What is porphyria? |

Causes and Symptoms

Porphyria refers to a group of diseases that share a common feature: a defect in the chain of chemical reactions that produce hemoglobin, the protein responsible for the transport of oxygen by the blood. These metabolic errors cause a buildup of porphyrins, resulting in two main types of illness: nervous system attacks and skin
lesions.

There are two major groups of porphyrias: erythropoietic and hepatic. In erythropoietic porphyria, the porphyrins are synthesized in the bone marrow; in hepatic porphyrias, they are produced in the liver. Each of these porphyrias has several subtypes. For example, acute intermittent porphyria (AIP) is a hepatic porphyria most common in young adults and adults in early middle age. Its attacks are triggered by alcohol, certain drugs, and hormonal changes (such as those accompanying pregnancy). Some patients experience two to three episodes per year, while others may have as few as three in a lifetime.

Since all forms of porphyria are rare, a physician may not suspect the disease at first. The symptoms of porphyria include abdominal disturbances, nausea, vomiting, reddish urine, and prickling sensations in the hands and feet. The hallmarks that distinguish porphyrias, however, are the skin and nervous system effects. Except for AIP, all the porphyrias cause extreme photosensitivity of the skin because the porphyrins that are deposited in the skin are excited by the ultraviolet aspect of sunlight. This reaction results in skin lesions, which may lead to disfigurement. The neurological disturbances of porphyria range from mild mental confusion to delirium and hysteria. If a porphyria is suspected, urine, stool, and blood tests are done to detect the presence of porphyrins.

Treatment and Therapy

Avoiding triggering factors is primary in the control of porphyria attacks. Alcohol and drugs, which may cause an attack, should be stopped. Protective clothing should be worn to prevent the irritating effects of sunlight. For certain porphyrias, drugs are available to suppress the formation of porphyrins. In the case of AIP, a simple increase in the consumption of carbohydrates is enough to inhibit the production of porphyrin-forming substances. The treatment of porphyrias is largely aimed at relieving its symptoms.

Bibliography:

American Porphyria Foundation. http://www.porphyriafoundation.com.

Goldman, Lee, and Dennis Ausiello, eds. Cecil Textbook of Medicine. 23d ed. Philadelphia: Saunders/Elsevier, 2007.

Greer, John, et al., eds. Wintrobe’s Clinical Hematology. 12th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health, 2009.

"Learning about Porphyria." National Human Genome Research Institute, April 18, 2013.

Parish, Kathy. “What’s Wrong with This Patient?” RN 53, no. 7 (July, 1990): 43–45.

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

"Porphyria." Mayo Clinic, May 7, 2011.

Rakel, Robert E., and Edward T. Bope, eds. Conn’s Current Therapy. Philadelphia: Saunders/Elsevier, 2007.

Wood, Debra. "Porphyria." Health Library, November 26, 2012.

How can the protagonist in the book Big Red be described?

There are a number of descriptors for Danny, the protagonist, in Big Red by Jim Kjelgaard. Big Red can be considered a “coming of age” story in which the protagonist changes from being child-like to accepting the responsibilities for his actions as a young man.

Early in the story, Danny is a hearty, young boy living in the Wintapi forest with his father, Ross. They live hand to mouth while making a meager living off...

There are a number of descriptors for Danny, the protagonist, in Big Red by Jim Kjelgaard. Big Red can be considered a “coming of age” story in which the protagonist changes from being child-like to accepting the responsibilities for his actions as a young man.

Early in the story, Danny is a hearty, young boy living in the Wintapi forest with his father, Ross. They live hand to mouth while making a meager living off of the land and small woodland animals.  Although it is a difficult life, Danny demonstrates he is a hard worker and astute student as he learns the life skills needed to survive in the harsh environment of the forest. In addition, he demonstrates his respect for that natural environment.  

When Danny visits the home of Mr. Haggin, their wealthy landlord, the reader sees a softer side to the boy as he falls in love with Big Red, a prized Irish Setter dog. Once again, the audience sees Danny’s ability as a quick thinker as he works with the dog’s trainer, and how he becomes responsible for the show dog’s life. He is determined make Mr. Haggin and Mr. Fraley proud while he learns to care for the dog and visits environments that are foreign to him.

As the book comes to its conclusion, the reader witnesses how Danny matures and accepts responsibility for his actions. After Big Red is injured, Danny knows that he is partially responsible for allowing the dog to become entangled in a precarious situation with a bear. He shows his empathy by caring for the dog, and displays his maturity by vowing to find a way to repay the cost of the dog who will never again be a show dog.  Danny displays the attributes of being a hearty, nature-loving, empathetic, determined, responsible young man.

What is art therapy? |

Overview

According to the American Art Therapy Association (AATA), art therapy is based on knowledge of human developmental and psychological theories and is an effective treatment for people with developmental, medical, educational, social, or psychological problems. The theory behind art therapy is based partially on the belief that creativity and healing may come from the same place. According to experts, art therapy is not merely arts and crafts, or purely recreational; it is multisensory and teaches people to use objects purposefully and to communicate their pain with the outside world.

Although human beings have used art as a mode of expression for thousands of years, art therapy was not recognized as a distinct profession until the late 1930s, when Margaret Naumberg, now considered the founder of art therapy, advocated using art as a gateway to the subconscious in conjunction with free association and psychoanalytic interpretation.

Artist Adrian Hill took credit for inventing the term “art therapy” in 1942.
While recovering from tuberculosis in a sanitarium, he felt
that his own foray into art led to his emotional recovery. Introducing painting to
his fellow patients, he found that they used artistic expression not only for
enjoyment but also for expressing fears and emotions.

Recognizing that artwork could be useful in helping patients express internal conflicts, the psychiatric staff at the Menninger Clinic in Kansas began to employ art as therapy. The first journal in the field, Bulletin of Art Therapy, began publishing in 1961, and the AATA, a national professional organization that regulates educational, professional, and ethical standards for art therapists, was established in 1969.

Mechanism of Action

There are two different poles of art therapy: art psychotherapy and art as therapy. Proponents of art as therapy suggest that the process of creating art itself is curative and that verbal reflection, discussions, or interpretations about the art itself are not necessary. Advocates believe that creative activity increases brain levels of serotonin, a hormone associated with feelings of well-being, and gives rise to the alpha brainwave patterns typically seen during periods of relaxed alertness.

Uses and Applications

Art psychotherapy proponents believe that artwork is most effective when used as a tool to elicit feelings, fears, and fantasies, which can then be worked through in traditional talk therapy. Regardless of their orientation, most contemporary art therapists integrate a variety of approaches, individualizing the treatment to best meet the needs of a specific client.

Special techniques are often particularly useful in helping people express
their feelings, develop social skills, solve problems, reduce anxiety, or
resolve emotional conflicts. In the unstructured approach, patients might select
from a variety of materials and media (such as paint, pastels, and clay) and use
them however they choose, allowing unconscious material to rise to the surface.
Then the therapist might ask the client to draw a family picture, which can help
elicit complex family dynamics such as unhealthy patterns of relating or poor
communication skills. Groups of people who share similar issues, such as having
had cancer, might work together to create a collage or mural that can then be used
to stimulate discussion of coping strategies.

Art therapists can practice alone or may be part of a treatment team that includes physicians, psychologists, nurses, social workers, counselors, and teachers. Art therapy, conducted in individual or group sessions, can be used with people of all ages, races, and ethnic backgrounds who have any one of a number of physical and emotional disorders. The adult coloring book, a loose form of art therapy, has become a mainstream trend.

Choosing a Practitioner

Art
therapists must possess a minimum of a master’s degree and
undergo a supervised practicum and a postgraduate internship before being
certified for practice. Art therapists are registered (the credential ATR) or
board certified (BC), or both, and practice in a variety of settings, including
community mental health centers and psychiatric clinics; hospitals, rehabilitation
facilities, and hospices; correctional facilities; nursing homes and senior
centers; schools and early intervention programs; disaster relief centers;
homeless shelters; and drug and alcohol rehabilitation programs.

Safety Issues

There are no known safety concerns with art therapy.

Bibliography

American Art Therapy Association. http://www.arttherapy.org.

Art Therapy Credentials Board. http://www.atcb.org.

Canadian Art Therapy Association. http://canadianarttherapy.org/.

Craig, Claire. Exploring the Self through Photography: Activities for Use in Group Work. Philadelphia: Jessica Kingsley, 2009. Print.

Edwards, David. Art Therapy. Thousand Oaks: Sage, 2004. Print.

King, Juliet L. Art Therapy, Trauma, and Neuroscience: Theoretical and Practical Perspectives. New York: Routledge, 2016.

Malchiodi, Cathy A. The Art Therapy Sourcebook. Rev. ed. New York: McGraw, 2007. Print.

Miller, Caroline. Arts Therapists in Multidisciplinary Settings. Philadelphia: Jessica Kingsley, 2016. Print.

Richardson, Carmen. Expressive Arts Therapy for Traumatized Children and Adolescents: A Four-Phase Model. New York: Routledge, 2016. Print.

Rubin, Judith Aron. The Art of Art Therapy: What Every Art Therapist Needs to Know. New York: Brunner, 2011. Print.

What is ethylene oxide? |

Related cancers:


Leukemia, stomach, lymphatic, pancreatic, and brain cancers

Definition:
Ethylene oxide is a flammable, colorless gas at temperatures above 51.3 degrees Fahrenheit. It is a three-atom ring made of two carbon atoms and one oxygen atom. Each of the two carbon atoms is bonded to two hydrogen atoms.

Exposure routes: Inhalation, ingestion, skin contact

Where found: Fumigation of foodstuffs, sterilization of hospital instruments, and various synthetic chemical operations

At risk: Workers in the detergent, fungicide, and synthetic chemical fields, especially those related to ethylene glycol manufacture

Etiology and symptoms of associated cancers:
The high reactivity of ethylene oxide is shown by ring opening and the introduction of new carbon groups at reactive sites in deoxyribonucleic acid (DNA). This type of reaction takes place largely at a nitrogen atom of guanosine. Such modified nucleic acid fragments have been observed in mice and are most prevalent in the liver, kidney, spleen, and testis. A variety of mutations and reverse mutations have also been found. Gene mutations and heritable translocations are common.

History: Ethylene oxide has been produced in large quantities in the United States since 1921. Annual production ranges between 2.6 million and 3.4 million metric tons. According to the US National Toxicology Program's 13th Report on Carcinogens
(2014), peak production in the United States reached over 4 million metric tons in 1999. The 13th ROC also reports that ethylene oxide is one of the top twenty-five chemicals produced in the United States in terms of production volume. Well over half of the production is consumed in the synthesis of the antifreeze, ethylene glycol.

Five studies of workers exposed to ethylene oxide, beginning in the mid-1980s, showed that exposure produces statistically significant excess tumor appearance. There are difficulties in the interpretation of each of these studies, but a causal relationship between the compound and tumor production is likely. Animal studies involving rats, mice, and hamsters clearly show its carcinogenicity.

Federal regulations exist for the control of ethylene oxide. The Department of Transportation (DOT) lists the chemical as hazardous and requires special marking, labeling, and transporting precautions. The Environmental Protection Agency (EPA) requires that the manufacture of ethylene oxide meet provisions for the control of volatile organic compounds (VOCs). Also, under the Clean Air Act, the compound is listed as one of thirty-three hazardous air pollutants that present the greatest threat to public health, and the EPA requires that as little as ten pounds of the substance must be reported. The Occupational Safety and Health Administration (OSHA) has set the permissible exposure limit at one part per million for an eight hour time weighted average with a five parts per million excursion level.

Bibliography

Amer. Cancer Soc. "Known and Probable Human Carcinogens." Cancer.org. ACS, 17 Oct. 2013. Web. 23 Oct. 2014.

US Agency for Toxic Substances & Disease Registry. "Toxic Substances Portal—Ethylene Oxide CAS ID#: 75-21-8." ATSDR, 3 Mar. 2011. Web. 23 Oct. 2014.

US Centers for Disease Control and Prevention National Inst. for Occupational Safety and Health. "Ethylene Oxide Sterilizers in Health Care Facilities: Engineering Controls and Work Practices (DHHS (NIOSH) Publication Number 89-115)." 13 July 1989. CDC.gov, 6 June 2014. Web. 23 Oct. 2014.

US Dept. of Health and Human Services Natl. Toxicology Program. "Ethylene Oxide: CAS No. 75-21-8." National Toxicology Program: 13th Report on Carcinogens (RoC). US DoHHS/NTP, 2 Oct. 2014. Web. 23 Oct. 2014.

US Dept. of Labor Occupational Safety & Health Administration. "Central Supply: Exposure to Ethylene Oxide Gas." OSHA.gov. US DoL/OSHA, n.d. Web. 23 Oct. 2014.

US Environmental Protection Agency. "Ethylene Oxide." 1992, 2000. EPA. EPA, 18 Oct. 2013. Web. 23 Oct. 2014.

US Environmental Protection Agency. "Rule and Implementation Information for Commercial Sterilizers." EPA Technology Transfer Network: Air Toxics Web Site. EPA, 17 Oct. 2013. Web. 23 Oct. 2014.

US Natl. Insts. of Health, Natl. Inst. of Environmental Health Sciences. Breast Cancer Risk and Environmental Factors. Research Triangle Park: NIH/NIEHS, 2012. Digital file.

What is a culture of animal cells?

Early History

Methodology for maintaining tissues in vitro (in laboratory vessels) began in 1907 with Ross Harrison at Yale College. Harrison placed tissue extracts from frog embryos on microscope slides in physiological fluids such as clotted frog lymph. The material was sealed with paraffin and observed; specimens could be maintained for several weeks. In 1912, Alexis Carrel began the maintenance of cardiac tissues from a warm-blooded organism, a chicken, in a similar manner. The term “tissue culture” was originally applied to the cells maintained in the laboratory in this manner, reflecting the origin of the technique. More appropriate to current techniques, the proper terminology is “cell culture,” since it is actually individual cells which are grown, developing as explants from tissue. Nevertheless, the terms tend to be used interchangeably for convenience.

Types of Cell Culture

The most common form of mammalian cell culture is that of the primary explant. Cells are removed from the organism, preferably at the embryonic stage; treated with an enzyme such as trypsin, which serves to disperse the cells; and placed in a laboratory growth vessel. Most of these vessels are composed of polystyrene or similar forms of plastic.

Most forms of cells are anchorage-dependent, meaning they will attach and spread over a flat surface. Given sufficient time, such cells will cover the surface in a layer one cell thick, known as a monolayer.

A few forms of cells, mainly hematopoietic (blood-forming) or transformed (cancer) cells, are anchorage-independent and will grow in suspension as long as proper nutrients are supplied.

Similar procedures are used in preparation of nonmammalian cell lines such as those from poikilotherms (cold-blooded organisms such as fish) or insects. Insect lines have become particularly important as techniques were developed for cloning genes in insect pathogens known as baculoviruses. Such cells can often be maintained at room temperature in suspension.

Development of Cell Lines

A characteristic of primary cells is that of a finite life span; normal cells will replicate approximately fifty times, exhibit symptoms of “aging,” and die. When primary cells are removed from a culture and cultured separately, they become known as a cell strain.

A few rare cells may enter “crisis” and begin to exhibit characteristics of abnormal cells such as anchorage-independence or unusual chromosome numbers. If these cells survive, they represent what is called a “cell line.” Cell lines express characteristics of cancer cells and are often immortal.

During the first half century of work in cell culture, only nonhuman cells were grown in culture. In 1952, George Gey, a physician at Johns Hopkins Hospital, demonstrated that human cells could also be grown continuously in culture. Using cervical carcinoma explants from a thirty-one-year-old African American woman named Henrietta Lacks, Gey prepared a continuous line from these cells. Known as HeLa cells, these cultures became standard in most laboratories studying the growth of animal viruses. Ironically, growth of HeLa cells was so convenient and routine that the cells frequently contaminated other cultures found in the same laboratories. Lacks's family had not given consent for her cells to be used for research, and, until 1973, had not known that her cells were being studied in labs around the world. In 2013 the National Institutes of Health agreed to give the family some control over Lacks's genome after information about the genome had already been made public. The case raised ethical concerns about balancing the family's right to privacy against the public health benefits of genomic research, and pointed to a need for policies to ensure that such research is conducted ethically.

Nutrient Requirements

Particular cells may have more stringent requirements for growth than other types of cells; in addition, primary cells have greater requirements than cell lines. However, certain generalities apply to the growth requirements for all cells. All cells must be maintained in a physiological salt solution. Required vitamins and amino acids are included in the mixture. Antibiotics such as penicillin and streptomycin are routinely added to suppress the growth of unwanted microorganisms. Nevertheless, sterility is of utmost importance since some organisms are unaffected by these antibiotics. Depending upon the type of cell, the particular pH, or acid content, of the culture may be variable. Most mammalian cells grow best at a pH of 7.0-7.2. For this reason, cells are generally grown in special incubators which utilize a relatively high CO2 atmosphere.

Replication of animal cells requires the presence of certain growth factors in the medium. Historically, the source of such factors has been serum, usually obtained from fetal bovines. Genetic engineering techniques have resulted in production of commercially available growth factors, eliminating the requirement for expensive serum for growth of some forms of cells in culture.

Genetics of Cells in Culture

Study of cultured animal cells has resulted in significant advancement in understanding many areas of cell regulation. For example, the role played by cell receptors in response to the presence of extracellular ligands such as hormones and other metabolites was clarified by studying the response of cells to such stimulation. Intracellular events, including the roles of enzymes in cell activities, were clarified and remain a primary area of research.

The ability to transform mammalian cells using isolated DNA has allowed for significant applications in genome analysis. Such genetic manipulation has led to a greater understanding of the role specific genes play in cell regulation. In particular, use of cultured cells was instrumental in clarifying the roles played by specific gene products in intracellular trafficking, the movement of molecules to specific sites within the cell. Similar techniques continue to be used to further understand the regulatory process.

Mammalian Cells and Oncogenesis

During the 1960s, Leonard Hayflick at the Wistar Institute in Philadelphia, Pennsylvania, observed that primary cells in culture exhibit a finite life span; normal cells generally divide no more than approximately fifty times (a phenomenon now called the Hayflick limit). Any cells that survive generally take on the characteristics of cancer cells.

During the same period, Howard Temin at the University of Wisconsin, while studying the growth of RNA tumor viruses in cultured cells, reported the apparent requirement for DNA production by these viruses in transforming normal cells into cancer cells. Temin’s and Hayflick’s investigations contributed significantly to explaining how cancer cells differ from normal cells and the understanding of genes involved in development of cancer cells. Eventually, this led to the discovery of oncogenes.

The term “oncogene” is somewhat misleading. Its definition was originally based on the fact that mutations in such genes may contribute to transformation of cells from normal to cancerous. The study of these genes in cultured cells clarified their role: Most oncogene products can be classified as growth factors, which stimulate cell growth; receptors, which respond to such stimulation; or intracellular molecules, which transfer such signals to the cell DNA. In other words, the normal function of the oncogene is to regulate replication of normal cells; only when these proteins are inappropriately expressed do they result in transformation of the cell.

Application of Cell Culture to Virology

The use of mammalian cells for the study of viruses represented among the earliest, and arguably among the most important, applications of the technique of cell culture. Prior to the 1940s, study of most animal viruses, including those that cause disease in humans, was confined to in vivo studies in animals. For example, the study of poliovirus required inoculation of the virus directly into the brains of suitable monkeys.

In 1949, John Enders and his coworkers demonstrated the growth of poliovirus in human embryonic cells, eliminating the requirement for monkeys. Their work played a critical role in the later development of poliovirus vaccines by Jonas Salk and Albert Sabin. The ability to grow viruses in cells maintained in the laboratory opened the field to nearly all virologists and biochemists, rather than restricting such studies to those with access to animal facilities.

Key Terms



cell lines

:

cells maintained for an indeterminate time in culture




HeLa cells

:

the first human tumor cells shown to form a continuous cell line




micropropagation

:

removal of small pieces of plant tissue for growth in culture




primary cells

:

explants removed from an animal




transformation

:

any physical change to a cell, but generally the change of a normal cell into a cancer cell





Bibliography

Butler, Michael. Animal Cell Culture and Technology. 2d ed. New York: BIOS Scientific, 2008. Print.

Castilho, Leda R., et al., eds. Animal Cell Technology: From Biopharmaceuticals to Gene Therapy. New York: Taylor, 2008. Digital file.

Davis, John. Animal Cell Culture: Essential Methods. Chichester: Wiley, 2011. Digital file.

Fox, Ira J., Nalu Navarro-Alvarez, and Alejandro Soto-Gutierrez. Methods in Bioengineering: Cell Transplantation. Boston: Artech, 2011. Digital file.

Freshney, R. Ian. Culture of Animal Cells: A Manual of Basic Technique. 6th ed. Hoboken: Wiley, 2011. Digital file.

Gold, Michael. A Conspiracy of Cells: One Woman’s Immortal Legacy and the Medical Scandal It Caused. Albany: State U of New York P, 1986. Print.

Hayflick, L., and P. Moorhead. “The Serial Cultivation of Human Diploid Cell Strains.” Experimental Cell Research 25 (1961): 585–621. Print.

Pollack, Robert, ed. Readings in Mammalian Cell Culture. 2d ed. Cold Spring Harbor: Cold Spring Harbor, 1981. Print.

Urbano, Kevin V. Advances in Genetics Research. New York: Nova, 2011. Digital file.

Skloot, Rebecca, and Gregory Mone. The Immortal Life of Henrietta Lacks. 2010. Unabridged. New York: Crown, 2013. Digital file.

Zimmer, Carl. "A Family Consents to a Medical Gift, 62 Years Later." New York Times. New York Times, 7 Aug. 2013. Web. 21 July 2014.

What are monoamine oxidase (MAO) inhibitors? How do they interact with other drugs?

Ephedra

Effect: Dangerous Interaction

Because it contains the stimulant ephedrine, combining the herb
ephedra with monoamine oxidase (MAO) inhibitors can rapidly
produce a severe, dangerous interaction and should be avoided. In the United
States, it is illegal to sell products containing ephedra.

Scotch Broom

Effect: Dangerous Interaction

The herb scotch broom contains high levels of tyramine, so it should not be taken with MAO inhibitors.

Green Tea

Effect: Probable Dangerous Interaction

Because it contains caffeine, green tea should not be
combined with MAO inhibitors.

Ginseng

Effect: Possible Dangerous Interaction

According to one report, the combination of ginseng and
the MAO inhibitor phenelzine caused worrisome symptoms. While this may have been
caused by caffeine contamination of the ginseng, experts recommend avoiding
ginseng-MAO inhibitor combinations.

St. John’s Wort

Effect: Possible Dangerous Interaction

Current thinking suggests that St. John’s wort functions somewhat
similarly to SSRI (selective serotonin-reuptake inhibitor)
antidepressants. Because SSRIs should not be combined with MAO inhibitors, St.
John’s wort probably should not be combined with them either.

5-hydroxytryptophan (5-HTP), S-adenosylmethionine (SAMe)

Effect: Possible Dangerous Interactions

Based on one case report and on current thinking about how they work,
SAMe and 5-HTP should not be combined with MAO
inhibitors.

Bibliography

Brinker, F. “Interactions of Pharmaceutical and Botanical Medicines.” Journal of Naturopathic Medicine 7 (1997): 14.

Iruela, L. M., et al. “Toxic Interaction of S-adenosylmethionine and Clomipramine.” American Journal of Psychiatry 150 (1993): 522.

Jones, B. D., and A. M. Runikis. “Interaction of Ginseng with Phenelzine.” Journal of Clinical Psychopharmacology 7 (1987): 201-202.

Who would make possible objections to the proposal?

Honestly, the vast majority of humanity would object to such a proposal.  There are few, if any, civilizations in the world that condone cannibalism.  Specifically, though, Swift would want both the Irish and the English to be horrified by this proposal.  The Irish should object on the basis that no parent should be comfortable with the prospect of selling their one-year-old child to be roasted and eaten.  What would their acquiescence to such a proposal say about them?  They would be terrible parents, no, terrible people if they happily sold their children as meat in order to turn a profit.  Such a proposal ought to make them question what they have done to find themselves in a position to be criticized in this way.  

Further, the English ought to object to this proposal as well.  The claim, even the ironic claim, that they would be not only willing but happy to eat babies and wear boots and gloves made of baby skin should be offensive enough to incite their anger.  Like the Irish, the English should question what they've done to deserve such criticism.

What is substance abuse education?

Overview

Throughout recent history, efforts have been developed to educate the public on the dangers of substance abuse. Much of this work has been targeted to youth populations, especially in school settings. Substance abuse prevention educators have assumed that educating people on the dangers and harmful nature of substance abuse alone will actually prevent drug use and addiction. However, many studies have questioned the effectiveness of this approach.

Traditionally, a common technique was to bring to the classroom a recovering addict to talk about drug use and how it negatively affected that person’s life. This approach was thought to be effective for preventing substance use. Another approach was for a teacher to show a film on substance abuse, a film that often included a number of scare tactics believed to deter youth from drug experimentation. Generally, the teacher would follow the film with a discussion of the dangers of drugs.

Another common method once believed to prevent substance abuse was for substance abuse educators to attend health fairs and simply hand out brochures to passersby. Health educators believed that if people knew about the negative effects of drug use, they would not use drugs. Much money and resources were spent in the hopes that educational brochures would deter people, primarily young people, from using tobacco, alcohol, or other drugs.

However, studies showed that these educational efforts were mostly ineffective. Substance abuse education is informative, but is not effective as a single, stand-alone approach to preventing substance use. Practitioners, who began to question their approach, also began to explore the nexus between substance abuse education and the prevention of drug abuse. In some cases, popular approaches to prevention education, such as the original Drug and Alcohol Resistance Education (D.A.R.E.) program and other singularly focused educational curricula, were shown to have adverse outcomes. For this reason, the National Institute on Drug Abuse (NIDA) substantially changed the D.A.R.E. curriculum.

Substance abuse education can be effective if the goal is to inform people of the facts of drug use and to train students of health care about the best practices associated with the substance abuse profession. Different disciplines offer their own perspectives on the issue of substance abuse. Some courses, in substance abuse counseling for example, teach student therapists how to work with clients who abuse substances.

Center for Substance Abuse Prevention

The Center for Substance Abuse Prevention (CSAP), part of the US Substance Abuse and Mental Health Services Administration (SAMHSA), created six strategies that many US states use to channel funding to their respective regions, counties, and community groups that conduct prevention programs. One of these areas is prevention education. This strategy includes two-way or multidirectional communication about substance abuse topics, including prevention programs that cover parenting techniques, social skills, and peer resistance skills.

Prevention education is one of six overall strategies that CSAP attaches to the Substance Abuse Prevention and Treatment block grant. The other five strategies include information dissemination, alternative activities, community-based processes, environmental approaches, and problem identification and referral.

The focus of prevention education is to provide substantive information. Simply passing out a brochure, for example, is considered information dissemination only. Adequate prevention education occurs in settings with interactive communication that leads, for example, to programs such as Life Skills Training (LST), which has been replicated nationally. This program has proven effective across multiple sites.

The LST program is a school-based program that prevents substance abuse and violence by targeting risky behaviors. The curriculum includes multiple sessions, over time, with interactive role-playing scenarios that engage the students in the program. A number of evidence-based educational programs in substance abuse exist on the National Registry of Evidence-based Programs and Practices (NREPP), which is sponsored by SAMHSA.

National Institute on Drug Abuse (NIDA)

NIDA, part of the National Institutes of Health, also provides some definitions and descriptions on substance abuse education and dissemination efforts. NIDA has two critical focuses. The first is the strategic support and conduct of research across a broad range of disciplines. The second is ensuring the rapid and effective dissemination and use of the results of that research to significantly improve prevention, treatment, and policy as it relates to drug abuse and addiction. Specifically, NIDA funds education and dissemination efforts that inform adults and youth about the neuroscience of addiction. Youth-focused curricula include Brain Power and NIDA Goes Back to School, programs with a substance-abuse educational component.

Many of the early programs identified by NREPP were programs that were funded in part by NIDA, which also published the book Preventing Drug Use among Children and Adolescents (1997). This work highlights a number of evidence-based, substance-abuse prevention programs, many of which have an educational focus. A number of programs have since been created and are being studied for effectiveness. The contributions and research funding that NIDA provides is crucial. Research results are interpreted and then transferred to the field to influence educational practice.

NIDA’s publication also highlights the risk-and-protective-factor approach to prevention. This approach, which has been adopted by most in the field of substance abuse prevention as the framework for programming, argues that there are multiple risk and protective factors in a person’s life that can influence each stage of youth development. These factors operate across a number of domains, some of which include substance abuse. The implications for prevention specialists is that these factors must be assessed and understood before implementing a prevention program or a strategy designed to decrease risk factors and to increase protective factors. This is exciting research, and NIDA was one of the first federal agencies to disseminate information on this approach.

Guiding Principles and Best Practices

As prevention knowledge continues to grow, new findings are being presented that have a role in guiding decision-making about funding and implementing prevention programs. Early findings on prevention education include the following:

• Providing information and educating people on the harms and risks associated with substance abuse is not an effective strategy when used in isolation from other approaches. Skill development in combination with education is preferred.

• Didactic approaches are not effective at preventing substance abuse. Interactive educational approaches are encouraged.

• When educating youth, peer approaches are preferred but require training and oversight.

• When implementing education programming in schools, lengthy curricula, including booster sessions, are preferred to short-term or one-time-only types of events.

• Social skills programs that include numer-ous risk-and-protective-factor approaches are preferred.

• Booster sessions are encouraged after the prevention education session has concluded.

• Role-playing components to substance abuse education programs are recommended.

• Educational programs that include parents and students are recommended.

This early work helped to guide the field of substance abuse prevention. Much of the early work of the Center for the Application of Prevention Technology, under CSAP contract, was to coordinate with states, jurisdictions, and tribal entities to transfer evidence-based information on substance abuse prevention programs and best practices to state leadership. It is within this context that education about substance abuse is often discussed. Communication covers what is effective and ineffective in this area.

College and University Education

Substance abuse education is growing. Colleges and universities offer many educational courses in substance abuse prevention and treatment, and the content of these courses varies widely. Some focus on substance abuse prevention, others focus on pharmacology, and still others focus on substance abuse treatment. Courses cover the sociology of substance abuse, criminal justice solutions to substance abuse problems, the medical implications for patients with substance abuse disorders, and substance abuse counseling. Courses are being taught traditionally, in the classroom, but also online.

Substance abuse certification and licensure requirements have driven much of this increased activity in substance abuse education. Professional education in substance abuse prevention could not happen without careful pedagogical approaches and scientific findings to guide effective practice in the field.

National Youth Anti-Drug Media Campaign

The National Youth Anti-Drug Media Campaign is an educational vehicle for substance abuse messages in the United States. Millions of dollars are spent annually to create, distribute, and broadcast messages across the country. The campaign is part of the Office of National Drug Control Policy (ONDCP) in Washington.

A number of messages are offered as part of a comprehensive media campaign. Although the vast majority of these messages are one-way communication episodes, substance abuse organizations use the material too. Also, the ONDCP and state authorities discuss how media messages can support substance abuse services regionally.

Bibliography

Brounstein, P., Janet Zweig, and Steve Gardner. Science-Based Practices in Substance Abuse Prevention: A Guide. Rockville: Center for Substance Abuse Prevention, 1998. Print.

Fisher, Gary, and Nancy Roget. Encyclopedia of Substance Abuse Prevention, Treatment, and Recovery. Thousand Oaks: Sage, 2009. Print.

Goddard, Gillian, Viv Smith, and Carol Boycott. "Substance Abuse (Drugs) Education." PSHE in the Primary School: Principles and Practice. New York: Routledge, 2013. 213–24. Print.

Hogan, Julie, et al. Substance Abuse Prevention: The Intersection of Science and Practice. Boston: Allyn, 2003. Print.

Mignon, Sylvia I. "Substance Abuse Prevention." Substance Abuse Treatment: Options, Challenges, and Effectiveness. New York: Springer, 2015. 175–90. Print.

National Institute on Drug Abuse. Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders. 2nd ed. Bethesda: DHHS, 2003. Print.

What internal and external conflicts does Uncle Jack face in To Kill a Mockingbird?

Uncle Jack decides to play "parent" to Scout in chapter 9 of To Kill a Mockingbird. He hears that Scout has been swearing up a storm to get attention, recently; so, he tells her that while he is visiting them for the week of Christmas, he doesn't want to hear any of her bad words. When she and Francis get in a fight, apparently Scout calls her cousin "a whore-lady" and jumps on him. When Jack discovers this, he says, "You know I told you you'd get in trouble if you used words like that? I told you, didn't I? . . . Well, you're in trouble now. Stay there" (84).

As Uncle Jack is spanking Scout, she screams that she hates him, she'll hate him for the rest of her life, and she'll never speak to him again. Now the external conflict is how tough it is for him to hurt Scout physically. The internal conflict is dealing with Scout's resentment after being physically punished by her favorite uncle. These conflicts seem to go hand-in-hand because afterwards, Jack asks Scout, "Why, I didn't think you'd hold it against me. . . I'm disappointed in you--you had that coming and you now it" (85).

Therefore, externally, Uncle Jack is faced with having to deal with Scout's decision to use a bad word and him having to hold himself to his threat to spank her. Then, he is faced with the internal and emotional backlash of having disciplined Scout for her actions. Both conflicts damage the relationship between the two of them until the truth is revealed about why Scout called Francis a "whore-lady"--to defend Atticus. Later, Atticus tells his brother the following:

". . . you had the right answer this afternoon, but the wrong reasons. Bad language is a stage all children go through, and it dies with time when they learn they're not attracting attention with it. Hotheadedness isn't. Scout's got to learn to keep her head and learn soon" (87).

In the end, Uncle Jack decides to keep the reason Scout used bad words with Francis a secret by not telling Atticus. This helps to mend his relationship with Scout and solve both external and internal conflicts for the future.

What are natural treatments for aging skin?

Introduction

The substances collagen and elastin give skin its firmness and elasticity.
With age, though, the collagen and elastin content of the skin gradually
decreases. As a result, the skin becomes looser, weaker, less elastic, and drier.
In addition, the fat pads under the skin begin to disappear. Wrinkles form, and
the skin begins to sag.

This gradual loss of structure has several causes: genetic programming (a built-in
“clock” that causes aging), cumulative sun damage (photoaging), and direct
chemical effects from cigarette smoking or abrasive chemicals, or both. Sun damage
also causes fine wrinkles that disappear when stretching the skin, surface
roughness, mottled pigmentation, “liver” spots, and skin
cancer.

In people who already have signs of aging skin and wish to reverse it, a number of
treatments are available. The drug tretinoin (retinoic acid, or Retin-A), a
substance related to vitamin A, has been shown effective for reversing the fine
wrinkles, splotchy pigmentation, and rough skin of sun damage. The hormone
estrogen is thought to help restore normal skin tone in
menopausal women, but the evidence for this widely held belief remains weak.

More aggressive treatments for aging skin include injections of botulin toxin,
dermabrasion, chemical peels, soft tissue augmentation, laser resurfacing, and
Gore-Tex threads.

Principal Proposed Natural Treatments

Two classes of natural treatments have shown promise in the treatment of aging skin: alpha-hydroxy acids (AHAs) and antioxidants. However, the evidence that they work remains incomplete, and AHAs can cause significant side effects.

Alpha-hydroxy acids. Alpha-hydroxy acids, such as glycolic acid
and lactic
acid, are substances derived from fruit and dairy products.
These are milder relatives of the substances used by dermatologists in chemical
peels, which are designed to remove damaged layers of the skin. Cosmetics
manufacturers are now adding AHAs to many skin-care products.

Meaningful evidence in support of AHAs comes from one double-blind, placebo-controlled study reported in 1996. This twenty-two-week study enrolled seventy-four women with sun-damaged skin. Participants received either 8 percent glycolic acid, 8 percent L-lactic acid, or placebo cream and applied it to the face and forearm. Although participants showed improvements in each of the three groups, superior results were achieved with each of the AHA creams than with the placebo cream. Another double-blind study compared estrogen cream, glycolic acid cream, and their combination with placebo. Both estrogen and glycolic acid improved skin aging.

AHAs are not always harmless. Possible side effects include burning, blistering,
severe redness, swelling (especially in the area of the eyes), bleeding, rash, and
increased sensitivity to the sun. There are also concerns that AHAs may increase
the risk of skin cancer. For all these reasons, the U.S. Food and Drug
Administration continues to investigate the use of AHAs in
cosmetic products to determine whether they should be reclassified as drugs.

Antioxidants. The ultraviolet light from the sun creates
free
radicals, naturally occurring substances that can harm many
tissues of the body, including the skin. Antioxidants
are substances that neutralize free radicals. On this basis, various antioxidants
have been investigated for their potential usefulness in treating or preventing
photoaging.

A small, three-month, double-blind, placebo-controlled study found benefit with a cream containing 5 percent alpha-lipoic acid. The use of this antioxidant substance improved several measures of aging skin especially skin roughness, compared with placebo. Benefits have also been seen in preliminary studies with a cream containing vitamin C. In a small double-blind study, the use of mixed antioxidants (lycopene, beta-carotene, vitamin E, and selenium) for twelve weeks improved skin roughness and scaling.

Oligomeric
proanthocyanidin complexes (OPCs) made from grape seed or
pine bark are widely marketed for the treatment of aging skin. These substances,
closely related to bioflavonoids, have antioxidant properties and might also
protect and strengthen collagen and elastin. These effects provide theoretical
reasons to believe that OPCs might be helpful for the treatment of aging skin.
However, despite widespread marketing, no properly designed studies have been
reported to indicate that OPCs provide any benefit.

In an eight-week, double-blind, placebo-controlled study of forty women who already had sun-damaged skin, the combined use of oral green tea and a topical green tea cream failed to prove more effective than placebo in improving the condition of sun-damaged skin. Some possible benefits were seen in microscopic evaluation of skin condition.

Studies on laboratory animals found that topical vitamin C and vitamin E helped prevent burning on exposure to ultraviolet light. A small double-blind study found that 2 grams (g) of vitamin C and 1,000 international units (IU) of vitamin E taken orally for eight days resulted in a modest decrease of sunburn induced by ultraviolet light. In addition, a fifty-day, placebo-controlled study of forty people found that higher doses of these vitamins provided a sun protection factor (SPF) of about 2.16. (The sun protection factor is 15 or higher in many sunscreens.) It appears that these vitamins must be taken together for best effect; when used alone, they do not appear to work.

The oral use of beta-carotene, lycopene, and other carotenoids
has shown preventive effects in some studies. Benefits have also been seen with
mixtures of various antioxidants taken together (vitamin E, zeoxanthin, lutein,
beta-carotene, and others).

Oral vitamin A has shown some promise for preventing skin cancer in people at risk for it, but the doses used in studies were quite high, considerably above recommendations for the maximum safe dose. Vitamin A should not be used with the drug tretinoin.

Topical vitamin A may be helpful for treatment of aging skin. One double-blind, placebo-controlled study found that a 0.4 percent vitamin A lotion applied three times a week significantly reduced the number of “fine” wrinkles in seniors. Benefits were also seen in terms of some biochemical measures of skin health.

Because these antioxidants work in an entirely different manner from standard sunscreen, it is reasonable to believe that they could offer a synergistic effect if taken while using sunscreen. However, this hypothesis has not been studied.

Other substances with antioxidant actions that have shown some promise for treating or preventing aging skin include cocoa, Vitis vinifera extract, milk thistle, and zinc. However, the supporting evidence that the use of these substances (taken either orally or topically) offers any benefit for the skin remains far too preliminary to be relied upon.

Any discussion of the potential benefits of antioxidants for preventing cancer must include the startling finding of a large study that tested the effect of mixed antioxidants. This trial, enrolling 7,876 women and 5,141 men, evaluated the potential benefits of a combination of vitamin C, vitamin E, beta-carotene, selenium, and zinc for preventing cancer. According to results published in 2007, no benefits were seen among the male participants, but among women, skin cancer rates actually appeared to increase. The cause of these findings remains unclear.

Other Proposed Natural Treatments

In a double-blind study of fifty women with signs of aging skin, the use of
topical niacinamide cream significantly improved skin appearance and elasticity
compared with placebo cream. A study published in 2007 tested a purified soy
isoflavone product (technically, isoflavone aglycones) for
treatment of aging skin. In this double-blind trial, twenty-six Japanese women in
their late thirties and early forties were given either placebo or 40 milligrams
(mg) daily of soy isoflavone aglycones for twelve weeks. Researchers monitored two
types of wrinkles near the eye: “fine” wrinkles and “linear” wrinkles. The results
indicated that the use of the soy product significantly reduced fine wrinkles
compared with placebo. (Effects on linear wrinkles were not significant.) As a
secondary measure, researchers also analyzed skin elasticity and found an
improvement in the women given the isoflavones compared to those given
placebo.

An unusual soy extract containing soybean trypsin inhibitor and Bowman-Birk protease inhibitor has also shown promise for aging skin. Sixty-five women with moderate skin damage from the sun received either soybean extract or placebo cream for twelve weeks. Compared to the women in the placebo group, treated women showed an improvement in mottled pigmentation, blotchiness, dullness, and fine lines, and an overall enhancement of texture, skin tone, and appearance.

The substance glucosamine is widely used for osteoarthritis, in part
because it seems to help collagen regenerate. For this reason, it has been
advocated as a treatment for aging skin. However, the only evidence that it works
comes from one poorly designed study. In this single-blind trial, seventy-two
women with symptoms of aging skin were divided into two unequal groups: a small
group that received no treatment and a much larger one that received a proprietary
mixture of glucosamine, amino acids, and minerals. The results indicated greater
improvement in the treated group compared to the untreated group. However, because
this was not a double-blind, placebo-controlled study, the results cannot be taken
as reliable.

The mineral silicon also has been proposed as a treatment for aging skin. In the one potentially meaningful published study, fifty women with sun-damaged skin were given either 10 mg silicon daily (as orthosilicic acid) or placebo for twenty weeks. Measurements of skin roughness and elasticity showed improvement in the silicon group compared with the placebo group. However, this study, performed by the manufacturer of a silicon product, was not well designed or well reported.

A proprietary dietary supplement containing soy, fish protein polysaccharides, white tea extract, and many other ingredients has also shown promise, according to a study performed by the manufacturer. Another study provides weak evidence that the substance DHEA (dehydroepiandrosterone) might be helpful for improving skin condition in the elderly.

In a preliminary double-blind study, coriander oil applied topically was more effective than a placebo cream at reducing redness from UVB exposure. This effect may or may not translate into long-term benefit for aging sun-damaged skin.

Numerous herbs and other natural products have been advocated for the treatment of aging skin. These products include aloe, Arnica, calendula, chamomile, dead sea minerals, gotu kola, para-aminobenzoic acid, thuja, and vitamin A. Other products claim to contain biological substances called growth factors (with names such as IGF-1, IGF-2, TGF-A, TGF-B, EGF, and FGF) and go on to claim that these growth factors improve skin condition. Still others claim to raise levels of human growth hormone in the body and, therefore, help produce youthful skin. However, there is no meaningful evidence that any of these treatments work.

Acupuncture face lifts are widely available for treating
facial wrinkles. They involve a series of treatments in which fine needles are
inserted into the face. However, there is no evidence to indicate that this method
produces any benefit.

Herbs and Supplements to Use with Caution

The herb St.
John’s wort contains a substance, hypericin, that increases
the skin’s sensitivity to the sun. For this reason, it is possible that the use of
St. John’s wort could accelerate sun damage of skin. Also, persons using the drug
Retin-A should not take high doses of vitamin A, as each might increase the
toxicity of the other.

Bibliography

Bissett, D. L., et al. “Niacinamide: A B Vitamin That Improves Aging Facial Skin Appearance.” Dermatological Surgery 31 (2005): 860-865.

Chiu, A. E., et al. “Double-Blinded, Placebo-Controlled Trial of Green Tea Extracts in the Clinical and Histologic Appearance of Photoaging Skin.” Dermatological Surgery 31 (2005): 855-860.

Cornacchione, S., et al. “In Vivo Skin Antioxidant Effect of a New Combination Based on a Specific Vitis vinifera Shoot Extract and a Biotechnological Extract.” Journal of Drugs in Dermatology 6 (2007): 8-13.

Elmets, C. A., et al. “Cutaneous Photoprotection from Ultraviolet Injury by Green Tea Polyphenols.” Journal of the American Academy of Dermatology 44 (2001): 425-432.

Fuchs, K. O., et al. “The Effects of an Estrogen and Glycolic Acid Cream on the Facial Skin of Postmenopausal Women.” Cutis 71 (2003): 481-488.

Greul, A. K., et al. “Photoprotection of UV-Irradiated Human Skin: An Antioxidative Combination of Vitamins E and C, Carotenoids, Selenium, and Proanthocyanidins.” Skin Pharmacology and Applied Skin Physiology 15 (2002): 307-315.

Heinrich, U., K. Neukam, et al. “Long-Term Ingestion of High Flavanol Cocoa Provides Photoprotection Against UV-Induced Erythema and Improves Skin Condition in Women.” Journal of Nutrition 136 (2006): 1565-1569.

Heinrich, U., H. Tronnier, et al. “Antioxidant Supplements Improve Parameters Related to Skin Structure in Humans.” Skin Pharmacology and Physiology 19 (2006): 224-231.

Hercberg, S., et al. “Antioxidant Supplementation Increases the Risk of Skin Cancers in Women but Not in Men.” Journal of Nutrition 137 (2007): 2098-2105.

Kafi, R., et al. “Improvement of Naturally Aged Skin with Vitamin A (Retinol).” Archives of Dermatology 143 (2007): 606-612.

Skovgaard, G. R., A. S. Jensen, and M. L. Sigler. “Effect of a Novel Dietary Supplement on Skin Aging in Post-menopausal Women.” European Journal of Clinical Nutrition 60 (2006): 1201-1206.

Wallo, W., J. Nebus, and J. J. Leyden. “Efficacy of a Soy Moisturizer in Photoaging.” Journal of Drugs in Dermatology 6 (2007): 917-922.

What are three examples that reveal how the narrator of "The Tell-Tale Heart" is insane?

Good question! We get the general impression that the narrator has totally lost touch with reality, but what evidence can we point to that supports this idea? Let's see:

1. "True!—nervous—very, very dreadfully nervous I had been and am, but why will you say that I am mad?"

Here, the narrator is saying, "Yeah, yeah, I'm nervous, but—crazy? No, not crazy!" The fact that he's denying that he's crazy ("mad") is a good hint that he...

Good question! We get the general impression that the narrator has totally lost touch with reality, but what evidence can we point to that supports this idea? Let's see:

1. "True!—nervous—very, very dreadfully nervous I had been and am, but why will you say that I am mad?"

Here, the narrator is saying, "Yeah, yeah, I'm nervous, but—crazy? No, not crazy!" The fact that he's denying that he's crazy ("mad") is a good hint that he truly is crazy. Why else would he bring it up, or be so defensive about it?

2. "I loved the old man. He had never wronged me. He had never given me insult. For his gold I had no desire. I think it was his eye! yes, it was this! He had the eye of a vulture—a pale blue eye, with a film over it."

In the quote above, the narrator is saying that the old man is a good guy, a friend even, and there's no reason to hate him or want to kill him. Yet he's got a weird-looking eye. That's insane! Sure, someone's physical flaw might creep you out or make you feel uncomfortable, but if you're in your right mind, that flaw won't make you want to kill that other person.

3. "You fancy me mad. Madmen know nothing. But you should have seen me. You should have seen how wisely I proceeded—with what caution—with what foresight—with what dissimulation I went to work!"

Here, the narrator is saying, "Well, you think I'm crazy, but I'm not, because look how carefully I planned this murder!" This is both funny and a perfect example of insane reasoning. You can't disprove craziness by pointing out how detailed the murder plan is. That just supports the idea that the narrator has lost his mind.