The 11 Official Criteria for Addiction

The 11 Official Criteria for Addiction Addiction Print The 11 Official Criteria for Addiction/Substance Use Disorder By Elizabeth Hartney, BSc., MSc., MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada. Learn about our editorial policy Elizabeth Hartney, BSc., MSc., MA, PhD Updated on September 20, 2019 Image Source / Getty Images More in Addiction Alcohol Use Addictive Behaviors Drug Use Nicotine Use Coping and Recovery You may be wondering what defines an addict or a substance use disorder.?? The Diagnostic and Statistical Manual of Mental Disorders  (DSM), which is the official text on which diagnoses are based, contains the criteria for substance use disorders and other mental health problems. The latest version of DSM is the fifth edition, known as DSM-5, and it has some significant changes to both the list of substance use disorders and the criteria that must be met in order to diagnose some of these conditions.?? Substance Use Disorders In the last edition of the DSM, DSM-IV, there were two categories: substance abuse and substance dependence. DSM-5 combines these two categories into one called substance use disorder.?? If your substance use causes significant problems in your life, such as health issues, disability, and or not meeting your responsibilities at work, home, or school, you may have a substance use disorder. Criteria for a Substance Use Disorder Substance use disorders are classified as mild, moderate, or severe, depending on how many of the diagnostic criteria you meet. The 11 DSM-5 criteria for a substance use disorder include:?? Hazardous use: Youve used the substance in ways that are dangerous to yourself and/or others, i.e., overdosed, driven while under the influence, or blacked out.Social or interpersonal problems related to use:  Your substance use has caused relationship problems or conflicts with others.Neglected major roles to use:  Youve failed to meet your responsibilities at work, school, or home because of your substance use.Withdrawal:  When youve stopped using the substance, youve experienced withdrawal symptoms.Tolerance:  Youve built up a tolerance to the substance so that you have to use more to get the same effect.Used larger amounts/longer:  Youve started to use larger amounts or use the substance for longer amounts of time.Repeated attempts to control use or quit:  Youve tried to cut back or quit entirely, but havent been successful.Much time spent using:  You spend a lot of your time using the substance.Physical or psychological problems related to use:  Your substance use has led to phy sical health problems like liver damage or lung cancer, or psychological issues, such as depression or anxiety.Activities given up to use:  Youve skipped activities or stopped doing activities you once enjoyed in order to use the substance.Craving:  Youve experienced cravings for the substance. Being Diagnosed With a Substance Use Disorder In order to be diagnosed with a substance use disorder, you must meet two or more of these criteria within a 12 month period.?? If you meet two or three of the criteria, you have a mild substance use disorder. Four to five is considered moderate, and if you meet six or more criteria, you have a severe substance use disorder. Types of Substance Use Disorders Each substance use disorder is classified as its own disorder. Here are the six most common substance use disorders in the United States:?? Alcohol use disorderTobacco use disorderCannabis use disorderStimulant use disorderHallucinogen use disorderOpioid use disorder The Difference Between Substance Use and Abuse

Business Ethics Essay - 1323 Words

Many business managers argue that the primary responsibility of a business is to turn a profit; however, society is more concerned for corporations to assume ethical responsibility, in which welfare for the greatest number of people will be promoted. This paper addresses the fact that the subjectivity of morals within the military and individual leaders; as some issues could be viewed as ethical by a group but not so by others. The members of an organization and its employees are part of the team, therefore the organization would benefit if their leaders are having strong ethical principles and positive relationships . Because business ethics helps the team work better both individually and as a unit, thus inspiring ethical values while†¦show more content†¦The method of emphasizing ethics enables the leaders to be more inquisitive about their ethical issues not only in the leadership workshop but also back at work. As we continue working to become â€Å"all you can beâ⠂¬ , we can start to let go of our petty self-interests. As we give back, we can potentially reconstruct our communities. As we serve in for military using the values of freedom, justice, equality, caring, and dignity, we can constantly renew the foundations of democracy. Definition of Ethics In accordance to Velasquez, ethics is the discipline that deals with â€Å"right† and â€Å"wrong† or â€Å"good† and â€Å"evil† decisions that are made in according with approved standards of behavior. This is normally regulated by society and legislated by laws from federal government, state, and the country in which the business is executed, as well as, highly scrutinized by the media. But ethical behavior should not stop there, because usually laws only set minimum standards which corporations could always improve on (Velasquez, 2006). The problems facing military personnel are similar to those that business leaders deal with because, both industries see the need for an operational approach to communication, and the commitment to their members to ensure profits and long term survival in their industry (Awad, E Ghaziri, H., 2006). Additionally, the military places strong emphasis in humanShow MoreRelatedBusiness Ethics : Ethic s And Business943 Words   |  4 Pagesdiscussions in Business is Ethics. Some people believe that the decisions businesses make in interest of the business has no place in ethics and that they are essentially amoral. These businesses believe that their main objective is to simply make a profit and that it does not affect the success of the business. Whereas some businesses believe that they have to take ethics into consideration, in order for their business to be a success. Richard T. De George (1999) states that ethics and business do notRead MoreThe Ethics Of Business Ethics1471 Words   |  6 PagesReview Nowadays, the concern for business ethics is growing rapidly in the business community around the world. Business ethics are focused on the judgment of decisions taken by managers and their behaviors. The issue regarding these judgments is the norms and cultures that shape these judgments. Business ethics are concerned about the issue, how will the issue be solved and how will it move ahead along the transition analysis as well (Carroll, 2014). Business ethics can be addressed at differentRead MoreEthics And Ethics Of Business Ethics1304 Words   |  6 PagesBusiness Ethics Varun Shah University of Texas at Dallas Business Ethics Morals are a crucial part of life. Without having principles one would never be able to distinguish the right from wrong and good from evil. Just as it applies to life in general, ethics is an integral part of doing business as well. When we here the term Business Ethics in our work place, we usually do not take it seriously and brush it off saying ‘it’s just a simple set of basic rules like not cheating and so on’. ThisRead MoreThe Ethics Of Business Ethics Essay1097 Words   |  5 PagesResource A discusses how ethics is crucial in business. There are three key ideas used to understand this. Firstly, making ethically wrong decisions tend to cause more upset than other general mistakes as purposeful unethical actions are not as easily forgiven or forgotten. Secondly, ethics provides businesses with a broader understanding of everything to do with their business. Business ethics is effectively just business it its larger human context. Thirdly, being unethical ca n tarnish the publicRead MoreThe Ethics Of Business Ethics1064 Words   |  5 Pages　　　　Business Ethics Ethics can be viewed as the rules and values that determine goals and actions people should follow when dealing with other human beings. However, business ethics can be defined as moral principles of a business. It examines moral or ethical problems that arise in a business environment. Generally, it has both normative and descriptive dimensions. Organization practice and career specialization are regarded as normative whereas academics attempting to understand business behaviourRead MoreThe Ethics Of Business Ethics757 Words   |  4 Pagesdeciding what to do in certain situations, ethics is what guides an individual to act in a way that is good, or right. Those involved in business settings apply ethics to business situations, known as business ethics. It is expected of businesses, small and large, to follow business ethics. There is a particular framework businesses are to follow. However, the reoccurring news headlines of poor business ethics prove differently. Poor busine ss ethics include bribery, corporate accounting scandalsRead MoreEthics And Ethics Of Business Ethics1200 Words   |  5 PagesEthics meaning in simple way for average person is what is right from wrong. According to Chris MacDonald (2010)† Ethics† can be defined as the critical, structured examinations of how we should behave - in particular, how we should constrain the pursuit of self-interest when our actions affect others. â€Å"Business ethics is the applied ethics discipline that address the moral features of commercial activity (Business ethics, 2008).Working in ethical way in business has a lot of benefits which can attractRead MoreBusiness Ethics Essay944 Words   |  4 PagesUnderstanding Business Ethics Unit 37: National Diploma Assignment brief TASK 1: Scenario: Business ethics - a study of a selected company With growing interest among consumers regarding the business ethics of the businesses brands that consumers buy, Westminster council wants to conduct an independent review of some of the organisations that sell their goods and services in the borough. You have been asked to select one of the following brands and conduct research into their business ethics. 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The Industrial Revolution Of Philadelphia - 1524 Words

INTRODUCTION: April 8, 2012 was the Sunday that Easter was celebrated that year. This date will also be forever remembered as the day that Lieutenant Robert Neary and Firefighter Daniel Sweeney lost their lives at the Thomas Buck Hosiery Factory fire in Philadelphia, PA. Since William Penn first founded the city of Philadelphia in 1682, it has been an evolving and growing city, from a 17th century colonial city to the capital of the United States during the American Revolution. The industrial revolution of the 19th century transformed the green fields of lower Kensington, a section of Philadelphia, to a mixture of homes and mills by 1875.†¦show more content†¦At 03:17 am, Engine 2 arrives on location and reports that he has heavy fire showing from the first and second floors, and requests a full first alarm assignment. One minute later he reported that he had fire all the way t o the roof in a 6-story building, 60’ x one city block. He then requested a full second alarm assignment and notified the dispatch center to prepare for the third alarm. Around 3:30 am, before most 2nd alarm companies arrived on the fireground. the first of many collapses occurred. A large section of wall collapsed from the upper story on the York Street side and crashed on to the street. By 4:01 am, this fire would grow to a five-alarm response. With the arrival of Engine 2 and other arriving companies, command was established, and the fire scene was divided into four geographic divisions (A, B, C, D) to manage this defensive fire. Command was passed from Engine 2 to the Battalion Commander, then to the Division commander and lastly to the Deputy Commissioner. As the fire intensified, the command structure grew to include an operations section, logistics, safety and an exposure group lead by a Battalion Chief. For over two hours the approximately 45 apparatus and ov er 150 firefighters and paramedics fought to contain the fire to the original complex and protect the surrounding neighborhood. The weather that night brought 17 mph winds, with gusts over 30 mph. These winds, combined with the heavy fire loadShow MoreRelatedThe Industrial Revolution : A Small Parts Of A Larger Manufacturing Development849 Words   |  4 PagesIn order to increase productivity of the fast changing economy, the Industrial Revolution presented new organizational strategies. Small parts of a much larger manufacturing development, known as outwork system were carried out in many individual homes. The outwork system was essential, especially for making footwear. The major step-forward was under the factory system. This system allowed work to be performed on a large scale in a single centralized location. A group of businessmen, Boston AssociatesRead MoreThe Labor Force since the First Industrial Revolution Essays912 Words   |  4 PagesLabor Force During the first Industrial Revolution, many social standards of the community were starting to change. Since there were new spinning and weaving machines available, the textile mill factories were built to increase their profit. The people who established these mills hired children and women to decrease their labor cost by paying them low wages and having poor working conditions for them as well. The Labor force impacted American culture through various means such as the child laborRead MoreEssay on Industrial Revolution1279 Words   |  6 PagesIndustrial Revolution Europe during the eighteenth century was at the height of the industrial revolution, none of which reached America. In New England the population was largely English, but America as a whole had more than 20 ethnic strains present, nowhere in Europe could such a heterogeneous mixture be found. America was unique in its political structure. Americans vested authority in personalities, rather than, as in England, in institutions of tradition. As a people they had been stripedRead MorePhiladelphi The United States1183 Words   |  5 PagesPhiladelphia is the largest city in the Commonwealth of Pennsylvania, the fifth-most-populous city in the United States, and the core of the sixth-largest metropolitan area in the country. Located in the Northeastern United States at the confluence of the Delaware and Schuylkill rivers, Philadelphia is the economic and cultural center of the Delaware Valley. Popular nicknames for Philadelphia are Philly and The City of Brotherly Love. 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Because of the reduction in production costs, the prices of goods could be reduced as well. This gave the poorer masses more accessRead MoreThe Constitution: a Democratic Document?954 Words   |  4 Pagesmortgage, to speak out. Creating chaos amongst the peaceful streets of Springfield, armed farmers were stopped by state militia. Shay s rebellion led way to the Philadelphia Convention in which fifty-five men representing twelve states congregated on 1787, in proposal of drafting a new constitution. Through the occurrence of the American Revolution, they were aware of the power that their people were able to execute and wanted to stabilize the g overnment by creating a new Constitution. Members included

Buad 310 Case Analysis Instruction Free Essays

BUAD 310 Spring 2013 Case Due by 4PM on Friday, May 3rd (in BRI 400C) In this case you will apply statistical techniques learned in the Regression part of BUAD 310. Please read the following instructions carefully before you start: †¢ This assignment uses data from the file MagAds13S. XLS, which you can download from Blackboard. We will write a custom essay sample on Buad 310 Case Analysis Instruction or any similar topic only for you Order Now After you download the file go to Data Load data from file in StatCrunch to open it (you don’t need to change any of the options when loading this data. ) †¢ The entire report should be typed and clearly presented without typos and grammatical errors. Copy and paste the relevant (explained further in more detail) regression output into your document. Do not attach any graphs. †¢ You are encouraged to work in groups (maximum size is 5). Any group submits only one report, in which the first page should have all the names and USC ID of the group members. A hard copy of the report needs to be submitted (an electronic copy is NOT acceptable). Before May 3rd, you can also hand in the report during class. When I am not in my office (BRI 400C), please drop the report in the office through the gap between the door and floor. Very important: present the problems in exactly the same order as they are listed. †¢ A note to Mac user: you might need to hold â€Å"shift† when selecting variables for the X-variables with multiple linear regression in StatCrunch. Magazine Advertising What factors influence the price of advertisements in magazines? Suppose you are part of a team of consultants hired by a retail clothing company wish ing to place advertisements in at least one magazine. They are curious about what types of costs they can expect for magazines with different readership bases so they most effectively utilize their advertising budget. Your team has collected cost data on 44 consumer magazines. In addition, your team has measured some other characteristics of the magazines and their audiences that may be useful in understanding the advertisement costs better. The variables are as follows, pagecost: Cost of a four-color, one-page ad (in dollars) circ: Circulation (projected, in thousands) percmale: Percent male among the predicted readership medianincome: Median household income of readership (in dollars) Some natural logarithms of the variables are also provided for your convenience. Your goal is to analyze the data with StatCrunch using Multiple Linear Regression methods and choose the best model to explain the differences in advertising costs between the different titles, and then to predict what the retail clothing company should expect to pay for advertising in the different magazines. Answer the following questions (with reasonable detail, not just â€Å"yes† or â€Å"no†, use one or two sentences per question). 1. Visually examine the scatter plots of the response variable, pagecost, versus each of the explanatory variables (circ, percmale, medianincome). In StatCrunch you can go to [Graphics( Scatter Plot] to do each plot. Describe the form and the direction of each relationship. Do not attach any graphs. 2. Perform a Regression analysis to predict pagecost using all three explanatory variables [Stat ( Regression ( Multiple Linear, then fill in the proper Response and Predictor variables, then click Next twice and under Save options select Residuals, Predicted values and 95% interval for either the mean or an individual (you will have to decide which one you need for part d! ). For he CI (or PI) to be produced you need to enter the values from part d in the row underneath the data table, in appropriate columns. Note that the value for circ has to be entered in the same units as all the values in the circ column. To produce a residual plot do a Scatter plot as in question 1, selecting Residuals as the Y variable and Predicted values as the X variable]. Include the regression output, but not the plot. a. Use the R-squared and the F-tes t to comment on the usefulness of the regression model you fitted (use the significance level of 5% for the test). b. Evaluate the regression assumptions by assessing the residual plot. c. Examine each of the explanatory variables individually to determine which are contributing significantly to the model. (Use the significance level of 5 %. Do NOT actually eliminate any variables from the regression at this stage. ) d. Using the same model with all the variables, provide an appropriate 95%-level interval to the retail clothing company for the amount that they would pay for a full-page ad in a magazine with a projected audience of 2,000,000 readers, 55 percent of which are male, with a median income of $30,000. Explain in one sentence and in simple terms what this interval means. 3. Rerun the regression in part 2 with circ replaced by LN_circ (the natural logarithm of the variable circ), keeping all the other variables the same. Include the relevant regression output (only the coefficient and ANOVA tables). [Stat ( Regression ( Multiple Linear, then fill in the proper Response and Predictor variables, then click Next twice and under Save options select Residuals and Predicted values. Produce a residual plot the same way as in question 2]. a. How does this model compare to the previous model using R-squared? Explain what this difference in the R-squared values means in simple terms. b. Evaluate the regression assumptions by assessing the residual plot. c. Examine each of the independent variables individually to determine which are contributing significantly to the newest model. (Use the significance level of 5 %. Do NOT actually eliminate any variables from the regression at this stage. ) 4. Rerun the regression in part 3 with LN_pagecost (the natural logarithm of pagecost) as the response (i. . the explanatory variables are LN_circ, percmale and medianincome). Include the regression output. [Stat ( Regression ( Multiple Linear, then fill in the proper Response and Predictor variables, then click Next twice and under Save options select Residuals, Predicted values and 95% interval for either the mean or an individual (you will have to decide which one you need for part d! ). For the CI (or PI) to be produced you need to enter the values from part d in the row underneath the data table, in appropriate columns. Note that the value for LN_circ has to be entered in the same units as all the values in the LN_circ column. Also note that the interval will be produced for the LN_pagecost variable. To produce a residual plot do a Scatter plot as in question 1, selecting Residuals as the Y variable and Predicted values as the X variable]. a. Evaluate the regression assumptions by assessing the residual plot. b. Examine each of the explanatory variables individually to determine which are contributing significantly to the new model. Use a significance level of 5%. . Remove the variables you find insignificant and re-run the model. Include the regression output for the new model. d. Using the new model, provide an appropriate 95% -level interval to the retail clothing company for the amount they would pay for a full-page ad in a magazine with the values given in 2. d (projected audience of 2,000,000 readers, 55 percent of which are male, with a median income of $30,000) using the newest model. Explai n in one sentence and in simple terms what this interval means. EXECUTIVE SUMMARY: (roughly about ? to 1 page) You are given the task of summarizing your findings for the board of directors of the retail clothing company. Since they are not very well-versed in regression techniques, you will need to explain things in easy-to-understand, simple and practical terms. Make sure to answer the following questions within the summary: 1. Describe each of the models you considered in parts 2-4 and how these models estimate the relationship between the cost of one-page ad and each of the explanatory variables (for each of the models you will need about one sentence per explanatory variable). . Specify which model you would recommend to best forecast the cost of one-page advertisements. Explain why this model should work well and why you picked this particular model from the ones you tried (go over the positives you see for this model and the negatives for the other models). †¢ Reminder: include only the relevant regression output in your final document. Do not attach or include any graphs. How to cite Buad 310 Case Analysis Instruction, Papers

The Effects of Alienation and Lonlieness in Live of the Saints Essay Example For Students

The Effects of Alienation and Lonlieness in Live of the Saints Essay The Effects of Alienation and Loneliness in Lives of the Saints Loneliness is a state of mind that leaves people depressed and emotionally weak. The members of the Innocente family suffer from alienation through various social groups. In Nino Ricci’s Lives of the Saints, Cristina and grandfather (Cristina’s father) are alienated from the community (grandfather is isolated from the community), and Vitto is alienated from his family. Alienation makes the lives of these characters lonely and depressing. Throughout the novel the development of Cristina’s character has been effected because of her alienation from the community, making her feel lonely and helpless. The citizens of Valle de Sole despise and neglect Cristina because of her attitude and uniquely strong personality. When Guiseppena says, â€Å"Cristina you and I were like sisters, you know I wouldn’t wish you any harm. But other people aren’t so kind, they like to see a person destroyed. You can afford to walk around like a princess. It turns people against you† (Ricci 53). We will write a custom essay on The Effects of Alienation and Lonlieness in Live of the Saints specifically for you for only $16.38 $13.9/page Order now Showing that Guiseppena, Cristina’s childhood friend even realizes that Cristina needs to change her attitude because the community will further neglect her, consequently making her more isolated and lonely. Therefore Cristina can only depend on herself and a few other close friends. Due to Christina’s loneliness she becomes short tempered, rude and her actions have brought shame to her father and his reputation. Her father proves his frustration when he says â€Å"was it for my sake you behaved like a common whore? Do you think you’re better than those people? They are my people not you, not someone who could do what you have done. I’ve suffered every day of my life, but I’ve never had to walk this town and hang my head in shame† (Ricci 149). As the mayor of Valle de Sole grandfather had the respect and admiration of the town. Though he loves Cristina very much his frustration is emphasized by calling Cristina, his own daughter, a whore. Although he did â€Å"suffer† (Ricci 149) everyday he had pride and now that pride has been stripped by his own daughter. Cristina’s actions and separation from the community not only affect her but affect her son Vitto also. The alienation Vitto suffers from his school and family builds him to become independent yet fearful. When Cristina was in the hospital for the second time Vitto comes home and asks his grandfather â€Å"did my mother come back? † (Ricci 116) His grandfather replies â€Å"make yourself something to eat; your mother is staying in the hospital a few days† (Ricci 116). Illustrating Vittos’ growing independence and maturity, being only seven years old he is forced to do more around the house and accept the circumstances his mother put herself and the family in. After his mother spoon feeds Vitto and holds his hand throughout his whole life, he is forced to make a drastic turn and essentially become the man of the house. Vitto also becomes more fearful and faces serious problems at school. The other boys at school harass Vitto in regards to his mother and as a result many fights occur ending with Vitto beaten up. â€Å"I was grateful nonetheless for the half hour or so from returning home after school† (Ricci 135). Vittos’ fear of these boys makes him stay after school every day in order to avoid them. Demonstrating that even the children of Valle de Sole know what his mother has done, except their victim is Vitto. The grandfather suffers from a lot of stress and struggle throughout his whole life, yet he does his best to keep his head held high, because being the mayor he must be an example to others. Cristina indirectly makes the community lose respect for him; as a result he too is neglected and alienated. â€Å"I’ve never had to walk through this town and hang my head in shame. Now people come to my house like they go to the circus, to laugh at the clowns† (Ricci 149). The people that once loved and looked up to grandfather now laugh at him as if he is a â€Å"clown† (Ricci 149) showing the degree of damage Cristina made him suffer. .u3ebe662754d8d48075d4269f75d7033f , .u3ebe662754d8d48075d4269f75d7033f .postImageUrl , .u3ebe662754d8d48075d4269f75d7033f .centered-text-area { min-height: 80px; position: relative; } .u3ebe662754d8d48075d4269f75d7033f , .u3ebe662754d8d48075d4269f75d7033f:hover , .u3ebe662754d8d48075d4269f75d7033f:visited , .u3ebe662754d8d48075d4269f75d7033f:active { border:0!important; } .u3ebe662754d8d48075d4269f75d7033f .clearfix:after { content: ""; display: table; clear: both; } .u3ebe662754d8d48075d4269f75d7033f { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u3ebe662754d8d48075d4269f75d7033f:active , .u3ebe662754d8d48075d4269f75d7033f:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u3ebe662754d8d48075d4269f75d7033f .centered-text-area { width: 100%; position: relative ; } .u3ebe662754d8d48075d4269f75d7033f .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u3ebe662754d8d48075d4269f75d7033f .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u3ebe662754d8d48075d4269f75d7033f .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u3ebe662754d8d48075d4269f75d7033f:hover .ctaButton { background-color: #34495E!important; } .u3ebe662754d8d48075d4269f75d7033f .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u3ebe662754d8d48075d4269f75d7033f .u3ebe662754d8d48075d4269f75d7033f-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u3ebe662754d8d48075d4269f75d7033f:after { content: ""; display: block; clear: both; } READ: Kant's Philosophy EssayHe is forced to give up his position of mayor because he could not cope with the shame and humiliation brought to him. Grandfather puts himself in a state of depression in his own house. For a veteran like himself, respect is the most important value in his life and he has now lost it all. â€Å"I’ll rot in this bed, I’ll die and rot here, you might as well have put me straight into the grave† (Ricci 158). Grandfather is emotionally and physically shattered he is depressed and weak; being sixty six year old he does not see a reason for him to live any longer. Not only is he alienated from the community but he has now alienated himself from his family. Cristina’s attitude and actions have has a chain reaction on everyone around her consequently leaving her father the most affected. In this novel alienation played a key role to the character development and plot of the story. The lives of Cristina, Vitto, and grandfather are affected because of the alienation they suffered from the community and their families. Therefore they have to face many hardships which drift their family and community ties apart.

Mother to Child Transmission Essay Example

Mother to Child Transmission Essay Example Mother to Child Transmission Essay Mother to Child Transmission Essay What is mother-to-child transmission? Mother-to-child transmission (MTCT) is when an HIV-infected woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding. Without treatment, around 15-30% of babies born to HIV positive women will become infected with HIV during pregnancy and delivery. A further 5-20% will become infected through breastfeeding. 1 Is MTCT a major problem? In 2008, around 430,000 children under 15 became infected with HIV, mainly through mother-to-child transmission. About 90% of these MTCT infections occurred in Africa where AIDS is beginning to reverse decades of steady progress in child survival. 2 In high income countries MTCT has been virtually eliminated thanks to effective voluntary testing and counselling, access to antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. If these interventions were used worldwide, they could save the lives of thousands of children each year. How can MTCT be prevented (PMTCT)? pic]An HIV positive mother and her HIV positive baby in India Effective prevention of mother-to-child transmission (PMTCT) requires a three-fold strategy. 3 4 Preventing HIV infection among prospective parents making HIV testing and other prevention interventions available in services related to sexual health such as antenatal and postpartum care. Avoiding unwanted pregnancies among HIV positive women providing appropriate counseling and support to women living with HIV to enable them to make informed decisions about their reproductive lives. Preventing the transmission of HIV from HIV positive mothers to their infants during pregnancy, labour, delivery and breastfeeding. Integration of HIV care, treatment and support for women found to be positive and their families. The last of these can be achieved by the use of antiretroviral drugs, safer infant feeding practices and other interventions. Antiretroviral drugs Treatment for the mother Women who have reached the advanced stages of HIV disease require a combination of antiretroviral drugs for their own health. This treatment, which must be taken every day for the rest of a womans life, is also highly effective at preventing mother-to-child transmission (PMTCT). Women who require treatment will usually be advised to take it, beginning either immediately or after the first trimester. Their newborn babies will usually be given a course of treatment for the first few days or weeks of life, to lower the risk even further. Pregnant women who do not yet need treatment for their own HIV infection can take a short course of drugs to help protect their unborn babies. The main options are outlined below, in order of complexity and effectiveness. Single dose nevirapine The simplest of all PMTCT drug regimens was tested in the HIVNET 012 trial, which took place in Uganda between 1997 and 1999. This study found that a single dose of nevirapine given to the mother at the onset of labour and to the baby after delivery roughly halved the rate of HIV transmission. 5 6 As it is given only once to the mother and baby, single dose nevirapine is relatively cheap and easy to administer. Since 2000, many thousands of babies in resource-poor countries have benefited from this simple intervention, which has been the mainstay of many PMTCT programmes. When is single dose nevirapine appropriate? A significant concern about the use of single dose nevirapine is drug resistance. Around a third of women who take single dose nevirapine develop drug resistant HIV,7 which can make subsequent treatment involving nevirapine and efavirenz (a related drug) less effective. Studies have found that drug resistance resulting from single dose nevirapine tends to decrease over time; if a mother waits at least six months before beginning treatment then it may be less likely to fail. 9  10 Nevertheless, in some cases the drug resistant HIV persists for many months in some parts of the body, even if it cannot be detected in the blood, and this may undermine the longer term effectiveness of treatment. 11 Whenever possible, women should receive a combination of drugs to prevent HIV resistan ce problems and to decrease MTCT rates even further. Among babies infected with HIV and exposed to single-dose nevirapine, around half have drug resistance at 6-8 weeks old. 12 Other infants may become infected with drug resistant HIV through breastfeeding. 13 Because of concerns about drug resistance and relatively low effectiveness, there is now general agreement that single dose nevirapine should be used only when no alternative PMTCT drug regimen is available. Whenever possible, women should receive a combination of drugs to prevent HIV resistance problems and to decrease MTCT rates even further. Nevirapine, however, is still the only single dose drug available to prevent MTCT. Other short course treatments require women to take drugs during and after pregnancy as well as during labour and delivery. This means they are much more expensive and more difficult to implement in resource poor settings than nevirapine, which can be used with little or no medical supervision at all. So, for now, single dose nevirapine remains the only practical choice for PMTCT of HIV in areas with minimal medical resources. Combining AZT with single dose nevirapine According to the World Health Organization (WHO) 2006 guidelines,   the recommended course of drugs for preventing mother to child transmission (PMTCT) in resources-limited settings should be a combination of AZT and single dose NVP. This approach is much more difficult to administer than single dose nevirapine on its own, but it is also significantly more effective, and is less likely to lead to drug resistance. AZT was first shown to reduce MTCT rates in 1994, and is the best-studied drug for this purpose. Under the 2010 guidelines, all HIV positive mothers, identified during pregnancy, should receive an extensive course of antiretroviral drugs to prevent mother to child transmission. For more information about the 2010 recommendations, please see AVERTs 2010 WHO Guidelines page. If these extensive drugs are not available, then the 2006 recommended course might be an option and a woman should begin taking AZT after 28 weeks of pregnancy (or as soon as possible thereafter). During labour she should take AZT and 3TC, as well as a single dose of nevirapine. If the woman receives less than four weeks of AZT during pregnancy then her baby should receive AZT for four weeks instead of one. Triple combinations The most effective PMTCT therapy involves a combination of three antiretroviral drugs taken during the later stages of pregnancy and during labour. This therapy is essentially identical to the treatment taken by HIV-positive people for their own health, except that it is taken only for a few months, and the choice of drugs may be slightly different. Triple therapy is usually recommended to women in high-income countries, and is becoming more widespread in the rest of the world and the WHO 2010 Guidelines, reflects this. AVERT. org has more information about HIV and pregnancy, including a discussion of these more sophisticated regimens. HIVNET 012 controversies In mid December 2004 a news story appeared alleging that side effects from single dose nevirapine during the HIVNET 012 study had been covered up. It claimed that US officials had been warned that nevirapine research was flawed and may have underreported thousands of severe reactions including deaths. By the time this news story appeared, a committee from the US Institute of Medicine was already engaged in a major independent review of the design, conduct, results and validity of the HIVNET 012 study. After evaluating extensive material from a variety of sources and reviewing primary source documents from Uganda, the investigation reported its findings in April 2005. The committee found that the original report on the HIVNET 012 study was sound, presented in a balanced manner, and can be relied upon for scientific and policy-making purposes. The allegations about unreported deaths were found to be completely untrue. Of the 306 mothers who received nevirapine, 16 experienced serious adverse events, and only one was thought possibly to be due to nevirapine. 14 The safety and effectiveness of single dose nevirapine has been confirmed by many other clinical trails. Although long-term use of nevirapine has been linked to liver damage, there is no evidence of any significant safety risk from a single dose to prevent MTCT. The December 2004 press story (which seems to have arisen from a personal feud between US officials) has been thoroughly discredited. 14, 15, 16, 17 Numerous subsequent studies, including a large clinical trial in Thailand, have reaffirmed that nevirapine is safe and effective at preventing MTCT. 15 HIV and safer infant feeding [pic]African woman breastfeeding A number of studies have shown that the protective benefit of drugs is diminished when babies continue to be exposed to HIV through breastfeeding. 6 17 Mothers with HIV are advised not to breastfeed whenever the use of breast milk substitutes (formula) is acceptable, feasible, affordable, sustainable and safe. However if they live in a country where safe water is not available then the risk of life-threatening conditions from formula feeding may be higher than the risk fro m breastfeeding. An HIV positive mother should be counselled on the risks and benefits of different infant feeding options and should be helped to select the most suitable option for her situation. 18 A baby fed on infant formula does not receive the special vitamins, nutrients and protective agents found in breast milk. And the cost of infant formula often puts it beyond the reach of poor families in resource poor countries, even if the product is widely available. Many women also lack access to the knowledge, potable water and fuel needed to prepare replacement feeds safely, or simply have no time to prepare them. If used incorrectly mixed with unsafe water, for example, or over-diluted a breast milk substitute can cause infections, malnutrition and even death. Furthermore, if a mother chooses not to breastfeed in settings where breastfeeding is the norm then this may draw attention to her HIV status and invite discrimination, violence or abandonment by her family and community. Another factor worth noting is the contraceptive effect of breastfeeding, which can help to lengthen the interval between pregnancies. Infant feeding advice for women with regular access to antiretroviral drugs For HIV positive women who choose, or who are advised to breastfeed, the World Health Organizations (WHO) recommendations are based on whether a women has access to antiretroviral drugs or not. If a woman has support and a regular supply of antiretroviral drugs then she should exclusively breastfeed for the first 6 months of an infants life and then introduce mix feeding until the infant is able to have a safe diet without breastmilk. Mixed feeding (breastfeeding mixed with bottle feeding of water or formula, or providing other foods) is only safe in this situation because the mother or infant is taking antiretrovirals. Infant feeding advice for women who do not have regular access to antiretroviral drugs In situations where health services cannot supply women or infants with a regular supply of antiretroviral drugs, for an extended period of time, women are recommended to exclusive breastfeed for the first 6 months of an infants life and rapidly wean to avoid mixed feeding. Mixed feeding is not recommend because studies suggest it carries a higher risk than exclusive breastfeeding. Potentially this is because it damages the lining of the babys stomach and intestines thus making it easier for HIV in breast milk to infect the baby. If a HIV positive mother does not have access to ARVs she is strongly recommended to rapidly wean. Unfortunately, the best duration for this is not yet known and may vary according to the infants age and/or the environment 19 20. Read more about HIV and breastfeeding. Caesarean sections A caesarean section is an operation to deliver a baby through its mother’s abdominal wall. When a mother is HIV positive a caesarean section may be done to protect the baby from direct contact with her blood and other bodily fluids. However, as with formula feeding, there is a need to weigh the risk of HIV transmission against the risk of harm due to the intervention. If the mother is taking combination antiretroviral therapy then a caesarean section will often not be recommended because the risk of HIV transmission will already be very low. Caesarean delivery may be recommended if the mother has a high level of HIV in her blood, but the procedure is seldom available and/or safe in resource poor settings. Challenges faced by PMTCT programmes Even where PMTCT services are available, not all women receive the full benefit. Reasons for HIV positive pregnant women not accessing drugs include: Not being offered an HIV test Refusing to take an HIV test Not returning for follow up visits Not adhering to self-administered drugs HIV testing is critical because women who do not know they are HIV positive cannot benefit from interventions. In 2009 an estimated 26% of the estimated 125 million pregnant women in low and middle-income countries received an HIV test. 21 However some women refuse to be tested because they fear learning that they have a life-threatening condition; because they distrust HIV tests; or because they do not expect their results to remain confidential, and fear stigma and discrimination following a positive result. Women having tested negative early in pregnancy can become infected during pregnancy; without returning to clinics for retesting treatment is not accessed22 . Sometimes women who test HIV positive do not return to clinics for follow up visits, or fail to take the drugs they have been given. This can happen because they have had negative experiences nteracting with clinic staff, fear or stigma or disclosure and because they did not receive adequate HIV counseling. because they have been poorly informed about HIV transmission and how it can be prevented. Fear of disclosure is a common rea son why women are reluctant to return to their HIV clinic. In the words of a woman from Cote dIvoire: My husband might see me with the medicines, and he will want to know what they are for. That way he will find out about my [HIV positive test] result. Even the location bothers me, because everyone who comes to the clinic knows what goes on [at the programme]. As soon as a pregnant woman is seen coming here, its known right away that she is seropositive. 23 One of the major problems in preventing mother-to-child transmission, it has been argued, is making the provision of ARV drugs the focus of PMTCT efforts. Access to other services such as counselling, care and treatment services, infant-feeding guidance, and in particular sexual and reproductive health is ignored as a result. 24   Therefore, it should not be assumed that the proportion of HIV-positive pregnant women who are receiving antiretroviral prophylaxis to prevent their child becoming infected – estimated at one-third in low and middle-income countries – are receivi ng comprehensive PMTCT services. 25 To achieve a high success rate, PMTCT programmes must have well-trained, supportive staff who take great care to ensure confidentiality. They must be backed up by effective HIV testing and counselling programmes and by good quality HIV/AIDS education, which is essential to eliminate myths and misunderstandings among pregnant women, and to counter stigma and discrimination in the wider community. Under these conditions, antiretroviral drugs have the potential to save many thousands of babies lives. International PMTCT initiatives There are a number of large-scale international initiatives to prevent mother-to-child transmission of HIV. These include: 1. The Presidents Emergency Plan for AIDS Relief (PEPFAR) 2. MTCT-Plus 3. The Global Fund 4. The Call to Action Project 5. The UN Interagency Task Team on MTCT The Presidents Emergency Plan for AIDS Relief (PEPFAR) On June 19th 2002, US President Bush announced a new $500 million International Mother and Child HIV Prevention Initiative to prevent the transmission of HIV from mothers to infants and to improve health care delivery in Africa and the Caribbean. The Initiative was later integrated into the Presidents Emergency Plan for AIDS Relief (PEPFAR). In 2008 PEPFAR was reauthorized with the original $ 15 billion funding now tripled to $ 48 billion over the next five years. The original Initiative had the aim of reaching one million women with HIV testing and counselling and providing preventive drugs to 80 per cent of HIV positive delivering women by 2007. It aimed to reduce mother-to-child transmission by 40 percent in its fourteen focus countries, twelve of which are in Africa. From fiscal year 2004 to FY 2007, PEPFAR has supported prevention of MTCT for women during more than 10 million pregnancies with antiretroviral drugs being provided in over 827,000 pregnancies. This has resulted in the prevention of an estimated 157,000 infant HIV infections. 26 AVERT. org has more information about the Presidents Emergency Plan for AIDS Relief in our PEPFAR page. MTCT-Plus The MTCT-Plus Initiative was established in 2002, and is coordinated by the Mailman School of Public Health at Columbia University. The Initiative aims to move beyond interventions aimed only at preventing infant HIV infection. It does this by supporting the provision of specialised care to HIV-infected women, their partners and their children who are identified in MTCT programmes. Funding for the initiative is provided by a group of private foundations, including the Gates Foundation, the Kaiser Family Foundation and the Rockefeller Foundation, as well as by PEPFAR via USAID. The MTCT-Plus Initiative provides operational funding, medications, training and technical assistance at 13 sites in sub-Saharan Africa and at one site in Thailand. Since its inception MTCT-Plus has provided care and treatment to more than 16,000 adults and children. 27 The Global Fund The Global Fund to Fight AIDS, Tuberculosis and Malaria is a public-private partnership that distributes grants worldwide to fund HIV/AIDS prevention and treatment programmes. Grants are distributed over two years and most countries receive some grants to fund PMTCT programmes. In 2008 the Global Fund announced that 271,000 HIV positive pregnant women had been reached with prophylaxis for PMTCT through Global Fund money in 2007. 28 AVERT. org has more about The Global Fund. The Call to Action Project The Elizabeth Glaser Pediatric AIDS Foundation initiated the Call to Action Project (CTA) in September 1999 to help reduce MTCT of HIV in resource poor countries. The CTA is a public-private partnership that receives funding from both private sources such as the Gates Foundation and government grants. CTA has worked or is now working at approximately 400 sites in nineteen countries worldwide, of which twelve are in Africa.

Maria Tallchief

Maria Tallchief Dates: January 24, 1925 - April 11, 2013Known for: first American and first Native American prima ballerinaOccupation: ballet dancerAlso known as: Elizabeth Marie Tall Chief, Betty Marie Tall Chief Maria Tallchief Biography Maria Tallchief was born as Elizabeth Marie Tall Chief and changed her name later to Europeanize it for career reasons. Her father was of Osage descent, and the tribe was the beneficiary of oil rights. Her family was well off, and she had ballet and piano lessons from age three. In 1933, pursuing opportunities for Maria and her sister, Marjorie, the Tall Chief family moved to California. Marias mother wanted her daughters to become concert pianists, but they were more interested in dance. One of Marias early teachers in California was Ernest Belcher, father of Marge Belcher Champion, wife and professional partner of Gower Champion. As a young teen, Maria, with her sister, studied with David Lichine and then with Bronislava Nijinska, who in 1940 cast the sisters in a ballet at the Hollywood Bowl that Nijinska had choreographed. After high school, Maria Tallchief joined the Ballet Russe in New York City, where she was a soloist. It was during her five years at the Ballet Russe that she adopted the name Maria Tallchief. While her Native American background led to skepticism about her talent by other dancers, her performances changed their minds. Her performances impressed audiences and critics. When George Balanchine became ballet master at the Ballet Russe in 1944, he took her as his muse and protege, and Maria Tallchief found herself in increasingly prominent roles which were adapted to her strengths. Maria Tallchief married Balanchine in 1946. When he went to Paris, she went as well and was the first American-born woman dancer to perform with the Paris Opera, in Paris and later with the Paris Opera Ballet in Moscow at the Bolshoi. George Balanchine returned to the US and founded the New York City Ballet, and Maria Tallchief was its prima ballerina, the first time an American had held that title. From the 1940s to the 1960s, Tallchief was one of the most successful of ballet dancers. She was especially popular and successful as and in The Firebird beginning in 1949, and as the Sugar Plum Fairy in The Nutcracker beginning in 1954. She also appeared on television, made guest appearances with other companies, and appeared in Europe. Having been trained by David Lichine early in her dance education, she played Lichines teacher, Anna Pavlova, in a 1953 movie. Tallchiefs marriage to Balanchine was a professional but not personal success. He began to feature Tanaquil Le Clerq in key roles, and he did not want to have children, while Maria did. The marriage was annulled in 1952. A brief second marriage failed in 1954. In 1955 and 1956, she was featured at the Ballet Russe de Monte Carlo, and in 1956 she married a Chicago construction executive, Henry Paschen. They had a child in 1959, she joined the American Ballet Theatre in 1960, touring America and the USSR. In 1962, when the recently-defected Rudolf Nureyev debuted on American television, he chose Maria Tallchief as his partner. In 1966, Maria Tallchief retired from the stage, moving to Chicago. Maria Tallchief returned to active participation in the dance world in the 1970s, forming a school connected with the Chicago Lyric Opera. When the school was the victim of budget cuts, Maria Tallchief founded her own ballet company, the Chicago City Ballet. Maria Tallchief shared duties as artistic director with Paul Mejia, and her sister Marjorie, also a retired dancer, became the schools director. When the school failed in the late 1980s, Maria Tallchief again became associated with the Lyric Opera. A documentary, Maria Tallchief, was created by Sandy and Yasu Osawa, to air on PBS in 2007-2010. Background, Family Father: Alexander Joseph Tall ChiefMother: Ruth Porter Tall Chief (Scots-Irish and Dutch ancestry)Siblings: one brother; sister Marjorie Tall Chief (Tallchief) Marriage, Children husband: George Balanchine (married August 6, 1946, annulled 1952); choreographer and ballet master)husband: Elmourza Natirboff (married 1954, divorced 1954; airline pilot)husband: Henry D. Paschen (married June 3, 1956; construction executive)daughter: Elise Maria Paschen (born 1959; poet, writing teacher) Education piano and ballet lessons from age 3Ernest Belcher, ballet teacher (father of Marge Champion)David Lichine, student of  Anna PavlovaMadame (Bronislava) Nijinski, sister of Vaslav NijinskyBeverly Hills High School, graduated 1942