Tuesday, 3 February 2015

How is heat transported around the body?

The human body uses a few different sources when it looks to increase its internal temperature. The most consistent and reliable form is the heat energy created through friction as muscles rub together during movement. As energy is used in the body, heat energy radiates from muscles and other respirating cells. This heat is then picked up by the blood and transferred around the body.


Most muscle groups are filled with very fine capillaries that...

The human body uses a few different sources when it looks to increase its internal temperature. The most consistent and reliable form is the heat energy created through friction as muscles rub together during movement. As energy is used in the body, heat energy radiates from muscles and other respirating cells. This heat is then picked up by the blood and transferred around the body.


Most muscle groups are filled with very fine capillaries that web through the tissue. As you move and use up energy, the heat is absorbed into your blood stream and carried around your body to help regulate your temperature. This can be seen whenever your body temperature is too high or too low. If your body temperature drops too low, your skin normally becomes paler. This is due to your blood vessels constricting and diverting most of your blood to your core in order to protect vital organs. You also begin to shiver in an attempt to generate more heat through muscle friction. When you begin to overheat, your blood vessels closest to your skin will expand, giving you a flushed appearance. Dilated vessels will give off more heat towards your skin that is then carried away by evaporating sweat. 

What is cryotherapy? |


Overview

Cryotherapy has been used since the time of ancient Egypt to treat external
pain and inflammation. In the nineteenth century, freezing was first used to
remove external tissue by using ice and salt. With the advent of liquid nitrogen
in the early twentieth century, freezing cells became commonplace. Later in the
century, with the development of nitrogen and argon gas, scientists were able to
develop the medical technology used in what is now known as cryosurgery.






Mechanism of Action

Applying extreme cold extraneously to inflammation or injuries constricts blood flow and numbs the nerves, reducing pain and swelling. Freezing external skin lesions or cancers kills the tissue and leads to the “shedding” of the skin. Applying extreme cold internally, by using nitrogen or argon gas cryosurgically, kills cells and extracts cancerous tissue from organs.




Uses and Applications

Externally, ice packs are commonly used in the treatment of sprains, sports injuries, and general pain and inflammation. In cryosurgery, at -40°Fahrenheit (-40°Celsius) ice crystallizes inside cells, causing them to burst and die. Surgeons use a needle to insert argon or nitrogen gas inside tissue containing precancerous or cancerous cells, freezing the cells and killing them. Dermatologists use freezing to remove warts, skin lesions, and tattoos. Eye surgeons use cryotherapy during cataract and retina surgery to freeze tissue and seal retinal holes. Brain surgeons use cryotherapy to freeze the thalamus and reduce the effects of Parkinson’s disease and other brain disorders. Cardiologists use cryotherapy to reduce heart muscle damage in persons who have had a heart attack.




Scientific Evidence

In 2009, at the Fifteenth World Congress of the International Society of Cryosurgery, scientific results showed that for persons who were unable to undergo traditional surgery for their cancers because of metastasizing, particularly persons with lung, liver, kidney, prostate, breast, or pancreatic cancer, cryosurgery was highly effective. Cryosurgery, compared with traditional chemotherapy treatments, had an increase of 30 to 50 percent in the partial or complete reduction of tumors.


In a double-blind study in 2005, fourteen youths received dental surgery, in
which each had his or her impacted third molar tooth extracted. Some participants
were treated with cryotherapy and others not. Those who received cryotherapy
treatments reported significantly less pain and swelling in the jaws.




Choosing a Practitioner

The American
Medical Association recommends that persons choose a
qualified, experienced, and licensed physician for all cryosurgery procedures.
This doctor should be knowledgeable and accomplished in using state-of-the-art
cryotherapy technology.




Safety Issues

Extreme cold applied to extraneous skin tissue for more than twenty minutes can
lead to frostbite. Cryotherapy that is used to treat internal organs
rarely results in bleeding, nerve damage, or infection.




Bibliography


Freiman, Anatoli, and Nathaniel Bouganim. “The History of Cryotherapy.” Dermatology Online Journal 11, no. 2 (2005). Available at http://dermatology.cdlib.org/112/reviews/hxcryo/freiman.html.



Jackson, Arthur, Graham Colver, and Rodney Dawber. Cutaneous Cryosurgery: Principles and Clinical Practice. 3d ed. New York: Taylor & Francis, 2006.



Katz, Aaron, and Philippa Cheetham. Living a Better Life After Prostate Cancer: A Survivor’s Guide to Cryotherapy. San Diego, Calif.: University Readers, 2009.



Korpin, Nikolai N., ed. Basics of Cryosurgery. New York: Springer, 2001.



Sulik, Sandra M., and Cathryn B. Heath. Primary Care Procedures in Women’s Health. New York: Springer, 2010.

What is reinforcement in psychology?


Introduction

The casual, everyday use of the word “reinforcement” generally refers to the granting of a reward for some behavior. While the use of this term by psychologists is more formal, a great deal of research has been dedicated to studying the effects of rewards on behavior. The most influential of the early studies were those done in the 1890s by American psychologist Edward L. Thorndike
. Thorndike created a problem box from which a hungry cat could escape by performing a specific action, such as pulling on a wire, stepping on a pedal, or some similar behavior, thereby gaining access to food. From these studies Thorndike proposed his famous law of effect; that is, actions that are followed by satisfying events are more likely to recur while actions that are followed by discomfort will become less likely. The more satisfying or the more discomfort, the greater the effect on subsequent behavior.











Not all psychologists have used the word “reinforcement” to describe the same processes. In research where he conditioned dogs to salivate upon hearing certain tones, the Russian physiologist Ivan Petrovich Pavlov
called pairing a stimulus (food) that automatically elicits a response (salivation) to a second stimulus (a tone) reinforcing; that is, the food reinforced the ability of the tone to generate the same response. This process has come to be known as Pavlovian conditioning. Unlike Thorndike, who was referring to consequences after the organism emitted some specific behavior, Pavlov was describing an effect that occurred during the presentation of stimuli before the organism responded. Another difference was that Thorndike studied an animal’s voluntary behavior while Pavlov studied a reflexive, glandular response.


Most psychologists followed Thorndike and reserved the term “reinforcer” for voluntary behavior and its consequences. For many, though, it meant any consequence to a behavior, whether it increased or decreased the behavior’s future probability. In this usage, a reinforcer could mean any kind of motivation, whether it was to seek a pleasant or to avoid an unpleasant set of circumstances. To be sure, there were modifying words for these specific situations. Thus, if a behavior resulted in the acquisition of some desired commodity (such as food), reducing a need or a drive state, it was said to be positive reinforcement. On the other hand, if the behavior caused an unpleasant situation to be terminated or avoided, it was called negative reinforcement. Both of these consequences would increase the rate of the behavior.


To make matters more confusing, some psychologists employed the term “reinforcement” even when the consequence reduced the likelihood of a specific behavior. In the 1960s, American psychologist Gregory A. Kimble described omission training as withholding a positive reinforcer when a specified response occurs. Conversely, Kimble said that if a negative reinforcer is given when the response occurs, this is punishment.




Modern Definitions

To maintain a reasonable degree of consistency, most psychologists use the term “reinforcement” exclusively for a process of using rewards to increase voluntary behavior. The field of study most associated with this technique is instrumental conditioning. In this context, the formal definition states that a reinforcer is any consequence to a behavior that is emitted in a specified situation that has the effect of increasing that behavior in the future. It must be emphasized that the behavior itself is not sufficient for the consequence to be delivered. The circumstances in which the behavior occurs are also important. Thus, standing and cheering at a basketball game will likely lead to approval (social reinforcement), whereas this same response is not likely to yield acceptance if it occurs at a funeral.


A punisher is likewise defined as any consequence that reduces the probability of a behavior, with the same qualifications as for reinforcers. A behavior that occurs in response to a specified situation may receive a consequence that reduces the likelihood that it will occur in that situation in the future, but the same behavior in another situation would not generate the same consequence. For example, drawing on the walls of a freshly painted room would usually result in an unpleasant consequence, whereas the same behavior (drawing) in one’s coloring book would not.


The terms “positive” and “negative” are also much more tightly defined. Former use confused these with the emotional values of good or bad, thereby requiring the counterintuitive and confusing claim that a positive reinforcer is withheld or a negative reinforcer presented when there is clearly no reward, and, in fact, the intent is to reduce the probability of that response (such as described by Kimble). A better, less confusing definition is to consider “positive” and “negative” as arithmetic symbols, as for adding or subtracting. They therefore are the methods of supplying reinforcement (or punishment) rather than descriptions of the reinforcer itself. Thus, if a behavior occurs, and as a consequence something is given that will result in an increase in the rate of the behavior, this is positive reinforcement. Giving a dog a treat for executing a trick is a good example. One can also increase the rate of a behavior by removing something on its production. This is called negative reinforcement. A good example might be when a child who eats his or her vegetables does not have to wash the dinner dishes. Another example is the annoying seat belt buzzer in cars. Many people comply with the rules of safety simply to terminate that aversive sound.


The descriptors “positive” and “negative” can be applied to punishment as well. If something is added on the performance of a behavior which results in the reduction of that behavior—that is positive punishment. On the other hand, if this behavior causes the removal of something that reduces the response rate—negative punishment. A dog collar that provides an electric shock when the dog strays too close to the property line is an example of a device that delivers positive punishment. Loss of television privileges for rudeness is an example of negative punishment.




Types of Reinforcers

The range of possible consequences that can function as reinforcers is enormous. To make sense of this assortment, psychologists tend to place them into two main categories: primary reinforcers and secondary reinforcers. Primary reinforcers are those that require little, if any, experience to be effective. Food, drink, and sex are common examples. While it is true that experience will influence what would be considered desirable for food, drink, or an appropriate sex partner, there is little argument that these items, themselves, are natural reinforcers. Another kind of reinforcer that does not require experience is called a social reinforcer. Examples are social contact and social approval. Even newborns show a desire for social reinforcers. Psychologists have discovered that newborns prefer to look at pictures of human faces more than practically any other stimulus pattern, and this preference is stronger if that face is smiling. Like the other primary reinforcers, experience will modify the type of social recognition that is desired. Still, it is clear that most people will go to great lengths to be noticed by others or to gain their acceptance and approval.


Though these reinforcers are likely to be effective, most human behavior is not motivated directly by primary reinforcers. Money, entertainment, clothes, cars, and computer games are all effective rewards, yet none of these would qualify as natural or primary reinforcers. Because they must be acquired, they are called secondary reinforcers. These become effective because they are paired with primary reinforcers. The famous American psychologist B. F. Skinner
found that the sound of food being delivered was sufficient to maintain a high rate of bar pressing in experienced rats. Obviously, under normal circumstances the sound of the food only occurred if food was truly being delivered.


How a secondary reinforcer becomes effective is called two-factor theory
and is generally explained through a combination of instrumental and Pavlovian conditioning (hence the label “two-factor”). For example, when a rat receives food for pressing a bar (positive reinforcement), at that same time a neutral stimulus is also presented, the sound of the food dropping into the food dish. The sound is paired with a stimulus that naturally elicits a reflexive response; that is, food elicits satisfaction. Over many trials, the sound is paired consistently with food; thus, it will be conditioned via Pavlovian methods to elicit the same response as the food. Additionally, this process occurred during the instrumental conditioning of bar pressing by using food as a reinforcer.


This same process works for most everyday activities. For most humans, money is an extremely powerful reinforcer. Money itself, though, is not very attractive. It does not taste good, does not reduce any biological drives, and does not, on its own, satisfy any needs. However, it is reliably paired with all of these things and therefore becomes as effective as these primary reinforcers. In a similar way, popular fashion in clothing, hair styles, and personal adornment, popular art or music, even behaving according to the moral values of one’s family or church group (or one’s gang) can all come to be effective reinforcers because they are reliably paired with an important primary reinforcer, namely, social approval. The person who will function most effectively as the approving agent changes throughout life. One’s parents, friends, classmates, teachers, teammates, coaches, spouse, children, and colleagues at work all provide effective social approval opportunities.




Why Reinforcers Work

Reinforcers (and punishers) are effective at influencing an organism’s willingness to respond because they influence the way in which an organism acquires something that is desired, or avoids something that is not desired. For primary reinforcers, this concerns health and survival. Secondary reinforcers are learned through experience and do not directly affect one’s health or survival, yet they are adaptive because they are relevant to those situations that are related to well-being and an improved quality of life. Certainly learning where food, drink, receptive sex partners, or social acceptance can be located is useful for an organism. Coming to enjoy being in such situations is very useful, too.


An American psychologist, David Premack, has argued that it is the opportunity to engage in activity, and not the reinforcer itself, that is important; that is, it is not the food, but the opportunity to eat that matters. For example, he has shown that rats will work very hard to gain access to a running wheel. The activity of running in the wheel is apparently reinforcing. Other researchers have demonstrated that monkeys will perform numerous boring, repetitive tasks to open a window just to see into another room. This phenomenon has come to be known as the Premack principle. Premack explains that any high-probability activity can be used to reinforce a lower-probability behavior. This approach works for secondary reinforcers, too. The opportunity to spend money may be the reinforcer, not the money itself. Access to an opportunity to eat, to be entertained, to be with others who are complimentary about one’s taste are all highly probable behaviors; thus, they reinforce work for which one may be paid.


According to Premack’s position, a child might eat vegetables to gain access to apple pie, but not vice versa. Obviously, for most children getting apple pie is a far more effective reward than getting vegetables. Nonetheless, as unexpected as this is, such a reversal is possible. For this to work two conditions must be met: The child must truly enjoy eating the vegetables (though apple pie could still be preferred), and the child must have been deprived of these vegetables for a fair amount of time. This may make more sense when considering what happens to a child who overindulges in a favored treat. The happy child who is allowed to dive into a bag of Halloween candy, after having polished off a few pounds of sweets, would not find candy all that attractive.


A newer view of Premack’s position that incorporates situations such as these is called the bliss point. That is, for each organism there is a particular level of each activity that is most desirable (that is, the bliss point). If one is below that level, that activity has become more probable and can be used as a reinforcer for other behaviors, even those that normally have a higher probability. Thus, if a child has not had vegetables in quite a while and has become tired of apple pie, the vegetables would be effective as reinforcers to increase pie eating, though only temporarily. Once the child has acquired the bliss point for vegetable eating (which is likely to be fairly quickly), its effectiveness is ended.


The bliss point idea addresses some of the confusion about positive and negative reinforcers as well. Intuitively, it seems that positive reinforcement should be the addition of a pleasant stimulus, and that negative reinforcement would be the removal of an unpleasant stimulus. However, as anyone who has overindulged in some favored activity knows, there are times when what is normally very pleasant becomes distinctly unpleasant. Thus, adding this stimulus would not be reinforcing, even though in general it seems that it should be. It is as if the organism conducts a cost-benefit analysis concerning its current state. If the consequence is preferable to the alternative, even one that is not particularly attractive, it will function as a reinforcer. Therefore, adding what would normally be an unpleasant stimulus is positively reinforcing if it is better than going without.


Another useful idea about what makes a particular situation reinforcing is called the establishing operation. This concept describes the process of creating a need for the particular stimulus. After a large meal, food is not an effective reinforcer, but after a period of not eating, it is. Denying an organism food establishes food as an effective reinforcer. The organism is below its bliss point. Secondary reinforcers can be explained by this concept as well. By pairing neutral stimuli with primary reinforcers, one is establishing their effectiveness. Finally, that different organisms find different situations or stimuli satisfying is no surprise. Ducks find the opportunity to swim satisfying; chickens do not. A species’ natural history establishes what will be effective as well.




Patterns of Reinforcer Delivery

It is not necessary to deliver a reinforcer on every occurrence of a behavior to have the desired effect. In fact, intermittent reinforcement
has a stronger effect on the stability of the response rate than reinforcing every response. If the organism expects every response to be reinforced, suspending reinforcement will cause the response to disappear very quickly. If, however, the organism is familiar with occasions of responding without reinforcement, responding will continue for much longer on the termination of reinforcers.


There are two basic patterns of intermittent reinforcement: ratio and interval. Ratio schedules are based on the number of responses required to receive the reinforcer. Interval schedules are based on the amount of time that must pass before a reinforcer is available. Both schedules have fixed and variable types. On fixed schedules, whatever the rule is, it stays that way. If five responses are required to earn a reinforcer (a fixed ratio 5, or FR 5), every fifth response is reinforced. A fixed interval of ten seconds (FI 10) means that the first response after ten seconds has elapsed is reinforced, and this is true every time (responding during the interval is irrelevant). Variable schedules change the rule in unpredictable ways. A VR 5 (variable ratio 5) is one in which, on the average, the fifth response is reinforced, but it would vary over a series of trials. A variable interval of ten seconds (VI 10) is similar. The required amount of time is an average of ten seconds, but on any given trial it could be different.


An example of an FR schedule is pay for a specific amount of work, such as stuffing envelopes. The pay is always the same; stuffing a certain number of envelopes always equals the same pay. An example of an FI is receiving the daily mail. Checking the mailbox before the mail is delivered will not result in reinforcement. One must wait until the appropriate time. A VR example is a slot machine. The more attempts, the more times the player wins, but in an unpredictable pattern. A VI example would be telephoning a friend whose line is busy. Continued attempts will be unsuccessful until the friend hangs up the phone, but when this will happen is unknown.


Response rates for fixed schedules follow a fairly specific pattern. Fixed ratio schedules tend to have a steady rate until the reinforcer is delivered; then there is a short rest, followed by the same rate. A fixed interval is slightly different. The closer one gets to the required time, the faster the response rate. On receiving the reinforcer there will be a short rest, then a gradual return to responding, becoming quicker and quicker over time. This is called a “scalloped” pattern. (Though not strictly an FI schedule, it does have a temporal component, so it illustrates the phenomenon nicely.) Students are much more likely to study during the last few days before a test and very little during the days immediately after the test. As time passes, study behavior gradually begins again, becoming more concentrated the closer the next exam date comes.




Bibliography


Flora, Stephen Ray. The Power of Reinforcement. Albany: State U of New York P, 2004. Print.



Hilgard, Ernest Ropiequet. Psychology in America: A Historical Review. San Diego: Harcourt, 1987. Print.



Kimble, Gregory A. Hilgard and Marquis’ Conditioning and Learning. 2nd ed. New York: Appelton-Century-Crofts, 1968. Print.



Kimble, Gregory A., Michael Wertheimer, and Charlotte L. White, eds. Portraits of Pioneers in Psychology. Washington: APA, 1991. Print.



Lieberman, David A. Learning: Behavior and Cognition. 3rd ed. Belmont: Wadsworth, 2000. Print.



Ormrod, Jeanne E. Human Learning. 6th ed. Boston: Pearson, 2012. Print.



"Positive Reinforcement: A Self-Instructional Exercise." Athabasca University. Athabasca University, 2013. Web. 7 July 2014.

Monday, 2 February 2015

What is assisted living? |


Introduction


Assisted living facilities provide assistance to people who require or desire some level of assistance in activities of daily living—eating, bathing, dressing, laundry, housekeeping, and assistance with medications—but do not require constant care, and are able to live somewhat independently. Residents in these facilities range from youths with independence-limiting disorders to the elderly.






Assisted living facilities differ from nursing homes or rest homes in that their residents are more independent and do not require around-the-clock care. Therefore, assisted living facilities typically provide emergency medical assistance for their residents twenty-four hours a day, but nursing homes have a substantial medical staff on duty at all times.




Levels of Assisted Living

Upon reaching retirement age, some people are fully capable of living independently but prefer to reside in an assisted living facility because it will relieve them of the necessity of doing housekeeping, of shopping for food and preparing their own meals, and of attending to such matters as home repair and upkeep. Such people prefer assisted living facilities because they not only can reduce their responsibilities in the present but also, in most cases, can provide enhanced care as they age and require increased personal care and attention.


Assisted living facilities are not the same as board and care facilities in which residents are generally housed in multiple occupancy bedrooms with shared bathrooms. Most assisted living facilities offer self-contained apartments or cottages, usually with rudimentary kitchen facilities. They range from one-room studios, to three-bedroom suites. Most attempt to appear residential rather than institutional. Weekly housekeeping is generally included in the assessed fees, as are such services as the frequent changing of bed linens, exercise facilities, directed social events, and transportation to medical and shopping facilities. Extra charges are generally levied for such services as doing personal laundry and supervising the administration of required medications.


Meals, included in the assessed fees, are generally served in a communal dining room but can, in most cases, be served on a temporary basis in the units of people who are unable to come to the dining room. Dining rooms are important in assisted living facilities because of the social interaction that occurs among people who eat together.


Many assisted living communities can provide more intense attention if a resident’s health declines to the point that independence is compromised. Even in such situations, however, residents are encouraged to help each other with such routine matters as dressing and bathing. Assuming some responsibility for fellow residents adds to the independence of both the giver and recipient of such assistance.


People whose health makes it necessary for them to receive more intensive nursing care usually vacate the apartment in which they have been living and enter the associated facility that provides enhanced care on a long-term basis. This facility may be likened to a
hospice, which is a facility for the terminally ill, although a hospice is generally available to people who are thought to have less than six months to live, whereas an enhanced care unit attached to an assisted living facility may admit people who are frail but whose life expectancy could be several years.




Cost of Assisted Living

Assisted living facilities generally cost 20 to 30 percent less than a nursing home. Those residing in assisted living facilities often enter such facilities when they are relatively healthy and may remain in them for a decade or more. Such facilities offer graduated levels of care as those living in them begin to need more intensive care than they initially required.


Some facilities offer extensive contracts that provide unlimited long-term nursing care as needed. Such contracts, however, are initially more costly than modified contracts that guarantee only specific amounts of long-term nursing care. As residents need increasing levels of care, the monthly assessments of those holding extensive contracts will be unchanged; however, the monthly assessments of those with modified contracts will increase after a specified amount of long-term nursing care is exceeded.


In most cases, the cost of living in assisted living facilities is the responsibility of the residents, although some may have private insurance policies to cover their expenses if they require long-term nursing care. Those who exhaust their financial resources usually qualify for long-term care reimbursement under Medicaid, but to qualify, they must be approaching utter destitution.




Demand for Assisted Care

During the first half of the twentieth century, the population of the United States doubled, and by the beginning of the twenty-first century, it had doubled again. Part of this dramatic increase was the result of higher birthrates, but the greater portion resulted from a significant rise in the elderly population.


According to the US Bureau of the Census, the number of people aged eighty-five or older about doubled between 1990 and 2009, and it is anticipated to more than double between 2010 and 2040. People are not only living longer, but they also are remaining active well into their seventies or eighties, sometimes continuing to work either full time or part time during these advanced years.


As the Social Security system becomes increasingly strained for funds, the age to which people will be forced to work to qualify for full benefits will gradually increase, possibly to between seventy and seventy-four years. Diseases that earlier resulted in fatalities are increasingly instead becoming chronic conditions because of advanced medications and procedures. Such advances in medical care and increased control of chronic diseases have made working to an advanced age a realistic expectation.




Dealing with Dementia

A major problem among the aging is dementia, often the result of Alzheimer’s disease. People suffering from this disorder may become increasingly forgetful and often appear to be confused. Because people usually slip into dementia gradually, the condition may go untreated for longer than is desirable.


In assisted living apartments or cottages that have kitchen facilities, a considerable fire danger is posed by those who are forgetful. They forget that food is cooking on stovetops, causing fire alarms to sound. This sort of problem often suggests that it is time for a resident to vacate the assisted living facility and move into a facility in which closer supervision is offered.


AlthoughAlzheimer’s patients gradually lose their ability to live independently, their overall physical condition may be quite good. They require special care and monitoring on a regular basis. Many continuing care retirement communities offer such care and also involve those suffering from Alzheimer’s disease in as much social interaction as they are capable of pursuing.




Need for Service Plans

To ensure that there is no misunderstanding about the responsibilities of an assisted care facility, people entering them, in collaboration with the administrators of such facilities, usually are signatories to a written document or contract that clearly states what will and will not be provided. Such service plans are subject to modification as conditions, particularly the health of residents, warrant. Such documents should indicate the period of time covered and provide for updates at specific intervals and for changes to be made if the physical condition of a resident changes significantly.


Documents of this sort are designed to protect both the facility and the resident. The resident should be represented both by concerned parties—family members or trusted friends—and by an attorney who represents the resident’s interests. Such an attorney may be an active participant in drawing up this document that specifies the provisions of the service plan.




Bibliography


Administration on Aging. A Profile of Older Americans. Washington: Department of Health and Human Services, 2002. Print.



Ball, Mary M., et al. Communities of Care: Assisted Living for African American Elders. Baltimore: Johns Hopkins UP, 2005. Print.



Baltes, Margaret. “Aging Well and Institutional Living: A Paradox?” Aging and Quality of Life: Charting New Territories in Behavioral Science Research. Ed. Ronald P. Abeles, Helen G. Gift, Marcia G. Ory, and Donna M. Cox. New York: Springer, 1994. Print.



Citro, J., and S. Hermanson. Assisted Living in the United States. Washington: American Assoc. of Retired Persons, Public Policy Institute, 1999. Print.



Hoban, Sandra. "Assisted Living 2013: On the Upswing." Long-Term Living: For the Continuing Care Professional 62.3 (2013): 28–30. Print.



Kozar-Westman, Maryalice, Meredith Troutman-Jordan, and Mary A. Nies. "Successful Aging Among Assisted Living Community Older Adults." Jour. of Nursing Scholarship 45.3 (2013): 238–46. Print.



Matthews, Joseph L. Choose the Right Long-Term Care: Home Care, Assisted Living, and Nursing Homes. 4th ed. Berkeley: Nolo, 2002. Print.



National Center for Assisted Living. Facts and Trends: The Assisted Living Source Book. Washington: American Health Care Association, 2001. Print.



Plys, Evan J., and Nancy G. Bliwise. "Family Involvement and Well-Being in Assisted Living." Seniors Housing & Care Jour. 21.1 (2013): 21–35. Print.



Schwarz, Benyamin, and Ruth Brent, eds. Aging, Autonomy, and Architecture: Advances in Assisted Living. Baltimore: Johns Hopkins UP, 1999. Print.

What are congenital defects? |


Normal Development

In order to understand the causes of birth defects, it is necessary to have some understanding of the stages of normal development. If the time and sequence of development of each organ are not correct, an abnormality may result. It has been useful to divide human pregnancy
into three major periods: the preembryonic stage, the embryonic stage, and the fetal stage.








The preembryonic stage is the first two weeks after fertilization. During this stage, the fertilized egg undergoes cell division, passes down the Fallopian tube, and implants in the uterine wall, making a physical connection with the mother. It is of interest to note that perhaps as many as one-half of fertilized eggs fail to implant, while half of those which do implant do not survive the second week. The second stage, the embryonic stage, runs from the beginning of the third week through the end of the eighth week. There is tremendous growth and specialization of cells during this period, as all of the body’s organs are formed. The embryonic stage is the time during which most birth defects are initiated.


The fetal stage runs from the beginning of the ninth week to birth. Most organs continue their rapid growth and development during this final period of gestation leading up to birth. By the end of the eighth week, the embryo, although it has features of a human being, is only about 1 inch (2.54 centimeters) long. Its growth is amazing during this period, reaching 12 inches (30 centimeters) by the end of the fifth month and somewhere around 20 inches (50 centimenters) by birth. It is evident from the description of normal development that the changes the embryo and fetus undergo are very rapid and complicated. It is not unexpected that mistakes can happen, leading to congenital disorders.




Causes of Birth Defects

Throughout history, examples of birth defects have been described by all cultures and ethnic groups. Although the incidence of specific malformations may vary from group to group, the overall incidence of birth defects is probably similar in all people on earth. According to 2014 data published by the World Health Organization, an estimated one in thirty-three infants has some sort of major or minor congenital disorder.


Humans have long sought an explanation for why some couples have babies afflicted with serious birth defects. Such children were long regarded as “omens” or warnings of a bad event to come. The word teratology (Greek for “monster causing”) was coined by scientists to reflect the connection of “monster” births with warnings. Frequently, ancient people sacrificed such babies. It was thought that such pregnancies resulted from women mating with animals or evil spirits. Maternal impression has long been invoked as an explanation for birth defects, and from early Greek times until more recent times, stories and superstitions abounded.


Of the birth defects in which a specific cause has been identified, it has been found that some are caused by genetic abnormalities, including gene mutations and chromosomal changes, while others are caused by exposure of the pregnant woman and her embryo or fetus to some sort of environmental toxin, such as radiation, viruses, drugs, or chemicals.




Examples of Birth Defects

Many birth defects are caused by changes in the number or structure of chromosomes. The best-known chromosomal disorder is Down syndrome, which results from individuals having an extra chromosome 21, giving them forty-seven chromosomes rather than the normal forty-six. A person with Down syndrome characteristically has a flattened face, square-shaped ears, epicanthal folds of the eye, a short neck, poor muscle tone, slow development, and below-average intelligence. Cystic fibrosis
is an example of a defect caused by a single gene. Affected people inherit a recessive gene from each parent. The disorder is physiological in nature and results in a lack of digestive juices and the production of thick and sticky mucus that tends to clog the lungs, pancreas, and liver, at times encouraging the development of potentially fatal respiratory infections. Cleft lip, or cleft palate, is multifactorial in inheritance (some cases are caused by chromosomal abnormalities, while others are the result of single-gene mutations). Multifactorial traits are caused by many pairs of genes, each having a small effect, and are usually influenced by factors in the environment. The result is that such traits do not follow precise, predictable patterns in a family.


Genetic factors account for the great majority of the birth defects in which there is a known cause. The remaining cases of known cause are attributed to maternal illness; congenital infections; exposure to chemicals, drugs, and medicines; and physical factors such as x-rays, carbon dioxide, and low temperature. The government warning on liquor bottles informs pregnant women that if they drink alcohol during a sensitive period of prenatal development, they run the risk of having children with fetal alcohol syndrome. There is a wide variation in the effects of alcohol on a developing fetus. Alcohol exposure can lead to an increased frequency of spontaneous abortion (or miscarriage), and it depresses growth rates both before and after birth. Facial features of a child exposed to alcohol may include eye folds, a short nose, small mid-face, a thin upper lip, a flat face, and a small head. These characteristics are likely to be associated with intellectual disabilities. Frequently, however, otherwise normal children have learning disorders and only a mild growth deficiency. Variation in the symptoms of prenatal alcohol exposure has made it difficult to estimate the true incidence of fetal alcohol syndrome. According to a 2014 report by the US Centers for Disease Control and Prevention, as many as 1.5 babies are born with fetal alcohol syndrome for every 1,000 live births in the United States.


For many babies born with a major birth disorder, no specific cause can be identified. Because of this rather large gap in knowledge, nonscientific explanations about the causes of birth defects flourish. What is known is that most congenital defects, whether caused by a genetic factor or an environmental factor, are initiated during the embryonic period. It is also known that some disorders, such as learning disorders, frequently result from damage to the fetus during the last three months of pregnancy. Knowledge about what can be done by parents to avoid toxic exposure and activity that could cause birth defects is critical.




Key Terms



sensitive period

:

a critical time during development when organs are most susceptible to teratogens





teratogen


:

any agent that is capable of causing an increase in the incidence of birth defects




teratology

:

the science or study of birth defects





Bibliography


Berul, Charles I., and Jeffrey A. Towbin, eds. Molecular Genetics of Cardiac Electrophysiology. Boston: Kluwer Academic, 2000. Print.



"Congenital Anomalies." World Health Organization. World Health Organization, 2014. Web. 21 July 2014.



Edwards, Jesse E. Jesse E. Edwards’ Synopsis of Congenital Heart Disease. Ed. Brooks S. Edwards. Armonk: Futura, 2000. Print.



Ferretti, Patrizia, et al., eds. Embryos, Genes, and Birth Defects. 2nd ed. Hoboken: Wiley, 2006. Print.



"Fetal Alcohol Spectrum Disorders (FASDs)." CDC. Centers for Disease Control and Prevention, 23 May 2014. Web. 21 July 2014.



Harvey, Richard P., and Nadia Rosenthal, eds. Heart Development. San Diego: Academic, 1999. Print.



Judd, Sandra J., ed. Congenital Disorders Sourcebook. 2nd ed. Detroit: Omnigraphics, 2007. Print.



Kelly, Evelyn B. Encyclopedia of Human Genetics and Disease. 2 vols. Santa Barbara: Greenwood, 2013. Print.



Kramer, Gerri Freid, and Shari Maurer. The Parent’s Guide to Children’s Congenital Heart Defects: What They Are, How to Treat Them, How to Cope with Them. New York: Three Rivers, 2001. Print.



Riccitiello, Robina, and Jerry Adler. “Your Baby Has a Problem.” Newsweek 129.9 (1997): 46. Print.



Rossen, Anne E. “Understanding Congenital Disorders.” Current Health 18.9 (1992): 26. Print.



Tomanek, Robert J., and Raymond B. Runyan, eds. Formation of the Heart and Its Regulation. Boston: Birkhauser, 2001. Print.



Wynbrandt, James, and Mark D. Ludman. The Encyclopedia of Genetic Disorders and Birth Defects. 3rd ed. New York: Facts On File, 2008. Print.

What is a barium swallow?




Cancers diagnosed:
Oral cavity (mouth) cancer; oropharyngeal (throat) cancer; vocal cord cancer, including laryngeal and hypopharyngeal cancer, glottic cancer, supraglottic cancer, subglottic cancer; esophageal cancer; stomach cancer; stomach polyps, which may precede stomach cancer; small intestine cancer, including carcinoid tumors, gastrointestinal stromal tumors, lymphomas, and adenocarcinoma





Why performed: A barium swallow with X rays is performed to help diagnose cancer of the mouth, throat, vocal cords, esophagus, stomach, and small intestine. When swallowed, barium sulfate shows up on X rays and highlights the linings of the above-mentioned structures. A double-contrast barium swallow involves swallowing substances that create air in the stomach to expand it, allowing a better view.



Patient preparation: Patients may be placed on a restricted diet a few days before the test. Patients should not eat, drink, chew gum, or smoke after midnight before the test. Patients receive instructions from their doctors about swallowing medications. The stomach needs to be empty for the procedure. In some cases, the stomach contents are removed through a tube placed in the nose. For women, a pregnancy test may be performed to ensure that the patient is not pregnant.



A barium swallow is an outpatient procedure that is performed at a hospital radiology department, outpatient radiology center, or doctor’s office. The test does not require anesthesia, and patients are awake. A barium swallow usually takes from thirty to sixty minutes, depending on the extent of the procedure. Patients disrobe and wear a gown for the test. Patients need to remove metal objects that may interfere with the X rays, including glasses, dentures, and jewelry.



Steps of the procedure: The patient’s vital signs are taken before the test and monitored during the test. Patients may sit, stand, or lie on an X-ray table for the procedure. Patients may be secured to the X-ray table if it is tilted to allow images to be taken from various angles.


X rays of the patient’s heart, lungs, and abdomen are taken. Then, patients drink sixteen to twenty ounces of barium sulfate. The barium sulfate is mixed in a thick drink that may have flavor added to it; otherwise, the drink is described as tasting chalky. The examination table may be tilted or pressure may be applied to the patient’s abdomen to help spread the barium. The barium is viewed on a barium fluoroscope monitor as it travels through the upper digestive tract. Still X-ray images can be taken at any time. Patients may need to drink more barium sulfate as the test progresses.


For a double-contrast barium swallow, the patient swallows baking soda crystals. The baking soda creates gas, and the air expands the stomach. Additional images are taken, and the patient is repositioned or the examination table is tilted as necessary.



After the procedure: Patients should drink plenty of fluids to help remove the barium from their bodies. Patients can eat a regular diet unless instructed otherwise. Bowel movements will contain barium for one to two days following the tests. The barium may make bowel movements appear white, gray, or pink in color.



Risks: A barium swallow is considered a low-risk procedure. The radiation exposure is low, but it carries a small risk of cancer. Patients may be allergic to the flavorings that are mixed with the barium drink. Occasionally, the barium may harden, resulting in intestinal blockage or constipation. Patients should contact their doctor if they have not had a bowel movement within one to two days of the procedure.



Results: The X-ray films are read by a radiologist. The ordering doctor may review the films as well. The linings of healthy structures are free of abnormal growths or polyps. Any abnormalities, such as cancer or precancerous tissues, appear as growths or polyps.




Bibliography


Carver, Elizabeth, and Barry Carver. Medical Imaging: Techniques, Reflection, and Evaluation. 2nd ed. Edinburgh: Churchill, 2012. Print.



Drop, A., et al. “The Modern Methods of Gastric Imaging.” Annales Universitatis Mariae Curie-SkÅ‚odowska 59.1 (2004): 373–81. Print.



Eisenberg, Ronald L., and Alexander R. Margulis. A Patient's Guide to Medical Imaging. New York: Oxford UP, 2011. Print.



Gore, R. M., et al. “Upper Gastrointestinal Tumours: Diagnosis and Staging.” Cancer Imaging 29.6 (2006): 213–17. Print.



Hosaka, K. “Radiological Investigation of the Mucosae Around Early Gastric Cancers.” Journal of Gastroenterology 41.10 (2006): 943–53. Print.



Kunisaki, C., et al. “Outcomes of Mass Screening for Gastric Carcinoma.” Annuals Surgical Oncology 13.2 (2006): 221–28. Print.



Levine, M. S., and S. E. Rubesin. “Diseases of the Esophagus: Diagnosis with Esophagography.” Radiology 237.2 (2005): 414–27. Print.



PasÅ‚awski, M., J. ZÅ‚omaniec, E. RuciÅ„ska, and W. KoÅ‚tyÅ›. “Synchronous Primary Esophageal and Gastric Cancers.” Annales Universitatis Mariae Curie-SkÅ‚odowska 59.1 (2004): 406–10. Print.



Summers, D. S., M. D. Roger, P. L. Allan, and J. T. Murchison. “Accelerating the Transit Time of Barium Sulphate Suspensions in Small Bowel Examinations.” European Journal of Radiology 62.1 (2007): 122–25. Print.



“Upper GI and Small Bowel Series.” MedlinePlus. Natl. Lib. of Medicine, 8 Oct. 2012. Web. 27 Aug. 2014.

What are home health services? How do they help cancer patients?




History: At one time, the poor were sent to the hospital while the wealthy received health care services in the comfort of their homes. Physicians made house calls and nurses made home visits. Both provided health care services and education. These nurses became known as public health or visiting nurses. In the twenty-first century, home health services are still provided in the patient’s residence, but the technology, costs, and scope of services have changed.



Coming home: Cancer patients are often discharged from hospitals while still recovering from illness or surgery. Supportive skilled services and treatments by the home health care team make it possible for cancer patients to heal in the comfort of their homes. Home health care agencies provide intermittent skilled and nonskilled home care services as indicated by the patient’s diagnosis, medical orders, and insurance reimbursement.


The home care team usually includes a multidisciplinary group of professionals such as registered nurses, nursing assistants/home health aides, physical therapists, respiratory therapists, occupational therapists, speech therapists, and medical social workers. Sometimes agencies also include chaplains and volunteers. Staff members work together to provide holistic health services in the home, with the physician providing oversight through the medical care plan.


Most home care agencies provide home health services for Medicare patients as well as private insurance and self-pay patients. To qualify for home health care services under Medicare, the patient must meet the following criteria:


  • Require a skilled service by a registered nurse, physical therapist, or occupational therapist.




  • Meet guidelines as a homebound patient due to illness or injury. The patient does not have to be bed-bound but must require considerable assistance or use a supportive device, such as a wheelchair or walker, to get around. The patient is able to leave the home only on a limited basis, usually for doctor office visits.




  • Be under the care of a qualified physician who provides written medical orders to the home care agency for skilled care services and treatments.




  • Receive home health services from a certified home care agency, subject to state and federal requirements and inspection.



Types of home health services: The interdisciplinary team of professionals coordinates the skills and knowledge needed to provide a comprehensive approach to home health services. Services may vary based on the needs of the cancer patient and the reimbursement. Services are provided on an intermittent basis (usually several times a week) so the caregiver remains the person responsible for daily continuous care. Home health services are not meant to be custodial or long term.


Skilled nursing services are provided by a registered nurse (R.N.). The nurse usually coordinates care and develops the patient’s plan of care. Nurses provide infusion therapy in the home for intravenous antibiotics, chemotherapy, or home parenteral nutrition (HPN). They support the patient and caregiver with teaching. They provide pain management and medication information. The R.N. supervises the home health aide who gives personal care to the patient in the home. Also, the nurse assesses ongoing problems and addresses these promptly. Home safety is important for effective home health services.


Physical therapists provide physical therapy to homebound patients with the goal of restoring function, encouraging independence, and minimizing decline. Physical therapists teach patients and caregivers how to maintain gains in function and prevent further injury.


Occupational therapists are key to enabling homebound patients to perform activities of daily living, such as bathing, dressing, feeding, or toileting. They may help redesign the placement of kitchen dishes and utensils to allow the patient with decreased functional ability to carry on daily chores. These professionals teach the patient how to use adaptive equipment such as a prosthesis. The goal is for the patient to attain the highest level of functioning possible.


Speech therapists work with patients who have suffered strokes, are neurologically compromised, or are having trouble swallowing or communicating, as is common among patients with cancers of the lips, mouth, or throat. Again, the goal is optimal function of the patient in normal routines.


Home health aides can make all the difference in the success of home health services. These caregivers are supervised and directed by the R.N. while providing personal hygiene care such as bathing, dressing, feeding, washing hair, or helping the patient walk. Sometimes they provide light housekeeping or a simple meal if these tasks are covered by the insurance provider. Many patients and caregivers report that the home health aide is the most helpful of all home health service providers.


Medical social workers assist cancer patients and caregivers to assess resources available in the community. Their skills are valuable as they facilitate referrals to other services, provide counseling and support, and act as patient advocates.


Registered dietitians and nutritionists may provide education for the patient and caregiver. These professionals are especially important if the patient is receiving an infusion of home parenteral nutrition (nutrition introduced nonintestinally, such as intravenously). They also can teach patients and caregivers critical aspects of diet and nutrition related to their cancer.


An infusion therapy company may provide infusion therapy products and equipment, becoming an important part of the home health care team. Once infusion therapy was provided only in a hospital setting, but now it is a part of home care services. Intravenous antibiotics, chemotherapy, or home parenteral nutrition is delivered through an infusion pump within the residence.


Specimens for tests ordered by the physician can be collected in the home. Samples can be taken by a registered nurse or phlebotomist. Lab tests can vary from routine blood counts to monitoring of medication/drug levels needed for the treatment plan.



Home medical equipment providers play a critical role in home health services. Specialized equipment provided in the home can make care of the patient more efficient and ease the physical stress on the caregiver. Typical equipment needs in the home include special beds designed for home use, walkers, wheelchairs, wound and ostomy supplies, catheters, bed pads for incontinence, and oxygen therapy and supplies.


Volunteers may be a part of the home health care service. They can provide a range of services such as cooking, cleaning, emotional support, providing transportation, making phone calls, or providing respite care while the caregiver rests or runs errands. These services are needed in the home but rarely are covered under the reimbursement insurance.


Chaplains are sometimes a part of the home care team, especially in a specialized home health service called hospice for terminally ill patients. These professionals provide spiritual support to the patient, caregiver, and home care staff.



Skilled vs. custodial health care services: Some cancer patients may not need a skilled service provided by professionals but may require support services to continue to stay in their homes. These services are considered custodial services and are usually not covered by Medicare or private insurance. Community or private agencies may provide support services such as private duty nurses or sitters to stay with the patient for shifts of eight to twelve hours, live-in companions, or home-delivered meals. Some pharmacies provide delivery services for medications. Groceries can be delivered to the home. These types of services are generally considered out-of-pocket expenses and are paid for by the patient, caregiver, or both. These services, however, can help the patient stay in the home environment. Medical social workers from a home health care agency are available to assess patient needs and make necessary referrals to community agencies.



Nontraditional therapy at home: Cancer patients may choose to pay for nontraditional care services delivered in their homes. Therapies and services that may be available to homebound patients include massage therapy, podiatrist services, and acupuncture services. Engaging in relaxation therapies such as yoga, meditation, tai chi, or guided imagery may be useful to reduce stress. Patients may choose to investigate or use herbal or vitamin supplements, but they should discuss any supplement with their health care provider before adding these to the mediations already prescribed; certain medication interactions can occur when supplements are taken with prescribed drugs. For their safety and optimal health outcome, patients are advised to discuss alternative therapies with their health care provider.



Balinsky, Warren L. Home Care: Current Problems and Future Solutions. San Francisco: Jossey-Bass, 1994.


Cannon, Geneva. Caring for Your Loved One Who Is Ill at Home: A Comprehensive Guide and Planner for Family Caregivers and Personal Home Care Assistants. Salisbury, Md.: Avenegg, 2006.


Gingerich, Barbara Stover, and Deborah Anne Ondeck, eds. Clinical Pathways for the Multidisciplinary Home Care Team. Gaithersburg, Md.: Aspen, 1997.


Meyer, Marie M., and Paula Derr. The Comfort of Home: A Complete Guide for Caregivers. Portland, Oreg.: CareTrust Publications, 2007.

Sunday, 1 February 2015

I am writing an essay about whether beauty pageants are a way of objectifying women. Can you help me to get started?

In order to get started writing your paper, I recommend you take some notes. First, what do you already know about beauty pageants? What do you want to know? When looking into whether or not pageants are objectifying, try to find opinions from both sides. Many people who participate in pageants say that it makes them feel good about themselves. Let's not forget that the voices of people who actually participate in these contests are important. On the other hand, some people feel that beauty pageants encourage women to fit into a narrow or unrealistic ideal of beauty. Let's consider the intent of beauty pageants and some of the criticisms on this activity.

Beauty pageants are a type of contest where women enter and compete for an award. The award may be in the form of money, a trophy, or a garment or accessory. Sometimes, multiple forms of the award are given, but all consistently add up to a monetary reward. The basis for judging the contestants is traditionally based on physical beauty standards, but some competitions also consider a woman's "inner beauty." Inner beauty may be measured based on her personality, passions, hobbies, talents, and whether she performs any sort of advocacy or charity work. Some pageants offer a college scholarship as a reward, and in recent years some pageants have moved away from the bikini portion of the contest in favor of a demonstration of skill in public speaking.


One of the biggest criticisms of beauty pageants is that they reward some women for fitting into narrow criteria of what constitutes inner and outer beauty. Depending on the time period and location of the beauty pageant, ideals of beauty are not concrete. What is considered beautiful in one year may be totally different in the next. Invariably, women who do not fit the criteria are excluded for their failure to meet arbitrary standards of beauty.


Many people criticize pageants for upholding racist or ethnocentric ideals of beauty. Historically, women of color have been excluded from participating in pageants for their skin color and/or bone structure. Even in international competitions, such as the Miss Universe pageant, contestants are expected to conform to an ideal of light skin and Anglo-European bone structure. This reinforces the idea that beauty is a very narrow category, yet women should be rewarded for fitting into such a narrow box.


Another criticism is that the "narrow box" of beauty excludes women who have healthy to excess amounts of body fat. In the United States especially, women are expected to be very thin and athletic, with little body fat. This reinforces the idea that women who are fat, curvy, pregnant, chubby, or however else you choose to call it, cannot be beautiful.


When children grow up participating in beauty pageants, it can teach them that their physical beauty (as determined by others) is more important than their personal happiness or comfort. The television program Toddlers and Tiaras has been controversial not just because it shows children participating in beauty pageants, but because a lot of the children don't want to be  made to participate in the first place. Many parents do not consider their child's input on whether or not they want to have a spray tan, get their teeth whitened, or wear a wig. This is especially a case of obectification because parents essentially treat their child as a plaything to be decorated and paraded, rather than a person with feelings and other interests.


The biggest critique of beauty pageants is that despite any measure of inner beauty involved, the contests reduce a woman or girl's value down to her physical appearance. Beauty or value in a person is not limited to their physical appearance. 


I think it would be a great idea for you to find some testimonies from current and/or past pageant participants. This opens up the opportunity to create citations in your paper and connect the subject to real, lived experiences.

(a) Calculate the total mass of a uniform layer of water covering the entire Martian surface to a depth of 3 m (see Section 6.8). (b) Compare it...

For this question we need Martian radius, which is about 3390 km (see the link attached).


Actually, enough accuracy is reached if we assume the layer is flat with the given thickness and with the surface area as of Mars.


The formula for the surface of a sphere is `4 pi R^3.` Numerically we obtain `0.003*4*pi*3390^2 approx433242 km^3.`


The mass of one cubical kilometer of water is `10^9` kg, so the total mass is about...

For this question we need Martian radius, which is about 3390 km (see the link attached).


Actually, enough accuracy is reached if we assume the layer is flat with the given thickness and with the surface area as of Mars.


The formula for the surface of a sphere is `4 pi R^3.` Numerically we obtain `0.003*4*pi*3390^2 approx433242 km^3.`


The mass of one cubical kilometer of water is `10^9` kg, so the total mass is about `4.3*10^14 kg.` This is about `10^6` times less than the given mass of Venus's atmosphere.

What is vicarious traumatization (VT)? |




Vicarious traumatization, also known as secondary traumatization or insidious trauma, is a mental condition in which an individual who did not personally experience a trauma absorbs the stressful feelings of a directly traumatized person. Vicarious trauma is one of three differing disorders that make up second-hand shock syndrome, which also includes compassion fatigue and secondary traumatic stress. People who experience vicarious trauma often experience symptoms similar to those of post-traumatic stress disorder (PTSD).


Vicarious trauma occurs after a person has discussed the traumatic experience with the trauma survivor in depth and experiences intensely empathetic feelings. The feelings can be so powerful that an individual integrates the survivor's trauma into his or her own life. Individuals who are at risk of vicarious traumatization include therapists, counselors, doctors, lawyers, teachers, journalists, friends, family members, and other secondary witnesses to trauma.




Signs and Symptoms

Certain factors contribute to an individual's chance of experiencing vicarious trauma. The condition is a direct result of feelings of empathy. Therefore, a person's private history can influence how he or she interprets another person's trauma. An individual who has things in common with the traumatized victim is more likely to experience vicarious trauma than someone with little in common with the victim. For professionals, work-related stress such as high workloads or office tensions can play a part in vicarious trauma. The repeated exposure to clients' trauma and the pressure of confidentiality also puts professionals at risk. Care-giving professionals are trained to manage their empathetic feelings, but outside influences such as personal issues that relate to the victims' problems can make emotional control for professionals difficult.


Individuals experiencing vicarious trauma exhibit a number of symptoms that parallel those observed in directly traumatized individuals. Common stress-related symptoms include anger, nervousness, over- or under-eating, difficulty sleeping, sadness, and difficulty discussing emotions. The stress often affects individuals' job performance but can also have an impact on their personal lives by invading their sense of trust, safety, and independence. Vicarious trauma can also affect people's memories and perceptions of others and themselves. Vicariously traumatized individuals tend to experience a loss of self-worth and become disinterested in their ambitions, often leading to thoughts of suicide. Many individuals who experience vicarious trauma tend to minimize their feelings, believing their reactions are unwarranted. If left untreated, vicarious trauma can last for months and sometimes years.


Vicarious trauma symptoms are often very similar to those of post-traumatic stress disorder. Secondary witnesses have been known to experience flashbacks, nightmares, and other invasive thoughts. Certain social situations can trigger stress and anxiety, causing the vicariously traumatized person to avoid places and people that bring on such feelings. Vicarious trauma also causes feelings of paranoia and fear, putting the individuals in hypervigilant states in which they are easily startled.




Second-Hand Shock Syndrome

Within the helping profession, vicarious trauma is often experienced simultaneously with compassion fatigue or secondary traumatic stress. These three disorders encompass what is known as second-hand shock syndrome. All three disorders are similar but have key differences.
Compassion fatigue
is a disorder in which professionals have been exposed to so much secondary trauma that they become emotionally exhausted. Over time, professionals can lose their ability to empathize with victims. Compassion fatigue can lead to professional inadequacy, especially if professionals begin to feel apathy about their clients' problems. An uninterested outlook not only affects the way a professional handles a victim's situation, but it can also affect the victim if he or she senses the listener's indifference.



Secondary traumatic stress occurs when people experience trauma indirectly through the victims' firsthand accounts. This disorder is a natural process whereby secondary witnesses of trauma automatically express empathy as they listen to the accounts. Secondary traumatic stress often manifests itself in unpredictable circumstances, such as when a friend's spouse suddenly leaves the marriage. Friends and family members of traumatized individuals are more likely to experience secondary traumatic stress than helping professionals are. The automatic manifestation of empathy distinguishes secondary traumatic stress from vicarious trauma, which occurs despite professionals' attempts to control their feelings.




Treatment

Individuals are encouraged to take certain actions when they feel they are at risk of experiencing vicarious trauma. Precautionary measures such as self-care assessments help specialists identify if they are feeling levels of empathy and compassion beyond what is considered professional. Other methods that professionals can employ to avoid vicarious trauma include taking breaks from work in order to recuperate. In general, people who believe they are absorbing other people's trauma should engage in recreational activities they enjoy. Relaxation techniques such as yoga and meditation help with easing troubled minds. Outdoor activities and exposure to sunlight increase endorphin levels and aid in taking the mind off work. If vicarious traumatization becomes overwhelming, individuals should seek professional help.




Bibliography


"For Professionals: Vicarious Trauma." Wendt Center for Loss and Healing. Wendt Center for Loss and Healing. Web. 2 Apr. 2015. http://www.wendtcenter.org/resources/for-professionals.html



Izzo, Ellie, and Vicki Carpel Miller. Second-Hand Shock: Surviving & Overcoming Vicarious Trauma. Scottsdale: HCI Press, 2010. 1–8. Print.



Nelson, Terri Spahn. "Vicarious Trauma: Bearing Witness to Another's Trauma." University of Illinois at Chicago. University of Illinois at Chicago. Web. 2 Apr. 2015. https://www.uic.edu/orgs/convening/vicariou.htm



"Secondary Traumatic Stress." National Child Traumatic Stress Network. National Child Traumatic Stress Network. Web. 2 Apr. 2015. http://www.nctsn.org/resources/topics/secondary-traumatic-stress



"Vicarious Trauma." American Counseling Association.American Counseling Association. Oct. 2011. Web. 2 Apr. 2015. http://www.counseling.org/docs/trauma-disaster/fact-sheet-9---vicarious-trauma.pdf



Zimering, Rose, and Suzy Bird Gulliver. "Secondary Traumatization in Mental Health Care Providers." Psychiatric Times. UBM Medica, LLC. 1 Apr. 2003. Web. 2 Apr. 2015. http://www.psychiatrictimes.com/ptsd/secondary-traumatization-mental-health-care-providers

What are measles? |


Causes and Symptoms

Measles is a highly contagious viral disease characterized by a maculopapular (pimply) rash that develops on the skin and spreads rapidly over much of the cutaneous surface of the body. Measles virus is classified with the paramyxoviruses, a class of viruses in which ribonucleic acid (RNA) serves as the genetic material. Closely related viruses in the same group include rinderpest and distemper virus, agents associated with disease in ruminants such as cows and in dogs or cats, respectively. It is likely that measles originated when one of these other animal viruses became adapted to humans several thousand years ago.



In modern times but before the advent of measles vaccination, measles was a common disease of childhood, usually appearing between the ages of five and ten. The illness is among the most contagious of infections, and the virus was generally spread among children in schools. Widespread immunization of children, begun in the 1960s, tended to push the age of exposure into the teenage years. Most outbreaks since the 1980s have occurred among college students. Since recovery from the disease confers lifelong immunity, infection among older adults is infrequent. In developing nations, places where vaccination may be haphazard, measles is still a disease of early childhood; malnutrition and related problems of poverty have resulted in a significant level of mortality among infected children.


Exposure generally follows an oral-oral means of transmission, as the person inhales contaminated droplets from an infected individual. The incubation period for active measles ranges from seven to fourteen days. During this early stage, the infected individual becomes increasingly contagious. The lack of any obvious symptoms during these early stages lends itself to the spread of the disease.


Contact by the virus with the surface cells of the respiratory passages, or sometimes the conjunctiva (the outer surface of the eye), allows the infectious agent to enter the body. The virus spreads through the local lymph nodes into the blood, producing a primary viremia. During this period, the virus replicates both in the lymph nodes and in the respiratory sites through which the virus entered the body. The virus returns to the bloodstream, resulting in a secondary viremia and widespread passage of the virus throughout the body by the fifth to seventh day after the initial exposure. Viral levels in the blood reach their peak toward the end of the incubation period, some fourteen days after infection. Once symptoms begin, the virus is widely disseminated throughout the body, including sites in small blood vessels, lymph nodes, and even the central nervous system.


The initial incubation period is followed by a prodromal stage, in which active symptoms appear. This stage is characterized by a fever that may reach as high as 103 degrees Fahrenheit, coughing, sensitivity of the eyes to light (photophobia), and malaise. Koplik’s spots appear on the buccal mucosa in the mouth one to two days prior to development of the characteristic measles rash.


The maculopapular rash first appears on the head and behind the ears and gradually spreads over the rest of the body during the course of twenty-four to forty-eight hours. Clear signs of respiratory infection appear, including a cough, pharyngitis, and occasional involvement of the bronchioles or even pneumonia. While malaise and anorexia (appetite loss) are common during the fever period, diarrhea and vomiting generally do not occur. Over time, the rash becomes increasingly dense, exhibiting a blotchy character. Desquamation is common in many affected areas of the skin. Gradually, over a period of three to five days, the rash begins to fade, usually following the sequence by which it first appeared. The rash fades first on the forehead, then on the extremities.


Complications, while they do occur, are unusual in otherwise healthy individuals. Most result from secondary bacterial infections. Occasionally, these complications may manifest themselves as infections of the ear. Pulmonary infections are common among cases of measles and account for most of the rare deaths that follow development of the disease. Photophobia is also common, accounting for the former belief that measles patients had to be kept in a dark room; as long as the patient is comfortable, this step is unnecessary.


The obvious manifestations of measles infection make the isolation of the virus unnecessary for diagnosis. Ironically, the near disappearance of measles in the United States has made most physicians there unfamiliar with the disease; it is not unusual for an attending physician to mistake the rash for another illness. For this reason, laboratory diagnosis is often useful. Laboratory confirmation is generally based on a serological assay for measles antibodies in the blood of infected persons.


A rare sequela to measles infection is the development of subacute sclerosing panencephalitis, a disease characterized by progressive neurological deterioration. The specific mechanism by which measles infection may develop into this disease remains unclear, but it may be the result of a rare combination of events in the victim. Since spread of the virus into the central nervous system is common during measles infection whereas the development of subacute sclerosing panencephalitis is rare (approximately one case per one hundred thousand measles infections), it is likely that some form of immune impairment is at the root of this disease. Diagnosis of subacute sclerosing panencephalitis is difficult and is based on developing dementia accompanied by unusual levels of measles antibodies in cerebrospinal fluid.




Treatment and Therapy

No specific treatment for measles is available; therapy consists of symptomatic intervention. Bed rest is recommended, and the patient should not come into contact with persons not previously exposed to the virus through either natural infection or immunization.


Itching of the rash is common and may be treated with cool water or the standard regimen of cornstarch or baking soda applications. The most common complications result from secondary bacterial infections, which generally take the form of otitis media (middle-ear infection), pharyngitis, or pneumonia. Appropriate use of antibiotics is usually sufficient to prevent or treat such complications.


Immunization with the measles virus may be either passive or active. Children less than one year of age and patients who are immunocompromised or chronically ill may be protected if human immunoglobulin is administered within a week after exposure. While effective immunity is short term, it is capable of protecting these individuals during this period. Since no active disease or infection develops, however, immunity to future infection remains minimal in these cases.


During the early 1960s, an effective
vaccine was developed to immunize children against measles. The vaccine consists of an attenuated form of the virus. Although early forms of the vaccine were inconsistent in producing a lifelong immunity, they were effective in decreasing the prevalence of the disease. Later generations of the attenuated vaccine proved more effective in developing long-term immunity among the recipients.


Since maternal antibodies are present in newborns, it is recommended that measles immunization begin between twelve and fifteen months of age. Often, this program is part of a combination MMR vaccine, for measles, mumps, and rubella (German measles). A second booster is given following elementary school. The American Academy of Pediatrics does not consider a third vaccination to be necessary if the approved routine has been followed. It is recommended that children who were first immunized prior to their first birthday should receive boosters at fifteen months of age and again at age twelve. Indications are that immunity from vaccination is long term, if not lifelong. Recovery from natural infection results in a lifelong immunity to measles.


Inconsistency of the first generation of vaccine resulted in ineffective immunity among some individuals vaccinated during the 1960s. A number of small outbreaks during the 1980s were the result. Most cases of measles, however, have occurred in individuals who failed to be immunized.




Perspective and Prospects

The origin and early history of measles is uncertain, as the first authentic description of measles as a specific entity was that by the Arab physician al-Razi (Rhazes) in a 910 CE treatise on smallpox and measles. Rhazes quoted earlier work by the Hebrew physician El Yehudi, so it is likely that familiarity with these respective illnesses had existed for some time.


Measles is entirely a human disease, with no known animal reservoir. Consequently, the paucity of human populations of sufficient size to maintain transmission means that the spread of such an epidemic disease would have been unlikely before 2500 BCE. It is probable that the disease entered the human species through adaptation of the similar animal viruses of rinderpest or distemper. The absence of any description of a disease like measles in the writings of Hippocrates (c. fourth century BCE) likewise renders it unlikely that the disease was widespread before that date.


Epidemic disease with a rash characteristic of measles is known to have spread through the Roman Empire during the early centuries of the common era. The difficulty in differentiating measles from smallpox by the physicians of the time contributes to the difficulty in understanding the history of the illness. It is certain that by the time of Rhazes, measles had become common in the population.


The terminology of measles lent further confusion during the Middle Ages. Measles was often referred to as morbilli, a Latin term meaning “little disease,” to distinguish it from il morbo, or plague. The word measles first appeared in the fourteenth century treatise Rosa Anglica, by John of Gaddesden. The term may have been applied initially to the sores on the legs of lepers (mesles), and it was only later that illnesses characterized by similar rashes (measles, smallpox, and rubella) were clearly differentiated by European physicians. The significance of a rash with a white center in the mouth was probably recognized by John Quier in Jamaica and Richard Hazeltine in New England during the latter portion of the eighteenth century, but it was in 1896 that the American pediatrician Henry Koplik firmly reported its role in early stages of the disease.


Measles followed the path of European explorers to the Americas during the sixteenth century. Repeated outbreaks of measles devastated American Indian populations, which had minimal immunity to the newly introduced disease. The most thorough epidemiological investigation of measles newly introduced into a population was that by Peter Panum in his study Observations Made During the Epidemic of Measles on the Faroe Islands in the Year 1846 (1940). In the population of 7,864 persons, 6,100 became ill, with 102 deaths. Mortality rates as high as 25 percent were not unusual in previously unexposed populations. In Hawaii in 1848, about 40,000 deaths occurred among the population of 150,000 persons following the introduction of measles. Even higher mortality rates probably occurred among the populations of Peru and Mexico in 1530–31, following their exposure to infected Spanish explorers.


The earliest attempt at immunization was probably that of Francis Home of Edinburgh in 1758. Home soaked cotton in the blood of measles patients and placed it on the small cuts on the skin of children. The viral nature of measles was first demonstrated by John Anderson and Joseph Goldberger of the United States Public Health Service, who in 1911 induced the disease in monkeys using filtered extracts from human tissue. In 1954, the virus itself was isolated by John Enders, who grew the agent in human and monkey tissue in a laboratory.


The first effective vaccine was developed by Enders in 1958 using an attenuated (live) form of the virus. The vaccine was tested and then licensed in 1963. Several variations of the vaccine that proved superior in producing long-term immunity were developed in the decades that followed. In 1974, the World Health Organization (WHO) introduced a widespread vaccination program within developing countries.


The absence of any natural reservoir for measles other than humans has made the eradication of the disease possible. Active immunization of children in the United States reduced the annual incidence of the disease from 482,000 reported cases in 1962 to fewer than 1,000 in the late 1990s. The Measles and Rubella Initiative, a collaboration between the WHO, UNICEF, American Red Cross, US Centers for Disease Control and Prevention (CDC), and UN Foundation, has vaccinated one billion children worldwide since 2000. While widespread vaccination and worldwide surveillance has made global eradication of the disease a realistic possibility, the WHO reports that more than twenty million people contract measles each year and that it remains one of the top killers of children around the world, causing 145,700 deaths in 2013. Most of these fatalities occurred in children younger than five.



Outbreaks in 2014 and 2015

Though the CDC reports that measles was declared eliminated (no longer endemic or constantly present) in the United States as of 2000 becuase of access to effective vaccination, a record number of cases were reported in 2014. Of the 644 cases that occurred throughout twenty-seven states that year, the CDC stated that the majority of people who suffered from the infection were unvaccinated; the incident was linked to travelers coming to the country from the Philippines, which had recently suffered an outbreak. At the beginning of the following year, yet more measles outbreaks were highly publicized. From January to the end of February, the CDC confirmed that 170 people from seventeen states had measles. Most of these cases were considered part of an ongoing outbreak that experts believed began when an infected traveler visited a California amusement park. Aside from this outbreak, three other unrelated outbreaks were reported in Illinois, Nevada, and Washington state. The CDC issued an official Health Advisory in January to inform health care providers about the incidents and the ongoing investigations. At the state level, by the beginning of March lawmakers in several states started pushing for stricter regulations regarding nonmedical exemptions for vaccination; the surgeon general stressed the importance of vaccinating children.





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