What is childhood obesity? |

Causes and Symptoms

A chronic or recurrent imbalance between energy expended (how active one is) and
energy ingested (how much one eats and drinks) will lead to overweight and
obesity, which have short- and long-term impacts on health outcomes. When
ingestion regularly exceeds expenditure, the unused energy is stored in
adipose
tissue, or body fat. From an evolutionary standpoint, animal
species that developed the capacity to store fat had a better chance of surviving
times of scarcity. Chronic storage of excessive energy, as commonly occurs when
levels of physical activity are less, produces its own physical pathology. Almost
every person who eats and drinks more than he or she uses in energy (usually
calculated in calories) will produce adipose tissue to store the excess energy.

Peptide hormones such as leptin and adiponectin regulate and
balance energy expended with energy ingested. When leptin is absent (leptin
deficiency), massive obesity is present; this condition improves when people are
given leptin. Adiponectin, the most abundant hormone in fat cells, is also an
insulin sensitizer and an anti-inflammatory signaler. Leptin and adiponectin,
along with other peptide hormones, initiate a series of signaling processes that
eventually lead to signaling hormones that turn on the food-seeking abilities of
organs and muscles.

There is no international consensus on clinically meaningful cutoffs for the classification of overweight and obese children. Commonly used criteria include 110 to 120 percent of ideal weight for height; weight-for-heigh z-scores of > 1 and > 2; and the 85th, 90th, 95th, 97th percentiles for body mass index (BMI), which is calculated by dividing weight in kilograms by square of height in meters squared. The American Medical Association Expert Committee recommendations suggest that a BMI that is equal to or greater than the 85th percentile but less than the 95th percentile for sex and age is considered overweight; a BMI equal to or greater than the 95th percentile for sex and age is considered obese; and a BMI equal to or greater than the 99th percentile is considered severely obese.

Childhood obesity has many detrimental effects and comorbidities (associated diseases and disorders) that often extend into adolescence and adulthood. It is simplistic to say that obese children will become obese adults. Still, childhood obesity often produces a metabolic syndrome that greatly increases the risk that the individual will remain obese into adolescence and adulthood. This syndrome has serious implications for quality of life and life expectancy. Metabolic syndrome is a combination of high insulin levels (hyperinsulinemia), obesity, high blood pressure (hypertension), and abnormal lipid levels (dyslipidemia). Metabolic syndrome initiates a process that leads to an excess of insulin production that, in turn, promotes high blood pressure and dyslipidemia. Together, these produce aortic and coronary atherosclerosis (hardening of the arteries) and clogging of the arteries by fatty deposits in the blood. According to the US Centers for Disease Control and Prevention, obese children are more likely to have risk factors for cardiovascular disease, such as high cholesterol (hypercholesterolemia) or high blood pressure (hypertension). Obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for the development of diabetes.

Genetic factors play a fundamental role in childhood obesity, as genetically obese
families illustrate. People cannot exchange the genes that they have inherited,
but environmental factors are also important, as they are the only ones where
weight management is possible.

The psychosocial impact of childhood obesity is no less serious than physical
syndromes, leading to poor body image, low self-esteem, social isolation,
recurrent anger, early forms of eating disorders, clinical depression, and
negatively acting-out in school and other social settings. Promoting physical
activity is an important intervention to lessen the psychological harm of obesity
as much as is controlling the amount and type of food and drink.

Treatment and Therapy

The most effective treatment for child obesity is prevention, and it can begin shortly after birth. Research shows that breast-fed children have significantly lower rates of obesity in later years. All children must gain weight as they grow, and having an adequate amount of fat cells during early antenatal development is critically important for maximal growth of key organs. Baby fat is important; its absence is problematic. As infants become toddlers and toddlers become children, the difference between healthy weight gains and weight gains that suggest the onset of obesity often require the expert eye of a pediatrician or family physician. A healthy five-pound weight gain in one five-year-old child may not be healthy in another child of the same age.

It is not until adolescence that children play a significant role in choosing and purchasing food. Until then, whatever children eat is most likely what adults have purchased or provided. Preventing obesity and correcting it when it occurs requires thoughtful selection of food and beverage items at home and school. Fast and take-out foods are always an easy solution to busy, hectic family schedules, but they are almost always obesity-promoting. Junk food snacks, also a quick solution to the transient hunger pangs of youth, are similarly harmful.

Prevention and treatment are almost one and the same in dealing with child
obesity. Parents control the food of children, and making available a variety of
healthy choices becomes an important part of achieving and maintaining healthy
bodies that have modest amounts of adipose tissue, as children with a BMI of less
than 20 are underweight and also unhealthy. Obesity is much less likely to occur
in families and schools that support healthy lifestyles: balanced nutritional
consumption, physical activity and exercise, and sufficient sleep. (As a group,
children who consistently get less sleep than they need are more likely to be
obese than are children who sleep enough. The specific number of hours any child
might need is a function of several factors, including age.)

Successful school-based interventions in the management of obesity include a
prioritization of physical education classes, healthy choices on the student
menu and in vending machines, proportional servings, encouraging water as the main
beverage, and the ready availability of after-school activities that involve
physical activity, such as intramural sports. When these elements are not present,
effective weight
management for school-age children is difficult.

The key to successful long-term obesity prevention and treatment involves
awareness of and respect for the individual child’s personal preferences and
enjoyments—nothing will enhance motivation more. Decreasing sitting time and the
active encouragement of free play is far more effective than mandates to exercise
or reduce food intake. Even in families where genetics play a major role in
obesity, a healthy lifestyle will decrease the negative impact that obesity can
have on the children’s overall health.

Perspective and Prospects

According to the Centers for Disease Control and Prevention (CDC), the percentage of children aged six to eleven years in the United States who were obese increased from 7 percent in 1980 to nearly 18 percent in 2012, and the percentage of adolescents aged twelve to nineteen years who were obese increased from 5 percent to nearly 21 percent over the same time period. Although a national study by the CDC showed that obesity among low-income preschoolers declined in nineteen states between 2008 and 2011, childhood obesity remains an epidemic that has achieved the status of a public health crisis. According to the World Health Organization (WHO), in 2010, forty-three million children (thirty-five million in developing countries) were estimated to be overweight or obese, and an additional ninety-two million were at risk of becoming overweight. The WHO estimates that the worldwide prevalence of childhood overweight and obesity increased from thirty-two million globally in 1990 to forty-two million in 2013. At this rate, the WHO predicts that by 2025, the number of obese infants and young children will rise to seventy million.

Obesity has profound impacts on children’s long-term physical and psychological health and, more often than not, leads to serious comorbidities in adulthood that are costly to treat and difficult to control. Focused strategies on modifying behavior and the slow but steady acquisition of healthy habits are the only ways that children will reliably manage the balance between calories consumed and calories burned. Adult habits, good and bad, are usually fostered during childhood. They reflect the level of care, attention, and perseverance of caregivers. Childhood obesity can be a problem of adults’ mismanagement much more than it is a problem of children’s choices. Parents, caregivers, and teachers make a major contribution to children when they provide a health-oriented environment in which children are more likely to acquire the habits that promote wellness throughout their lives.

In 2010, First Lady Michelle Obama began the national "Let's Move!" campaign to comprehensively fight the childhood obesity epidemic within a generation. The program aimed at increasing physical activity and education for children, ensuring better nutrition in school lunches, and providing more information to parents to aid in healthy eating practices. Not long after its inception, President Barack Obama signed the Healthy, Hunger-Free Kids Act into law. This act called for reforms in school lunch programs nationwide, including setting new nutritional standards for the food served at lunch and in vending machines. As part of the campaign's fifth birthday, the First Lady included exercise and dance activities in 2015's annual Easter egg roll event at the White House. As of that year, debates still ensued over whether the program was having any direct effect on the epidemic. Critics cited statistics that continue to show that too many American children are still struggling with obesity.

Bibliography

Berg, Frances.
Underage and Overweight: America’s Childhood Obesity
Epidemic—What Every Parent Needs to Know. New York: Random,
2005. Print.

"Childhood Obesity
Facts." Centers for Disease Control and Prevention. Centers
for Disease Control and Prevention, 13 Aug. 2014. Web. 22 Aug.
2014.

Dawes, Laura. Childhood Obesity in
America: Biography of an Epidemic. Cambridge: Harvard UP, 2014.
Print.

De Onis, Mercedes, Monika Blössner, and
Elaine Borghi. "Global Prevalence and Trends of Overweight and Obesity among
Preschool Children." American Journal of Clinical Nutrition
92.5 (2010): 1257–64. Print.

"Facts and Figures on Childhood Obesity." World Health Organization. WHO, 29 Oct. 2014. Web. 6 Aug. 2015.

Lipshultz, Steven E., Sarah E. Messiah,
and Tracie L. Miller, eds. Pediatric Metabolic Syndrome:
Comprehensive Clinical Review and Related Health Issues. New
York: Springer, 2012. Print.

May, Ashleigh L., et al. "Vital Signs:
Obesity among Low-Income, Preschool-Aged Children—United States, 2008–2011."
MMWR: Morbidity and Mortality Weekly Report 62.31
(2013): 629–34. Web. 22 Aug. 2014.

Ogden, Cynthia, and
Margaret Carroll. "NCHS Health E-Stat: Prevalence of Obesity among Children
and Adolescents: United States Trends 1963–1965 through 2007–2008."
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Disease Control and Prevention, 4 June 2010. Web. 22 Aug. 2014.

Okie, Susan.
Fed Up! Winning the War Against Childhood Obesity.
Washington: National Academies P, 2005. Print.

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Obesity in the Toddler Offspring of Mothers with Gestational Diabetes."
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Joerg Luedicke. "Weight-Based Victimization: Bullying Experiences of Weight
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Sothern, Melinda S.,
Heidi Schumacher, and T. Kristian von Almen. Trim Kids: The Proven
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Print.

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What causes Adela’s breakdown? Why does she accuse Aziz? What qualities enable her to admit the truth at the trial?

in the first part of the novel, Adela develops feelings of confusion because of traveling to India, settling into a new culture, and having issues with her fiancé. The trip by ship to India was long and probably somewhat stressful; it's stressful enough traveling by plane, but in A Passage to India travelers must go by ship and it takes a lot longer. During the trip, Adela was first exposed to the other British colonists, many of whom were already accustomed to living in India. Their influence on Adela was negative and added to her confusion and stress.

Once in India, Adela finds the culture and the physical environment very different from what she is used to. She experiences severe culture shock, made worse by the other colonists' negativity towards the country and the Indian people, for example by not allowing them access to the Chandrapore club. Forster describes the frenetic atmosphere in Chandrapore, with a lot of emphasis on the heat and light of the sun, and on the sky and filth and the severe natural environment surrounding everyone.

Adela went to India because her future husband was there, but after spending some time together there, the two of them realize that they do not belong together. For Adela, this break-up would be a serious shock, and add a great deal to her stress. In the early 1900s, a woman was often defined by her husband and didn't have any career or possessions of her own. Adela traveled to a distant, foreign country expecting to marry and make a life there, but before the trip to the Malabar Caves with Aziz, her life plans are disintegrated, leaving her confused and stressed.

When she goes to the caves with Aziz, she is a very confused and stressed woman, close to a break down. As she explores the first cave, the close atmosphere, heat, darkness, and strange sound qualities affect her tremendously. Then she finds herself climbing the hill alone with Aziz, whereupon they discuss his marital status, a subject that a man and woman in that time should not discuss together unless they are married to one another. Specifically, Adela, who doesn't know very much about the local Muslims, asks Aziz if he has more than one wife. This question shocks Aziz. Adela also holds Aziz's hand as they climb, which is not really appropriate, and she thinks about how attractive she finds him. So Adela has her mind on marriage, relationships, and physical attractiveness when she enters the cave and becomes separated from Aziz. She thinks that Aziz comes in and rapes her, but later she realizes that this only happened in her crazed imagination.

Adela actually does not fall for the horrible racism among the other British colonists around her. She is, however, greatly influenced by Mrs. Moore and Fielding, the two British who are very open-minded and friends with Aziz. So at the trial, when she realizes she had been wrong, she knows it is the right thing to do to admit her mistake rather than send an innocent man to prison. 

You can find more information about A Passage to India by clicking . 

In Anthem, what lies beyond the city, and why has Equality 7-2521 never been there?

Beyond the city is the Uncharted Forest. The first thing we hear about the forest from Equality 7-2521 is that this area is so restricted that the leaders have made a rule forbidding thoughts about it.

Beyond the ravine there is a plain, and beyond the plain there lies the Uncharted Forest, about which men must not think.

He goes on to explain that men do not go into the forest because there are no trails, and because wild animals kill and eat whoever enters before long. Later, Equality 7-2521 finds out that it is actually quite possible to traverse the Uncharted Forest. He is able to keep the animals away by building a fire every night, and feeds himself by hunting and killing his own food.

The Uncharted Forest symbolizes previously forbidden possibilities and independence. At first glance, the Uncharted Forest is simply a place that is forbidden to enter. However, it goes deeper than that. Not only was entry forbidden, the leaders went so far as to convince the people that they would not be able to survive in the forest on their own.

Men never enter the Uncharted Forest, for there is no power to explore it and no path to lead among its ancient trees which stand as guards of ancient secrets.... These men do not return. They perish from hunger and from the claws of the wild beasts which roam the forest.

When he is forced to run to the Uncharted Forest to protect the box, Equality 7-2521 finds out that he is perfectly capable of keeping himself alive, proving to himself that he can survive independently of the collective.

After Liberty 5-3000 (The Golden One) joins him, Equality 7-2521 and Liberty 5-3000 travel through the Uncharted Forest and find mountain ranges beyond the forest. They find an old house, a relic from the Unmentionable Times, and settle there.

What is surgery support? |

Introduction

Surgery, even relatively minor surgery, is a significant trauma to the body. The
surgical incision itself can cause swelling (edema), pain,
and bruising; anesthesia frequently causes nausea and bloating. Certain surgeries
that damage the body’s lymphatic system, such as radical mastectomy, can cause a
specific form of long-lasting swelling called lymphedema.

Modern surgery involves numerous sophisticated nondrug techniques to help wounds
heal rapidly and completely. Various medications can be used to help offset the
side effects of anesthesia.

Principal Proposed Natural Treatments

A variety of herbs, supplements, and other alternative therapies show promise in alleviating problems encountered following surgery. However, many such substances have shown the potential to increase the risk of bleeding during or after surgery. Furthermore, it is not possible to determine all the potential interactions between herbs and drugs used for anesthesia. For this reason, herbs and supplements should be used for surgical support only under the supervision of a physician.

Proteolytic enzymes. According to most studies, proteolytic
enzymes may help reduce pain, bruising, and swelling after
surgery. A double-blind, placebo-controlled trial of eighty people undergoing knee
surgery found that treatment with mixed proteolytic enzymes after surgery
significantly improved rate of recovery, as measured by mobility and swelling.

Another double-blind, placebo-controlled trial evaluated the effects of a similar
mixed proteolytic enzyme product in eighty persons undergoing oral surgery. The
results showed reduced pain, inflammation, and swelling in the treated group
compared with the placebo group. Benefits were also seen in another trial of mixed
proteolytic enzymes for dental surgery and in one study involving only
bromelain.

Other double-blind, placebo-controlled studies have found bromelain helpful in nasal surgery, cataract removal, and foot surgery. However, a study of 154 persons undergoing facial plastic surgery found no benefit.

Bromelain thins the blood and could increase risk of bleeding during or after surgery. For this reason, physician supervision is essential.

Oxerutins and other bioflavonoids. Oxerutins
have been widely used in Europe since the mid-1960s, primarily as a treatment for
varicose veins. Derived from a naturally occurring bioflavonoid called rutin,
oxerutins were specifically developed to treat varicose veins and related venous
problems. However, they may also be helpful for treating swelling following
surgery. Closely related bioflavonoids from citrus fruit also may be helpful.

Women who have undergone surgery for breast cancer may experience a lasting and troublesome side effect: swelling in the arm caused by damage to the lymph system. With the veins, the lymphatic system is responsible for returning fluid to the heart. When this system is damaged by breast cancer surgery, fluid accumulates in the arm. Three small, double-blind, placebo-controlled studies enrolling more than one hundred people have examined the effectiveness of oxerutins in lymphedema following breast cancer surgery, with generally good results.

In a small, six-month, double-blind study, oxerutins reduced swelling and improved
comfort and mobility compared with placebo. Another study found benefit with a
combination formula containing oxerutins, ginkgo, and the drug heptaminol. The
citrus
bioflavonoids diosmin and hesperidin have also shown promise
for lymphedema following breast cancer surgery, as has a product containing
hesperidin plus a bioflavonoid-rich extract of the herb butcher’s broom. One
should not use bioflavonoid combinations containing tangeretin if also taking
tamoxifen for breast cancer.

Oxerutins might also be helpful for the ordinary swelling that occurs after any type of surgery. In one double-blind trial, researchers gave oxerutins or placebo for five days to forty people recovering from minor surgery or other minor injuries and found oxerutins significantly helpful in reducing swelling and discomfort.

Oligomeric proanthocyanidins. Oligomeric
proanthocyanidins (OPCs), substances found in grape seed and
pine bark, may also be helpful for recovery from surgery. Like oxerutins, to which
they are chemically related, OPCs are thought to work by reducing leakage from
capillaries.

A double-blind, placebo-controlled study of sixty-three women with breast cancer found that 600 milligrams (mg) of OPCs daily for six months reduced postoperative symptoms of lymphedema. Additionally, in a double-blind, placebo-controlled study of thirty-two people who were followed for ten days after having a face-lift, swelling disappeared much faster in the treated group.

Acupuncture and acupressure. Acupuncture
and acupressure are two related forms of treatment that involve
stimulating certain locations on the body known as acupuncture points. Numerous
studies have evaluated treatment on a single acupuncture point, P6, for the relief
of nausea following anesthesia. This point is located on the inside of the
forearm, about two inches above the wrist crease.

Many controlled studies involving more than two thousand people have tested the potential benefits of stimulation at P6 in people undergoing surgery. In most of these trials, treatment was carried out through the surgery itself, as well as afterwards. The results of these trials, involving various types of surgery and diverse forms of acupuncture and acupressure, tend to contradict one another. On balance, however, it appears that acupuncture and acupressure may reduce intraoperative (during surgery) and postoperative nausea to some extent beyond that of the placebo effect.

Acupuncture has also been explored as a means of reducing pain after surgery, with inconsistent results. In a 2008 review of fifteen randomized, controlled trials, however, researchers determined that acupuncture is capable of reducing pain and the need for opioid medications (morphine and related agents) immediately following surgery, compared with sham (fake) acupuncture. A small randomized trial of seventy persons found that acupuncture may decrease dry mouth and pain after removal of lymph nodes in the neck for cancer treatment. Contrary to popular belief, acupuncture does not appear to be helpful for providing or enhancing anesthesia itself.

Other Proposed Natural Treatments

The herb ginger is thought to have antinausea effects. In studies,
ginger has been given before surgery to prevent the nausea that many people
experience when they awaken from anesthesia. However, despite some early positive
results, the preponderance of evidence indicates that ginger is not helpful for
this purpose.

One should not use ginger either before or immediately after surgery or labor and delivery without a physician’s approval. There are theoretical concerns that ginger may affect bleeding.

Preliminary evidence suggests that peppermint oil may be helpful for postoperative
flatulence and nausea. Also, a preliminary controlled study found that the
honeybee product propolis mouthwash following oral surgery significantly
speeded healing time compared with placebo.

One small, double-blind, placebo-controlled study found that magnet therapy patches of the “unipolar” variety reduced pain and swelling after suction lipectomy. However, a study of 165 people undergoing various forms of surgery failed to find that the use of static magnets over the surgical incision reduced postsurgical pain. Furthermore, the positioning of static magnets at the acupuncture-acupressure point P6 in persons undergoing ear, nose, and throat or gynecological surgeries reduced nausea and vomiting no better than placebo in a randomized trial. A small pilot study involving eighty women undergoing breast augmentation procedures found that daily pulsed electromagnetic field therapy reduced postoperative discomfort significantly more than placebo therapy within three days of surgery.

A double-blind, placebo-controlled study examined thirty-seven people undergoing surgery for carpal tunnel syndrome. The use by these persons of an ointment made from the herb Arnica (combined with homeopathic Arnica tablets) appeared to slightly reduce postsurgical pain.

Horse
chestnut has effects similar to OPCs and has also shown
promise for reducing postoperative swelling. A preliminary study suggests that
topically administered capsaicin provides short-term pain relief immediately
following hernia repair surgery. In two studies, the sports supplement
creatine has been tried as an aid to strengthen recovery
after knee surgery, but no benefits were seen.

Good nutrition is essential to recovery from any physical trauma. For this reason, the use of a multivitamin-multimineral supplement in the weeks before surgery, and for some time afterward, might be advisable.

A placebo-controlled study failed to find that onion extract could help reduce
skin scarring following surgery. Another study found that massage therapy reduced
postoperative pain. The use of a fish oil product as part of a total
parenteral nutrition regimen (intravenous feeding) may help speed recovery after
major abdominal surgery.

Treatment via inhalation of essential oils is called aromatherapy.
One controlled trial found that lavender oil, administered through an oxygen face
mask, reduced the need for pain medications following gastric banding surgery.

At least twenty controlled studies, enrolling more than fifteen hundred people,
have evaluated the potential benefit of hypnosis for people undergoing surgery.
Their combined results suggest that hypnosis may provide benefits both during and
after surgery, including reducing anxiety, pain, and nausea; normalizing blood
pressure and heart rate; minimizing blood loss; and speeding recovery and
shortening hospitalization. Many of these studies were of very poor quality,
however.

Relaxation
therapy techniques, such as meditation, guided imagery, and
self-hypnosis, have also shown promise for relieving some of the discomforts of
surgery. One study found minimal benefits with music therapy, however.

Herbs and Supplements to Use with Caution

Numerous herbs and supplements have the potential to cause problems during or after surgery, including some of those discussed here. For this reason, one should not use any herb or supplement in the week before surgery, except under a physician’s supervision.

For example, the herb garlic significantly thins the blood,
and case reports suggest that garlic can increase bleeding during or after
surgery. It is probably advisable to avoid garlic supplements before surgery and
not to restart the supplements after surgery until all risk of bleeding is past.
However, raw garlic consumed in food may not present the same risk. A
placebo-controlled study found that one-time consumption of raw garlic consumed in
food at the fairly high dose of 4.2 mg did not impair platelet function. Also,
volunteers who continued to consume the dietary garlic for one week did not show
any change in their normal platelet function.

The use of the herb ginkgo has also been associated with
serious bleeding complications related to surgery. Many other herbs and
supplements have also shown potential for increasing risk of bleeding. Most
prominent among these are high-dose vitamin E and policosanol. Others include
bromelain, chamomile, devil’s claw, dong quai, feverfew, fish oil, ginger, horse
chestnut, ipriflavone, mesoglycan, papaya, phosphatidylserine, red clover, reishi,
vitamin A, and white willow. In addition, one report suggests that the use of St.
John’s wort may interact with anesthetic drugs.

Bibliography

Aasvang, E. K., et al. “The Effect of Wound Instillation of a Novel Purified Capsaicin Formulation on Postherniotomy Pain.” Anesthesia and Analgesia 107 (2008): 282-291.

Allen, T. K., and A. S. Habib. “P6 Stimulation for the Prevention of Nausea and Vomiting Associated with Cesarean Delivery Under Neuraxial Anesthesia.” Anesthesia and Analgesia 107 (2008): 1308-1312.

Bechtold, M. L., et al. “Effect of Music on Patients Undergoing Outpatient Colonoscopy.” World Journal of Gastroenterology 12 (2006): 7309-7312.

Cepeda, M. S., et al. “Static Magnetic Therapy Does Not Decrease Pain or Opioid Requirements.” Anesthesia and Analgesia 104 (2007): 290-294.

Chung, V. Q., et al. “Onion Extract Gel Versus Petrolatum Emollient on New Surgical Scars.” Dermatological Surgery 32 (2006): 193-198.

Habib, A. S., et al. “Transcutaneous Acupoint Electrical Stimulation with the ReliefBand for the Prevention of Nausea and Vomiting During and After Cesarean Delivery Under Spinal Anesthesia.” Anesthesia and Analgesia 102 (2006): 581-584.

Hedén, P., and A. A. Pilla. “Effects of Pulsed Electromagnetic Fields on Postoperative Pain: A Double-Blind Randomized Pilot Study in Breast Augmentation Patients.” Aesthetic Plastic Surgery 32 (2008): 660-666.

Kim, J. T., et al. “Treatment with Lavender Aromatherapy in the Post-Anesthesia Care Unit Reduces Opioid Requirements of Morbidly Obese Patients Undergoing Laparoscopic Adjustable Gastric Banding.” Obesity Surgery 17 (2007): 920-925.

Klaiman, P., et al. “Magnetic Acupressure for Management of Postoperative Nausea and Vomiting.” Minerva Anestesiologica 74 (2008): 635-642.

Lang, E. V., et al. “Beneficial Effects of Hypnosis and Adverse Effects of Empathic Attention During Percutaneous Tumor Treatment.” Journal of Vascular and Interventional Radiology 19 (2008): 897-905.

Lee, H., and E. Ernst. “Acupuncture Analgesia During Surgery.” Pain 114 (2005): 511-517.

Pfister, D. G., et al. “Acupuncture for Pain and Dysfunction After Neck Dissection.” Journal of Clinical Oncology 28 (2010): 2565-2570.

Scharbert, G., et al. “Garlic at Dietary Doses Does Not Impair Platelet Function.” Anesthesia and Analgesia 105 (2007): 1214-1218.

Tyler, T. F., et al. “The Effect of Creatine Supplementation on Strength Recovery After Anterior Cruciate Ligament (ACL) Reconstruction.” American Journal of Sports Medicine 32 (2004): 383-388.

Usichenko, T. I., et al. “Auricular Acupuncture for Pain Relief After Ambulatory Knee Surgery.” CMAJ: Canadian Medical Association Journal 176 (2007): 179-183.

Wang, S. M., et al. “Extra-1 Acupressure for Children Undergoing Anesthesia.” Anesthesia and Analgesia 107 (2008): 811-816.

What is meditation? |

Indications and Procedures

One of the most popular techniques used in meditation is concentration, in which one focuses attention on a single object such as the function of breathing, a candle flame, or a visualized image. When attention wanders, the practitioner brings it gently back to the original focus. Sometimes a mantra, a chosen word or phrase given by a teacher or chosen by the practitioner (such as the om mantra of Tibetan Buddhism), is repeated silently or aloud.

Guided imagery utilizes listening to a voice, recorded or live, that guides the practitioner to visualize a beautiful and peaceful place, where one feels calm and secure. Walking meditation, tai chi, and qi gong focus on movement, breathing, and ritual, and the practice of yoga
incorporates breathing and movement or physical postures to help relax body and mind. Soothing music may also be used with any of the techniques. Prayer and silent reading of and reflection on inspirational texts are other common forms of meditation. Teachers recommend starting slowly with five-minute sessions, working up to twenty minutes once or twice a day.

Uses and Complications

Meditation techniques, which are thousands of years old, are being promoted as a benefit to health and well-being, primarily in stress-related conditions. Meditation traditionally has been and is used in a religious sense to deepen one’s understanding and involvement with the spiritual, mystical, and sacred aspects of life. It is also used as an exercise in self-discovery and revelation, helping the practitioner turn inward, temporarily shutting out worldly cares and strife to find inner peace and calm. Being religious, however, is not essential to meditation; in fact, most everyone can learn the techniques and reap the health benefits of this age-old practice. Physical limitations and preexisting mental health concerns should be taken into consideration before undertaking specific meditative practices, and practitioners should make their instructors aware of these conditions.

Numerous studies confirm that prolonged or interpersonal stress can produce such conditions as constriction of blood vessels, pain and swelling in joints, suppression of the immune system, decreases in white blood cells and changes in their function, and high cholesterol levels. Chemicals such as adrenaline, produced when the body is under stress, can raise blood pressure, increase heart rate, and cause other harmful physiological responses when stress is persistent or sustained. Stress is also linked to many diseases and conditions, including heart attacks, diabetes, cancer, allergies, and skin disorders.

Meditation, in helping the patient to relax, reduces muscle tension and decreases the release of these harmful chemicals. A number of stress-related conditions have been shown to benefit from meditation, including chronic pain, arthritis, infertility, psoriasis, respiratory conditions such as asthma and emphysema, premenstrual syndrome (PMS), tension headaches, Irritable bowel syndrome (IBS), ulcers, insomnia, and fibromyalgia.

Bibliography

Benson, Herbert, and Miriam Z. Klipper. The Relaxation Response. 25th anniversary ed. New York: Avon Books, 2000.

Harmon, Robert, and Mary Ann Myers. “Prayer and Meditation as Medical Therapies.” Physical Medicine and Rehabilitation Clinics of North America 10, no. 3 (August, 1999): 651–662.

Kabat-Zinn, Jon. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. 10th anniversary ed. New York: Hyperion, 2005.

"Meditation: A Simple, Fast Way to Reduce Stress." Mayo Foundation for Medical Education and Research, April 21, 2011.

National Center for Complementary and Alternative Medicine. "Meditation: An Introduction." National Institutes of Health, US Department of Health and Human Services, February 21, 2013.

"Relaxation Therapies." Health Library, September 17, 2012.

Scholten, Amy, and Brian Randall. "How to Meditate." Health Library, November 14, 2012.

Trivieri, Larry, Jr., and John W. Anderson, eds. Alternative Medicine: The Definitive Guide. 2d ed. Berkeley, Calif.: Ten Speed Press, 2002.

What is wheezing? |

Causes and Symptoms

Wheezing is a whistling or grating noise created when a person’s breathing passages are narrowed or blocked. It can be accompanied by tightness in the chest or shortness of breath, as well as anxiety due to difficulty breathing.

Wheezing is a symptom of several disorders. The most common causes of chronic wheezing are asthma and emphysema. Temporary wheezing due to obstruction by mucus can be caused by bronchitis, pneumonia, viral infections, and allergies as well as smoking and inhalation of fumes or foreign matter. The exact timing of the wheeze can give clues to its cause. Bronchitis causes a noise at the very end of a complete exhalation. Wheezing at the start of exhalation usually indicates asthma or emphysema. Wheezing only when inhaling is a sign of asthma.

Conditions such as gastroesophageal reflux disease, vocal cord dysfunction, and genetic disorders that affect the lungs, such as cystic fibrosis, can also cause wheezing. Patients with heart failure often develop cardiac asthma caused by a pulmonary edema, in which fluid builds up in the lungs because of inefficient pumping of the heart. Less commonly, wheezing may be a symptom of tumors, joint disorders, or heart aneurysms. Radiation therapy for cancer or other diseases can also cause the airways to constrict.

Treatment and Therapy

Treatment for wheezing involves treating the underlying disorder. Doctors may do blood work or administer x-rays; antibiotics and antihistamines may be prescribed for allergies or infections.

Medicines are often given to manage the discomfort and anxiety this symptom causes. For chronic wheezing, respiratory inhalers are usually prescribed. Bronchodilators give temporary relief by relaxing the airways. Bronchodilators can cause dependence, however, and patients should be monitored continually by a doctor. More severe symptoms may require regular use of corticosteroid inhalers, which reduce inflammation in the airways and make them less likely to constrict.

For mild wheezing, drinking warm liquids and inhaling moist, heated air, such as from a vaporizer or a hot shower, is helpful. Severe wheezing may require hospitalization and use of a strong bronchodilator, an oxygen tent, or a respiratory tube.

Perspective and Prospects

The Western use of bronchodilators for treatment of bronchitis and asthma began in the nineteenth century, although Indian medicine had used plant derivatives for similar effect for thousands of years. Corticosteroids became standard treatment during the 1970s.

Although wheezing is a well-managed symptom, determining the precise cause is often extremely difficult. This is especially true for doctors with limited resources in developing countries, where pneumonia is the most common respiratory cause of child mortality.

Bibliography

Barnes, Peter J., and Simon Godfrey. Asthma and Wheezing in Children. New York: Taylor & Francis, 1999.

Carson-DeWitt, Rosalyn. "Asthma—Adult." Health Library, September 30, 2012.

Shuman, Jill. "Bronchitis." Health Library, June 24, 2013.

Silverman, Michael, ed. Childhood Asthma and Other Wheezing Disorders. New York: Oxford University Press, 2002.

"Wheezing." MedlinePlus, May 16, 2010.

In Romeo and Juliet, what is the purpose of the Chorus?

As was the case in ancient Greek theater, the Chorus provides commentary on the play, and its purpose in the Prologue seems to be to tell the audience exactly what is going on and will happen in the play. The Prologue is essentially a plot summary, and what it gives away in suspense by giving away the ending, it makes up for by creating dramatic irony that can be heartbreaking. We know throughout the play...

As was the case in ancient Greek theater, the Chorus provides commentary on the play, and its purpose in the Prologue seems to be to tell the audience exactly what is going on and will happen in the play. The Prologue is essentially a plot summary, and what it gives away in suspense by giving away the ending, it makes up for by creating dramatic irony that can be heartbreaking. We know throughout the play that Romeo and Juliet are "star-cross'd," doomed to take their own lives. This makes their tender expressions of love for one another all the more poignant, and their attempts to overcome fate all the more tragic. The second appearance of the Chorus, in Act II, is less clear. It reinforces the idea that the two lovers are struggling against the forces of fate and their family ties. It also emphasizes the power of love to "meet tempering extremities with extreme sweet." In many ways, the Chorus, along with simply relating the key plot elements, reinforces some of the key themes in the play.

What is acupuncture? |

Indications and Procedures

The theory and practice of acupuncture are rooted in the Chinese concept of life—the Chi or qi (both are pronounced “chee”). The belief is that all things, animate and inanimate, have an internal source of energy, the Chi. This energy stabilizes the chemical composition of matter, and when this matter is broken down, energy is released. The practice of acupuncture is thought to stimulate this energy to relieve pain and speed healing.

According to the ancient Chinese system of medicine, two categories of organs are associated with the Chi: the Tsang and the Fou. The Fou is the group of organs that absorb food, digest it, and expel waste. They are all hollow organs such as the stomach, the large and small intestines, the bladder, and the gallbladder. Tsang organs are all associated with the blood—the heart, which circulates the blood around the body; the lungs, which oxygenate the blood; the spleen, which controls the red corpuscles; and the liver and the kidneys. For the flow of energy to remain steady, it must pass unimpeded from one organ to another. If the organ is weak, the resultant energy that is passed on to the next organ is weakened. Acupuncture stimulates specifically designated points found on pathways in the body (called meridians) to correct the problem.

According to the Chinese system, the human “circuit” of energy is made up of twelve meridians, which stretch along the limbs from the toes and the fingers to the face and chest. There are six meridians in the upper limbs and six in the lower. Ten meridians are connected to a main organ by branches from the sympathetic nervous system, and each of these meridians contains the Chi, which varies in strength and is governed by the nerve impulses arising from the organs. The meridians and their attendant vessels contain the flow of energy that enables the body to function efficiently.

The meridian points that proved to be effective for certain ailments were organized, and specific names were given to each. Later, the meridian line concept was hypothesized in order to explain the effectiveness of the points. These meridian points were selected by observing the effects of stimulation on particular signs and symptoms.

According to modern medical concepts, some of these points are thought to be relating points at which the autonomic nervous system is stimulated by a specific visceral disorder. Anatomically, some of the meridian points appear to correspond to areas where a nerve appears to surface from a muscle or areas where vessels and nerves are located relatively superficially, such as areas between a muscle and a bone or between a bone and a joint. These areas are generally composed of connective tissue.

The meridians are stimulated by the insertion of needles. The needles that are commonly used range in size from the diameter of a hair to that of a sewing needle. In China, round and cutting needles are commonly used. In Europe, the needles are slightly shorter and slightly wider in diameter.

The needles are made of gold, silver, iron, platinum, or stainless steel. Stainless steel needles are most commonly used. Infection caused by needle puncture is said to be extremely rare. This may be the case because the minor injury created by the needle is controlled by biological reaction. It is routine to wipe the skin with alcohol before inserting the sterilized needle. The needle itself may be wiped with alcohol sponges before each insertion on the same patient. Needles are discarded after being used in patients with a history of jaundice or hepatitis.

Insertion of a needle requires great skill and much practice. There are three different angles of penetration into the skin: perpendicular, oblique, and horizontal. These angles correspond to 90 degrees, 45 degrees, and a minimum angle, respectively. The angles may be chosen on the basis of the thickness of the skin and the proximity to muscle or bone at the desired puncture point. The depth of penetration will vary.

Tapping (the tube method) is one method of insertion: When the diameter of the needle is small, this method is extremely effective. The needle is placed into the tube from either direction, and the tube is shorter than the needle. Gentle tapping of the needle handle with the right index finger introduces the needle easily. The tapping finger must be removed from the needle head immediately; otherwise, it causes pain. The tube is removed gently with the right index finger and thumb.

In the twirling method (the freehand method), the left thumb and index finger make contact at the acupuncture point. The left hand is called the pushing hand. Next, the skin is cut with the needle tip, after which the needle is inserted by pushing and twirling it with the right hand.

The objective of the advancement of the needle and the needle motion is to create a needle feeling in the patient. This is a dull, aching, paralyzing, or compressing feeling or a combination of these sensations that radiates to a distal or proximal portion of the body. When the patient notices the needle feeling, the operator increases the feeling by using various needle motions. Numerous motions are available, such as the single-stick, twirling, vibration, intermittent, and retention motions.

Light skin and muscle massage is recommended in order to prepare the body to accept needle stimulation. Prepuncture massage makes skin cutting easier and helps the patient relax. In addition to these advantages, massage may make it possible to detect pathologies such as nodules, spasms, pain, and depression. Postpuncture massage helps to confirm muscle hypersensitivity and the disappearance of pain or hard nodules that existed before the acupuncture was performed.

The amount of stimulation equals the strength of stimulation multiplied by the number of treatments; this is dependent on the sensitivity of the patient. Gradual increases of stimulation are essential. In general, for acute disease, treatment is usually given once a day for ten days and then terminated for three to seven days. For chronic ailments, treatment is administered once every two to three days for ten treatments and then terminated for seven days. The patient is placed in a supine, sitting, prone, or side position—the position that is most convenient for the patient and physician. A special position, however, may be needed in order to relax the painful area.

One of the most important factors to be considered in effective acupuncture treatment is the accurate selection of acupuncture points. These points must be selected according to the specific ailment. The precise location of acupuncture points is crucial for obtaining the maximum therapeutic effect. This is difficult because of the different sizes and shapes of patients’ bodies. Each acupuncture point is considered to be only about 3 millimeters in diameter.

Uses and Complications

Acupuncture, which is one mode of stimulation therapy, works by changing the pattern of passage of stimulation from the peripheral nerves to the central nervous system. Stimulation treatments such as hot soaks and the management of certain pain problems with physical therapy have long been in existence.

The basic approach of modern medicine involves removing the causal factor of disease. In this approach, the pain associated with disease or with a surgical procedure may not be eradicated instantaneously, however, and the management of pain becomes an issue until the disease is cured or until the surgery and recuperation are complete. Controlling chemical receptors and reducing the sensitivity of those receptors is one way of treating pain. Intensive studies of the stimulation that causes pain have indicated that intrinsic chemical substances (polypeptides) such as histamine and serotonin, which stimulate the receptors, are essential for pain. Therefore, an antagonistic drug for these chemicals is often effective in controlling pain.

Although acupuncture is used to treat conditions as diverse as allergies, circulatory disorders, dermatologic disorders, gastrointestinal disorders, genital disorders, musculoskeletal disorders, neurologic disorders, and psychiatric and emotional disorders, the use of acupuncture for pain control (analgesia) can be described as the most basic level of treatment.

The English words “anesthesia” and “analgesia” are misleading when used to describe the freedom from surgical or obstetrical pain that can be produced by acupuncture. If “analgesia” is described as insensibility to pain without loss of consciousness, it is a more appropriate word than “anesthesia,” which is described as an insensibility, general or local, induced by anesthetic agents, and a loss of sensation of neurogenic or psychogenic origin.

Acupuncture can produce numbness in any part of the body. The patient under acupuncture analgesia remains able to converse and cooperate with the surgical or obstetrical team. Obstetric patients are aware of uterine contractions and are able to use their muscles to bring forth the fetus. Surgical patients can tell when incisions are made but do not perceive them as painful. There is no loss of memory, as in hypnosis or general anesthesia, and no paresthesia (abnormal sensations) comparable to the sensations following local anesthesia.

Most operating room deaths and cases of cardiac arrest in the United States are caused by chemical anesthesia rather than by surgery. Patients with anesthetic risks because of heart, liver, or kidney disease tolerate acupuncture analgesia well. Acupuncture is contraindicated for children under the age of seven, hemophiliacs, pregnant women, and people who have a fear of needles.

Acupuncture can be used to induce a feeling of well-being and calmness to allay the fear and apprehension most patients feel before surgery. It also appears to reduce both bleeding during surgical procedures and the incidence of shock. Postoperative acupuncture analgesia patients are spared nausea and the difficulties with urinating and defecating that frequently follow chemical anesthesia. Acupuncture analgesia does not mask symptoms as chemical anesthetics and analgesics do. The patient remains aware of his or her symptoms, but acupuncture diminishes those symptoms to a tolerable level.

Postoperative pain does not usually occur for several hours after acupuncture analgesia has been terminated. When it does occur, acupuncture can be used again instead of narcotics, and the treatment seldom needs to be repeated more than once or twice. Some acupuncturists leave small needles superficially inserted for several days to give postoperative pain relief. Others give regular acupuncture treatments, leaving the needles in place for twenty minutes per day for as many days as are necessary.

The main disadvantage of acupuncture analgesia is that it is less reliable than chemical analgesia or anesthesia. In some cases, acupuncture analgesia cannot be induced or becomes inadequate during a surgical procedure. It may not produce the relaxation desirable for some abdominal surgeries. For this reason, backup chemical anesthetics and analgesics are also available in most cases.

The actual induction of acupuncture analgesia takes about twenty minutes—slightly longer than chemical anesthesia. In most cases, electroacupuncture instruments must remain attached to all acupuncture needles during the entire procedure, but these can usually be kept away from the surgical field. The more skilled the acupuncturist, the fewer the needles required. In China, major surgical procedures have been performed with only one acupuncture needle as analgesia and without electric supplementation.

The same type of thin (usually 30-gauge) stainless steel needles that are used for acupuncture treatments are used for acupuncture analgesia. In general, the points that are used to relieve chronic pain in a specific area are the points of choice for analgesia. To obtain sufficient analgesia for surgery, it is usually necessary to heighten the effect of the acupuncture needles by twirling them continually or by attaching electronic instruments to them to deliver a current of about two hundred microamperes, with a pulsating wave at a frequency of two hundred per minute during the entire procedure. The use of electronic instruments will usually increase the depth of analgesia or prolong an analgesic effect that is beginning to wear off.

Besides the acupuncture points for analgesia of specific areas of the body, points are often used to relieve anxiety and promote a feeling of well-being. Needles are usually inserted for twenty minutes the evening before surgery, as well as for at least twenty minutes before the actual surgery begins.

The theoretical principles of vital energy transmission are used in determining which acupuncture points should be effective for the anticipated surgery. Acupuncture points on meridians passing directly through, or in the vicinity of, the surgical area are usually selected. An attempt is made to use points on these meridians that are as far away from the surgical field as possible.

Perspective and Prospects

According to most reports, acupuncture appears to have been developed in the northernmost area of the middle region of China around 300 BCE. People in this area were primarily nomads, moving from one area to another.

Chinese high priests, who also often served as physicians, observed that men who were wounded in combat often reported the sudden disappearance of illnesses from which they had suffered for years. For example, a wound in a specific area of the foot would reduce blood pressure or relieve a headache or toothache, or an injury on the dorsal aspect of the knee joint would cure a migraine. Over the years, the high priests recorded numerous observations of the phenomenon of a wound in one part of the body curing a long-standing complaint at another point. They discovered that it was the location of the wound that was significant. A pinprick in the correct location was enough to effect relief. It was noted that certain points of the body responded more noticeably to stimulation than other points and that frequently there was a direct correlation between the points that were responsive and a particular ailment. They were subsequently named meridian points.

At a later time, when metal was introduced to the culture, needles were used as an irritant at meridian points, and it was thought that pain from a specific ailment was diverted in a linear fashion through the meridian points to the surface of the body. Thus the concept of the “meridian line” was developed, and thus acupuncture was discovered.

At first, the surgeon-priests used fish bones and sharpened splinters of bamboo to effect the pricks. Later came finely honed needles. Warlords and nobles were treated with needles forged from gold and silver. As the science of acupuncture developed, it was discovered that the needles needed only to be inserted in a point of skin measuring about one-tenth of an inch.

The earliest book describing acupuncture was written in 50 BCE. It described the clinical applications of acupuncture with anatomical physiological references that were based principally on the concept of the meridian lines of the body.

In 1912, Yüan Shih-K’ai, who had trained in a modern Western culture, took office as president of the Republic of China. Under his rule, old Chinese medicine—including acupuncture—that had developed from tradition and experience was unable to survive except in outlying areas of China. In 1949, however, when Mao Zedong formed the People’s Republic of China, he tried to repopularize the old methods of Chinese medicine, which had been helpful to him. In the 1930s, when Mao and his followers were retreating to the north, he was forced to depend mainly on these traditional methods for medical treatment.

In 1955, Shyuken, a follower of Mao, stated his belief that acupuncture was effective in the management of illness. He wished to study the ancient Chinese way of medicine more systematically, comparing it to Western medicine, which he believed to be too analytical. Thus, a new medical movement began that united Western and Chinese medical practices.

Stimulation therapy using local heat, massage, and pressure has been known since ancient times. Long periods of observations and analysis by Chinese physicians of the effects of irritation of varying degrees at particular points on the body surface made it possible to relate specific points on the body (meridian points) to specific conditions.

According to ancient Chinese clinical concepts, the meridian points served as peeping holes into the body and passing holes for energy. The total number of meridian points was believed to be 365. Each was named according to its effect, anatomical location, appearance, and relation to the meridian line. These meridian points were selected initially according to measurements based on the patient’s own unique anatomical standard (using the length between certain anatomical points; for example, between the shoulders). The exact location of a meridian point was then selected by the examiner, who felt with his or her fingertips the areas chosen by the initial measurement and observed the patient’s response.

Acupuncture’s popularity, like that of most techniques and discoveries, has waxed and waned throughout the years; for the most part, however, the Chinese have remained faithful to the five-thousand-year-old practice. The laws and methods of acupuncture have endured, although these methods have been increasingly combined with Western medical techniques. Gradually, the practice of acupuncture has spread throughout the world, particularly in France, Russia, Japan, Switzerland, Germany, and the United States.

In 1997, the US National Institutes of Health (NIH) concluded that the efficacy of acupuncture is highly promising and a worthwhile research endeavor, especially in treating postoperative chemotherapy nausea and dental pain. It was noted that acupuncture could be useful in asthma and addiction treatment and in stroke rehabilitation. Research has identified many of the mechanisms of action in acupuncture, most notably the release of opioids and other peptides and the corresponding changes of neuroendocrine functioning.

In 2007, the National Health Interview Survey found that there were 79.2 visits to an acupuncture practitioner per 1,000 people that year, a significant increase compared with the numbers from 1997. In 2010, the United Nations Organization for Education, Science and Culture added Chinese acupuncture to its Representative List of the Intangible Cultural Heritage of Humanity, which was designed to promote awareness of the significance of intangible cultural traditions and practices. Although the number of people who use acupuncture is significant, the Food and Drug Administration (FDA) reports exceedingly few complications. However, some instances of pneumothorax related to acupuncture have been reported over the years, especially concerning practitioners performing the procedure without proper training. In early 2015, a woman filed a lawsuit against a San Diego chiropractor for collapsing her lung during an acupuncture treatment that he was not licensed to conduct.

A review of government-funded research studies on acupuncture found numerous uses being evaluated, including labor stimulation, postsurgical wound healing, control of chemotherapy-induced vomiting, and the treatment of substance abuse, incontinence, autism, cerebral palsy, and depression. As of 2015, the effectiveness of acupuncture remains debated and under scientific review.

Bibliography

"Acupuncture." Mayo Clinic. Mayo Foundation for Medical Education and Research, 25 Jan. 2012. Web. 4 Feb. 2015.

"Acupuncture: What You Need to Know." National Center for Complementary and Integrative Medicine. Natl. Center for Complementary and Integrative Medicine, Nov. 2014. Web. 4 Feb. 2015.

Cassidy, Claire Monod. Contemporary Chinese Medicine and Acupuncture. New York: Churchill, 2002. Print.

Ernst, Edzard, and Adrian White, eds. Acupuncture: A Scientific Appraisal. Boston: Butterworth, 2000. Print.

Hai, Hong, ed. Acupuncture: Theories and Evidence. Hackensack: World Scientific, 2013. Print.

Kidson, Ruth. Acupuncture for Everyone: What It Is, Why It Works, and How It Can Help You. Rochester: Inner Traditions, 2001. Print.

Manaka, Yoshio, Kazuko Itaya, and Stephen Birch. Chasing the Dragon’s Tail: The Theory and Practice of Acupuncture in the Work of Yoshio Manaka. Brookline: Paradigm, 1997. Print.

Mann, Felix. Reinventing Acupuncture: A New Concept of Ancient Medicine. Boston: Butterworth, 2000. Print.

Molassiotis, A., et al. "A Randomized, Controlled Trial of Acupuncture Self-Needling as Maintenance Therapy for Cancer-Related Fatigue after Therapist-Delivered Acupuncture." Annals of Oncology 24.6 (2013): 1645–52. Print.

Stux, Gabriel, and Bruce Pomeranz. Basics of Acupuncture. 5th ed. New York: Springer, 2003. Print.

How does matter change states (i.e from solid to gas)? What happens to the particles? How do you calculate the relative atomic mass of an element?...

The Basic Structure of Matter

Matter is composed of particles which are held together by intermolecular forces. Particles are composed of one or more atoms. Atoms are composed of subatomic particles called, protons, neutrons, and electrons.

States of Matter

• 
  Solids: Solid particles are held tightly together by strong intermolecular forces. There is very little movement of the particles. This means that the particles have low kinetic energy.

• 
  Liquids: Liquid particles are held together more loosely than solid particles. They able to slide past one another and they possess more kinetic energy.

• 
  Gases: The intermolecular forces between gas particles are negligible. The particles move around rapidly and have high kinetic energy.

When heat energy is absorbed by a solid, the intermolecular forces between the particles are reduced. The particles are then able separate and move around (i.e. the substance becomes a liquid).

When heat energy is absorbed by a liquid, it eventually overcomes the intermolecular forces holding the liquid particles together. The particles are then free to move around (i.e. the substance becomes a gas).

Chemical and Physical Change

• 
  Physical Change: In a physical change, the particles of a substance are rearranged, but do not change into different particles. Examples of physical changes include: state changes such as melting and evaporation, shredding paper, mixing sand and water.

• 
  Chemical Change: In a chemical change, the particles of a substance do change into different particles. Examples of chemical changes include: burning, digesting, reacting.

Relative Atomic Mass

The relative atomic mass of an element is a "weighted average" of the masses of all of the isotopes of the element. Isotopes are different forms of the same element with different numbers of neutrons.

A weighted average is one that takes into account the percentages of each substance. The relative mass of an element is calculated by multiplying the percentage of each isotope times its mass, and adding the resulting answers together. 

Example: The relative mass of chlorine can be calculated by determining the weighted average mass of chlorine's isotopes using the information shown below.

    Isotope            Percentage          Mass (amu)

    Chlorine-35          75%                    35

    Chlorine-37          25%                    37

Relative mass = (.75)(35) + (.25)(37) = 35.5 amu. 

The relative mass is the number that is used as the atomic mass in the periodic table.

Explain the impact of Uncle Tom's Cabin outside of the United States

Though we often focus on the firestorm it ignited against slavery in the United States, Uncle Tom's Cabin had a huge influence outside of its country of origin. According to David Reynolds' book covering the impact of Uncle Tom's Cabin, called Mightier than the Sword, Stowe's novel helped inspire revolutionary movements in Russia, Brazil, China and Cuba. Because of uncomfortable parallels between Southern U.S. slavery and serfdom in Russia, the book was initially banned in...

Though we often focus on the firestorm it ignited against slavery in the United States, Uncle Tom's Cabin had a huge influence outside of its country of origin. According to David Reynolds' book covering the impact of Uncle Tom's Cabin, called Mightier than the Sword, Stowe's novel helped inspire revolutionary movements in Russia, Brazil, China and Cuba. Because of uncomfortable parallels between Southern U.S. slavery and serfdom in Russia, the book was initially banned in Russia, though people were able to get copies in French and German--and after the czar freed the serfs, it was available in Russia. It influenced Russian revolutionaries such as Lenin and radical reformers such as the writer Leo Tolstoy. It was, according to Reynolds, the number one bestseller across Europe in the nineteenth century. Charles Dickens, whose novels often focused on the plight of the poor in industrialized England, wished he had written the novel and Queen Victoria wanted to meet Stowe, although she was advised against it, due to Stowe's "radicalism." Overall, the book is the poster child for how a work of literature, through arousing emotions, can have a outsize influence on political life and hence history, particularly, in this case, movements that fought for the liberation or increased rights of oppressed peoples. 

What are Fusarium? |

Definition

Fusarium are widely distributed plant pathogens
that can cause skin, wound, lung, and invasive infections in humans.
Fusarium also produce many allergens and mycotoxins.

Natural Habitat and Features

Fusarium are widely distributed fungi (molds) that grow on a variety of substrates, including plants (and
their roots), food, soil, and wet, indoor environments. Fusarium
tend to produce fast-growing, woolly to cottony, flat-spreading cultures and come
in many colors, including white, gray, red, cinnamon, pink, yellow, and
purple.

Fusarium are present mainly in the anamorphic or asexual phase. Some Fusarium species also have a telemorphic phase and produce ascospores. Some of the more common Fusarium ascospore forms are Gibberella avenacea, intricans, zea, subglutinans, and moniformis; these are the telomorphic forms of F. avenaceum, equiseti, graminearum, subglutinans, and verticilloides, respectively. Haematonectria spp.are teleomorphic forms of F. solani.

Fusarium often produce two types of asexual spores, including macroconidia, borne on long sickle or banana-shaped structures, and microconidia, borne on chains. Many species of Fusarium also produce chlamydospores, which are thick-walled resting spores that can survive long periods in unfavorable conditions, such as drought.

Like most fungi, Fusarium are usually identified by macroscopic and microscopic features, although molecular methods such as 28S rRNA (ribosomal ribonucleic acid) gene-sequencing may also be used.

Pathogenicity and Clinical Significance

Fusarium exposure can adversely affect human health by three
mechanisms: infection (fusariosis), exposure to allergens, and exposure to toxics produced by
Fusarium. Fusarium frequently invade the skin, especially if the skin is damaged by trauma, burns, or diabetic
ulcers. Fusarium also can invade the eyes (endophtalmitis), nasal
sinuses, and lungs. Localized Fusarium infections may disseminate
through the bloodstream to become life-threatening infections.

Invasive disseminated Fusarium infections commonly occur in
immunocompromised persons, such as those with leukemia, lymphoma, or HIV
infection; those who are malnourished or neutropenic;
persons suffering from burns or other skin trauma; and persons taking
immunosuppressive drugs following bone or organ transplantation. Invasive
Fusarium infections can spread through blood vessels and cause
tissue infarction (tissue death).

The rate of Fusarium invasive infection is on the rise and now
makes up 1 to 3 percent of all invasive fungal infections. Disseminated
invasive Fusarium infections have high mortality rates that range
from about 30 to 90 percent.

F. solani is the most common cause of skin and disseminated invasive Fusarium infections (about 50 percent), followed by oxysporum (about 20 percent) and verticillioidis and monilforme (about 10 percent each).

Fusarium also produce a variety of toxins (mycotoxins), including fumonisins, trichothecenes, and zearalenones. Domestic animals and humans have become acutely ill after eating foods contaminated with Fusarium mycotoxins.

Fumonisins can increase the risk of some cancers, can damage the immune system, and can cause respiratory problems. Trichothecenes damage the immune and nervous systems, block cell protein synthesis, and cause vomiting. Zearalenones are estrogen-mimicking chemicals that can cause early female puberty, infertility, and spontaneous abortion in humans and other mammals. Human studies have linked consumption of Fusarium-contaminated corn (maize) with higher rates of early female puberty. Exposure to airborne Fusarium spores can also worsen asthma and sinus problems.

Drug Susceptibility

Fusarium infections are sometimes difficult to diagnose in their
early and less serious stages. Infections can often be diagnosed by culturing
Fusarium from the blood and from skin lesions. High resolution
computed
tomography (CT) scans of the chest are often useful in
diagnosing fusariosis. Polymerase chain reaction (PCR) blood tests also are used
to diagnose Fusarium infections.

Localized Fusarium
skin
infections can often be treated with topic antifungal drugs
such as natamycin and voriconazole. Disseminated Fusarium
infections are often difficult to treat because few antifungals are consistently
effective against many Fusarium species. Amphotericin B is often
used as a first-line drug against Fusarium; however, roughly 50
percent of Fusarium isolates, including many
solani and verticilloides, are resistant to
amphotericin B. Some Fusarium strains are susceptible to
voriconazole and posaconazole, while few Fusarium isolates are
susceptible to itraconazole. Most Fusarium strains are resistant
to the new echinocandin drugs (anidulafungin, caspofungin, and micafungin). These
chinocandin drugs are generally effective in treating disseminated
Aspergillus and Candida infections.

Other treatments that may be helpful in some cases of fusariosis include surgical debulking of Fusarium-infected tissue, removal of contaminated catheters, and using granulocyte-colony-stimulating factors.

The best method for controlling Fusarium infections is
avoidance of the mold. Medical experts recommended that immunocompromised persons
who are hospitalized be placed in rooms with positive air pressure, air
filtration, sterile water, and adequately cleaned surfaces, sinks, and showers to
reduce the risk of Fusarium infection. Any water damage or
visible mold growth in hospital rooms should be cleaned immediately. To
significantly reduce exposure to Fusariumand their mycotoxins in
the home, persons should keep dry, clean, and refrigerated all stored food, such
as grains, fruits, vegetables, and animal feeds.

Bibliography

Marom, Edith M., et al. “Imaging of Pulmonary Fusariosis in Patients with Hematologic Malignancies.” American Journal of Roentgenology 190 (2008): 1605-1609.

Nucci, Marcio, and Elias Anaissie. “Fusarium Infections in Immunocompromised Patients.” Clinical Microbiology Reviews 20 (2007): 695-704.

Patridge-Hinckley, Kimberly, et al. “Infection Control Measures to Prevent Invasive Mould Diseases in Hematopoietic Stem Cell Transplant Recipients.” Mycopathologica 168 (2009): 329-337.

Samson, Robert, Ellen Hoesktra, and Jens Frisvad. Introduction to Food and Airborne Fungi. 7th ed. Utrecht, the Netherlands: Central Bureau for Fungal Cultures, 2004.

Stanzani, Marta, et al. “Update on the Treatment of Disseminated Fusariosis: Focus on Voriconazole.” Therapeutics and Clinical Risk Management 3 (2007): 1165-1173.

Webster, John, and Weber, Roland. Introduction to Fungi. New York: Cambridge University Press, 2007.

How are men affected by behavioral addictions?

Causes

Neither scientists nor mental health experts know exactly what causes behavioral addictions, although the latest research does provide evidence for the possibility of a genetic role. A variant of the NRXN3 gene, previously linked to smoking, drug, and alcohol addictions, has also been linked to impulsivity in men.

This link does not mean the gene causes behavioral addictions, but it can set the stage for their development when combined with other social, psychological, cultural, and emotional factors. Men are at least twice as likely as women to become dependent on drugs and alcohol, increasing men’s vulnerability to sex, gambling, and Internet addictions as well, as they share a high comorbidity rate.

In general, behavioral addictions among men have been increasing as society has changed. The proliferation of computer games, social networking sites, and pornography on the Internet make these activities prime targets for abuse. The growing availability of casinos and promotion of lotteries and sports betting have resulted in an increase in pathological gambling. The emphasis on physical attractiveness has resulted in more exercise addictions, while easy access to credit cards, especially among college-age youth, has led to more shopping addictions.

Risk Factors

Studies have shown that men between age sixteen and twenty-five represent the most vulnerable age group for many behavioral addictions, including Internet, gambling, computer gaming, shopping, sex, and exercise addictions, although an addiction can begin at any age. Also vulnerable are men with substance abuse addictions and men with depression, anxiety, perfectionism, low self-esteem, and poor social skills.

The greatest risk for an exercise addiction, usually bodybuilding or running, can be found among men who are borderline narcissistic or who have an eating disorder. At high risk for a gambling addiction are men who identify pathologically with wealth. Other risk factors include child abuse, often a factor in sex addictions, and chronic unemployment, a factor especially in computer gaming and Internet addictions. Men with physical disabilities might also be at a higher risk for any of the sedentary addictions, such as computer gaming or television watching.

Screening and Diagnosis

Guidelines for diagnosing pathological gambling are provided in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders . A variety of screening tools are available to help with the diagnosis of other addictions. These tools include the running addiction scale, exercise dependence scale, Internet addiction diagnostic questionnaire, Internet addiction test, workaholism battery, compulsive buying scale, sexual addiction screening test, and online cognition scale.

In addition to conducting tests, the mental health professional usually conducts a physical exam of the client and, in some cases, talks to family members or obtains legal records for additional information. While a diagnosis is usually only made after a thorough examination, sometimes it depends on one criterion: the inability of the client to limit his behavior to within a normal, healthy range.

Symptoms

As a person becomes addicted to a behavior or activity, the initial sense of pleasure or euphoria, similar to that induced by drugs or alcohol, often gives way to pain or a variety of negative thoughts and emotions. In some cases, the activity actually alters the chemistry of the body so that the person becomes both physically and psychologically dependent. When withdrawal is attempted, the addict may experience mood swings, insomnia, depression, headaches, and other physical or emotional symptoms.

Symptoms also may include the inability to perform satisfactorily at work or to maintain regular hours. Many addicts end up losing their jobs because of repeated absences or tardiness. Divorce, losing custody of children, and destroying friendships are also common among addicts.

Compulsive gamblers and shoppers usually end up with devastating financial problems. Exercise addicts often have prolonged pain and may have had multiple physical injuries or surgeries that would normally have convinced a nonaddict to stop the activity. Sexual addictions often result in sexually transmitted diseases and in unintended pregnancies. Internet and computer game addictions cause eating and sleep disorders, vision problems, headaches, and hygiene issues related to not bathing or using the toilet regularly. Suicide is prevalent among men with severe behavioral addictions, as the shame, guilt, financial problems, and other woes are often too difficult to handle.

Treatment and Therapy

Treatment for a behavioral addiction often involves many steps. There are no miracle medications. Finding the underlying cause of the problem is key to a successful treatment plan.

A behavioral addiction can sometimes be a symptom of, or exist alongside, a mental disorder or illness, such as depression, bipolar disorder, or an obsessive-compulsive disorder. In those cases, pharmacological intervention is the normal course and would take precedence over treating the behavioral addiction. Psychotherapy will help uncover any repressed attitudes or child abuse that can be at the root of an addiction.

In many cases, the standard form of treatment is a twelve-step program similar to the model conceived by Alcoholics Anonymous or individual cognitive-behavior therapy (CBT) administered by a mental health expert. Family or couples therapy also is included when relevant.

CBT and the related twelve-step programs explore the negative or maladaptive thoughts, or cognitions, which are often the source of an addiction. For example, gambling addicts usually place an abnormally high value on personal wealth, whereas compulsive shoppers tend to believe their identities are closely associated with consumer goods. CBT will also confront the shame and denial often associated with addictions and help a man to ask for forgiveness from the people he has hurt. Most therapy programs also include an educational component to teach relevant skills, such as good nutrition or financial management.

Prevention

A man can prevent a behavior or activity from becoming an addiction by maintaining a healthy and balanced lifestyle and remaining vigilant when too much time, energy, or attention is focused on one particular activity. A balance between sedentary activities and sports, and between work and leisure, is important, as is nurturing happy, productive relationships and pursuing a fulfilling career.

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What are pesticides? How do they affect the food chain?

Related cancers:

Lymphomas, brain tumors, leukemias, and cancers of the breast, skin, stomach, prostate, and ovaries

Definition:
Pesticides refer to any substance or mixture of substances intended for preventing, destroying, repelling, or lessening the damage of any pest. A pest is any living organism that could harm crops and people or other animals, or is in an undesirable location. Pesticides may be chemical, biological, or antimicrobial. They are released into the environment primarily through the spraying of insecticides on fruits and vegetables and other crops, such as corn, wheat, rice, and cotton, and by the use of herbicides on grass. Pesticides are believed to be responsible for a number of cancers.

Exposure routes:
Ingestion, inhalation, absorption

Where found: Pesticides are found in the environment, in streams, rivers, lakes, groundwater, and the soil, including fields (where chlorophenols, particularly in the form of weed killers, build up over the years) and chemically treated lawns. DDT, banned in the United States in 1972, still exists in the soil and is stored in the fatty tissues of individuals; it may also be on products imported into the United States from countries where it is allowed.

Pesticides have entered the food chain: chemicals from pesticides get into groundwater or streams, then into the grass and other vegetation, then into herbivorous animals and then carnivorous and omnivorous animals such as humans. Those animals at the top of the food chain, such as humans or scavengers, fare worse than those below them, as the buildup of toxins is much greater at the top. In the aquatic food chain, chemicals from pesticides enter agricultural runoff or wastewater, then are taken up by algae and plankton, then small organisms, then larger fish, and finally humans. Fish containing mercury or other chemicals can be lethal to people.

At risk: People who produce or distribute pesticides, agricultural workers and people living in close proximity to fields, people who use pesticides in and around their homes, and people who eat fish or pesticide-treated fruits and vegetables

Etiology and symptoms of associated cancers:
Studies have shown that human bodies contain hundreds more chemicals, including those contained in pesticides, than they did in the mid-twentieth century. Pesticides are linked to lymphoma, a cancer of the white blood cells. Of the two kinds of lymphoma, Hodgkin and non-Hodgkin lymphoma (NHL), the latter is most associated with pesticide carcinogens. Non-Hodgkin lymphoma begins when a blood cell (lymphocyte) becomes malignant and subsequently produces descendants of the single cell in which mutations (errors) have occurred. Although lymphoma can occur in any part of the body, tumors typically form in the lymphatic system, meaning bone marrow, lymph nodes, the spleen, and blood. The initial symptoms are usually perceived as swelling around the lymph nodes at the base of the neck, fever, fatigue, and unexplained weight loss.

Breast cancer is linked to organochlorine pesticides, which affect the endocrine system. Absorbed through ingested foods, the pesticides mimic, alter, or modulate hormonal activity and are therefore known as endocrine disruptors. Raising the activity and quality of estrogens the human body produces causes tumors to form. Pesticides are also linked to ovarian cancer, in that malignant ovarian tumors are endocrine related and hormone dependent.

Atrazine—used on some 75 percent of the United States corn crop, as of 2012, according to the EPA—exists in most drinking water supplies in the Midwest and has been linked to birth defects in farmers’ children. Long-term exposure to atrazine has been linked to weight loss, cardiovascular damage, retina and muscle degeneration, and cancer.

Organophosphate pesticides, which have largely replaced organochlorine pesticides, are connected with skin and eye problems, headaches, dizziness, nausea, vomiting, and abdominal pain. The thirty-seven compounds that make up this group destabilize a key enzyme in the brain known as cholinesterase, causing trauma to the brain and nervous system. Studies have related pesticide risk with respiratory problems, memory disorders, dermatologic conditions, cancer, depression, neurologic deficiencies, miscarriages, and birth defects. Primarily, these pesticides affect the nervous system by disrupting the enzyme that regulates acetylcholine, a neurotransmitter.

Definitive proof that DDT is a human carcinogen is still lacking, but it has been associated with liver and lung tumors, as well as lymphoma, in experimental animals, as reported in the Thirteenth Report on Carcinogens (2014). Epidemiological studies have further shown association with breast cancer, leukemia, multiple myeloma, and liver cancer in humans.

History: More than four thousand years ago, Sumerians dusted sulfur on their crops to kill insects, and more than two thousand years ago, ancient Greeks used pesticides to protect their crops. By the fifteenth century, arsenic, mercury, and lead—highly toxic chemicals—were used on crops to eliminate insects. During the seventeenth century, farmers used nicotine sulfate, derived from tobacco leaves, as an insecticide, and in the nineteenth century, pyrethrum, extracted from chrysanthemums, and rotenone, removed from roots of tropical vegetables, were used as pesticides.

In 1939 Swiss scientist Paul Müller discovered the potency of a compound made of carbon and hydrogen called dichlorodiphenyltrichloroethane (DDT), first used in World War II against typhus, plague, malaria, and dengue and yellow fevers. After the war, DDT use in the United States soared. Farmers killed pests such as boll weevils that were devastating cotton crops, and the government used low-flying crop-dusting planes to rid the forests of gypsy moths. Other parts of the world began using DDT to combat malaria; after homes and huts were sprayed in North Africa, Asia, India, and Zanzibar, the number of malaria cases declined drastically.

In 1962 Rachel Carson published
Silent Spring, the product of more than four years of research, in which she maintained that pesticides were harming wildlife and the environment. Using meticulous documentation, Carson claimed that the government knew little about the dangers of pesticides. Although the book was criticized as well as praised, it spurred concerns about pesticides and other pollutants, leading to the beginning of the environmental movement and President Richard M. Nixon’s creation of the Environmental Protection Agency (EPA) in 1970. Soon the EPA targeted DDT, eventually banning it in 1972. Although time has proven Carson’s position on the harm from pesticides to wildlife correct, the idea that DDT is a human carcinogen is still being investigated.

In the years since its ban, DDT has been replaced by a huge array of insecticides, herbicides, and pesticides that have been tentatively linked with tumors and cancers of the lymphatic, endocrine, neurological, respiratory, and reproductive systems but have not been proven to be carcinogens. Although studies have shown an increase in the rates of tumors or cancers in agricultural areas where large amounts of pesticides are used, scientific proof of the connection is inconclusive. Because of the gap in time between exposure and the first symptoms of illness (frequently decades) and the inability to pinpoint a particular pesticide as the carcinogen, definite scientific proof is hard to provide.

Nevertheless, strict regulations are in effect: The EPA must approve any pesticide for sale or use in the United States, and the Food Quality Protection Act (1996) requires the oversight of the manufacture, distribution, and use of pesticides. Although the causal relationship between pesticides and cancer is hard to establish, pesticides have other proven health risks, and many people in the United States are trying to minimize or avoid their use. The EPA provides many suggestions on how to use pesticides more safely, and some people have turned to organically grown products as a way to avoid most pesticides.

Because of the carcinogenic potential of pesticides, the organic foods industry has grown. The Organic Foods Production Act (1990) authorized national standards for the production, handling, and processing of organically grown agricultural products. Essentially, organic farming is an ecological system that avoids chemical pesticides, promotes soil conservation, and integrates the parts of the farming system into an ecological whole. Although organic farming cannot guarantee that the soil does not contain pesticide residue, the practice follows methods designed to minimize contamination from air, soil, and water. Organic meat, poultry, eggs, and dairy products come from animals that are not given any antibiotics or growth hormones and that are raised on organically grown feed. Organic food is produced without using conventional pesticides or fertilizer made from synthetic ingredients or sewage sludge. Organic farms use cover crops, green manures, animal manures, and crop rotation to manage weeds, insects, and diseases and promote biological activity and long-term soil health.

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