complications.

U.S. Department of Health and Human Services. “Tuberculosis: Getting Healthy, Staying Healthy.” Available at http://www.niaid.nih.gov/topics/tuberculosis/understanding/documents/tb.pdf. An overview of tuberculosis, including how the disease is spread, how it is diagnosed, and treatment options.

What is the difference between a molecule and a molecular ion?

A molecule is made up of atoms of one or more elements. Some examples of molecules are oxygen gas (O2), Hydrogen gas (H2), sulfuric acid (H2SO4), carbon dioxide (CO2), water (H2O), among others. In a molecule, the atoms are combined in a certain fixed ratio. For example, in water (H2O), hydrogen and oxygen atoms combine in a 2:1 ratio. 

A molecular ion is formed when electrons are added to or removed from a molecule. When...

A molecule is made up of atoms of one or more elements. Some examples of molecules are oxygen gas (O2), Hydrogen gas (H2), sulfuric acid (H2SO4), carbon dioxide (CO2), water (H2O), among others. In a molecule, the atoms are combined in a certain fixed ratio. For example, in water (H2O), hydrogen and oxygen atoms combine in a 2:1 ratio. 

A molecular ion is formed when electrons are added to or removed from a molecule. When electron/s are removed, the ion gains a net positive charge, while addition of electrons will give a net negative charge to the molecular ion. For example, H2+ is a molecular ion and is formed when a molecule of hydrogen gas loses an electron. 

Another difference is that molecules are neutrally charged, that is, they do not have any charge. In comparison, a molecular ion is either positively charged or negatively charged, depending on whether it gained or lost electron/s.

Hope this helps. 

What is Napoleon's role on Animal Farm and what happens to him?

Napoleon’s role on Animal Farm is leader and dictator, and he eventually becomes indistinguishable from a human being. 

Old Major the pig is the one who comes up with the original vision for Animal Farm, but Napoleon is the one who acts on it.  When Old Major dies, Napoleon is the driving force for rebelling against the humans and organizing the animals into a human-free farm.  He is a tyrant and eventually no one can tell the difference between him and his minions and the people. 

From the beginning, the two pigs Napoleon and Snowball vie for power. 

Napoleon was a large, rather fierce−looking Berkshire boar, the only Berkshire on the farm, not much of a talker, but with a reputation for getting his own way. Snowball was a more vivacious pig than Napoleon, quicker in speech and more inventive, but was not considered to have the same depth of character. (Ch. 2) 

Napoleon begins by contradicting Snowball, quietly and then actively.  Snowball believes in a more literal and idealistic version of Old Major’s dream.  He wants the farm to build a windmill to electrify the farm and prefers for decisions to be made by committee.  Napoleon just wants power. 

After initially opposing Snowball, Napoleon drives him off.  He had secretly trained his own personal security force of guard dogs.  Despite decrying Snowball’s windmill designs, he announced that the windmill would be built.  It was a good way to keep everyone busy. 

The pigs gained more and more control over the farm.  It began with small things that separated the pigs from the other animals, such as the disappearing milk and apples.  Then the pigs began changing the commandments that they had instituted to support Old Major’s vision.  Squealer, Napoleon’s mouthpiece, explains away all of Napoleon’s decisions.  The other animals just accept them. 

The pigs had moved into the farmhouse, learned to walk on two legs, and even traded with humans for alcohol.  Napoleon gained further control over the farm with a campaign of terror.  Animals were afraid to speak against him because of the guard dogs, and he made an example out of some of the animals. 

The four pigs waited, trembling, with guilt written on every line of their countenances. Napoleon now called upon them to confess their crimes. They were the same four pigs as had protested when Napoleon abolished the Sunday Meetings. (Ch. 7) 

By the end of the book, Napoleon and the other pigs are playing cards with the humans and when the animals look in, they can’t tell the pigs from the people.  Napoleon went from being a respected and revered leader to a tyrant who cared for nothing more than gaining and keeping power.

What was the calico cat's name?

"The calico cat" had no name. Although the dog is called Ranger, the kittens are called Puck and Sabine, and other animals in the story also have their own names, the main character of the mother cat never has a name.

Notice how the narrator describes the cat throughout the first several chapters as "the calico cat" and simply with the pronouns "she" and "her." After the calico cat gives birth to her kittens, the narrator sometimes calls her "the mama cat." It's interesting that the narrator continues to explore the cat's feelings and reactions, as well as her plans and ideas, while the story takes shape all around the cat--and yet she never gets a name!

Why?

Well, the humans who owned this cat have abandoned her, as we know for certain from this opening passage:

"There is nothing lonelier than a cat who has been loved, at least for a while, and then abandoned on the side of the road."

So perhaps those owners were all-around insensitive people who never bothered to name the calico cat in the first place.

Or perhaps they did give the cat a name, but when they abandoned her, maybe the cat wanted to shake off whatever name they had given her, in anger.

Or perhaps she didn't remember what they had called her. That's a possibility, since we know that her memory of being with the humans is fuzzy from when the narrator describes her recollection of the abandonment as "Something about a car, something about a long drive."

Regardless of why she has no name, her namelessness moves forward with her in the story as a distinctive character trait. The lack of a name marks her, in a sense, as having had a different sort of infancy than the other animals she associates with.

We know that names and the lack thereof play an important role in the story. Consider Gar Face. We don't know his real name, though we're told by the narrator in Chapter 6 that he "had a name once, a real name," but that after suffering the worst abuse from his father, he carved it into a tree, walked away from it and from his father, and never looked back. Did the calico cat do the same thing and leave her name behind with her abusers? This raises a question to consider throughout the story: Is a regular name a mark of normalcy, or possibly an indication of acceptance from others? What else does a name mean?

What is a hysterectomy? |

Indications and Procedures

The term “hysterectomy” comes from the Greek hystera, meaning “uterus,” and ektome, meaning “to cut out.” While hysterectomy refers to the removal of the uterus and, most commonly, the attached Fallopian tubes, there are several types of hysterectomies. Total hysterectomy, contrary to popular belief, does not mean that the ovaries are removed with the uterus. Rather, the term indicates the removal of the uterus and cervix. Subtotal, or partial, hysterectomy is the excision of the uterus above the cervix; the cervix is left in place. Either one or both ovaries may be removed with the uterus (unilateral oophorectomy or bilateral oophorectomy). Salpingo-oophorectomy refers to the removal of one of the Fallopian tubes along with the accompanying ovary, while bilateral salpingo-oophorectomy refers to the
removal of both Fallopian tubes and ovaries.

Indications for hysterectomy can be divided into noncancerous and cancerous conditions. Within the noncancerous category, the most common indication for hysterectomy is symptomatic fibroids.
Many women have fibroids, and the majority of fibroids do not cause symptoms and can be left alone. Symptomatic fibroids are those which are large enough to cause pressure symptoms in the pelvis, compress the bladder or rectum, or cause pain or discomfort during intercourse. Another type of symptomatic fibroids are those which cause excessively heavy menstrual bleeding and, when severe, anemia.

A hysterectomy is indicated in these situations if the patient fails to respond to less conservative therapy for symptomatic fibroids. Examples of conservative therapy for heavy bleeding include high-dose estrogen or birth control pills. A hysterectomy is usually performed only when childbearing is no longer desired, since removal of the uterus precludes pregnancy. Prior to hysterectomy, large fibroids may be shrunk with a course of a hormone called gonadotropin-releasing hormone. Unfortunately, this treatment results in menopausal symptoms, including hot flushes and bone density depletion, and therefore cannot be used for prolonged periods of time. More recently, treatments such as uterine artery embolization, in which the arteries feeding the uterus are blocked off using foreign particles such as gel foam, have been tried as an alternative to hysterectomy, in an attempt to preserve the uterus and avoid major surgery.

Another indication for hysterectomy is in patients who have had recurrent fibroids after myomectomy. A myomectomy is the surgical removal of isolated fibroids, rather than removal of the uterus itself. The benefit is that the uterus can be preserved, although the downside is that fibroids may regrow. Hysterectomy is the definitive treatment for uterine fibroids.

Another noncancerous indication for hysterectomy is adenomyosis, a painful condition whereby the cells of the uterine lining are abnormally embedded in the uterine muscle. No good treatments exist for this condition besides hysterectomy. Another indication for hysterectomy occurs in cases of abnormal uterine bleeding in which the bleeding is refractory to management with nonsurgical treatments, such as birth control pills or procedures that ablate the uterine lining. Other less common indications for hysterectomy are uterine prolapse
(in which the uterus descends into the vaginal canal, causing discomfort or urinary incontinence), chronic pelvic pain (refractory to more conservative management), and large infections of the uterus and pelvis that are unresponsive to antibiotics. Hysterectomy may also be performed as part of a cesarean section if the surgeon encounters uncontrollable bleeding after delivery of the infant.

Uterine cancer

is a clear indication for hysterectomy. Often, the cancer causes abnormal uterine bleeding. Prior to hysterectomy, the cancer has usually been confirmed on biopsy of the uterine lining. If the cancer is small and localized to a small area of the uterus, then removal of the uterus alone may be curative. More often, however, uterine cancer may have spread more deeply into the uterine wall or even grown beyond the uterus. In these cases, hysterectomy may be accompanied by more extensive surgery that includes removing lymph nodes or other pelvic structures.

Most frequently, hysterectomy is accomplished through a 6- to 8-inch midline incision running either down from the navel or across the lower abdomen near or below the hairline (known as a “bikini incision”). This procedure is referred to as an abdominal hysterectomy. Vaginal hysterectomy is the removal of the uterus through the vaginal canal, rather than through a surgical opening in the abdomen. This procedure is most often performed to resolve prolapse (because the uterus has already descended into the vaginal canal) or when the uterus is not massively enlarged and can be pulled down and out through the vagina. If the hysterectomy is performed because of large fibroid tumors, then the abdominal approach is usually used. On rare occasions, a vaginal hysterectomy may be facilitated using laparoscopy. In these cases, laparoscopy enables visualization and manipulation of the uterus via small incisions in
the abdomen to assist in removal of the uterus through the vaginal canal.

During the hysterectomy, the patient is almost always under general anesthesia. The patient lies on her back for abdominal hysterectomies. In vaginal hysterectomies, the patient’s legs are placed in stirrups and the knees are spread apart to enable the gynecologist to gain access to the vaginal canal. The actual removal of the uterus involves clamping, transecting, and suture ligating the blood vessels that feed the uterus and the tissues that anchor the uterus in the pelvic cavity. Care is taken by the surgeon to avoid the ureters, the tubes carrying urine from the kidney to the bladder. The ureters are very close to the lower part of the uterus and can be damaged easily. If the entire uterus is removed, then the top end of the vagina, called the cuff, is sutured closed. If the cervix is left in place, then the top of the cervix is sutured closed.

After the surgery, the patient receives narcotic pain medication and antibiotics to prevent infection and is monitored carefully to confirm that vital signs are stable and recovery is appropriate. Laboratory tests may be performed to ensure that the patient is not unusually anemic and that important organs such as the kidneys are functioning properly. Until a patient is able to walk, a catheter (a rubber tube attached to a collecting bag) will be used to pass urine. Patients may initially take liquids by mouth. When they can tolerate liquids, indicating no apparent injury to the bowels, patients may begin to take solid food. A patient may be hospitalized for two to four days after the hysterectomy, although hospital stays in general have been shortening in length. On the whole, patients who receive vaginal hysterectomies have shorter hospital stays than patients receiving abdominal hysterectomies, assuming that no complications arise. Patients can usually resume normal sexual functioning six weeks after the surgery.

Uses and Complications

Hysterectomy can be used to provide relief from pressure, pain, and bleeding from the uterus. It may also be curative in the early stages of uterine cancer and can increase survival in later stages. For women who are finished with childbearing and whose lifestyles or responsibilities do not allow them to try more conservative treatments, many of which require several months to take effect, hysterectomy can provide definitive relief from symptoms within the defined time period needed to undergo scheduled surgery. In cases of life-threatening uterine hemorrhage, hysterectomy can save a woman’s life.

The common complications of hysterectomy are those which are common to many major surgeries. One complication is excessive blood loss. The average blood loss during a hysterectomy is estimated at between 400 and 500 cubic centimeters (about a pint). When removal of the uterus is difficult, for instance because of the position of large fibroids, increased blood loss is likely to occur. When excessive blood loss is of concern, the patient’s blood levels may be checked during the procedure. A patient who is significantly anemic may receive blood transfusions to avoid poor oxygenation of the major organs and to increase blood volume, and hence avoid shock. The number of transfusions depends on the amount of blood estimated to be lost. If a blood vessel continues to bleed after the patient leaves the operating room, then the patient may need to return to the operating room to have the bleeding vessel identified and sutured.

Another common complication of hysterectomy is infection. Even when aseptic techniques are followed, an infection may develop several days after the surgery. This is particularly true in vaginal hysterectomies, where the surgeon works through the vaginal canal, considered a clean but contaminated field. For this reason, patients are given antibiotics immediately prior to surgery in order to prevent infection. A patient who shows signs of infection after the surgery may be placed on an extended course of antibiotics. The source of these infections can range from the vaginal cuff site to the peritoneum (the lining of the pelvic and abdominal cavity) and the urinary tract.

The third major complication that can occur with hysterectomy is inadvertent damage to internal organs. The urinary tract and the bowels are particularly at risk during hysterectomy because of their proximity to the uterus. The ureters can be occluded inadvertently by the misplacement of a suture. If discovered early, this damage can be repaired. If the problem is not recognized, however, then a damaged ureter can result in kidney malfunction. For this reason, kidney function is carefully followed after the hysterectomy through blood tests. Since the bladder sits on the bottom half of the uterus, it is a common organ that can be damaged during a hysterectomy. If the bladder is accidentally entered using the scalpel during surgery, then it can usually be repaired during the procedure. Postsurgery, the patient may need prolonged catheterization of the bladder to enhance bladder recovery. The large and small intestines are another common site of surgical injury. They can be accidentally cut or sutured. Sometimes, this problem is not detected until after the patient has left the operating room, and the problem becomes apparent when normal
bowel function does not return in a timely fashion postoperatively. The patient may experience nausea, vomiting, and abdominal distension and discomfort and may not be able to pass gas from the rectum.

Another complication that can occur after surgery is the formation of blood clots, particularly in the leg veins, as a result of the patient’s immobility during and after surgery. These clots can be dangerous when they break off from their source and move into the lungs, a condition called pulmonary
embolism.
Large pulmonary emboli can be life-threatening. Pulmonary emboli can be prevented using warm compression stockings during and after surgery to promote blood flow. Early ambulation (walking) after surgery can also decrease the chances of developing leg vein clots and pulmonary emboli.

Long-term complications of hysterectomy also include scar formation in the pelvis, called adhesions, which can interfere with bowel function or cause pelvic pain. Some patients may experience the prolapse of the remaining pelvic organs (such as the bowels and bladder) into the space formerly occupied by the uterus. Procedures may be employed during the hysterectomy to anchor the vaginal cuff and close any spaces where prolapse might occur.

In rare cases, removal of the uterus can inadvertently decrease blood supply to any remaining ovaries, leading to ischemia and loss of ovarian function. In these cases, the patient may experience the symptoms of estrogen deficiency, also known as menopausal symptoms. They include hot flashes, vaginal dryness, and, when estrogen deficiency is prolonged, bone density loss. In women whose hysterectomies included removal of the ovaries, the hot flashes may become apparent a few days after surgery. In these cases, estrogen therapy or other medications may be of benefit.

The impact of a hysterectomy on a woman’s psychological state varies from woman to woman. In women who have been suffering a great deal from their symptoms, be it pressure and pain or abnormal bleeding, a hysterectomy can be a relief and enable them to return to their activities of daily living. Hysterectomy can improve sexual function in many cases. In other women, a hysterectomy can trigger a sense of loss and represent the end of the woman’s fertility, which is often associated with youth and vitality.

Perspective and Prospects

In ancient times, the complaints of women and the illnesses of the female organs were viewed as coming from an “unhappy uterus.” It was believed that the uterus had the primary purpose of childbearing and that, when the uterus was not occupied with this function, it might show its wrath by abnormal bleeding and pain. These beliefs prevailed for centuries; early medical history indicates that women’s gynecologic complaints were largely ignored. Moreover, no safe surgical procedures had been developed.

A noteworthy event in early American medical history was the operation attempted and documented by a frontier physician and surgeon, Ephraim McDowell. In 1809 in Danville, Kentucky, this daring young doctor carried out experimental surgery on a middle-aged woman to remove a huge ovarian tumor. Without the benefit of anesthesia and a sterile technique, he performed successful abdominal surgery on four out of five other patients.

Myomectomy, or removal of a fibroid tumor of the uterus, was the next procedure to be performed—first in France and later (about 1850) in Massachusetts by Washington Atlee. The first hysterectomy was successfully performed by Walter Burnham in the same decade, but he lost twelve of his next fifteen hysterectomy patients. In the text Operative Gynecology (1898), Howard A. Kelly of Baltimore describes one hundred hysterectomies that he performed in the late nineteenth century, all done because of pelvic infection. He lost only four patients, though convalescence for some survivors was prolonged.

Remarkable medical progress occurred in the nineteenth century in abdominal and vaginal surgical techniques. In the 1850s, Marion Sims of South Carolina was the first to perform vaginal surgery in the United States. He successfully repaired a vesicovaginal fistula, an abnormal opening between the bladder and the vagina through which urine escapes into the vagina. In the late nineteenth century, the “Manchester” operation for uterine prolapse
was performed by A. Donald in Manchester, England. Prior to this procedure, uterine prolapse was treated with a pessary, a device inserted into the vagina to hold the uterus in place.

In the 1930s, N. Sproat Heany of Chicago devised the present-day technique of vaginal hysterectomy. Vaginal (as opposed to abdominal) hysterectomy, it was believed, resulted in a less complicated procedure with shorter convalescence and more cosmetically pleasing results for most patients. For some time, vaginal hysterectomy was viewed as superior to abdominal hysterectomy. In the 1970s, between 25 and 40 percent of all hysterectomies were accomplished vaginally, depending on the age of the woman at the time of surgery. In 1981, however, a landmark study published by the US Congress, weighing the costs, risks, and benefits of hysterectomy, stated that women undergoing vaginal hysterectomy are more likely to have postoperative fever and to receive antibiotic treatment. Moreover, vaginal hysterectomy patients may undergo further surgery at a rate as high as 5 to 10 percent.

By the late 1980s and early 1990s, the trend among many gynecologists had shifted away from hysterectomy to more conservative treatments, when possible. Physicians began to question whether hysterectomies were, in some or even in most cases, medically necessary. As more information became available to women regarding alternatives to hysterectomy (a major revenue-producing surgical procedure in the United States), many women became more apt to question their physicians when told that hysterectomy was the only possible solution to their gynecological problems.

Bibliography

Clark, Jan. Hysterectomy and the Alternatives: How to Ask the Right Questions and Explore Other Options. Rev. ed. London: Vermilion, 2000.

Dennerstein, Lorraine, Carl Wood, and Ann Westmore. Hysterectomy: New Options and Advances. 2d ed. New York: Oxford University Press, 1999.

Doherty, Gerard M., and Lawrence W. Way, eds. Current Surgical Diagnosis and Treatment. 12th ed. New York: Lange Medical Books/McGraw-Hill, 2006.

"Hysterectomy." MedlinePlus, February 26, 2012.

"Hysterectomy—Laparoscopic Surgery." Health Library, March 15, 2013.

"Hysterectomy—Open Surgery." Health Library, September 27, 2012.

Ikram, M., M. Saeed, and Shazia Jabeen. "Hysterectomy Comparison of Laparoscopic Assisted Vaginal Versus Total Abdominal Hysterectomy." Professional Medical Journal 19, no. 2 (March/April, 2012): 214–220.

Moore, Michele C., and Caroline M. de Costa. Do You Really Need Surgery? A Sensible Guide to Hysterectomy and Other Procedures for Women. New Brunswick, N.J.: Rutgers University Press, 2004.

Stenchever, Morton A., et al. Comprehensive Gynecology. 5th ed. St. Louis, Mo.: Mosby/Elsevier, 2007.

What is a hip replacement?

Indications and Procedures

The most common reason for hip replacement
surgery is the decline in efficiency of the hip joint that often results from osteoarthritis. Osteoarthritis is a common form of arthritis
that causes joint and bone deterioration, which may lead to the wearing down of cartilage and cause the underlying bones to rub against each other. This may result in severe pain
and stiffness in the affected areas. Other conditions that may lead to the need for hip replacement include rheumatoid arthritis
(a chronic inflammation of the joints), avascular necrosis (loss of bone caused by insufficient blood supply), and
injury.

Generally, physicians may be more inclined to choose less invasive techniques such as physical therapy, medication, or walking
aids before resorting to surgery. In some cases, exercise programs may help reduce hip pain. In addition, if preliminary treatment does not improve the patient’s condition, doctors may use corrective surgery that is not as invasive as hip replacement.

Typically, a candidate for total hip replacement surgery (THR) possesses a hip that has worn out from arthritis, falls, or other conditions. The hip consists of a ball-and-socket joint wherein the head of the femur (thigh bone) fits into the hip socket, or acetabulum. In a normal hip, this arrangement provides for a relatively wide range of motion. For some older adults, however, deterioration caused by arthritis and other conditions reduces the effectiveness of this arrangement, compromising the integrity of the hip socket or the femoral head. This state can lead to extreme discomfort.

Total hip replacement may provide the best long-term relief for these symptoms. Total hip replacement involves the removal of diseased bone tissue and the replacement of that tissue with prostheses (artificial devices used to replace missing body parts). Usually, both the femoral head and the hip socket are replaced. The femoral head is replaced with a metal ball that is attached to a metal stem and placed into the hollow marrow space of the femur. The hip socket is lined with a plastic socket. Other materials have also been used effectively as hip replacements.

In some cases, the surgeon will use cement to bond the artificial parts of the new hip to the bone tissue. This approach has been the traditional method of ensuring that the artificial parts hold. One problem with this method is that over time, cemented hip replacements may lose their bond with the bone tissue. This may result in the need for an additional surgery. However, a cementless hip replacement has been developed. This approach includes a prosthesis that is porous so that bone tissue may grow into the metal pores and keep the prosthesis in place.

Both procedures have strengths and weaknesses. In general, recovery time may be shorter with cemented prostheses, since one does not have to wait for bone growth to attach to the artificial prostheses. However, the potential for long-term deterioration of the replaced hip must be considered. A cemented hip generally lasts about fifteen years. With this in mind, physicians may be more likely to use a cemented prosthesis for patients over the age of seventy. Cementless hip replacement may be more advisable for younger and more active patients. Some physicians have used a combination of approaches, known as a “hybrid” or “mixed” hip. This combination relies on an uncemented socket and a cemented femoral head.

Uses and Complications

Total hip replacements are generally quite successful, with about 98 percent of surgeries proceeding without serious complications. In rare instances, however, complications occur, including blood clots and infections during surgery and hip dislocation or bone fracture after surgery. In addition, in some cases, bone grafts may be used to assist in the restoration of bone defects. In these instances, bone may be obtained from the pelvis or the discarded head of the femur. Other postoperative complications may include some pain and stiffness.

Patients recovering from total hip replacement usually remain in the hospital up to ten days if there are no complications. However, physical therapists may initiate therapy as soon as the day after surgery. Physical therapy involves the use of exercises that will improve recovery. Many patients are able to sit on the edge of their bed, stand, and even walk with assistance as early as two days after surgery. Patients must remember that their artificial hip may not provide the same full range of motion as an undiseased hip. Physical therapists teach patients how to perform daily activities without placing an undue burden on their new hips. This may require learning a new method of sitting, standing, and performing other activities.

While many factors may affect recovery time, full recovery from surgery may take up to six months. At that point, many patients enjoy such activities as walking and swimming. Doctors and physical therapists may discourage patients from participating in such high-impact activities as jogging or playing tennis, which may burden the new hip. Despite these restrictions, many patients are able to perform normal activities without pain and discomfort. Nonetheless, people who have undergone hip replacement surgery are advised to consult with their doctors about proper exercise and activity levels.

Perspective and Prospects

Total hip replacement is one of the most common surgical interventions that older adults face. The American Academy of Orthopedic Surgeons estimates that more than 285,000 hip replacement surgeries are performed in the United States each year. The majority of hip replacements are performed on individuals over the age of sixty-five. One of the reasons for this is that the activity level of older adults is lower than that of younger adults, therefore reducing the concern that the new hip will wear out or fail. However, technological advances have improved the quality of the artificial hip, making hip replacement surgery a more likely intervention for younger adults as well.

Bibliography

A.D.A.M. Medical Encyclopedia. "Hip Joint Replacement." MedlinePlus, June 22, 2012.

Bucholz, Robert, and Joseph A. Buckwalter. “Orthopedic Surgery.” Journal of the American Medical Association 275, no. 23 (June 19, 1996).

Duffey, Timothy P., Elliott Hershman, Richard A. Sanders, and Lori D. Talarico. “Investigating the Subtle and Obvious Causes of Hip Pain.” Patient Care 31, no. 18 (November 15, 1997)..

Dunkin, Mary Anne. “Hip Replacement Surgery.” Arthritis Today 12, no. 2 (March/April, 1998).

Finerman, Gerald A. M., et al., eds. Total Hip Arthroplasty Outcomes. New York: Churchill Livingstone, 1998.

Kellicker, Patricia Griffin. "Hip Replacement." Health Library, May 6, 2013.

Lane, Nancy E., and Daniel J. Wallace. All About Osteoarthritis: The Definitive Resource for Arthritis Patients and Their Families. New York: Oxford University Press, 2002.

MacWilliam, Cynthia H., Marianne U. Yood, James J. Verner, Bruce D. McCarthy, and Richard E. Ward. “Patient-Related Risk Factors That Predict Poor Outcome After Total Hip Replacement.” Health Services Research 31, no. 5 (December, 1996).

Morrey, Bernard, ed. Joint Replacement Arthroplasty. 3d ed. Philadelphia: Churchill Livingstone/Elsevier, 2003.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. "Hip Replacement." National Institutes of Health, April 2012.

OrthoInfo. "Total Hip Replacement." American Academy of Orthopaedic Surgeons, December 2011.

Silber, Irwin. A Patient’s Guide to Knee and Hip Replacement: Everything You Need to Know. New York: Simon & Schuster, 1999.

Trahair, Richard C. S. All About Hip Replacement: A Patient’s Guide. New York: Oxford University Press, 1999.

Van De Graaff, Kent M., and Stuart Ira Fox. Concepts of Human Anatomy and Physiology. 5th ed. Dubuque: Iowa: Wm. C. Brown, 2000.

What is sodium? |

Sodium is one of about one hundred chemical elements, the mineral substances that make up everything in the universe. Sodium is one of the most vital chemical characteristics of animal life, which could not exist without it. Because of sodium's high reactivity—its ability to combine with other elements to form compounds—people have used sodium for a variety of purposes, including to make rock salt, baking soda, and table salt. Though nearly all foods in human diets contain some amount of sodium, consuming too much of it over long periods can cause a range of health problems such as hypertension and kidney disease.

The Chemistry of Sodium

Pure sodium is a semisolid silver metal with a softness and composition like butter. Because it lacks much density—solidity or compactness—sodium is extremely light and can float on water. As with many metals, it conducts, or transmits, electricity and heat extremely well.

The
periodic table of the elements
, a scientific chart containing chemical information for all known elements, reveals more specific facts about sodium. Its chemical symbol, the lettered representation of an element's name, is "Na," which is derived from the ancient Latin word for sodium, natrium. The name "sodium" itself descends from the Latin sodanum, a word that past civilizations gave to a form of sodium that alleviated headaches. English-speaking people later referred to this chemical as “soda.”

The periodic table also provides information about sodium's atomic state. An atom is the most basic chemical unit of everything that exists. One atom of sodium has an atomic number of 11. An element's atomic number is determined by the number of protons and electrons, two types of subatomic particles, contained within one of its atoms. An atom of sodium therefore has eleven of each of these particles.

One of sodium's defining traits is its reactivity. The element is so versatile and so easily combines with other elements that it cannot be found in pure form in nature. Rather, sodium must be chemically extracted from compound substances such as sodium chloride, the rock salt that forms naturally in oceans. Over many years, people around the world have discovered myriad uses for sodium and the range of compounds it can help create.

Human Uses of Sodium

Sodium compounds have been used to create now-commonplace household products such as baking soda (sodium bicarbonate), soda (sodium carbonate), paper and photographs (sodium sulfate), and borax (sodium borate), the chemical used in laundry detergents. Sodium also can be combined with small amounts of the element neon to create sodium vapor lamps. These lights are bright and inexpensive to maintain, which is why they commonly are used in stadiums and on highways.

The most common natural compound of sodium is sodium chloride, composed of sodium and chlorine, the same substance that forms oceanic rock salt. People have used this naturally occurring chemical to manufacture road salt, which is used in winter to melt snow and ice on roads. Sodium chloride also can be mixed with water and applied to pottery and ceramics as a salt glaze finish. A related process involves making substances called frits. Essential components in glassmaking, frits are made from sodium carbonate created from a sodium chloride base.

A highly popular domestic use of sodium chloride is table salt. Salt is used for many culinary purposes, including cooking, baking, preserving perishable foods, and adding extra flavor to prepared meals. Edible salt was an especially valuable commodity in less industrialized times, when countries around the world sometimes raided foreign salt mines to build up their own supplies. Although the human body requires a certain daily amount of sodium, too much can instigate a range of health problems, including increased risk of heart attack and stroke.

Sodium and Health

In proper amounts, sodium is essential to human health. It helps regulate blood pressure and blood volume while also allowing muscles to expand and contract as they should. Healthy foods that contain natural quantities of sodium include milk, celery, beets, and a variety of other vegetables and fruits. Most of the processed foods available in grocery stores and restaurants, however, contain added sodium, which has been cooked or baked into the items and is impossible to separate. Foods generally high in added sodium include snack foods such as potato chips, canned foods, and frozen meats such as sausage and bacon.

Eating any of these foods in excess can raise a person's daily sodium intake to well above the healthy recommended amount. The United States Centers for Disease Control and Prevention (CDC) suggests that healthy adults younger than fifty-one consume no more than 2,300 milligrams of sodium daily. The CDC also urges adults older than fifty-one, especially those with histories of diabetes or heart, liver, or kidney disease, to limit their daily sodium intake to 1,500 milligrams because consuming too much sodium over an extended period can lead to
hypertension
, or high blood pressure. Hypertension strains the body's blood vessels; over time, this strain can increase a person's risk of suffering a heart attack or stroke.

To counteract the negative effects of excess sodium in the body while also contributing to overall good health, people should consume about 4,700 milligrams of potassium a day, according to the CDC. Potassium directly opposes sodium, working to lower blood pressure and ultimately benefit heart health. Foods naturally high in potassium include bananas, potatoes, fresh beans, broccoli, and carrots.

Bibliography

Hamer, Frank, and Hamer, Janet. "Alphabetical Entries." The Potter's Dictionary of Materials and Techniques. 5th ed. London: A&C Black Publishers Ltd., 2004, 342–344. Print.

Krebs, Robert E. "Guide to the Elements." The History and Use of Our Earth's Chemical Elements. 2nd ed. Westport, CT: Greenwood Press, 2006, 50–52. Print.

"Salt." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Web. 23 Dec. 2014. http://www.cdc.gov/salt/

"Sodium in Diet." Medline Plus. U.S. National Library of Medicine. Web. 23 Dec. 2014. http://www.nlm.nih.gov/medlineplus/ency/article/002415.htm

Why does a comet tail form when it nears the sun?

The exact composition of comets varies considerably, but the great majority of them come from the farthest reaches of the solar system and are basically just gigantic dirty snowballs, meaning that they are composed primarily of ice, but also have a few other things mixed in. They're too small to have an atmosphere or any significant gravity, so their cohesion and identity as a comet is dependent entirely upon them staying cold enough to remain...

The exact composition of comets varies considerably, but the great majority of them come from the farthest reaches of the solar system and are basically just gigantic dirty snowballs, meaning that they are composed primarily of ice, but also have a few other things mixed in. They're too small to have an atmosphere or any significant gravity, so their cohesion and identity as a comet is dependent entirely upon them staying cold enough to remain in one piece. This was famously demonstrated by Shoemaker-Levy 9, which shattered into multiple pieces due to the influence of heat and gravity as it entered the inner solar system.

When comets form tails, they actually have two-- one of which is very visible, the other less so. The dust tail is less visible, and tends to more so in the direction that the comet is traveling. The ion tail always points directly toward the sun, no matter what direction the comet is traveling. Both tails can be thought of like steam coming off of the comet as it heats up, and the radiation from the sun interacts with it. Just as when you blow on hot soup and see the steam moving away from your breath, so too is the sun "blowing" on the comet, pushing hot particles away from it as it heats up, and those particles form the tail. These particles, which generally remain on the same orbital path as the comet, are typically responsible for seasonal meteor showers. 

What is stevens-johnson syndrome? |

Causes and Symptoms

Stevens-Johnson syndrome begins with a nonspecific upper respiratory tract infection or after the consumption of a particular drug. The early symptoms last for one to fourteen days and consist of fever, sore throat, headache, cough, body aches, and sometimes vomiting and diarrhea. Subsequently, a flat, red rash (erythema multiforme) breaks out over the face and trunk that later spreads to the rest of the body. Painful blisters form in the center of the rash, and the skin around the blisters is quite loose and rubs off easily. Patients have a headache, fever, weakness (malaise), and a cough that produces thick, pus-filled material.

Blisters can form on the mucous membranes that line the mouth (preventing the patient from eating or drinking), throat, genitals, eyes, and anus. If the urinary tract is involved, then the patient will not be able to urinate. Eye involvement causes the eyes to swell and fill with pus so that they seal shut. Blisters on the surface of the eyes (corneas) can scar them. Lesions in the respiratory tract restrict breathing, and tissue sloughing can cause respiratory collapse. Sores in the digestive tract can cause diarrhea and narrowing of the esophagus. The open, skinless sores are also susceptible to infections.

Stevens-Johnson syndrome is classified according to the percentage of the skin affected. If 10 percent or less of the body surface area detaches, then the patient has Stevens-Johnson syndrome. If 10 to 30 percent of the skin detaches, then the patient has overlapping Stevens-Johnson syndrome/toxic epidermal necrolysis (TEN). If more than 30 percent of the skin is detached, then the patient has TEN.

Drug reactions cause most cases of Stevens-Johnson syndrome. The drugs that may trigger it include antibiotics, such as penicillin, ciprofloxacin, and sulfa drugs; anticonvulsant drugs, such as phenytoin, carbamazepine, and barbiturates; nonsteroidal anti-inflammatory drugs (NSAIDs); the antigout drug allopurinol; the narcolepsy treatment modafinil (Provigil); anti-Human immunodeficiency virus (HIV) drugs; diuretics; and topical ocular medications. Viral, bacterial, fungal, and protozoan infections can also cause the disease, as can various types of cancers. Between one-quarter and one-half of all cases of Stevens-Johnson syndrome are idiopathic, which means that there is no discernable cause. There is also a genetic basis for this disorder.

Diagnosis requires a skin biopsy, which shows extensive cell death, detachment of the upper layer of the skin (epidermis) from the middle layer of the skin (dermis), and infiltration of the skin with particular white blood cells called lymphocytes.

The large amount of skin loss in TEN is similar to a severe burn and is life threatening. Water and salts leak through the denuded areas and can produce organ failure. Infection at the damaged areas is also a major cause of death in TEN patients.

Treatment and Therapy

The most important therapeutic step is to discontinue all drugs suspected of triggering the disease. Management of symptoms is also essential. Mouthwashes can treat oral lesions and allow fluid intake, which, when coupled with the intravenous replacement of fluid and salts, can prevent dehydration and electrolyte imbalance. Skin lesions are treated as burns. Topical anesthetics can reduce pain, and denuded skin areas are covered with saline compresses. Any secondary infection that develops must be rapidly identified and treated.

There is no universally accepted drug treatment for Stevens-Johnson syndrome. Oral corticosteroids appear to help during the first few days, but not after that. In advanced cases of TEN, corticosteroids increase the incidence of complications. Intravenous delivery of antibodies (immunoglobulins) against the Fas ligand that mediates cell death has helped small groups of TEN patients, but this treatment has not been systematically evaluated. Also, drugs that down-regulate the immune system have been used, but too little data exists to evaluate their efficacy properly.

Perspective and Prospects

Stevens-Johnson syndrome was first described in 1922 by Albert Mason Stevens and Frank Chambliss Johnson. They encountered two young boys who showed inflammation of the mucous lining of the cheeks, pus-filled eyes, and the generalized skin blisters that are now commonly associated with the disease. Stevens and Johnson originally thought that the boys suffered from a type of unknown infectious disease. Bernard Thomas named the condition in 1950. The condition gained public attention in 2010 when it contributed to the death of former professional basketball player Manute Bol.

No treatment for Stevens-Johnson syndrome provides consistent benefits to patients in systematic studies. Nevertheless, several treatments have shown promise in small studies. For example, intravenous immunoglobulin treatments, skin grafts, the antitransplant rejection drug cyclosporine, and a blood filtration procedure called plasmapheresis have successfully treated small groups of patients with few complications and little mortality. However, until larger, double-blind, placebo-based studies establish the efficacy of these treatments, they will remain experimental.

Bibliography

Berman, Kevin, et al. "Erythema Multiforme." MedlinePlus, Nov. 20, 2012.

Boyer, Woodrow Allen. Understanding Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Raleigh, N.C.: Lulu Press, 2008.

Kellicker, Patricia, and Peter Lucas. "Erythema Multiforme." Health Library, Sept. 30, 2012.

Koh, Mark-Jean-Aan, and Kwang-Yong Tay. “An Update on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children.” Current Opinion in Pediatrics 21, no. 4 (August, 2009): 505–510.

Parrillo, Steven J. “Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.” Current Allergy and Asthma Reports 7, no. 4 (July, 2007): 243–247.

"Stevens-Johnson Syndrome." Mayo Clinic, Apr. 9, 2011.

Warn, Dana, and Nancy Matharu. Stevens-Johnson Syndrome: A Booklet for Children and Their Families. Vancouver, B.C.: Provincial Health Services Authority, 2006.

What is prescription drug addiction?

Causes

When used as prescribed, prescription drugs can help to improve the quality of life for people with chronic pain or chronic health conditions, such as attention deficit hyperactivity disorder (ADHD), narcolepsy, anxiety, or sleep disorders. However, when used long term, some prescription drugs can lead to drug abuse and addiction.

Most people take prescription medications as they are prescribed, but according to the National Institute on Drug Abuse, a growing number of people are taking prescription medications for nonmedical reasons, and such abuse can lead to addiction. It is unclear why prescription drug abuse is on the rise. One theory is that prescription medications have become more accessible. More drugs are being prescribed than ever before, and pharmacies on the Internet have made it easy for people to obtain prescription drugs, even without a prescription. Some people also mistakenly believe that because prescription medications are prescribed for medical reasons, they are safer alternatives to street drugs.

Opioids. When used as prescribed, opioids are intended to treat pain in persons with chronic health conditions such as cancer, back pain, arthritis, muscle or bone pain, diabetic neuropathy, phantom limb pain, and pain caused by injuries that are slow to heal. Opioids also are used to treat severe short-term pain from surgical procedures, injuries, or painful medical conditions, such as shingles.

Opioids block the nerve receptors in the body that cause a person to perceive pain. They also affect the regions of the brain that perceive pleasure, which results in an initial feeling of euphoria followed by a calm, drowsy feeling. As a result, many people use them to feel good or to get high, to relieve stress, or to relax in social situations.

Central nervous system (CNS) depressants. CNS depressants, which are used to treat anxiety disorders, sleep disorders, muscle tension, and seizure disorders, slow brain function and produce a calm, drowsy effect. They are often used to get high, to relieve stress, to relax in social situations, or to counteract the effects of other drugs, such as stimulants.

Stimulants. Stimulant medications, which are used for the treatment of ADHD or narcolepsy, increase alertness, energy, and attention. When taken as prescribed, stimulant medications slowly increase the production of dopamine—a neurotransmitter that is responsible for feelings of pleasure—in the brain. However, when taken in higher than normal doses or by routes other than oral, they can cause a rapid increase in dopamine, which results in a feeling of euphoria. Stimulant medications are often used to get high or to decrease appetite.

Risk Factors

Risk factors for prescription drug addiction may include a genetic predisposition to addiction, but people who are not genetically predisposed to addiction can still become addicted. Other factors contribute to prescription drug addiction, including early onset of drug abuse (teenage years or early twenties); addictions to other substances, either past or present; peer pressure; and easy access to prescription drugs.

Symptoms

Symptoms of prescription drug addiction will depend, somewhat, on the type of drug to which the person is addicted. However, symptoms that are common to all prescription drug addictions include taking a higher dose of the medication than what the doctor prescribed or taking the medication more frequently than called for by the prescription. People who are addicted to prescription drugs may find themselves calling the doctor’s office more frequently for refills or asking the physician to prescribe higher doses.

Opioids. In addition to increasing the medication’s dose and frequency without permission from the doctor, opioid addicts have the following symptoms from use: constipation, excessive sleeping, depression, confusion, slurred speech, poor coordination, itching, tiny pupils, paranoia, excessive sweating, poor judgment, low blood pressure, and shallow breathing.

CNS depressants. Symptoms of addiction to CNS depressants may include drowsiness or excessive sleeping, slurred speech, depression, confusion, unsteady gait, lack of coordination, impaired memory, poor judgment, slowed breathing, low blood pressure, and involuntary rapid eye movements.

Stimulants. A person who is addicted to stimulant medications may experience weight loss, staying awake for long periods of time, irritability, mood swings, excessive energy, poor judgment, bloodshot eyes, high blood pressure, rapid or irregular heartbeat, dangerously high body temperatures, anxiety, paranoia, and seizures.

People who are addicted to prescription drugs may do things that they would not do otherwise. For example, to get more drugs or money to buy more drugs, people who are addicted to prescription medications might seek prescriptions from more than one doctor (a practice known as doctor shopping), steal money or items that they can sell for money, forge prescriptions, or engage in prostitution for money.

When people who are addicted to prescription drugs run out of drugs and are unable to get more, they may experience withdrawal symptoms. Symptoms of opioid withdrawal include fever, chills, shaking, stomach cramps, nausea or vomiting, diarrhea, muscle aches, increased sensitivity to pain, insomnia, watery eyes, runny nose, irritability, and panic. Symptoms of CNS depressant withdrawal include anxiety, insomnia, tremors, weakness, delirium, and seizures. Symptoms of stimulant withdrawal include intense cravings, irritability, headaches, nausea, vomiting, mood swings, anxiety, depression, increased appetite, fatigue, shaking, sweating, insomnia, and confusion.

Prescription drug addiction can lead to a number of complications, especially when the drugs are taken in large doses or combined with alcohol or other drugs. Opioids can increase a person’s risk of choking. They also can slow breathing. If taken in large doses or used in combination with alcohol, antihistamines, barbiturates, or benzodiazepines, opioids can lead to respiratory depression, a life-threatening condition that can slow a person’s breathing to a point where breathing may actually stop.

CNS depressants can cause memory problems and can also affect body temperature. If taken in large doses or used in combination with other substances that may cause drowsiness, such as alcohol, opioids, antihistamines, and some over-the-counter cold medications, CNS depressants can lead to respiratory depression, coma, and death.

Stimulant medications can cause increased blood pressure, irregular heart rate, increased body temperature, and a decrease in appetite, which can lead to malnutrition. In large doses, they can cause seizures, paranoia, or hallucinations, and stroke. If taken with certain over-the-counter cold medications, stimulant medications may raise blood pressure to a dangerously high level. They also may cause irregular heart rhythms.

Addiction to prescription medications may have other consequences, in addition to physical complications. For example, driving while under the influence can lead to a motor vehicle accident or arrest. Prescription drug addiction can also have an adverse effect on school or work performance.

Screening and Diagnosis

Physicians are in a unique position not only to screen patients for prescription drug abuse but also to help them recognize when they have a problem, to set recovery goals, and to seek treatment. Diagnosis of prescription drug addiction is usually based on the patient’s symptoms and medical history.

Health care providers may screen patients by asking about past or present substance use or abuse, and by asking about current medication use, including the dosage, frequency, reason for use, and for what period of time the person has been taking the medication. Blood and urine tests also may be used to determine what prescription medications a patient has been taking and to track treatment progress.

Pharmacists can help screen patients for prescription drug addiction by checking prescriptions closely to see if they may have been forged or modified and by watching for multiple prescriptions from different doctors. Pharmacists also can alert nearby pharmacies when fraud or doctor shopping has been detected.

Treatment and Therapy

Prescription drug addiction is a treatable condition. The type of treatment will depend on the type of drug to which the person is addicted and on the needs of the individual. Successful treatment programs are usually a combination of detoxification, counseling, and, in some cases, medications. Many people go through more than one round of treatment before they are able to fully recover from their addiction.

Opioids. Initial treatment for opioid addiction may include medications to help alleviate the symptoms of withdrawal. Methadone and buprenorphine, both synthetic opioids, are the most commonly used drugs to treat symptoms of opioid withdrawal. Both are highly regulated drugs that are usually prescribed to people who are enrolled in a treatment program for opioid addiction.

Methadone and buprenorphine ease withdrawal symptoms and relieve cravings. Methadone has been used for decades to treat opioid addiction. Buprenorphine was approved by the US Food and Drug Administration for the treatment of opioid dependence in 2002. Patients will need medical supervision during treatment for opioid withdrawal.

Counseling following treatment for opioid withdrawal symptoms can help patients learn to function without drugs, handle drug cravings, and avoid people and situations that could lead to relapse. Support groups and twelve-step programs such as Narcotics Anonymous can help with the treatment of opioid addiction and with the adjustment to a new, drug-free lifestyle.

CNS depressants. People who are addicted to CNS depressants should not abruptly stop taking the medication because withdrawal from CNS depressants can be life-threatening. Instead, the medication dose must be gradually tapered until it is safe to stop taking the drug altogether. Patients will need medical supervision during treatment for withdrawal from CNS depressants. After the patient has been successfully weaned from the drug, cognitive-behavioral therapy can help the recovering addict to increase his or her coping skills, thereby eliminating the perceived need for the drug.

People who are addicted to CNS depressants often have coaddictions, such as alcoholism, so approaches to treatment must address all addictions. Support groups and twelve-step programs such as Narcotics Anonymous also can help with the treatment of addiction to CNS depressants.

Stimulants. There are no medications to help alleviate withdrawal symptoms in patients who are addicted to prescription stimulants. One approach is to slowly decrease the dosage until the patient has been weaned. Patients will need medical supervision during treatment for withdrawal from stimulant medications. Once the patient has stopped taking the medication, behavioral therapy is often used to help patients recognize risky situations, avoid drug use, and more effectively cope with problems.

Another treatment that has been proven effective for stimulant addiction is contingency management. During contingency management, patients are given vouchers for drug-free urine tests. The vouchers can be exchanged for rewards that promote healthy living. Support groups and twelve-step programs such as Narcotics Anonymous also can help with the treatment of prescription stimulant addiction.

Prevention

Most people who take prescription medications as prescribed do not become addicted. There are some steps that people can take to decrease their risk of addiction, including the following:

• Ask if the medication being prescribed is addictive and if there are any alternative medications.

• Follow the directions on the medication label without exception.

• Avoid increasing a medication dose without discussing it with the health care provider who prescribed the medication.

• Avoid taking medication that was prescribed for someone else.

Parents too can take steps to help ensure that their children do not become addicted to prescription drugs. Preventive steps include keeping prescription medications in a locked cabinet; discussing with children the dangers of prescription medications, including the dangers of sharing medications with others; and properly disposing of prescription medications.

Pharmacists can help prevent prescription drug addiction by giving patients clear information about how medications should be taken and by providing information about potential side effects or drug interactions. Prescribers can help to prevent prescription drug addiction by noting increases in the amount of drug a patient needs to get the same therapeutic effect and by tracking frequent requests for refills.

Bibliography

Fishbain, D. A., et al. “What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review.” Pain Medicine 9.4 (2008): 444–59. Print.

Lewis, Todd F. "Prescription Drug Addiction." Treatment Strategies for Substance and Process Addictions. 127–47. Alexandria: American Counseling Association, 2015. PsycINFO. Web. 2 Nov. 2015.

McCabe, S. E., C. J. Teter, and C. J. Boyd. “Medical Use, Illicit Use, and Diversion of Abusable Prescription Drugs.” Journal of American College Health 54.5 (2006): 269–78. Print.

National Institute on Drug Abuse. “Prescription and Over-the-Counter Medications.” June 2009. Web. 30 Oct. 2015. http://www.nida.nih.gov/infofacts/PainMed.html.

National Institute on Drug Abuse. “Prescription Drugs: Abuse and Addiction.” Oct. 2011. Web. 30 Oct. 2015. http://www.nida.nih.gov/researchreports/prescription/prescription6.html.

Waters, Rosa. Prescription Painkillers: Oxycontin, Percocet, Vicodin, and Other Addictive Analgesics. Broomall: Mason Crest, 2015. Print.

What is penis envy? |

Introduction

Sigmund Freud
, the Austrian founder of psychoanalysis, formulated a theory of psychosexual development. The energy that drove this development was called libido, sexualized energy. This theory was biologically oriented and rested on the assumption that the goal of female development was to achieve what the male possessed, namely a penis. Freud believed that discovering the absence of a penis caused profound emotional injury and became the basis for future personality development in the female.

Freud’s Biological Theory

In 1905, in “Three Essays on the Theory of Sexuality,” Freud stated that girls notice that boys have penises and, as a result, experience intense feelings of envy and wish to be boys. Later he added that both boys and girls develop a sexual theory in which both originally had a penis, and boys assume that girls originally possessed a penis but lost it through castration. This fear in boys of meeting the same fate leads to the resolution of the Oedipus complex, with the boy relinquishing his sexual feelings toward his mother and identifying with his father. Males then adopt a low opinion of females due to their lack of penises.

This envy that girls experience is supposed to profoundly influence their future personality development in several ways. Overcome by powerful feelings of envy, they feel unfairly treated. According to Freud, anatomy is destiny, in that girls want to possess the male sex organ. First they seize on the idea that the clitoris can serve as a penis substitute. Eventually, they are forced to concede that the clitoris is not an adequate substitute and experience a profound trauma as a result. One of the possible outcomes of this trauma is the development of the masculine protest. Girls may assume masculine personality characteristics or, as adults, may withdraw from sexual experience entirely to avoid powerful feelings of inadequacy.

When girls discover that all females lack a penis, hostility develops toward the mother, who is seen as having deprived them of this sex organ. They then wish for their father to give them either a penis or a baby, which serves as a penis substitute. The discovery of this wish was considered critical by Freud, who viewed it as a sign that bedrock had been reached in psychoanalytic treatment and that termination was at hand.

Another example of the importance that Freud placed on penis envy was his postulating a direct connection between masochism (the sexual pleasure derived from pain) and female personality development. In his attempt to demonstrate this connection, he selected penis envy as the first experience leading to this conclusion.

Post-Freudian Elaboration

Erik H. Erikson
, a pupil of Freud's who emigrated to the United States, combined ego psychology with what he called life-span theory. In this theory, drives or instincts are significant, but the emphasis is on interaction with the significant people in one’s own environment. Erikson accepted Freud’s formulation that girls experience trauma at discovering their lack of a penis, but he differed from Freud in that he emphasized not abnormal behavior but rather the healthy, adaptive processes in the ego of the girl. He shifted away from the trauma of loss to the healthy ego resources that lead to a woman having a positive view of herself. Anatomy was important to Erikson because it provides a framework for male and female experience, but group membership, history, and individual personality all contribute to female personality development. He felt that while male and female ego processes have much in common, the differences in male and female experience and development should be identified and studied.

Karen Horney
, a German-born psychoanalyst who emigrated to the United States, felt that this model was too restrictive and needed to expand to include the role of culture in personality development. She recognized that it was entirely possible that girls experience some feelings of envy due to their lack of a penis. However, she also noticed in her clinical practice that boys also experience envy in relation to girls. She found that boys envied girls’ breasts and their ability to produce children when adult.

Horney stated that, in classical psychoanalysis, the libidinal development of women was evaluated from a male perspective, and she questioned whether, since observations are gender influenced, these formulations could be accurate. She emphasized that basing female development on male standards was at best incomplete, since female development includes events not found in male development, such as pregnancy and childbirth.

Horney stated that some penis envy may be entirely normal. Having the opportunity to contact his genitals through urination, the boy may find it easier to satisfy his sexual curiosity; the fact that the boy routinely contacts his genitals may make it more acceptable to take the steps toward masturbation. However, she felt that these feelings of envy in women would ordinarily not lead to feelings of inferiority or the development of the masculine protest. She found that Freud’s formulation of the masculine protest was based on his study of neurotic women.

Horney stated that conditions other than penis envy would be necessary for a female to reject her gender. One such condition was if the father rejected his daughter’s femaleness. Another condition was if the mother projected such a negative image of the female role that the girl did not wish to identify with that image.

Horney emphasized that culture plays a significant role in female personality development. She felt that girls are often subtly and sometimes harshly made to feel inferior and that due to the masculine nature of the culture, girls may be excluded from occupations and other opportunities, which would contribute to feelings of inferiority. She pointed out that in a culture that demeans women sexually, makes it unacceptable for women to be assertive, and makes it difficult for women to be economically independent, it would be easier for women to feel inferior, not because of a lack of a penis, but because of the prevailing attitudes that culture holds toward women.

Bibliography

Balsam, Rosemary. "Freud, Females, Childbirth, and Dissidence: Margarete Hilferding, Karen Horney, and Otto Rank." Psychoanalytic Review 100.5 (2013): 695–716. Print.

Bayne, Emma. "Womb Envy: The Cause of Misogyny and Even Male Achievement?" Women's Studies International Forum 34.2 (2011): 151–60. Print.

Blanton, Smiley. Diary of My Analysis with Sigmund Freud. New York: Hawthorn, 1972. Print.

Erikson, Erik H. Childhood and Society. Rev. ed. New York: Norton, 1995. Print.

Freud, Sigmund. The Standard Edition of the Complete Psychological Works of Sigmund Freud. Ed. James Strachey. 24 vols. London: Hogarth, 1953–74. Print.

Horney, Karen. Feminine Psychology. 1967. New York: Norton, 1993. Print.

Monte, Christopher. Beneath the Mask: An Introduction to Theories of Personality. 8th ed. Hoboken: Wiley, 2009. Print.

Starr, Karen E., and Lewis Aron. "Women on the Couch: Genital Stimulation and the Birth of Psychoanalysis." Psychoanalytic Dialogues 21.4 (2011): 373–92. Print.

What is lego therapy? |

LEGO is the brand name of a popular series of construction toys produced by the Danish company LEGO Group and sold internationally. LEGO toys use plastic pieces, known as bricks, to create a variety of objects, including buildings, vehicles, and items/scenes representing popular film franchises. LEGO therapy is a set of therapeutic techniques and group-based tasks that use LEGO blocks or similar toy construction block products to encourage social interaction and verbal and nonverbal communication among children with developmental disorders.

LEGO therapy has been embraced as an emerging tool for coping with autism and autism spectrum disorder (ASD), a group of lifelong neurodevelopmental disorders that among other things are characterized by cognitive impairment and difficulties with social interactions and communicating verbally and nonverbally. Since LEGO therapy was first integrated into ASD play therapy models in the 1990s, variations on the technique have spread throughout Europe and North America and are now used in a variety of play-therapy settings to teach a variety of skills to infants, children, and adolescents with ASD.

Background

The earliest research studies in LEGO therapy were published by Dr. Daniel LeGoff, who is credited as the technique’s forerunner and who is a specialist in pediatric neuropsychology and in the assessment and treatment of neurodevelopmental and neurobehavioral conditions in infants and children. LeGoff ’s inspiration for LEGO therapy came from a coincidental encounter between two patients who both happened to bring LEGO creations to his waiting area on the same day. Though the two young boys, both with Asperger syndrome, seemed to ignore each other during previous meetings, they became interested in interacting when each arrived with LEGO models. LeGoff was inspired to use this interest in LEGO creations to form a new play therapy technique.

In his 2004 research paper on the subject, LeGoff describes the basic model for his method of LEGO therapy, which involves the formation of small interactive groups that cooperate to complete LEGO-based projects. Each participant is given individual and joint roles within the group and is asked to follow interactive rules that help guide the ways in which they interact with others in the group. In addition to group interactions, each participant is encouraged to use LEGO blocks individually. Group members also intermittently interact with therapists who help with the development and use of attention skills, turn taking, eye contact while communicating, and conversation skills. LeGoff’s initial study involved forty-seven children and took place over twelve weeks. The study indicated that participants made statistically significant gains in interactivity with one another and with therapists, including in the frequency of self-initiated interactions with other group members and in the duration of a typical interaction. In 2006, the journal Autism published further research by LeGoff and colleagues, including a three-year follow-up evaluation of participants in original LEGO therapy projects. According to the follow-up study, participants in LEGO therapy programs achieved significantly higher levels of improvement than did patients with autism spectrum disorder who participated in alternative, non-LEGO therapeutic programs. Since the late 2000s, a large number of ASD support and research organizations have adopted LEGO therapy as an alternative or a supplementary tool in treating brain development disorders.

Impact

In 2014, researchers studying and evaluating LEGO-based therapy as a method for treating autism spectrum disorders include Dr. Gina Gómez de la Cuesta, a former LeGoff student and a graduate of the Cambridge University Autism Research Centre; Dr. G. W. Krauss of the Y.A.L.E. Schools, a group of schools in New Jersey and Pennsylvania for students with developmental and learning disabilities; and Dr. Chris Rogers of the Center for Engineering Education and Outreach (CEEO) at Boston’s Tufts University. Rogers pioneered a study using LEGO robotics products in therapeutic workshops. In addition, the National Autistic Society of England and the Autism Research Centre have adopted LEGO therapy into their recommended treatment options for ASD patients.

In 2014, LeGoff and others collaborated on the book LEGO
®
-Based Therapy: How to Build Social Competence through LEGO
®
-Based Clubs for Children with Autism and Related Conditions. The book provides instructional guidance for ASD therapists and educators and describes the process of integrating LEGO-based therapy programs into treatment options. Detailed descriptions are also given on how to lead individual and group LEGO therapy sessions. The process begins by introducing prospective members of LEGO clubs to the rules and basic skills needed to start building with LEGO or similar construction blocks. Participants are then gathered into small groups, called LEGO Clubs, containing some individuals with ASD as well as others who do not have diagnosed functional disorders. The groups meet regularly (once a week is recommended) for ninety-minute sessions in order to fully participate in collaborative building projects.

An important component of LEGO therapy is the division of the group into various roles, which include supplier, builder, director, and engineer. For instance, some participants may be assigned to connect LEGO blocks together, while another member may be assigned to sort and organize the brick supply by color and size, and another individual may be assigned to design and plan the overall project. During the course of the program, roles are rotated among group members. This allows participants to experiment with, be exposed to, and learn to interact with other group members using verbal and nonverbal communication skills. Therapists are encouraged to create systems that allow for positive reinforcement to be given in the form of rewards and praise, which will encourage individual members and the group as a whole to work toward achieving various group goals.

LEGO therapy makes use of the tendency of many with ASD to gravitate toward systematic and repetitive activities, which then encourages continued involvement in the LEGO therapy groups and marked improvement in communication and social skills. As therapy sessions advance, participants have the opportunity to practice communicating emotions and desires to their group members and to therapists who oversee the groups. Behavior is then modified in order to engage more positively and appropriately with the group.

Research on the benefits of LEGO therapy is ongoing and has been used in the robotics field with a humanoid robot in order to study human-robot interactions and the potential benefits of robotics therapy. The study found that long-term use of LEGO therapy involving a humanoid robot resulted in significant improvement in interactive parameters among participants.

LEGO therapy is a relatively recent technique in play therapy for individuals with ASD, and additional studies are required to evaluate the potential of this and similar therapeutic methods. While LEGO therapy has been used primarily throughout North America and in some parts of Europe, the practice and acceptance of the technique has begun to spread internationally. Given the low initial investment and ease of implementation, LEGO therapy has the potential to become a common tool in treating ASD.

Bibliography

Barakova, Emilia I., et al. "Long-Term LEGO Therapy with Humanoid Robot for Children with ASD." Wiley Online Library. John Wiley, 13 Nov. 2014. Web. 21. Nov. 2014.

LeGoff, Daniel B. "Use of LEGO® as a Therapeutic Medium for Improving Social Competence." Journal of Autism and Developmental Disorders 34.5(2004): 557–71. Print.

LeGoff, Daniel B., and Michael Sherman. "Long-Term Outcome of Social Skills Intervention Based on Interactive LEGO® Play." Autism 10.4 (2006): 317–29. Print.

LeGoff, Daniel B., et al. LEGO
®
-Based Therapy: How to Build Social Competence through LEGO
®
-Based Clubs for Children with Autism and Related Conditions. Philadelphia: Jessica Kingsley, 2014. Print.

"LEGO Therapy Expands at Y.A.L.E." Y.A.L.E. School. Y.A.L.E. School, 16 May 2011. Web. 21 Nov. 2014.

"Lego Therapy Offered to Children with Autism." BBC. BBC, 7 Aug. 2014. Web. 21 Nov. 2014.

"LEGO Therapy." ASDAID. ASD AID, n.d. Web. 21 Nov. 2014.

McCullough, Marie. "Legos: Building Blocks in Autism Therapy." OC Register. Orange County Register, 21 Aug. 2013. Web. 21 Nov. 2014.