What are some similarities and differences between the American Civil War and World War II?

The American Civil War and World War II are without a doubt the two most pivotal conflicts in the history of the United States. Let us look at a few similarities and differences between them, beginning with what the two wars had in common. 

Both wars required a massive effort and sacrifice on the part of the American people. Nearly 2.5 million men served in the Union Army during the Civil War, amounting to over...

The American Civil War and World War II are without a doubt the two most pivotal conflicts in the history of the United States. Let us look at a few similarities and differences between them, beginning with what the two wars had in common. 

Both wars required a massive effort and sacrifice on the part of the American people. Nearly 2.5 million men served in the Union Army during the Civil War, amounting to over 10 percent of the overall population. About 16.5 million men served during World War II, a similar proportion to the overall population. Casualties were horrific in both conflicts. While the Civil War had a higher overall death toll (especially when one includes Confederate casualties) over 400,000 men died in battle or of other causes during World War II. Both wars had a strong ideological aspect. The Civil War began as a war to reunite the Union, but by its end had become a fight to end slavery. World War II was always a war against the forces of fascism and militarism, one which was, at its heart, about the survival of democracy. 

Many of the differences are fairly obvious. The Civil War was an internal struggle, fought on American soil, while World War II was fought overseas. All sides made war on civilian populations in World War II. More civilians than combatants perished in the war, a fact with no parallel in the American Civil War. Another difference was that the emergence of new technologies meant that tactics and strategy had changed considerably between the two wars. The airplane, in particular, completely changed the face of war in World War II. 

What is the relationship between schools and infectious disease?

Definition

Infectious diseases are rarely the top concern of school and public health
officials in the United States. Instead, of central concern are obesity, diabetes,
asthma, smoking, substance abuse, eating disorders, and bullying behaviors.
Now-routine immunization requirements for school entrance have reduced the occurrence of
infectious diseases in schools in industrialized nations. However, these diseases
have not been completely eradicated, and seasonal infections such as influenza
require ongoing school readiness.

Contagious Diseases of the Skin, Hair, and Eyes

Particularly in the preschool and elementary school years, infections that visibly affect the skin, hair, and eyes are fairly common. These diseases may be caused by viruses, bacteria, fungi, or lice; they may be mild and self-limited with no other symptoms outside the skin, or they may cause significant illness.

Chickenpox. Although it is seen less commonly since the varicella
vaccine was licensed in 1995, chickenpox still occurs in localized outbreaks in
children who are not immunized. Chickenpox is caused by the varicella
virus, which spreads easily by inhaling infected droplets released when a child
sneezes or coughs. The virus can also be spread though direct contact with
chickenpox skin blisters. Varicella vaccine is now required for school entrance in
nearly every state, and it is about 90 percent effective in preventing the
illness. For the small percentage of children who still develop chickenpox, even
after being vaccinated, the illness is usually mild and, generally, comes with
fewer than fifty skin lesions.

For nonimmunized children, chickenpox is more severe and may result in
pneumonia, infection of the brain (encephalitis), and other complications. For this reason, one
should never deliberately expose a child to chickenpox to “get the infection over
with.” An infected child may be contagious for one or two days before any skin
blisters appear, and the child will remain contagious (and should be kept home
from school) until all of the blisters have dried up and crusted over.

Impetigo. Impetigo is an infection of the skin
caused by Staphylococcus or Streptococcus
bacteria. Both types of this disease are highly contagious by direct contact, and
both spread easily among young children in preschool settings. Impetigo develops
as an area of redness and blistering of the skin that quickly weeps (oozes)
yellowish fluid and becomes covered with honey-colored crusts. This often occurs
on the face or arms and begins in an area of irritated skin, such as a patch of
eczema or a scratch. Treatment is with either oral antibiotics or an antibiotic
cream, and the child should be kept from school until twenty-four hours after
treatment is begun.

Erythema infectiosum. Also called fifth
disease, erythema infectiosum is a mild illness
often seen in school outbreaks in the late winter and spring months. Generally,
the only symptoms are reddened cheeks followed by a fine, lacy, red rash over the
trunk that may be slightly itchy. This infection is caused by parvovirus B19;
about one-half of adults are immune. However, adults and older children not
previously exposed may also have painful and swollen joints, and there can be some
risk of miscarriage for nonimmune pregnant women exposed to the virus. Children
with fifth disease are contagious only before they break out in the rash, and they
are no longer contagious by the time the rash appears. For this reason, most
school systems do not advise keeping an otherwise asymptomatic child with fifth
disease at home.

Head lice. Head lice (pediculosis capitis) has
long been associated with school-related infectious diseases, and it is most
common in preschool and elementary school children. Infestation of the hair with
these 2 millimeter parasitic insects generally causes more anxiety than actual
physical discomfort, as the lice do not carry disease and tend to cause only minor
itching. In many countries, cases of head lice appear in nearly all children.

Lice treatments involve the application of one of several approved treatments (available over the counter and by prescription), with repeat treatments either on day nine or in a three-dose regimen with repeat treatments on days seven and fourteen. In the past, undergoing treatment meant that children would be refused readmission to school until treatment was completed and there were no remaining visible “nits” (eggs and dead egg-casings) clinging to the hair shaft. However, the difficulty in removing all nits even after successful treatment, and the frequent misidentification of dandruff, skin particles, and scabs as nits, led to many uninfested children being excluded from school for an average of twenty days.

Many school policies are changing. Head lice are most commonly spread by direct head-to-head contact, which is not commonplace in the classroom beyond the preschool years. Lice are much less likely to be spread by the shared use of brushes, combs, and headgear. In the United States, most head lice are probably transmitted during close sleeping arrangements, such as the sharing of beds at sleepovers and summer camps, rather than at school. The American Academy of Pediatrics (AAP) recommends that school nurses be well trained in proper diagnosis of head lice, particularly in recognizing nits, mainly to avoid diagnostic confusion. At the same time, the AAP recommends that school districts abandon their “no-nit” policies for a child’s return to school, and that children should return to school the day after their first treatment, even if nits remain visible in the hair.

Conjunctivitis. The most common cause of conjunctivitis, or pinkeye, is a viral
infection of the clear membrane covering the white of the eye
and lining the eyelids. Viral conjunctivitis causes reddened, itchy eyes with a
clear watery discharge, and it is spread by contact with secretions (tears and
nasal discharge) that often are spread from the fingers. Children may remain
contagious for ten to twelve days. Bacterial conjunctivitis also causes reddened
eyes, but it is more likely to result in thick, puslike, yellow or green eye
secretions, and it responds quickly to antibiotic drops. Students with bacterial
conjunctivitis can usually return to school twenty-four hours after beginning
treatment, but students with viral conjunctivitis should remain home until they
are symptom free or until cleared by a physician.

Methicillin-resistant Staphylococcus aureus
(MRSA). MRSA has become a problem in schools, particularly in
physical education classes and high school athletic programs. This type of
bacteria mainly causes skin infections, usually of open
wounds, and is resistant to many common antibiotics that were previously able to
treat Staphyloccocus (staph) infections. MRSA causes redness,
swelling, pain, and pus, and it must be diagnosed by a bacterial culture. It
spreads by direct skin-to-skin contact or by contact with a used bandage, towel,
or surface in a locker room or other athletic facility. Athletes who have a break
in the skin should clean the area and cover it to prevent infection. Those who
already have an MRSA-infected wound should always keep the area completely covered
to prevent spreading the infection to another person. As long as the infected area
is not draining and can be completely covered, infected athletes, according to the
CDC, do not need to be excluded from athletic participation. It also is not
necessary to close or completely disinfect a school if a student has been
diagnosed with MRSA.

Respiratory Infections

Common cold. The most common respiratory illness in schools is
the viral infection known as the common cold. Caused by a variety of
viruses and spread by coughs, sneezes, and contaminated surfaces such as
doorknobs, colds affect otherwise healthy young children up to six times per year.
Chances are that each classroom will have a minimum of one child with a cold.
Although some preschools and day-care centers may exclude children from attending
if they exhibit cold symptoms, no medical reason exists for doing so, because
these illnesses are mild, self-limited, and ubiquitous.

Influenza. Another respiratory illness, influenza, is
of much greater concern in schools. Influenza, commonly referred to as the flu, is
characterized by respiratory symptoms more severe than those of the common cold.
Flu symptoms also include high fever, headache, and muscle aches, and the flu has
the potential for complications, including pneumonia and, rarely, death. The
illness is contagious and is transmitted through inhaling or contacting the
droplets of an infected person’s cough or sneeze.

Influenza occurs in predictable seasonal outbreaks during the winter months in both the Northern (peaking in January and February) and Southern (peaking in July and August) hemispheres. Several slightly different influenza viruses circulate each year, and these viruses tend to change year to year. Each year’s flu vaccine is tailored to prevent the viruses that are predicted for that year by virologists. These predictions are not always completely correct, meaning that in some years, even those persons who get that season’s vaccine will not be well protected.

Schools have three main strategies at their disposal for preventing large
outbreaks of influenza among students and staff. The primary tool is immunization.
The CDC recommends that all children older than age six months receive an annual
seasonal influenza vaccine, and schools often encourage this by means of letters
and other reminders to parents. Particularly in years in which a new strain of flu
is causing a pandemic, such as the 2009 H1N1 virus pandemic, schools may
provide in-school vaccinations with parental approval.

The second strategy available to schools for the prevention of influenza
outbreaks is attention to basic hygiene measures. Schools are teaching children to
cover their mouths and noses with a tissue when coughing or sneezing and to
discard the tissue in the trash immediately afterward. Alternatively, children are
being taught to sneeze into their arms near their elbows, instead of into their
bare hands, if no tissue is available. Handwashing is emphasized as a means to prevent transmission after coughing,
sneezing, blowing one’s nose, or touching an object that has been used by a sick
person. In preschools and elementary schools, children should be given frequent
opportunities for handwashing, and when no water is available, children should
have access to a gel-based hand sanitizer. These concepts can be reinforced as
part of morning announcements, in handouts, and through frequent review.

The third tool available to schools to manage influenza is attendance policy. Children and staff who display flulike symptoms should not attend school. However, because persons with influenza are contagious for about twenty-four hours before showing any symptoms, and will remain contagious until about the fifth day of illness, this type of attendance policy cannot completely protect students and staff. During the 2009 pandemic flu season, some schools closed when a significant number of students became ill. In general, however, this practice is not recommended for a variety of reasons, including that when schools are closed, parents often bring younger children to a babysitter, a neighbor, or even to the workplace. Older children, especially teenagers, often use this time away from school to congregate with their friends, often in public places. Overall, it appears that a school closure because of a flu scare aids in spreading the virus into the community, rather than keeping it contained. However, if absenteeism among teachers and staff is so high that the school cannot function appropriately, school closures may be inevitable.

Strep throat. Streptococcal pharyngitis, or strep throat,
is another common respiratory illness in school-age children. The majority of sore
throats are caused by some of the many viruses that cause the common cold, but up
to 30 percent may be caused by the bacterium Streptococcus
pyogenes. Children with a sore throat, fever, swollen lymph nodes
(glands) in the neck, headache, and, sometimes, abdominal pain and vomiting are
most likely to have strep throat, which is spread by infected droplets from
coughing and sneezing and from contaminated hands. Strep throat should be
diagnosed either by a rapid screening test or a throat culture, so that
antibiotics are not used unnecessarily for a viral infection. Antibiotics should
be given for a minimum of twenty-four hours before an infected child returns to
school, and they are critical for the prevention of later complications from
S. pyogenes. These complications include scarlet
fever, heart valve damage, and kidney damage.

Bacterial meningitis. Bacterial meningitis is a serious
illness that is life-threatening, may begin during the school day, and may
progress in severity in a matter of hours. Any child who develops a headache,
along with a stiff neck, fever, confusion, or rash or discoloration of the skin,
should be taken to a hospital for emergency treatment. If a certain type of
bacterial meningitis (meningococcal meningitis) is diagnosed,
health officials will contact the school and identify students and staff who were
in direct contact with the infected child so that prophylactic (preventive)
antibiotics can be administered to all who had contact.

Bacterial meningitis spreads by infected droplets from a cough or sneeze. A vaccine called meningococcal conjugate vaccine (MCV4) is routinely recommended at ages eleven and twelve years. Meningitis is also caused by a wide variety of viruses and is generally less severe. It is not prevented by or treated with antibiotics.

Gastrointestinal Infections

Gastroenteritis. Diarrhea and vomiting (gastroenteritis) is usually a more serious problem among
preschool and early elementary age students, who are more likely to have poor
restroom hygiene and more likely to put their hands, toys, and other items in or
near their mouths. Infections causing these symptoms can be classified as being
waterborne, food-borne, or acquired from another person or animal through contact
with their feces or body secretions.

A sudden, large outbreak of gastroenteritis in a school is often caused by a food-borne illness from cafeteria food. In this case, school officials should alert local or state health officials. Health officials will conduct an investigation of the outbreak to determine the cause. The investigation will include extensive questioning of students and staff, microbiological testing of food remnants and kitchen surfaces, and medical testing of cafeteria staff.

Other sudden, large outbreaks in a school may prove to be caused by
noroviruses, which can be food-borne but are more often
spread quickly and easily from person to person through either direct contact with
contaminated feces or vomit or from touching contaminated surfaces such as
restroom doors or another person’s towel. A norovirus infection tends to cause a
day or two of severe diarrhea in children, and then clears on its own.

Impact

Given that fifty-five million children age eighteen years and younger attend schools each day in the United States, an infectious disease affecting one child could potentially affect (and infect) many more. Many of the worst infectious diseases are rarely, if ever, seen in today’s schools because of stringent, compulsory school immunization laws. Today’s schools, however, face other potential infectious disease challenges.

Some students remain unimmunized because of their parent’s religion, or because
of other reasons, providing an opening for disease outbreaks. Antibiotic
resistance, such as that seen with MRSA infections, is likely
to become a more widespread problem. Immigrant populations in some areas increase
a student’s potential exposure to tuberculosis. As teens engage in oral
and genital sex at earlier ages, herpes infections, gonorrhea, human
immunodeficiency virus infection, and other sexually transmitted infections will
likely become more prevalent among teen social networks, which tend to revolve
around school activities. School nurses and administrators, and public health
officials, should continue to devote time and attention to infectious disease in
the schools.

Bibliography

Aronson, Susan S., and Timothy R. Shope. Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. 2d ed. Elk Grove Village, Ill.: American Academy of Pediatrics, 2009. A reference on infectious disease management and prevention in school and child-care settings.

Centers for Disease Control and Prevention. “Questions and Answers About Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools.” Available at http://www.cdc.gov/features/mrsainschools.

Fisher, Margaret C. Immunizations and Infectious Diseases: An Informed Parent’s Guide. American Academy of Pediatrics, 2006. A pediatrician explains childhood infection and its prevention.

Frankowski, Barbara L., and Joseph A. Bocchini, Jr. “Clinical Report: Head Lice.” Pediatrics 126 (August, 2010): 392-403. A report from the American Academy of Pediatrics’ Council on School Health and the Committee on Infectious Diseases includes a clinical overview of head lice diagnosis and treatment and expert opinion on school policies related to head lice.

Lee, Marilyn B., and Judy D. Greig. “A Review of Gastrointestinal Outbreaks in Schools: Effective Infection Control Interventions.” Journal of School Health 80 (2010): 588-598. A review of documented gastrointestinal illness outbreaks in schools since 2000.

What is bulimia? |

Causes and Symptoms

Bulimia is typically regarded as a psychologically based disorder caused by childhood experiences, family influences, and social pressures, particularly on young women to be thinner than natural. Many people who develop bulimia have been overweight in the past and suffer from poor self-image and depression. Body weight is often within normal limits, but persons with bulimia perceive themselves as fat and are often obsessed with their body image. Others may have a history of sexual or physical abuse or of alcohol or drug abuse. Medical research suggests that bulimia may be partially caused by impaired secretion of cholecystokinin (CKK), a hormone that normally induces a feeling of fullness after a meal, or by depletion of the chemical serotonin in the brain, which contributes to a craving for carbohydrates.

Intense preoccupation with food and weight are invariably present, and eating binges are followed with self-induced vomiting or the ingestion of laxatives to rid the body of the consumed food. Depression and suicidal feelings sometimes accompany bulimia. The disorder can cause nutritional deficiencies, dehydration, hormonal changes, gastrointestinal problems, changes in metabolism and blood chemistry, heart disorders, persistent sore throat, and teeth and gum damage as a result of the acidic nature of regurgitated food.

Treatment and Therapy

Treatment of bulimia requires a combination of nutritional counseling, medication, and psychotherapy. Psychotherapists try to get to the root of any underlying psychological problems and resolve them. Various modes of group and cognitive behavioral therapy have proven effective.

Cognitive therapy usually includes confronting people with bulimia about their inaccurate perceptions of body weight and making contracts with them to shift their focus to nutrition rather than weight gain in exchange for rewards. Group therapy has helped many bulimics stop their binge eating, while treatment with antidepressant drugs, especially fluoxetine (Prozac), has helped many bulimic patients gain partial or full relief from their symptoms. Hospitalization is common treatment and is virtually always necessary if body weight is more than 30 percent below ideal.

Perspective and Prospects

Bulimia was classified as a distinct disorder by the American Psychiatric Association in 1980; the name was officially changed to bulimia nervosa in 1987. The disorder occurs mostly in adolescent and young adult females, with only about 10 percent of cases in males. Many cases of bulimia end after a few weeks or months but may reoccur. Other cases last for years without interruption.

In 2006, researchers developed a new test that analyzes carbon and nitrogen in hair, which is suggestive of eating disorders. This technique is beneficial because eating disorders are difficult to diagnose, in part because sufferers sometimes do not know that they have an eating disorder or do not want to be honest. By analyzing just five strands of hair, researchers were able to diagnose anorexia and bulimia accurately 80 percent of the time. This test may hasten treatment and prove an effective and objective method of monitoring recovery.

Bibliography:

Fairburn, Christopher G., and Kelley D. Brownell, eds. Eating Disorders and Obesity: A Comprehensive Handbook. 2d ed. New York: Guilford, 2005.

Maj, Mario, et al., eds. Eating Disorders. New York: Wiley, 2003.

National Association of Anorexia Nervosa and Associated Disorders. ANAD, 2013.

National Eating Disorders Association. NEDA, n. d.

Parker, James M., and Philip M. Parker, eds. The 2002 Official Patient’s Sourcebook on Binge Eating Disorder. San Diego, Calif.: Icon Health, 2002.

Reindl, Shiela M. Sensing the Self: Women’s Recovery from Bulimia. Cambridge, Mass.: Harvard UP, 2001.

Swain, Pamela I., ed. Anorexia Nervosa and Bulimia Nervosa: New Research. New York: Nova Science, 2006.

Vorvick, Linda J. "Bulimia." MedlinePlus, Feb. 13, 2012.

Wood, Debra. "Bulimia Nervosa (Bulimia)." Health Library, Sept. 10, 2012.

What is rosacea? |

Causes and Symptoms

Guy de Chauliac, a French surgeon, first described rosacea medically in the fourteenth century, attributing the condition to the excessive consumption of alcoholic drinks. It is now known that although alcohol may exacerbate the condition, rosacea can develop in individuals who have never consumed alcohol. While the actual cause is unknown, rosacea is more common in fair-skinned people who flush easily and those whose family members have had the condition.

The most common triggers for this flushing are hot drinks, caffeine, alcohol, spicy foods, cosmetics, stress, exercise, sunlight, wind exposure, and extreme heat or cold. There is no cure for rosacea, but it can be treated.

Untreated, rosacea may progress from facial redness to slight swelling, pimples, pustules, and prominent facial pores on the nose, mid-forehead, and chin. In some patients, particularly in men, the oil glands enlarge, causing a bulbous, enlarged red nose and puffy cheeks. Thick bumps can develop on the lower half of the nose and nearby cheeks. This stage is known as rhinophyma, a condition made famous by actor W. C. Fields with his red, bulbous nose. Rhinophyma can be extremely disfiguring, and its mistaken association with alcoholism can cause embarrassment and affect self-esteem.

Treatment and Therapy

Rosacea and rhinophyma cannot be cured, but the symptoms can be lessened or even eliminated. Oral and topical antibiotics and avoidance of triggers are the primary ways in which rosacea is managed. Eyelid washing and prescription medication may be recommended for patients whose eyes are affected.

Rhinophyma is usually treated with surgery. The excess tissue that has developed can be removed with a scalpel or a laser or through electrosurgery.

Bibliography

Brownstein, Arlen, and Donna Shoemaker. Rosacea: Your Self-Help Guide. Oakland, Calif.: New Harbinger, 2001.

Hall, John C., and Gordon C. Sauer. Sauer’s Manual of Skin Diseases. 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2010.

Hellwig, Jennifer, and Purvee S. Shah. "Rosacea." Health Library, September 10, 2012.

Mackie, Rona M. Clinical Dermatology. 5th ed. New York: Oxford University Press, 2003.

Parker, James N., and Philip M. Parker, eds. The Official Patient’s Sourcebook on Acne Rosacea. San Diego, Calif.: Icon Health, 2002.

Plewig, Gerd, and Albert M. Kligmanerd. Acne and Rosacea. 3d rev. ed. New York: Springer, 2000.

"Questions and Answers about Rosacea." National Institute of Arthritis and Musculoskeletal and Skin Diseases, October, 2012.

"Rosacea." American Academy of Dermatology, 2013.

Rosacea.org. http://www.rosacea.org.

Turkington, Carol, and Jeffrey S. Dover. The Encyclopedia of Skin and Skin Disorders. 3d ed. New York: Facts On File, 2007.

Identify and explain the 4 major interest groups involved in the Panama Canal Negotiations leading up to the Torrijos-Carter Treaties.

The most important interest group involved in the negotiations that led to the Torrijos-Carter Treaties was of course the government of Panama. But there were also three other interest groups, different parts of the US government: The Department of Defense, which considered the Panama Canal an essential strategic asset that must remain under US military control, the President and Department of State, who wanted the people of Panama to achieve self-determination and become a free and independent country; and the US Congress, which was responsible for ratifying the treaty and was divided between the two extremes, with some in Congress supporting independence for Panama and others insisting on the strategic interest in retaining US control.

An important undertone in all of this was the ongoing Cold War; the President of Panama, Omar Torrijos, had attained power through a military coup and had some socialist leanings that frightened many American policymakers.

Also important was the fact that in 1976, in the middle of negotiations, the US had a Presidential election. President Gerald Ford had supported limited independence for Panama (essentially granting the US control of the canal, but not the country), while the new candidates James Carter and Ronald Reagan wanted to maintain US control. James Carter won the election, and went on to negotiate the treaties---hence "Torrijos-Carter". Initially he was opposed to Panama's independence, but eventually the Secretary of State convinced him that Ford's plan for limited independence was the right approach.

Carter made the treaties top priorities, and despite opposition from the Department of Defense and many in Congress he negotiated the withdrawal of US troops and ceded control of the country to the government of Panama, while including a provision that the canal itself must remain accessible to the US.

There were actually two treaties signed in 1979; one established the neutrality of the Panama Canal, and the other granted independence to Panama. Theoretically it also granted Panama control of the canal, but only after a 20-year lag. The Panama Canal Zone itself was thus not actually ceded to the Republic of Panama until 1999, during the interim, Torrijos died and was replaced by Manuel Noriega, who was forcibly ousted by US troops in 1989.

What is saffron as a dietary supplement?

Overview

The Mediterranean herb saffron, long used in cooking, is made from the dried stigma (top of the female portion) of the Crocus sativa flower. Each flower has only three small stigmas, and about seventy-five thousand flowers are needed to produce 1 pound of saffron. As a cooking herb, saffron is valued for its intense orange-yellow color and its subtle flavor.

Medicinally, saffron has been used since ancient times for strengthening digestion, relieving coughs, smoothing menstruation, relaxing muscle spasms, improving mood, and calming anxiety. Saffron contains vitamin B2
along with a yellow flavonoid called crocin, a bitter glycoside called picrocrocin, and the volatile, aromatic substance called safranal.

Uses and Applications

The best evidence for medicinal effects of saffron involve the treatment of depression. According to five preliminary double-blind studies, the use of saffron at 30 milligrams (mg) daily is more effective than placebo and just as effective as standard treatment for major depression. However, all these studies were small and preliminary and were performed by a single research group in Iran. Larger studies and independent confirmation is necessary to determine whether this expensive herb is truly effective for depression.

Other proposed uses of saffron have even weaker supporting evidence. Test-tube and animal studies hint that saffron and its constituents may help prevent or treat cancer, reduce cholesterol levels, protect against side effects of the drug cisplatin, and enhance mental function.

Dosage

In the foregoing studies of depression, saffron was used at a dose of 30 mg daily as an alcohol-based extract.

Safety Issues

Saffron appears to be safe. One study found no serious adverse effects among healthy volunteers given up to 200 mg per day of saffron for one week. It is often said that very high doses of saffron can cause abortion and possible toxic symptoms, but there is no scientific documentation of these supposed effects. However, the so-called meadow saffron, Colchicum autumnale, is highly toxic, and sometimes people mistake one for the other. Also, the safety of saffron use in young children, pregnant or nursing women, and people with severe liver or kidney disease has not been established.

Bibliography

Abdullaev, F. I., and J. J. Espinosa-Aguirre. “Biomedical Properties of Saffron and Its Potential Use in Cancer Therapy and Chemoprevention Trials.” Cancer Detection and Prevention 28 (2004): 426-432.

Gout, B., C. Bourges, and S. Paineau-Dubreuil. “Satiereal, a Crocus sativus L. Extract, Reduces Snacking and Increases Satiety in a Randomized Placebo-Controlled Study of Mildly Overweight, Healthy Women.” Nutrition Research 30 (2010): 305-313.

Modaghegh, M. H., et al. “Safety Evaluation of Saffron (Crocus sativus) Tablets in Healthy Volunteers.” Phytomedicine 15 (2008): 1032-1037.

Noorbala, A. A., et al. “Hydro-alcoholic Extract of Crocus sativus L. Versus Fluoxetine in the Treatment of Mild to Moderate Depression.” Journal of Ethnopharmacology 97 (2005): 281-284.

What are risk factors for addiction?

The Addictive Personality?

Solving the addiction problem is much more complex than “just saying no,” as the antidrug campaign popularized by former First Lady Nancy Reagan encouraged. A major misconception about addiction is that certain substances, by themselves, can turn the unwary into “dope fiends.” Because substance abuse involves problems with impulse control, many researchers believed that dependence is mostly a matter of personality, speculating that there may be a certain addictive personality profile that puts people at risk for addiction.

The National Survey of American Attitudes on Substance Abuse, an annual survey conducted by the National Center on Addiction and Substance Abuse at Columbia University, states that “every child in America is at risk of using drugs, regardless of race, ethnicity, or economic status.” People of all racial and ethnic groups can develop addictions, and nearly half Americans over the age of twelve had tried marijuana as of the 2014 National Survey on Drug Use and Health but most do not become addicts. Only 10 percent of all people who experiment with drugs become addicted.

Why does addiction affect only some people and not others? The answer appears to lie not so much in a person’s personality but more in a person’s vulnerability to drug abuse and addiction. Vulnerability is a product of the interaction of a person’s environment, age, and biology. The common denominator is body chemistry and how the brain reacts to addictive substances. The addictive process shares common elements and influences, although the pathways will differ from person to person.

A National Academy of Sciences study in the 1980s concluded that there is no single set of psychological characteristics that fit all addictions, but the study did report common elements in people from addiction to addiction. Personality characteristics that were studied include depression, anxiety, dependent or antisocial behavior, and difficulty formulating long-term personal goals.

There appear to be commonalities and valid risk factors but no true way to characterize an addictive personality. While certain personality traits play a role in addictive behavior, most behavioral experts concur that the triad of social factors, psychological factors, and physiological components is at the core of the addiction process, but the exact nature of their interplay remains unknown.

Psychological Risk Factors

Addiction comprises psychological conditions involving biological processes and genetics that have physical, environmental, and neurochemical aspects. Impulsivity and sensation-seeking are the psychological characteristics that have been commonly reported as factors associated with higher risk for addiction. Also considered is how a person perceives risk. Persons who have a low-risk perception tend to focus on potential benefits and cannot or do not see the adverse consequences in situations of uncertain outcome.

The prevalence of addiction to illicit drugs and to nicotine is higher in persons who also have a comorbid mental illness. As of the National Survey on Drug Use and Health, more than 8 million American adults with substance-related disorders had comorbid psychiatric disorders—namely, major depression, personality disorders, anxiety disorders, and schizophrenia. Nearly all personality disorders are marked by impairments in impulse control. Consequently, people with such a diagnosis are at a higher risk for addiction. This is especially true for antisocial and borderline personality disorders. Antisocial personality disorder is a pervasive pattern of disregard for and violation of the rights of others and an inability or unwillingness to conform to social norms. Such persons are impulse-dysfunctional, have deficits in attention, lack the ability to reflect, and lack sensitivity. Borderline personality disorder is a pervasive pattern of instability in interpersonal relationships, self-image, affect regulation, and impulse control.

People with anxiety disorders are at increased risk for developing addictions because they may use substances to reduce their anxiety and control their symptoms. A National Epidemiologic Survey on Alcohol and Related Conditions found that any anxiety disorder of the
Diagnostic and Statistical Manual of Mental Disorders
, diagnosed in the year of the survey, was associated with a 13.02 percent prevalence of alcohol use disorder, which increased with a diagnosis of two coexisting disorders.

A later study of patients from three urban, university-affiliated outpatient clinics investigated the association of individual anxiety and mood disorders and drinking patterns, defined as three drinks, two or more times a week for heavy drinking and four or more times a week for frequent drinking. Overall percentages were 6.19 percent for heavy drinking and 8.31 percent for frequent drinking. Post-traumatic stress disorder was associated more with heavy drinking and panic disorder more with frequent drinking (but with less heavy drinking). No significant relationship was found between alcohol use and two or more coexisting disorders.

Persons with
attention deficit hyperactivity disorder (ADHD) in general are at higher risk for addictions because one of the primary features of ADHD is impulsivity, which involves premature, risky behavior and poorly conceived actions. Aside from their impulsivity, people with the disorder have difficulty recognizing risks and do not associate them with negative consequences; people with ADHD lack sound judgment and become frustrated easily, all of which makes them highly susceptible to addictive behavior.

Approximately one-half million teenagers struggle with eating disorders . While not strictly an adolescent disorder, the median age of onset for an eating disorder is between twelve and thirteen years old for the three major disorders (anorexia nervosa, bulimia nervosa, and binge eating), according to a 2010 study released by the National Eating Disorders Association. These addictions manifest as intense preoccupations with food, weight, and body image but are complex conditions involving physical, psychological, interpersonal, and social issues. Like other addictions, eating disorders have patterns, although no one factor causes an eating disorder.

Risk factors for anorexia include fear of growing up, inability to separate from the family, need to please or be liked, perfectionism, need to control, need for attention, lack of self-esteem, high family expectations, parental dieting, and family discord. Risk factors for bulimia include difficulty regulating mood, impulsive acts (such as shoplifting and substance abuse), sexual abuse, and family dysfunction.

Biological Factors

Since the early 1990s, scientists have amassed a wealth of data about the neurophysiologic processes and biologic mechanisms that underlie the triggering of pleasure, reward, and addiction, resulting in the classification of addiction as a biological brain disease. These neurochemical changes and genetic influences, which account for up to 40 to 60 percent of the predisposition to addiction, along with family history of addiction, age, and gender, are all biologically based risk factors that affect a person’s vulnerability to addiction.

The prefrontal cortex (the gray matter of the anterior part of the frontal lobe) is part of the cerebral cortex, the convoluted outer layer of gray matter of the cerebrum that coordinates sensory and motor information. The prefrontal cortex is involved in behavior control through executive functioning (EF)—abstract thinking, motivation, planning, and inhibition of impulsive responses. The prefrontal cortex is highly developed in humans but is not fully developed until adulthood. Thus, certain groups, such as people with ADHD and antisocial personality disorder, and adolescents, who have deficient, dysfunctional, or immature EFs, will be predisposed to impulse control problems and have a higher risk for substance abuse and addiction.

With chronic substance abuse, the brain’s ability to control impulses becomes further compromised because addicting substances reduce functioning specifically in that area. Simply put, this initiates a vicious cycle of impulse control problems leading to dangerous behavior that perpetuates the impulsivity.

The limbic system controls basic emotions, drives, and behaviors and affects motivational and mood states. Because it links certain brain structures that regulate people’s ability to feel pleasure, the limbic system is essential to the brain’s reward circuitry.

The neurotransmitter dopamine has long been known to become activated and to regulate feelings of pleasure, and it now appears to also be key in determining the motivational state. With chronic drug use, the persistent release of dopamine programs the limbic brain regions and the prefrontal cortex to embed drug cues into the amygdala (one of the limbic system structures), a process that floods the brain’s reward system, enhances the motivational state, and creates the obsessive craving for drugs. Hence, there is an inherent risk cycle of reinforced drug taking that leads to addiction. This compulsive drive toward drug use is exacerbated by deficits in impulse control and decision making.

Personal relevance, the state of being able to relate internal and external stimuli to establish a sense of belonging, is important in personality development. The bilateral caudate nucleus (BCN) and pregenual anterior cingulate cortex (PACC) are both known to be active in this process. BCN is a medial basal ganglia involved in motor control. PACC is found in the frontal part of the cingulate cortex surrounding the corpus callosum; it is involved in emotional aspects of brain function and linked to anhedonia.

Another brain region, the bilateral anterior insula (BAI), not previously reported to be active in personal relevance, was investigated specifically during personal relevance in an experiment into neural responses evoked by reward and the attribution of personal relevance. BAI is normally involved in empathy, compassion, and interpersonal phenomena, and in decision-making under complex and uncertain situations. Based on analyses, the response to personally relevant stimuli is dependent on the novelty seeking personality trait, and the neuronal responses of BAI, BCN, and PACC may be predictors of addiction risk.

Other studies have found evidence of additional biological risk factors. Deficient cortisol reactivity to a variety of stressors has been implicated as a risk factor for alcohol and nicotine dependence. In addition, persons with alcohol and drug-abusing parents who show preexisting alterations in frontal-limbic interactions with the hypothalamic-pituitary-adrenocortical axis may be more vulnerable to addiction. Task-based activation in the inferior frontal gyrus and right insula has been associated with risk aversion, and activation in the nucleus accumbens and parietal cortex has been associated with both risk seeking and risk aversion. According to the investigators, these findings indicate that individual differences in attitudes toward risk taking are reflected in the brain’s functional architecture and may have implications for engaging in real-world risky behaviors.

Children and adolescents who exhibit aggressive behaviors, who demonstrate a lack of self-control, and who have a difficult temperament may be at risk for drug addiction, especially if they have been physically abused or have parents who are dependent on drugs or alcohol. These children and adolescents usually view authority with disrespect and feel out of control. Those who have been abused may be consumed by feelings of violence and may turn to drugs to suppress the anger, anxiety, and aggression caused by earlier trauma.

Risk Factors Related to Age and Gender

Because the prefrontal cortex is the last part of the brain to develop, thirteen- to nineteen-year-olds tend to use other parts of the brain (for example, emotional areas) when making decisions and are at high risk for substance abuse and addiction. Adolescent characteristics are predictors of adult alcohol use and abuse, and their effect varies as a function of age and type of alcohol outcome.

According to the Substance Abuse and Mental Health Services Administration, twelve- to seventeen-year-olds who smoke, compared with nonsmoking youth, are more than eight times more likely to use illegal drugs and more than seventeen times more likely to drink heavily. In the same age group, weekly marijuana users are nine times more likely than nonusers to experiment with illegal drugs or alcohol.

There is a robust association between age at first drink and risk of alcohol use disorder, reflecting willful rather than uncontrolled heavy drinking. Heavy episodic drinking is a measure of higher-risk drinking. Substance abuse prevalence is greatest among eighteen- to twenty-five-year-olds and more common in men than in women, but the relative risk of marijuana use is approximately equal for men and women.

Males and females experience adolescence differently because of various social, cultural, physiological, and psychological differences. In males, puberty tends to increase aggressive behavior and causes them to crave being an adult; males at this age also experiment with sexual behavior and with alcohol, tobacco, or illegal drugs. In females, puberty tends to increase the incidence of depression, lessen self-confidence and self-worth, and reduce physical activity, school performance, and aspirations; females at this age become more vulnerable to negative outside influences and mixed messages about risky behaviors. They are also at higher risk for sexual abuse, which has been associated with substance abuse.

In aging adults, fewer women than men consume alcohol, women who do drink consume less alcohol than men, and total alcohol intake decreases after retirement. Despite the latter, alcohol abuse and alcoholism may be under-recognized and, in terms of absolute numbers, may be becoming a silent epidemic, despite the overall decrease in alcohol consumption with increasing age.

Environmental Factors

Environmental risk factors are those characteristics in a person’s surroundings and everyday life that increase his or her likelihood of becoming addicted to drugs. These characteristics include one’s family dynamics, social and cultural surroundings, housing, school, employment status, economic status, education level, and peer group.

Risk of drug abuse increases substantially during times of transition—changing schools, moving, divorce, and puberty. One of the biggest factors contributing to drug abuse risk is having friends who engage in addictive behavior. Teens are six times more likely to use marijuana when they believe that all or most of the students in their grade use drugs.

Lackadaisical family attitudes about drugs and alcohol, family substance use, dysfunctional parenting, and parental abuse (physical, emotional, or sexual) are contributing risk factors to substance abuse and addiction. If parents use alcohol, tobacco products, or other substances, their children are more likely to use them too.

Excessive deprivation or overindulgence in early life and inconsistencies in parental behavior, such as too much or too little love or discipline, or frequent instances of sudden switching from unrealistic praise to destructive criticism, can make a child more likely to use drugs or alcohol. Studies have found that latchkey children who are left home alone two or more days per week were four times more likely to have gotten drunk than those who had parental supervision five or more times per week; children who have the least adult monitoring start using drugs at earlier ages; and the earlier a child starts using drugs, the greater the likelihood a serious problem will develop.

Cultural beliefs, availability of drugs in the community, and acceptability of use within a person’s social environment and peer group contribute to drug use. People living in urban communities are more at risk for illicit drug and alcohol abuse than those living in rural communities. Those living in rural areas, however, are at greater risk of becoming addicted to prescription pain medication, binge drinking as adolescents, and using tobacco products of any kind. Among rural inhabitants, low socioeconomic status and isolation are risk factors of note.

Academic failure, particularly in later elementary years, is a risk factor for addictions because it begets low self-esteem. According to a 2003 National Household Survey on Drug Use, children age twelve to seventeen years who enjoyed going to school, felt that their assigned schoolwork was meaningful, or believed that what they learn in school would be important later in life, were less likely to have used illicit drugs or alcohol compared with those who did not have the same positive attitudes toward school. Female students were more likely than male students to have positive attitudes toward school, and Asian, black, and Hispanic youths were more likely than white youths to have these positive attitudes.

Teens are more likely to smoke, drink, or use illegal drugs if they have a negative attitude, difficulty adapting to change, and an inability to “go with the flow.” Teens at risk are those with changing family structures; easy access to alcohol, tobacco, or illegal drugs; adverse peer pressure; little adult supervision; unsafe places to learn, play, and socialize; and no good role models.

Perspectives

Resolving the monumental problem of substance abuse and addictive disorders will require education about addictive substances, recognition of susceptible personality traits and risk factors associated with addiction, and better understandings of the complex interactions of psychological, environmental, and biological factors that contribute to the development of addiction.

Bibliography

Barnes, Gordon, Robert Murray, and David Patton. The Addiction-Prone Personality. New York: Springer, 2007. Print.

Courtwright, David. Forces of Habit: Drugs and the Making of the Modern World. Cambridge: Harvard UP, 2001. Print.

Nakken, Craig M. The Addictive Personality: Understanding the Addictive Process and Compulsive Behavior. 2nd ed. Center City: Hazelden, 1996. Print.

"Substance Abuse in Rural Areas." Rural Assistance Center. Rural Assistance Center, 15 May 2015. Web. 27 Oct. 2015.

Thombs, Dennis. Introduction to Addictive Behaviors. 3rd ed. New York: Guilford, 2006. Print.

What kind of joint is the knee joint?

There are three types of joints in the human body: fibrous, cartilaginous and synovial joints. This classification is based on the material used for making the joint. For example, fibrous joints are those that are joined by fibrous ligaments. Cartilaginous joints, on the other hand, are the joints in which bones are connected together by cartilage. Synovial joints are formed by a fluid-filled capsule, known as the synovial capsule and cartilage. They are also classified...

There are three types of joints in the human body: fibrous, cartilaginous and synovial joints. This classification is based on the material used for making the joint. For example, fibrous joints are those that are joined by fibrous ligaments. Cartilaginous joints, on the other hand, are the joints in which bones are connected together by cartilage. Synovial joints are formed by a fluid-filled capsule, known as the synovial capsule and cartilage. They are also classified based on mobility. For example, fibrous joints are permanent (and hence immobile), cartilaginous joints are partially movable, while synovial joints are mobile or freely movable joints.

Knee joints are synovial joints, while the joint between the teeth and jaw is fibrous and those between vertebrae are cartilaginous joints. The joints at our ankle are also synovial joints. In fact, synovial joints are the most common classification of joints in our body. 

Hope this helps. 

What are tetracycline antibiotics? |

Definition

Tetracycline, which is produced by Streptomyces
spp., is a broad-spectrum antibiotic
that is useful against a wide range of gram-positive and
gram-negative bacteria. Tetracyclines are not generally
first-line agents but are still often prescribed. Activity is similar to the
macrolide
antibiotics, such as erythromycin. Tetracyclines are commonly
used as topical or oral agents for acne. They are also among the drugs of choice
for Lyme disease and anthrax infection and remain somewhat commonly used against
rickettsial infections and sexually transmitted diseases, especially chlamydia.

Mechanism of Action

Tetracyclines are bacteriostatic agents that work by inhibiting
protein
synthesis at the ribosomal level. They bind to ribonucleic
acid (RNA) at the 30S site and then inhibit subsequent binding of the
aminoacyltransfer-RNA to the ribosome. This action terminates peptide chain
growth. More lipophilic agents in this class, such as minocycline, also disrupt
cytoplasmic membrane function and cause key cellular components to leak from the
cell, leading to cell death.

Drugs in This Class

The common drugs in this class are tetracycline, doxycycline, demeclocycline, and minocycline. They are well absorbed and can be taken by mouth. They should not, however, be taken within two hours of ingesting dairy products, antacids, or other foods or multivitamin and mineral preparations that contain calcium, iron, aluminum, or magnesium; chelation of the drug with the metal ion will result. The drug will then become insoluble and the drug will not be properly absorbed.

Drugs in this class are associated with nausea, vomiting, diarrhea, dizziness, and vertigo. Like other broad-spectrum antibiotics, they frequently lead to superinfection, particularly of Candida albicans. They should not be prescribed to children under the age of twelve years because they are highly associated with a progressive and permanent discoloration of teeth, particularly during the years in which the permanent set is developing. They also are not advised for pregnant women because of the potential of liver toxicity.

All agents in this class can lead to photosensitivity, so persons should be advised to limit sun exposure to avoid serious sunburn, particularly when first beginning the medication. This reaction is most common with demeclocycline.

Another unique issue related to tetracyclines is the presence of a Fanconi-like syndrome caused by anhydro-4-epitetracycline, a degradation product that can form over time; it is toxic to the kidneys and can be fatal. For this reason, outdated or expired tetracycline and demeclocycline should never be taken. Because the degradation product is formed by a dehydration reaction at C-6, only tetracyclines that have a C-6 hydroxyl group are at risk for this problem. Minocycline and doxycycline do not have this group and are free of this toxicity.

Impact

Tetracycline products are most often used for acne and for Lyme disease prophylaxis. Minocycline and doxycycline are most commonly used. Doxycycline, which received widespread attention in the wake of the 2001 anthrax bioterrorism scare in the United States, is one of the primary agents used for anthrax, including inhalation anthrax. Tetracyclines also are commonly included in animal feed.

Bibliography

“Antibiotics and Antimicrobial Agents.” Foye’s Principles of Medicinal Chemistry. Ed. by Thomas L. Lemke, et al. 7th ed. Philadelphia: Lippincott, 2013. Print.

Murray, Patrick R., Ken S. Rosenthal, and Michael A. Pfaller. Medical Microbiology. 8th ed. Philadelphia: Mosby/Elsevier, 2016. Print.

Sanford, Jay P., et al. The Sanford Guide to Antimicrobial Therapy. 45th ed. Sperryville: Antimicrobial Therapy, 2015. Print.

Tortora, Gerard J., Berdell R. Funke, and Christine L. Case. “Antimicrobial Drugs.” Microbiology: An Introduction. 10th ed. San Francisco: Benjamin Cummings, 2010. Print.

What are disinfectants and sanitizers?

Definition

Disinfectants and sanitizers are antimicrobials. A “disinfectant” destroys pathogens (disease-causing microorganisms, such as
bacteria) but not spores and not all viruses. A “sanitizer”
reduces the number of harmful microorganisms, or germs, so that they are not an
infectious hazard. Disinfection and sanitization are effective only if a surface
area is clean. “Clean” means that a surface has been cleared of soil, dust,
organic matter (such as blood or stool), and microorganisms. Cleaning usually can
remove large amounts of harmful microorganisms, but it usually does not kill them
and does not disinfect or sanitize surfaces.

According to industry standards, a disinfectant must be capable of reducing the level of pathogenic bacteria by 99.999 percent during a time frame greater than five but less than ten minutes under conditions of the AOAC Use-Dilution Test. A disinfectant destroys all pathogens on a surface or object. Disinfectant products or processes can be ranked as low, medium, or high level. A sanitizer must reduce the level of harmful microorganisms by in a specific bacterial test population 99.999 percent (in a process known as a 5 log reduction) within thirty seconds under conditions of the AOAC Germicidal and Detergent Sanitizers Test (GDS).

One substance may work both as a sanitizer and a disinfectant. For example, an iodophor, when used at 25 ppm (parts per million of available iodine), is a sanitizer. However, that same product, when applied at 75 ppm, is a disinfectant. After using the sanitizer, which kills 99.999 percent of bacteria, five thousand bacteria per square foot would remain. These remaining microorganisms reproduce by splitting into two every fifteen minutes. The result is that those five thousand bacteria per square foot have now become 1 million bacteria per square foot within, for example, five hours.

The U.S. Environmental Protection Agency (EPA) is the governing body
for antimicrobials. It places antimicrobials into four categories: sterilizers,
disinfectants, sanitizers, and antiseptics and germicides. A sterilizer is
equipment used in medical procedures. Cleaning professionals are concerned only
with disinfectants and sanitizers, which are chemical antimicrobial agents, in
contrast to physical antimicrobial agents, such as heat and radiation. Antiseptics and germicides are for use on living beings and are
governed by the U.S. Food and Drug Administration (FDA). A sanitizer may be called an antiseptic when it is used on tissue.
(Antiseptics are safe to use in this case because they do not have the same
killing power as disinfectants.)

Development of Sanitizers and Disinfectants

Infection control was pioneered by hospitals in the nineteenth century. Out of the filth, disease, and poverty of the early nineteenth century came sanitary reform. One of the more significant contributors to the health revolution was the technological, sociological, and environmental phenomenon now known as the sanitary era or the public health campaign. The goal of this campaign was to destroy all possible harmful microorganisms.

Health officials believed it was practical to allow a minimum of ten minutes of contact time with a sanitizer or disinfectant to accomplish this objective. As a result, most disinfectant tests were developed to ascertain whether any bacteria could survive exactly ten minutes of contact. When contact times that are significantly less than ten minutes are allowed, it becomes difficult to get a meaningful result from the Use-Dilution Test.

In food service and public-health related industries, interest in antimicrobials appeared much later than it did in hospitals. Conditions of use were different, so tests based on ten minutes of contact were not practical. In many cases even today, thirty seconds is about the maximum time one can realistically expect for contact in food and drink service (such as when a bartender washes a glass).

Because it is not realistic to expect complete kill in thirty seconds, the GDS test was developed to count microbes. (The Use-Dilution Test, in contrast, indicates the presence of bacteria but yields no counts.) Experts figured that it was possible to get, in thirty seconds, a 99.999 percent reduction in the amount of bacteria with the use of practical agents (such as detergents).

Common Mechanism of Action

A wide range of substances are used as disinfectants. These include alcohols, aldehydes, hydrogen peroxide, iodine, and potassium permanganate solution. Bromine and chlorine are the most common disinfectants and sanitizers for drinking and recreational waters.

The most widely used disinfectants and sanitizers are powerful oxidizers, which means that the atoms of these elements can accept
electrons or hydrogens, or both. Hydrogen peroxide, bromine, and chlorine
compounds oxidize the complex molecules present on the surface of bacteria,
causing their cell walls and cell membranes to disrupt. The proteins on the
surface become irreversibly damaged and start to stick together, forming clumps.
This happens quickly: A strong solution of sodium hypochlorite (NaOCl, also known
as household bleach) solution that is used to disinfect a toilet, for example,
kills bacteria within seconds. The bacterial cell cannot respond to the damage
quickly enough, and the whole cell simply splits open and dies.

Later research has shown that bacteria do have some capacity to resist an attack by bleach. Contact with hypochlorous acid was found to switch on a gene in some bacteria. This gene is part of the pathway that bugs use to cope with heat stress and the bleachlike substances that cells of the immune system produce to fight infection. If the concentration of bleach solution is low, bacteria with genes that resist this sort of cellular attack might survive.

Impact

It has been claimed that the major decline in mortality in the late nineteenth and early twentieth centuries resulted from innovations in environmental sanitation. About one century later, in 1997, Life magazine considered drinking water chlorination and filtration to be “probably the most significant public health advancement[s] of the millennium.”

Today, modern hospital disinfectants must show efficacy in eliminating three primary organisms: Staphylococcus aureus, Salmonella, and Pseudomonas aeruginosa. However, hospital administrations generally require disinfectants with even more efficacy.

Many people in developed countries have grown to accept reduced rates of
illness as the norm, and outbreaks that once would have been accepted as an
unavoidable part of life are now considered crises of public health that require
swift and decisive interventions. However, much of the developing world has yet to
reap the benefits. According to World Health Organization (WHO) data,
worldwide, two of every ten people live with no source of safe drinking water and
four of every ten people lack access to a simple pit latrine.

There remains more work to be done. WHO has promoted as one of its Millennium Development Goals the reduction by one-half, by the year 2015, of the proportion of people without sustainable access to safe drinking water and basic sanitation. Efficacious and inexpensive, chlorine disinfectants have been employed to help achieve this critical humanitarian goal.

Bibliography

Block, Seymour S., ed. Disinfection, Sterilization, and Preservation. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2001. A comprehensive and practical reference on contemporary methods of disinfection, sterilization, and preservation and their medical, surgical, and public health applications.

Fraise, Adam P., Peter A. Lambert, and J.-Y. Maillard, eds. Russell, Hugo, and Ayliffe’s Principles and Practice of Disinfection, Preservation, and Sterilization. Malden, Mass.: Wiley-Blackwell, 2004. A highly respected established text covering in detail many methods to prevent and eliminate microbial growth.

Novick, Lloyd F., Cynthia B. Morrow, and Glen P. Mays, eds. Public Health Administration: Principles for Population-Based Management. Sudbury, Mass.: Jones and Bartlett, 2008. The principles, practices, and skills essential to successful public health administration. Includes information on the Healthy People 2010 objectives and chapters on bioterrorism and emergency preparedness, public health systems research, and public health law.

What is hemophilia? |

Causes and Symptoms

Thecirculatory system must be self-healing; otherwise, continued blood loss from even the smallest injury would be life-threatening. Normally, all except the most catastrophic bleeding is rapidly stopped in a process known as hemostasis. Hemostasis takes place through several sequential steps or processes. First, an injury stimulates platelets (unpigmented blood cells) to adhere to the damaged blood vessels and then to one another, forming a plug that can stop minor bleeding. This association is mediated by what is called the von Willebrand factor, a protein that binds to the platelets. As the platelets aggregate, they release several substances that stimulate vasoconstriction, or a reduction in size of the blood vessels. This reduces the blood flow at the injury site. Finally, the aggregating platelets and damaged tissue initiate blood clotting, or coagulation. Once bleeding has stopped, the firmly adhering clot slowly contracts, drawing the edge of the wounds together so that tough scar tissue can form a permanent repair on the site.

Formation of a blood clot involves the participation of nearly twenty different substances, most of which are proteins synthesized by plasma. All but two of these substances, or factors, are designated by a roman numeral and a common name. A blood clot will be defective if one of the clotting factors is absent or deficient in the blood, and clotting time will be longer. The clotting factors, with some of their alternative names, are factor I (fibrinogen), factor II (prothrombin), factor III (tissue factor or thromboplastin), factor IV (calcium), factor V (proaccelerin), factor VII (proconvertin), factor VIII (antihemophilic factor), factor IX (Christmas factor), factor X (Stuart factor), factor XI (plasma thromboplastin antecedent), factor XII (Hageman factor), and factor XIII (fibrin stabilizing factor).

Several of the clotting factors have been discovered by the diagnosis of their deficiencies in various clotting disorders. The inherited coagulation disorders are uncommon conditions with an overall incidence of probably no more than 10 to 20 per 100,000 of the population. Hemophilia A, the most common or classic type of coagulation disorder, is caused by factor VIII deficiency. Hemophilia B (or Christmas disease) is the result of factor IX deficiency. It is quite common for severe hemophilia to manifest itself during the first year of life. Hazardous bleeding occurs in areas such as the central nervous system, the retropharyngeal area, and the retroperitoneal area. Bleeding in these areas requires admission to the hospital for observation and therapy. Joint lesions are very common in hemophilia because of acute spontaneous hemorrhage in the area, especially in weight-bearing joints such as ankles and knees. Urinary bleeding is often present at some time. The appearance of pseudotumors, caused by swelling involving muscle and bone produced by recurrent bleeding, is also common.

Hemophilia is transmitted entirely by unaffected women (carriers) to their sons in a sex-linked inheritance deficiency. Congenital deficiencies of the other coagulation factors are well recognized, even though bleeding episodes in these cases are uncommon. Deficiency of more than one factor is also possible, although documentation of such cases is rare, perhaps because only patients with milder variations of the disease survive.

Von Willebrand’s disease, unlike the hemophilias that mainly involve bleeding in joints and muscles, involves mainly bleeding of mucocutaneous tissues or skin. It affects both men and women. This disease shares clinical characteristics with hemophilia A, or classic hemophilia, including decreased levels of clotting factor VIII. This similarity made the differentiation between the two diseases very difficult for a long time. It has been established that there are two different factors involved in von Willebrand’s disease, each with a different function. The von Willebrand factor is involved in the adhesion of platelets to the injured blood vessel wall and to one another and, together with factor VIII, circulates in plasma as a complex held by electrostatic and hydrophobic forces. The von Willebrand factor is a very large molecule, consisting of a series of possible multimeric structures. The bigger and heavier the multimer, the better it works against bleeding. Von Willebrand’s disease is one of the least understood clotting disorders. Three types have been identified, with at least twenty-seven variations. With type I, all the multimers needed for successful clotting are present in the blood, but in lesser amounts than in healthy individuals. In type II, the larger multimers, which are more active in hemostasis, are lacking, and type III patients exhibit a severe lack of all multimers.

Treatment and Therapy

The normal body is continually producing clotting factors in order to keep up with natural loss. Sometimes the production is stepped up to cover a real or anticipated increase in the need for these factors, such as in childbirth. Hemophiliacs, lacking some of these clotting factors, may lose large amounts of blood from even the smallest injury and sometimes hemorrhage without any apparent cause. The symptoms of their diseases may be alleviated by the intravenous administration of the deficient clotting factor. How this is done depends on the specific factor deficiency and the magnitude of the bleeding episode, the age and size of the patient, convenience, acceptability, cost of product, and method and place of delivery of care.

There are many sources for clotting factors. Fresh frozen plasma contains all the clotting factors, but since the concentration of the factors in plasma is relatively low, a large volume is required for treatment. Therefore, it can be used only when small amounts of clotting factor must be delivered. Its use is the only therapy for deficiencies of factors V, XI, and XII. Plasma is commonly harvested from single donor units to minimize the risk of infection by the
hepatitis virus or
Human immunodeficiency virus (HIV), thus eliminating the risk involved in using pooled concentrates from many donors. Cryoprecipitates are the proteins that precipitate in fresh frozen plasma thawed at 4 degrees Celsius. The precipitate is rich in factors VIII and XIII and in fibrinogen, and carries less chance of infection with hepatitis. Its standardization is difficult, however, and is not required by the Food and Drug Administration. As a result, dosage calculation can be a problem. In addition, there is no method for the control of viral contamination. Therefore, cryoprecipitates are not commonly used unless harvested from a special known and tested donor pool. Clotting factor concentrates present many advantages. They are made from pooled plasma obtained from plasmapheresis or a program of total donor unit fractionation and are widely available. Factors VIII and IX can also be produced from plasma using monoclonal methods. Porcine factor VIII presents an alternative to patients with a naturally occurring antibody to human factor VIII.

Other substances can replace missing clotting factors as well. The synthetic hormone desmopressin acetate (also known by the letters DDAVP) has been used to stimulate the release of factor VIII and von Willebrand factor from the endothelial cells lining blood vessels. It is commonly used for patients with mild hemophilia and von Willebrand’s disease. DDAVP has no effect on the concentration of the other factors, and aside from the common side effect of water retention, it is a safe drug. Antifibrinolytic drugs prevent the natural breakdown of blood clots that have already been formed. Although such drugs are not useful for the primary care of hemophiliacs, they are useful for use after dental extractions and in the treatment of other open wounds, after a clot has formed.

Between 10 and 15 percent of the patients affected with severe hemophilia develop factor VIII inhibitors (antibodies), which prevents their treatment with the usual methods. Newer therapeutic approaches have provided additional options for the management and control of bleeding episodes. The use of prothrombin complex concentrates or porcine factor VIII concentrates is indicated for low responders (those with a low amount of antibodies present in their system). An option for high responders is to try to eradicate the inhibitor present in their systems. One way to do this is with a regimen of immunosuppressive drugs. These are very limited in value, however, and cannot be used with HIV-positive hemophiliacs. The drugs used in this approach include substances such as cyclophosphamide, vincristine, azathioprine, and corticosteroids. Another approach utilizes intravenous doses of gamma globulin to suppress, but not eradicate, the inhibitors. Yet another strategy is an immune tolerance regimen, in which factor VIII is administered daily in small amounts. This method causes the inhibitors to decrease and, in some cases, disappear. The regimen can also involve the prophylactic use of factor VIII (or factor VIII in combination with immunosuppressive drugs).

The introduction of plasma clotting factor concentrates has changed the treatment of patients with clotting factor deficiencies. It has brought about a remarkable change in the longevity of these patients and their quality of life. The availability of cryoprecipitates and concentrates of factors II, VII, VIII, IX, X, and XIII has made outpatient treatment for bleeding episodes routine and home infusion or self-infusion a possibility for many patients. Hospitalization for inpatient treatment is rare, and early outpatient therapy of bleeding episodes has decreased the severity of joint deformities.

Nevertheless, other problems are apparent in hemophiliac patients. Viral contamination of the factor concentrates has allowed the development of chronic illnesses, infection with HIV, immunologic diseases, liver and renal diseases, joint disorders, and cardiovascular diseases. While the use of heat for virus inactivation, beginning in 1983, resulted in a reduction in HIV infections, the majority of patients exposed to the virus had already been infected. The strategies to prevent contraction of hepatitis from these concentrates include vaccination against the contaminating viruses and the elimination of viruses from the factor replacement product. The non-A, non-B hepatitis virus is difficult to remove, however, and the use of monoclonal factors seems to be the only solution to this problem. In general, difficulties associated with treatment have been largely eliminated through the production of the required clotting factors using recombinant DNA techniques, a process performed independent of human blood.

Treatment of von Willebrand’s disease also includes pressure dressing, suturing, and oral contraceptives. A pasteurized antihemophiliac concentrate that contains substantial amounts of von Willebrand factor is used in severe cases.

Hematomas
, or hemorrhages under the skin and within muscles, can frequently be controlled by application of elastic bandage pressure and ice. The ones that cannot be controlled easily within a few hours may cause muscle contraction and require factor replacement therapy. Exercise is recommended for joints after bleeding, as it helps protect joints by increasing muscle bulk and power and can also help relieve stress. Devices to protect joints, such as elastic bandages and splints, are commonly used. In extreme cases, orthopedic surgical procedures are readily available.

Analgesics, or painkillers, play an important part in the alleviation of chronic pain. Because patients cannot use products with aspirin and/or antihistamines, which inhibit platelet aggregation and prolong bleeding time, substances such as acetaminophen, codeine, and morphine are used. Chronic joint inflammation is reduced by the use of anti-inflammatory agents such as ibuprofen and drugs used with rheumatoid arthritis patients.

The need for so many specialties and disciplines in the management of hemophilia has led to the development of multidisciplinary hemophilia centers. Genetic education (information on how the disease is transmitted), genetic counseling (the discussion of an individual’s genetic risks and reproductive options), and genetic testing have provided great help to patients and affected families. Early and prenatal diagnosis and carrier detection have provided options for family planning.

Perspective and Prospects

Descriptions of hemophilia are among the oldest known accounts of genetic disease. References to a bleeding condition highly suggestive of hemophilia go back to the fifth century, in the Babylonian Talmud. The first significant report in medical literature appeared in 1803 when John C. Otto, a Philadelphia physician, described several bleeder families with only males affected and with transmission through the mothers. The literature of the nineteenth century contains many descriptions of the disease, particularly the clinical characteristics of the hemorrhages and family histories. The disease was originally called haemorrhaphilia, or “tendency toward hemorrhages,” but the name was later contracted through usage to hemophilia (“tendency toward blood”), the accepted name since around 1828.

Transfusion therapy was proposed as early as 1832, and the first successful transfusion for the treatment of a hemophiliac patient was reported in 1840 by Samuel Armstrong Lane. The use of blood from cows and pigs in the transfusions was explored but abandoned because of the numerous side effects. It was not until the beginning of the twentieth century that serious studies on clotting in hemophilia were started. Attention was directed to the use of normal human serum for treatment of bleeding episodes. Some of the patients responded well, while others did not. This result is probably attributable to the fact that some had hemophilia A—these patients did not respond because factor VIII, in which they are deficient, is not present in serum—while some others had hemophilia B, for which the therapy worked. In 1923, harvested blood plasma was used in transfusion, and it was shown to work as well as whole blood. With blood banking becoming a reality in the 1930s, transfusions were performed more frequently as a treatment for hemophilia.

The history of the fractionation of plasma began around 1911 with a Dr. Addis, who prepared a very crude fraction by acidification of plasma. In 1937, Drs. Patek and Taylor produced a crude fraction which, on injection, lowered the blood-clotting time in hemophiliacs. In the period from 1945 to 1960, a number of plasma fractions with antihemophiliac activity were developed. The use of fresh frozen plasma increased as a result of advances in the purification of the fractions. Some milestones can be identified in the production of the plasma fractions: the development of quantitative assays for antihemophiliac factors, the discovery of cryoprecipitation, and the development of glycine and polyethylene precipitation.

In 1952, four significant and independent publications indicated that there is a plasma-clotting activity separate from that concerned with classic hemophilia—in other words, that there are two types of hemophilia. One (hemophilia A) is characterized by a deficiency in factor VIII, while the other (hemophilia B) is characterized by deficiency in factor IX. Carriers of hemophilia A can have a mean factor VIII level that is 50 percent lower than that of normal females, while carriers of hemophilia B show levels of factor IX that are 60 percent below normal. The two diseases have the same pattern of inheritance, are similar in clinical appearance, and can be distinguished only by laboratory tests.

Hemophilias are caused by a disordered and complex biological mechanism that continues to be explored. Recombinant DNA techniques have now revealed the molecular defect in factor VIII or factor IX deficiencies in some families, demonstrating that a variety of gene defects can produce the classic phenotype of hemophilia. These techniques have also provided new tools for carrier detection and prenatal diagnosis.

Current treatment of hemophilia has converted the hemophiliac from an in-hospital patient to an individual with more independent status. Crucial in this development has been the creation of comprehensive care centers and of the National Hemophilia Foundation, which provide comprehensive treatment for the hemophilia patient. Home treatment with replacement therapy has become common. With the advancement of recombinant DNA technology, the future looks brighter for the sufferers of this disease.

Bibliography

Bloom, Arthur L., ed. The Hemophilias. New York: Churchill Livingstone, 1982.

Hilgartner, Margaret W., and Carl Pochedly, eds. Hemophilia in the Child and Adult. 3d ed. New York: Raven Press, 1989.

Hoffman, Ronald, et al. Hematology: Basic Principles and Practice. Philadelphia: Saunders/Elsevier, 2013.

Jones, Peter. Living with Haemophilia. 5th ed. New York: Oxford University Press, 2002.

Judd, Sandra J., ed. Genetic Disorders Sourcebook: Basic Consumer Information About Hereditary Diseases and Disorders. 4th ed. Detroit, Mich.: Omnigraphics, 2010.

King, Richard A., Jerome I. Rotter, and Arno G. Motulsky, eds. The Genetic Basis of Common Diseases. 2d ed. New York: Oxford University Press, 2002.

Leenhardt, Christine, Erik E. Berntorp, and Keith W. Hoots. Textbook of Hemophilia. 2d ed. Hoboken, N.J.: Wiley-Blackwell, 2010.

Ma, Alice D., Harold Ross Roberts, and Miguel A. Escobar. Hemophilia and Hemostasis: A Case-Based Approach to Management. Hoboken, N.J.: John Wiley & Sons, 2013.

Makris, M., and C. Kasper. "The World Federation of Hemophilia Guideline on Management of Haemophilia." Haemophilia 19, no. 1 (December, 2012): 1ff.

National Hemophilia Foundation. http://www.hemo philia.org.

Parker, James N., and Philip M. Parker, eds. The Official Patient’s Sourcebook on Hemophilia: A Revised and Updated Directory for the Internet Age. San Diego, Calif.: Icon Health, 2005.

Rodak, Bernadette, ed. Hematology: Clinical Principles and Applications. 4th ed. St. Louis, Mo.: Saunders/Elsevier, 2012.

Voet, Donald, and Judith G. Voet. Biochemistry. 4th ed. Hoboken, N.J.: John Wiley & Sons, 2011.

Pleas name the literary techniques used in this quote (Jane Eyre) She played: her execution was brilliant; she sang: her voice was fine; she...

The above quote is taken from Chapter 17 of Charlotte Bronte’s Jane Eyre, and the pronoun of “she” refers to Blanche Ingram, a beautiful socialite from the old Victorian aristocracy who wants to marry Mr. Rochester. In the novel, Blanche serves as a foil to Jane because Blanche is arrogant and self-entitled, using her physical beauty to draw the attention of Mr. Rochester.  Conversely, Jane is described as a kind, compassionate soul who attracts...

The above quote is taken from Chapter 17 of Charlotte Bronte’s Jane Eyre, and the pronoun of “she” refers to Blanche Ingram, a beautiful socialite from the old Victorian aristocracy who wants to marry Mr. Rochester. In the novel, Blanche serves as a foil to Jane because Blanche is arrogant and self-entitled, using her physical beauty to draw the attention of Mr. Rochester.  Conversely, Jane is described as a kind, compassionate soul who attracts Mr. Rochester through her humility and inner beauty. The two women are perceived as foils because they illuminate the contrasting sides of their individual personalities. Thus, on a surface level, this quote elucidates the foil because it sets up the contrast between Jane and Blanche by naming Blanche’s talents. 

On a deeper level, there are other literary devices present.  First and foremost, the quote demonstrates an anaphora, which is the deliberate repetition of words or word order at the beginning of each phrase or sentence. In the quote, the anaphora is the repetition of “She played,” “she sang,” and “she talked.”  Further, the anaphora is an extension of parallelism, which is a literary device that uses repeating words in a certain pattern or rhythm to provide emphasis or juxtaposition.  In the example, “She played: her execution was brilliant; she sang: her voice was fine;” is parallelism because each side of the semi colon follows the same syntactical pattern. The excerpt also contains descriptive imagery because Bronte describes the sound of Blanche’s voice as being fine, fluent and with a “good accent.”  Finally, the diction, which is the specific word choice of a given text, is significant in this quote because this except is from Jane’s point of view as she describes Blanche and compares the beautiful socialite to herself.  Thus, the word choice of “brilliant,” “fine,” and “good accent,” are very telling in how Jane perceives Blanche as a fellow woman competing for Rochester’s heart.