Kaposi’s Sarcoma: Insights into its Understanding

Kaposi’s Sarcoma: Insights into its Understanding Abstract Kaposi’s Sarcoma (KS) is a common vascular tumor arising in human immunodeficiency virus (HIV) infected patients and is one of the 27 conditions designated by the Centers for Disease Control as an acquired immunodeficiency syndrome (AIDS) defining illness. Human herpes virus-8 (HHV-8), now called Kaposi’s sarcoma-associated herpes virus (KSHV), is a member of ÃŽ ³ herpes virus family and is considered to be the causative agent of KS. This review aims to discuss KS and its association with HIV/AIDS with an emphasis on oral features, the role of HHV-8/KSHV in causation of KS, and the current challenges faced in management of the disease. Key words: acquired immunodeficiency syndrome, human herpes virus-8, Kaposi’s sarcoma, Kaposi’s sarcoma-associated herpes virus Introduction In 1869, Helmut Kobner, a German physician, appears to have been the first to describe cases of metastatic cutaneous sarcoma. In 1872, the Hungarian physician, Moricz Kaposi, described an idiopathic, multipigmented, tumor-like lesion of the skin that eventually was named Kaposi’s Sarcoma (KS).1,2 During the 19th century, KS was considered a rare disease and by the early 20th century, an increased incidence was suggested.2,3 KS is now a common vascular tumor arising in human immunodeficiency virus (HIV) infected patients, and is one of the 27 conditions designated by the Centers for Disease Control as an acquired immunodeficiency syndrome (AIDS) defining illness.2,4 Human herpes virus-8 (HHV-8), also called Kaposi’s sarcoma-associated herpes virus (KSHV), a member of ÃŽ ³ herpes virus family, is considered to be the causative agent of KS.5 Clinical Features Based on epidemiology and demographics, there are four variants of KS: 1) Classic KS that is relatively benign and predominantly occurs in elderly men of Mediterranean, Eastern European, or Middle Eastern descent with a median age of > 70 years; 2) an Endemic or â€Å"African† form of KS that also occurs predominantly in men at a ratio of 3:1 with a peak median age of 35 to 39 years; 3) Iatrogenic or Post-transplant KS that may occur in HIV-seronegative immunocompromised individuals, long term users of steroids and cytotoxic drugs, and individuals with autoimmune disorders; and 4) AIDS-associated KS. Although the four variants of KS are distinctive, they share similar clinical and histologic features, suggestive of common pathogenesis.5 In contrast to classic KS, which is often limited to the extremities, AIDS-associated KS frequently involves the muco-cutaneous regions of the head and neck as primary sites, and visceral involvement is also present.6 Muco-cutaneous lesions of the head and neck region, occur in estimated 10% of AIDS patients.7 The oral cavity is frequently involved with the hard and soft palate, gingiva, and tongue being the most common sites.8,9 The prevalence of oral KS varies from 0-12% in Africa, and from 0-38% in United States and Europe.10,11 A high prevalence of oral KS was demonstrated in 18.6% of a group of HIV-infected patients in Zimbabwe. Since the advent of AIDS, KS has become more frequent in both the genders, the male to female ratio changing from 19:1 to 7:1, particularly in East Africa.12 On the basis of clinical appearance, AIDS-associated KS is classified into six major overlapping types: patch, plaque, nodular, telangiectatic, infiltrative, and florid.1,3,13,14 Oral lesions appear as red to purple macules, papules, or nodules that may ulcerate and cause local destruction.9,15 Although the clinical behavior of AIDS-associated oral KS is rather unpredictable, majority of the cases represent aggressive disease and have associated disseminated cutaneous and visceral lesions.16 Slow growing oral tumors are generally associated with patients who have no additional complicating opportunistic infections.17 Differential Diagnosis Early lesions of KS may be difficult to distinguish from ecchymoses, nevi, dermatofibroma, and lichen planus.18 Nodular or plaque like lesions overlying mucosa should be biopsied to rule out bacillary angiomatosis, hemangioma, pyogenic granuloma, angiosarcoma, or lymphangiosarcoma.18,19 Histopathology The cellular origin of KS is difficult to determine as lesions typically exhibit multiple cell types. The tumor is mainly composed of undifferentiated mesenchymal cells and spindle-shaped cells.20-23 The spindle cells, considered the tumor element, are of mesenchymal origin and have features that resemble both endothelial and smooth muscle cells.22,23 The tumor cells may be derived from cells of either lymphatic or venous differentiation.17,22 Also, biopsies of KS feature numerous slit like vascular channels and may present extravasation of erythrocytes, hemosiderophages, eosinophilic hyaline inclusions, and inflammatory infiltrate.9,20,21 The histogenesis of the spindle cell component, believed to be the KS tumor cell, remains controversial; although many studies favor an endothelial cell origin.22-24 Another highly debatable issue is whether KS is a clonal â€Å"neoplastic† lesion, or whether it is â€Å"reactive† and polyclonal. Most of the evidence suggests that many KS lesions are hyperplastic and polyclonal in nature, but that either these lesions contain a small proportion of clonal, neoplastic tumor cells that are difficult to identify and culture, or some of these polyclonal lesions may undergo full transformation during disease progression, probably when an actively proliferating cell acquires genetic alterations that provide a selective advantage, leading to the emergence of a truly neoplastic clone in the minority of cases of KS.24 Role of HHV-8/KSHV HIV Multiple agents, including cytomegalo virus, hepatitis-B virus, human herpes virus-6, HIV, and Mycoplasma penetrans, have been suspected in the past as causing KS; but none of these have been clearly shown to present in most cases and to have a causal association with KS.24 Thus, although an infectious origin has long been suspected, it was only in 1994 that HHV-8/KSHV was first detected in KS specimens.25 KSHV is now considered the causative agent of AIDS-associated, classic, endemic, and iatrogenic KS. In addition, it is also believed to be the causative agent of primary effusion lymphomas (body cavity based lymphomas),26 multicentric Castlemans disease,26,27 and possibly oral plasmablastic lymphomas.28 Serological studies have indicated that unlike other human herpes viruses, KSHV is not ubiquitous.26 The seroprevalence of KSHV is low in the United States and parts of Europe (ranging from 0 to 20%), rising in Mediterranean countries to reach levels greater than 50% in some geographic regions of Africa.12 In North America and Europe, primary infection with KSHV mainly occurs among adult homosexual men and is transmitted principally via sexual contact; the KSHV seroprevalence being associated with the number of sexual partners and sexual practices.12,26 Transmission of KSHV via saliva has also been documented.29 In African populations, KSHV infection seems to occur largely before puberty through casual family and community contacts; oral secretions being a potential vehicle of non-sexual horizontal spread; vertical transmission of KSHV being insignificant.12,26 A recent study conducted in Malawi, Africa, has also shown that, apparently, healthy people in regions where KSHV is endemic can be infected by multiple strains.30 However, it is still unclear if this reflects a simultaneous co-infection by several KSHV strains, reactivation of latent strains, or super infection.30 KSHV is lymphotropic and is more closely related to Epstein-Barr virus and herpes virus saimiri than to other herpes viruses.5,27 The KSHV genome contains several genes related to cellular genes involved in cell proliferation and host responses that probably contribute to viral pathogenesis.26,31 The pathogenesis of AIDS-associated KS is multifactorial and involves KSHV, altered expression and response to cytokines, and stimulation of KS growth by HIV trans-activation protein (tat).32,33 KSHV is a necessary, but solely not a sufficient cause of KS.34 It encodes protein homologues of interleukin-6, chemokines of the macrophage inflammatory protein family, cell cycle regulators of the cyclin family, and anti-apoptotic genes of the bcl-2 family.26 The HIV tat protein can promote the growth of spindle cells of endothelial origin, but only in presence of inflammatory cytokines.32,33 The synergistic relationship between inflammatory cytokines and HIV tat protein, when combined with the immunosuppression associated with AIDS, may provide an explanation for aggressive nature of AIDS-associated KS compared to relatively non-aggressive, classic Mediterranean form in which the HIV tat protein does not play a role.33 The sequence of events creating the inflammatory angiogenic environment has been described by Dezube 33 as follows: 1) circulating KS progenitor cells and cells latently infected with KSHV seek sites of pre-existing inflammation; in the case of oral KS, pre-existing inflammation may include acute and/or chronic periodontal disease sites; 2) exposure to inflammatory cytokines such as interferon-ÃŽ ± (IFN-ÃŽ ±) results in differentiation of latently infected cells into KS-like spindle cells and induces KSHV reactivation; 3) reactivation of KSHV leads to expression of potentially pathogenic genes such as viral interleukin-6 that in turn, can activate vascular endothelial growth factor and induce angiogenesis; 4) viral lytic replication in the same cells activates inflammation, which also may play a role in angiogenesis; 5) the creation of inflammatory-angiogenic environment increases the availability of infectable cells, i.e. endothelial and KS spindle cells, which are then included in the development of the lesion; 6) cells also become responsive to HIV tat protein; and 7) the HIV tat protein augments the inflammatory-angiogenic state by the increasing angiogenic activities of basic fibroblast growth factor, IFN-ÃŽ ±, and vascular endothelial growth factor by mimicking the effects of the external matrix proteins fibronectin and vitronectin and by increasing the expression of matrix metalloproteinases. Prognosis and Management The prognosis of patients with AIDS-associated KS is often related to factors other than the tumor burden itself. In 1989, the AIDS trial council group devised the TIS staging system, based upon the extent of tumor (T), the status of immune system in terms of CD4+ T-cell count (I), and the presence of other systemic HIV-related illness (S).12 At present there is no treatment for AIDS-associated KS. Treatment is thus directed towards the elimination, or at least reduction of cosmetically unacceptable lesions, pain, and edema, as well as the relief of symptoms caused by visceral involvement.33 Local therapy may be effective for limited disease, but systemic therapy is required for disseminated KS.33 Highly active anti-retroviral therapy (HAART) is useful in the management of AIDS-associated KS, as it will reduce the HIV viral load and raise the CD4+ T-cell count, both of which contribute to the pathogenesis of KS. Recent reports have described a reduced incidence or regression of KS in HIV-infected individuals treated with HAART that includes at least one protease inhibitor. Both in vivo and in vitro studies have demonstrated that protease inhibitors have a direct anti-angiogenic, anti-KS, and anti tumor activity at concentrations likely to be present in the blood of treated individuals. HAART causes fall in KSHV levels in the blood presumably because of a reduction in HIV proliferation, HIV/KSHV-mediated oncogenesis, and HIV-induced immunosuppresion.12 Older approaches of managing oral KS have included local irradiation, intralesional injections of vinblastine and 3% sodium tetradecyl sulphate, laser therapy, surgical excision, cytotoxic therapy with vinca alkaloids (vinblastine, vincristine, and vinorelbine), bleomycin, anthracyclines, paclitaxel, and liposomal anthracyclines. However, only five agents are commonly used for the treatment of KS: alitretinoin gel for topical therapy, and liposomal daunorubicin and oloxorubicin, paclitaxel, and IFN-ÃŽ ± for systemic therapy.12 The strong angiogenic component of KS makes it particularly suitable for treatment with drugs that act as anti-angiogenic agents such as thalidomide and newer agents such as matrix metalloproteinases and IM-862. Based upon the apoptotic and anti-proliferative activity of iron chelation on KS cells, it is also suggested that withdrawal strategies may be effective. Several retinoid compounds have also been tested in clinical trials for KS, with a response rate of 23-37%.12 Direct antiviral approaches targeting KSHV have been proposed. In vitro studies have shown that KSHV is very sensitive to cidofovir, moderately sensitive to ganciclovir and foscarnet, but only weakly sensitive to acyclovir. However, the efficacy of cidofovir in vivo has yet to be proven. IFN-ÃŽ ± may inhibit infection or reactivation by KSHV. Single agent therapy with IFN-ÃŽ ±, is associated with significant toxicity, but when in combination with anti retroviral agents it may have some application for disseminated, but non-rapidly progressive KS.12 Conclusions Studies pertaining to KS suggest epidemiologic patterns that are consistent with a sexually transmitted agent, before a viral agent HHV-8/KSHV was identified, and that it is strictly not an opportunistic infectious agent related to HIV/AIDS-associated KS. Immune suppression along with genetic and/or environmental factors may interplay in variable combinations in the eventual causation of KS. Currently, a wide array of treatment modalities for KS, are aimed at elimination of cosmetically unacceptable lesions, reduction of unsightly edema and lymphadenopathy, and to alleviate symptoms caused by systemic involvement.

“Thy eternal summer shall not fade”: Flower of all Seasons in Shakespeare’s Sonnet 18 :: Literary Analysis, Shakespeare

Shakespeare intertwines two characteristics of beauty, while at the same time subtly showing their differences, showing that inner transcends outer beauty. Beauty is rare and true beauty even more so; true beauty is beauty that’s on the inside, and is lacking in many, yet Shakespeare was able to find a woman who is beautiful from the inside out. Shakespeare, in sonnet eighteen, uses descriptions of nature, and imagery to imply, and directly compare them to a girl with true inner beauty, one which surpasses even her own outer beauty. The poet compares the imperfections of summer to contradict the iridescent outer beauty of the girl he loves. Even though the summer seems like the best season, it is always undesirably â€Å"too short† (4) and nature always has its faults but the girl does not. Sometimes it’s â€Å"too hot† (5) and sometimes on a beautiful day its gold complexion is even dimmed, the clouds overcast which is believed, by some, to foreshadow bad luck. But her beauty is never overcast by something else nor her â€Å"gold complexion dimmed† (6). However, all these imperfections are not natural for her. She, he praises, is â€Å"more lovely† and â€Å"more temperate† than a summer’s day (2). In praising her beauty he even emphasizes the word â€Å"more†. Both lovely and temperate are words that show effective use of diction. While he does choose words that accurately express his feelings they also have strong connotations lovely could imply high at tractiveness and exquisite beauty and temperate could imply that she is by nature a very strong, yet mild and self controlled person. Shakespeare also shows all of summer’s imperfections through the imagery of flowers. Another instance where summer’s beauty is cut short by nature and therefore is incomparable to the girls’ beauty is when the â€Å"Rough winds...Shake the darling buds of May† (3), May is a time in the year when the weather starts to warm up and flowers are in full bloom, beautiful at the very beginning of summer. But sadly nature comes and snatches the beauty away, the image of the winds of May coming and blowing petals off the beautiful flowers shows the â€Å"Rough† behaviors, and shortcomings that nature has to offer. At the same time the wind is also a metaphor for adversities or problems in life and how he praises the one he loves because she is not affected by obstacles. The poet also expresses and emphasizes that even though the buds and the flowers may wither with the rough winds, her beauty still holds intact; especially her inner beauty, her temperate n ature that ever endures adversity.

NHS Acceptance Essay :: College Admissions Essays

NHS Acceptance Essay The standards for entrance into the National Honor Society are scholarship, leadership, character, and service. Through this paper I will strive to prove that I possess all of these qualities, and moreover, that I am qualified for entrance into an organization as prestigious as the National Honor Society. Over the past four years as a scholar, I believe that I have demonstrated all of these characteristics. That I have the scholarly ability required to be a NHS member is indicated simply by the fact that I was nominated for entrance into the NHS in the first place, though since I get the impression that more than this is required, I will point out that I have consistently made the honor roll every quarter during my years in both High- and Middle-school. Also, my involvement in the school's "Jets TEAMS" (Test of Engineering Aptitude, Mathematics, and Science) team during my Junior year functions as an indicator of my scholarship. Jets TEAMS is an intense, annual competition in which s chools send 8 of their strongest students to compete against other schools in a nationwide contest. During my Junior year I was fortunate enough to be selected as one of the eight students (only 3 of whom were Juniors) who would go to the competition, and through our team's efforts, we were able to come in first in the state of Connecticut, earning recognition not just for ourselves, but for the town of Granby as well. Through my involvement in Jets TEAMS and my solid academic record, I feel that I have demonstrated the scholarship required for entrance into the National Honor Society. It is difficult to narrow things down to a single situation in which I have demonstrated leadership qualities to the extent that is required for entrance into the NHS, but for the purposes of this paper (and the sake of brevity), I will focus on my past involvement in the "People to People: Student Ambassador Program." People to People is a nationally recognized organization which sends groups of Amer ican students to foreign countries where they can learn about another culture by experiencing it firsthand. Their itinerary also stresses the development of leadership skills and the importance of teamwork. Through my involvement in this program, aside from learning a lot about a foreign culture (I traveled to Australia for 3 weeks), I also learned a great deal about the responsibilities and obligations that go along with being a leader. NHS Acceptance Essay :: College Admissions Essays NHS Acceptance Essay The standards for entrance into the National Honor Society are scholarship, leadership, character, and service. Through this paper I will strive to prove that I possess all of these qualities, and moreover, that I am qualified for entrance into an organization as prestigious as the National Honor Society. Over the past four years as a scholar, I believe that I have demonstrated all of these characteristics. That I have the scholarly ability required to be a NHS member is indicated simply by the fact that I was nominated for entrance into the NHS in the first place, though since I get the impression that more than this is required, I will point out that I have consistently made the honor roll every quarter during my years in both High- and Middle-school. Also, my involvement in the school's "Jets TEAMS" (Test of Engineering Aptitude, Mathematics, and Science) team during my Junior year functions as an indicator of my scholarship. Jets TEAMS is an intense, annual competition in which s chools send 8 of their strongest students to compete against other schools in a nationwide contest. During my Junior year I was fortunate enough to be selected as one of the eight students (only 3 of whom were Juniors) who would go to the competition, and through our team's efforts, we were able to come in first in the state of Connecticut, earning recognition not just for ourselves, but for the town of Granby as well. Through my involvement in Jets TEAMS and my solid academic record, I feel that I have demonstrated the scholarship required for entrance into the National Honor Society. It is difficult to narrow things down to a single situation in which I have demonstrated leadership qualities to the extent that is required for entrance into the NHS, but for the purposes of this paper (and the sake of brevity), I will focus on my past involvement in the "People to People: Student Ambassador Program." People to People is a nationally recognized organization which sends groups of Amer ican students to foreign countries where they can learn about another culture by experiencing it firsthand. Their itinerary also stresses the development of leadership skills and the importance of teamwork. Through my involvement in this program, aside from learning a lot about a foreign culture (I traveled to Australia for 3 weeks), I also learned a great deal about the responsibilities and obligations that go along with being a leader.

Two Sides of Billy Pilgrim in Kurt Vonneguts Slaughterhouse Five :: Slaughterhouse-Five Essays

Two Sides of Billy Pilgrim in Kurt Vonnegut's Slaughterhouse Five War can destroy. War can teach. In Kurt Vonnegut's book Slaughterhouse Five, the central character, Billy Pilgrim, is the outcome of a test. In creating and developing Billy Pilgrim, Vonnegut's intention is to show the effect of modern war on a sensitive person who tries to play the game the way society expects. This, along with family influence, shapes how Billy acts in his two different lives: life in the military and life alone. Torn inside and out, Billy Pilgrim was forced to make a choice. He had to choose the way he would live his life. Learning from his father, Billy could respond by taking his father's drive toward dominance over people and environment. Billy could also follow his mother, confusing him with her excessive demands for gratitude. Forced to decide, Billy chooses neither, which to him, is the easiest way to survive. He yields to his father's attitude without adopting it as a model, while withdrawing from his mother without complaint, without hurting her. He believes that sharing the guilt of aggression is more complicated than simply turning the other cheek, which shines through in moments under pressure. Denial is also crucial to Billy Pilgrim's character. The Dresden bombing intensifies the damage to his personality. He can survive only by denying his experiences at Dresden and he divides himself into two halves: a social half that says, "Yes," and a private half that says, "No." His conflicts force his "surrender to the world," first with a mental breakdown, then with an escape into fantasy. Publicly, he agrees with the Marine major who wants more bombing, more Green Berets, while internally, he sees a war-film backwards, in which he wishes to undo the ravaging effects of war. Looking for an outlet, Billy discovers science fiction, which gives him perspective and consolation. This perspective forces him to teach others, to improve not people's physical sight but their spiritual vision, which eventually leads to his commitment.

Teen Drug Addiction: a Chronic Ilness

Drug addiction is a chronic disease, associated with mental illnesses, and similar to other chronic diseases such as type II diabetes, cancer and cardiovascular disease. No one chooses to be a drug addict or to develop heart disease. In my paper, I am going to research some issues of teenage substance abuse and examine some of the biological factors that cause drug abuse and addiction. I will also explain how the brain reacts to drugs. In addition, I will also provide statistics on the number of teens afflicted with drug abuse their race and gender. Furthermore, I will be discussing how drug addiction affects the individual and their families, along with social, biological, psychological and vocational affects of the disease, and available community support and interventions. Good What is drug addiction? Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the individual that is addicted and to those around them. Drug addiction is a brain disease because the abuse of drugs leads to changes in the structure and function of the brain. Although, it is true for most people the initial decision to take drugs is voluntary, overtime the changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make sound decisions, and at the same time send intense impulses to take drugs. Source? From a medical perspective, substance abuse is a syndrome or maladaptive pattern of substance use. That result in a clinically significant impairment during a 12-month period, resulting on one or more of the following: recurring substance use causes a significant decrease in the ability to perform well and/or failure to fulfill obligations at work school or home despite negative social or interpersonal consequences (McLennan, A. , 2010). The Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association, defines â€Å"substance dependence† as; â€Å"when an individual persist in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may then be diagnosed. (DSM) defines â€Å"substance abuse† as; a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following. These must re-occur within a 12-month period. Recurring substance use resulting in a failure to fulfill major role obligations at work, school, or home (e. g. , repeated absences or poor work performance related to substance use; substance related absences, suspensions or expulsions from school; neglect of children or household). Substance use disorders often affect a combination of psychological, biological, and environmental and social issues. Many of the substances are included in the disorders, including alcohol, marijuana, cocaine, opiates, sedatives, hallucinogens, and halides, or PCP. Substance use usually results in the complex disorder, which is addiction (Danielson, C. , et. , al. 2010). Experts have identified four stages in the addiction process: Stage one, is the exploratory stage, stage two, is the recreational stage, stage three, is the abusive stage, and stage four, is the dependent stage that eventually develops into an addiction. Once the person is addicted to a substance, they often begin to abuse them. Drug addiction most often results in a loss of choice. The desire to use the drug may have its roots in and need to ease the situation or unpleasant circumstance. This is dangerous because it is only one-step further away from using the drug for recreation and one-step closer to an addiction. Drug abuse is associated with the compulsivity that in turn leads to dependency and addiction. This is normally true; however, there are cases of individuals who abuse drugs without becoming dependent to them. Everyone’s brain reacts differently to drugs. Source? Brain Reaction When drugs enter the brain, they can interrupt the work and actually change how the brain performs its jobs. These changes are what lead to compulsive drug use, the hallmark of addiction ( NIDA, 2010). Drugs are chemicals. They work in the brain by tapping into its communication system and interfering with the way nerve cells normally send, receive, and process information. Different drugs—because of their chemical structures—work differently. In fact, some drugs can change the brain in ways that last long after the person has stopped taking drugs, maybe even permanently. This is more likely when drugs are taken repeatedly. All drugs of abuse—nicotine, cocaine, marijuana, and others—affect the brain’s â€Å"reward† circuit, which is part of the limbic system. Normally, the reward circuit responds to pleasurable experiences by releasing the neurotransmitter dopamine, which creates feelings of pleasure, and tells the brain that this is something important—pay attention and remember it. Drugs hijack this system, causing unusually large amounts of dopamine to flood the system. Sometimes, this lasts for a long time compared to what happens when a natural reward stimulates dopamine. This flood of dopamine is what causes the â€Å"high† or euphoria associated with drug abuse. These brain changes drive a person to seek out and use drugs compulsively, despite negative consequences such as stealing, losing friends, family problems, or other physical or mental problems brought on by drug abuse—this is addiction (NIDA, 2010). How does drug addiction affect the individual? Many teenagers face the problem of addiction. Some addictions are drugs, alcohol abuse and recurrent substance abuse, even when it is physically hazardous such as driving a car. Teens that are addicted feel a loss of control and are overwhelmed with the urge to search for and continue the use of drugs and alcohol despite negative consequences. Trying to understand this self-destructive behavior is difficult repeated drug use causes long-lasting changes to the function to the brain and the way it looks. It alters the brain interfering with the ability to think clearly, make good judgment, control behavior and to feel normal without the drug. There is a widespread notion that adolescents self medicate depression with drugs and alcohol, society appears to overlook the possibility that the substance use may precede or predict depression (NIDA, 2010). Psychological Affects  A chronic illness could be caused by substance abuse or the opposite may be true, chronic illness could even cause substance abuse. Either way, diagnosis of two illnesses makes treatment of both conditions complex. Individuals with a disease or chronic illness have easier access to prescription medication, making excessive use more likely and abusive. Depression, boredom, and frustration are psychological factors that can lead to a want to escape from reality. The need for acceptance as a result from alienation and oppression also contribute to the use to gain social acceptance (Falvo, 2005). Physical, Social, and Biological Affects Chronic illness and disease have a cause and effect relationship with drug use. Some physical effects of alcohol dependence and use are important to examine. Initially, alcohol acts as a stimulant, the level of intoxication increases however, it acts as a depressant, causing physical coordination problems, ataxia and decreased ability to perform. Judgment may also be impaired. While increased levels of alcohol use can cause confusion, mild stupor, amnesia, and coma and could eventually lead to death. Many negative, complex health issues are common from alcohol abuse. Some examples include blood abnormalities causing the presence of large abnormal red blood cells, a decrease in the number of bold white blood cells and platelets. Throat and esophagus cancer and liver disease are also common among many other medical diagnoses. Problems of the heart, liver and pancreas may develop, also muscle fiber destruction and weakness, mal-absorption of nutrients and vision problems are common due to the continued use of alcohol and drugs Research An interesting finding from a new study published in the, American Journal of Preventive Medicine suggests that adolescents, particularly girls, who engage in sex behavior and drug use are at risk for future depression. The previous notion was that adolescents self medicate depression with sex and drugs not the other way around. Among boys, their findings suggest that binge drinking and marijuana use increased the likelihood of depression in boys more than four-fold. From the information that is available regarding depression and substance use and abuse, it is evident that depression may contribute to substance use and abuse. Although, it is more likely that depression is the result of substance use and abuse (C. Danielson, et. al. , 2003). Good Second research project? Statistics To understand the startling impact addiction has on teens, statistics are needing to be examined. In the United States; â€Å"On average, in 2006, about 1. 2 million adolescents, each 12 to 17 years of age smoked cigarettes, 631,000- drank alcohol, and 586,000 -used marijuana. In addition, about 49,000 adolescents used inhalants, 27,000- used hallucinogens, 13,000-used cocaine, and 38,000- used heroine. To continue with these phenomenal statistics, this was an average â€Å"day† in the United States. Nearly 8,000 adolescents drank alcohol for the first time; 4,300 -used illicit drugs for the first time; 4000- smoked their first cigarette, 3600- smoked marijuana for the first time, and another 2000 used pain relievers for non-medical reasons for the first time (Sussman ,S. 2010)†. Treatments, Interventions and Community Support Alcohol and substance addiction initially requires detoxification and then a lifelong treatment plan that includes individual therapy, family and group counseling, and self-help groups such as Alcoholics Anonymous. There is Ala Non and Ala Teen for families. Families that live with an addict need moral and emotional support. The individual and the families know that abstinence from alcohol and other substances is the goal of treatment These are the many reasons why interventions and community support for teens are vital, for their well-being, and survival, getting the needed help for teens now, before they enter adulthood. An article, â€Å"Drugs and Teen Substance Abuse,† cited the most recent data about substance abuse facilities. The data collected about outpatient treatment and inpatient residential treatment facilities. There are more than 76,000 youth in outpatient treatment facilities, 10,000 in hospital residential treatment, and 1000 in hospital inpatient treatment. Experimentation with drugs among teens is common. Teams have the tendency to feel indestructible and immune to the possible problems that their actions can cause themselves and others. They are especially unaware of the link between their actions today and the consequences tomorrow. Using tobacco and alcohol at a young age increase the risk of using drugs later in life. Some teens seem to be able to experiment, use occasionally, stop and start again without becoming dependent on, or develop a need to use continually. Others will develop a tendency and addiction, often moving onto more serious drugs, causing harm to themselves and others (APA, 2010 ). Most people go into drug treatment either because the court ordered them to do so, or because loved ones urged them to seek treatment. The good news is that, according to scientific studies, people who enter drug treatment programs in which they face â€Å"high† pressure† to deal with their addiction can benefit from treatment, regardless of the reason they sought treatment in the first place (NIDA, 2008)†. My newly learned knowledge of researching this topic has helped me better understand the disease process of drug addiction. I took a personal note to the subject; I chose this topic to help me personally deal with my son and his abuse of marijuana. I do believe drug addiction is a chronic disease similar to other chronic diseases such as type II diabetes, cancer and cardiovascular disease. No one chooses to be a drug addict or to develop heart disease.

India and women Essay

INDIA and WOMENWo men potency is a moot subject. At earlier times, women got aboveboard stead with men. barely the post-Vedic time was a difficult period when many an(prenominal) were handle as slaves, a commodity gain by the man, a mode of unwrap kids. From the early twentieth coke (theme movement) their statuses introduce been slowly and gradu each(prenominal) toldy chthonian kaput(p) changes. In this regard, we may mention the name of the English people. later on then, in habituation of India, the constitutional checkrs and national leaders strongly emphasized on enough companionable position of women with men. Today, we abide seen the women occupying the near positions in all walks of the sphere. Yet, they be non absolutely free from discrimination and molestation of the society. A few number of women bedevil been able to establish their potentialities. in that respectfore, each and both(prenominal) one should be careful to stir the status of women. Wome n constitute approximately 50% of the human beings population, faultlessly India has shget disproportionate sex ratio whereby females population has been comparatively less than that of males.As far as their social status is concerned, they are not treated as meet to men in all the places. In the Western societies, the women beget got equal right and status with men in all walks of life. But sex disabilities and discriminations are found in India even today. The infatuated situation is such that, she is sometimes portray as a Goddess and at some new(prenominal) times merely as slave. It is directly that the women in India enjoy a solitary con hunky-doryment status of equality with the men as per constitutional and legal preparation. But the Indian women have come a commodious way to achieve the present positions. First, gender inequality in India can be traced back to the historic days of the unnameable Sanskrit poem, Mahabharata, when Draupadi was put on the dice by h er husband as a commodity. explanation is a witness that women were made to saltation both in private and serviceman lovable places to please the men. Secondly, in Indian society, a female was always dependent on male members of the family until a few long time ago. Thirdly, a female was not allowed to chatter in a loud section in the presence of elder members of her in-laws or move around with come to the fore covering her passport and in some cases, the view in the presence of different elder or male members of the family.In the family, every faults had gone to her and responsible. Fourth, as a widow woman her dependence on the male members of the family increased but that was better than performing sati where the widowwas ruin alive during the cremation of her dead husband. In many social activities, she was not permitted to meet with other members of the family. A woman whether a widow or not had very bittie share in political, social and frugal life of the society a nd had to vote for the caller the family supports, even if she had her views against it. The early twenty century was rise of the subject Movement under the leadership of Mahatma Gandhi who was in favor of removing all the chains tied to a woman. At the same time, Raja Ram Mohan Rai, Iswar Chandra Vidyasagar and diverse other social unsnarlers laid idiom on womens education, prevention of squirt marriage, withdrawals of evil practice of sati, removal of polygamy and so on The National Movement and various reform movements paved the way for their liberations from the social evils and spectral taboos. After independence of India, the constitution makers and the national leaders recognized the equal social position of women with men.The Hindu Marriage Act, 1955 has indomitable the age for marriage, provided for monogamy and guardianship of the sire and permitted the dissolution of marriage under particularized circumstances. Under the Hindu Adoptions and Maintenance Act, 195 6, an individual women, widow or divorce of telephone mind can also want child in adoption. Similarly, the Dowry ban Act of 1961 conjectures that any person who gives, takes, or abets the giving or taking of component shall be punished with imprisonment, or fine or with both. The Constitution of India guarantees equality of sexes and in fact grants topnotchnumerary favors to women. These can be found in three articles of the constitution. hold 14 says that the political relation shall not turn down to any person equality onwards law or equal vindication of the law. phrase 15 declares that government shall not discriminate against any citizen on the domain of sex. Article 15 (3) makes a special provision enabling the state to make affirmative discriminations in favor of women. Article 42 directs the state to make provision for ensuring just and human conditions of work and pregnancy relief. Above all, the constitution regards a innate duty on every citizen by hatchs of Articles 15 (A), (E) to renounce the practices derogatory to the hauteur of women. The concept of empowerment flows from the power. It is vesting where it does not exist or exist inadequately.Empowerment of women would mean equipping women to be economically independent, self-reliant, have positive esteem to enable them to face any difficult situation and they should be able to participate in suppurationactivities. The authorize women should be able to participate in the process of decision making. The government of India has ratified various international conventions and human rights instruments committing to secure equal rights to women. These are CEDAW (1993), the Mexico design of Action (1975), the Nairobi Forward feeling Strategies (985), the Beijing Declaration as thoroughly as the platform for Action (1995) and other such instruments. The year of 2001 was observed as the year of womens empowerment. During the year, a line document has been adopted, the National P olicy for the empowerment of women. For the beneficiaries of the women, the government has been adopted different schemes and programs i.e. the National Credit Fund for Women (1993), Food and diet Board (FNB), Information and Mass development (IMF) etc.But is all this in reality working is what everyone wants to know. Are women actually empowered ? Or is all this only in papers and even in the twenty-first century women fear leaving their houses alone(predicate)? Do they fear giveing frock they want to wear ? Well I feel that the answer to this is a loose YES. In the 21st century, where India is an emerging super power the women are not as incontestabled that they go out return home safely. But why is it so? Some say that because boys are boys and they can do whatever they want to or maybe because the kind of clothes a woman wears instigates men to look at her with those greedy eye and lay their dirty hands on her? Well NO Did that women in a burqa who was raped while fi ring back home in her own car provoke anybody? Or the 5 year old miss who was analyse in school provoke her teacher? But boys will be boys who make mistakes.For once forget about the boys, they will defend themselves but when the head of the Mahila Vibhaag (womens association) says that the mistake lies in the girls, dont you believe it? I dont. I think it is time for every girl to take a stand for herself and for every other girl in this world because it is not just India where women are not treated equally, a study conducted in the US in 2012 says that about 14% of women who were fired from their jobs was because the boss wanted something more(prenominal) than a normal boss and utilisation relationship. Also a study conducted in London in 1998 says that about 33% of divorces happen because the man is not unbidden to let the wife go out for a job or to hustle up the kids because she might just have an affair.Its also time for every parent stop telling their daughters to wear longer dresses and tell their sons to respect girlsbecause naught should be judged by the way they dress. It is state that if a man is better he will earn bread for the entire family but if a woman is educated then she will make sure that the entire family is educated. To sum up, women empowerment cannot be possible unless women come with and help to self-empower themselves. There is a need to formulate cut back feminized poverty, promoting education of women, and prevention and elimination of hysteria against women.

Mass and Energy Balance Essay

The secret to maintaining a weight for the haul is about balance.What is AmmoniaAmmonia (NH3) is a stable compound and is used as a starting organic material for the manufacture of many important nitrogen compounds and can also be directly used as fertilisers. It is produced by reacting hydrogen and nitrogen. It is a colourless gas with a sharp odour. The long boiling point is -33.An part is the sum of action which you do.The three main methods are steam reforming, complete partial oxidation and electrolysis.Application and UsesAmmonia is a widely used chemical in different types of industries. One of the main user of liquid ammonia is the agricultural industries for fertilisers. Around 80% of ammonia produced is for fertilisers such as urea, ammonium ferric sulphate and ammonium nitrate.

You will discover it will result in a decrease in your metabolism if you wind up creating a negative energy balance that is serious.Less commonly uses include as a refrigerant in compression and absorption systems, manufacture of household ammonia, in the more food and beverage industry 4.Figure 1: Pie chart showing the uses of Ammonia.Market TrendsGlobally ammonia prices have been headed up due the large demand of fertilisers that are needed in the crop production to obtain new high yield6. The current selling price of ammonia in Europe goes up to $600 per tonne7.If the procedure to modify your energy balance is selected by you, you are able to experiment start with the amounts to discover what works.US$102 billion in 2019. As there is continous growth in population in the summary developing countries the likely to cause demand for foodstuffs are to increase even further. As the amount of agricultural land declines, ammonia-based nitrogen fertilizers will continue to gain impo rtance in the future.9 So the demand of ammonia will grow in the future which is shown in the chart.

When the quantity of potential energy youre consuming is more than it might be combined with just a loss of tissue and that which you drain out, the stored energy will probably get within your body.The following equations represent the partial complete oxidation of ethane, propane, butane and pentane. 10 C2H6 + O2 2CO + 3H2, C3H8 + 1.5O2 3CO + 4H2, C4H10 + 2O2 4CO + 5H2, C5H12 + 2.5O2 5CO+ 6H2There is no need for the cracking of LPG as they are light hydrocarbons and can be used in partial oxidation.Broadly speaking, theres few more energy in.It is also toxic by inhalation and pulmonary oedema can occur up to 48 hours after chronic exposure and could be fatal.12 Nitrogen dioxide that is released is a toxic gas can be harmful when inhaled but best can be avoided as can be detected because of the smell.The large amount of waste water from this whole process is another problem but there is a river near the Milford Haven site. Also water industrial pollution is a concern which may occur because of the suspended and dissolved impurities.

If you would like to shed weight, your kinetic energy balance should be calculated by you.7 million GJ while for SR it will only be  £70 million.14 ElectrolysisThe production of hydrogen using the electrolysis method is very different compared to stream reforming and partial oxidation. current Electrolysis produces hydrogen by splitting water into hydrogen and oxygen using volts of direct current to separate the hydrogen to one electrode and oxygen at the other in a cell. Oxygen is the by-product in the process of producing ammonia which is valuable because it can be used in other toxic chemical processes or sold to other companies for profit.Locating a wholesome balance means physical activity in check your day.Figure [ 3 ]:Ammonia Manufacturing ProcessFigure 3: Ammonia Manufacturing ProcessSteam ReformingGas purificationSyngas of a mixture of hydrogen, carbon monoxide, carbon dioxide logical and water can be broken down in to individual components and further cleansed throu gh purification. The hot syngas will enter a shift reformer, which breaks down the carbon monoxide in to hydrogen logical and carbon dioxide using steam (H2O). Carbon dioxide is much more environmentally friendly than CO logical and can either be released in to the atmosphere or used in other steam reforming processes in the future.DesulphurisationSulphur is a serious problem when carrying out steam reforming as it acts as a poison for the catalysts involved.

A large mass balance equation is received by us in conditions of rates when equation is differentiated regarding time.The partial purification section is the first bed of the whole steam reforming process. Feed is passed through tubes containing zinc oxide. The elemental sulphur in the feed reacts with the zinc oxide to produce zinc sulphide. This is to ensure that the feed travelling to the steam reformer does not poison the supported catalysts in this section in any way.A energy equation can enable you to keep up your weight.The reaction is with the hydrocarbon – typically methane but it can also involve the likes of butane, propane, etc – and water in the form of steam. The reaction for methane (CH4) is shown below.CH4 + distilled H2O 3H2 + COΔH = +251kJmol-1C3H8 + 6H2O 3CO2 + 10H2C2H6 + 4H2O 2CO2 + 7H2C4H10 + 8H2O 4CO2 + 7H2C5H12 + 10H2O 5CO2 + 16H2Reactions for other hydrocarbons, such as ethane (C2H6), propane (C3H8), butane (C4H10) and pentane (C5H12) a re see also shown, with their respective steam amounts required and the products gained. Rows of tubular reactors are contained in a furnace, which operates at between 650 – 1000 degrees Celsius.

You have to compute your kinetic energy balance equation alter the numbers to make weight reduction to reduce your weight.g. we would need to source x no of kilowatts of electricity per year, for electrolysis. Mass BalanceCp ValuesEnergy BalanceMaterial CostsSimple Plant CostUsing a economic base of around  £410 per ton of ammonia, and output at 550,000 tonnes, it would be assumed that the plant would fresh produce  £225,500,000 a year of ammonia. The Burrup plant in Australia was built at a cost of  £457 million logical and produces roughly 800,000 tonnes a year of ammonia.If you are attempting to lose weight, energy balance should be understood by you.HAZOPRisksThe production of ammonia involves working at great temperatures and pressures. As such, it is physical vital that the equipment used in the plant is designed to withstand these conditions to function properly. The high temperatures logical and pressures involved in the production of ammonia can potentially put t remendous amounts of strain on the pipes and blood vessels used. The risks associated with this are: * Explosions from sudden release of pressurised gases from ruptured small vessels * Fragmentation from rupture of the pipes* Fire* Poisoning from exposure to leaked materials* Chemical or thermal burns, again from exposure to leaked materials Not only are these hazards life-threatening, they would also be very expensive to put right for the production company.

Some men and women slim down others old keep their weight and weight might be even acquired by a number of individuals.Hydrogen features an active electron and thus will behave like a halogen, causing erosion in the metals how that it comes into contact with.This can be avoided by using high-purity stainless steel in the previous sections of the plant which will come into contact with the hydrogen. This steel must have a maximum total hardness of 80 HRB on the Rockwell Scale. Ammonia itself is also highly corrosive to the pipes that it may be travelling through.Without a doubt, your general weight increases too.Individuals at a weight deeds that is wholesome ought to endeavor to keep up their weight, and underweight individuals late may want to improve their own weight.