What is hearing loss? |

Causes and Symptoms

The causes of hearing loss vary, although three major factors enhance the progression of loss as one ages: exposure to noise, previous middle-ear disease, and vascular disease. There are basically two types of hearing loss, conductive hearing loss and sensorineural hearing loss. Conductive hearing loss
results from interference with sound vibration through the external and middle ear. In other words, the sound cannot get to the inner ear. In some types of conductive hearing loss, if the sound amplitude is increased enough, then the person may be able to hear. Possible reasons for conductive hearing loss include impacted or large amounts of cerumen (wax) in the ear, foreign bodies (such as soap, food, or insects) in the ear canal, otitis media (middle-ear infection), rheumatoid arthritis, and otosclerosis, in which the stapes becomes fixed to the oval window of the cochlea. Sensorineural hearing loss is caused by damage to the inner ear, the auditory nerve, or the brain.

Earwax buildup is a common and treatable cause of conductive hearing loss. There have been reports that as much as 25 percent of nursing home residents have impacted cerumen. Older adults can be taught how to remove the wax on their own. Cerumenex (by prescription only) and Debrox (sold without a prescription) can be used as directed, followed by lavage to remove the wax and residual medication. Some health care providers recommend the instillation of mineral oil into the ear canal twenty-four hours before removal to help soften the wax, followed by lavage with one part hydrogen peroxide to three parts water at room temperature.

Sensorineural hearing loss
means the presence of disease anywhere from the organ of Corti to the brain. The result is loss of hearing high tones, for it is the hair
cells in the basal curvature of the organ of Corti that are sensitive to high tones. Presbycusis is sensorineural hearing loss caused by aging
of the inner ear. The onset of presbycusis may begin anytime from the third to the sixth decade of life, depending on type. Presbycusis affects more than 50 percent of individuals over age sixty-five. Older adults suffering from these disturbances show distinct and differing audiograms, which are used clinically to diagnose types of impairment. The standard type of presbycusis with hearing loss at high Hertz is often associated with sensory and neural presbycusis. There are four types of presbycusis: sensory, neural, metabolic, and cochlear conductive.

The elderly first start to lose hearing in the high-frequency range. High-frequency consonants and sibilants become more difficult to recognize—for example, f, g, l, t, s, ch, sh, and th. In presbycusis, high-frequency sounds become unintelligible. Understanding spoken words depends largely on the clear perception of high-frequency consonants rather than low-frequency vowel sounds. This is why words starting with the above letters or combinations become unintelligible. Many times, older adults have both conductive and sensorineural frequency losses. The precise cause of the defect requires help from a specialist and the use of sophisticated audiometric testing.

The sound waves that travel through the ear have two main characteristics, frequency and amplitude. Frequency is related to the pitch of a sound and is measured by the number of vibrations or cycles per second. The higher the vibration frequency, the higher the perceived pitch of the sound. Hertz (Hz) is the unit of measurement to denote cycles per second. Amplitude is related to the loudness of a sound. The greater the intensity with which a sound strikes the eardrum, the louder the tone. The unit of measurement of intensity of sound is decibels (dB).

Among the offenders to hearing are radio headphones, lawn mowers, diesel trucks, heavy machinery, and loud music. A single very loud noise can damage the middle ear. An eardrum can be broken by sounds reaching 160 decibels to 1,000 Hertz. Also, continuous noise of more than 80 to 85 decibels can cause harm to hearing. Normal conversation is measured at 60 decibels. A noisy restaurant, a vacuum cleaner, an electric shaver, and a screaming child can reach decibels between 80 and 85 decibels. Louder everyday noises include a blow-dryer (100 decibels), a subway train (100 decibels), and a car horn (110 decibels). Anyone exposed to noise in the 80 decibel range should wear hearing protection.

Another common hearing problem is tinnitus
(ringing in the ears). Medications such as aspirin, aminoglycoside antibiotics, and diuretics can cause toxic effects to the hair cells of the organ of Corti, thereby resulting in sensorineural hearing loss. Tinnitus, an internal noise generated within the hearing system, occurs in many types of hearing disorders at all ages, but it is reported more frequently in the elderly. Tinnitus affects seven million people, of which 10 to 37 percent are elderly, and that number is growing. The ringing sound is generally high pitched with sensorineural loss and low pitched with conductive hearing loss. However, tinnitus may be present with or without hearing loss. Some types of tinnitus do not usually awaken people out of sleep nor do they interfere with leisure activities. Older adults can attempt to alleviate the condition through biofeedback or by disguising the sound. Soft radio music and other distracting sounds may offer some comfort.

Treatment and Therapy

There are many treatments for hearing loss and, depending on the type of loss, some treatments work better than others. For example, with conductive hearing loss, if the cause is excessive earwax buildup, then the results can be remarkable when the wax is removed. For both types of hearing loss, conductive and sensorineural, simple measures can be used to facilitate better communication.

One technique that can help in communicating with someone with hearing loss is facing the person when speaking, so that he or she can see one’s face and lips. Using simple, short sentences or phrases and speaking slowly in a low voice can be helpful. Loudness is not helpful and can be irritating, whereas a low voice enables people to hear lower frequencies, which usually can be heard more easily.

Although hearing aids
may help certain types of hearing loss, many people do not like to use them. A person wearing such a device for the first time needs to go through an adjustment period, and some older adults do not give themselves enough time to get used to the hearing aid. Some hearing aids have been known to cause irritation to the external ear. Also, the increased humidity within the external auditory canal may cause infectious otitis externa.

There are basically three kinds of hearing aids: the body type, the behind-the-ear-type, and in-the-ear type. The body type resembles a handheld amplifier with a wire that attaches to an earpiece. The behind-the-ear type is worn behind and in the ear. A person with poor eyesight and rheumatoid arthritis would probably benefit from the body type or behind-the-ear type. These types are easier to see and handle because of their larger size. The in-the-ear devices are small and cosmetically more acceptable, but they are more difficult to manipulate. The selection often depends on the wearer’s personal preference, vision capabilities, and manual dexterity.

It takes time to adjust to using a hearing aid. Sounds and voices are made louder, not clearer. The wearer must become accustomed to the background noise. Often, the user must be encouraged to continue using the hearing aid during this adjustment period. The greatest satisfaction is achieved with hearing aids if hearing loss is between 55 and 80 decibels. There is only partial benefit if the loss is greater than 80 decibels.

Perspective and Prospects

Hearing is regarded by some to be the most important of the five senses. It is imperative for people to protect their hearing for as long as they can. In today’s world, where excessive noises are bombarding eardrums everyday, people need to protect themselves.

Hearing loss occurs when hair cells in the ear are damaged or destroyed by excessively loud noise or moderately loud noise for prolonged periods of time. Hearing loss usually occurs gradually and without pain. Over time, sounds become muffled and higher frequency sounds become hard to distinguish. Normal conversation occurs around 60 decibels. Anything higher than 60 decibels for extended periods of time may lead to hearing loss. According to the Ear Institute in Los Angeles, about 30 percent of hearing loss is due to exposure to loud sounds.

There are ways to reduce excessive noise levels in the environment. First, the time exposed to loud noises should be limited. This can be accomplished by removing the sound or decreasing the volume. The popular audio products now on the market can pose a risk to hearing. Most people are not aware of the potential dangers of listening to music at high volumes. A person listening to music by wearing earphones should not be heard by the person standing next to them. Similarly, a loud device such as a vacuum cleaner should be operated for no more than ten minutes at a time, with a five-minute break between uses.

It is interesting to note that hearing loss results from both loudness and time exposure. For example, a one-time gunshot noise near the ear can be just as damaging as extended exposure to loud music at 120 decibels for fifteen minutes or more. Anyone working in an environment that reaches noise levels of more than 85 decibels for extended periods of time should wear protective devices. Earplugs and hearing protection devices are needed for construction workers, traffic personnel, musicians, disc jockeys, air traffic personnel, nightclub employees and patrons, or anyone exposed to loud noises.

Scientists are conducting research to discover whether damaged hair cells of the ear are capable of rebuilding their structure over a forty-eight-hour period (the time that it takes for hearing to return after a temporary loss). Researchers speculate that permanent hearing loss may occur when self-repair mechanisms are compromised.

Scientists are studying blood flow in the cochlear section of the ear to evaluate how drugs may affect hair cells. Researchers are also examining blood flow to the cochlea when people are exposed to conversational sound and loud sounds. It seems that when a person is exposed to loud sounds, the blood flow in the cochlea drops. Drugs that are used to treat blood flow problems, such as in peripheral vascular disease, may show a benefit to maintaining blood flow to the cochlea. These and other drug therapies may show promising results in helping people with hearing loss. Finally, with a reduction in harmful noise, hearing loss will decrease.

Bibliography

Carmen, Richard, ed. The Consumer Handbook on Hearing Loss and Hearing Aids: A Bridge to Healing. 3d rev. ed. Sedona, Ariz.: Auricle Ink, 2009.

Carson-DeWitt, Rosalyn. "Hearing Loss." Health Library, September 10, 2012.

Craine, Michael. Hear Well Again: A Step by Step Program to Better Hearing. Chapel Hill, N.C.: Professional Press, 1999.

Gallo, Joseph J., et al., eds. Handbook of Geriatric Assessment. 4th ed. Sudbury, Mass.: Jones and Bartlett, 2006.

"Hearing Loss." Medline Plus, May 22, 2012.

"Hearing Loss." National Institute on Aging, April 30, 2013.

Mahoney, Janet. “Hearing Loss and Assessment: A Concern for All.” Nursing Spectrum 13, no. 1 (January 10, 2000).

Paterson, J. “What You Need to Know About Hearing Loss.” USA Weekend, November 21, 1997.

Shelp, Scott G. “Your Patient Is Deaf, Now What?” RN 60, no. 2 (February, 1997): 37–41.

Tabloski, Patricia A. Gerontological Nursing. 2d ed. Upper Saddle River, N.J.: Pearson, 2010.

Why does Gatsby fail to convince Daisy to leave Tom?

Gatsby fails to convince Daisy Buchanan to leave her husband, Tom, because Tom reveals how Gatsby made his fortune. Daisy tells Tom that she is going to leave him, but then Tom says he found out Gatsby and his crony, Meyer Wolfsheim, purchased a bunch of drug-stores so that they could sell grain alcohol over the counter. This is illegal because the novel takes place during the era known as Prohibition, so it is a...

Gatsby fails to convince Daisy Buchanan to leave her husband, Tom, because Tom reveals how Gatsby made his fortune. Daisy tells Tom that she is going to leave him, but then Tom says he found out Gatsby and his crony, Meyer Wolfsheim, purchased a bunch of drug-stores so that they could sell grain alcohol over the counter. This is illegal because the novel takes place during the era known as Prohibition, so it is a criminal activity to distribute or sell alcohol. 

Tom also reveals that Gatsby and Wolfsheim let Tom's friend take the fall on something and go to prison for a month; this friend could, apparently, reveal more secrets about them if Wolfsheim hadn't scared him out of it. Finally, Tom says that "That drug-store business was just small change. . . but [Gatsby's] got something on now that [Tom's friend is] afraid to tell [Tom] about." At this point, Daisy loses her nerve. Nick narrates, "her frightened eyes told that whatever intentions, whatever courage she had had, were definitely gone." She must realize Gatsby can never give her the kind of life to which she is accustomed; she would be a criminal's wife, which is clearly unpalatable to her.

Was it Hoover's administration that caused the Great Depression that affected the USA and the rest of the world?

No, Hoover's policies were not the cause of the Great Depression---though they may have made it worse.

The consensus among economists and historians as to the cause of the Great Depression is that the stock market panic of 1929 triggered a financial crisis which threw hundreds of banks into insolvency. Droughts also contributed by reducing food production and raising food prices.

The response---or lack thereof---was crucial to what made the Great Depression so great. Banks were allowed to fail; the FDIC did not yet exist to insure banks against failure. This created a cascade through the financial system, where suddenly billions of dollars effectively evaporated from existence as the collapse of one bank which owed to another bank collapsed the next bank, and so on. There was effectively far less money supply than there had been previously, so there was not enough money to purchase the products being sold. Because the US was still on the classical gold standard, the Federal Reserve had very little power to expand the money supply.

This led to deflation, which made debts even worse, and also triggered layoffs because workers are loathe to accept lower nominal wages even if their inflation-adjusted wage has not changed.

Hoover was also quite conservative in terms of his fiscal policy response; he could have initiated huge government investment projects to employ workers and increase spending---as FDR would later do in the New Deal---but he largely avoided doing so, believing that the market would simply correct itself in due time and any such intervention would do more harm than good. He also adamantly refused to engage in deficit spending, even though a depression is exactly the time when deficit spending is necessary.

Hoover cannot be blamed for the stock market panic itself, and of course he cannot be blamed for droughts. So in that sense he did not cause the Great Depression. But his response was far too passive and ineffectual, and resulted in a much more prolonged and severe depression than would have occurred under better fiscal and monetary policy.

What are neurotic disorders? |

Introduction

Neurosis is a general term used to describe various forms of mental disorders that involve symptoms of anxiety, depression, hysteria, phobia, and obsessive compulsiveness. The Scottish physician and researcher William Cullen first used the term during the eighteenth century. At that time, a whole range of symptoms and diseases were referred to as neurotic and were thought to be organically based, with specific, localized points (for example, digestive neurosis). The Austrian psychiatrist Sigmund Freud
coined the term

psychoneurosis
to denote and describe his discovery that neurotic disorders do not have localized organic origins but are psychological in nature and caused by early emotional trauma, the results of which are psychological and emotional conflict. Based on his research into neurotic disorders with colleague and physician Josef Breuer, Freud created the theory and mental health discipline of psychoanalysis. The psychoanalytic understanding of mental disorders is based on the observation that early life experience, in combination with an individual’s biological givens, affects later emotional development and that many of the sources of one’s psychological symptoms (for example, unhappiness and anxiety) stem from early experiences with parents and other caregivers. These early interpersonal experiences, coupled with one’s early temperament, have emotional consequences that are largely unconscious in nature.

The symptomatology associated with various neurotic disorders, then, stems from emotional conflicts originating in early life. Although the sources of these conflicts are unconscious, the consequences of this unrecognized emotional turmoil lead to various psychological symptoms.

Early Conception of Neurotic Disorders

During the end of the nineteenth century and the early part of the twentieth century, Freud described the two broad types of neuroses: transference neuroses and narcissistic neuroses. He thought that patients with psychotic symptoms or severe depression were incapable of forming a relationship with their treating psychoanalyst; they were narcissistic, autistic-like, and consequently unable to be helped by psychotherapeutic means. He believed that patients with hysterical, phobic, or obsessive-compulsive symptoms, however, were capable of developing an emotional tie to the analyst. He referred to the special nature of the patient-doctor relationship as transference
and referred to patients with hysterical, phobic, or obsessive-compulsive symptoms as suffering from transference neuroses. These patients were amenable to “the talking cure.”

Freud first began to formulate his theory of psychoneurosis, his discovery that symptoms had psychological meaning, after studying in France with the famous French neurologist
Jean-Martin Charcot, who demonstrated that patients’ symptoms under hypnosis
could be displaced or eliminated. For example, a woman with an arm paralysis could be hypnotized and the paralysis transferred from one arm to another. This observation, coupled with his experience of treating sexually repressed upper-middle-class patients in the late nineteenth and early twentieth centuries in Vienna, led Freud to the conclusion that neurotic symptoms stem from early sexual wishes and desires that were unacceptable and therefore rendered unconscious. Psychological defense mechanisms such as repression are used to eliminate unacceptable thoughts or feelings or painful inner emotional conflicts.

Freud believed that around the age of three or four, the child wanted to possess the parent of the opposite sex and get rid of the same-sex parent (the Oedipus complex in boys, the Electra complex in girls). Because of basic physical limitations and fear of retaliation, these desires had to be repressed. Unresolved sexual conflict and less-than-successful repression of these wishes and desires led to the various forms of neurotic symptoms. These symptoms represented repressed sexual conflict that was striving for release and gratification (“the return of the repressed”). The particular symptom both symbolized and disguised the nature of the conflict. The specific fixation point at which the individual’s sexual development was arrested dictated the “choice” of a particular neurotic disorder or symptom. Heightened sexual pleasure was localized at three bodily areas, corresponding to three different stages of development. The three stages of childhood sexuality were labeled oral, anal, and phallic, with the Oedipus complex culminating at the phallic stage of development. Healthy negotiation of these stages and the Oedipus complex dictated normal heterosexual relationships. Fixation or arrest during these stages of development culminated with problems in intimate heterosexual relationships as an adult as well as in the development of neurotic symptomatology.

The symptoms associated with hysterical neurosis have been recognized since antiquity. They include unstable and tense emotional experience, hypochondrias, overreaction to external demands, sexual conflict coupled with heightened flirtatiousness toward the opposite sex, and lack of psychological insight. Hysterical neurosis may lead to a conversion of anxiety into physical symptoms.

Freud also discovered that the hysteric’s predominant mode of defense against conflict and distress is repression. With repression, an individual is unable consciously to remember or experience disturbing feelings, thoughts, or wishes. In hysterical neurosis, unacceptable thoughts and feelings have been eliminated from consciousness via this mechanism of defense. The presence, however, of a neurotic symptom reflects the fact that repression was incomplete. Unacceptable anger at a loved one, for example, will be repressed from consciousness, but one may be left with the symptom of paralysis of the arm. A psychological conflict is converted into a physical symptom.

The obsessive neurotic is seen as utilizing his or her intellect excessively, so as to avoid emotional conflicts or experience. These individuals, therefore, will excessively ruminate, be hyperrational, and avoid their emotions completely. They use the defense mechanism of intellectualization and also of reaction formation, whereby one behaves the opposite of what one truly but unacceptably feels. The obsessive neurotic, therefore, may be overly kind and rational toward someone at whom she or he is enraged but also loves.

Freud also wrote about phobia
as a neurosis whereby an individual uses the defense mechanism of displacement, transferring a danger that is internal (castration anxiety, for example) onto an external danger that symbolizes the inner anxiety. Castration anxiety due to Oedipal conflict may lead to a displacement of that fear onto an external danger, with the phobic child, for example, manifesting a seemingly irrational fear of being bitten by a horse.

Contemporary Understanding

Modern psychoanalytic understanding of neurotic disorders is broader than the early Freudian classifications of hysteria, obsessive-compulsiveness, and phobia, with less emphasis on sexual conflict as the sole causative feature. Conflicts involving a range of early emotions and impulses are seen as implicated in the development of neurotic disorders. Modern psychoanalysts use scientific approaches to enhance theory and practice. The University of Michigan research psychoanalyst Howard Shevrin, for example, has provided empirical brain-based evidence for the presence of unconscious psychological conflict and has enhanced the understanding of the role of unconscious conflict in the formation of psychological symptoms.

Sexuality and aggression continue to be seen as essential driving forces that shape development and are central factors in the construction of neurotic symptoms. Additionally, the modern psychoanalyst considers factors associated with later points of development, when examining neurotic symptomatology.

The developing child is seen as possessing immature intellectual, emotional, and imaginative capacities. He or she is faced with managing inner fears as well as with negotiating relationships with primary caretakers. Frustration and conflict inevitably emerge, and patterns of emotional experience, fantasy, and behavior develop in response to these early experiences. Modern psychoanalysis emphasizes the position that character, behavior, and the imagination of the child all reflect, in part, solutions to the inevitable conflicts experienced by the child as a result of his or her wishes, urges, and fantasies that are unacceptable to caretakers and also ambivalently felt by the child (hateful feeling toward one’s mother, for example). Emotional conflict, guilt, and self-condemnation inevitably result to some degree or other and necessitate the mobilization of various psychological defense mechanisms, including repression. Fears, wishes, and thoughts that are unacceptable and censored take on a dangerous, forbidding dimension. These unresolved, repressed thoughts and feelings lead to the creation of unconscious fantasies that are in conflict with the more conscious self and may cause seemingly senseless or unreasonable emotional turmoil. For example, a young boy who is frightened, ashamed, and guilt-ridden by his hateful impulses toward his father will repress these urges. As an adult, he may inexplicably feel like a “monster” (an unconscious fantasy of himself when angry) whenever he naturally asserts himself, without consciously understanding why self-expression is so difficult.

Modern psychoanalysis differentiates a range of neurotic disorders within two broad classifications: symptom neurosis and character neurosis. The symptom neuroses are specific and tied to specific symptoms. Hysterical neurosis, obsessive neurosis, depressive neurosis, and anxiety neurosis all reflect underlying emotional conflicts but are manifested through different symptoms. For example, the hysteric converts emotional turmoil into somatic complaints. The obsessive is emotionally cut off from self and others and is ritualistic, while the depressive is sad, with chronic self-esteem problems. The anxiety neurotic ruminates and may have a specific irrational fear (phobia).

With symptom neurosis, the neurotic is distressed and the symptoms are ego-dystonic; that is, the symptoms are felt to be alien, unwanted, and foreign to the self. With character neurosis, however, symptoms are not present and the character neurosis is reflected by maladaptive and enduring personality patterns of behavior and experience that, although neurotic, are accepted features of the individual’s self or identity (ego-syntonic). Others may perceive an obsessive neurotic personality, for example, as unemotional and excessively avoidant of feelings, but he or she will see himself as objective and fastidious. The hysterical neurotic personality will view himself or herself as spontaneous and not excessively emotional, whereas the depressive neurotic personality may realize he or she is always depressed, but believe that it is for good reasons. Because the neurotic pattern of behavior is ego-syntonic, neurotic personalities are more difficult to treat.

Psychoanalytic Treatment

Psychoanalytic
psychotherapy seeks not only to relieve current symptoms but also to deal with root emotional conflicts and causes of the symptoms or behavioral patterns. Because the sources of one’s conflicts, symptoms, and behavior patterns are essentially unconscious, and because defenses have been constructed to help one adapt as effectively as possible, psychoanalytic treatment takes time, is intensive, and lasts from one to three or more years. The therapeutic relationship that develops is intimate and intense. The psychoanalyst and patient collaborate in the exploration of the patient’s symptoms and style of relating. This leads to the patient becoming aware of his or her underlying sources of conflict, not only intellectually but also emotionally. The emotional understanding occurs predominantly through the understanding of feelings, thoughts, and fantasies that arise out of the realistic and unrealistic (transference) dimensions of the therapeutic relationship. It is through the relationship that the patient can reexperience, in the here and now, how his or her inner conflicts and unconscious difficulties have been creating symptoms and dysfunctional repetitive patterns of behavior. The analyst and patient work together to understand how and why certain wishes and desires, feelings, thoughts, and unconscious fantasies have developed and contribute to the patient’s emotional and behavioral difficulties. Over the course of treatment, the patient’s capacity for emotional integration improves, as does his or her capacity to function without self-defeating behaviors, emotions, and thoughts.

Bibliography

Boag, Simon. Freudian Repression, the Unconscious, and the Dynamics of Inhibition. London: Karnac, 2012. Print.

Bowlby, Rachel. Freudian Mythologies: Greek Tragedy and Modern Identities. New York: Oxford UP, 2007. Print.

Doctor, Ronald M., Ada P. Kahn, and Christine Adamec. The Encyclopedia of Phobias, Fears, and Anxieties. New York: Facts on File, 2008. Print.

Fenichel, Otto. The Psychoanalytic Theory of Neurosis. New York: Routledge, 2010. Digital file.

Kligman, D. The Development of Freud’s Theories: A Guide for Students of Psychoanalysis. Madison: International Universities P, 2001. Print.

Mitchell, L. S., and M. Black. Freud and Beyond: A History of Modern Psychoanalysis. New York: Basic, 1995. Print.

Moore, B., and E. Fine. Psychoanalytic Terms and Concepts. New Haven: Yale UP, 1994. Print.

Phillips, Adam. Becoming Freud: The Making of a Psychoanalyst. New Haven: Yale UP, 2014. Print.

Sandler, J., A. Holder, C. Dare, and A. Dreher. Freud’s Model of the Mind: An Introduction. Madison.: International Universities P, 1997. Print.

Westen, D. “The Scientific Legacy of Sigmund Freud: Toward a Psychodynamically Informed Psychological Science.” Psychological Bulletin 124.3 (1998): 331–71. Print.

What is galactosemia? |

Causes and Symptoms

In classic I galactosemia, a congenital deficiency of the enzyme galactose-1-phosphate uridyl transferase (GALT) causes galactose to accumulate instead of being converted to glucose for energy production. As galactose accumulates in the child’s tissues and organs, it will have a toxic effect and cause various signs and symptoms. Galactosemia means “galactose in the blood.” Galactose is a sugar that may be found alone in foods but is usually associated with lactose, a milk sugar.

A gene mutation on the short arm of chromosome 9 has been identified in babies with galactosemia. About one in forty thousand newborns is affected with this autosomal recessive disorder. Both parents serve as carriers; they are not themselves affected, but each conception carries a one in four chance that the child will be born with galactosemia. Prenatal diagnosis is possible in cultured fibroblasts from amniotic fluid. Mandatory screening programs in many states test all newborns for galactosemia during the first week of life.

Galactosemia is an example of a multiple-allele system. In addition to the normal allele (G) and the recessive allele (g), a third allele, known as GD, has been found. The D allele is named after Duarte, California, where it was discovered. The existence of three alleles produces six possible genotypic combinations in the deoxyribonucleic acid (DNA). These enzymatic activities may range from 0 to 100 percent. Consequently, it is very important to monitor each patient with biochemical studies.

Homozygous recessive infants (gg) are unaffected at birth but develop symptoms a few days later, including jaundice, vomiting, an enlarged liver from extensive fatty deposits, cataracts, and failure to thrive. Mental retardation and death may also occur if dietary treatment has not been started.

Treatment and Therapy

Galactosemia is treated by removing foods that contain galactose from the diet. Since milk and milk products are the most common source of galactose, infants with galactosemia should not be given these foods. Serious problems can be prevented through this early exclusion of galactose.

While it is not possible for a child with galactosemia to have an entirely galactose-free diet, all persons with galactosemia should limit galactose intake from foods to a very low level. The galactose-1-phosphate levels determine the degree of dietary restriction for each individual. Advice from a dietician is needed.

Bibliography

Badash, Michelle. "Galactosemia." Health Library, November 26, 2012.

Berry, Gerard T. "Galactosemia: When is it a Newborn Screening Emergency?" Molecular Genetics & Metabolism 106, no. 1: 7–11.

Cummings, Michael R. Human Heredity: Principles and Issues. 8th ed. Pacific Grove, Calif.: Brooks/Cole, 2009.

"Galactosemia." MedlinePlus, May 1, 2011.

Icon Health. Galactosemia: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: Author, 2004.

Kasper, Dennis L., et al., eds. Harrison’s Principles of Internal Medicine. 16th ed. New York: McGraw-Hill, 2005.

Rudolph, Colin D., et al., eds. Rudolph’s Pediatrics. 21st ed. New York: McGraw-Hill, 2003.

What are cytokines? |

Cancers treated:
Renal cell carcinoma, melanoma, lymphoma, Kaposi sarcoma, chronic myelogenous leukemia, hairy cell leukemia

Delivery route: Subcutaneous or intravenous (IV) injection

How these agents work: Cytokines are unique in that they bind to individual cell receptors. They can regulate several parts of the immune system by stimulating the production of cellular molecules that can attach themselves to the surface of tumor cells, where they have an antitumor effect. Other cytokines suppress the activity of cells and thus inhibit their action.

Cytokines have more than one mechanism of action, and many aspects of their cellular signaling are being actively researched. They are being investigated for their ability to kill tumor cells and for their potential to act as vaccines or adjuvant stimulants against the development of cancer cells by presensitizing the immune system to kill cancer cells if they develop.

Immunotherapy is still being aggressively studied for mechanisms of action, stimulation, and suppression, and it is believed that it will work in conjunction with other therapies rather than alone. The attractiveness of immunotherapy is the specificity of attacking only cancer cells and not harming normal cells, finding small numbers of cancer cells not identified though other treatment modalities, and using the existing immune system to treat cancer.

The main types of cytokines used to treat cancer are interferons and interleukins. Interferon alfa (IFN-alfa), which enhances immune response to cancerous cells and may also inhibit their growth or survival, has been approved by the US Food and Drug Administration (FDA) for treatment of melanoma, Kaposi sarcoma, hairy cell leukemia, and lymphoma. Interleukin 2 (IL-2), also known as T-cell growth factor, promotes the production of white blood cells and certain antibodies; the synthetic version, known as aldesleukin, has been approved to treat metastatic kidney cancer and metastatic melanoma. In addition, certain hematopoietic growth factors, including erythropoietin, interleukin 11, and granulocyte colony-stimulating factor, are sometimes used to alleviate side effects of some chemotherapies.

Side effects: Common side effects of cytokine treatment include nausea and vomiting, acute toxicity, capillary leak syndrome, low blood pressure, high cardiac output, liver toxicity, renal toxicity, pulmonary edema, fever, chills, gastric acidity, and infection. Most of the toxic side effects can be reversed. Fever and chills are treated with acetaminophen, and antibiotics are used for infection. Cytokine storm is a syndrome that can occur with the overstimulation of cytokines and can result in severe adverse effects, including death.

Braumüller, Heidi, et al. "T-Helper-1-Cell Cytokines Drive Cancer into Senescence." Nature 494.7437 (2013): 361–65. Print.

Britten, Cedrik Michael, et al., eds. Cancer Immunotherapy Meets Oncology: In Honor of Christoph Huber. Heidelberg: Springer, 2014. Print.

Caliguri, Michael A., and Michael T. Lotze, eds. Cytokines in the Genesis and Treatment of Cancer. Totowa: Humana, 2007. Print.

Dranoff, Glenn. "Cytokines in Cancer Pathogenesis and Cancer Therapy." Nature Reviews Cancer 4.1 (2004): 11–22. Print.

"Biological Therapies for Cancer." National Cancer Institute. Natl. Insts. of Health, 12 June 2013. Web. 30 Sept. 2014.

Lee, Sylvia, and Kim Margolin. "Cytokines in Cancer Immunotherapy." Cancers 3.4 (2011): 3856–93. Web. 30 Sept. 2014.

How does Julie think the wolves can help her?

The part of the plot that you are asking about is in part one of Jean Craighead George's story.  At this point in the book, Julie is referred to by her Eskimo name, Miyax.  She is completely lost, which is bad in normal situations, but Miyax's situation is not normal.  She is on the North Slope of Alaska, which is about as barren of a wasteland as you can get.  

The barren slope stretches...

The part of the plot that you are asking about is in part one of Jean Craighead George's story.  At this point in the book, Julie is referred to by her Eskimo name, Miyax.  She is completely lost, which is bad in normal situations, but Miyax's situation is not normal.  She is on the North Slope of Alaska, which is about as barren of a wasteland as you can get.  

The barren slope stretches for three hundred miles from the Brooks Range to the Arctic Ocean, and for more than eight hundred miles from the Chukchi to the Beaufort Sea. No roads cross it; ponds and laces freckle its immensity.

In addition to being a barren wasteland, it's full of wolves.  That's scary, but Miyax is not scarred of the wolves . . . at all.  In fact, she believes that the wolves can help her.  She knows that the wolves are better hunters and killers than her, so Miyax is hoping to figure out a way to communicate with the wolves.  She wants to tell the wolves that she is hungry and needs some of their food.  The wolves will help Miyax (Julie) by supplying her with food.  

Miyax stared hard at the regal black wolf, hoping to catch his eye. She must somehow tell him that she was starving and ask him for food. This could be done she knew, for her father, an Eskimo hunter, had done so. One year he had camped near a wolf den while on a hunt. When a month had passed and her father had seen no game, he told the leader of the wolves that he was hungry and needed food. The next night the wolf called him from far away and her father went to him and found a freshly killed caribou.

What inferences or conclusions can you draw about the narrator's state of mind as it changes during the course of the story "The Scarlet Ibis" by...

The narrator’s state of mind changes throughout “The Scarlet Ibis” by James Hurst.

Readers make judgments or evaluations based on a character’s emotions, actions, or words. The author gives the reader information and he/she is able to make inferences. In “The Scarlet Ibis” the reader is able to infer a number of details about the narrator’s frame of mind.

One characteristic the reader can infer about Brother is that he carries an inherent meanness in him. He shows his disappointment with both cruel thoughts and actions.  "I began to make plans to kill him by smothering him with a pillow" when he was just a baby. Brother’s dreams for a companion who would play and explore with him are dashed when his little brother is born with many disabilities. Brother’s intrinsic unkindness is reaffirmed later in the story when he forces Doodle to touch the coffin Father had made for him. And, again we witness Brother as he leaves Doodle alone and afraid during the storm, which leads to the child’s death. Based on these actions, his state of mind does not seem to be that of a concerned, loving brother.

Brother is a tenacious individual as witnessed in his attempts, against all odds, to teach Doodle to stand and walk. But, this tenacity is born out of selfishness because Brother does not want to be embarrassed by Doodle’s disabilities. Brother gets caught up in the excitement of Doodle’s physical progress so much that the boys keep their escapades from the family until Doodle is proficient enough to walk on his own. This happens after Brother pushes him past his limitations over and over. Again, one can question Brother’s state of mind. Is he concerned more about himself than his brother’s well-being?

From the beginning of the story to its end, the reader can infer that Brother carries guilt with him. In the exposition, he describes the setting with melancholy tones, and tells the reader how he remembers his brother.

But sometimes (like right now), as I sit in the cool, green-draped parlor, the grindstone begins to turn, and time with all its changes is ground away-and I remember Doodle.

And, at the story’s conclusion he describes how he found Doodle unresponsive and bleeding. Knowing he ran ahead and left his brother in a bad situation, he shakes Doodle before realizing that the unthinkable has happened.  Only after succumbing to his selfishness and meanness does he live with the guilt of knowing that he was partially responsible for his brother’s death.

I began to weep, and the tear-blurred vision in red before me looked very familiar. "Doodle!" I screamed above the pounding storm and threw my body to the earth above his. For a long time, it seemed forever, I lay there crying, sheltering my fallen scarlet ibis from the heresy of rain.

What are some examples of irony in Act 2 of The Importance of Being Earnest by Oscar Wilde?

In Act 2 of The Importance of Being Earnest, Oscar Wilde gains most of his humor through situational irony, that is, things that are the opposite of what is expected. At the beginning of the scene, Miss Prism scorns "this modern mania for turning bad people into good people at a moment's notice." This is ironic in two respects: first, most people would favor a sinner's reformation and second, true reformation rarely happens instantaneously.

Next Cecily admonishes Algy, who is pretending to be Ernest, "I hope you have not been leading a double life, pretending to be wicked and being really good all the time. That would be hypocrisy." Again, the irony works on two levels: first, the usual way a hypocrite acts is to pretend to be good while really being wicked, and second, Algy actually is pretending here, although Cecily doesn't know it. That is dramatic irony, where the audience knows something a character doesn't.

When Algy says that good looks "are a snare that every sensible man would like to be caught in," his remark is ironic in that a snare, by definition, takes one against one's will.

Miss Prism, upon learning that Ernest is dead, says, "What a lesson for him! I trust he will profit by it." Her remark is humorously ironic since dead men cannot profit from life's lessons.

Jack's unthinking reply to Cecily, "I haven't got a brother!" is ironic in that without realizing it he denies the lie that he has worked so hard to perpetrate, and when he tells the literal truth, Cecily won't accept it, mistaking his answer for a figurative disowning of his brother.

Cecily's long explanation of her fantasy romance with Ernest to Algernon, who is pretending to be Ernest, is highly ironic as Algy learns about things in "his" past that he has done from a woman he has only just met. Gwendolen's description of her father's role is ironic because it exchanges the expected role in society of men with that of women: "The home seems to me to be the proper sphere for the man."

The conversation between Gwendolyn and Cecily about their engagements is hilariously ironic since each of them believes the other woman is speaking of the same man when they are really only speaking of the same imaginary character who is being played by two different men.

The tea war is ironic since taking tea is usually a genteel occasion, but here it becomes aggressive, yet cloaked in exaggerated civility.

In Act 2, Wilde takes the audience on a wild ironic ride, careening from one unexpected twist to another. 

What are gastrointestinal disorders? |

Causes and Symptoms

What and how people eat, their digestion, and their toilet habits affect their health more than any other voluntary daily activity. Breathing, circulation, and the brain’s control of most bodily functions normally take place without conscious thought. The intake of nourishment, by contrast, affords a great variety of choices. Accordingly, poor or self-destructive eating and toilet habits lie behind many gastrointestinal (GI) disorders. Yet not all disorders result from an individual’s habits. Many arise because of a person’s cultural or physical environment, some are hereditary or congenital, and a fair amount have no known cause. All told, more than one hundred disorders may originate in the GI tract and related organs, including infections, cancer, dysfunctions, obstructions, autoimmune diseases, malabsorption of nutrients, and reactions to toxins taken in during eating, drinking, or breathing. Furthermore, diseases in other organs, systemic infections such as lupus, immune suppression such as that caused by Acquired immunodeficiency syndrome (AIDS), reactions to altered body conditions as during pregnancy, and psychiatric problems can all affect the gut.

The symptoms of GI disorders range from mildly uncomfortable to life-threatening, although seldom does any single symptom except massive bleeding lead quickly to death. Indigestion, bloating, and gas send more people to gastroenterologists than any other set of symptoms, and they often reflect nothing more than overeating. Pain anywhere along the gut, aversion to food (anorexia), and
nausea are general symptoms common to many disorders, although noncardiac chest pain is likely to come from the esophagus while pain in the abdomen points to a stomach or intestinal problem. Red blood in the stool indicates bleeding in the intestines, black (digested) blood suggests bleeding in the upper small bowel or stomach, and vomited blood indicates injury to the stomach or esophagus—all dangerous signs that require prompt medical attention. Chronic diarrhea, fatty stool, constipation, difficulty in swallowing, hiccuping, vomiting, and cramps point to disturbances in the GI tract’s orderly, wavelike contractions or absorption of nutrients and fluid. Dysentery (bloody diarrhea) usually comes from severe inflammation or lesions caused by viruses, bacteria, or other parasites. Malnourishment is a sign of badly disordered digestion, and ascites (fluid accumulation in body cavities) can result from serious disease in the liver or pancreas. Likewise, jaundice, the yellowing of the skin or eyes because of high bilirubin levels, signals problems in the liver, pancreas, or their ducts.

The large number and complexity of GI disorders do not allow a quick, comprehensive summary. Fortunately, many are uncommon, and the most frequent problems can be described through a tour of the GI tract. The GI tract is basically a tube that moves food from the mouth to the anus, extracting energy and biochemical building blocks for the body along the way. Thus, a disorder that interrupts the flow in one section of the intestines can have secondary effects on other parts of the gut. Disorders seldom affect one area alone.

The esophagus. The GI tract’s first section, the esophagus, is simply a passageway from the mouth to the stomach. Although it rarely gets infected, the esophagus is the site of several common problems, usually relatively minor, if painful. Muscle dysfunctions, including slow, weak, or spasmodic muscular movement, can impair motility and make swallowing difficult, as can strictures, which usually occur at the sphincter to the stomach. The mucosal lining of the esophagus is not as hardy as in other parts of the gut. When acid backflushes from the stomach into the esophagus, it inflames tissue there and can cause burning and even bleeding, a condition popularly known as
heartburn and technically called gastroesophageal reflux disease (GERD). Retching and vomiting, usually resulting from alcohol abuse or associated with a hiatal hernia, can tear the mucosa. Smokers and drinkers run the risk of esophageal cancer, which can spread down into the gut early in its development and can be deadly; however, it accounts for only about 1 percent of cancers. Most esophageal conditions can be cured or controlled if diagnosed early enough.

The stomach. To store food and prepare it for digestion lower in the gut, the stomach churns its contents into a homogenous mass and releases it in small portions into the small bowel; meanwhile, the stomach also secretes acid to kill bacteria. Bacteria that are acid-resistant, however, can multiply there. One type, Helicobacter pylori, is thought to be involved in the development of
ulcers and perhaps cancer. Overuse of aspirins and other nonsteroidal anti-inflammatory drugs (NSAIDs) can also cause stomach ulcers. A variety of substances, including alcohol, can prompt inflammation and even hemorrhaging. Stomach cancer
has been shown to strike those who have a diet high in salted, smoked, or pickled foods; the most common cancer in the world, although not in the United States, it has a low survival rate. When stomach muscle function fails, food accumulates until the stomach overstretches and rebounds, causing vomiting. Some foods can coalesce into an indigestible lump, and hair and food fibers can roll into a ball, called a bezoar; such masses can interfere with digestion.

The small intestine
. The five to six meters of looped gut between the stomach and colon is called the small intestine. It secretes fluids, hormones, and enzymes into food passing through, breaking it down chemically and absorbing nutrients. Although cancers seldom develop in the small intestine itself, they frequently do so in the organs connected to it, the liver and pancreas. The major problem in the small bowel is the multitude of diseases causing diarrhea, dysentery, or ulceration: They include bacterial, viral, and parasitic disease; motility disorders; and the chronic, progressive inflammatory illness called Crohn’s disease, which also ulcerates the bowel wall. Although most diarrhea is temporary, if it persists diarrhea severely weakens patients through dehydration and malnourishment. For this reason, diarrheal diseases caused by toxins in water or food are the leading cause of childhood death worldwide. An increasingly common disorder of the small bowel is celiac disease, or gluten enteropathy, an autoimmune disease that results in malabsorption. Furthermore, the small bowel can become paralyzed, twisted, or kinked, thereby obstructing the passage of food. Sometimes its contents rush through too fast, a condition called dumping syndrome. All these disorders reduce digestion, and if they are chronic, then malnutrition, vitamin deficiency, and weight loss ensue.

The large intestine. The small intestine empties into the large intestine, or colon, the last meter of the GI tract; here the water content of digestive waste matter (about a liter a day) is reabsorbed, and the waste becomes increasingly solid along the way to the rectum, forming feces. Unlike the small bowel, which is nearly sterile under normal conditions, the colon hosts a large population of bacteria that ferments the indigestible fiber in waste matter, and some of the by-products are absorbed through the colon’s mucosa. Bacteria or parasites gaining access from the outside world can cause diarrhea by interfering with this absorption (a condition called malabsorption) or by irritating the mucosa and speeding up muscle action. For unknown reasons, the colon can also become chronically inflamed, resulting in cramps and bloody diarrhea, an illness known as ulcerative
colitis;
Crohn’s disease also can affect the colon. Probably because it is so often exposed to a variety of toxins, the colon is particularly susceptible to cancer in people over fifty years old: Colorectal cancer accounts for the fourth highest number of cancer deaths worldwide, in an equal proportion of men and women. As people age, the muscles controlling the colon deteriorate, sometimes forming small pouches in the bowel wall, called diverticula, that can become infected (diverticulitis). In addition, small knobs called polyps can grow, and they may become cancerous. One of the most common lower GI disorders is constipation, which may derive from a poor diet, motility malfunction, or both.

The rectum. The last segment of the colon, the
rectum collects and holds feces for defecation through the anus. The rectum is susceptible to many of the diseases affecting the colon, including cancer and chronic inflammation. The powerful anal sphincter muscle, which controls defecation, can be the site of brief but intensely painful spasms called proctalgia fugax, which strikes for unknown reasons. The tissue lining the anal
canal contains a dense network of blood vessels; straining to eliminate stool because of constipation or diarrhea or simply sitting too long on a toilet can distend these blood vessels, creating hemorrhoids, which may burn, itch, bleed, and become remarkably uncomfortable. If infected, hemorrhoids or anal fissures may develop painful abscesses (sacs of pus). Extreme straining can cause the rectum to turn inside out through the anus, or prolapse.

The liver. The GI tract’s organs figure prominently in many disorders. The liver is a large spongy organ that filters the blood, removing toxins and dumping them with bile into the duodenum. A number of viruses can invade the liver and inflame it, a malady called
hepatitis. Acute forms of the disease have flulike symptoms and are self-limited. Some viruses, however, as well as alcohol or drug abuse and worms, cause extensive cirrhosis (the formation of abnormal, scarlike tissue) and chronic hepatitis. Although only recently common in the United States, viral hepatitis has long affected a large number of people in Southeast Asia; because hepatitis can trigger the mutation of normal cells,

liver cancer is among the most common cancers worldwide. Hepatitis patients often have jaundice, as do those who, as a result of drug reactions, cancer, or stones, have blocked bile flow. Because of congenital or inherited errors of metabolism, excess fat, iron, and copper can build up in the liver, causing upper abdominal pain, skin discolorations, weakness, and behavioral changes; complications can include cirrhosis, diabetes mellitus, and heart disease.

The gallbladder
. A small sac that concentrates and stores bile from the liver, the gallbladder is connected to the liver and duodenum by ducts. The concentrate often coalesces into stones, which seldom cause problems if they stay in one place. If they block the opening to the gallbladder or lodge in a duct, however, they can cause pain, fever, and jaundice. Although rare, tumors may also grow in the gallbladder or ducts, perhaps as a result of gallstone obstruction.

The pancreas. Lying just behind the stomach, the pancreas produces enzymes to break down fats and proteins for absorption and insulin to metabolize sugar; a duct joins it to the duodenum. The pancreas can become inflamed, either because of toxins (largely alcohol) or blockage of its duct, usually by gallstones. Either cause precipitates a painful condition,
pancreatitis, that may last a few days, with full recovery, or turn into a life-threatening disease. If the source of inflammation is not eliminated, then chronic pancreatitis may develop and with it the gradual loss of the pancreas’ ability to make enzymes and insulin. Severe abdominal pain, malnutrition, diarrhea, and diabetes may develop. Pancreatic cancer has a very poor prognosis, with five-year survival less than 5 percent in most cases. Scientists are unsure of the causes; pancreatitis, gallstones, diabetes, and alcohol have been implicated, but only smoking is well attested to increase the risk of contracting pancreatic cancer, which is
very lethal and difficult to treat. It is estimated that cigarette smoking is responsible for 30 percent of pancreatic cancer cases.

Functional diseases. Finally, some disorders appear to affect several parts of the GI tract at the same time, often with no identifiable cause but with chronic or recurrent symptoms. Gastroenterologists call them functional diseases, and they afflict as much as 30 percent of the population in Western countries. People with
Irritable bowel syndrome (IBS) complain of abdominal pain, urgency in defecation, and bloating from intestinal gas; they often feel that they cannot empty their rectums completely, even after straining. Functional dyspepsia manifests itself as upper abdominal pain, bloating, early feelings of fullness during a meal, and nausea. Also included in this group are various motility disorders in the esophagus and stomach, whose typical symptom is vomiting, and pseudo-obstruction, a condition in which the small bowel acts as if it is blocked but no lesion can be found. Many gastroenterologists believe that emotional disturbance plays a part in some of these diseases.

Feldman, Mark, Lawrence S. Friedman, and Lawrence J. Brandt, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. New ed. 2 vols. Philadelphia: Saunders/Elsevier, 2010.

"Gastrointestinal Disorders." Columbia University College of Dental Medicine, March 1, 2013.

"GI Disorders." International Foundation for Functional Gastrointestinal Disorders, January 17, 2013.

Heuman, Douglas M., A. Scott Mills, and Hunter H. McGuire, Jr. Gastroenterology. Philadephia: W. B. Saunders, 1997.

Janowitz, Henry D. Indigestion: Living Better with Upper Intestinal Problems, from Heartburn to Ulcers and Gallstones. New York: Oxford University Press, 1994.

Sachar, David B., Jerome D. Waye, and Blair S. Lewis, eds. Pocket Guide to Gastroenterology. Rev. ed. Baltimore: Williams & Wilkins, 1991.

Thompson, W. Grant. The Angry Gut: Coping with Colitis and Crohn’s Disease. New York: Plenum Press, 1993.

What does Jack suggest to start a fire?

Twice in the story Jack finds himself having no means of starting a fire. The first occurs in chapter 2 when the boys have made a huge pile of firewood in response to Ralph's suggestion that they build a signal fire. When Ralph asks him to light the fire, Jack blushes and says, "You rub two sticks. You rub--" He is obviously trying to recall the survivalist technique most boys hear about at some point...

Twice in the story Jack finds himself having no means of starting a fire. The first occurs in chapter 2 when the boys have made a huge pile of firewood in response to Ralph's suggestion that they build a signal fire. When Ralph asks him to light the fire, Jack blushes and says, "You rub two sticks. You rub--" He is obviously trying to recall the survivalist technique most boys hear about at some point but few ever perform. But when Piggy arrives, Jack gets a different idea: "His specs--use them as burning glasses." Instead of asking Piggy for the use of his lenses, Jack snatches them off Piggy's face. Ralph then uses them to light the fire.

Later, in chapter 8, after Jack has created his own tribe and they have killed the sow, Roger asks him how they will make a fire to cook it. Jack responds, "We'll raid them and take fire." 

Interestingly, in both situations Jack resorts to taking without asking when, if he had asked, he would certainly have been given what he requested. These incidents show Jack's tendency to resort to violence rather than use the conventions of society to acquire what he needs.

What are attitude formation and change?

Introduction

An attitude is a person’s positive or negative evaluation of an object or thought; examples include “I support gun control,” “I dislike brand X,” and “I love the person next door.” Much research finds that attitudes can influence a broad range of cognitive processes, such as social inference, reasoning, perception, and interpretation, and can thereby influence behavior. In general, people favor, approach, praise, and cherish those things they like and disfavor, avoid, blame, and harm those things they dislike. Given that attitudes can have pervasive effects on social behavior, it is important to understand how they are formed and changed.

Attitudes can be formed directly through observation of one’s own behavior or through experience with the attitude object. They may also be formed by exposure to social influences such as parents, peers, the mass media, schools, religious organizations, and important reference groups. William McGuire notes that attitudes are one of the most extensively studied topics in social psychology. Much of this research has centered on the question, Who says what to whom, with what effects?

For example, research has varied the source (the “who”) of a message and found that people tend to be most persuaded by credible, trustworthy, attractive, and similar communicators. Research on message characteristics (the “what”) has shown that appeals to fear increase persuasion if accompanied by specific recommendations for how to avoid the fear; that there is a tendency for arguments presented first to have more impact, especially if there is a delay between hearing the arguments and making an evaluation; and that messages that present only one side of an issue are most effective when the recipient lacks the skills or motivation to process the information. In general, research has shown that an audience (the “whom”) is less persuaded if the message is wildly discrepant from their original beliefs; such research also finds that an audience is less persuaded if they have been forewarned about the persuasion attempt and take steps to prepare a counterargument. The effects of social influence are usually described in terms of compliance (attitude change, often short-lived, as a result of wanting to obtain rewards or avoid punishment), identification (change as a result of seeking to be similar to or distinguished from the source of a message), and internalization (change as a result of accepting a position on the basis of its merits).

Early Research

The learning model, perhaps social psychology’s first theory of persuasion, is based on the research of Carl Hovland
and his colleagues at Yale University in the 1950s. According to this model, a message is persuasive when it rewards the recipient at each of the following stages of psychological processing of a message: attention, comprehension, message learning, and yielding. For example, a highly credible source is persuasive because people find it rewarding to attend to and comprehend what he or she says and then to act on it.

One problem with the learning model of persuasion is that subsequent research in the 1960s found that persuasion could occur even if the message was only minimally comprehended and the message’s content was forgotten or never learned. To account for these results, the cognitive response approach posited that the key determinant of persuasion was not message learning but the thoughts running through a person’s head as that individual received a communication. Effective communications are ones that direct and channel thoughts so that the target thinks in a manner agreeable to the communicator’s point of view.

Later research reversed the causal sequence of the learning model from one of “attitudes cause behavior” to “behavior causes attitudes.” Two theories that use this counterintuitive approach are cognitive dissonance theory and self-perception theory. According to consistency theories such as cognitive dissonance theory, people attempt to rationalize their behavior and to avoid a state of dissonance, or simultaneously holding two contradictory cognitions (ideas, beliefs, or opinions). Persuasion occurs as a result of resolving this dissonance. For example, fraternity and sorority pledges often must perform embarrassing behavior to gain admission to the organization. The thoughts “I just ate a plate of grasshoppers as an initiation rite” and “It is stupid to eat grasshoppers” are dissonant with a positive view of the self. One way to reduce this dissonance is to reevaluate the fraternity or sorority more positively: “I ate those grasshoppers because I wanted to join a great club.”

Self-perception theory states that attitudes are based on observing one’s own behavior and then attributing the behavior to underlying beliefs. For example, suppose a man is at a dinner party and is served brown bread, which he then eats. When asked if he likes brown bread, he observes his eating behavior and concludes that he does (unless there is some other plausible reason, such as coercion or politeness). Although dissonance theories serve to explain attitude change when existing attitudes conflict with a person’s current behavior, self-perception theory proposes that when there is no better available explanation for a person’s behavior, observing what the person does is the best indication of his or her attitudes.

Social judgment theory attempts to explain how attitude formation and change occur within a single social context. Attitude change can occur when the context for making judgments is changed. For example, in one study, men rated photographs of women as much less attractive after viewing the 1970s television show Charlie’s Angels. In other words, the very attractive female stars of Charlie’s Angels provided a highly positive context in which to rate the photographs and thus made women of average attractiveness appear much less attractive.

Dual-Mode Processing Models

In an effort to synthesize the vast amount of persuasion research, psychologists proposed a dual-mode processing approach to attitude formation and change. Dual-mode processing models emphasize two factors that influence the success of a persuasion attempt: the recipient’s motivation and the recipient’s ability to process an argument.

Richard Petty and John Cacioppo have suggested that there are two routes to persuasion. In the peripheral route, recipients give little thought to a message, perhaps because they have little motivation to think about it or lack the necessary skills. Persuasion via this route is based less on the arguments made and more on simple persuasion cues or heuristics such as the credibility of the source and the number of other people who agree with the message. Cognitive dissonance, self-perception, and social judgment theory models of attitude change often emphasize peripheral routes, as anxiety reduction, the lack of alternative explanations, and contextual cues are the important determinants of persuasion, rather than careful analysis of the message.

In the central route, where people are motivated and able to process the message, recipients carefully scrutinize the communication, and persuasion is determined by the quality and cogency of the arguments. The central route is emphasized in cognitive response theories of persuasion. Although cognitive responses can vary on a number of dimensions, two of the most important ones are evaluation and elaboration. Most cognitive responses to a message are either positive evaluations (support arguments) or negative evaluations (counterarguments) of the message’s conclusion. Studies have shown that disrupting these cognitive responses and decreasing the recipient’s ability to process the argument using a mild distraction, such as background noises or difficult-to-read print, results in more persuasion when the recipient’s natural tendency would be to make arguments against the message and less persuasion when the recipient normally would have supported the message. Elaboration refers to how much thought a recipient gives to a message. Recipients who are highly motivated to analyze an argument are likely to give it more thought.

Dual-process models of attitude change have led researchers to examine when and why recipients are motivated to process a message carefully. Three such motivations have been suggested: to make sense of themselves and their world, to protect or defend existing self-perceptions or worldviews, and to maintain or enhance their social status. When the message corresponds to an individual’s immediate motivations, persuasion attempts are more effective. For example, individuals who are more image conscious and motivated to enhance their social status are more likely to be persuaded by arguments that emphasize the social consequences of a behavior, while messages that emphasize the personal benefits of a behavior are more effective with those who are more internally guided.

Functional theories of attitude change incorporate these motivational goals. Functional theories posit that attitude formation and change are made when such change would function to serve a recipient’s needs. For example, consider someone who is prejudiced against an ethnic group. This negative attitude helps the person interpret, often incorrectly, social reality (“Members of this ethnic group can do no good and often are the cause of problems”) and maintain a positive view of self (“I am better than they are”), and it may also enhance the person’s social status (“I am a member of a superior social group”). Advertisers make use of functional theories when they market products to appeal to self-images; in such cases, a product is used in order to obtain a desired image, such as appearing to be sophisticated, macho, or a modern woman.

History of Persuasion Research

In an article published in 1935, Gordon Allport declared that attitude is social psychology’s “most indispensable construct.” Research on attitudes began in the 1920s in the United States as a response to changing social conditions. The period was marked by the rise of new mass media such as radio and mass-circulated magazines, the development of large-scale consumer markets, and the changing nature of political activity. Such developments required that citizens' attitudes and opinions regarding a variety of issues be measured and tracked. Academic researchers responded by developing techniques of attitude scaling and measurement and by laying the foundation for survey methodology. The first empirical research on attitudes sought to address questions such as “How are movies changing Americans’ attitudes and values?” and “Has modern life changed traditional cultural attitudes?”

World War II changed the focus of attitude research from measurement to understanding attitude change and persuasion. Many of the post–World War II attitude researchers had either fled Nazi Germany or worked for the Allies in an attempt to defuse Nazi propaganda and bolster their fellow citizens’ attitudes toward the war effort. After the war, in the 1950s, many researchers attempted to explain the propaganda and attitude-change tactics used during the war and later increasingly employed in the mass media. This research resulted in the development of learning, functional, social judgment, and cognitive consistency theories of persuasion.

Practical Applications

Research and theorizing on attitude change have led to the development of numerous tactics and principles of persuasion. These principles are useful for interpreting persuasion effects, such as those that occur in mass media and interpersonal or organizational settings, and for directing persuasion attempts. Three of the more popular tactics will be discussed here.

One of the simplest and most surefire ways to ensure positive cognitive responses is to induce the target to argue for the message conclusion, a tactic known as self-generated persuasion. For example, in one study during World War II, women were asked to “help” a researcher by coming up with reasons that other women should serve organ and intestinal meats (brains, kidneys, and so on) to their families as part of the war effort. These women were eleven times as likely to serve such meats as those who were merely lectured to do so. In another study, some consumers were asked to imagine the benefits of subscribing to cable television, while others were simply informed about those benefits. Those who imagined subscribing were two and a half times as likely to subscribe as those who were merely told why they should.

The foot-in-the-door technique makes use of cognitive dissonance theory. In this tactic, the communicator secures compliance with a large request by first putting his or her “foot in the door” by asking for a small favor that almost everyone will typically do. For example, in one study, residents were asked to place in their yards a large, ugly sign that read “Drive Carefully.” Few residents complied unless they had been “softened up” the week before by an experimenter who got them to sign a petition favoring safe driving. For those residents, putting the ugly sign in the yard helped avoid cognitive dissonance: “Last week I supported safe driving. This week I will be a hypocrite if I do not put this ugly sign in my yard.”

Another effective tactic is to add a decoy, or a worthless item that no one would normally want, to a person’s set of choices. For example, a real-estate agent may show customers overpriced, run-down homes, or a car dealer may place an old clunker of a used car on his or her lot. Consistent with social judgment theory, such decoys create a context for judging the other “real” alternatives and make them appear more attractive. An unsuspecting consumer is then more likely to select and buy these more attractive items.

Attitude research since the 1960s has sought to test and develop the major theories of attitude change, to refine the principles of persuasion, and to apply these principles to an ever-expanding list of targets. For example, research on the relationship between attitude change and memory of a communication led to the development of a cognitive response analysis of persuasion in the late 1960s. Many of the compliance techniques described by Robert Cialdini and by Anthony Pratkanis and Elliot Aronson were first elaborated in this period. As knowledge of persuasion improves, the principles of persuasion are increasingly applied to solve social problems. Prosocial goals to which theories of persuasion have been applied include decreasing energy consumption and increasing waste recycling, slowing the spread of acquired immunodeficiency syndrome (AIDS) by changing attitudes toward safe-sex practices, lowering the automobile death toll by increasing seat-belt use, improving health by promoting practices such as good dental hygiene and regular medical checkups, improving worker morale and worker relationships, and reducing intergroup prejudice.

Bibliography

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Chen, Frances S., et al. "In the Eye of the Beholder: Eye Contact Increases Resistance to Persuasion." Psychological Science 24.11 (2013): 2254–61. Print.

Cialdini, Robert B. Influence: Science and Practice. 5th ed. Boston: Pearson, 2009. Print.

Crano, William D., and Radmila Prislin, eds. Attitudes and Attitude Change. New York: Psychology, 2008. Print.

Eagly, Alice H., and Shelly Chaiken. The Psychology of Attitudes. Fort Worth: Harcourt, 1993. Print.

Jay Frye, G. D., Charles G. Lord, and Sara E. Brady. "Attitude Change following Imagined Positive Actions toward a Social Group: Do Memories Change Attitudes, or Attitudes Change Memories?" Social Cognition 30.3 (2012): 307–22. Print.

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Seo, Kiwon, James Price Dillard, and Fuyuan Shen. "The Effects of Message Framing and Visual Image on Persuasion." Communication Quarterly 61.5 (2013): 564–83. Print.

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In Harper Lee's To Kill a Mockingbird, how does Atticus show Jem and Scout that he cares for them equally?

In Harper Lee’s To Kill a Mockingbird,Atticus Finch has the challenge of raising two young children on his own. Though his maid, Calpurnia, takes care of chores and cooking meals for the family, Atticus is fully committed to raising his children, and imparting unto them his values about fairness and justice. As with any family with more than one child, Atticus shows his children that he cares for them equally in a variety of...

In Harper Lee’s To Kill a Mockingbird, Atticus Finch has the challenge of raising two young children on his own. Though his maid, Calpurnia, takes care of chores and cooking meals for the family, Atticus is fully committed to raising his children, and imparting unto them his values about fairness and justice. As with any family with more than one child, Atticus shows his children that he cares for them equally in a variety of ways.

A telling example occurs near the beginning of the book. As Atticus tucks Scout in for the night, she asks to play with his pocket watch. Atticus mentions that the watch will belong to Jem one day, as it is custom for a son to receive his father’s watch. He goes on to say that when Scout is an adult, he will give her a ring and necklace that once belonged to her mother. By telling this to Scout, he is also reassuring her that she, too, will have a permanent connection to her parents, especially the mother she never knew.

Atticus also makes it clear to his children that a proper education is important for both of them. Despite his long hours working as a defense attorney, Atticus takes time each evening to read to Scout, something he has done since she was an infant. Because of this attention, Scout knows how to read even before her first day of school. Even when Scout becomes frustrated at school due to the teacher and other students, Atticus talks to her like an adult so that she will not stay antagonistic against education. Atticus' actions reveal much about his character considering that southern culture at the time put a lower value on women’s education than it does today.

What are some historical events that happened in the book Fever 1793?

Laurie Halse Anderson's historical novel Fever 1793takes place in Philadelphia. As portrayed in the book, Philadelphia was then the nation's capital. The narrator of the novel mentions the State House, where the Congress then met. Coffeehouses, like the one portrayed in the novel, were common in Philadelphia at the time, and they were places where people could gather to speak about politics and to exchange ideas. The character of Eliza in the novel is...

Laurie Halse Anderson's historical novel Fever 1793 takes place in Philadelphia. As portrayed in the book, Philadelphia was then the nation's capital. The narrator of the novel mentions the State House, where the Congress then met. Coffeehouses, like the one portrayed in the novel, were common in Philadelphia at the time, and they were places where people could gather to speak about politics and to exchange ideas. The character of Eliza in the novel is a freed slave, and Philadelphia was home to about 2,000 freed slaves at the time. 

In addition, an actual yellow fever epidemic broke out in Philadelphia in July of 1793. It was the first significant yellow fever epidemic in the United States. Of the approximately 45,000 people then living in the city, 5,000 died and an estimated 17,000 left the city. Dr. Benjamin Rush, who is a character in the novel and who actually signed the Declaration of Independence, was a major figure in combating the disease. He believed in a treatment of giving his patients mercury and bleeding them. Dr. Rush mistakenly believed that African-American people were immune to the disease, and many African-Americans carried the responsibility of caring for sick patients. When they started to perish, this idea was discounted. While Dr. Rush praised their efforts, some in the community saw their work as an example of profiteering. Absalom Jones and Richard Allen, two African-Americans who had worked to help patients during the epidemic, published their own account of their work to discount these rumors. The Appendix (at the back of Fever 1793) provides more details about the historical background of the novel. 

What is the summary of "The Singers" by Henry Wadsworth Longfellow?

"The Singers" is a poem about three different singers who are sent to the Earth by God. Their purpose is to sing a variety of songs and to

touch the hearts of men,

And bring them back to heaven again.

In the poem, each singer is in a different stage of life. The first singer is a young man who plays a golden lyre. He wanders as he plays his dreamy music. He is depicted as being carefree.

The second singer has a beard and...

"The Singers" is a poem about three different singers who are sent to the Earth by God. Their purpose is to sing a variety of songs and to

touch the hearts of men,

And bring them back to heaven again.

In the poem, each singer is in a different stage of life. The first singer is a young man who plays a golden lyre. He wanders as he plays his dreamy music. He is depicted as being carefree.

The second singer has a beard and it can be assumed that he is middle-aged because of the two singers he is between. He is a serious and contemplative person. He sings in the marketplace, and is

stirred with accents deep and loud

The hearts of all the listening crowd.

The last singer is an older man, whose hair is gray. This older man appears to be wise. When he sings, it is

in cathedrals dim and vast,

While the majestic organ rolled

Contrition from its mouths of gold.

People who hear all three of the singers cannot decide who is best. God looks at all three singers and knows that they each have a special gift. The gift of the young man is to charm. The gift of the middle-aged man is to strengthen. The gift of the older man is to teach. At the end of the poem, it is concluded that

He whose ear is tuned aright

Will hear no discord in the three,

But the most perfect harmony.

How does Harper Lee directly and indirectly characterize Mr. Avery?

A writer uses direct characterization by directly stating a character's physical, emotional, and/or mental traits. An example from the novel would be the presentation of Scout's teacher: "Miss Caroline was no more than twenty-one. She had bright auburn hair, pink cheeks, and wore crimson nail polish." 

Indirect characterization, on the other hand, requires that the reader infer what the character is like through what s/he says, what s/he does, and what others say about the character....

A writer uses direct characterization by directly stating a character's physical, emotional, and/or mental traits. An example from the novel would be the presentation of Scout's teacher: "Miss Caroline was no more than twenty-one. She had bright auburn hair, pink cheeks, and wore crimson nail polish." 

Indirect characterization, on the other hand, requires that the reader infer what the character is like through what s/he says, what s/he does, and what others say about the character. One must read carefully when determining characterization through what others say, because their opinions may not be accurate. An example of this inaccuracy would be the depictions of Boo Radley as a monster-like figure.

Mr. Avery is largely presented through indirect characterization. Our first glimpse of him shows him to be one who "makes change in the collection plate," leading us to infer that he is stingy. In addition, the same paragraph reveals him to be somewhat crude, as "a closer inspection revealed an arc of water descending from the leaves and splashing in the yellow circle of the street light, some ten feet from source to earth, it seemed to us." Here, Mr. Avery uses the restroom outside, oblivious to the fact that anyone can see him, including the neighborhood children.

Further indirect characterization leads us to conclude that Avery does not care for children. When it snows, an unusual occurrence for the area, he blames it on the kids: “See what you’ve done?” he said. “Hasn’t snowed in Maycomb since Appomattox. It’s bad children like you makes the seasons change.” As to his physicality, the sentence preceding this one directly characterizes Mr. Avery as flushed and portly: "He had a pink face and a big stomach below his belt."

What are antioxidants? Do they help treat cancer?

Cancers treated or prevented: Antioxidants are used to treat most types of cancer, although their effectiveness is questionable. They are usually taken for cancer prevention, although the link between antioxidant consumption and cancer prevention in humans is not proven.

Delivery routes: Oral, as tablets, caplets, capsules, powder, or tea; some fruits and vegetables are high in antioxidants

How these compounds work: Free radicals are formed during normal cellular metabolism. Free radicals are compounds that are unstable because they contain an unpaired electron. This unpaired electron causes the free radical to react with other molecules in order to gain another electron, creating an electron pair and a more stable molecule. The process of gaining an electron is called oxidation. Antioxidants in the body react with free radicals and make them harmless to cells. Cells naturally make many antioxidants such as glutathione and coenzyme Q10 (ubiquinone). When the number of free radicals exceeds the antioxidants available to neutralize them, however, the body develops a condition called oxidative stress. Oxidative stress appears to make cells especially susceptible to damage.

Free radical formation and oxidation are normal processes. Oxidation and oxidative stress, however, are thought to contribute to aging, as well as to cancer, cardiovascular disease, and other chronic diseases. In the absence of adequate antioxidant compounds, free radicals most often combine with and damage DNA, cellular proteins, and molecules in cell membranes. This damage can cause gene mutations and change cellular metabolism, which may lead to cancer and other diseases. Exposure to ultraviolet (UV) light, radiation, cigarette smoke, and other known carcinogens increases the number of free radicals that are formed, suggesting another link between free radicals, oxidative stress, and cancer.

In theory, increasing the amount of antioxidants in the body should decrease the amount of damage to DNA and cells and reduce the risk of cancer. Antioxidants have been shown to prevent or slow the development of some cancers in cell cultures grown in the laboratory and in some animal studies. The results in human studies have been mixed. Despite claims by some manufacturers of antioxidant dietary supplements, no clear link between antioxidant consumption and cancer prevention or treatment has been established in humans. The role of antioxidants in the prevention and treatment of cancer is of high interest to research scientists. Many clinical trials are being conducted, and there is no cost for qualified individuals to participate in a clinical trial.

The body makes some antioxidants, but others must be acquired through diet. Common antioxidants that the body does not make include vitamins A, C, and E, carotenoids, and flavonoids. Selenium is a mineral that is not strictly an antioxidant but is essential to many antioxidant reactions and often classed with the antioxidants. Coenzyme Q10 and glutathione are antioxidants naturally produced by the body that are also manufactured sold as high-dose supplements.

Vitamin A (retinol) is a fat-soluble vitamin found in liver, egg yolks, whole milk, and dairy products made with whole milk. It is also sold as a dietary supplement and is included in most multivitamin tablets and in special antioxidant formulations such as ACE, a combination of vitamins A, C, and E. Vitamin A is essential to health, but its role in cancer prevention and treatment is unclear. All-trans-retinoic acid (ATRA, Vesanoid) is a pharmaceutical drug that is a derivative of vitamin A. It is successfully used to treat promyelocytic leukemia and is being studied in individuals with breast and skin cancers. To date, however, vitamin A alone has not shown the same cancer-reducing effects as ATRA.

Alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein, zeaxanthin, and lycopene are all carotenoids that show antioxidant activity in laboratory tests. These compounds are found in red, yellow, and orange plants such as carrots, cantaloupe, mango, and tomato. Beta-carotene and lycopene are also sold as dietary supplements either individually or in combination with other antioxidants. In the body, carotenoids are converted into vitamin A. An examination of twenty-one studies relating lycopene consumption and prostate cancer found that men with the highest lycopene intake had a modest decrease in the incidence of prostate cancer. The role of carotenoids in cancer prevention is actively being studied.

Vitamin C (ascorbic acid) is a water-soluble vitamin found in citrus fruits. For centuries, it has been known that vitamin C is essential for preventing the disease scurvy. Dietary supplements of vitamin C are often promoted as a preventive or treatment for the common cold, although clinical studies have not proved its effectiveness. Vitamin C has very strong antioxidant activities. Nevertheless, multiple human studies have failed to find a significant link between cancer prevention and vitamin C intake.

Vitamin E is a group of related compounds, the most active of which is alpha-tocopherol. Vitamin E is a fat-soluble vitamin with antioxidant properties. It is found in olive, sunflower, and safflower oils and in many nuts. The role of vitamin E in cancer prevention is controversial. The National Institutes of Health reported in 2013 that the antioxidant qualities of vitamin E make it possible to block the formation of carcinogenic qualities of various foods and damaging effects of free radicals. However, human trials and studies have not linked the intake of vitamin E with a reduction of cancer incidence. A 2014 study from the Public Health Sciences Division of the Fred Hutchinson Cancer Research Center elaborated on this by stating that high doses of the vitamin have the potential for a heightened risk for developing prostate cancer in some men.

Flavonoids are a group of antioxidant compounds found primarily in brewed tea, red wine, dark chocolate, apples, berries, and citrus fruits. These compounds have antioxidant activity. Traditional Chinese medicine has promoted the health effects of green tea for centuries, and recent studies show that dark (bitter) chocolate in small quantities may promote heart health, but the role of flavonoids in cancer prevention is unclear.

Selenium is a mineral found in fish, shellfish, grains, Brazil nuts, and many vegetables that are grown in selenium-rich soils. By itself, selenium is not an antioxidant, but it plays a critical role in antioxidant activity and is often classified with the antioxidants that must be acquired through diet. Selenium deficiency has been linked to increases in colorectal, lung, and prostate cancers. Increased selenium intake in people who are not selenium deficient, however, does not decrease the risk of developing cancer. Additionally, selenium is toxic in large doses.

Coenzyme Q10 and glutathione are the main antioxidants made by the body. They are also sold as dietary supplements. Studies of individuals who supplemented their diet with synthetic coenzyme Q10 or glutathione found no evidence that these supplements protected against cancer.

Individuals who maintain a healthy weight and eat a diet low in fats and high in fruits, vegetables, and whole grains develop cancer at a lower rate than individuals who eat a more traditional American diet high in fat and low in fruits and vegetables. The American Cancer Society and the National Cancer Institute recommend that individuals meet as many of their vitamin, mineral, and antioxidant needs as possible by eating a healthy, varied diet rather than by taking dietary supplements. As of 2014, neither organization recommended the use of antioxidant supplements to treat or prevent cancer.

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