What is shiatsu? |

Overview

Shiatsu, a Japanese word meaning “finger pressure,” is a traditional, noninvasive healing technique in which the fingertips and especially the thumbs are used to apply pressure along the body’s meridian system to unblock energy dams and reinstate optimal energy flow. This energy, called qi in Chinese and ki in Japanese, is considered the essence of life. The underlying belief is that unbalanced energy invites illness and injury.

The Chinese introduced shiatsu into Japan more than fifteen hundred years ago. In 1940, the Japan Shiatsu College was founded by Tokujiro Namikoshi to systematically train shiatsu practitioners in anatomy, physiology, and therapeutic technique. The localized deep-muscle stimulation, sometimes referred to as “acupuncture without needles,” is believed to induce a healing response.

Mechanism of Action

Shiatsu is performed on a large quilted floor mat with the client lying down. No massage oil is used, and the client may remain dressed in comfortable clothing. The practitioner finds the energy points on each of the fourteen meridians along the body and works them to trigger the release of endorphins, which in turn reduce blood pressure, increase circulation, and stimulate lymphatic drainage.

Shiatsu also involves the rotating and stretching of the joints to straighten the pathways. In areas of low energy, long stretches will allow energy to flow in, as will pressure held for ten to fifteen seconds. Conversely, quick stretches and brief periods of pressure will dispel excess energy that has built up.

Shiatsu is considered a method of touch communication, as the practitioner reads the energy flow of the client and assesses overall health. By the end of a session, the client may express an emotional release, such as by crying or laughing. The caring touch of the shiatsu practitioner is thought to arouse the self-healing response within the client.

Uses and Applications

Shiatsu is used to improve body function, to release tension, and to improve circulation for relief from stress. It quiets an overstimulated sympathetic nervous system. It also stimulates the release of endorphins, natural painkillers produced by the body, and excites the immune system. These effects make shiatsu beneficial for targeting muscular, internal, and emotional pain. In addition to bringing relief from discomfort, shiatsu also imparts a calmer mind, clearer thinking, and a general sense of well-being. Self-shiatsu may be performed, often in combination with yoga breathing, meditation, and sound therapy.

In Japan, shiatsu has been recognized and regulated as a distinct health profession since the mid-twentieth century. It is indicated for nervous system disorders such as neuralgia; for stroke recovery, polio, and insomnia; for digestive system disorders such as chronic enteritis and constipation; and for metabolic disorders such as gout. It is contraindicated in cases of trauma, internal bleeding, malignancies, ulcers, active infections, acute inflammation, and blood vessel disease.

Scientific Evidence

In double-blind studies, shiatsu has been shown to improve the quality of sleep for elderly nursing home residents with sleep disturbances and to reduce agitation in elderly nursing home residents with dementia. It increased arm movement and decreased depression in persons recovering from hemiplegia stroke. The use of shiatsu was significantly correlated with increasing body weight in premature babies. It reduced chronic low back pain more effectively than physical therapy, and improvement was still evident at the six-month follow-up. However, studies have failed to show that shiatsu is any more effective than placebo at preventing nausea and vomiting in surgical patients, in emergency room patients with fractures, and in women in labor.

Choosing a Practitioner

Reputable practitioners of shiatsu in the United States should have graduated from an accredited massage therapy school and must practice in accordance with each state’s respective licensing requirements. The term “Shiatsupractor” (a registered trademark of the International Shiatsu Association) is a title recognized around the world and is given to those who have completed formal education and training as a professional shiatsu practitioner.

Safety Issues

Shiatsu should not be performed on persons who are prone to blood clots because there is a risk that the localized pressure could dislodge clots. This massage technique should not be applied directly over open wounds, inflamed skin or rashes, bruises, tumors, hernias, mending bone fractures, or surgical sites. It is not recommended for pregnant women, for people with osteoporosis, or for people who have recently undergone chemotherapy or radiation therapy.

Bibliography

American Organization for Bodywork Therapies of Asia. http://www.aobta.orga.

Beresford-Cooke, Carola. Shiatsu Theory and Practice. 3d ed. New York: Churchill Livingstone/Elsevier, 2010. This illustrated textbook includes a DVD of shiatsu techniques and routines.

Liechti, Elaine. Shiatsu: Complete Illustrated Guide. Rockport, Mass.: Element Books, 2002. In addition to the history of shiatsu and diagrams of techniques and pressure points, this book contains information on self-shiatsu.

Lundberg, Paul. The Book of Shiatsu: A Complete Guide to Using Hand Pressure and Gentle Manipulation to Improve Your Health, Vitality, and Stamina. New York: Fireside Books, 2003. Written by a master shiatsu practitioner and instructor. An authoritative guide that also presents many color drawings and photographs.

Shiatsu Diffusion Society. http://shiatsupractors.org.

Somma, Corinna. Shiatsu. Upper Saddle River, N.J.: Prentice Hall, 2006. This textbook includes protocols for the various client positions and study questions and chapter tests.

What is Werner syndrome? |

Risk Factors

The Werner syndrome (WRN) gene is transmitted as an autosomal recessive trait. The risk for Werner syndrome is related to the level of consanguinity (close relation) in a population.

In the United States, Werner syndrome occurs in approximately 1 in 200,000 births. However, it is more common in the Japanese population (approximately 1 in 20,000 to 1 in 40,000; based on the frequencies of detectable heterozygous mutations). This is likely the result of a founder mutation in the Japanese population.

Etiology and Genetics

The WRN gene is located on chromosome 8 (cytogenetic location: 8p12-p11.2) and codes for a DNA helicase belonging to the RecQ family. This DNA helicase normally plays an important role in cell division, maintenance, and repair of DNA, and the regulation of telomeres. DNA helicases are critical for preserving genome integrity. The molecular role of the WRN gene in Werner syndrome is not yet known. Mutations in the WRN gene (also called RECQL2 or REQ3) lead to the production of an abnormally short, nonfunctional Werner protein. This mutated form of WRN cannot interact with DNA, probably because of defective transport of the WRN protein to the nucleus. It is thought that cells with the mutated form of WRN may divide more slowly or stop dividing earlier than normal, thus causing growth problems. Additionally, without a functional WRN protein, DNA damage may accumulate that could prevent normal cell functions and cause the health problems seen in Werner syndrome. The genome of Werner syndrome cells is highly unstable, with large, spontaneous DNA deletions. Telomere length dynamics are abnormal—that is, as cells divide, telomeres shorten more rapidly than normal. The unstable genome of Werner syndrome cells may play a key role in the pathogenesis of Werner syndrome.

So far, fifty distinct mutations have been discovered since the WRN gene was first cloned in 1996. All these mutations result in the elimination of the nuclear localization signal, thus impeding any functional interactions in the nucleus.

Symptoms

The age of onset of Werner syndrome is variable, but patients develop normally until they reach puberty. One of the first signs of Werner syndrome is the lack of a growth spurt in the early teen years, which results in short stature. After puberty, patients begin to age rapidly, and by age forty, they appear several decades older than they are.

The cardinal signs and symptoms (onset after age ten years) of Werner syndrome include cataracts in both eyes; characteristic skin patterns (tight skin, atrophic skin, pigmentary alterations, ulceration, hyperkeratosis, regional subcutaneous atrophy); characteristic birdlike faces (nasal bridge appears pinched and subcutaneous tissue is diminished); short stature; premature graying and/or thinning of scalp hair; and parental consanguinity (third cousin or closer) or affected sibling.

Additional signs and symptoms include Type II diabetes mellitus; hypogonadism (secondary sexual underdevelopment, diminished fertility, testicular or ovarian atrophy); osteoporosis; osteosclerosis of distal phalanges of fingers and/or toes; soft-tissue calcification; premature atherosclerosis (history of myocardial infarction); neoplasms; abnormal voice (high-pitched, squeaky, or hoarse); and flat feet.

Screening and Diagnosis

In families in which the disease-causing mutations have been identified in an affected family member, prenatal screening (genetic testing) is available and family members may be tested. Diagnosis is based on the presence of the cardinal signs and symptoms of Werner syndrome.

Treatment and Therapy

There is no cure for Werner syndrome. Therapy is based on the treatment of symptoms: aggressive treatment of skin ulcers with standard therapies; control of Type II diabetes mellitus (promising results have been reported with the use of pioglitazone); cholesterol-lowering drugs if the lipid profile is abnormal; surgical treatment of ocular cataracts; treatment of malignancies in a standard fashion (except that radiation therapy is not used, as it may do more harm than good to those with Werner syndrome). Current clinical trials are studying the treatment of symptoms. Preliminary laboratory findings suggest restoring normal WRN function in cells from a patient with Werner syndrome may correct the molecular defects.

Prevention and Outcomes

Early diagnosis is useful so that screening for cancer and associated diseases such as diabetes can then be performed on a regular basis. Genetic counseling for patients and their family is advised.

Patients usually live to their late forties or early fifties, the most common cause of death being cancer or atherosclerosis.

Bibliography

Ariyoshi, Kentaro, et al. “Introduction of a Normal Human Chromosome 8 Corrects Abnormal Phenotypes of Werner Syndrome Cells Immortalized by Expressing an hTERT Gene.” Journal of Radiation Research 50.3 (2009): 253–59. Print.

Chen, Lishan, and Junko Oshima. “Werner Syndrome.” Journal of Biomedicine and Biotechnology 2.2 (2002): 46–54. Print.

Coppede, Fabio. "The Epidemiology of Premature Aging and Associated Comorbidities." Clinical Interventions in Aging 8 (2013): 1023–32. Print.

Goto, Makoto, Robert W. Miller, and Nihon Gan Gakkai. From Premature Gray Hair to Helicase-Werner Syndrome: Implications for Aging and Cancer. Tokyo: Japan Scientific Societies, 2001. Print.

Muftuoglu, Meltem, et al. “The Clinical Characteristics of Werner Syndrome: Molecular and Biochemical Diagnosis.” Human Genetics 124.4 (2008): 369–77. Print.

Parker, Philip M. Werner Syndrome: A Bibliography and Dictionary for Physicians, Patients, and Genome Researchers. San Diego: Icon Group Intl., 2007. Print.

"Werner Syndrome." Genetics Home Reference. Natl. Lib. of Medicine, Dec. 2012. Web. 2 Sept. 2014.

What are date rape drugs?

Common Date Rape Drugs

Rohypnol (flunitrazepam), gamma hydroxybutyrate (GHB), and ketamine are common date rape drugs. Alcohol and MDMA (3,4-methylenedioxy-methamphetamine, also known as ecstasy or Molly) are also used to commit sexual assaults. All of these drugs affect judgment and behavior and can put a person at risk for sexual assault or risky sexual activity.

Rohypnol use began to gain popularity in the United States in the early 1990s. It is a benzodiazepine (chemically similar to sedative-hypnotic drugs such as Valium or Xanax) and is illegal in the United States. It is legal in Europe and Mexico, where it is prescribed for sleep problems and used for anesthesia. It is exported to the United States illegally.

Rohypnol is a pill that dissolves in liquid. Some of these pills are small, round, and white. Newer pills are oval and green-gray in color. When placed into a drink, the pills’ dye makes clear liquids turn bright blue and dark drinks turn cloudy. However, this color change is often difficult to see in a dark drink, such as cola or dark beer, or in a darkened room, such as a nightclub or bar. Also, pills with no dye are still available. The pills also can be ground into a powder.

GHB (Xyrem) is a central nervous system depressant that was approved by the US Food and Drug Administration (FDA) in 2002 for use in the treatment of narcolepsy (a sleep disorder). This approval came with severe restrictions, including its use only for the treatment of narcolepsy, and with the requirement that it be monitored by the FDA through a patient registry.

GHB also is a metabolite of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). It exists naturally in the brain, but at much lower concentrations than those found when GHB is abused. GHB comes in a few forms: a liquid with no odor or color, a white powder, and a pill. It can make a drink taste slightly salty.

Ketamine is legal in the United States for use as an anesthetic for humans and animals. It is mostly used with animals. Veterinary clinics are sometimes burglarized for their ketamine supplies. Ketamine comes as a liquid and a white powder.

Effects on the Human Body

The sedative-hypnotic effects of date rape drugs are powerful. The drugs can affect a person quickly and without that person’s knowledge, which makes them especially appealing to potential perpetrators of assault. The length of time that the effects last varies and depends on how much of the drug is taken and if the drug is mixed with other drugs or alcohol. Alcohol makes the drugs even stronger and can cause serious health problems, even death.

The effects of Rohypnol occur within thirty minutes of ingestion and can last for several hours. A victim may look and act like someone who is drunk. He or she might have trouble standing, might have slurred speech, or might pass out. GHB takes effect in about fifteen minutes and can last three or four hours. A small amount of GHB can have a big effect. Ketamine is fast-acting. A victim might be aware of what is happening but unable to move. Ketamine also causes memory problems. Later, a victim might not remember what occurred while drugged.

It is often difficult for a person to know if he or she has been drugged and assaulted. Most victims do not remember details of the incident. The victim might not be aware of the attack until eight or twelve hours after it occurred, after the drug effects wear off.

Date rape drugs can leave the body quickly. By the time a victim receives help, the drug involved in the attack is likely out of the person’s system. However, there are other signs that indicate a person might have been drugged, including the following, in which the person feels drunk and has not had any alcohol or feels like the effects of drinking alcohol are stronger than usual; wakes up feeling hung over and disoriented or having no memory of a period of time; remembers having a drink, but cannot recall anything after that; finds that his or her clothes are torn or are not fitting properly; or feels like he or she had sex but cannot remember having sex.

Persons who have ingested a date rape drug should get medical care immediately. As with any sexual assault, it is important that the victim not urinate, douche, bathe or shower, brush teeth, wash hands, change clothes, or eat or drink before seeing a medical professional. Doing so may destroy evidence of the assault. The hospital will use a rape kit to collect any evidence. The victim should ask the hospital to take a urine sample that can be used to test for date rape drugs. Rohypnol stays in the body for several hours and can be detected in the urine up to seventy-two hours after ingestion. GHB leaves the body within twelve hours.

Bibliography

Adams, Colleen. Rohypnol: Roofies—“The Date Rape Drug.” New York: Rosen, 2007. Print.

Albright, J. A., S. A. Stevens, and D. J. Beussman. “Detecting Ketamine in Beverage Residues: Application in Date Rape Detection.” Drug Testing and Analysis 4.3–4 (2011). Print.

“Commonly Abused Drugs Chart.” National Institute on Drug Abuse. NIH, Oct. 2015. Web. 29 Oct. 2015.

“DrugFacts: MDMA (Ecstasy or Molly).” National Institute on Drug Abuse. NIH, Sept. 2013. Web. 29 Oct. 2015.

Németh, Z., B. Kun, and Z. Demetrovics. “The Involvement of Gamma-Hydroxybutyrate in Reported Sexual Assaults: A Systematic Review.” Journal of Psychopharmacology 24.9 (2010): 1281–87. Print.

Discuss the irrationality of the mob in scene three of Act lll in Julius Caesar. How does this prove that being uninformed is dangerous? Do we see...

The question refers to Act lll, scene lll, when the mob attacks Cinna the poet. Since he bears the same name as Cinna the conspirator, they decide to kill him. When he pleads for his life and cries out that he is Cinna the poet, they are so driven by their lust for blood and revenge, that they shout that he should be torn to pieces for his bad verses. The innocent Cinna loses his life because the mob has become a savage, bloodthirsty force that has lost all reason.

It was Antony's highly emotive speech whilst standing next to the slain Caesar's bloody body in the market, that drove the crowd into a frenzy. Antony's speech had manipulated them to such an extent that they turned away from Brutus and demanded his blood and vengeance on all those who conspired with him in Caesar's assassination.

The idea of the mob being uninformed is somewhat problematic. An assumption that they are uninformed about why Caesar had been killed would not be entirely correct since Brutus had admitted to being an assassin. He also, most eloquently, gave reasons why Caesar's death was necessary. The crowd then responded with praise for Brutus and his co-conspirators for having had their good interests at heart and rescuing Rome from a possible tyrant.

The crowd was swayed by Brutus' fluency and were positive about what had been done. It was Antony's articulate appeal to their emotions, his use of clever rhetoric, as well the provision of proof relating to Caesar's generosity, that turned the mob against the conspirators.

One can, therefore, say that they were well-informed and that their actions were not the result of not knowing anything but were the consequence of knowing so much. They were driven by emotion, not ignorance.

The idea that 'uninformed' refers to the throng being uneducated is more accurate. Most of the multitude were common labourers and servants of the privileged. They were, therefore, more in touch with their instincts and emotions and, as such, easily manipulated by both Brutus' and Antony's rhetoric. The fact that they could o easily switch allegiance from the one to the other proves this. 

Yes, the same mob mentality exists even today and it does not matter whether the mob is educated or not. Once people are driven by their emotions, they relinquish reason and lose themselves in the mass. Individual identity is sacrificed. This type of behaviour is illustrated whenever there is a riot or a protest which turns violent.

We are currently witnessing it in protests at South African university campuses where students have become violent and destructive. We also saw it in the streets of a few American cities in the recent past in protests against police prejudice and racism. We were also witnesses to this sort of behaviour during Euro 2016 when fans clashed in the streets.  

In Animal Farm by George Orwell, in what ways did Boxer work harder than the other animals?

Boxer, being the biggest and strongest animal on the farm, adopted the maxim, "I will work harder!" soon after the Rebellion. He was keen to do his best for the good of all and was motivated by the freedom the animals experienced at the time. His commitment is clearly illustrated in the following excerpt from chapter three:

Boxer was the admiration of everybody. He had been a hard worker even in Jones's time, but now he seemed more like three horses than one; there were days when the entire work of the farm seemed to rest on his mighty shoulders. From morning to night he was pushing and pulling, always at the spot where the work was hardest. He had made an arrangement with one of the cockerels to call him in the mornings half an hour earlier than anyone else, and would put in some volunteer labour at whatever seemed to be most needed, before the regular day's work began. His answer to every problem, every setback, was "I will work harder!"—which he had adopted as his personal motto.

It was after Snowball's expulsion by Napoleon that Boxer really proved his mettle. Three Sundays after Snowball's removal, Napoleon declared that the plans for the building of a windmill had actually been his idea and that they would start erecting it. The construction, however, presented a number of problems since the animals had to drag huge stones from the bottom of the quarry to the top, where they would then be toppled over the edge to shatter into manageable pieces below. 

This was a slow and very difficult process, but Boxer inspired everyone with his hard work. Whenever Boxer encountered a problem, including when a boulder was ready to slip, he would use every ounce of his strength to stop it from rolling back into the quarry, as revealed in chapter 6:

Nothing could have been achieved without Boxer, whose strength seemed equal to that of all the rest of the animals put together. When the boulder began to slip and the animals cried out in despair at finding themselves dragged down the hill, it was always Boxer who strained himself against the rope and brought the boulder to a stop. To see him toiling up the slope inch by inch, his breath coming fast, the tips of his hoofs clawing at the ground, and his great sides matted with sweat, filled everyone with admiration. Clover warned him sometimes to be careful not to overstrain himself, but Boxer would never listen to her. His two slogans, "I will work harder" and "Napoleon is always right," seemed to him a sufficient answer to all problems.

Later in the novel, Boxer gave specific instructions so he could do even more work:

He had made arrangements with the cockerel to call him three-quarters of an hour earlier in the mornings instead of half an hour. And in his spare moments, of which there were not many nowadays, he would go alone to the quarry, collect a load of broken stone, and drag it down to the site of the windmill unassisted.

He was even prepared to come out at nights during the harvest moon to do extra labor.

Unfortunately, the half-built structure was destroyed during a terrible storm and the animals had to start all over again, but Boxer was up to the task. After the animals' exhausting efforts finished by autumn, the windmill was finally finished, but tragedy struck again when Frederick and his men blew it to pieces. Once again, it had to be rebuilt and, once again, Boxer proved his mettle and dedication. 

Boxer worked so hard that it eventually affected his health. He suffered a split hoof, which took a long time to heal. We read in chapter nine, however, that he refused to give up:

Boxer refused to take even a day off work, and made it a point of honour not to let it be seen that he was in pain. In the evenings he would admit privately to Clover that the hoof troubled him a great deal. Clover treated the hoof with poultices of herbs which she prepared by chewing them, and both she and Benjamin urged Boxer to work less hard. "A horse's lungs do not last for ever," she said to him. But Boxer would not listen. He had, he said, only one real ambition left—to see the windmill well under way before he reached the age for retirement.

Once Boxer's hoof was healed, he worked harder than ever. He had, however, lost much of his vitality and looked weaker than ever before, but continued working, even though Clover and Benjamin expressed concern and asked him to look after his health. He only repeated his motto, "I will work harder!" and continued to work.

Boxer's hard work was never really rewarded. We read in chapter nine that he fell desperately ill and was lying on his side with blood trickling from his mouth. The poor beast believed that he would be able to retire and then live a life of comfort and relaxation. It was not to be. The pigs sold him to the knacker and bought a case of whiskey with the proceeds. Squealer later spun a story about how bravely Boxer had passed away, stating his last words were to encourage the other animals by whispering in his final breath:

"'Forward in the name of the Rebellion. Long live Animal Farm! Long live Comrade Napoleon! Napoleon is always right.' Those were his very last words, comrades."

1. Who has been more successful Bob or Jimmy? 2. How does Bob describe Jimmy--strengths and weakness? 3. Based on his actions, describes Bob...

Bob has only been superficially more successful than Jimmy. Bob has some flashy clothes and accessories, but he has no home, no family, no friends (except Jimmy), no roots, and he is continually on the lam. He is wanted by the Chicago police and may be facing a long term in jail. Jimmy does not make a lot of money, but he has a secure job with the New York police and will get a...

Bob has only been superficially more successful than Jimmy. Bob has some flashy clothes and accessories, but he has no home, no family, no friends (except Jimmy), no roots, and he is continually on the lam. He is wanted by the Chicago police and may be facing a long term in jail. Jimmy does not make a lot of money, but he has a secure job with the New York police and will get a pension when he retires. Jimmy undoubtedly is married and has a home and family. He obviously likes his work. He is proud of his uniform. He is respected. He probably has a wide circle of friends. He has no serious worries, unlike Bob who is always looking over his shoulder for fear that the law is catching up with him. Bob brags and shows off the symbols of his monetary success, but he is not a happy man. He travels a thousand miles just to see his only friend--and finds out that his friend can no longer be his friend because he has become a cop who turns him over to the Chicago police. For twenty years the two men have traveled down two different roads.

Bob describes Jimmy with these phrases--not knowing he is talking to Jimmy in person:

"...for he always was the truest, staunchest old chap in the world."

"He was a kind of plodder, though, good fellow as he was."

Based on Bob's actions, the reader pictures him as a flamboyant, materialistic, ambitious, loquacious, superficial, and dishonest con artist who has cultivated a friendly persona he uses to beguile and manipulate people. He starts off trying to manipulate Jimmy the moment he appears, never giving him a chance to introduce himself as the old friend Bob has been waiting for. Bob might be described in the vernacular as "a cheap crook."

In the book A Long Way From Chicago, what caused a commotion at Shotgun's wake?

In the book, a great commotion was caused at Shotgun's wake when the gauze that hung over the open coffin moved mysteriously. As the gauze began rippling and puckering on one end, the vigil attendees became visibly frightened. The suddenly mobile hearse cloth had changed a respectable vigil into a seemingly macabre, paranormal experience; it gave the impression that the deceased man was desperately trying to come back to life.

When the reporter realized what...

In the book, a great commotion was caused at Shotgun's wake when the gauze that hung over the open coffin moved mysteriously. As the gauze began rippling and puckering on one end, the vigil attendees became visibly frightened. The suddenly mobile hearse cloth had changed a respectable vigil into a seemingly macabre, paranormal experience; it gave the impression that the deceased man was desperately trying to come back to life.

When the reporter realized what was happening, he miraculously snapped out of his alcohol-induced stupor. It was at this time that Grandma Dowdel grabbed her twelve-gauge Winchester rifle and fired off both barrels. She blew the lid off the coffin and sprayed bullets above the heads of the terrified mourners. The reporter was so terrified that he didn't dare find his way to the door. Instead, he leaped out the window, screaming that the dead had come back to life and Grandma Dowdel was shooting at him.

Meanwhile, the narrator and his grandmother were presumably the only ones who saw her tomcat flee from the inside of the coffin after the bullets flew. The narrator surmised that his grandmother must have gotten some ideas when she initially saw her cat enter the coffin. So, in the story, the commotion was actually caused by Grandma Dowdel's cat. The old woman just took advantage of her cat's antics to create even more commotion by shooting off both barrels of her rifle.

What is Internet medicine? |

Science and Profession

The Internet is a computer-based tool that is facilitating communication among vast numbers of individuals, groups, businesses, and governments. In addition to facilitating purely social and business-related ventures, the Internet is proving to be a valuable tool for improving the state of public health. This is because a new type of medical care and medical services has developed. These services, typically called telehealth, telemedicine, and e-medicine, use the Internet as a key tool in their dispensation, organization, and evaluation of health care services. Such services have taken the form of a variety of health care-related websites that provide services once available only through a face-to-face visit with a doctor or other health or social services professional. The websites are valuable in that they provide almost instantaneous information and other communications assistance to patients, their families, treatment professionals, trainers, trainees in the health care and social service professions, and medical researchers.

In terms of assisting patients, Internet-based medical approaches provide a variety of services to individual Internet users. First, they provide a wealth of information on different symptoms and medical conditions. They also allow for screening of such conditions to see if they warrant further attention from medical professionals and advice on how to handle minor health ailments and medical emergencies. They also help consumers to find medical advice, health care providers, self-help or support groups, and therapy over the Internet, all of which may or may not be supervised by medical professionals. Finally, they can give patients and their families information on different treatment options, including common procedures, the latest in alternative medicine, and even current clinical trials information.

Internet medicine can also be very helpful for family members of individuals having medical problems. Often, family members do not know how best to help their significant others in times of medical need. To meet this need, websites may post a wide variety of information that can help people understand the conditions, the requirements of treatment, the limits of treatment, and things they can do to be helpful to the ill family member. Additionally, websites sometimes offer lists of resources for family members.

Health care and social service providers also find the Internet beneficial for their work. For some, it might be as simple as using the Internet to schedule appointments, or to communicate test results, reminder information about treatment procedures, or appointment reminders via e-mail with clients. For others, it might involve using special websites to conduct assessments of clients for the purpose of tracking their treatment success or progress. Professionals may also use telemedicine in order to learn about new treatments and procedures, or to learn about new drugs and other pharmaceutical products. In addition, health care and social service providers may benefit their general practice by using the Internet to keep abreast of new clinical trials to test state-of-the-art treatments, changes in licensing laws affecting their practice, and the development of new health care databases for tracking, triage, and communication with insurance companies. Finally, some providers are actually using the Internet for health services delivery.

Health care providers in training and their trainers also benefit greatly from telemedicine. To trainees living in remote areas or those who might be highly mobile, such as those in the armed forces, the Internet provides immediate access to large online libraries, knowledgeable online teachers, and databases full of important medical information. Both long-established and new institutions interested in telemedicine increasingly are translating typical face-to-face training approaches into distance-based training programs utilizing the Internet. Encyclopedias, descriptions of techniques, pictures of what different conditions might look like both inside and outside the body, and even video of actual procedures are available online. Similarly, instruction in the use of such material is available online through training programs that lead to certificates of training and actual accredited degrees, ranging from bachelor’s to doctoral degrees and postdoctoral training. In addition to helping individuals who are at remote locations, such material also can be used to reach a larger number of trainees than might typically be able to observe or attend such training. The increased ability to teach, show procedures, or give supervision at a distance using pictorial, written, oral, and video information greatly facilitates continuing education and
improvement of general health care practice. It also helps to facilitate the evaluation of those practices and training sessions. Since all of the work takes place over the Internet, different aspects of the work can be monitored and evaluated electronically.

Much of the evaluation of this kind of information is done by researchers who are studying client, trainer, provider, or even health care system behavior and organization. This is done by evaluating information, also known as data, in individual sessions or visits to websites, as well as by examining data that are collected over time, across multiple visits. For instance, a person might first go to a website for information on a specific medical condition and then, at a later time or times, come back and look up different treatment approaches, or visit online discussion groups. What they do from time to time would be evaluated by researchers to see how individuals use the site, how long they stay on it, or what things they try searching for that may not yet be on the site. The process of watching behavior over time is called tracking. Tracking allows researchers to profile the users of websites to learn more about their behavior, usually for the purpose of predicting their behavior and response to treatment. The information gathered by creating tracking databases of what happens with Web site users can be used to improve services and to decrease long-term health care service, training, and administration costs on a continuing basis.

Because of all the data being collected on how individuals are using different websites or other Internet-based services, there has been some concern over the individual’s right to privacy and the protection of the information collected. For instance, some people have been concerned that if they are searching for information related to the human immunodeficiency virus (HIV) or substance use, they might be identified as being at risk for having that condition whether they do or not. Furthermore, many individuals do not want that information linked to their identities or medical records. On one hand, they may be wishing to avoid solicitation of business from sellers of medical services or products because of their association with the condition; they do not want their personal information sold for that purpose to the providers of such products or services. On the other hand, they may also wish to maintain privacy and keep their information confidential so as to avoid having any threat to their future insurability or their ability to get health care coverage. As an example, if a health care provider such as a health maintenance organization (HMO) tracked users’ information on a website and discovered, through the database, that someone who was now applying for coverage had certain medical conditions, that person might have a greater risk of being refused coverage if his or her time on the website was not completely anonymous. In sum, given these concerns, users of Internet medicine need to understand that there are differences between the terms privacy, confidentiality, and anonymity, as well as in the legal issues and protections one can exercise when using this type of medicine. Each website may be operating under different constraints, and so it is always important for users of these services to be sure they understand how the websites handle privacy. Finding out how a website protects or does not protect the privacy of its users is the only way users can determine how safe it is to reveal confidential information when they use a specific website.

Diagnostic and Treatment Techniques

One of the biggest opportunities offered by Internet medicine is that of increasing the ability of individuals to do self-screening for medical conditions to see if they need medical assistance. Likewise, the ability of service providers to do screening and assessment for a larger number of people is increased relative to what can be done in person. This is because the assessments can be administered via the computer, saving valuable provider time. Additionally, assessments can be completed online and sent to providers in advance for immediate evaluation. While it may be some time before conclusive diagnoses can be offered via online technology, such advances are not far off; the differences between online and in-person assessments are being studied.

Intervention via the Internet is also much improved because large quantities of information can be dispensed electronically, printed out by clients or their families, or distributed to large numbers of individuals. Such informational interventions can be important for facilitating proper compliance with medical prescription regimens, helping clients to avoid bad drug interactions, or providing reminders about other things needed to facilitate wellness. Informational interventions can also be used for primary prevention, or preventing problems from happening in the first place. By providing suggestions for problem prevention, much suffering could be spared and many health care dollars can be saved. This is especially true for teenagers and college-age populations, who are often savvy web users.

Treatment also takes place on the Internet via simultaneous online interactions such as in chat rooms, communicating via videoconferencing as in a normal conversation but using video cameras, and simple asynchronous e-mail between the client and the provider. Generally this type of treatment is a complement to face-to-face treatment. For instance, some HMOs use online support groups as additional treatment for persons already receiving therapy. Others are using programs such as self-guided online courses that clients can work through to benefit their health. In general, practitioners are permitted to do this so long as they are properly licensed. This usually requires being licensed by the state in which they are practicing and/or where the client is receiving the services.

Perspective and Prospects

The Internet continues to grow on a daily basis, with an increasing number of computer owners and websites taking advantage of its capabilities. Communications technologies are also improving constantly, allowing for almost instant individual communication of written, oral, and visual information at distances and speeds that were inconceivable in the past. As a result of these developments, as well as increases in health care costs and the potential economic and health benefits provided by Internet medicine, this specialty area is here to stay. Commitments by governments to examine such developments in health care underscore this likelihood. In 1998, for example, the Health Resources and Service Administration of the United States Department of Health and Human Services established the Office for the Advancement of Telehealth. This office is devoted to advancing the use of telehealth and Internet-based medicine to facilitate improvement in the state of public health and research on public health. The ability of such approaches to provide more services with streamlined administrative procedures and decreased costs holds much promise for improving the state of public health.

Bibliography

American Telemedicine Association. American Telemedicine Association, 2012.

Armstrong, Myrna L., ed. Telecommunications for Health Professionals: Providing Successful Distance Education and Telehealth. New York: Springer, 1998. Print.

Coiera, Enrico. Guide to Health Informatics. 2d ed. New York: Oxford University Press, 2003. Print.

Cullen, Rowena. Health Information on the Internet: A Study of Providers, Quality, and Users. Westport: Praeger, 2006. Print.

Davis, James B., ed. Health and Medicine on the Internet: A Comprehensive Guide to Medical Information on the World Wide Web. 4th ed. Los Angeles: Practice Management Information, 2003. Print.

Goldstein, Douglas E. E-Healthcare: Harness the Power of the Internet, e-Commerce, and e-Care. Gaithersburg, Md.: Aspen, 2000. Print.

Hadeed, George, et al. Telemedicine for Trauma, Emergencies, and Disaster Management. Boston: Artech House, 2011. Print.

Harding, Anne. "Telemedicine Improves Care for Kids Seen in Rural ERs." MedlinePlus, August 19, 2013.

Kinsella, Audrey. Home Telehealth in the Twenty-first Century: A Resource Book About Improved Care Services That Work. Kensington, Md.: Information for Tomorrow, 2003. Print.

Maheu, Marlene, Ace Allen, and Pamela Whitten. E-Health, Telehealth, and Telemedicine: A Guide to Startup and Success. San Francisco: Jossey-Bass, 2001. Print.

McKenzie, Bruce C., ed. Medicine and the Internet. 3d ed. New York: Oxford University Press, 2002. Print.

MedlinePlus. "Evaluating Internet Health Information: A Tutorial from the National Library of Medicine." MedlinePlus, April 19, 2012.

Mayo Clinic. "Telehealth: When Health Care Meets Cyberspace." Mayo Clinic, May 13, 2011.

Office for the Advancement of Telehealth. http://www .hrsa.gov/telehealth.

Price, Joan. Complete Idiot’s Guide to Online Medical Resources. Indianapolis, Ind.: Que, 2000. Print.

Riva, Giuseppe, and B. K. Wiederhold. Annual Review of Cybertherapy and Telemedicine 2012: Advanced Technologies in the Behavioral, Social and Neurosciences. Amsterdam: IOS Press, 2012. Print.

Society of Critical Care Medicine. "What Is Telemedicine?" My ICU Care, 2001–2013.

West, Darrell M., Edward Alan Miller, and the Brookings Institution. Digital Medicine: Health Care in the Internet Era. Washington, DC: Brookings Institution Press, 2009. Print.

Wootton, Richard, et al. Telehealth in the Developing World. Ottawa: International Development Research Centre; London: Royal Society of Medicine Press, 2011. Print.

How can I compare Fragonard's "The Swing" to Renoir's "Luncheon of the Boating Party"? How are they similar?

These paintings, though painted more than 100 years apart, have many similarities. Both are now considered to be masterpieces of their respective art-historical eras, Fragonard’s of the Rococo period and Renoir’s of the Impressionist. Both Rococo and Impressionism were artistic movements that, in their early years, drew scorn from the general public and the traditional art community. Both paintings combine elements of landscape, portraiture, and still life into one artwork.  Both are joyous and celebratory...

These paintings, though painted more than 100 years apart, have many similarities. Both are now considered to be masterpieces of their respective art-historical eras, Fragonard’s of the Rococo period and Renoir’s of the Impressionist. Both Rococo and Impressionism were artistic movements that, in their early years, drew scorn from the general public and the traditional art community. Both paintings combine elements of landscape, portraiture, and still life into one artwork.  Both are joyous and celebratory rather than overly serious or historical. Both present scenes that highlight the cultural values of their times. Fragonard shows the love of classical themes by placing cherub and Cupid sculptures in the painting and has the lady wearing a traditional shepherdess’s hat, a very conventional theme of poetry and painting. In the postures and clothing depicted, along with the location deep in a forest, there is a hint of the generally secretive, unspoken-of nature that portrayals of romance from this time period often invoked (with the great exception that the suitor hiding below the swinging lady is sneaking a glimpse up her flowing skirts). Renoir details the changing times of the late 1800’s with women and men of different social classes openly drinking and carousing together in public, and the desire of that public to see itself depicted in fine artworks.

Both paintings emphasize color and light in their compositions, and both are oriented along a strong diagonal: the swing in Fragonard and the table and awning in Renoir.

Both the Rococo and the Impressionist movements were a reaction to what was then perceived as an overpowering conservatism dominant in the artistic and general culture of both time periods. Rococo was a reaction to the strictures imposed on art and culture by the overly ornate Baroque period, which immediately preceded it, and was dominated by religious and court (government) sanctioned themes. Rococo attempted to be light, airy, bright, curvy, and comedic; and also a little bit naughty as The Swing attests. Impressionism was a reaction to the strictness of the French Academy, which judged all new paintings and tried to preserve a tradition of historical, religious, and noble portraiture as the only acceptable subjects for a painting. Impressionism rebelled against the Academy by depicting scenes and subjects from everyday modern life in candid settings (like a group of friends partying on a boat over lunch); landscapes were painted outside using direct observation (en plein air), rather than inside a studio.

As to differences between the paintings, there are some pertinent ones. Fragonard’s The Swing was painted in 1767 and Renoir’s Luncheon in 1880. Fragonard’s subject matter is an idealized version of reality painted in a studio and was commissioned by a nobleman. Renoir’s subject matter is anchored in the texture of the actual, lived-in world. The subjects in the painting are his friends (including his future wife) at an actual location. Note the diversity of styles and type of persons depicted: everything from t-shirts to top hats. And lastly, Fragonard’s painting was made while he lived in a Monarchy (though one that would last only about 20 years after the painting) and Renoir’s was painted in a Democratic Republic (though one which struggled to be born and included periods of regression back to a Monarchy). Great artworks are truly timeless but the circumstances surrounding their creation should never be ignored. (Check out the link to the Tate museum in London for Yinka Shonibare's contemporary take on Fragonard's The Swing).

What is hygiene? |

Definition

Hygiene involves more than cleanliness; it encompasses the habits humans practice to reduce the risk of receiving and transmitting infectious diseases.

Types of Hygienic Practice

Handwashing. Studies have shown that handwashing is the single most effective way to protect oneself from illness and to avoid passing microorganisms to others. Hands should be washed often, particularly before preparing food; after handling uncooked meat; before eating; after using the toilet; after changing a diaper; after sneezing, coughing, or blowing one’s nose; before inserting and removing contact lenses; after gardening or working in dirt or soil; and after touching animals or cleaning up after them. The Centers for Disease Control and Prevention (CDC) notes that this crucial form of prevention may not always be an option in lower income countries, where clean water and soap are not abundant resources, a reality that often contributes to the rapid spread of disease.

One should wash hands in clean, preferably warm, running water with a lathering liquid or bar soap. Hands should be rubbed together, making sure the soap contacts all skin surfaces, for a minimum of fifteen to twenty seconds. The soap should then be rinsed off with running water. Hands may be dried with a clean cloth towel, paper towel, or air dryer.

If soap and water are not available, one can use an alcohol-based hand sanitizer. Hands should be rubbed together until the alcohol evaporates and the hands are dry.

Showering and bathing. Bathing or showering with comfortably hot, clean water and liquid or bar soap that lathers removes dirt and sweat that contain microorganisms and also moisturizes the skin to create a more efficient barrier. Clean and moisturized skin also promotes the healing of cuts, abrasions, burns, and rashes.

Oral hygiene. Brushing and flossing one’s teeth after meals
protect the teeth and gums from dental caries, or cavities, and
periodontal disease. Regular visits to a dentist and dental hygienist keep the
oral cavity clean and allow for the early detection and treatment of tooth, gum,
and mouth diseases.

Covering coughs and sneezes. When a person sneezes or coughs,
saliva and other mucus containing bacteria and viruses are released as
droplets into the air. To limit transmission, sneezes and coughs should be covered
using a disposable tissue, a handkerchief, one’s sleeve, or one’s hand, which
should be washed as soon as possible after coughing or sneezing into it.

Environmental hygiene. Housekeeping is important because disinfecting surfaces, especially in the kitchen and bathroom, kills disease-causing bacteria. All cloth towels should be washed in hot water with detergent. Dishes should be washed with dish soap and hot water.

Impact

Hygiene practices, especially handwashing, reduce the incidence of illness, lower the cost of medical care associated with illness, decrease the number of lost days from work and school, and potentially save lives.

Bibliography

American Medical Association. “Hand Washing, Alcohol-Based Rubs Help Curb Influenza Outbreaks.” American Medical News 52.6 (2009). Print.

Centers for Disease Control and Prevention. An Ounce of Prevention Keeps the Germs Away: Seven Keys to a Safer, Healthier Home. Atlanta: CDC, 2002. Print.

Heymann, David L., ed. Control of Communicable Diseases Manual. 18th ed. Washington, DC: Amer. Public Health Assn., 2004. Print.

"Hygiene in Lower Income Countries." Centers for Disease Control and Prevention. CDC, 24 June 2014. Web. 31 Dec. 2015.

Marriot, Norman G., and Robert B. Gravani. Principles of Food Sanitation. 5th ed. New York: Springer, 2006. Print.

Wallace, Robert B., ed. Maxcy-Rosenau-Last Public Health and Preventive Medicine. 15th ed. New York: McGraw, 2007. Print.

What is case management for cancer?

Goals of case management: The principal goal of case management is to help patients and their families navigate the complex and fragmented health care system by coordinating efforts among service providers to deliver timely, appropriate, and cost-effective care according to each individual’s needs. Health care has been increasingly moving toward a patient-centered model, in which the values, preferences, cultural traditions, family situations, and lifestyles of patients and their families are taken into consideration. Therefore, case management typically tries to involve patients and their families in prevention plans, treatment options, and financial decisions. It also aims to reduce health care costs for patients and service providers. By coordinating all the various functions of treating people for serious diseases such as cancer, efficiency is increased and cost is decreased. Case management also tries to improve the standards of care for patients.

Many medical and government organizations along with individual hospitals, clinics, and medical centers (including cancer centers) have established case management guidelines. These guidelines, based on empirical research and numerous trials and observations, provide a system to help patients across what is known as the continuum of care. Clinical and ethical standards apply in all areas of care, from prevention of disease to end-of-life issues, and to all the components of case management.

Case management components: Case management has developed a set of core components: screening and assessment, treatment, community involvement, arranging for nonmedical services, monitoring, and reassessment. These core components, along with sets of subcomponents, come together to create a specific care plan for each patient. For example, the case management components and subcomponents for the care plan of a seventy-five-year-old man with prostate cancer might include the following:

• Screening and assessment: examinations by the patient’s primary care provider, referrals to an oncologist or urologist, testing to determine the nature of the disease, establishing a treatment plan based on the stage of the cancer, evaluating the patient’s financial status, creating the cancer care plan





• Treatment: aggressive radiation therapy, five days a week for seven weeks at a cancer center





• Community involvement: scheduling rides for the patient to and from the cancer center with volunteers from the local chapter of the American Cancer Society, introducing the patient and the patient’s family to a local support group, referring the patient to an oncology social worker





• Arranging for nonmedical services: working with Medicare or Medicaid to pay for treatment





• Monitoring: periodic checking to see that all components of the cancer care plan are functioning, and adjusting the plan if necessary





• Reassessment: scheduled follow-up visits with doctors, the oncology social worker, and Medicare or Medicaid

Managing all these components to create the cancer care plan is the job of the medical case manager.

The medical case manager: Most medical case managers (MCMs) are registered nurses. The medical case manager may also be a staff member of a hospital or cancer center and is often hired by an employer or insurance carrier. The role of the medical case manager includes, but is not limited to, the following:

• Overseeing patients’ cancer care throughout diagnosis, treatment, and follow-up





• Assessing patients’ health, nutrition, psychological, and care needs





• Assessing patients’ financial needs





• Educating patients on different cancer types, treatments and side effects, and possible outcomes to allow them to make informed decisions about their care





• Helping patients communicate more effectively with their doctors





• Linking patients with the appropriate community resources





• Coordinating the efforts of the cancer care team

The cancer care team: Each cancer patient’s needs are different. Meeting those needs requires a team of professionals with different expertise. Depending on the patient, the cancer care team may consist of the following individuals, all under the watchful eye of the medical case manager:

• Oncology social worker: a professional trained in counseling and providing practical assistance in navigating the health care system





• Psychiatrist or psychologist: to help the patient who has trouble coping psychologically with cancer





• Nurses: providers of a wide range of help, from implementing the care plan to answering questions for the patient and family





• Home health aide: a worker who helps cancer patients at home with daily living tasks





• Rehabilitation specialists: physical, occupational, and speech therapists who help patients recover from the physical changes caused by cancer or cancer treatment





• Oncology nutritionist: a specialist who advises on diet to help the patient cope with the consequences of cancer and side effects of treatment





• Hospice workers: caregivers who focus on the special needs of patients with terminal cancer
  Case management
  
  

Cohen, E., and T. Cesta. Nursing Case Management: From Concept to Evaluation. 3d ed. St. Louis: Mosby, 2000.

Fattoursso, D., and C. Quinn. A Case Manager’s Study Guide. 2d ed. Sudbury, Mass.: Jones and Bartlett, 2004.

Mullahy, C. The Case Manager’s Handbook. Sudbury, Mass.: Jones and Bartlett, 2004.