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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Millie McCoy and Christine McCoy (July 11, 1851 – October 8, 1912) were American conjoined twins who went by the stage names "The Carolina Twins", "The Two-Headed Nightingale" and "The Eighth Wonder of the World". The Twins traveled throughout the world performing song and dance for entertainment.
Mary and Eliza Chulkhurst (or Chalkhurst), commonly known as the Biddenden Maids, were a pair of conjoined twins supposedly born in Biddenden, Kent, England, in the year 1100. They are said to have been joined at both the shoulder and the hip, and to have lived for 34 years. It is claimed that on their death they bequeathed five plots of land to the village, known as the Bread and Cheese Lands. The income from these lands was used to pay for an annual of food and drink to the poor every Easter. Since at least 1775, the dole has included Biddenden cakes, hard biscuits imprinted with an image of two conjoined women.
Although the annual distribution of food and drink is known to have taken place since at least 1605, no records exist of the story of the sisters prior to 1770. Records of that time say that the names of the sisters were not known, and early drawings of Biddenden cakes do not give names for the sisters; it is not until the early 19th century that the names "Mary and Eliza Chulkhurst" were first used.
Edward Hasted, the local historian of Kent, has dismissed the story of the Biddenden Maids as a folk myth, claiming that the image on the cake had originally represented two poor women and that the story of the conjoined twins was "a vulgar tradition" invented to account for it, while influential historian Robert Chambers accepted that the legend could be true but believed it unlikely. Throughout most of the 19th century little research was carried out into the origins of the legend. Despite the doubts among historians, in the 19th century the legend became increasingly popular and the village of Biddenden was thronged with rowdy visitors every Easter. In the late 19th century historians investigated the origins of the legend. It was suggested that the twins had genuinely existed but had been joined at the hip only rather than at both the hip and shoulder, and that they had lived in the 16th rather than the 12th century.
In 1907, the Bread and Cheese Lands were sold for housing, and the resulting income allowed the annual dole to expand considerably, providing the widows and pensioners of Biddenden with cheese, bread and tea at Easter and with cash payments at Christmas. Biddenden cakes continue to be given to the poor of Biddenden each Easter, and are sold as souvenirs to visitors.
Islamophobia in the media refers to the occurrence or perception that media outlets tend to cover Muslims or Islam-related topics in a negative light. Islamophobia is defined as "Intense dislike or fear of Islam, esp. as a political force; hostility or prejudice towards Muslims".
In Chinese alchemy, elixir poisoning refers to the toxic effects from elixirs of immortality that contained metals and minerals such as mercury and arsenic. The official "Twenty-Four Histories" record numerous Chinese emperors, nobles, and officials who ironically died from taking elixirs in order to prolong their lifespans. The first emperor to die from elixir poisoning was likely Qin Shi Huang (d. 210 BCE) and the last was Yongzheng (d. 1735). Despite common knowledge that immortality potions could be deadly, fangshi and Daoist alchemists continued the elixir-making practice for two millennia.
Surgery to separate conjoined twins may range from very easy to very difficult depending on the point of attachment and the internal parts that are shared. Most cases of separation are extremely risky and life-threatening. In many cases, the surgery results in the death of one or both of the twins, particularly if they are joined at the head or share a vital organ. This makes the ethics of surgical separation, where the twins can survive if not separated, contentious. Alice Dreger of Northwestern University found the quality of life of twins who remain conjoined to be higher than is commonly supposed. Lori and George Schappell and Abby and Brittany Hensel are notable examples.
In 1955, neurosurgeon Harold Voris (1902-1980) and his team at Mercy Hospital in Chicago performed the first successful operation to separate Siamese twins conjoined (Craniopagus twins) at the head, which resulted in long-term survival for both. The larger girl was reported in 1963 as developing normally, but the smaller was permanently impaired.
In 1957, Bertram Katz and his surgical team made international medical history performing the world's first successful separation of conjoined twins sharing a vital organ. Omphalopagus twins John Nelson and James Edward Freeman (Johnny and Jimmy) were born to Mr. and Mrs. William Freeman of Youngstown, Ohio, on April 27, 1956. The boys shared a liver but had separate hearts and were successfully separated at North Side Hospital in Youngstown, Ohio by Bertram Katz. The operation was funded by the Ohio Crippled Children's Service Society.
Recent successful separations of conjoined twins include that of the separation of Ganga & Jamuna Shreshta in 2001, who were born in Kathmandu, Nepal, in 2000. The 197-hour surgery on the pair of craniopagus twins was a landmark one which took place in Singapore; the team was led by neurosurgeons Chumpon Chan and Keith Goh. The surgery left Ganga with brain damage and Jamuna unable to walk. Seven years later, Ganga Shrestha died at the Model Hospital in Kathmandu in July 2009, at the age of 8, three days after being admitted for treatment of a severe chest infection.
A case of particular interest was that of infants Rose and Grace ("Mary" and "Jodie") Attard, conjoined twins from Malta who were separated in Great Britain by court order over the religious objections of their parents, Michaelangelo and Rina Attard. The surgery took place in November, 2000, at St Mary's Hospital in Manchester. The operation was controversial because Rose, the weaker twin, would die as a result of the procedure as her heart and lungs were dependent upon Grace's. (The twins were attached at the lower abdomen and spine.) However, if the operation had not taken place, it was certain that both twins would die. Grace survived to enjoy a normal childhood.
In 2003 two 29-year-old women from Iran, Ladan and Laleh Bijani, who were joined at the head but had separate brains (craniopagus) were surgically separated in Singapore, despite surgeons' warnings that the operation could be fatal to one or both. Their complex case was accepted only because high tech graphical imagery and modelling would allow the medical team to plan the risky surgery. Unfortunately, an undetected major vein hidden from the scans was discovered during the operation. The separation was completed but both women died while still in surgery on July 8, 2003.
A crush fetish is a fetish and a paraphilia in which one is sexually aroused when someone crushes objects, food, and sometimes small animals (frequently insects) with their body, usually under their foot, or when crushed oneself. The term soft crush refers to the more common fetish surrounding videos involving inanimate objects (such as food) or small invertebrates (e.g. insects, snails, worms, arachnids) being crushed, while the term hard crush refers to such videos involving larger animals with vertebrae, and arguably more pain-susceptible animals (e.g. reptiles, birds, mammals). The preference could be barefoot, high-heels, flip flops, socks, and so on, depending on the fetishist. Most soft crush fetishists prefer to distinguish themselves from hard crush fetishists, believing that crush films with larger animals give the entire group a bad label.
There are currently no known laws forbidding the crushing of objects and insects, but the production or trade of crush erotica involving live vertebrates is condemned by animal rights activists and is illegal in many countries, including the United States and Great Britain. In the United States, interstate commerce in [hard] crush videos has been illegal since 2010, and many other countries also have banned them.
"'Conjoined twins" are identical twins joined in utero. An extremely rare phenomenon, the occurrence is estimated to range from 1 in 49,000 births to 1 in 189,000 births, with a somewhat higher incidence in Southeast Asia and Africa. Approximately half are stillborn, and an additional one-third die within 24 hours. Most live births are female, with a ratio of 3:1.
Two contradicting theories exist to explain the origins of conjoined twins. The more generally accepted theory is "fission", in which the fertilized egg splits partially. The other theory, no longer believed to be the basis of conjoined twinning, is fusion, in which a fertilized egg completely separates, but stem cells (which search for similar cells) find like-stem cells on the other twin and fuse the twins together. Conjoined twins share a single common chorion, placenta, and amniotic sac, although these characteristics are not exclusive to conjoined twins as there are some monozygotic but non-conjoined twins who also share these structures in utero.
The most famous pair of conjoined twins was Chang and Eng Bunker (Thai: อิน-จัน, In-Chan) (1811–1874), Thai brothers born in Siam, now Thailand. They traveled with P.T. Barnum's circus for many years and were labeled as the Siamese twins. Chang and Eng were joined at the torso by a band of flesh, cartilage, and their fused livers. In modern times, they could have been easily separated. Due to the brothers' fame and the rarity of the condition, the term "Siamese twins" came to be used as a synonym for conjoined twins.
Islamophobia is an intense fear or hatred of, or prejudice against, the Islamic religion or Muslims, especially when seen as a geopolitical force or the source of terrorism.
The term was first used in the early 20th century and it emerged as a neologism in the 1970s, then it became increasingly salient during the 1980s and 1990s, and it reached public policy prominence with the report by the Runnymede Trust's Commission on British Muslims and Islamophobia (CBMI) entitled "Islamophobia: A Challenge for Us All" (1997). The introduction of the term was justified by the report's assessment that "anti-Muslim prejudice has grown so considerably and so rapidly in recent years that a new item in the vocabulary is needed".
The causes and characteristics of Islamophobia are still debated. Some commentators have posited an increase in Islamophobia resulting from the September 11 attacks, some from multiple terror attacks in Europe and the United States, while others have associated it with the increased presence of Muslims in the United States and in the European Union. Some people also question the validity of the term. The academics S. Sayyid and Abdoolkarim Vakil maintain that Islamophobia is a response to the emergence of a distinct Muslim public identity globally, the presence of Muslims is in itself not an indicator of the degree of Islamophobia in a society. Sayyid and Vakil maintain that there are societies where virtually no Muslims live but many institutionalized forms of Islamophobia still exist in them.
The etymology of English elixir derives from Medieval Latin "", from Arabic ("al-ʾiksīr"), probably from Ancient Greek ("xḗrion" "a desiccative powder for wounds"). "Elixir" originated in medieval European alchemy meaning "A preparation by the use of which it was sought to change metals into gold" (elixir stone or philosopher's stone) or "A supposed drug or essence with the property of indefinitely prolonging life" (elixir of life). The word was figuratively extended to mean "A sovereign remedy for disease. Hence adopted as a name for quack medicines" (e.g., Daffy's Elixir) and "The quintessence or soul of a thing; its kernel or secret principle". In modern usage, "elixir" is a pharmaceutical term for "A sweetened aromatic solution of alcohol and water, serving as a vehicle for medicine" ("Oxford English Dictionary", 2nd ed., 2009). Outside of Chinese cultural contexts, English "elixir poisoning" usually refers to accidental contamination, such as the 1937 Elixir sulfanilamide mass poisoning in the United States.
"Dān" 丹 "cinnabar; vermillion; elixir; alchemy" is the keyword for Chinese immortality elixirs. The red mineral cinnabar ("dānshā" 丹砂 lit. "cinnabar sand") was anciently used to produce the pigment vermilion ("zhūhóng" 朱紅) and the element mercury ("shuǐyín" 水銀 "watery silver" or "gǒng" 汞).
According to the "ABC Etymological Dictionary of Old Chinese", the etymology of Modern Standard Chinese "dān" from Old Chinese "*tān" (< *"tlan" ?) 丹 "red; vermillion; cinnabar", "gān" 矸 in "dāngān" 丹矸 from *"tân-kân" (< *"tlan-klan" ?) "cinnabar; vermillion ore", and "zhān" from *"tan" 旃 "a red flag" derive from Proto-Kam-Sui *"h-lan" "red" or Proto-Sino-Tibetan *"tja-n" or *"tya-n" "red". The *"t-" initial and *"t-" or *"k-" doublets indicate that Old Chinese borrowed this item. (Schuessler 2007: 204).
Although the word "dan" 丹 "cinnabar; red" frequently occurs in oracle script from the late Shang Dynasty (ca. 1600-1046 BCE) and bronzeware script and seal script from the Zhou Dynasty (1045-256 BCE), paleographers disagree about the graphic origins of the logograph 丹 and its ancient variants 𠁿 and 𠕑. Early scripts combine a 丶 dot or ⼀ stroke (depicting a piece of cinnabar) in the middle of a surrounding frame, which is said to represent:
- "jǐng" 井 "well" represents the mine from which the cinnabar is taken" ("Shuowen Jiezi")
- "the crucible of the Taoist alchemists" (Léon Wieger )
- "the contents of a square receptacle" (Bernhard Karlgren)
- "placed in a tray or palette to be used as red pigment" (Wang Hongyuan 王宏源)
- "mineral powder on a stretched filter-cloth" (Needham and Lu).
Many Chinese elixir names are compounds of "dan", such as "jīndān" 金丹 (with "gold") meaning "golden elixir; elixir of immortality; potable gold" and "xiāndān" 仙丹 (with "Daoist immortal") "elixir of immortality; panacea", and "shéndān" 神丹 (with "spirit; god") "divine elixir". "Bùsǐ zhī yào" 不死之藥 "drug of deathlessness" was another early name for the elixir of immortality. Chinese alchemists would "liàndān" 煉丹 (with "smelt; refine") "concoct pills of immortality" using a "dāndǐng" 丹鼎 (with "tripod cooking vessel; cauldron") "furnace for concocting pills of immortality". In addition, the ancient Chinese believed that other substances provided longevity and immortality, notably the "língzhī" 靈芝 ""Ganoderma" mushroom".
The transformation from chemistry-based "waidan" 外丹 "external elixir/alchemy" to physiology-based "neidan" 內丹 "internal elixir/alchemy" gave new analogous meanings to old terms. The human body metaphorically becomes a "ding" "cauldron" in which the adept forges the Three Treasures (essence, life-force, and spirit) within the "jindan" Golden Elixir within the "dāntián" 丹田 (with "field") "lower part of the abdomen".
In early China, alchemists and pharmacists were one in the same. Traditional Chinese Medicine also used less concentrated cinnabar and mercury preparations, and "dan" means "pill; medicine" in general, for example, "dānfāng" 丹方 semantically changed from "prescription for elixir of immortality" to "medical prescription". "Dan" was lexicalized into medical terms such as " dānjì" 丹劑 "pill preparation" and "dānyào" 丹藥 "pill medicine".
The Chinese names for immortality elixirs have parallels in other cultures and languages, for example, Indo-Iranian "soma" or "haoma", Sanskrit "amrita", and Greek "ambrosia".
Fear of surgery or other invasive medical procedure may be known as tomophobia. Fear of surgery is not a fear experienced often, but is still just as harmful as those that are more common. Since surgery is not a common occurrence, the fear is more based on inexperience or something that is out of the ordinary. This fear is one of those categorized under all fears of medical procedures that can be experienced by anyone, all ages, and have little need for actual psychological treatment, unless it is uncharacteristically causing the patient to react in a way that would be harmful to his or her health.
Therapeutic approaches for GIDC differ from those used on adults and have included behavior therapy, psychodynamic therapy, group therapy, and parent counseling. Proponents of this intervention seek to reduce gender dysphoria, make children more comfortable with their bodies, lessen ostracism, and reduce the child's psychiatric comorbidity. The majority of therapists currently employ these techniques. "Two short term goals have been discussed in the literature: the reduction or elimination of social ostracism and conflict, and the alleviation of underlying or associated psychopathology. Longer term goals have focused on the prevention of transsexualism and/or homosexuality."
Individual therapy with the child seeks to identify and resolve underlying factors, including familial factors; encourage identification by sex assigned at birth; and encourage same-sex friendships. Parent counseling involves setting limits on the child's cross-gender behavior; encouraging gender-neutral or sex-typical activities; examining familial factors; and examining parental factors such as psychopathology. Longtime researchers of gender identity disorder, Kenneth Zucker and Susan Bradley, state that it has been found that boys with gender identity disorder often have mothers who to an extent reinforced behavior more stereotypical of young girls. They also note that children with gender identity disorder tend to come from families where cross-gender role behavior was not explicitly discouraged. However, they also acknowledge that one could view these findings as merely indicative of the fact that parents who were more accepting of their child's cross-gender role behavior are also more likely to bring their children to a clinical psychiatrist as opposed to parents who are less accepting of cross-gender role behavior in their children (Bradley, Zucker, 1997). " Proponents acknowledge limited data on GIDC: "apart from a series of intrasubject behaviour therapy case reports from the 1970s, one will find not a single randomized controlled treatment trial in the literature" (Zucker 2001). Psychiatrist Domenico Di Ceglie opines that for therapeutic intervention, "efficacy is unclear," and psychologist Bernadette Wren says, "There is little evidence, however, that any psychological treatments have much effect in changing gender identity although some treatment centres continue to promote this as an aim (e.g. Zucker, & Bradley, 1995)." Zucker has stated that "the therapist must rely on the 'clinical wisdom' that has accumulated and to utilize largely untested case formulation conceptual models to inform treatment approaches and decisions."
According to tradition Mary and Eliza Chulkhurst, or Chalkhurst, were born to relatively wealthy parents in Biddenden, Kent, in the year 1100. The pair were said to be conjoined at both the shoulder and the hip. They grew up conjoined, and are said to have "had frequent quarrels, which sometimes terminated in blows". At the age of 34, Mary Chulkhurst died suddenly. Doctors proposed to separate the still-living Eliza from her sister's body but she refused, saying "as we came together we will also go together", and died six hours afterwards. In their wills, the sisters left five pieces of land in the Biddenden area comprising around in total to the local church, with the income from these lands (claimed to have been 6 guineas per annum at the time of their death) to provide an annual dole of bread, cheese and beer to the poor every Easter. Henceforward, the lands were to be known as the Bread and Cheese Lands.
Transphobia is a range of negative attitudes, feelings or actions toward transgender or transsexual people, or toward transsexuality. Transphobia can be emotional disgust, fear, violence, anger or discomfort felt or expressed towards people who do not conform to society's gender expectations. It is often expressed alongside homophobic views and hence is often considered an aspect of homophobia. Transphobia is a type of prejudice and discrimination similar to racism and sexism, and transgender people of color are often subjected to all three forms of discrimination at once.
Child victims of transphobia experience harassment, school bullying, and violence in school, foster care, and social programs. Adult victims experience public ridicule, harassment including misgendering, taunts, threats of violence, robbery, and false arrest; many feel unsafe in public. A high percentage report being victims of sexual violence. Some are refused healthcare or suffer workplace discrimination, including being fired for being transgender, or feel under siege by conservative political or religious groups who oppose laws to protect them. There is even discrimination from some people within the movement for the rights of gender and sexual minorities.
Besides the increased risk of violence and other threats, the stress created by transphobia can cause negative emotional consequences which may lead to substance abuse, running away from home (in minors), and a higher rate of suicide.
In the Western world, there have been gradual changes towards the establishment of policies of non-discrimination and equal opportunity. The trend is also taking shape in developing nations. In addition, campaigns regarding the LGBT community are being spread around the world to improve acceptance; the "Stop the Stigma" campaign by the UN is one such development.
Starting with the youngest, fear of surgery is extremely common among young children. Explained best by Christine Gorman in Kids and Surgery, “Surgery is scary enough for adults. But imagine what goes through the mind of a three-year-old when he sees a doctor or nurse all suited up and wearing a surgical mask: “It’s a monster! It’s got big eyes and no mouth! It’s taking me away from Mommy and Daddy.” No wonder half of all children from ages of 2 to 10 show evidence of distress—from bed-wetting to nightmares—for at least two weeks after their operation. Some of them remain traumatized even six months later.” This statement shows that the fear that comes when young children go into surgery can be a serious matter because they are still traumatized by the effects for weeks after the surgery has taken place. Being scared of surgery has led to “eating disorders, sleep disturbances, regression to earlier levels of behavior, depression, and somatizations such as loss of voice after tonsillectomy.” Many children see surgery as a form of punishment and, since they sometimes can’t see what they did “wrong”, the fear is escalated, leaving greater chance for a longer effect on the psychological and emotional feelings of the child.
Millie and Christine (the "Carolina Twins") were born in Columbus County, North Carolina on July 11, 1851, to Jacob and Monemia McKoy who were slaves of blacksmith, Jabez McKay. The McKay farm was near the town of Whiteville. Prior to the sisters' birth, their mother had borne seven other children, five boys and two girls, all of ordinary size and form. The twins were conjoined at the lower spine and stood at an approximately 90-degree angle to each other.
The twins were first sold at 10 months of age to South Carolinian John C. Pervis. Pervis and McKay reached an agreement where Pervis exhibited the girls for pay and then paid a percentage to McKay. Fourteen months after the original sale, they were sold to a showman, Brower, who had the backing of a wealthy merchant named Joseph Pearson Smith. Brower first exhibited the twins at North Carolina's first state fair, held in 1853. They were constantly being called "Freaks of Nature". The North Carolina state fair was a success for Brower and The Carolina Twins; however, Brower's fortune changed over the next months. Brower was conned by a Texas adventurer, who offered land worth an estimated forty-five thousand dollars as a purchase price for the twins. Brower accepted, sent the twins on to the Texan, and then waited several days for the deeds before realizing that he had been swindled. Brower returned to North Carolina to relate the loss to Joseph Pearson Smith. Since Brower was left destitute, Smith was given the promissory note and was now the owner of The Carolina Twins. Millie and Christine were handled by several managers before being reclaimed by Smith in Britain in 1857.
On 1 January 1863 the Emancipation Proclamation ended their slave status and they were no longer anyone's property. Before their emancipation, the girls had been showcased in fairs and freak shows in several U.S. cities and even Montreal, Canada.
Smith traveled to Britain to collect the girls and brought with him their mother, Monemia, from whom they had been separated. He and his wife provided the twins with an education and taught them to speak five languages, dance, play music, and sing. During their time in Britain, they met Queen Victoria. For the rest of the century, the twins enjoyed a successful career as "The Two-Headed Nightingale", and appeared with the Barnum circus. In 1869, a biography on the twins, titled "History and Medical Description of the Two-Headed Girl", was sold during their public appearances. Joanne Fish Martell, former court reporter, discovered a memoir written by the girls at the age of 17 and with that and other sources, created her book "Millie-Christine: Fearfully and Wonderfully Made", which was published in 2000. The twins' motto was "As God decreed, we agreed," and they strove to turn impediments into assets. As toddlers, they were clumsy and fell down quite frequently. They eventually developed a sideways walk that turned into a crowd-pleasing dance style. They were able to master keyboard duets with one soprano and one alto voice, and learned to harmonize.
When they were in their 30's, the twins moved back to the farm where they were born, which their father had bought from Jabez McKay and left to them.
On October 8, 1912, Millie and Christine died at age 61 of tuberculosis; Christine died 12 hours after her sister. They were buried in unmarked graves but in 1969 they were moved to a cemetery in Whiteville.
"Sex reassignment therapy" (SRT) is an umbrella term for all medical treatments related to sex reassignment of both transgender and intersex people.
Individuals make different choices regarding sex reassignment therapy, which may include female-to-male or male-to-female hormone replacement therapy (HRT) to modify secondary sex characteristics, sex reassignment surgery (such as orchiectomy) to alter primary sex characteristics, chest surgery such as top surgery or breast augmentation, or, in the case of trans women, a trachea shave, facial feminization surgery or permanent hair removal.
To obtain sex reassignment therapy, transsexual people are generally required to undergo a psychological evaluation and receive a diagnosis of gender identity disorder in accordance with the Standards of Care (SOC) as published by the World Professional Association for Transgender Health. This assessment is usually accompanied by counseling on issues of adjustment to the desired gender role, effects and risks of medical treatments, and sometimes also by psychological therapy. The SOC are intended as guidelines, not inflexible rules, and are intended to ensure that clients are properly informed and in sound psychological health, and to discourage people from transitioning based on unrealistic expectations.
The time workers spend in hot environments should be limited, with an increase of recovery time spent in cool environments. Use of more efficient procedures and tools is beneficial to reducing metabolic demands of the job. Heat tolerance may be increased by implementing a heat tolerance plan and increasing physical fitness. Employees should be trained to recognize and treat the early signs and symptoms of heat illnesses, and employers should provide cool water for employees.
There is a general lack of consensus in the diagnosis and treatment of DID and research on treatment effectiveness focuses mainly on clinical approaches described in case studies. General treatment guidelines exist that suggest a phased, eclectic approach with more concrete guidance and agreement on early stages but no systematic, empirically-supported approach exists and later stages of treatment are not well described and have no consensus. Even highly experienced therapists have few patients that achieve a unified identity. Common treatment methods include an eclectic mix of psychotherapy techniques, including cognitive behavioral therapy (CBT), insight-oriented therapies, dialectical behavioral therapy (DBT), hypnotherapy and eye movement desensitization and reprocessing (EMDR). Medications can be used for comorbid disorders or targeted symptom relief. Some behavior therapists initially use behavioral treatments such as only responding to a single identity, and then use more traditional therapy once a consistent response is established. Brief treatment due to managed care may be difficult, as individuals diagnosed with DID may have unusual difficulties in trusting a therapist and take a prolonged period to form a comfortable therapeutic alliance. Regular contact (weekly or biweekly) is more common, and treatment generally lasts years—not weeks or months. Sleep hygiene has been suggested as a treatment option, but has not been tested. In general there are very few clinical trials on the treatment of DID, none of which were randomized controlled trials.
Therapy for DID is generally phase oriented. Different alters may appear based on their greater ability to deal with specific situational stresses or threats. While some patients may initially present with a large number of alters, this number may reduce during treatment—though it is considered important for the therapist to become familiar with at least the more prominent personality states as the "host" personality may not be the "true" identity of the patient. Specific alters may react negatively to therapy, fearing the therapist's goal is to eliminate the alter (particularly those associated with illegal or violent activities). A more realistic and appropriate goal of treatment is to integrate adaptive responses to abuse, injury or other threats into the overall personality structure. There is debate over issues such as whether exposure therapy (reliving traumatic memories, also known as abreaction), engagement with alters and physical contact during therapy are appropriate and there are clinical opinions both for and against each option with little high-quality evidence for any position.
Brandt et al., noting the lack of empirical studies of treatment effectiveness, conducted a survey of 36 clinicians expert in treating dissociative disorder (DD) who recommended a three-stage treatment. They agreed that skill building in the first stage is important so the patient can learn to handle high risk, potentially dangerous behavior, as well as emotional regulation, interpersonal effectiveness and other practical behaviors. In addition, they recommended "trauma-based cognitive therapy" to reduce cognitive distortions related to trauma; they also recommended that the therapist deal with the dissociated identities early in treatment. In the middle stage, they recommended graded exposure techniques, along with appropriate interventions as needed. The treatment in the last stage was more individualized; few with DD became integrated into one identity.
The International Society for the Study of Trauma and Dissociation has published guidelines to phase-oriented treatment in adults as well as children and adolescents that are widely used in the field of DID treatment. The first phase of therapy focuses on symptoms and relieving the distressing aspects of the condition, ensuring the safety of the individual, improving the patient's capacity to form and maintain healthy relationships, and improving general daily life functioning. Comorbid disorders such as substance abuse and eating disorders are addressed in this phase of treatment. The second phase focuses on stepwise exposure to traumatic memories and prevention of re-dissociation. The final phase focuses on reconnecting the identities of disparate alters into a single functioning identity with all its memories and experiences intact.
A study was conducted with the goal of developing an "expertise-based prognostic model for the treatment of complex posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID)". Researchers constructed a two-stage survey and factor analyses performed on the survey elements found 51 factors common to complex PTSD and DID. The authors concluded from their findings: "The model is supportive of the current phase-oriented treatment model, emphasizing the strengthening of the therapeutic relationship and the patient's resources in the initial stabilization phase. Further research is needed to test the model's statistical and clinical validity."
In summary, key policy interventions for the prevention of stunting are:
- Improvement in nutrition surveillance activities to identify rates and trends of stunting and other forms of malnutrition within countries. This should be done with an equity perspective, as it is likely that stunting rates will vary greatly between different population groups. The most vulnerable should be prioritized. The same should be done for risk factors such as anemia, maternal under-nutrition, food insecurity, low birth-weight, breastfeeding practices etc. By collecting more detailed information, it is easier to ensure that policy interventions really address the root causes of stunting.
- Political will to develop and implement national targets and strategies in line with evidence-based international guidelines as well as contextual factors.
- Designing and implementing policies promoting nutritional and health well-being of mothers and women of reproductive age. The main focus should be on the 1000 days of pregnancy and first two years of life, but the pre-conception period should not be neglected as it can play a significant role in ensuring the fetus and baby's nutrition.
- Designing and implementing policies promoting proper breastfeeding and complementary feeding practice (focusing on diet diversity for both macro and micronutrients). This can ensure optimal infant nutrition as well as protection from infections that can weaken the child's body. Labor policy ensuring mothers have the chance to breastfeed should be considered where necessary.
- Introducing interventions addressing social and other health determinants of stunting, such as poor sanitation and access to drinking water, early marriages, intestinal parasite infections, malaria and other childhood preventable disease (referred to as “nutrition-sensitive interventions”), as well as the country's food security landscape. Interventions to keep adolescent girls in school can be effective at delaying marriage with subsequent nutritional benefits for both women and babies. Regulating milk substitutes is also very important to ensure that as many mothers as possible breastfeed their babies, unless a clear contraindication is present.
- Broadly speaking, effective policies to reduce stunting require multisectoral approaches, strong political commitment, community involvement and integrated service delivery.
Transsexual people experience a gender identity that is inconsistent with, or not culturally associated with, their assigned sex, and desire to permanently transition to the gender with which they identify, usually seeking medical assistance (including hormone replacement therapy and other sex reassignment therapies) to help them align their body with their identified sex or gender.
"Transsexual" is generally considered a subset of "transgender", but some transsexual people reject the label of "transgender". A medical diagnosis of gender dysphoria can be made if a person expresses a desire to live and be accepted as a member of their identified sex, and if a person experiences impaired functioning or distress as a result of their gender identity.
Homophobia encompasses a range of negative attitudes and feelings toward homosexuality or people who are identified or perceived as being lesbian, gay, bisexual or transgender (LGBT). It has been defined as contempt, prejudice, aversion, hatred or antipathy, may be based on irrational fear, and is often related to religious beliefs.
Homophobia is observable in critical and hostile behavior such as discrimination and violence on the basis of sexual orientations that are non-heterosexual. Recognized types of homophobia include "institutionalized" homophobia, e.g. religious homophobia and state-sponsored homophobia, and "internalized" homophobia, experienced by people who have same-sex attractions, regardless of how they identify.
Negative attitudes toward identifiable LGBT groups have similar yet specific names: lesbophobia is the intersection of homophobia and sexism directed against lesbians, biphobia targets bisexuality and bisexual people, and transphobia targets transgender and transsexual people and gender variance or gender role nonconformity. According to 2010 Hate Crimes Statistics released by the FBI National Press Office, 19.3 percent of hate crimes across the United States "were motivated by a sexual orientation bias." Moreover, in a Southern Poverty Law Center 2010 "Intelligence Report" extrapolating data from fourteen years (1995–2008), which had complete data available at the time, of the FBI's national hate crime statistics found that LGBT people were "far more likely than any other minority group in the United States to be victimized by violent hate crime."
The term "homophobia" and its usage have been criticized by several sources as unwarrantedly pejorative
The diagnostic criteria for Dorian Gray syndrome are:
- Signs of dysmorphophobia
- Arrested development (inability to mature)
- Using at least two different medical-lifestyle products and services:
- Hair-growth restoration (e.g. finasteride)
- Antiadiposita to lose weight (e.g. orlistat)
- Anti-impotence drugs (e.g. sildenafil)
- Anti-depressant drugs (e.g. fluoxetine)
- Cosmetic dermatology (e.g. laser resurfacing)
- Cosmetic surgery (e.g. a face-lift, liposuction)
Ensuring proper nutrition of pregnant and lactating mothers is essential. Achieving so by helping women of reproductive age be in good nutritional status at conception is an excellent preventive measure. A focus on the pre-conception period has recently been introduced as a complement to the key phase of the 1000 days of pregnancy and first two years of life. An example of this is are attempts to control anemia in women of reproductive age. A well-nourished mother is the first step of stunting prevention, decreasing chances of the baby being born of low birth-weight, which is the first risk factor for future malnutrition.
After birth, in terms of interventions for the child, early initiation of breastfeeding, together with exclusive breastfeeding for the first 6 months, are pillars of stunting prevention. Introducing proper complementary feeding after 6 months of age together with breastfeeding until age 2 is the next step.
Obesity in North Africa and the Middle East is a notable health issue. In 2005, the World Health Organization measured that 1.6 billion people were overweight and 400 million were obese. It estimates that by the year 2015, 2.3 billion people will be overweight and 700 million will be obese. The Middle East, including the Arabian Peninsula, Eastern Mediterranean, Turkey and Iran, and North Africa, are no exception to the worldwide increase in obesity. Subsequently, some call this trend the New World Syndrome. The lifestyle changes associated with the discovery of oil and the subsequent increase in wealth is one contributing factor.
Urbanization has occurred rapidly and has been accompanied by new technologies that promote sedentary lifestyles. Due to accessibility of private cars, television, and household appliances, the population as a whole is engaging in less physical activity. The rise in caloric and fat intake in a region where exercise is not a defining part of the culture has added to the overall increased percentages of overweight and obese populations. In addition, women are more likely to be overweight or obese due to cultural norms and perceptions of appropriate female behavior and occupations inside and outside of the home.
The nature of the injury varies depending on the size and location of the fistula, so a surgeon with experience is needed to improvise on the spot. Before the person undergoes surgery, treatment and evaluation are needed for conditions including anemia, malnutrition, and malaria. Quality treatment in low-resource settings are possible (as in the cases of Nigeria and Ethiopia).
Treatment is available through reconstructive surgery. Primary fistula repair has a 91% success rate. The corrective surgery costs about US$100 – 400, and the cost for the entire procedure, which includes the actual surgery, postoperative care, and rehabilitation support, is estimated to cost $300–450. Initial surgeries done by inadequately trained doctors and midwives increase the number of follow-up surgeries that must be performed to restore full continence. Successful surgery enables women to live normal lives and have more children, but it is recommended to have a cesarean section to prevent the fistula from recurring. Postoperative care is vital to prevent infection. Some women are not candidates for this surgery due to other health problems. In those cases, fecal diversion can help the patient, but not necessarily cure them.
Besides physical treatment, mental health services are also needed to rehabilitate fistula patients, who experience psychological trauma from being ostracized by the community and from fear of developing fistulae again. A study on the first formal counseling program for fistula survivors in Eritrea shows positive results, whereby counseling significantly improved the women's self-esteem, knowledge about fistulae and fistula prevention, and behavioral intentions for "health maintenance and social reintegration" following surgery.