What are interest inventories? |

Introduction

Since the inception of the interest inventory in the late 1920s, its development in the context of educational and vocational counseling has expanded considerably. The interest inventory is a questionnaire-type device designed to measure the intensity and breadth of an individual’s interests. Most often, the specific interests measured by an inventory relate to a variety of vocational and avocational activities. The term “interest” refers to a very specific aspect of human behavior. An interest is an enduring trait, a predilection for a particular activity, avocation, or object. It is a special attitude that engages the individual and motivates him or her to move toward the object of interest.

An interest inventory is distinct from both an achievement test
and an aptitude test. An achievement test measures an individual’s current ability to perform a particular task. An aptitude test measures potential or capacity for performing that task in the future. An interest inventory, on the other hand, measures a person’s liking for a particular task without reference to the individual’s actual ability to perform the task or potential for doing so in the future. For example, a high school student may show a high interest in the field of nursing. This interest alone, however, does not mean that he or she has any current nursing skills, nor does it indicate that the student has the mental ability, physical stamina, or emotional makeup for success in the nursing field.

What then is the rationale for examining patterns of interest? First, interest in a particular activity provides some motivation for engaging in that activity. Therefore, when one identifies areas of interest, one is also identifying areas in which a person might have the degree of motivation necessary for following through on that activity. Second, the scores obtained from an interest inventory are helpful in pointing out which groups of persons an individual most resembles. Finally, it has been shown that there is some relationship between a person’s domain of interest and the occupational field that that person may eventually choose.

The construction of an interest inventory may be empirically based (that is, based on observation of factual information) or theory-based (based on systematic principles concerning occupational categories). Some inventories have utilized a combination of these approaches. In its development, the empirically based inventory would be administered to various criterion groups of successful persons representing particular occupations. The inventory would also be given to a reference group, a large group representing people in general. The items on the inventory that set apart a particular criterion group from the larger reference group would then become part of the scale for that occupation. A person would be considered to have a high score on a particular occupational scale if he or she has interests that closely match the criterion group’s interests.

Other inventories are simply based on occupational theory. One well-known theory that has been utilized in the construction of interest surveys was first set forth in John L. Holland’s 1992 publication Making Vocational Choices: A Theory of Careers. The theory involved the categorization of occupations into the following six types: realistic, investigative, artistic, social, enterprising, and conventional. Other occupational categories have also been devised and used as the bases for interest inventory construction and scoring. Interest inventories also differ on the basis of the format used in the construction of the items. Some inventories ask the individual to indicate the degree of interest he or she has in a particular activity, whereas others use a forced-choice format, asking the testee to make an either/or choice between two activities.

Popular Inventories

In their book Career Guidance and Counseling Through the Life Span (1996), Edwin L. Herr and Stanley H. Cramer reviewed some commonly used interest inventories. Some of the inventories, such as the well-known Strong Interest Inventory (SII), the Career Assessment Inventory (CAI), and the Vocational Preference Inventory (VPI), yield results based on Holland’s six general occupational themes. Others, such as the Career Occupational Preference System (COPS) and the Vocational Interest Inventory (VII), are constructed around Anne Roe’s eight occupational groups.

Interest inventories also differ in terms of their intended use. The Interest Determination, Exploration, and Assessment System (IDEAS) was developed for grades six through twelve; the Geist Picture Interest Inventory (GPII) is intended for culture-limited and educationally deprived populations; and the Kuder Occupational Interest Survey (KOIS) is designed for high school students and adults. The scope of occupations explored is another variable. The Minnesota Vocational Interests Inventory (MVII) deals with skilled occupations, while the COPS, Form P, deals with professional occupations. Some inventories are hand scored, while others are scored by computer. Tests such as the SII can be computer administered as well. Some of the inventories are designed to be used in conjunction with the Dictionary of Occupational Titles, published by the US Employment Service, or the
Occupational Outlook Handbook, published by the U.S. Department of Labor, Bureau of Labor Statistics, and available online. The KOIS and the Ohio Vocational Interest Inventory (OVII) are two such examples.

There are various ways to judge the relative value or dependability of these measurement devices. First of all, one must consider the reliability of the inventory. Interests are human traits with a somewhat enduring quality. They are not expected to change radically over a short period of time. The reliability of the inventory is a measurement of how stable scores on the inventory would be if the inventory were administered to the same person over a period of time.

A second consideration in determining the value of an inventory is its validity. Though there are many ways to approach test validity, the aim is to determine if the inventory is really measuring interests as opposed to some other trait. Studies are often undertaken to see if scores on one interest inventory are consistent with scores on another interest inventory that is considered to be a valid measure. Another test of validity involves giving the interest inventory to persons in that occupation to see if their interest scores emerge in the direction expected. Information about the specific reliability and validity of a particular interest inventory is reported in the manual developed for its use.

Of particular concern in evaluating an interest inventory is the possibility of sex-role bias. The extent to which an interest inventory is constructed to perpetuate stereotypical male and female roles is a major issue. The SII, for example, attempted to use both male and female criterion groups for each occupation on the inventory. This posed some problems, such as finding sufficient numbers of males or females in certain occupations. Care was also taken in revisions to eliminate inappropriate references to gender; for example, “policeman” was changed to “police officer.”

Inventory Uses

Interest inventories are typically used in educational and vocational counseling. Most interest inventories are devised to assist a person in pinpointing possible career options. This entails assessing not only his or her interests in terms of particular careers but also interests related to college majors. Often an interest inventory will be helpful in determining where an individual’s interests lie in relation to larger clusters of occupational groupings. Interest inventories are also used by researchers in obtaining information about the vocational interests of specific groups for the purpose of planning and implementing career training programs and noting overall occupational trends.

The following case study serves as an illustration of the practical use and interpretation of the interest inventory. It includes a student profile based on the KOIS and the recommendations that a counselor might make to this student in the light of the results obtained.

“John” is a seventeen-year-old adolescent in his junior year of high school. He is enrolled in a college preparatory program and has often verbalized at least a tentative interest in following in the footsteps of his father, who works in commercial real estate appraisal. His grades in art and drafting classes indicate that he has a propensity for visual thinking and illustration. John would be the first to admit, however, that his interests are very practical in nature, and he is not drawn toward philosophical debates. John’s entire class was administered the KOIS through the counseling and guidance department of his school. The tests are computer-scored, and results are distributed to the students during individual appointments with the school counselor.

John’s KOIS report form indicates that his results appear to be dependable. His interests in ten vocational activities are ranked in order of his preference for each. As compared with other males, his top interests, which are literary, persuasive, artistic, and mechanical, are average in intensity. The two areas ranked least interesting to John are social service and musical. John’s patterns of interest as compared with men in many different occupations are most consistent with auto salesperson, photographer, travel agent, buyer, retail clothier, radio station manager, and real estate agent. Furthermore, John shows an interest pattern most similar to men in the following college majors: business administration, physical education, economics, and engineering.

John’s counselor reminds John that the KOIS measures interests, not aptitudes or other personal variables that are part of a successful career match. The counselor observes that John’s KOIS profile does accentuate some of the areas of interest to which John has alluded during his high school years. She notes that on the KOIS there were several indications that John might like an occupation related to business and sales.

As a follow-up to the KOIS, the counselor points out that John could benefit from exploring various school programs that offer the college majors that surfaced on his report form. She encourages John to talk to college representatives about his particular interests. She suggests that John look into some of the occupations that appeared on his KOIS report and possibly utilize such resources as the US Department of Labor’s Guide for Occupational Exploration in learning about working conditions, employment prospects, promotion opportunities, and related occupational opportunities. The counselor also encourages John to talk with persons working in those general areas of employment that appeared on his KOIS. Exploration of other careers in the same job families as those which appeared on his report form might also prove beneficial. For John, the KOIS is probably the most beneficial in providing him with the impetus for continued career exploration.

The counselor, in perusing all the scores of the junior class members with whom she is working, may note overall patterns of interest appearing in the KOIS report forms. This information may lead her to make certain provisions for those interests in the school’s career awareness program, in the type of invited speakers, and in the kinds of college and training program representatives invited to make presentations at the school.

While John was given the opportunity to take an interest inventory in high school, there are other situations in which a person may do so. Professional career counselors offer such opportunities to interested parties through college and university career centers and vocational rehabilitation services, in workshops for those planning second careers, and in private practice settings.

Vocational Counseling

Interest inventories can be situated in the overall context of vocational counseling, a field whose origins stemmed from the focus on job productivity and efficiency that arose during the Industrial Revolution. Frank Parsons is credited with laying the foundation for the field of career development. In his book Choosing a Vocation (1909), Parsons articulated a conceptual framework for career decision making. He emphasized that career decision making must be based on a clear understanding of one’s personal attributes (such as aptitudes, interests, and resources) as related to the requirements of the job field. Parsons’s theory provided the theoretical backdrop for the more scientifically oriented trait-factor approach to vocational counseling that would soon follow.

Getting displaced American workers back on the job was a major impetus in vocational counseling after the Great Depression of the 1930s. During that era, the University of Minnesota became a center for the development of new assessment devices to measure individual differences, and researchers there designed instruments that became part of test batteries used in counseling centers around the country. E. G. Williamson’s work in career counseling research led to the publication of the Dictionary of Occupational Titles by the U.S. Employment Service in 1939. D. G. Paterson and J. G. Darley were also prominent among those psychologists who developed what is referred to as the “Minnesota point of view,” or trait-factor theory.

Trait Factor Theory

This trait factor approach has been the basis for many of the interest inventories that have been devised. Attempts were made to match the personal traits (in this case, interests) of the individual with the requirements of particular careers and job environments. The interest inventories have been the most widely used.

The most popular interest inventory is the Strong Interest Inventory. The first version of the SII was published in 1927 by Edward K. Strong, Jr., from Stanford University; this inventory has been in use ever since. At that time it was known as the Strong Vocational Interest Blank, a project on which Strong worked tirelessly, revising and improving it until his death in 1963. In that same year, David P. Campbell at the University of Minnesota Center for Interest Measurement Research assumed the task of continuing to update Strong’s work. Along with Jo-Ida Hansen, Campbell produced the interest inventory that was redesignated the Strong-Campbell Interest Inventory in its fourth (1985) edition. The 1997 edition, however, was published under the name of the Strong Interest Inventory, and subsequent versions of the inventory have retained that name.

Probably the most common alternative to the SII is the Kuder Occupational Interest Survey, which was first published by G. Frederic Kuder as the Kuder Preference Record. Differences can be noted between the KOIS and the SII in terms of their technical construction and scales.

Although many interest inventories have been devised since the idea was first conceived, most of these inventories have focused on interests in career activities and related college majors. The 1970’s, however, brought about the notion of inventories designed to measure leisure interests. Richard N. Bolles, in his book The Three Boxes of Life (1981), indicated that, in addition to meaningful work, people need to engage in the pursuit of two other “boxes,” that of learning/education and that of leisure/playing. This more holistic approach may be more evident in the interest inventories yet to be developed.

Bibliography

Bolles, Richard. What Color Is Your Parachute? Rev. ed. Berkeley: Ten Speed, 2007. Print.

Bringman, Wolfgang. A Pictorial History of Psychology. Chicago: Quintessen, 1997. Print.

Capuzzi, David, and Mark D. Stauffer. Career Counseling: Foundations, Perspectives, and Applications. 2nd ed. New York: Routledge, 2012. Print.

Farr, J. Michael, and Lavern Lidden. Guide to Occupational Exploration. 3d ed. Indianapolis: JIST, 2001. Print.

Farr, J. Michael, Lavern Lidden, and Lawrence Shatkin. Enhanced Occupational Outlook Handbook. 7th ed. Indianapolis: JIST, 2009. Print.

Graham, John R., and Jack A. Naglieri, eds. Assessment Psychology. Vol. 10. Hoboken: Wiley, 2012. Print. Handbook of Psychology.

Gregory, Robert. Psychological Testing: History, Principles, and Applications. 7th ed. Boston: Pearson, 2007. Print.

Herr, Edward, and Stanley Kramer. Career Guidance and Counseling Through the Life Span. 5th ed. New York: Harper, 1996. Print.

Sacks, Peter. Standardized Minds: The High Price of America’s Testing Culture and What We Can Do to Change It. Cambridge: Perseus, 2000. Print.

Wood, Chris, and Danica G. Hays. A Counselor's Guide to Career Assessment Instruments. 6th ed. Columbus: NCDA, 2013. Print.

Zunker, Vernon. Career Counseling: Applied Concepts of Life Planning. 7th ed. Pacific Grove: Brooks, 2006. Print.

Dee is referred to as a child who has "made it." What does this mean?

Dee has "made it" in the sense that she got out and found a way to prosper despite her humble beginnings.  Her mother noticed how bright and quick Dee was as a child and so saved up to send her away to school to receive a better education than the one she could get at home.  Dee has gone on to a full and busy life, with little time to return home, and she has...

Dee has "made it" in the sense that she got out and found a way to prosper despite her humble beginnings.  Her mother noticed how bright and quick Dee was as a child and so saved up to send her away to school to receive a better education than the one she could get at home.  Dee has gone on to a full and busy life, with little time to return home, and she has also always seemed somewhat embarrassed about her home.  Mama says, "She wrote me once that no matter where we 'choose' to live, she will manage to come see us. But she will never bring her friends."  For all her intelligence, Dee doesn't seem to realize that Mama and Maggie probably don't have a whole lot of choice in terms of where they live.  They run a farm, live in a rural setting in the south in the first half of the twentieth century, and therefore, they probably live where they need to live to make things work.  For all her intelligence, Dee doesn't really get it.  Nonetheless, because Dee seems to have made a different kind of life for herself -- one where she has an education, wears pretty dresses and sunglasses and has a car and fancy friends -- she is referred to as having "made it."

What are rickets? |

Causes and Symptoms

Rickets is a relatively rare bone disease
that most frequently afflicts children. It is the result of insufficient or inefficient absorption of vitamin D in the body, which causes a progressive softening and weakening of the bone. Certain physical conditions can reduce digestion or absorption of fats and may also diminish vitamin D absorption by the intestines. The loss of calcium and phosphate from the bone eventually causes destruction of the supportive bone matrix. In adult deficiency, demineralization (osteomalacia) may occur in the spine, pelvis, and lower extremities, causing osteoporosis (an adult disorder causing brittle bones).

Symptoms of rickets may include pain or tenderness of the long bones and pelvis, skeletal deformities such as bowlegs, bumps in the rib cage (rachitic rosary), spinal and pelvic deformities (including kyphosis or scoliosis), pigeon breast, an asymmetrical or odd-shaped skull, increased tendency toward fractures, dental deformities and cavities, night fevers, muscle cramps, impaired growth, decreased muscle tone and growth, and general weakness and restlessness.

Hereditary rickets is a sex-linked vitamin D-resistant disorder that occurs when the kidney is unable to retain phosphate. Rickets may also occur in children with liver or biliary disorders, when vitamin D and fats are inadequately absorbed.

Treatment and Therapy

Uncomplicated infantile rickets can be cured with a daily replacement of deficient calcium, phosphorous, and vitamin D. Clinical testing reveals improvement after one week. Dietary sources of vitamin D include fish, liver, and processed milk. In addition, moderate exposure to sunlight is therapeutic. Skeletal deformities can be corrected with good posture or body braces; in some cases, surgery may be necessary. If rickets is not corrected in children, short stature and skeletal deformities may become permanent.

Bibliography

Alan, Rick, and Michael Woods. "Rickets." Health Library, Feb. 25, 2013.

Ballard, Carol. Bones. Rev. ed. Chicago: Heinemann Library, 2002.

Bentley, George, and Robert B. Greer, eds. Orthopaedics. 4th ed. Oxford, England: Linacre House, 1993.

Currey, John D. Bones: Structures and Mechanics. 2d ed. Princeton, N.J.: Princeton University Press, 2006.

"Hereditary Hypophosphatemic Rickets." Genetics Home Reference, Sept. 2010.

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

Kaneshiro, Neil K., and David Zieve. "Rickets." MedlinePlus, Aug. 1, 2012.

"Rickets." MedlinePlus, June 29, 2012.

Tortora, Gerard J., and Bryan Derrickson. Principles of Anatomy and Physiology. 13th ed. Hoboken, N.J.: John Wiley & Sons, 2012.

Wenger, Dennis R., and Mercer Rang. The Art and Practice of Children’s Orthopaedics. New York: Raven Press, 1993.

What are hemorrhoids? |

Causes and Symptoms

Hemorrhoids, some physiologists suggest, are one of the prices that humans pay for
walking upright. The vascular system—the veins and arteries that circulate
blood—evolved in an animal that walked on all fours. Now that humans spend most of
their time standing, gravity puts awkward pressure on the system, and at the
bottom of major parts of the system, as in the tissue around the anus, the
column of blood above weighs heavily on the network of small blood vessels there.
It does not take much additional pressure to cause a vessel’s wall to balloon out.
When it does, the result is a hemorrhoid, a little pouch protruding on the surface
of the anus, similar to a hernia or varicose
vein. Most people have hemorrhoids, even if they do not realize
it, and the major symptoms are rarely dangerous, although they can be annoying and
often painful. Sometimes, however, hemorrhoids develop into or mask
life-threatening diseases.

The term “hemorrhoid” derives from Greek words meaning “blood flowing,” an apt
description of the circulatory activity in the anal walls and an inadvertently apt
warning of what most alarms people—hemorrhoids occasionally bleed. (The
alternative, and now obsolescent, term “piles” comes from Latin
pila, a ball, apparently a metaphor for the appearance of
hemorrhoids.) Specifically, the “blood flowing” refers to the supple blood vessels
of the internal rectal plexus, a series of pouches that act as cushions to help
seal the anus shut. When these pouches become enlarged, they turn into
hemorrhoids, which jut from the anus wall and swell up to three centimeters in
length.

Because of the sphincter that controls defecation, not all hemorrhoids are
visible without the aid of special instruments. The anus, an oval opening about
three centimeters in front of the spine, is the valve ending the digestive tract.
Like the mouth’s lips, which begin the tract, the anus can purse shut, a state
made possible by two concentric, circular sphincter muscles which act like
drawstrings on a cloth bag. When sensors in the rectum signal
the time to defecate, these muscles relax to pass stool and then immediately
contract to close the anus again. As in the mouth, external skin meets the
internal mucosal membrane in the anus; the meeting place is a corrugated joint
called the dentate line (or, alternatively, the anorectal juncture or pectinase
line). It is in this area—between the skin covering the external (or lower)
sphincter and the mucosa over the internal (or upper) sphincter—that hemorrhoids
form. Those that bulge out from the dentate line or above are hidden from sight by
the closed anus and are called internal hemorrhoids; those that protrude below the
closed anus, and so can be seen or felt, are called external hemorrhoids.

External hemorrhoids are the ones famed for vexing people. When the skin is stretched over swelled hemorrhoids, its sense receptors are activated, making the hemorrhoids burn and itch, sometimes so intolerably that the urge to scratch them is uncontrollable. Scratching, especially with abrasive materials such as toilet paper, often scrapes and tears the tissue. The bright red blood from these lesions is easily noticeable on the toilet paper and may even drip into the toilet bowl or onto underclothes. Likewise, the passage of a hard, dry stool often abrades hemorrhoids to the point of bleeding.

Internal hemorrhoids do not itch or burn and rarely cause pain because the mucosal
tissue over them has no nerve endings, but they can also bleed when a passing
stool damages them. (Pain may be “referred,” however, from a damaged internal
hemorrhoid to the sciatic nerve, bladder, lower back, or genitals; that is, a
person feels little or no pain in the anorectal area, but suddenly pain flares in
one of these other areas.) An especially elongated internal hemorrhoid at times
can protrude through the anus, a condition called prolapse.
Usually, it spontaneously recedes or can be pushed back inside with a finger, but
upon rare occasion a group of internal hemorrhoids prolapse, swelling and sending
the internal sphincter into painful spasms. A doctor’s help may then be required
to reduce the pain and fit the hemorrhoids inside.

The blood vessels in the internal rectal plexus swell so easily because they lack
valves. Without valves to regulate the local flow of blood, the walls are
vulnerable to any sudden increase in pressure. Even a small, transient increase
above the normal pressure of blood circulation can cause the vessels to bulge.
Often, these bulges disappear when the excess pressure disappears or remain
swollen only briefly afterward. If the increased pressure is high enough, however,
a permanent protrusion results, drooping from the anal wall. Even then, if the
hemorrhoid is internal, the patient may feel no discomfort and may not realize
that a hemorrhoid has formed.

Some people are more susceptible to chronic hemorrhoids than others because of a
hereditary lack of elasticity in the blood vessels. In such people, standing for
long periods of time can add enough pressure to make hemorrhoids swell.
Nevertheless, anyone can get hemorrhoids—all that is needed is enough pressure in
the lower abdomen. Straining on the toilet due to constipation
to pass stool is the most common cause. Since a poor diet can lead to
constipation, hemorrhoids can be a secondary effect of poor eating habits. Those
who like to sit on the toilet a long time, reading or watching television while
waiting for a bowel movement, also increase pressure on the anus because of the
posture and the compressing effect of the toilet ring, and they are likely to
develop hemorrhoids. People who regularly lift heavy weights as part of their jobs
or for recreation are especially susceptible if they hold their breath while
lifting: This action pushes the diaphragm downward on organs below it,
including the anus, putting pressure on them. Similarly, during pregnancy
women can develop hemorrhoids as the expanding womb crowds and increases pressure
on nearby organs; these hemorrhoids are exacerbated by delivery, but they usually
go away afterward. Psychologists add to these causes the guilt that some people
feel about eating and excreting, guilt spawned by overindulgence in food or bad
toilet training; they bear down on their bowels to defecate as quickly as possible
and by doing so stress the hemorrhoidal vessels. Finally, hemorrhoids occasionally
develop because of some serious diseases, such as heart failure
and cirrhosis of the liver, which elevate pressure in the veins,
and rectal
cancer, which can create a false sense of fullness so that
the person strains to pass a stool that is not really there.

Although they seldom do more than itch, external hemorrhoids can thrombose—develop clots of coagulated blood from a burst or
swollen vessel under the skin—and grow as large as a grape. A doctor can relieve
the pain by slicing open the hemorrhoid and squeezing out the clot. Left alone, a
thrombosed hemorrhoid may rupture, causing a painful and bloody mess that is ripe
for infection. Yet the greatest threat of hemorrhoids lies not
in the symptoms themselves but in how they might be confused with those of other,
deadly diseases. Colorectal cancer, inflammatory bowel
disease, and sexually transmitted diseases such as syphilis,
gonorrhea, and herpes can lead to discharges of blood, as can anal fissures
(cracks in the anal canal), fistulas (tunnel-like passages between
an infected gland and mucosa or skin), and abscesses
(pus-filled sacs under the mucosa). A person who dismisses the bloody discharge as
simply a flare-up of hemorrhoids may be delaying treatment for the real cause. In
the case of colorectal cancer, one of the most common cancers in the United
States, such a delay can be fatal. Only a doctor has the tools and vantage point
to distinguish between the relatively benign hemorrhoids and a dangerous
disorder.

Treatment and Therapy

Since hemorrhoid-like symptoms can be produced by deadly diseases, a thorough
checkup at the doctor’s office includes an examination of the anus and rectum,
especially if the patient has noticed bleeding. In addition to the visual
inspection and “digital” examination, during which the doctor inserts a finger and
feels around for enlarged hemorrhoids or other masses, patients provide clues by
describing the color, amount, and time of bleeding. If the blood is bright red and
occurs in small quantities during or just after defecation, hemorrhoids are most
likely to blame. If dark red blood or clots appear in the stool or seep out
randomly, however, the doctor will look for other causes, inspecting the anus,
rectum, and colon with various types of endoscopes, fiber-optic-filled flexible
tubes that can also collect tissue samples. Once the doctor rules out other
diseases, the patient has three basic choices: change habits, rely on therapy, or
have the hemorrhoids removed.

If a person’s hemorrhoids do not cause severe discomfort, the doctor will likely
recommend a diet with high fiber and water intake. Fiber and water
together make stools bulky and soft. They pass more easily during defecation than
small, hard, dry stools. The patient does not have to strain, and so no further
pressure is put on existing hemorrhoids. Furthermore, soft stools do not scrape
hemorrhoids and cause them to bleed. The doctor will also suggest regular
exercise, since this helps the bowels work more efficiently and reduces the chance
of constipation. Finally, the patient may receive instructions on the proper way
to breathe during heavy exertion so as to lessen the stress on the hemorrhoids.
With a better diet, more exercise, and less physical straining, patients may find
that hemorrhoids have disappeared completely. Weight loss may also improve
hemorrhoids.

Until hemorrhoids shrink, they plague the patient, and to reduce the itching and
burning a number of therapies prove effective, if only temporarily. An ice
compress eases the discomfort, as does a sitz bath (sitting for at least fifteen
minutes in shallow warm water), which also cleanses the site of potentially
infecting wastes and promotes healing in damaged tissue. Should these relatively
simple and cheap measures be impracticable, a variety of ointments, creams,
medicated pads, and suppositories, either prescription or nonprescription, may
provide relief. Some are inert, such as petroleum jelly, and coat and lubricate
the hemorrhoids, protecting them from irritation. Some have an astringent effect,
tightening and sealing tissue and thereby protecting it. Others have anesthetic
ingredients, numbing the tissue, or anti-inflammatory effects, decreasing
swelling. None of these medications has a proven capacity to make swelling go away
entirely, and those with active ingredients may cause an allergic response. For
patients with constipation, doctors may prescribe stool softeners to eliminate
straining during defecation. Laxatives are usually to be avoided because the
chemicals in them irritate hemorrhoids, and the resulting diarrhea often causes
urgency and pressure in the rectal area.

When hemorrhoids become chronically and unusually swollen or the patient can no longer endure the discomfort, removing them is the last resort. This cure is certain, although not necessarily permanent, but it has its cost in pain and recovery time. There are seven basic methods, six that cause the target hemorrhoid to shrivel, to drop off on its own, or both, and one, surgery, that removes it directly.

The surgical removal of hemorrhoids, called hemorrhoidectomy, is a relatively
simple operation; nevertheless, it is usually reserved for those patients who
cannot undergo one of the other methods. The patient is given a local anesthetic
to deaden sensation in the anus, although some patients are rendered unconscious
with a general anesthetic. The surgeon cuts off the hemorrhoid at its base and
then sews the wound closed with absorbable sutures. The recovery period may
require hospitalization for up to a week, during which pain medication, stool
softeners, and anal pads are necessary until the tissues heal. Bed rest after
hospitalization and sitz baths may also be beneficial. Because of this recovery
time—as much as a month all together—hemorrhoidectomies are not widely popular
among patients or physicians. Moreover, urine retention, infection, and
hemorrhaging after the operation are possible complications.

The remaining methods avoid the trauma of cutting, and the first of them,
ligation, is one of the oldest of all the methods. Ancient Greek physicians tied a
thread around a hemorrhoid to strangle its blood supply; modern
gastroenterologists or proctologists use special rubber bands. The effect is the
same: The hemorrhoid dries up, shrivels, and falls off. Little pain accompanies
the procedure, which is done in the doctor’s office.

Likewise, sclerotherapy, cryosurgery, and infrared coagulation are only for
internal hemorrhoids because the pain would be too intense on external
hemorrhoids. In sclerotherapy, the doctor injects a liquid—usually phenol in oil
or quinine in urea—that seals closed the blood vessels at the base of the
hemorrhoid. With no blood in them, the vessels eventually shrink to normal
dimensions, and, if stressing pressure on them is not resumed, the hemorrhoid
disappears. In cryosurgery, super cold liquid nitrogen or nitrous oxide is applied
to the hemorrhoid, freezing it and killing the tissue. The hemorrhoid slowly melts
and, as it does, shrinks and finally sloughs off. Popular in the 1970s and early
1980s, cryosurgery lost favor because of the messy and extended recovery time.
Useful for mild, small hemorrhoids, infrared coagulation involves a beam of
infrared light that, aimed at the hemorrhoid, shrinks it by cauterizing the
tissue. The heat of the beam can cause pain in other parts of the anus during the
procedure.

The remaining methods, laser surgery and electric current coagulation, can be used
on external hemorrhoids. Like infrared coagulation, laser surgery trains a beam of
light—in this case intense visible light—that burns and shrinks the hemorrhoid to
a stub. Since the laser cauterizes as it destroys tissue and therefore seals off
blood vessels, its main advantage over regular surgery lies in reduced bleeding.
Recovery time is shorter, about a week, and hospitalization is usually not
necessary. In electric current coagulation, electrodes pass either direct or
alternating current through the hemorrhoids. Because tissue is a poor conductor,
the resistance to the current creates heat, which cooks the hemorrhoid,
coagulating and shrinking it.

Which method the surgeon, gastroenterologist, or proctologist uses depends partly
upon the physician’s and patient’s preferences and partly upon the size and
location of the hemorrhoid. Ligation remains the most frequently used method
because it is relatively cheap and fast.

Perspective and Prospects

Certainly, hemorrhoids are no laughing matter. Yet the long-standing taboo in the
United States about excretion and the anus has prompted many Americans either to
laugh nervously about their hemorrhoids or to keep silent, preferring to suffer
stoically rather than to risk becoming the target of jokes. For this reason, it is
nearly impossible to say how many sufferers there are in the United States. The
peak prevalence of hemorrhoids occurs between ages forty-five and sixty-five
years, and men and women are equally affected. An estimated 5 percent of the
general population in the United States is thought to be affected. Hemorrhoids are
also common during pregnancy and childbirth, although they usually spontaneously
regress postpartum.

Whatever the exact statistic, clearly many people share a problem that embarrasses
them too much to discuss openly or that they believe is too trivial for medical
attention. If they need relief from the itching and pain, they treat themselves. A
large industry in home remedies and over-the-counter medications serves them. The
benefits of such medications are difficult to assess, and some authorities claim
that petroleum jelly eases the itching and burning as much as any preparation
specifically intended for hemorrhoids. Folk remedies, such as suppositories made
of tobacco or compresses soaked in papaya juice, can damage tissue outright,
making the problem worse. Moreover, throughout the United States specialized
clinics offer surgical cures for hemorrhoids, promising patients quick relief on
an outpatient basis and using expensive methods, particularly laser surgery.

Many people, therefore, spend considerable money and time to tend a chronic
discomfort that can as readily be prevented or palliated by a change in habits,
doctors claim. Like colon cancer and many other intestinal ailments, hemorrhoids
are most common in populations whose diet includes a high number of processed
foods, which are low in fiber. While fiber is no panacea, people in cultures whose
diet contains significant fiber have larger stools and fewer intestinal complaints
in general. Increasing one's fluid and fiber intake is considered the first-line
treatment of hemorrhoids.

Because hemorrhoids are in most cases preventable or controllable without treatment, they have been cited, along with deadly maladies such as colon cancer and inflammatory bowel disease, in criticisms of both the American diet and Americans’ eagerness to rely on medical intervention to save them from their own unhealthy habits. In the case of hemorrhoids—while they are not exclusively a malady of Western civilization—the fast pace and pressures of life, the attitudes about defecation, and the eating habits of industrial cultures help give them a distracting prominence.

Bibliography

“Help for Hemorrhoids
Includes Fiber, Fluids, and Fitness.” Environmental
Nutrition 23.4 (2000): 7. Print.

Jacobs, Danny. "Clinical Practice:
Hemorrhoids." New England Journal of Medicine 371.10
(2014): 944–51. Web. 23 Feb. 2015.

Litin, Scott C., ed.
Mayo Clinic Family Health Book. 4th ed. New York:
HarperResource, 2009. Print.

Lohsiriwat, Varut.
"Approach to Hemorrhoids." Current Gastroenterology Reports
15.7 (2013): 1–4. Print.

Minkin, Mary Jane.
“Prevent Hemorrhoids.” Prevention 50.6 (1998): 76.
Print.

Okus, Ahmet. "Local
Pain-Reducing Methods after Hemorrhoidectomy." World Journal of
Surgery 37.8 (2013): 2007–8. Print.

Peikin, Steven R.
Gastrointestinal Health. Rev. ed. New York: Quill, 2001.
Print.

Raspallo, Benjamin M.,
and Philip Salinitri D. Hemorrhoids: Symptoms, Diagnosis and
Treatment. New York: Nova Biomedical, 2010. Print.

Yang, Hyung Kyu.
Hemorrhoids. Heidelberg: Springer, 2014.
Print.

How is music art? |

Though we often think of art as something to be seen with the eyes, music is considered an art form because it involves creativity and skill. Like other forms of art, music involves creative expression of thoughts, feelings, and/or ideas through the arrangement of a set of characteristic components. In the same way a painter expresses their idea through the arrangement of color, shape, texture, and symbols, a musician communicates through the arrangement (or re-arrangement)...

Though we often think of art as something to be seen with the eyes, music is considered an art form because it involves creativity and skill. Like other forms of art, music involves creative expression of thoughts, feelings, and/or ideas through the arrangement of a set of characteristic components. In the same way a painter expresses their idea through the arrangement of color, shape, texture, and symbols, a musician communicates through the arrangement (or re-arrangement) of sounds and rhythm.

As I mentioned above, music involves skill as well as creativity in expression. You are probably no stranger to the fact that it takes many years to become an expert in playing an instrument. Some people may be said to have a "talent" or natural capability for the skill of playing an instrument. In both visual art and music, the artist hones and uses their skill to fluently express the message behind their work. 

Music, as an art form, is often at the forefront of questions about the nature of art. For example, must art be beautiful to be appreciated? Must art adhere to previously established rules? Many genres of music which have evolved over the past century (like heavy metal, electronica, and "noise music") may be considered post-modernist for their challenging traditions of what makes music artistic. Even when a style of music is at odds with traditional or classical forms, if it can be said to be both creative and displaying some skill, it is art.

What are genetic diseases? |

Causes and Symptoms

Hereditary units called genes determine the majority of the physical and biochemical characteristics of an organism. Genes are composed of a chemical compound called
deoxyribonucleic acid (DNA) and are organized into rod-shaped structures called
chromosomes that reside in each cell of the body. Each human cell carries forty-six chromosomes organized as twenty-three pairs, each composed of several thousand genes. Twenty-two of the chromosome pairs are homologous pairs; that is, similar genes are located at similar sites on each chromosome. The remaining chromosomes are the sex chromosomes. Human females bear two X chromosomes, and human males possess one X and one Y chromosome.

During the formation of the reproductive cells, the chromosome pairs separate, and one copy of each pair is randomly included in the egg or sperm. Each egg will contain twenty-two autosomes (non-sex chromosomes) and one X chromosome. Each sperm will contain twenty-two autosomes and either one X or one Y chromosome. The egg and sperm fuse at fertilization, which restores the proper number of chromosomes, and the genes inherited from the baby’s parents will determine its sex and much of its physical appearance and future health and well-being.

Genetic diseases are inherited as a result of the presence of abnormal genes in the reproductive cells of one or both parents of an affected individual. There are two broad classifications of genetic disease: those caused by defects in chromosome number or structure and those resulting from a much smaller flaw within a gene. Within the latter category, there are four predominant mechanisms by which the disorders can be transmitted from generation to generation: autosomal dominant inheritance, in which the defective gene is inherited from one parent; autosomal recessive inheritance, in which defective genes are inherited from both parents, who themselves may show no signs of the disorder; X-linked chromosomal inheritance (often called sex-linked), in which the flawed gene has been determined to reside on the X chromosome; and multifactorial inheritance, in which genes interact with each other and/or environmental factors.

Errors in chromosome number include extra and missing chromosomes. The most common chromosomal defect observed in humans is
Down syndrome, which is caused by the presence of three copies of chromosome 21, instead of the usual two. Down syndrome occurs at a frequency of about one in eight hundred live births, this frequency increasing with increasing maternal age. The symptoms of this disorder include intellectual disability, short stature, and numerous other medical problems. The most common form of Down syndrome results from the failure of the two copies of chromosome 21 to separate during reproductive cell formation, which upon fusion with a normal reproductive cell at fertilization produces an embryo containing three copies of chromosome 21.

Gross defects in chromosome structure include duplicated and deleted portions of chromosomes and broken and rearranged chromosome fragments.
Prader-Willi syndrome results from the deletion of a small portion of chromosome 15. Children affected with this disorder are prone to intellectual disability, obesity, and diabetes. Cri du chat (literally, “cat cry”) syndrome is associated with a large deletion in chromosome 5. Affected infants exhibit facial abnormalities, are severely intellectually disabled, and produce a high-pitched, catlike wail.

Genetic diseases caused by defects in individual genes result when defective genes are propagated through many generations or a new genetic flaw develops in a reproductive cell. New genetic defects arise from a variety of causes, including environmental assaults such as radiation, toxins, or drugs. More than four thousand such gene disorders have been identified.

Manifestation of an autosomal dominant disorder requires the inheritance of only one defective gene from one parent who is afflicted with the disease. Inheritance of two dominant defective genes, one from each parent, is possible but generally creates such severe consequences that the child dies while still in the womb or shortly after birth. An individual who bears one copy of the gene has a 50 percent chance of transmitting that gene and the disease to his or her offspring.

Among the most common autosomal dominant diseases are
hyperlipidemia and hypercholesterolemia. These disorders result in elevated levels of lipids and cholesterol in the blood, respectively, which contribute to artery and heart disease. Onset of the symptoms is usually in adulthood, frequently after the affected individual has had children and potentially transmitted the faulty gene to them.

Huntington’s chorea causes untreatable neurological deterioration and death, and symptoms do not appear until affected individuals are at least in their forties. Children of parents afflicted with Huntington’s chorea may have already made reproductive decisions without the knowledge that they might carry the defective gene. They risk a 50 percent chance of transmitting the disease to their offspring.

Autosomal recessive genetic diseases require that an affected individual bear two copies of a defective gene, inheriting one from each parent. Usually the parents are simply carriers of the defective gene; their one normal copy masks the effect of the one flawed copy. If two carriers have offspring, those children have a 25 percent chance of receiving two copies of the flawed gene and inheriting the disease and a 50 percent chance of being asymptomatic carriers.

Cystic fibrosis
is an autosomal recessive disease that occurs at a rate of about one in two thousand live births among Caucasians. The defective gene product causes improper chloride transport in cells and results in thick mucous secretions in lungs and other organs.
Sickle cell disease, another autosomal recessive disorder, is the most common genetic disease among African Americans in the United States. Abnormality in the protein hemoglobin, the component of red blood cells that carries oxygen to all the body’s tissues, leads to deformed blood cells that are fragile and easily destroyed.

X-linked genetic diseases are transmitted by faulty genes located on the X chromosome. In the case of X-linked recessive diseases, which are by far the more common, females need two copies of the defective gene to acquire such a disease, and in general women carry only one flawed copy, making them asymptomatic carriers of the disorder. Males, having only a single X chromosome, need only one copy of the defective gene to express an X-linked disease. Males with X-linked disorders inherit the defective gene from their mothers, since fathers must contribute a Y chromosome to male offspring. All male offspring of a carrier female will have a 50 percent chance of inheriting the defective gene and developing the disease. In the rare case of a female with two defective X-linked genes, 100 percent of her male offspring will inherit the disease gene and, assuming that the father does not carry the defective gene, her female offspring will be carriers. There are more than 250 X-linked disorders, some of the more common being Duchenne
muscular dystrophy, which results in progressive muscle deterioration and early death; hemophilia; and
red-green color blindness, which affects about 8 percent of Caucasian males.

Multifactorial inheritance, which accounts for a number of genetic diseases, is caused by the complex interaction of one or more genes with each other and with environmental factors. This group of diseases includes many disorders that, anecdotally, “run in families.” Representative disorders include cleft palate, spina bifida, anencephaly, and some inherited heart abnormalities. Other diseases appear to have a genetic component predisposing an individual to be susceptible to environmental stimuli that trigger the disease. These include cancer, hypertension, diabetes, schizophrenia, alcoholism, depression, and obesity.

Diagnosis and Detection

Most, but not all, genetic diseases manifest their symptoms immediately or soon after the birth of an affected child. Rapid recognition of such a medical condition and its accurate diagnosis are essential for the proper treatment and management of the disease by parents and medical personnel. Medical technology has developed swift and accurate diagnostic methods, in many cases allowing testing of the fetus prior to birth. In addition, tests are available that determine the carrier status of an individual for many autosomal recessive and X-linked diseases. These test results are used in conjunction with genetic counseling of individuals and couples who are at risk of transmitting a genetic disease to their offspring so that they can make informed decisions about their reproductive futures.

Errors in chromosome number and structure are detected in an individual by analyzing his or her chromosomes. A small piece of skin or a blood sample is taken, the cells in the sample are grown to a sufficient number, and the chromosomes within each cell are stained with special dyes so that they may be viewed with a microscope. A picture of the chromosomes, called a karyotype, is taken, and the patient’s chromosome array is compared with that of a normal individual. Extra or missing chromosomes or alterations in chromosome structure indicate the presence of a genetic disease. The analysis of karyotypes is the method used to detect Down, Prader-Willi, and cri du chat syndromes, among others.

Defects in chromosome number and structure can also be identified in the fetus prior to birth. Samples may be collected from the fetus by
amniocentesis or by
chorionic villus sampling. In amniocentesis, a needle is inserted through the pregnant woman’s abdomen and uterus, into the fluid-filled sac surrounding the fetus. A sample of this fluid, the amniotic fluid, is withdrawn. The amniotic fluid contains fetal cells sloughed off by the fetus. The cells are grown for several weeks until there are enough to perform chromosome analysis. This procedure is performed only after sixteen weeks’ gestation, in order to ensure adequate amniotic fluid for sampling.

Chorionic villus sampling relies on a biopsy of the fetal chorion, a membrane surrounding the fetus that is composed of cells that have the same genetic constitution as the fetus. A catheter is inserted through the pregnant woman’s vagina and into the uterus until it is in contact with the chorion. The small sample of this tissue that is removed contains enough cells to perform karyotyping immediately, permitting diagnosis by the next day. Chorionic villus sampling can be performed as early as the eighth or ninth week of pregnancy. This earlier testing gives the procedure an advantage over amniocentesis, since the earlier determination of whether a fetus is carrying a genetic disease allows safer pregnancy termination if the parents choose this course.

Karyotype analysis is limited to the diagnosis of genetic diseases caused by very large chromosome abnormalities. The majority of hereditary disorders are caused by gene flaws that are too small to see microscopically. For many of these diseases, diagnosis is possible through either biochemical testing or DNA analysis.

Many genetic disorders cause a lack of a specific biochemical necessary for normal
metabolism. These types of disorders are frequently referred to as “inborn errors of metabolism.” Many of these errors can be detected by the chemical analysis of fetal tissue. For example,
galactosemia is a disease that results from the lack of galactose-1-phosphate uridyl transferase. Infants with this disorder cannot break down galactose, one of the major sugars in milk. If left untreated, galactosemia can lead to developmental disabilities, cataracts, kidney and liver failure, and death. By analyzing fetal cells obtained from amniocentesis or chorionic villus sampling, the level of this important chemical can be assessed, and, if necessary, the infant can be placed on a galactose-free diet immediately after birth.

DNA analysis can be used to determine whether a genetic disease has been inherited when either the chromosomal location of the gene, the chemical sequence of the DNA, or particular DNA sequences commonly associated with the gene in question (called markers) are known.

Genes are made up of sequences of four chemical elements of DNA: adenine (A), guanine (G), thymine (T), and cytosine (C). Sometimes the proper DNA sequence of a gene is known, as well as the changes in the sequence that cause disease. Direct analysis of the DNA of an individual suspected of carrying a certain genetic disorder is possible in these cases. For example, in sickle cell disease, it is known that a change in a single DNA chemical element leads to the disorder. To test for this disease, a tissue sample is obtained from the fetus, and the DNA is isolated from the cells and analyzed with highly specific probes that can detect the presence of the defective gene that will lead to sickle cell disease. Informed action may then be taken regarding the future of the fetus or the care of an affected child.

Occasionally a disease gene itself has not been precisely isolated or had its DNA sequence determined, but sequences very near the gene of interest have been analyzed. If specific variations within these neighboring sequences are always present when the gene of interest is flawed, these nearby sequences can then be used as markers for the presence of the defective gene. When the variant sequences are present, so is the disease gene. Prenatal testing for cystic fibrosis has been done by looking for such variant sequences.

Individuals who come from families in which genetic diseases tend to occur can be tested as carriers, so they will know the risk of passing a certain disease to their offspring. For example, individuals whose families have a history of cystic fibrosis, but who themselves are not affected, may be asymptomatic carriers. If they have children with individuals who are also cystic fibrosis carriers, they have a 25 percent chance of passing two copies of the defective gene to their offspring. DNA samples from the potential parents can be analyzed for the presence of a defective gene. If both partners are carriers, their decision about whether to have children will be made with knowledge of the possible risk to their offspring. If only one or neither of them is a carrier, their offspring will not be at risk of inheriting cystic fibrosis, as it is an autosomal recessive disease. Carrier testing is possible for many genetic diseases, as well as for disorders that appear late in life, such as Huntington’s chorea.

Many of the gene flaws of multifactorial diseases, those that interact with environmental factors to produce disease, have been identified and are testable. Individuals who know they have a gene that puts them at risk for certain disorders can incorporate preventive measures into their lifestyle, thus minimizing their chances of developing the disease. For example, certain cancers, such as colon and breast cancer, have a genetic component. Individuals who test positive for the genes that predispose them to develop cancer can modify their diets to include cancer-fighting foods and receive frequent medical checkups to detect cancer development at its earliest, most treatable stage. Those with genes that contribute to arteriosclerosis and heart disease can modify their diets and increase exercise, and those with a genetic predisposition for alcoholism can avoid the consumption of alcohol.

Perspective and Prospects

The scientific study of human
genetics and genetic disease is relatively new, having begun in the early twentieth century. However, there are many early historical records that recognize that certain traits are hereditarily transmitted. Ancient Greek literature is peppered with references to heredity, and the Jewish book of religious and civil laws, the Talmud, describes in detail the inheritance pattern of hemophilia and its ramifications for circumcision.

The Augustinian monk Gregor Mendel worked out many of the principles of heredity by manipulating the pollen and eggs of pea plants over many generations. His work was conducted from the 1860s to the 1870s but was unrecognized by the scientific community until 1900.

At about this time, many disorders were being recognized as genetic diseases. Pedigree analysis, a way to trace inheritance patterns through a family tree, has been used since the mid-nineteenth century to track the incidence of hemophilia in European royal families. This analysis indicates that the disease was transmitted through females (indeed, hemophilia is an X-linked disorder). In the early twentieth century, Archibald Garrod, a British physician, recognized certain biochemical disorders as genetic diseases and proposed accurate mechanisms for their transmission.

In 1953, Francis Crick and James D. Watson discovered the structure of DNA; thus began studies on the molecular biology of genes. This research resulted in the monumental discovery in 1973 that pieces of DNA from animals and bacteria could be cut and spliced together into a functional molecule. This recombinant DNA technology fostered a revolution in genetic analysis, in which pieces of human DNA can be removed and put into bacteria. The bacteria then replicate millions of copies of the human DNA, permitting detailed analysis. These recombinant molecules also produce human gene products, such as RNA and protein, thereby facilitating the analysis of normal and aberrant genes.

The recombinant DNA revolution spawned the development of DNA tests for genetic diseases and carrier status. Knowledge of what a normal gene product is and does is exceptionally helpful in the treatment of genetic diseases. For example, Duchenne muscular dystrophy is known to be caused by the lack of a protein called dystrophin. This suggests that one possible treatment is to provide functional dystrophin to an individual with this disease.

Ultimately, medical science seeks to treat genetic diseases by providing a functional copy of the flawed gene to the affected individual. While such gene therapy would not affect the reproductive cells—the introduced gene copy would not be passed down to future generations—the normal gene product would alleviate the genetic disorder in the individual.

Bibliography:

Cooper, Necia Grant, ed. The Human Genome Project: Deciphering the Blueprint of Heredity. Rev. ed. Mill Valley, Calif.: University Science Books, 1994.

GeneTests. http://www.ncbi.nlm.nih.gov/sites/GeneTests

Genetic Alliance. http://www.geneticalliance.org

Gormley, Myra Vanderpool. Family Diseases: Are You at Risk? Baltimore: Genealogical Publishing, 2007.

Hereditary Disease Foundation. http://www.hdfoundation.org

Jorde, Lynn B., John C. Carey, and Michael J. Bamshad. Medical Genetics. 4th ed. Philadelphia: Mosby/Elsevier, 2010.

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

Lewis, Ricki. Human Genetics: Concepts and Applications. 10th ed. New York: McGraw-Hill, 2012.

McCance, Kathryn L., and Sue E. Huether, eds. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 6th ed. Saint Louis: Mosby/Elsevier, 2010.

Marshall, Elizabeth L. The Human Genome Project: Cracking the Code Within Us. New York: Franklin Watts, 1997.

Milunsky, Aubrey, and Jeff M. Milunsky, eds. Genetic Disorders of the Fetus: Diagnosis, Prevention, and Treatment. 6th ed. Hoboken, N.J.: Wiley-Blackwell, 2010.

Springhouse Corporation. Everything You Need to Know About Diseases. Springhouse, Pa.: Author, 1996.

Wingerson, Lois. Mapping Our Genes: The Genome Project and the Future of Medicine. New York: Plume, 1991.

Why do you think Laurie reported Charles's good behavior grimly, while he had delighted in telling about Charles's bad behavior?

In the ironic ending to Shirley Jackson's short story "Charles" Laurie's mother discovers that although her son has been faithfully reporting the deeds and misdeeds of a boy named Charles in his kindergarten class there is in reality no Charles. Laurie is really Charles, which should come as no surprise to the reader in light of Laurie's behavior at home where he torments his baby sister and often talks back to his father. Charles is...

In the ironic ending to Shirley Jackson's short story "Charles" Laurie's mother discovers that although her son has been faithfully reporting the deeds and misdeeds of a boy named Charles in his kindergarten class there is in reality no Charles. Laurie is really Charles, which should come as no surprise to the reader in light of Laurie's behavior at home where he torments his baby sister and often talks back to his father. Charles is made up because Laurie doesn't care to receive punishment at home as well as school and because he seems to be beyond reproach in the eyes of his mother. Laurie seems to relish his bad behavior at school. He gleefully reports of Charles's bad conduct. He shouts out that Charles yelled in school or hit another child.

Eventually, the kindergarten teacher appears to have made progress with Laurie's behavior, much to the child's dismay. His usual happy reports are labeled grim and he shrugs apathetically when he tells his mother that Charles was the teacher's helper and was rewarded with an apple. Obviously the malevolent manifestation of Charles is more pleasing to Laurie. When Charles/Laurie reverts to the negative, Laurie reports to his mother with "a voice slightly awed." For Laurie, the life of the miscreant is much more exciting than abiding by the rules of his teacher and the school.   

What is thermoreception? |

Introduction

Humans have thermoreceptors that can detect the flow of heat energy. These specialized sensory receptors can detect the flow of heat as a change in temperature, and convert this information into nerve impulses. Conversion into nerve impulses places the information into a form that can be processed by the central nervous system, allowing a compensating response, if required, to be initiated.

Humans and other mammals have two kinds of thermoreceptors. One type, called the warm thermoreceptor, becomes active in sending nerve impulses when the body surroundings or an object touched reaches temperatures above 30 degrees Celsius. Nerve impulses from the warm thermoreceptors increase proportionately in frequency as the temperature rises to about 43 degrees Celsius; past this temperature, impulses from the warm thermoreceptors drop proportionately in frequency until they become inactive at about 50 degrees Celsius.

The second type of thermoreceptor becomes active in generating nerve impulses at temperatures below about 43 degrees Celsius. Nerve impulses from these receptors, called cold thermoreceptors, increase proportionately as temperatures fall to about 25 degrees Celsius. Below this temperature, the frequency of nerve impulses generated by the receptors drops proportionately; as temperatures fall to about 5 to 10 degrees Celsius, activity of the cold thermoreceptors falls to zero. The activity of cold and warm thermoreceptors overlaps between temperatures of about 30 and 40 degrees Celsius. Within this range, the sensation of heat or cold results from an integration in the brain of nerve impulses generated by both cold and warm receptors.

At temperatures below about 15 degrees and above about 45 degrees Celsius, pain receptors become active and increase proportionately in activity as temperatures rise or fall beyond these levels. There is a narrow range of overlap of the limits of pain receptors and thermoreceptors, so that temperatures between about 5 and 15 degrees Celsius are felt as both cold and pain (or as “freezing cold”) and temperatures between about 43 and 50 degrees Celsius are felt as both heat and pain (or “burning hot”). Temperatures beyond the 5-degree and 50-degree limits for the thermoreceptors stimulate only the pain receptors and are felt primarily or exclusively as pain. Curiously, the cold receptors become active as pain receptors as the temperature rises above about 45 degrees Celsius. The dual activity of the cold thermoreceptors may account for the fact that freezing cold and burning heat may produce a similar sensation.

Adaptation Process

Both types of thermoreceptors adapt quickly as the temperature stabilizes. Adaptation refers to the fact that as a stimulus is maintained at a constant level, the nerve impulses generated by a receptor drop in frequency. In effect, the receptor undergoes a reduction in sensitivity if the stimulus remains constant. If the stimulus changes, the receptor again generates nerve impulses at a frequency proportional to the intensity of the stimulus. The ability of receptors to adapt makes them sensitive to a change in stimulus, which is often the factor of greatest importance to an appropriate response.

The rapid adaptation of thermoreceptors is part of common experience. In going from the outdoors into a warm room on a cold day, one immediately detects the warmer temperature and has a resultant strong sense of a temperature change. After a few minutes, one no longer notices the temperature difference, as one’s thermoreceptors adapt and reduce their generation of nerve impulses. If the temperature of the room changes by only a degree or so, however, the generation of impulses by the thermoreceptors increases again, and one becomes aware of the change.

Spatial Summation and Receptor Location

Thermoreceptors also show strong spatial summation. If only a very small region of the body is stimulated, one has difficulty discerning whether a temperature change has been experienced, or even whether the stimulus is hot or cold. As the surface area stimulated increases, impulses arriving in the brain from thermoreceptors are summed, so that perception of the change increases proportionately. If only a square centimeter of skin is stimulated by a warm or cold probe, for example, one might not be able to detect a temperature change smaller than about 1 degree Celsius. If the entire body surface is stimulated, as in total immersion in water, one becomes exquisitely sensitive to changes in temperature. Summation of information from all surface thermoreceptors may allow detection of temperature changes as small as one hundredth of one degree Celsius.

Thermoreceptors in humans are most numerous at the body surface, where they are located immediately under the skin. Each thermoreceptor can detect temperature changes over an area of about 1 millimeter in diameter. Cold thermoreceptors occur in greater numbers at the body surface than warm receptors: Depending on the body region, there may be as many as three to ten cold thermoreceptors for each warm thermoreceptor. Thermoreceptors of both types are particularly densely distributed in the skin of the tongue and the lips. In these regions, there may be as many as twenty to thirty or more thermoreceptors per square centimeter of surface. About a third as many thermoreceptors occur in the skin of the fingertips. In other parts of the body surface, only a few thermoreceptors occur per square centimeter.

Physical and Chemical Mechanisms

Although the locations of cold and heat receptors can be pinpointed on the body surface by touching the skin with a warm or cold probe, it has proved difficult to detect particular structures responsible for thermoreception. One group of cold thermoreceptors, however, has been identified as branched nerve endings that terminate near the inner surfaces of cells in the skin. Presumably, other cold thermoreceptors and the warm thermoreceptors are little more than naked nerve endings that cannot be distinguished from pain and some touch receptors, which have a similar appearance.

Little is understood about the physical and chemical mechanisms underlying thermoreception; however, it is considered likely that the reception mechanism depends on increases and decreases in chemical reaction rates in the receptor cells as the temperature rises and falls. In general, chemical reaction rates approximately double for each 10-degree increase in temperature or are halved for each 10-degree fall. Thermoreceptors probably respond to these increases or decreases in chemical reaction rates rather than directly detecting the changes in heat flow responsible for changes in temperature. The thermoreceptors responsible for detecting heat are also sensitive, to some degree, to chemicals. This explains why spices such as red peppers give the sensation of heat when placed on the tongue or rubbed into the skin. Other chemicals, such as menthol, feel cold on the tongue or skin.

Body Temperature Maintenance

Thermoreception has two primary functions in warm-blooded animals such as humans. One is detection of extreme temperatures, so that a person can respond to avoid tissue damage by burning or freezing. The second is maintenance of normal body temperature of 37 degrees Celsius.

Maintenance of body temperature, or homeostasis, involves both conscious and automated responses. At temperatures not too far above and below the range of comfort (about 22 to 24 degrees Celsius), one feels consciously warm or cool and responds by one or more voluntary methods to decrease or increase skin temperature, such as donning or removing clothing. The automated responses maintaining body temperature are complex and involve a variety of systems. Changes in internal temperature are detected by thermoreceptors in the body interior, particularly in the hypothalamus—a brain structure containing the center that detects and regulates internal body temperature. The thermoreceptors of the hypothalamus are extremely sensitive to shifts from the normal body temperature of 37 degrees Celsius. If such changes occur, the hypothalamus triggers involuntary responses that adjust body temperature.

If the internal body temperature rises above 37 degrees, sweat glands in the skin are stimulated to release their secretion, which evaporates and cools the body surface. Heat loss is also promoted by dilation of the peripheral vessels, which increases blood flow to the body surface. Blood cooled at the surface is carried to the body interior by the circulatory system, where it removes heat from internal regions and causes a drop in body temperature. In addition to these cooling mechanisms, release of thyroxin from the thyroid gland is inhibited. The resulting reduction in the concentration of this hormone in the circulation slows the rate at which body cells oxidize fuel substances and diminishes the amount of heat released by these reactions in the body.

If the internal body temperature falls below 37 degrees Celsius, a series of automated responses with opposite effects triggered. Peripheral blood vessels contract, reducing the flow of blood to the body surface. The output of thyroxin from the thyroid gland increases; the increased thyroxin concentration stimulates body cells to increase the rate at which fuel substances are oxidized to release heat within the body. Although the effect of the response in humans is not pronounced, a drop in internal temperature also stimulates contraction of small muscles at hair roots over the body. The contraction, which is felt as “goose bumps,” raises body hairs and increases the dead-air space at the surface of the body. If the drop in internal temperature becomes more extreme, shivering caused by rhythmic contractions of voluntary muscles is induced. Shivering increases body temperature through the heat released by the muscular contractions.

Role of the Hypothalamus

The hypothalamus has been identified as the region of the brain regulating body temperature through observations of the effects of injuries and electrical stimulation. Damage to the hypothalamus can inhibit such temperature-regulating responses as sweating and dilation or constriction of peripheral blood vessels. Conversely, experimental electrical stimulation of the hypothalamus can induce the regulatory responses. These observations indicate that the primary temperature-regulating center of the hypothalamus is in its anterior or preoptic region. The automated responses triggered by the hypothalamus in addition to conscious responses allow humans to maintain an almost constant body temperature in the face of a wide variety of environmental conditions. These combined automated and conscious responses allow humans to survive and remain active in a wider range of environmental conditions than any other animal.

The body temperature maintained by the thalamus is not actually set perfectly and constantly at 37 degrees. For most persons, the internal body temperature varies over a range of about 0.6 degree, with the lowest temperatures in the early morning and the highest point at about four to six in the afternoon. This daily variation in body temperature is called the circadian temperature rhythm.

Although the body temperature is normally set at 37 degrees, the set point can be adjusted upward to produce fever as a part of the body’s response to infection by invading organisms. Raising the body temperature above 37 degrees results from the same automated responses that normally raise internal temperatures—shivering, constriction of peripheral blood vessels, and an increase in the rate of metabolic reactions.

Fever

Several types of bacteria secrete substances that can directly stimulate the hypothalamus to raise its set point and induce fever. Substances of this type, capable of inducing fever, are termed pyrogens. Other substances derived through the breakdown of infecting bacteria, or from substances released through the breakdown of body tissues in disease, particularly fragments of some body proteins, can indirectly trigger the hypothalamus to raise its set point. These substances are engulfed by certain types of white blood cells, including macrophages. On engulfing the breakdown substances, the white blood cells release a powerful pyrogen called interleukin-1. This substance stimulates the secretion of a type of hormone, the prostaglandins, which in turn induces the hypothalamus to raise its temperature set point above 37 degrees. The advantage that fever provides to the body in fighting infection is unclear. Aspirin and corticosteroids are able to reduce fever by inhibiting the secretion of prostaglandins.

When the body’s ability to regulate temperature is exceeded, resulting in extreme hyperthermia or hypothermia, the results can be extremely serious. Fevers above about 41 to 42 degrees Celsius, or about 106 to 108 degrees Fahrenheit, can cause severe or fatal damage if the body temperature is not quickly lowered by treatments such as water or alcohol sponging of the skin. The high temperatures injure or kill body cells, particularly in the brain, liver, and kidneys, and cause internal bleeding. Damage to brain cells from extremely high fever is essentially irreversible and may cause permanent impairment or even death within minutes.

Hyperthermia and Hypothermia

Under some conditions, as on hot and humid days or when the body is immersed in hot water, the normal physiological reactions regulating body temperature are ineffective and body temperature may rise uncontrollably. If the air temperature rises above about 38 degrees Celsius on days in which the humidity approaches 100 percent, for example, temperature regulation by sweating and dilation of peripheral blood vessels is ineffective. Under such conditions, internal body temperature may rise to damaging levels, particularly if physical exercise is attempted. The resulting reaction, known as hyperthermia
or heat stroke, may include dizziness and abdominal distress or pain in milder cases; more severe heat stroke may produce delirium or even death. Hyperthermia differs fundamentally from fever in that the set point of the hypothalamus remains at 37 degrees. Another difference is that the circadian temperature rhythm is maintained during fever, but not in hyperthermia. In addition to high environmental heat and humidity, hyperthermia may be caused by cocaine and psychedelic drugs.

Low environmental temperatures can also exceed the body’s capacity to regulate its internal temperature. Heat loss attributable to accidental or intentional immersion in ice water, for example, induces a steady drop in internal body temperature that cannot be effectively reversed by shivering, constriction of peripheral blood vessels, or increases in chemical reaction rates. The effects of extreme cold in lowering body temperature are magnified by impairment of the regulatory function of the hypothalamus. At body temperatures below about 34 degrees Celsius, the function of the hypothalamus in temperature regulation becomes severely impaired. Shivering usually stops below 32 degrees. At internal temperatures below about 28 degrees Celsius, the temperature regulation centers of the hypothalamus cease to function entirely. Below this temperature, internal body temperature falls rapidly, breathing slows greatly or arrests, and the heart may develop an irregular beat or stop beating entirely. Death follows quickly if breathing or the heartbeat stops. Any fall of body temperature below 35 degrees is known as hypothermia.

Surgical Applications

For some surgical procedures, body temperature is deliberately reduced by administering a drug that inhibits activity of the hypothalamus. The body is then immersed in ice water or surrounded by cooling blankets until internal temperatures reach levels of 30 degrees or below. At these temperatures, the heart can be stopped temporarily without significant damage to the brain or other body tissues. Induced reduction of body temperatures in this manner is routinely used in heart surgery.

Bibliography

Berne, Robert M., and Matthew N. Levy, eds. Physiology. 5th ed. St. Louis: Mosby, 2004. Print.

Coren, Stanley. Sensation and Perception. 6th ed. Hoboken: Wiley, 2004. Print.

Guyton, Arthur C., and John E. Hall. Textbook of Medical Physiology. 12th ed. Philadelphia: Elsevier, 2010. Print.

Hertenstein, Matthew J., and Sandra Jean Weiss. The Handbook of Touch: Neuroscience, Behavioral, and Health Perspectives. New York: Springer, 2011. Print.

Schmidt-Nielsen, Knut. Animal Physiology: Adaptation and Environment. 5th ed. New York: Cambridge UP, 1998. Print.

Was there a war after the Trail of Tears?

No.  The Native Americans were not powerful enough to fight or resist the federal government.  Andrew Jackson advocated "Indian Removal" and when he was an army general he led campaigns against the Creek and Seminole tribes in Georgia, Alabama, and Florida.  The result was that thousands of acres of Native American land went to white farmers.  After he was president he continued this policy, signing the Indian Removal Act in 1830.  This act empowered the...

No.  The Native Americans were not powerful enough to fight or resist the federal government.  Andrew Jackson advocated "Indian Removal" and when he was an army general he led campaigns against the Creek and Seminole tribes in Georgia, Alabama, and Florida.  The result was that thousands of acres of Native American land went to white farmers.  After he was president he continued this policy, signing the Indian Removal Act in 1830.  This act empowered the federal government to exchange eastern Indian lands for lands in the "Indian Colonization Zone" (modern day Oklahoma).  Despite the Act's requirement that the removal treaties be fair and non-coercive, this was mostly ignored in practice.

In 1831, under threat by the US Army, the Choctaw became the first tribe to walk the "Trail of Tears."  The forceful transfer of thousands of other Native Americans, from a variety of different tribes, was to follow.  During these years a substantial portion of Native Americans died on the journey, where they were bound, beaten and denied food, water, or medical attention.

Despite the federal government's promise that the Indians would be left alone once they went to the new land, white settlers continued to push west and encroach upon the Indian territory.  Slowly, the Native Americans' land shrank until finally in 1907 Oklahoma became a state and Indian territory was no more. 

What is intimacy? |

Introduction

Intimacy is the opening of oneself to another person so that the two individuals can share with each other their innermost thoughts and feelings that are usually kept hidden from other people. The word “intimacy” derives from intimus, the Latin term for “inner” or “inmost.” It d a kind of sharing that comes from within and inspires thoughts of closeness, warmth, and shared affection. Intimacy also involves getting close enough to another person that he or she can see not only one’s positive qualities and strengths but also one’s hidden faults and weaknesses. Authentic closeness between two persons requires that both of them step out of their traditional roles, dispense with their usual facades, and try to become their true selves. Intimacy with another person is, therefore, a combination of individual identity and mutual sharing. In a healthy intimacy, two individuals move into a relationship with each other, sharing common interests without losing their separate identities. Interpersonal exchange in intimate relationships is an end in itself rather than a means to achieving any other goal.

Intimacy, by its very nature, is elusive, subjective, and intensely private. An important basis of intimacy is the sharing of private thoughts and feelings through self-disclosure. Such self-disclosure involves the sharing of both pleasant and unpleasant feelings and emotions. There appears to be something uniquely intimate about sharing personal pain. It is also considered intimate to share feelings of love, caring, attraction, and closeness, as well as well as hopes, joys, accomplishments, and pride. The sharing of joyous experiences and cherished memories is considered to be as intimate as that of unpleasant experiences and long-suppressed secrets. In addition, intimacy refers not just to the act of self-disclosure but also to the interpersonal interaction in which self-disclosure is validated and reciprocated.

Nonverbal behaviors are as important to intimacy as are verbal expressions. Sex is cited as the most frequent example, but other examples include being with another person in an atmosphere of comfort and ease; hand-holding; hugging; sharing excitement, joy, and laughter; and doing things together. Other examples include sharing the touch, taste, and smell of cherished objects. Feeling good in the presence of each other, touching each other in silence, having a quiet dinner together, and silently sharing excitement and anticipation are some other examples that illustrate intimacy.

Intimacy also d a special type of feeling that is often described in terms of warmth, closeness, and love. Intimacy can thus refer to individual behavior (such as self-disclosure), to interactions between two partners, to types of relationships, and to specific feelings. Intimate partners experience a unique sense of exuberance, warmth, and vitality. Sometimes they waver, intermittently feeling both closeness and distance. At other times, there can be a simultaneous experience of both closeness and distance.

Self-Identity

A positive and realistic sense of self is a prerequisite for healthy intimacy. Intimacy requires a full awareness of one’s own feelings, thoughts, and values and the ability to bring that awareness into a relationship with another. As one becomes aware of one’s own self-identity and self-understanding, one is able to move into a relationship with another individual who also maintains a somewhat similar sense of healthy self-identity. Intimacy involves being able to share worlds while maintaining one’s own boundaries. It requires being honest with oneself and one’s partner, even during those times when one is not focused on sharing or is in some other way preoccupied.

A person who is aware of his or her own needs and is willing to explore his or her own limitations and potentialities will allow another to do the same. This may, at times, lead to conflicts. Variations in emotional expression, the nature of attention, and the quality of communication are bound to occur in a relationship from time to time and are unavoidable. The truly intimate partners are able to handle such occasional turmoil with graceful acceptance and mutual respect.

Healthy intimacy is notable for an ability to maintain a solid, self-sustained sense of identity while remaining emotionally engaged with another. The sense of self in a person involved in an intimate relationship is very resilient. Such a person is able and willing to differ with another and still maintain his or her unique identity, expressed through thoughts, feelings, values, vulnerabilities, strengths, desires, and fantasies. A person with a healthy sense of self can tolerate multiple, distinct, and coequal realities. Such people can be themselves in the presence of others, and can accept others being themselves.

A less-than-healthy relationship is marked by blurred or indistinct boundaries. In such relationships, a person pays an inordinate amount of attention to the other individual to monitor his or her actions and, more important, reactions. Even minor differences can be anxiety producing and/or threatening. One attempts to deny, minimize, or rapidly smooth differences out of existence. Contact with a partner is neither solid nor comfortable because the closeness causes anxiety about losing one’s self, whereas separateness creates anxiety about losing the other person. If the self-identity is shaky or insecure, there is an inability to maintain proper boundaries and, in turn, a resistance to really “letting in” another person—whether emotionally or intellectually. In extreme cases, contact with the partner’s differing reality is so difficult that it may give rise to an illusion of an alternate reality or a sense of no connection whatsoever.

An alternative to this sort of distortion is to allow both oneself and one’s partner to be transparent and visible. When separateness is maintained, the option to know another person exists. One’s self is solid enough to withstand the risks that accompany intense emotional involvement—the inevitability of misunderstanding, disappointment, disapproval, conflict, rejection, and even loss. In a paradoxical sense, one can only have as good a relationship as one is willing to lose. This is one of the key dynamics that largely determines how much emotional intensity and intimacy a person is capable of handling.

Risk and Vulnerability

Being intimate with another individual necessitates risk and vulnerability through self-disclosure. Intimacy inherently feels risky because one goes out to the edge of individual expression without being certain how the other person will respond. Whereas closeness affirms and sustains a relationship, intimacy reveals and affirms individuality, and, in the process, changes the nature and quality of a relationship. A person who is able to maintain individuality in the midst of togetherness can reap the rewards of both closeness and intimacy. If not, one swings between compulsive togetherness and reactive individuality.

Intimate relationships evolve gradually and naturally. The more valued the relationship, the more there is to lose. One feels more anxiety in being intimate in the sense of being honestly and fully oneself. There is always some amount of tension between closeness and intimacy. The paradox of closeness and intimacy is that the only way to really have either is to be willing at times to sacrifice closeness for the sake of intimacy.

Intimacy and Sexuality

Although intimacy is commonly thought of in connection with sex, sex is not a necessary component of intimacy. Satisfying intimate relationships in themselves are the most important source of people’s happiness. Intimacy is a very important ingredient in the quality of love
and sex. A high degree of intimacy between two lovers or spouses contributes to the happiness, emotional stability, and sexual enrichment of both. All activities are more enjoyable and life is richer and more colorful when shared with an intimate partner. Sexual experiences are more pleasurable if the partners know each other intimately, when they are completely open and vulnerable, when they can trust each other to care about each other’s feelings, and when they take pleasure in each other’s pleasure.

Intimacy and Well-Being

Humans are social animals, and without intimate relationships they risk loneliness and depression. The availability of intimate relationships is an important determinant of how well people master life’s crises. Satisfying intimate relationships are a very important source of most people’s happiness. An intimate involvement with a special someone provides a person with a purpose and meaning in life and seems to promote a sense of overall well-being. Intimate relationships have been shown to buffer people from the pathogenic effects of stress. People in intimate relationships have fewer stress-related symptoms and faster recoveries from illnesses. Intimate partners confide in each other, which has been shown to carry its own health benefits. Individual well-being and intimate relationships appear to be closely intertwined. People in satisfied intimate relationships have been shown to be less vulnerable to the negative outcomes of stress than those who lack such relationships.

Difficulties in Intimacy

People may find it difficult to develop and maintain intimacy in two different ways: They are compulsively searching for intimacy but are unable or unwilling to invest time and energy in developing meaningful intimate relationships, or they are afraid of losing their identity and, therefore, purposefully avoid intimate relationships.

Some people harbor unrealistic expectations about intimacy and closeness. Such people are always looking for instant intimacy, even at the cost of compromising their basic values. They tend to share secrets instantly and pour out their life stories in search of establishing immediate contact and emotional intensity. In doing so, they often end up surrendering their personal boundaries in a relationship. This tendency to lose the sense of self and define oneself through the response of others is called emotional fusion. In such a fusion, the boundaries of self become quite vague, and the person is unable to withstand much pressure or disagreement from another. Holding a distinct, self-defined position can be a very frightening experience for such a person. In such relationships, partners try to merge their internal experiences into a single common reality. As a result, each person’s well-being gets inextricably linked to the other’s experience and wishes. Both focus on the other, trying to ensure consensus and avoid defining their own reality.

A person with fear of intimacy is basically afraid of losing ego boundaries. There is a lack of interest in and motivation for becoming intimate with others. In most cases, such disturbance in the capacity to form intimate interpersonal relationships stems from early adverse experiences within one’s family. Such a person has an active fear of closeness, suffers from self-doubts, and actively distrusts others. He or she has a very low self-image and is easily susceptible to loneliness and depression. Such a person sees himself or herself as undeserving of the love and support of others, is afraid to trust others, and has an unrealistic fear of dependence. When a person is repeatedly unable to share inner thoughts and feelings with a single other person in a sustained manner, he or she may experience emotional isolation.

Bibliography

Brehm, Sharon S. Intimate Relationships. 5th ed. New York: McGraw, 2008. Print.

Brown, Norman, M., and Ellen S. Amatea. Love and Intimate Relationships. Philadelphia: Brunner, 2000. Print.

Carlson, Jon, and Len Sperry, eds. The Intimate Couple. Philadelphia: Brunner, 1999. Print.

Firestone, Robert W., and Joyce Catlett. Fear of Intimacy. Washington: APA, 2000. Print.

Halling, Steen. Intimacy, Transcendence, and Psychology: Closeness and Openness in Everyday Life. New York: Palgrave, 2008. Print.

Horstman, Judith. The Scientific American Book of Love, Sex, and the Brain: The Neuroscience of How, When, Why, and Who We Love. San Francisco: Jossey-Bass, 2012. Print.

Levine, Suzanne Braun. How We Love Now: Sex and the New Intimacy in Second Adulthood. New York: Viking, 2011. Print.

Paludi, Michele Antoinette. The Psychology of Love. Santa Barbara: Praeger, 2012. Print.

Prager, Karen J. The Psychology of Intimacy. New York: Guilford, 1995. Print.

Sternberg, Robert J., and Karin Weis, eds. The New Psychology of Love. New Haven: Yale UP, 2008. Print.

How can one write a follow-up letter about a cashier position?

If an individual has interviewed for a position as a cashier, or pretty much any other position with most companies, and wishes to follow-up with the office that interviewed him or her, there are two ways to proceed. One is through a phone call to the hiring office, inquiring as to whether a decision has been made with respect to filling the vacant position in question. The other option, and the one specified in the...

If an individual has interviewed for a position as a cashier, or pretty much any other position with most companies, and wishes to follow-up with the office that interviewed him or her, there are two ways to proceed. One is through a phone call to the hiring office, inquiring as to whether a decision has been made with respect to filling the vacant position in question. The other option, and the one specified in the question, is through letter or email. This option can be preferable, as it provides the prospective applicant an opportunity to reemphasize his or her desire to be hired.

A letter to a human resources office or to any other hiring office (not all companies have human resources offices, especially small businesses) should begin with an expression of gratitude for the opportunity to be considered for the position in question, in this case, as a cashier. This expression of gratitude (e.g., "Thank you for the opportunity to be interviewed for the position of cashier") should be followed with emphasis, without going overboard, on the prospective applicant's desire to work for this particular company and to have a future with this company. Interest in a future with the company displays a commitment to stick-around and not bolt at the first opportunity. Companies strongly prefer, unless the position is explicitly advertised as "temporary," applicants who display an interest in being with the company for a long time. This does not mean that the prospective applicant should display a willingness to remain there forever; it simply means that the applicant won't be looking for a better job as soon as he or she is hired for this one.

Finally, a follow-up letter or email should end with an expression of hope for hearing from the company. In other words, the applicant is looking forward to a decision from the company as to whether a job will be offered.

Most managers appreciate displays of commitment and maturity on the part of prospective employees. A follow-up letter is a useful way to check that box.