What are polyps? |

Causes and Symptoms

The causes of polyps vary depending on the location of the polyp growth in the body. Symptoms are also site dependent.

Nasal polyps consist of inflamed tissue in the mucous membrane lining of the nose or sinuses. Causes of nasal polyps may be allergies, chronic infection, cystic fibrosis, and asthma. They usually develop around the ethnoid sinuses (inside the top of the nose) and may block the airway, resulting in difficulty breathing or shortness of breath because of obstruction. Breathing through the mouth, anosmia (loss of the sense of smell), and a runny nose are common symptoms.

Vocal cord polyps are caused by mechanical injury, such as shouting, and usually occur on one vocal cord. Polyps are not to be confused with vocal cord nodules, which are generally caused by chronic abuse such as singing. Symptoms include hoarseness and a breathy or raspy voice.

Gastric polyps are rare and are usually discovered by accident, such as during an upper gastrointestinal endoscopy (a viewing of the interior of the stomach). Causes include
Helicobacter pylori (H. pylori) infection and chronic gastritis (inflammation of the stomach) caused by an autoimmune response. Gastric polyps usually do not cause symptoms; if symptoms do occur, they may include nausea, vomiting, abdominal pain, bleeding, or a feeling of fullness after eating even small amounts.

Colorectal polyps grow on the lining (mucous membrane) of the colon (also known as the large intestine) or rectum and may be caused by abnormal cell growth, heredity (family history or inherited disorder), or inflammatory diseases such as ulcerative colitis or Crohn’s disease. Small polyps do not usually cause symptoms. If symptoms do occur, then they may include blood in a bowel movement, rectal bleeding, fatigue due to anemia from loss of blood, or pain.

Uterine polyps develop in the lining of the uterus and are caused by an overgrowth of endometrial cells. Occasionally, uterine polyps may slip through the cervix into the vagina, resulting in cervical polyps. The exact cause of uterine and cervical polyps is unknown, but may be related to the estrogen hormone level, chronic inflammation or clogged blood vessels in the cervix. Symptoms may include bleeding, heavy or irregular menstrual periods, or a white or yellow discharge of mucus (leukorrhea), or there may be no symptoms.

Treatment and Therapy

The treatment for polyps varies by site. The most common treatments are medication and removal (polypectomy), either surgically or during colonoscopy/sigmoidoscopy (intestines), colposcopy (vagina and cervix), or some other endoscopic procedure (throat, stomach, small bowel). Biopsy of the polyp may be done to determine if it is malignant (cancerous) or benign (not cancerous).

It is possible to prevent some polyps. Controlling allergies and managing chronic sinusitis may prevent nasal polyps. Vocal cord polyps are directly related to injury from yelling, so reducing or eliminating such abuse may lessen the potential for development. Stomach polyps caused by H. pylori may be controlled by treating the underlying bacteria, and controlling gastritis may diminish the occurrence.

The goal of treatment for nasal polyps is to reduce the size of the polyp or to remove it. Because nasal polyps may occur in response to allergies or chronic sinusitis, medications such as corticosteroids (a drug that reduces inflammation), antihistamines, and antibiotics (a drug to fight infection) may be effective in shrinking the size of the polyp. If the polyp is in the sinus cavity, then endoscopic surgery using a small camera and tube inserted into the sinus allows the physician to remove the polyp.

Vocal cord polyps usually require surgical removal to restore the normal speaking voice. Voice therapy with a speech pathologist may be needed to prevent future occurrences. Stomach polyps require biopsy and, if there is concern, surgical removal. Medications to treat gastritis, including antibiotics, may be used. Routine colonoscopy and flexible sigmoidoscopy are recommended for routine cancer screening, and if a colorectal polyp is seen during the procedure, it is removed. If colorectal polyps are causing symptoms, then surgical removal either through colonoscopy or removal of a portion of the intestine may be needed. Uterine polyps may be watched, medications may be used to shrink them, or surgery may be used to remove them; if the polyps are cancerous, then a hysterectomy (removal of the uterus) is usually necessary.

Perspective and Prospects

Polyps are usually benign (not cancerous), but they can become malignant (cancerous) over time or in certain areas. Risk factors include age, obesity, family history, poor overall health (including allergies and chronic infections), stomach ulcer, infection, and inherited disorders such as cystic fibrosis or familial adenomatous polyposis. Prevention and screening, routine visits to the physician for health maintenance, and good health behaviors are important to prevent, recognize, or manage polyps. Prompt treatment is indicated if polyps cause symptoms or if a biopsy demonstrates malignant cells.

Bibliography

Bremmer, Hermann, et al. "Colorectal Cancers Occurring after Colonoscopy with Polyp Detection: Sites of Polyps and Sites of Cancers." International Journal of Cancer 133.7 (2013): 1672–79. Print.

Church, James M. “Laparoscopic versus Colonoscopic Removal of a Large Polyp.” American Journal of Gastroenterology 104.10 (2009): 2633–34. Print.

Hellings, Peter W., and Hens Greet. “Rhinosinusitis and the Lower Airways.” Immunology and Allergy Clinics of North America 29.4 (2009): 733–40. Print.

Huber, Aaron R., and James F. Shikle. “Benign Fibroblastic Polyps of the Colon.” Archives of Pathology and Laboratory Medicine 133.11 (2009): 1872–76. Print.

Lev, Robert, and M. Peter Lance. Adenomatous Polyps of the Colon: Pathobiological and Clinical Features. 1990. New York: Springer, 2012. Print.

Maydeo, Amit, and Vinay Dhir. "The Gallbladder Polyp Conundrum: A Riddler on the Wall." Gastrointestinal Endoscopy 78.3 (2013): 494–95. Print.

Thakkar, Kalpesh, Douglas S. Fishman, and Mark A. Gilger. "Colorectal Polyps in Childhood." Current Opinion in Pediatrics 24.5 (2012): 632–37. Print.

Why do you think Macbeth does not kill Banquo and Fleance himself?

This is an excellent question. If we look at it from the perspective of Macbeth himself, it can be answered that the main reason he has for not killing Banquo and Fleance himself is that he is concerned about his public image. He hopes against hope that he and his wife have gotten away with their murder of King Macduff and their usurpation of the Scottish crown: but he would like to keep a low...

This is an excellent question. If we look at it from the perspective of Macbeth himself, it can be answered that the main reason he has for not killing Banquo and Fleance himself is that he is concerned about his public image. He hopes against hope that he and his wife have gotten away with their murder of King Macduff and their usurpation of the Scottish crown: but he would like to keep a low profile and try to build a good reputation with the people. It turns out that his hired murderers bungle the job of killing Fleance. Macbeth is widely suspected of being behind that father-son murder attempt, and this leads to his being suspected of the murder of King Duncan as well.

From the perspective of Macbeth's creator, it appears that William Shakespeare wanted to preserve some degree of audience sympathy for his tragic hero. We, of course, know that Macbeth was behaving villainously. But he loses less of our respect by distancing himself from the deed as much as possible.

The same would apply to Shakespeare's reason for having Macduff and his family killed by emissaries. When Shakespeare has Macbeth meet his downfall in the fifth act, it seems obvious that the playwright wanted his audience to preserve at least some small amount of sympathy for his tragic hero. So Macbeth's crimes are either perpetrated by agents or else are only described by others, such as Lennox and Ross.

What is a gastrectomy? |

Indications and Procedures

The stomach is an important organ in the gastrointestinal system. It receives the food that has been swallowed from the esophagus and immediately begins to process it. The stomach produces and secretes gastric juices, which include hydrochloric acid and an enzyme called pepsin for digestion
. As the stomach collects it, food is churned and mixed with the gastric fluid before it is passed to the first region of the small intestine, the duodenum. Occasionally, the stomach becomes cancerous or has an ulcer that will not heal and thus must be surgically removed.

Complete removal of the stomach, a total gastrectomy, is a relatively rare operation usually performed to treat stomach cancer

. Partial gastrectomy, however, in which only the diseased portion of the stomach is removed surgically, is fairly common. A partial gastrectomy is often performed to treat a peptic ulcer that fails to heal after medical treatment. Peptic ulcers
, which include gastric and more commonly duodenal ulcers, may not respond to drug therapy and can place the patient at risk for bleeding into the gastrointestinal tract or even complete perforation of the stomach or duodenal wall. Therefore, the indications for gastrectomy include perforation, obstruction, massive bleeding, and severe abdominal pain.

Gastrectomy requires hospitalization, general anesthesia, and postoperative care. An anesthesiologist will administer a general anesthetic, rendering the patient unconscious and insensible to pain during the operation. A nasogastric tube is passed into the stomach via the nose and nasal cavity so that any stomach contents can be removed using suction before an incision is made into the stomach.

During total gastrectomy, the whole stomach is removed and the esophagus is attached to the jejunum. The two most common types of partial gastrectomy surgeries are the Billroth I and Billroth II. A surgeon performing a Billroth I will remove the diseased part of the stomach and attach the remaining healthy stomach to the duodenum. The Billroth I is also known as gastroduodenostomy. This operation preserves most of the digestive functions. Billroth II gastrectomy requires the surgeon to perform a gastrojejunostomy in which the remaining stomach is joined with the jejunum and bypasses the duodenum. Thus the opening of the duodenum must be closed to prevent the digestive contents from escaping into the abdominal cavity.

During the recovery period, the nasogastric tube is left in place to help drain the secretions from the gastrointestinal system until the body is recovered enough to eliminate these secretions normally. Once the normal movement of the digestive tract (peristalsis) is detected, the patient is given very small amounts of fluid. If the intestines can process the ingested fluids, then the nasogastric tube is removed and the amount of fluid ingested is gradually increased. Typically, if there is no pain or nausea and vomiting, the patient can be started on a diet containing small amounts of solid food.

Uses and Complications

The risk of complications is relatively high in a total gastrectomy and lessens if smaller portions of the stomach are removed. The overall rate of complications is approximately 10 percent.

Since the stomach has such an important role in the process of digestion, it is not surprising that complications and adverse effects occur postsurgically. Some of the most common symptoms noted after gastrectomy include a feeling of discomfort and fullness after ingesting a relatively small meal. This feeling is attributable to the fact that the stomach volume has been reduced in a partial gastrectomy or eliminated in a total gastrectomy. New ulcers may also form and necessitate further drug treatment. Gastritis (inflammation of the stomach lining) may also occur after surgery, as well as a condition called dumping syndrome
. Patients with dumping syndrome feel weak, nauseated, and light-headed after a meal because the food moves too rapidly out of the stomach. Most of these side effects can be treated with medications and dietary changes.

Long-term complications include malabsorption
problems. Occasionally after gastrectomy, the digestive system cannot compensate adequately for the loss of the stomach, leading to poor digestion and absorption of nutrients. The most common malabsorptive disorder following gastrectomy is the inability to absorb vitamin B12. The stomach produces a substance called intrinsic factor which is required for the absorption of this essential vitamin. Without intrinsic factor and the ability to absorb vitamin B12, the patient must receive monthly injections of the vitamin for the rest of his or her life.

Perspective and Prospects

Early detection of stomach cancers and ulcers may help reduce the need for gastrectomies. Endoscopic examinations in which the physician can observe the lining of the stomach through a surgical tube passed into the patient’s mouth and down the esophagus may aid in the early detection of stomach problems such as cancer and ulcers that are failing to heal.

Aggressive medical management of gastrointestinal ulcers will likely reduce the chance that an ulcer will perforate and require gastrectomy. Antiulcer medications are available to reduce the amount of stomach acid released, to add to the protective barrier of the stomach, and to eradicate the bacteria known to cause many ulcers. Destroying the bacteria, Helicobacter pylori, increases the likelihood of curing the patient of ulcer formation.

Bibliography

Brunicardi, F. Charles, et al., eds. Schwartz’s Principles of Surgery. 9th ed. New York: McGraw-Hill, 2010.

"Gastrectomy." MedlinePlus, December 10, 2012.

Leikin, Jerrold B., and Martin S. Lipsky, eds. American Medical Association Complete Medical Encyclopedia. New York: Random House Reference, 2003.

Mohamed, Habeeb. "Laparoscopic Sleeve Gastrectomy: An Ideal Procedure for Control of Morbid Obesity." World Journal of Laparoscopic Surgery 5, no. 2 (May–August, 2012): 89–101.

McCoy, Krisha. "Gastrectomy." Health Library, November 26, 2012.

What are computer models of cognition?

Introduction

Human cognition depends on the operation of the neural anatomy that forms the nervous system. Essentially, the brain is composed of some 100 billion neurons. Roger Penrose has divided the brain into three areas: primary, secondary, and tertiary. Each of these three areas has a sensory and motor component. The primary areas are the visual, olfactory, somatosensory, and motor areas. These areas handle the input and output functions of the brain. The secondary areas lie near the primary regions and process the input received by the primary areas. Plans of action are developed in the secondary areas, and these actions are translated into movements of the muscular system by the primary cortex. The tertiary area makes up the rest of the brain. The most complex, abstract, sophisticated, and subtle activity of the brain occurs here. Information from the different sensory areas is received, collected, integrated, and analyzed. As Penrose says, “memories are laid down, pictures of the outside world are constructed, general plans are conceived and executed, and speech is understood or formulated.” Thus, information or stimulation from the environment is received or input at the primary sensory areas. This information is then processed in increasingly complex and sophisticated ways in the secondary and tertiary sensory areas. The processed sensory information is sent to the tertiary motor area in the form of a grand plan of action, and it is then refined into plans for specific actions at the secondary and primary motor regions.

Models of Information Processing

The question for psychologists to solve is how to represent or model this complex activity that is the basis for human thought and action in the three regions of the brain. The theory of information processing contends that human cognition can be successfully modeled by viewing the operation of the brain as analogous to the operation of a computer. Penrose observed that the brain presents itself as “a superb computing device.” More specifically, Robert J. Baron stated:
The fundamental assumption is that the brain is a computer. It is comprised of some 100 billion computational cells called neurons, which interact in a variety of ways. Neurons are organized into well defined and highly structured computational networks called neural networks. Neural networks are the principal computational systems of the brain.

A field known as neurocomputing, or computational neuroscience, holds great promise for providing such a computer-based model. The particular kind of computer to be used is a neurocomputer, which is modeled on the actual structure or architecture of the brain. The unit of the neurocomputer is the processing element, or neurode, which corresponds to a biological neuron. The neurocomputer is constructed of many neurodes that are interconnected to one another to form a neural network. Each neurode can receive a number of inputs, either externally or from other neurodes, and each input has a weight or strength given to it. These weights are all summed, and a single output results. This output can then act as an input to other neurodes to which it is interconnected. If the output is excitatory, it will encourage firing of the interconnected neurodes; if the output is inhibitory, it will discourage firing of the interconnected neurodes. The neurocomputer processes all the inputs and outputs in a parallel manner (that is, all of the neurodes can potentially operate simultaneously). The software that runs the neurocomputer is called netware. The netware provides the interconnections between neurodes, how the neural network will react to the input it receives (training law), and how the input and output are related to each other (transfer function). Neurocomputers are drastically different from any other kind of computer because their architecture and operation are modeled after the human brain. Thus, neurocomputers can perform human functions, such as being taught to learn new behaviors. Maureen Caudill refers to these computers as being “naturally intelligent,” as opposed to the serial computer used with “artificial intelligence.”

Because neurocomputers are constructed as analogues of the human nervous system, they are particularly adept and useful for solving the kinds of problems that the human brain can solve. Conventional computers would have great difficulty solving these problems because they are constructed to perform certain kinds of tasks very quickly and efficiently (for example, processing large amounts of numbers very rapidly), tasks that the human brain cannot do nearly as well.

Uses of Artificial Intelligence

In Naturally Intelligent Systems (1990), Caudill and Charles Butler discuss two applications of neurocomputers and neural networks, one in medicine and the other in finance.

A machine called the vectorcardiograph was found, in tests, to be able to detect heart problems better than cardiologists could. The usual electrocardiograph records signals received from up to twelve leads placed on different parts of the body. Each recording is made separately and in a particular sequential order. In contrast, the vectorcardiograph records signals from only three locations (front-back, head-foot, right-left), and it records all three sources of data simultaneously. This parallel processing of the information suits the vectorcardiograph very nicely to neural networks.

Essentially, the vectorcardiograph was trained in three stages to differentiate between normal and abnormal electrocardiograms, much as a human is trained to discriminate or distinguish between two stimuli. In the first stage, the system was trained to recognize all the normal cases presented to it and a portion of the abnormal cases presented to it. The input weights were then set at the appropriate values and training continued. In the second stage, the neural network was trained also to recognize all normal cases and a portion of the remaining abnormal cases. Again, the input weights were set at their appropriate values. The third stage of training commenced, and training continued until the system could recognize the remaining abnormal cases. The training set consisted of vectorcardiographs from 107 people, half of whom were judged to be normal and half abnormal. When the vectorcardiograph was presented with sixty-three new cases never before presented, it correctly diagnosed 97 percent of the normal and 90 percent of the abnormal cases. Trained clinicians were able to identify, respectively, 95 percent and 53 percent of the cases. The diagnostic capabilities of the vectorcardiograph demonstrate the capabilities and potentials of neural networks.

A neural network known as the Multiple Neural Network Learning System (MNNLS) can be trained to make decisions to accept or reject a mortgage application. The system uses twenty-five areas of information that are divided into four categories: cultural (credit rating, number of children, employment history); financial (income, debts); mortgage(amount, interest rate, duration); and property (age, appraised value, type).

The MNNLS is a system of nine separate neural networks that are divided into three different layers, with three networks in each area. Each layer is analogous to a panel of three experts. One expert in each of the three layers concerns itself only with financial information, the second only with cultural and mortgage information, and the third with all four categories. When presented with a mortgage application, the first layer attempts to arrive at a decision. If the three “experts” all agree, the mortgage is accepted or rejected; however, if one of the experts disagrees with another, then the application goes to the second layer of experts, and the same process is repeated. The MNNLS is useful because it is very efficient and accurate. It is efficient because it is able to process a wide variety of problems because the neural networks correspond to different experts. The first layer effectively handles simple decisions, whereas the second and third layers can handle increasingly difficult decisions. MNNLS agreed with decisions made by humans about 82 percent of the time. In those cases in which the MNNLS disagreed with the human decision, the MNNLS was in fact nearly always correct. This happens because the MNNLS is a neural network that insists on consensus of a panel of experts (that is, consensus between separate neural networks). It would be economically unfeasible to have a panel of humans evaluate mortgages; however, a single person evaluating applications is more likely to make a mistake than a panel of evaluators.

Metaphors of Modeling

Stephen J. Hanson and David J. Burr astutely observed that “the computer metaphor has had a profound and lasting effect on psychological modeling.” The influence of the computer can be seen especially in its use in artificial intelligence and in computer metaphors of learning and memory, in which information is processed, encoded, stored, and retrieved from three distinct memory stores (sensory, short-term, and long-term memory). The particular computer that has been used as the metaphor of the human mind and cognition has been the digital or serial computer.

It eventually became apparent to cognitive scientists, however, that the digital computer is actually a poor analogy for the human mind, because this computer operates in a decidedly nonhuman way. For example, the digital computer operates much too fast—much faster than the human mind can process information. It also processes much more data than the human mind can process. If the software is sound, the digital computer is perfect and operates error-free. Human problem solving, on the other hand, is characterized by mistakes. The digital computer is not capable of autonomous learning. It does only what it is told to do by the program; it cannot teach itself new things, as can a human. The digital computer is very poor at pattern recognition tasks, such as identifying a human face, something an infant can do very rapidly. The digital computer provides no information about the underlying structure (the nervous system) that makes human cognition and information processing possible.

A number of cognitive scientists have argued that the fields of artificial intelligence and traditional cognitive science have reached dead ends because of their reliance on the digital computer analogy of the mind, which is limited and largely inaccurate. Cognitive science and neurophysiology are now striking out in a promising new direction by using neural networks and neurocomputers as the analogue of the human mind. The human mind is closely related to the human brain; many would argue that the mind is equivalent to the brain. Therefore, to study the mind and cognition, the researcher must build a computer that is modeled on the architecture of the brain. The neurocomputer is modeled on the human brain, and the digital computer is not.

Unlike digital computers, neurocomputers operate in a manner consistent with the operation of the human nervous system and human cognition. Neurocomputers provide a potentially promising way to understand cognition, as well as providing a productive connection and interrelationship with neurophysiology.

Bibliography

Addyman, Caspar, and Robert M. French. "Computational Modeling in Cognitive Science: A Manifesto for Change." Topics in Cognitive Science 4.3 (2014): 332–41. Print.

Allman, William F. Apprentices of Wonder: Inside the Neural Network Revolution. New York: Bantam, 1990. Print.

Caudill, Maureen, and Charles Butler. Naturally Intelligent Systems. 3d ed. Cambridge, Mass.: MIT P, 1993. Print.

Coward, L. Andrew. A System Architecture Approach to the Brain: From Neurons to Consciousness. New York: Nova Biomedical, 2005. Print.

Frankish, Keith, and William M. Ramsey. The Cambridge Handbook of Cognitive Science. Cambridge: Cambridge UP, 2012. Print.

Friedenberg, Jay, and Gordon Silverman. Cognitive Science: An Introduction to the Study of Mind. Thousand Oaks: Sage, 2006. Print.

Gill, Satinder, ed. Cognition, Communication and Interaction: Transdisciplinary Perspectives on Interactive Technology. New York: Springer, 2007. Print.

Hanson, Stephen J., and David J. Burr. “What Connectionist Models Learn: Learning and Representation in Connectionist Networks.” Behavioral and Brain Sciences 13.3 (1990): 471–518. Print.

Harnish, Robert. Minds, Brains, Computers: An Historical Introduction to Cognitive Science. New York: Blackwell, 2002. Print.

Marsa, Linda. "Computer Model Mimics Infant Cognition." Discover Jan./Feb. 2012: 53. Print.

Penrose, Roger. The Emperor’s New Mind: Concerning Computers, Minds, and the Laws of Physics. New York: Penguin, 1991. Print.

Stillings, Neil A., et al. Cognitive Science: An Introduction. Cambridge: MIT P, 1998. Print.

Throughout Jack London's story, "To Build a Fire," the man remembers "the old man on Sulphur Creek" and his advice. Find examples and note the...

Although we are told that the man traveling alone in the Yukon is not much of a thinker, he does recall the advice of the old man on Sulphur Creek six times during his journey.  It is significant that the old timer doesn’t come to mind, however, until nearly halfway into the man’s journey, when he is already having trouble.  He is simply too stubborn and prideful to follow the old expert’s advice.

The traveler first thinks of the old man when he is unable to eat his sandwich, ironically because his mouth is literally frozen shut by the 75 degree below zero weather.  The man realizes that the old timer was right that it gets cold in the Yukon, and he recounts how he had laughed at the man, admitting to himself that “one must not be too sure of things.” Yet instead of turning back at this realization, our traveler stubbornly continues his fateful journey.

After falling through the ice up to his knees, the man thinks in more detail about the advice the old timer had given him:  don’t fail in your first attempt to build a fire, especially with wet feet, which cannot rewarm when it’s 75 degrees below.  As he sets his fire up, the man feels ”grateful for the advice.” Once the fire is going, however, he thinks for the third time of the old timer’s advice and smiles in a condescending way at how serious the old man had sounded. He’s proud that even though he has gotten wet, he has managed it just fine.  “Those old men were rather womanish, he thought...Any man who was a man could travel alone.” Our traveler is way too arrogant for his own good, because unfortunately, he does fail at keeping the fire going.

As he tries in a panic to restart the fire, he twice admits to himself that the old man was right about the importance of traveling with a companion, who could have built the fire for him.  Still somewhat in denial, he thinks that he is likely to lose some toes.  The harsh reality is that he’s unable to start a fire, so he is going to die.

The man’s final thought of the old timer on Sulphur Creek occurs as he sits freezing to death in the snow.  He is having a final moment of denial, thinking that when he returns to the U.S. he can tell people what real cold is.  Then he sees the old man in his mind, “...warm and comfortable, and smoking  a pipe.”  Facing harsh reality, the dying man says aloud, “‘You were right, old fellow.  You were right.´”  He is finally humbled into fully admitting the wisdom of the old man’s warnings, but it is simply too late.

What are twelve-step programs for family and friends?

Introduction

Addictions

of all descriptions exact a grievous emotional and physical toll on family members and close associates of the addict. People who live in close association with an addict for any considerable time develop patterns of behavior and ways of looking at the world that are decidedly maladaptive. Spouses, partners, parents, and children become socially isolated, frustrated, and discouraged at futile efforts to bring about reform in the loved one and they have difficulty identifying their own needs and desires and in taking reasonable steps to see that their needs are met. Depression and physical illnesses with a strong psychological component are common in this demographic.

There is a definite hereditary component to addiction that appears to be a combination of anomalies in brain chemistry that influence pleasure-seeking behavior and, in the case of alcoholism, differences in metabolism that reduce adverse consequences of excessive use in the early stages of the disease. Children and siblings of addicts are at high risk of becoming addicts themselves and can benefit from any program that reduces their chances of involvement. Growing up in an addicted environment also increases the likelihood that a person will select an addicted partner and remain in a destructive relationship, perpetuating the unhappy family cycle.

The term addict conjures an image of a person addicted to illegal street drugs, particularly heroin. However, in terms of impact on families, alcohol is the most common and most damaging substance of abuse; thus efforts to repair the damage caused by addiction, whether through twelve-step programs or through psychiatric intervention, concentrate on alcoholism. This focus on alcoholism occurs because the use of hard drugs typically destroys relationships and breaks up families before a chronic pattern of dysfunction is established.

Al-Anon

Al-Anon was founded after Alcoholics Anonymous (AA), which itself was founded in 1935. Within a few years AA had established a small network of groups meeting regularly to share stories and achieve sobriety through working a series of twelve steps. Briefly, these steps involve admission of powerlessness, reliance on a higher power, identification of and admission of shortcomings, making restitution (when possible) to persons harmed, continuing to lead a sober and spiritual life, and carrying the message to current alcoholics.

The original AA membership was overwhelmingly male. At many meetings the wives would get together informally to discuss how to be supportive of their husbands’ recovery and also to share experiences about the challenges they were facing in their own lives. Lois Wilson, wife of AA cofounder Bill Wilson, was active from the start in facilitating a New York group for wives and in corresponding with similar groups in other parts of the country. The first (1939) edition of Alcoholics Anonymous contains the chapters “to Wives” and “the Family Afterwards,” incorporating some of Lois Wilson’s experience and wisdom. These chapters, however, were written by Bill Wilson and emphasize how families can reinforce and support the man’s sobriety rather than how to help with the emotional recovery of the wives of alcoholics.

As these groups evolved it became apparent that the twelve-step format also could be used to benefit the spouses of alcoholics, substituting “powerless over the alcoholic” for “powerless over alcohol.” A woman working the twelve steps of what later became Al-Anon was encouraged to detach from her husband’s addiction, abandon efforts to reform him, and concentrate on strengthening her own connection to a higher power, on identifying and trying to eliminate undesirable patterns of thought and behavior in her own life, and on making amends to people who had been harmed by her own actions.

In 1941, Lois Wilson began collaborating with Ann B., wife of an AA member who was unable to stay sober. Over the next ten years family groups developed under the guidance of the two women. Al-Anon became a formal organization in 1951. It has its own corporate structure, parallel to AA but entirely separate from it. In 1957, Bob, a California teenager with an alcoholic father, established the first group for young people, and in 1959 the Alateen Committee was formed within Al-Anon to coordinate groups for minor children of alcoholic parents. Alateen groups have an adult Al-Anon sponsor and usually meet at the same time and location as an established Al-Anon group.

As of 2012, Al-Anon/Alateen had r25,418 groups worldwide. According to its 2015 member survey, the average Al-Anon member has been in the program for thirteen years. More than three-quarters of Al-Anon members have had a relationship with an alcoholic spouse or partner, and more than 40 percent by an alcoholic father or stepfather. In about one-quarter of cases the spouse or partner is in recovery in AA.

How Al-Anon Works

Like AA, Al-Anon is open to anyone with a desire to recover from the adverse effects of living with an alcoholic. There are no dues or fees for membership; the organization is supported through voluntary contributions and through the sale of literature. The first step for an individual is usually to locate and attend a meeting. There are online, telephone, and correspondence resources for people in small communities without Al-Anon meetings.

It is recommended that an individual get a sponsor, a person who has some experience with the program, to guide them through the twelve steps. Unlike AA, Al-Anon publishes a twelve-step workbook and a number of pamphlets with specific guidance and advice on psychological matters.

The membership is slowly changing, but Al-Anon remains a mostly female fellowship of partners and former partners of alcoholics.

There is a common misconception that Al-Anon exists to help a spouse, sibling, or parent get an alcoholic loved one sober, and that Al-Anon will provide some “magic formula” or will help to organize an intervention. This is not the case. Al-Anon provides hope for leading a stable and happy life despite damage done by the alcoholic; it is up to the alcoholic to seek his or her own recovery.

Other Programs

There exists a plethora of twelve-step programs for addressing myriad addictions, compulsive behaviors, and miscellaneous life problems. None is as widespread or successful as AA. At one time or another most of these programs have probably spawned a few coordinating family groups of their own, but the only groups with staying power are Nar-Anon, Co-Dependents Anonymous (CODA), and Adult Children of Alcoholics (ACA). Addictive behaviors such as gambling and pornography often have alcohol abuse as a comorbidity, in which case Al-Anon is a useful resource.

Nar-Anon, for family members of hard-drug addicts, filed articles of incorporation in 1971 and established a world service office in 1976. Meetings are held mainly in urban areas in the United States. Members are more likely to be parents and siblings of addicts than spouses of addicts, and the problems addressed can include extensive legal involvement.

The goal of ACOA membership is emotional sobriety. The organization, founded in New York City in 1976, publishes a variety of literature, including a “big book,” collections of personal stories, and a step workbook.

CODA is a twelve-step format fellowship of people whose problems in relationships stem from being raised in dysfunctional families. Its common purpose is to develop healthy relationships; members gather to support and share with each other in a journey of self-discovery and self-love. To the extent that the dysfunction of the family stemmed from addictive behavior, CODA can help a person from an addictive background.

Although they still follow the twelve-step format, ACA and CODA deemphasize the need for personal reform that characterizes AA and Al-Anon. Recovery tends to be an elusive concept, at least when compared with AA and Narcotics Anonymous. Although it may be questionable how much improvement the twelve-step approach produces in emotional health, many people find it sufficiently helpful to continue participating, and a twelve-step program has the advantage of being accessible to all at little to no cost.

Bibliography

ACA World Services. Adult Children: Alcoholic/Dysfunctional Families. Torrance: ACA World Services, 2006.Print.

Al-Anon Family Groups. How Al-Anon Works for Families and Friends of Alcoholics. Virginia Beach: Al-Anon Family Groups, 2008. Print.

Borchert, William G. The Lois Wilson Story: When Love Is Not Enough. Center City: Hazelden, 2005. Print.

Rivinus, Timothy M., ed. Children of Chemically Dependent Parents: Multiperspectives from the Cutting Edge. New York: Brunner, 1991. Print.

Zajdow, Grazna. Al-Anon Narratives: Women, Self-Stories, and Mutual Aid. Westport: Greenwood, 2002. Print.

In the story "The Sniper," what atmosphere does the author convey to the reader? Give concrete examples.

I think a pair of words that accurately describes the atmosphere of that story is cold and impersonal.  The reason (concrete example) why I think that is because the narrator does not use any names.  The characters are described, but never named.  "The sniper," "the enemy sniper," and "the old woman" are how the narrator identifies characters.  By not naming anybody, the reader feels that those people are nothing more than targets or pieces on...

I think a pair of words that accurately describes the atmosphere of that story is cold and impersonal.  The reason (concrete example) why I think that is because the narrator does not use any names.  The characters are described, but never named.  "The sniper," "the enemy sniper," and "the old woman" are how the narrator identifies characters.  By not naming anybody, the reader feels that those people are nothing more than targets or pieces on a battlefield.  They are expendable, which is a cold way to look at a human.  

Another word that I think describes the atmosphere of this story is tense.  The story is short, but it packs a lot of intensity to it.  Once the sniper identifies the woman and machine gunner as targets, the narration of the story picks up in speed.  The sentence structure becomes shortened which gives it a clipped feeling of pace.  Each sentence is also action oriented.  This happened. Then that. Then this.  

The turret opened. A man’s head and shoulders appeared, looking toward the sniper. The sniper raised his rifle and fired. The head fell heavily on the turret wall. The woman darted toward the side street. The sniper fired again. The woman whirled round and fell with a shriek into the gutter.

The reader feels like a part of the firing action.  Spot target, shoot, work bolt, new target, shoot again.  It's tense, because the scene is happening quickly and describing a life and death situation.  

What is the significance of Romeo asking Balthasar whether he has "letters from the Friar"?

Romeo is looking for any important news about Juliet while he serves his exile in Mantua. It would probably be correct to assume the Friar would act as a surrogate in the delivery of letters between Romeo and Juliet. The Friar also promised he would eventually attempt to reconcile the situation by announcing the marriage and begging the Prince for a pardon. Of course, it's way too soon for that to happen, but the ever-impatient...

Romeo is looking for any important news about Juliet while he serves his exile in Mantua. It would probably be correct to assume the Friar would act as a surrogate in the delivery of letters between Romeo and Juliet. The Friar also promised he would eventually attempt to reconcile the situation by announcing the marriage and begging the Prince for a pardon. Of course, it's way too soon for that to happen, but the ever-impatient Romeo is looking for any bit of news from Verona. In Act V, Scene 1, Romeo has just had a dream where he received good news. He says,

If I may trust the flattering truth of sleep,
My dreams presage some joyful news at hand.
My bosom’s lord sits lightly in his throne,
And all this day an unaccustomed spirit
Lifts me above the ground with cheerful thoughts.

He also foreshadows his death in this short speech as he says Juliet found him dead and tried to kiss him back to life:

I dreamt my lady came and found me dead
(Strange dream that gives a dead man leave to
think!)
And breathed such life with kisses in my lips
That I revived and was an emperor.

This event does happen in Scene 3 but, unfortunately, Romeo has already taken a deadly poison when Juliet kisses him.

Balthasar's news is not from the Friar. Instead, he tells Romeo that Juliet is dead and that he has seen her taken to the Capulets' tomb. Rather than send his letter about the plot to fake Juliet's death with Balthasar, Friar Laurence sends Friar John with the letter, but he is delayed by a plague threat. The all-important news does not reach Romeo, as Balthasar arrives first with the "ill news" of Juliet's supposed death.

What substances can and cannot diffuse directly through the lipid bilayer?

It is very important for a cell to be able to exercise some control over what can enter and what can exit a cell through the cell membrane (lipid bilayer).  Because of the nature of the lipids that make up the membrane, only certain molecules can diffuse directly through the membrane down their concentration gradients.  The tails of the phospholipids that make up the bilayer are hydrophobic and non-polar.  Principle of "like dissolves like" applies...

It is very important for a cell to be able to exercise some control over what can enter and what can exit a cell through the cell membrane (lipid bilayer).  Because of the nature of the lipids that make up the membrane, only certain molecules can diffuse directly through the membrane down their concentration gradients.  The tails of the phospholipids that make up the bilayer are hydrophobic and non-polar.  Principle of "like dissolves like" applies here.  Substances that are unlike the lipids, that are hydrophilic or polar, will not diffuse directly through the membrane as they will be repelled by the lipids.  Also, in order to fit through the membrane, substances that can diffuse through the membrane must be small.  Only substances that are small, uncharged, and non-polar such as oxygen and carbon dioxide gases may diffuse directly through a lipid bilayer.  This process is known as simple diffusion.  

Other molecules like ions, amino acids, water, and sugars may also diffuse through the membrane, but they require carriers or channels in order to move down their concentration gradients.  These molecules may be too large, charged, or polar and a protein-based carrier or channel in a way shields these substances from the lipids that would otherwise repel such substances.  Diffusion through a carrier or channel is known as facilitated diffusion.

Why did Orwell choose Winston as his protagonist in 1984?

In 1984, Winston Smith is employed within the Party's propaganda department, the Ministry of Truth. His job is to ensure that all existing documentation matches the aims and beliefs of the Party, to create the perception that the Party is consistent in its views; this involves changing documents, erasing the names and photographs of individuals who the Party deems "unpersons," and generally rewriting history. Having the main character serve this role is important to...

In 1984, Winston Smith is employed within the Party's propaganda department, the Ministry of Truth. His job is to ensure that all existing documentation matches the aims and beliefs of the Party, to create the perception that the Party is consistent in its views; this involves changing documents, erasing the names and photographs of individuals who the Party deems "unpersons," and generally rewriting history. Having the main character serve this role is important to the story, because Winston has more insight into the truth about the world he lives in than others employed in different sectors of the Party. It is important throughout the story that Winston is a person who is aware of the Party's propagandizing, lying, and revisionism; it is the knowledge he gains from doing his job that allows him the awareness he needs to begin secretly hating and rebelling against the party. If, for example, Julia were the narrator of the story, there would be no insight into the process of revisionism; Julia hates the oppressive government too, but her job doesn't put her in a position of constant awareness of the ways in which she is being lied to.

What is motion sickness? |

Causes and Symptoms

Motion sickness appears to be caused by overstimulation of the balance centers of the inner ears by repeated back-and-forth and up-and-down movements. Messages are carried from this area of the inner ear, known as the vestibular apparatus, to the medulla oblongata in the brain, which is responsible for the vomiting reaction. The nerve pathways for this journey are not entirely known, but certainly the cranial nerve, which is responsible for hearing and balance, is involved. Responses in the medulla oblongata set into motion automatic motor reactions in the upper gastrointestinal tract, diaphragm, and abdominal muscles that lead to vomiting.

Individuals vary considerably in their susceptibility to motion sickness, and experts believe that there may be an inherited tendency toward the problem. Shifting visual input (such as watching waves on the horizon), a poorly ventilated environment, and fear and anxiety all seem to play a role in the development and severity of motion sickness.

The diagnosis of motion sickness is usually self-evident. Vertigo, nausea, and vomiting follow exposure to a repetitive and usually irregular rocking motion while in a moving vehicle or on an amusement park ride. The first indication of motion sickness may be yawning, excessive salivation, pale skin, and sweating. The person may begin to breathe deeply or complain of sleepiness. The patient may also develop a need for air, dizziness, or a headache. In most cases, nausea and vomiting occur sooner or later. On an extended trip, patients with motion sickness may eventually develop a tolerance to the motion and feel better, or they may continue to feel sick. If severe rocking motions develop once again, however, patients may also become sick again. Repeated vomiting may lead to dehydration and low blood pressure. Depression is another feature of prolonged motion sickness.

Treatment and Therapy

This malady is far easier to prevent than to treat. People who suffer from motion sickness should avoid drinking liquids just before and during short trips. On longer trips, they should limit liquids and have only small, easy-to-digest foods at regular intervals. Plenty of fresh air may also help prevent sickness. Those prone to motion sickness should not read in a car or other moving vehicle. Focusing the eyes well above the horizon while riding in a car or on a boat may help. People who are susceptible to motion sickness should also avoid amusement park rides that involve swinging and rocking.

Sufferers of motion sickness may be treated with over-the-counter or prescription medications an hour before travel begins. Medications used for this purpose include diphenhydramine, promethazine, prcochlorperazine, chlorpromazine, scopolamine, dimenhydrinate, cyclizine, buclizine, and meclizine. They are available in a variety of forms, including tablets, rectal suppositories, and transdermal patches. Many of these drugs cause sleepiness, which may be helpful during a trip but cause drowsiness or lack of alertness on arrival. Another common side effect of some of these drugs is dry mouth. In most cases, these medications are more effective when given before vomiting begins. An extract of ginger root has been recommended as a treatment using a natural substance, and so having fewer side effects. Some objective studies, however, have failed to demonstrate its efficacy.

If the person has already begun vomiting, medications must be given by injection, rectal suppository, or a transdermal patch. In cases of prolonged vomiting, where dehydration is a concern, the patient may require intravenous fluids. Of particular concern is the individual who is already ill with another disease and also suffers from motion sickness. Such patients may have serious complications related to the vomiting and resulting dehydration.

Nonpharmacologic treatments for motion sickness abound. The best known are acupressure wristbands. The autogenic-feedback training (AFT) exercise, designed by the National Aeronautics and Space Administration (NASA), is a self-regulation and biofeedback training scheme that has shown promise in studies of space motion sickness in astronauts. It requires a minimum of six hours of training and so is not the quick fix that drugs promise. NASA scientists have also explored devices for holding the astronaut’s head steady, since head movement appears to exacerbate motion sickness. Such an apparatus might be applicable to the civilian population as well.

Perspective and Prospects

Motion sickness is a common problem in children and some adults. New drugs to treat the problem are being explored. A number of chemicals showing promise are related to or interact with serotonin, a chemical that participates in a number of regulatory systems in the body. Drug companies are working on new drug delivery systems to make antinausea medications easier to take. Other advances include drug regimens that will provide antinausea effects without sleepiness.

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