African Sleeping Sickness: What is it and What is Being Done To Stop it?
African Trypanosomiasis, or African Sleeping Sickness, is a vector borne parasitic disease. The disease is transmitted by an infected Tsetse fly. As the infected fly takes a blood meal from its mammalian host, parasites enter the host through the lymphatic system and into the bloodstream. Once inside the bloodstream, the parasite turns into trypomastigotes, which are then carried throughout the rest of the body and reach other vital bodily fluids. During this whole process, the trypomastigotes are continuously multiplying by binary fission. The whole life cycle of the tsetse fly can be seen in figure 1 (CDC, 2015).
Once infected, there are two stages that a person goes through with the disease. Stage 1 (haemolymphatic stage) is when non-specific symptoms such as headaches and fevers begin to present themselves. During this stage, the disease is very easy to treat, but very difficult to diagnose so many cases go undiagnosed, allowing for the parasite to invade the person’s central nervous system, which leads to stage 2. In stage 2 (neurological phase), the parasite has reached the central nervous system of its host. During this stage, specific symptoms start to appear including convulsions, confusion, violent behavior, and the most notable symptom- inability to sleep at night and extreme sleepiness during the day (Doctors Without Borders, 2015).
There are 36 African countries consider endemic for sleeping sickness, but of these 36, 7 countries are responsible for 97% of all reported cases. This disease is most present in very poor, rural countries where there is difficulty to diagnose the disease, political instability, and lack of proper health surveillance. All of these factors make diagnosing and treating the disease more difficult, but they also leave uncertainty of the accurate number of cases prevalent each year (DNDI, 2012). The Democratic Republic of Congo has the highest rate of infection, reporting 1000 new cases each year and accounting for roughly 85% of all cases (WHO, 2016). The distribution of the disease can be seen in figure 2.
Currently, the WHO has noted that elimination of the disease is feasible, and they have even set a target date for elimination as the year 2030. To make this possible, surveillance of the disease is going to need to increase in many afflicted countries. Many of the health care facilities and resources in the endemic countries are weak and poorly staffed. Increased support and external assistance is necessary to ensure the surveillance of the disease and early diagnosis. Additionally, environmental changes can affect the disease. Given the changing climate and the massive population growth in Africa, some areas may be affected worse than before, or areas that were endemic may have the relief of a smaller fly population. Drought and increased temperatures can drive flies away. Although this can be good for some countries, other countries that were not endemic may notice an increase in the disease. All of this is dependent upon population growth and climate change, so constant surveillance of those issues and predictions for the future will need to occur to ensure control over the disease (Franco et al., 2014).
Fig 1: life cycle of the tsetse fly
Fig 2: distribution of the disease throughout Africa
Works Cited:
“Trypanosomiasis, Human African (sleeping Sickness).” World Health Organization. World Health Organization, Feb. 2016. Web. 06 Nov. 2016.
“Biology.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Mar. 2015. Web. 06 Nov. 2016.
“Sleeping Sickness.” MSF USA. N.p., 25 Mar. 2016. Web. 06 Nov. 2016.
“About Sleeping Sickness.” DNDi. N.p., 2012. Web. 06 Nov. 2016.
Franco, Jose R., Pere P. Simarro, Abdoulaye Diarra, and Jean G. Jannin. “Epidemiology of Human African Trypanosomiasis.” Clinical Epidemiology. Dove Medical Press, 6 Aug. 2014. Web. 06 Nov. 2016.
Controlled Cognitive Engagement
A recent study is being conducted by the American Psychological Association in United Kingdom airports. Airport security agents are being trained to use a conversational based screening method rather than the traditional method of examining body language (Chakrabarti, Strauss). In this experiment lasting approximately eight months, the new screening method was 66 percent effective in determining dishonesty in the fake passengers compared to only 3 percent when just examining body language (Dando, Bull).
In this new experimental study called the Controlled Cognitive Engagement method (CCE), security agents engage in friendly, informal conversation by asking passengers seemingly unrelated and unpredictable questions about information the passenger should know (Edman). Regular travelers should not feel any pressure and it should not seem like an interrogation. Typical questions often include the name of the a high school principal or the first job they worked for. The research team recruited 204 participants with 113 male and 91 female participants. The group included college students and undercover detectives. The participants each received £60 and an additional £60 was awarded if they were able to avoid being detected by the security agents. Each of the participants were given a week to come up with a story to tell agents (Ekman).
The CCE method requires more thinking on the agent’s side who must think of different questions to ask each passenger rather than simply repeating old ones. This limits the criminal’s ability to predict what questions will be asked and their ability to rehearse them. The risk of racial profiling is also reduced with the same procedure being used for each passenger. The suspicious signs methods used in most airports is not very effective but is often used because of its cheap training (Fisher, Geiselman).
References
Chakrabarti, S., & Strauss, A. (2002). Carnival booth: An algorithm for defeating the computer-based passenger screening system. First Mon-day, 10. Retrieved from http://firstmonday.org/issues/issue7_10/chakrabarti/index.html
Dando, C. J., & Bull, R. (2011). Maximising opportunities to detect verbal deception: Training police officers to interview tactically. Journal of Investigative Psychology and Offender Profiling, 8, 189–202. http://dx .doi.org/10.1002/jip.145
Dando, C. J., Bull, R., Ormerod, T. C., & Sandham, A. (2013). Helping to sort the liars from thetruth-tellers: The gradual revelation of information during investigative interviews. [Advance online publication]. Legal and Criminological Psychology, n/a. http://dx.doi.org/10.1111/lcrp.12016 DePaulo, B. M., Lindsay, J. J., Malone, B. E., Muhlenbruck, L., Charlton, K., & Cooper, H. (2003). Cues to deception. Psychological Bulletin, 129, 74–118. http://dx.doi.org/10.1037/0033-2909.129.1.74
Ekman, P. (2009). Lie-catching and micro-expressions. In C. Martin (Ed.), The philosophy of deception. Oxford: Oxford University Press http://dx.doi.org/10.1093/acprof:oso/9780195327939.003.0008 Evans, J. S. B. T. (2008). Dual-processes accounts of reasoning, judgment, and social congnition. Annual Review of Psychology, 59, 255–278. http://dx.doi.org/10.1146/annurev.psych.59.103006.093629
Fisher, R. P., & Geiselman, R. E. (1992). Memory enhancing techniques for investigative interviewing: The cognitive interview. Springfield, IL: Charles C Thomas.
Bilingual Brains: Function, Structure, and Neuroimaging
The mere existence of those who speak multiple languages raises many questions in terms of brain structure and function. Namely, how do people acquire new languages and, once acquired, where does the brain ‘place’ these languages? Furthermore, does language processing happen in the same place for all of a polyglot’s languages? Luckily, today’s neuroimaging tools provide us with a non-invasive way of answering these questions. Firstly, we must consider what we know of the bilingual brain without the use of neuroimaging. It has already been observed that bilingual people suffering from aphasia (an inability or difficulty in comprehending and formulating language due to a stroke or other brain-related trauma) did not always suffer its effects in the same way for each language. This suggests the possibility that bilingual brains ‘store’ languages in different parts of the brain at least some of the time. It is also already known that early on in language learning the second language is processed by a sort of translation from the first language and that as proficiency is gained the use of the second language becomes a more fluid and unconscious process. Functional neuroimaging processes like positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) now allow us to directly observe these processes in action thus understanding why and how they occur (Perani 2003).
There is no question that being bilingual effects the structure of the brain and can be beneficial to the health of the bilingual speaker. The below image displays the regions with higher activation and higher white-matter integrity in bilinguals.
Figure 1. Effects of Bilingualism on the Brain. Green depicts grey matter regions that show high activation during bilingual language switching, red-yellow depicts areas of higher white matter integrity in bilingual adults as compared to monolingual adults. (Bialystok 2012)
These structural differences have long been attributed to the repeated finding that bilinguals have better working memory and better ability to switch attention/tasks. It has also been shown that bilinguals activate the regions of their brain that speak either language no matter what language is being utilized. It is this joint activation that creates what is known as higher neuroplasticity in polyglots, also contributing to lower rates and later onset of dementia in bilinguals (Bialystok 2012).
These structural differences in the separation of languages in bilinguals have been physically observed. A 2004 study mapped the functional separation of languages by electrical stimulation. The research finds that language-specific sites exist in all speakers. However, in 60% of bilinguals, their language use was contained not in one language site, but two. Furthermore, it was found that language production resulted from the use of not only language-specific sites but also shared sites. This means that bilingual brains have physical areas dedicated to respective languages separately, but that there is also an overlap in the use of these areas (Lucas 2004). This lends physical evidence to the belief in bilingual neuroplasticity in that bilinguals undoubtedly get more use, and more varied use, of certain parts of their brains. Furthermore, a 2006 study used fMRI imaging to exactly place where it is in the brain that bilinguals control language processing. The study concludes that the left caudate (see Figure 2) “plays a significant role in language control”. In essence, it is the left caudate that controls which of the previously mentioned language specific sites are activated and how they interact, allowing the bilingual to speak two distinct languages. (Crinion 2006)
Figure 2. Location and activation of the left caudate. Bilinguals were presented semantically related word pairs in two different languages and it was the left caudate that showed most activity, meaning it may be this region that controls language-switching.
Unfortunately, research has also been done to show that bilingualism may effect the speaker’s ability to separate languages. A 2005 experiment asked bilingual patients to press a button if the name of the object shown to them started with a vowel but not with a consonant, and vice versa. Specifically, in this experiment patients were speakers of German and Spanish. A control group of monolingual German or Spanish speakers was also tested. It was found that bilinguals made more mistakes in their answers and their responses were slowed by about 100 to 200 milliseconds. This was timed physically and by fMRI imaging (Rodriguez-Fornells 2005). It can be inferred that this delay is a consequence of the language-specific sites and shared sites that are used simultaneously in bilinguals, as shown in the previous study. However, a 100 to 200 millisecond delay in response does not quite constitute a worrisome consequence of being bilingual, especially in light of all of its benefits. The results of all of these studies, while they answer many questions, warrant further exploration into the structure and function of bilingual brains. Moreover, questions about the function and structure of the brains of those who speak more than two languages has not been explored.
References
Bialystok, E., Craik, F. I., & Luk, G. (2012, April). Bilingualism: Consequences for Mind and Brain. Trends in Cognitive Science, 16(4), 240-248. Retrieved October 30, 2016.
Crinion, J., Turner, R., Grogan, A., Hanakawa, T., Noppeney, U., Devlin, J., . . . Price, C. (2006, June 9). Language Control in the Bilingual Brain. American Association for the Advancement of Science, 312, 1537-1540. Retrieved October 30, 2016.
Lucas, T. H., II, McKhann, G. M., II, & Ojemann, G. A. (2004, September). Functional Separation of Languages in the Bilingual Brain: A Comparison of Electrical Stimulation Language Mapping in 25 Bilingual Patients and 117 Monolingual Control Patients. Journal of Neurosurgery, 101, 449-457. Retrieved October 30, 2016.
Perani, D. (2003). Functional Neuroimaging and the Bilingual Brain. Friulian Journal of Science, 4, 115-131. Retrieved October 30, 2016.
Rodriquez-Fornells, A., Van der Lugt, A., Rotte, M., Britti, B., Heinze, H., & Münte, T. F. (2005). Second Language Interferes with Word Production in Fluent Bilinguals: Brain Potential and Functional Imaging Evidence. Journal of Cognitive Neuroscience, 17(3), 422-433. Retrieved October 30, 2016.
Punishment as a device for accident prevention. Deterrent effects of traffic enforcement.
From the very beginning of road traffic history people understood that without any laws or regulations, all movement on the roads would be in the so-called “state of nature,” which means that the molecules within an environment, represented as cars on the city streets, would be in constant and uncontrolled motion, allowing for random collisions and accidents. The existence of this traffic’s tendency towards chaos contributed to the evolution of traffic environment – first traffic legislation, the “Locomotive on Highways Act”, was adopted by the British Parliament in 1861 and limited the weight of allowed vehicles to 12 tons as well as imposed a 10 mph speed limit (Ross, 1993). Furthermore, more and more elements and control devices have been added to the system, including first license plates in France in 1893, first driver license in the U.K. in 1904, and the first traffic light in Ohio in 1914 (Legge et al., 1993). Creation of laws and rules raised the need for their enforcement, since, as it is widely known, laws are being broken as long as they exist.
In order to prevent people from breaking the law, authorities have to come up with reasonable punishments depending on the severity of a violation. The key aspect in any kind of punishment, as the research shows, is the certainty of a sanction, since it acts as a much stronger deterrent than an increase in the severity of the punishment (Purssell et al., 2012). For example, the law allows police officers to administer tests for screening purposes at the site of a potential traffic violation before arrest (Porter, 2013), which increases the likelihood of detecting illegal behavior (Ritchey et al., 2011). Furthermore, immediate consequences produce a much stronger deterring effect on drivers than those that have to be reviewed before being imposed, which usually happens long after the violation. Finally, the deterrent effects of a certain punishment can be separated into two categories: specific and general (Purssell et al., 2012). In the case of drinking and driving, for instance, the specific effect is that the sanctioned driver will most likely never drink and drive again, and the general part is that people become more aware of the legal sanctions, which prevents people who might otherwise drink and drive from doing so. This leads to another key aspect of the “punishment” concept – the need for public awareness to achieve the deterrent effect. In the modern world, mass media along with high-visibility enforcement form a current that is powerful enough to keep the population informed about the laws and sanctions associated with them (Alonso et al., 2015).
Figure 1: Example of deterrent effect using road signs
Source: The Policy Studies Journal
Figure 2: Example of deterrent effect using road signs
Source: The Policy Studies Journal
Of course, it is true that legislation against impaired driving is the best way to prevent crashes, and the statistics are in agreement with this fact. Driving prohibitions and vehicle impoundments for blood alcohol content above 0.08% along with alcohol counseling programs reduce impaired driving recidivism by about 8-9 % (Alonso et al., 2015). Moreover, enforcement of the laws in British Columbia, for example, reduced the amount of alcohol-related traffic crashes from an average of 113 in September 2010 to 68 in September 2011, which is an impressive 40% decline (Purssell et al., 2012).
On the other hand of the issue, it is important to look at the situation from the perspective of pedestrians, since pedestrian deaths due to traffic accidents do not necessarily mean that the driver was at fault, since, for instance, the term “recklessness” can be used to characterize both a driver and a pedestrian. In fact, statistics show that the fault lies within the pedestrian in the majority of cases, and “two of every three pedestrians killed by motor vehicles were either violating a traffic law or acting in an obviously unsafe manner (Wittels, 1949).” About 75% of pedestrians killed in traffic accidents were victims of their own carelessness (Wittels, 1949), which means that our ultimate goal, the goal of achieving zero traffic fatalities, has to be focused and concentrated at the intersection of raising both driver’s and pedestrian’s awareness of traffic laws, regulations, and sanctions.
Figure 3: “Portrait of a man begging for trouble. Besides ignoring the comparative safety of the crosswalk, he is hazardously catching up n his reading en route.
Source: Saturday Evening Post
Works Cited (MLA Format)
Alonso, Francisco, Juan Pastor, Luis Montoro, and Cristina Esteban. “Driving under the Influence of Alcohol: Frequency, Reasons, Perceived Risk and Punishment.” Substance Abuse Treatment, Prevention & Policy Journal 10.1 (2015): 1-9.
Legge, Jerome, and Joonghoon Park. “Policies to Reduce Alcohol-Impaired Driving: Evaluating Elements of Deterrence.” Social Science Journal 75.3 (1994): 594-606.
Porter, Lauren. “Trying Something Old: The Impact of Shame Sanctioning on Drunk Driving and Alcohol-Related Traffic Safety.” Law & Social Inquiry 38.4 (2013): 863-91.
Purssell, Roy, and Jeffrey Brubacher. “Alcohol-related Traffic Fatalities Declining.” British Columbia Medical Journal 54.2 (2012): 90-91.
Ritchey, Mark, and Sean Nicholson-Crotty. “Deterrence Theory and the Implementation of Speed Limits in the American States.” The Policy Studies Journal 39.2 (2011): 332-34.
Ross, Laurence. “Punishment as a Factor in Preventing Alcohol-related Accidents.” Addiction Journal 88.1 (1993): 997-1002.
Wittels, David. “They Ask to Be Killed.” Saturday Evening Post 221.27 (1949): 11-66.
Cannabis and its Effects in Relation to Schizophrenia
The debate continues in the United States as to whether cannabis should be legalized throughout the country. Many avid cannabis smokers advocate for cannabis legalization because it can provide some benefits to people’s health. However, studies show that cannabis can worsen psychotic symptoms especially in patients with schizophrenia.
For example, a study published in the European Archives of Psychiatry and Clinical Neuroscience consisted of a total of 39 schizophrenic patients with histories of cannabis abuse, and compared them to a control group of 39 schizophrenic patients with no history of substance abuse. At the end of the 5-year span of the study, only 27 cases and 26 controls were left to investigate. The study found that “8/27 cases (30%) had continued cannabis abuse, 6/27 (22%) had become alcohol abusers. Only one patient of the control group had started abusing alcohol. Patients with previous cannabis abuse had significantly more rehospitalizations, tended to worse psychosocial functioning, and scored significantly higher on the psychopathological syndromes “thought disturbance” (BPRS) and “hostility” (AMDP)” (Caspari et al., 1999).
Furthermore, a study published in the Biological Psychiatry journal was conducted that tested the effects of 0 mg, 2.5 mg, and 5 mg of intravenous Δ-9-tetrahydrocannabinol (Δ-9-THC) on 13 stable schizophrenic patients and compared them to the effects on healthy subjects without schizophrenia. The study found that “Delta-9-tetrahydrocannabinol transiently increased 1) learning and recall deficits; 2) positive, negative, and general schizophrenia symptoms; 3) perceptual alterations… [and] Schizophrenia patients were more vulnerable to Δ-9-THC effects on recall relative to control subjects” (D’Souza et al., 2005).
Lastly, a study published in the Arch Gen Psychiatry journal tested schizophrenic patients who abused and compared them to a group of schizophrenic patients who did not abuse cannabis. As seen in the figure below, cannabis abusers were much more likely to experience a psychotic relapse than were non-abusers (Linszen et al., 1994).
Positive and Negative Schizophrenic Symptom Severity in Relation to amount of THC over Time
Therefore, it is clear that cannabis use can be very dangerous for schizophrenic patients and can worsen addictive and psychotic behavior.
Cannabis can also have adverse psychotic effects on people without schizophrenia. For example, study published in The Lancet found that after collecting data from 35 studies, “There was an increased risk of any psychotic outcome in individuals who had ever used cannabis (pooled adjusted odds ratio=1·41, 95% CI 1·20–1·65). Findings were consistent with a dose-response effect, with greater risk in people who used cannabis most frequently (2·09, 1·54–2·84)” (Moore et al., 2007). Furthermore, a study published in the Neuropsychopharmacology journal found that administering THC on heathy subjects produced positive and negative schizophrenia symptoms. As seen in the figure below, the severity of symptoms increased with increase amounts of THC (D’Souza et al., 2004).
Percentage of Prior Schizophrenic Patients without Relapse over Time, Cannabis Abusers vs. Non-Abusers
Therefore, cannabis has the ability to cause psychotic and schizophrenic symptoms even in healthy patients.
The debate over legalization of cannabis is definitely not black and white. Many advocates praise it for its calming and healing properties. However, many research studies have adequately shown that cannabis can exacerbate psychotic symptoms and behaviors in people with schizophrenia and without it.
Works Cited
Caspari D. Cannabis and schizophrenia: results of a follow-up study. European Archives of Psychiatry and Clinical Neuroscience. Vol 249, p 45-49. 1999.
D’Souza DC, Abi-Saab WM, Madonick S, et al. Delta-9-tetrahydrocannabinol effects in schizophrenia: Implications for cognition, psychosis, and addiction. Biological Psychiatry. Vol 57, p 594-608. 2005.
D’Souza DC, Perry E, MacDougall L, et al. The Psychotomimetic Effects of Intravenous Delta-9-Tetrahydrocannabinol in Healthy Individuals: Implications for Psychosis. Neuropsychopharmacology. Vol 29, p 1558-1572. 2004.
Linszen DH, Dingemans PM, Lenior ME. Cannabis Abuse and the Course of Recent-Onset Schizophrenic Disorders. Arch Gen Psychiatry. Vol 51, p 273-279. 1994.
Moore THM, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. The Lancet. Vol 370, p 319-328. 2007.
Lina Mohamed-Assignment 5
Lina Mohamed October 31, 2016
Effectiveness of Homeopathy: CAM-Complementary and Alternative Medicine
MHC 20301-Paper Assignment 5
Professor Glen Kowach
Holistic medicine is gaining popularity due to raising awareness of side effects of pharmaceuticals. In 2007, Complementary and Alternative Medicine (CAM) was used by 38% of adults and 12% of children. Hopefully, there has been an increase in these numbers since then. People of all backgrounds use CAM however it is not equally distributed. For example, women use CAM more along with people with higher levels of education and higher incomes. CAM therapies need to become more advertised and accessible to people so that not only the privileged in America hear about it. CAM therapies include acupuncture, types of physical therapies, deep breathing exercises, diet-based therapies, meditation and so much more. These therapies have increased drastically from 2002 to 2007.
Prescription painkiller overdoses are a public health epidemic that needs to be solved because painkillers are being sold more than ever. Quantity of prescription painkillers sold to pharmacies was 4 times larger in 2010 than in 1999. There is so much that can be done to reduce the supply and intake of these pills and to decrease the overdoses that occur in the United States. States can improve monitoring programs, advertise natural alternatives, educate the public and ensure people do not take more than they need.
Conventional medicine/drugs is valuable but also has its problems. Prescription drugs and painkillers just treat symptoms temporarily without fixing the real problem. Also drugs become dangerous if there is more than one drug taken at a single time. Homeopathic remedies offer a solution. For example, if someone is sick and has many symptoms, instead of prescribing them many drugs, homeopathic physicians can prescribe a remedy that will stimulate their immune system and then provide an overall improvement in the person’s health rather than just target one symptom of one illness. Homeopathy embodies a system that combines the scientific aspects with the art of healing which is more successful than just the science and masking symptoms.
Natural practices will emerge because people will realize that it is necessary for physical and mental health. Homeopathic remedies target the person’s overall health by doing things like stimulating the immune system and overall health thereby preventing future diseases/illnesses. People may argue that homeopath and alternative medicine cannot cure everything. This is true. However, it can cure a lot and instead of harming our bodies when there are alternatives, we should resort to natural antidotes.
-(NCCIH, 2008). Use of Complementary and Alternative Medicine in the United States. National Center for Complementary and Integrative Health. Retrieved from:
https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm
-Alternative Medicine: The Definitive Guide (2nd Edition)– June 6, 2002 Retrieved from Google Scholars: https://books.google.com/books?hl=en&lr=&id=OyrhatOdk9gC&oi=fnd&pg=PA270&dq=natural+alternatives+to+painkillers&ots=68fhOAE58y&sig=-malo2jqTO8ylS5N_CVlAN-PFSo#v=onepage&q=natural%20alternatives%20to%20painkillers&f=false
-(Dahlgreen, 2015) Many believe Alternatives are effective. YouGovUK. Retrieved from:
https://yougov.co.uk/news/2015/03/06/many-believe-alternative-medicine-effective/
-(2011) Prescription Painkiller Overdoses in the US. CDC. Retreived from:
http://www.cdc.gov/vitalsigns/painkilleroverdoses/
–(Ullman, 1988) Homeopathy Medicine For The 21st Century. The Futurist. Retrieved from:
The Cost-Effect Ratio of the Cyberknife: System Shows Promise Over Other Techniques
Ariana Gopal
Past research has indicated that the Cyberknife system, a form of stereotactic radiosurgery, shows promise as a means of treating various forms of cancer. For example, this radiosurgery technique has had a positive impact on treating prostate cancer; it has been linked to lowering PSA values as well as increasing the amount of time patients treated with the technique are disease free (Davis et al., 2015). Additionally, the Cyberknife has had a positive impact on reducing toxicities and improving pain for people treated for spinal lesions (Gerszten et al., 2004).
Although the Cyberknife system has had a positive impact on treating several types of cancer, there has been a lack of exploration regarding the cost-effect ratio of being treated with the Cyberknife versus other treatment methods. This information will be evaluated in this assignment.
It has been indicated that radiation treatments can vary widely when cost is taken into consideration. For example, a single treatment with standard radiation therapy can cost near $2,000 for one treatment, whereas treatment with the Cyberknife system is closer to $4,000 per treatment (Fawcett, 2009). But in addition to the actual cost of the treatment, the actual outcomes and toxicities of the different treatments must also be taken into account in order to successfully evaluate the cost-effect ratio of the Cyberknife system. Past research has compared the effects of the Cyberknife system to traditional radiation therapy, also known as external beam radiation therapy, or EBRT for short. For example, a study conducted in 2009 used treatment outcomes and toxicities to compare the cost-effect ratio of the Cyberknife and EBRT (Papatheofanis et al., 2009). The study showed that patients treated with Cyberknife had a higher net health benefit over those treated with EBRT and was calculated to be $1900 less than EBRT, indicative that the Cyberknife system is superior and more cost effective than EBRT (Papatheofanis et al., 2009). Another study also compared these two treatment methods for cancer patients with spine metastasis. The research indicated that treatment with the Cyberknife system was costlier, but had less pain and later stage toxicities associated with it when compared to the EBRT (Haley et al., 2011). Additionally, people treated with EBRT were more likely to need additional radiation interventions than those treated with the Cyberknife (Haley et al., 2011). Lastly, a study comparing Cyberknife radiosurgery to interventional microvascular decompression for patients with trigeminal neuralgia indicated that patients treated with the Cyberknife system had an average reduction in hospital costs of 34% per patient when compared to those treated with surgical intervention, indicative that it is more cost-efficient (Tarricone et al., 2008).
Overall, the scientific literature suggests that the Cyberknife system is more cost effective when compared to traditional radiation techniques as well as to surgical procedures, as indicated by Tarricone’s article.
Table 1 shows the average direct healthcare cost for patients evaluated in Tarricone et al.’s research. The table clearly indicates that the overall cost for the Cyberknife system was cheaper by over 2,000 Euros when compared to the microvascular decompression treatment. (Tarricone et al., 2008)
References
Davis, J., Sharma, S., Shumway, R., Perry, D., Bydder, S., Simpson, C. K., & D’ambrosio, D. (2015, December 04). Stereotactic Body Radiotherapy for Clinically Localized Prostate Cancer: Toxicity and Biochemical Disease-Free Outcomes from a Multi-Institutional Patient Registry. Cureus.
Fawcett, N. (2009). Radiation treatment costs vary widely by delivery, study finds. The University Record.
Gerszten, P., Ozhasoglu, C., Burton, S., Vogel, W., Atkins, B., Kalnicki, S., & Welch, W. (2004). Cyberknife frameless real-time image-guided stereotactic radiosurgery for the treatment of spinal lesions [Abstract]. Neurosurgery, 55(1).
Haley, M. L., Gerszten, P. C., Heron, D. E., Chang, Y., Atteberry, D. S., & Burton, S. A. (2011). Efficacy and cost-effectiveness analysis of external beam and stereotactic body radiation therapy in the treatment of spine metastases: A matched-pair analysis [Abstract]. Journal of Neurosurgery: Spine, 14(4), 537-542.
Papatheofanis, F. J., Williams, E., & Chang, S. D. (2009). Cost-Utility Analysis Of The Cyberknife System For Metastatic Spinal Tumors [Abstract]. Neurosurgery, 64 (SUPPLEMENT).
Tarricone, R., Aguzzi, G., Musi, F., Fariselli, L., & Casasco, A. (2008). Cost-effectiveness analysis for trigeminal neuralgia: Cyberknife vs microvascular decompression. Neuropsychiatric Disease and Treatment, 4(3), 647-652.
Narrative Medicine in the Context of Childhood Chronic Pain
Previous studies have established that medical testing cannot detect all types of physical pain. Individuals that are victim to a system where a physical and usually quantitative measurement of pain symptoms is customary, often are left feeling helpless and resigned. This issues sets up the importance of narrative medicine in a clinical setting. Using a qualitative measure to supplement medical testing is helpful is arriving at a holistically derived diagnosis to better treat the root of the ailment (Hurwitz et al., 2004). Principles of narrative medicine allow the patient to tell a complete story with a beginning, plot, and end, in which they are given the liberty to shape their retelling of their symptoms around a larger narrative of their life (Sandelowski, 1991). Narrative medicine in the realm of chronic pain and children is especially appropriate to discuss. Patients experiencing chronic pain are often dismissed and invalidated by physicians because they are unable to find an underlying cause. Narratives by children are often viewed as incredible sources of information for diagnosis because of the their age. A 2009 semi-interview style study was conducted with children ages ten to eighteen regarding their chronic pain. The goal of the study was to understand the role of chronic pain in the context of the rest of their lives via a qualitative analysis. The narratives that the children shared had several overlapping themes, allowing researchers to create certain archetypes. The study suggests that the archetype of the story told by the patient should be taken into consideration and that the physician should aim to eventually remodel the narrative after treatment to put the patient in a powerful role in the narrative of their life.
Figure 1. One of the leading graduate level programs dedicated entirely to narrative medicine
One fallback of the use of narrative medicine include that it takes more time to be able to tell and listen to a patient’s narrative. Additionally, narratives are subjective. Even though it is a form of raw data from the patient regarding their pain, subjectivities are inevitable in patient-physician relationships due to the structural confines of class, race, and gender (Lorde, 2003). Not only this, but if the patient has told their pain narrative to another individual before visiting their physician, how that individual responded to the narrative– perhaps a facial expression, gesture, or comment– may incite the patient to retell their narrative differently to the physician. (Meldrum et al., 2009)
Citations:
Columbia University Medical Center | Program in Narrative Medicine. (n.d.). Retrieved December 03, 2016, from http://www.narrativemedicine.org/
Hurwitz, B., Greenhalgh, T., & Skultans, V. (Eds.). (2004). Narrative research in health and illness (pp. 1-20). Malden, MA: BMJ books.
Lorde, A. (2003). The master’s tools will never dismantle the master’s house. Feminist postcolonial theory: A reader, 25, 27.
Meldrum, M. L., Tsao, J. C. I., & Zeltzer, L. K. (2009). “I can’t be what I want to be”: Children’s Narratives of Chronic Pain Experiences and Treatment Outcomes. Pain Medicine, 10(6), 1018-1034.
Sandelowski, M. (1991). Telling stories: Narrative approaches in qualitative research. Image: the journal of nursing scholarship, 23(3), 161-166.
What is Transmedia Storytelling?
With the introduction of digital media into the world of marketing and communications, traditional methods of “print and publish” are no longer sufficient to captivate both the time (and money) of consumers. This is where transmedia storytelling comes in. As defined by Henry Jenkins, “Transmedia storytelling represents a process where integral elements of a fiction get dispersed systematically across multiple delivery channels for the purpose of creating a unified and coordinated entertainment experience. Ideally each medium makes its own unique contribution to the unfolding of the story” (Ryan, 2). In other words, transmedia storytelling boils down to a cross-network of various media that are founded off of a central idea/story but focus on different and unique elements of said story. The prime example of George R.R. Tolkien’s A Song of Fire and Ice, the book series upon which the T.V. show Game of Thrones originated from and where various fan-written stories (aka fanfiction) have been derived from. Each piece of media related to the series – books, movies, television, Internet, music – focuses on different aspects of the novels, but are all still connected under one unifying story.
Figure 1. Process of transmedia storytelling.
Transmedia storytelling has become the new way of media distribution and consumption because of the intimacy and power it provides to the consumers at hand. Stories are meticulously detailed and allow the consumer to develop a strong emotional connection that advertisements and newspapers have failed to achieve. In the spectrum of transmedia storytelling, there is a foundation layers that engage the audience into expanding and searching the story world created for them, “transmedial universes can be understood as intersubjective communicative constructs with a normative component” (Thon, 32). There is a dialogue that is created in transmedia storytelling that isn’t achieved in traditional mediums of communication; a non-linear, two-way connection between the sender and the receiver. This connection is created in a way that makes sense to the audience, as if they themselves are placed directly into the content that they interact with, “The early transmedia storytelling strategies that led viewers through different narrative experiences, separated by a linear temporal structure as well as different devices, have evolved into a layering of experiences onto a single narrative moment” (Evans, 125).
With this new way of communicating, established mediums are already taking heed and integrating transmedia storytelling into the content they produce and the marketing campaigns they run. One example of this is in comics, “…transmedial unity and its entities need to be created and re-created in a process that is continual and historical, showcasing its historicity in the temporal significations of the visuality involved in its storytelling” (Packard, 72). Comics, in particular, tend to adhere to transmedia storytelling because of the nature of its content. Superheroes and villains exists in fictional worlds where the writers have the ability to collaborate with other writers and artists to create a crossover between two characters from different worlds. The intangibility of content like this allows the story to be told in any different ways and through various other outlooks. The emotional investment and the feeling of control that the consumer gains from engaging with it is why transmedia storytelling is so powerful and why it has become the forefront of how media communication works in the 21st century.
Works Cited:
- Ryan, Marie-Laure. “Transmedia Storytelling: Industry Buzzword or New Narrative Experience?” Storyworlds: A Journal of Narrative Studies, vol. 7, no. 2, 2015, pp. 1–19. http://www.jstor.org/stable/10.5250/storyworlds.7.2.0001.
- Evans, Elizbeth. “Layering Engagement: The Temporal Dynamics of Transmedia Television.” Storyworlds: A Journal of Narrative Studies, vol. 7, no. 2, 2015, pp. 111–128. http://www.jstor.org/stable/10.5250/storyworlds.7.2.0111.
- Thon, Jan-Noël. “Converging Worlds: From Transmedial Storyworlds to Transmedial Universes.” Storyworlds: A Journal of Narrative Studies, vol. 7, no. 2, 2015, pp. 21–53. http://www.jstor.org/stable/10.5250/storyworlds.7.2.0021.
- Packard, Stephan. “Closing the Open Signification: Forms of Transmedial Storyworlds and Chronotopoi in Comics.” Storyworlds: A Journal of Narrative Studies, vol. 7, no. 2, 2015, pp. 55–74. http://www.jstor.org/stable/10.5250/storyworlds.7.2.0055.
Language, Consciousness, and Bilingualism: Do the Languages We Speak Really Effect Thought Patterns?
Language and consciousness are inseparable. Sure, consciousness exists without language; plenty of non-verbal animals are conscious in a similar way to humans. However, human consciousness in the way that we know it does not exist without language. At one point in history it may have, but no longer. Furthermore, language has never existed without consciousness. Language can be said to be one of multiple “agents of consciousness”. Unfortunately, defining consciousness is a rather difficult task. As such, defining the relationship between language and consciousness is significantly challenging. In fact, Jens Allwood states in Some Comments on Wallace Chafe’s “How Consciousness Shapes Language” that “pursuing this task [the question of the relationship between consciousness and identification, understanding and interpretation] will involve an in-depth probe into the nature of the relation between consciousness and the need for background information”. Physically one can see the connections between the parts of the brain responsible for both written and spoken language comprehension in the diagram below produced by The Human Connectome Project of the University of Southern California. The second diagram displays these connections within the human brain as a whole.
Figure 1. Structural Connectivity Between Language Processing Systems in the Human Brain. The figure displays the strength of connection between the language processing structures of the brain; the warmer the color, the stronger the connection.
Figure 2. Overall Connectivity of White Matter Fibers in the Human Brain. This figure shows the connectivity between white matter fibers in the brain as a whole; it is the information from Figure 1 put into context
We know that the use of language assumes that a person has a sort of cursory knowledge of each word being used and the topic of discussion. Wallace L. Chafe defines this in Language and Consciousness as “the linguistic distinction between given and new information”. Chafe asserts that differences in language create differences in assumed given and new information. Furthermore, depending on the language a speaker may be blissfully unaware as to what is given or new information in their lingua franca and that of another. Coming back to Allwood, one must consider that, at its most basic, language is composed of “intonation units”. This being the concept that each sound we make corresponds to a specific idea. Allwood argues against the validity of such units as concrete concepts and their correlation to one specific idea or concept. Even so, the ability of language to create ideas, images, and concepts within our minds is clear. As such, the connection between language and consciousness is undeniable.
This connection bears a specific relevance to the concepts of bilingualism and second language learning. The question arises, as asserted by Richard W. Schmidt in The Role of Conciousness in Second Language Learning, whether or not language learning is a conscious process, an unconscious process, or some combination of the two. Furthermore, one could even question whether or not conscious and unconscious thought are even to be considered as separate in the first place. Schmidt concludes that the role of conscious thought in language learning has been underplayed and that unconscious “picking up” of language does not play quite as large a role as we believe it to. This assumption may stem from the fact that not enough research has been done in terms of the conscious role of second language learning.
An experiment conducted by the University of Newcastle upon Tyne in England has attemoted to objectively place the differences in thought process and categorization created in bilingual minds. The researchers sought to observe the difference in the way bilingual speakers of English and Japanese categorized objects. It seems that a subject’s the level of familiarity with English changed whether test subjects more easily separated objects into categories of shape or material. For example, subjects were given an object such as a cork pyramid and asked to match it to either one of the objects presented to them. One of these matched the original object in shape (a plastic pyramid) and one matched in material (a piece of cork). The more experienced in English the subject was, the more often they categorized an object by shape. Monolingual English speakers also more often categorize by shape while monolingual Japanese speakers more often categorize by material. In reference to consciousness, this may mean that English speakers inherently think in a more concrete objective based fashion while Japanese speakers think in a more abstract and profound fashion when it comes to categorization. This raises the question of whether or not speaker’s actual consciousness is shaped by the language(s) they speak.
While it is a widely held belief that this is indeed the case, John H. McWhorter in The Language Hoax: Why the World Looks the Same in Any Language disagrees. McWhorter does not disagree that because language and culture are inherently connected, different cultures and thus languages have words for concepts in that culture not found in other languages. However, he disputes that this means that these speakers of different languages think about these concepts differently. Therefore, he disagrees with the belief that speaking a certain language creates a certain worldview or way of experiencing life in the speaker. Nevertheless, research like this displays the profound connections between language and consciousness. Whether or not this consciousness consists of worldviews or the simple fact that language has the unique ability to conjure images in our minds is irrelevant. The way we think is indubitably related to the very human action of connecting concepts to sounds and symbols.
References
Allwood, J. (1996). Some Comments on Wallace Chafe’s “How Consciousness Shapes Language” Pragmatics and Cognition, 4(1), 55-64. Retrieved October 19, 2016.
Chafe, W. L. (1974, March). Language and Conciousness. Language, 50(1), 111-133. Retrieved October 19, 2016, from JSTOR.
Cook, V., Bassetti, B., Kasai, C., Sasaki, M., & Takahashi, J. A. (2006). Do Bilinguals Have Different Concepts? The Case of Shape and Material in Japanese L2 Users of English [Abstract]. International Journal of Bilingualism, 10(2), 137-152. Retrieved October 19, 2016.
Hoge, K. (2014, August 7). The Language Hoax: Why the World Looks the Same in Any Language, by John H. McWhorter. Retrieved October 19, 2016, from https://www.timeshighereducation.com/books/the-language-hoax-why-the-world-looks-the-same-in-any-language-by-john-h-mcwhorter/2014926.article
Schmidt, R. W. (1988, July). The Role of Consciousness in Second Language Learning. Applied Linguistics, 11(2), 129-158. Retrieved October 19, 2016, from Oxford journals.
