IT ethics: Hacking And Copyrights Essay

IT morals is another part of morals that is developing and changing quickly as IT innovation likewise develops and creates. The term â€Å"IT ethics† is available to translations both expansive and limited. From one viewpoint, for instance, IT morals may be seen barely as the endeavors of expert rationalists to apply conventional moral hypotheses or prudence morals to issues with respect to the utilization of IT innovation. Then again, it is conceivable to interpret IT morals in an extremely wide manner to incorporate, also, measures of expert practice, sets of accepted rules, parts of IT law, open approach, corporate morals †even certain themes in the human science and brain research of registering. In the industrialized countries of the world, the â€Å"information revolution† as of now has altogether modified numerous parts of life †in banking and business, work and work, clinical consideration, national protection, transportation and diversion. Thus, data innovation has started to influence network life, family life, human connections, training, opportunity, majority rule government, etc. IT morals in the broadest sense can be comprehended as that part of applied morals, which studies and dissects such social and moral effects of data innovation (Bynum). As of late, this vigorous new field has prompted new college courses, meetings, workshops, proficient associations, educational program materials, books, articles, diaries, and exploration focuses. The presentation of the World Wide Web in 1990 has catalyzed the development of the Internet, which is as yet developing today at exceptional rates and IT morals is rapidly being changed into â€Å"global data ethics†. The ongoing development of the Internet has come about not just in an expansion in the measure of accessible information, yet additionally in an increment in the issues characteristic to its utilization and conveyance. It has become certain that customary guidelines of direct are not generally material to this new medium, so new moral codes are currently being created. Edward F. Gehringer gives wide and wide-extended arrangement of moral issues in data innovation region. He recognized after principle parts of IT morals (Gehringer): Nuts and bolts; Business; IT Abuse; Protected innovation; Security; Dangers; Social Justice Issues; Despite the fact that, by and by each case includes at any rate two of those issues. From the start, let us examine issues of copyrights in present-day IT industry. It appears that this issue manages pretty much every perspective recorded above and it will be genuine case of morals usage in IT. In article â€Å"Napster, DVD cases bring up copyright issues in computerized age†, we can watch a few issues concerning copyright issues of IT industry. The article examines this issue on case of Napster, the Internet web crawler which permits more than 60 millions shoppers to discover and download free music. â€Å"Experts state the cutting edge setting in which copyright questions are being raised †as exemplified by the Napster case in California and a DVD-encryption case out of New York †additionally shows that the law is consistently a couple of steps behind technology.† The Recording Industry Association of America documented a claim against Napster in December 2000, blaming the organization for empowering the illicit replicating and dispersion of copyright music for a monstrous scope. Creator states that the case brings up key issues about opportunity of data and action on the Internet and what copyright assurances artists have or don't have in the inte rnet. â€Å"For those and different reasons, lawful specialists point to the Napster case as significant to the eventual fate of the internet and copyright law in the United States, the world’s pioneer in cutting edge issues†, he states. In this article, the essayist additionally depicts how copyright law needs correction since it has gotten so entangled and strange. He likewise keeps up that many substance suppliers and copyright legal advisors will in general engender â€Å"made-up rules† that indicate to explain ambiguities, for example, the lawfulness of sharing music on distributed document sharing systems. Creator attests that copyright rules, in any case, are in extensive transition nowadays and next to no is clear about these new advances. As per article, we without a doubt have no commitment to keep made-up rules, in spite of the fact that it is in some cases simple to confound these plausible necessities with genuine ones. Given this disarray, it reasons that the requirement for copyright change is dire. With the unfolding of the Internet and other exceptionally trend setting innovation, individuals all around the globe are currently ready to duplicate, download, and appropriate copyrighted material easily. Tragically, the utilization of the Internet has expanded the contention with copyright laws.â In 1998, Congress passed the Digital Millennium Copyright Act to address the dubious issue of copyright assurances in an advanced domain. A significant part of that law was hostile to circumvention insurance, which banished individuals from dodging secret word ensured and other secure Web destinations that give access to innovative works. The law said the copyright proprietors could record common claims against the individuals who break into such secure Web destinations. This is the legitimately pertinent law in the DVD case. At its center, copyright law says that the makers of certain abstract and creative works reserve the privilege to guarantee that unapproved individuals don't utili ze their work for unapproved purposes. The makers hold the copyright. They can surrender their selective right to distributers or other approved elements temporarily or forever. Enactment and court decisions have held that individuals have a huge option to utilize special cases inside the copyright law to stay away from claims. Then again, if the larger part of on-screen characters managed by the copyright law are conventional end-clients, it looks bad to demand that every one of them hold copyright counsel so as to fit herself inside specialties made to suit organizations and establishments, nor is it savvy to draw the lines where the delegates of today’s current partners demand they would like to draw them. Expanding the solutions and bans of the current copyright law to oversee the regular demonstrations of non-business, non-institutional clients is a crucial change. To do as such without influencing a radical move in the copyright equalization will require a similarly central change in the copyright legal plan. In an entire, issues in article raised well indeed, restricting two distinct perspectives on copyright issue †from creator’s and from consumer’s side. Without a doubt, both the Napster and DVD cases raise free discourse, reasonable use and copyright issues, which makes them imperative to future legitimate and administrative activity in the cutting edge region. Utilizing those cases author shows questionable issues and infers that the requirement for copyright change is critical. Then again there is no solid help for reasons wherein way enactment concerning copyrights could be built up. As I would see it, the persuasiveness encompassing computerized copyright all in all, and distributed document sharing and DVD encryption specifically, warmed in article, moves extraordinary disarray about what the copyright law does and doesn't restrict. By and large, the greater part of the key lawful inquiries are as yet disrupted, to some extent since copyright litigants have come up short on cash and left business before their cases could go to preliminary. In that vacuum, some copyright proprietors are asserting that their favored guidelines of direct are settled legitimate necessities. There might be a moral commitment to observe genuine principles, in any event, when they appear to be nonsensical. However, there is any moral commitment to follow made-up ones. For sure, in this unique situation, we may have a moral commitment to oppose them. While thinking about this new and propelled method of sharing data, with respect to copyright laws, the accompanying variables must be evaluated: the legitimateness of the circumstance, monetary misfortunes and additions, and good issues. Two unique perspectives can be unavoidably contended over this disputable issue; the individuals who think the downloading of copyrighted material, without the authorization of the creator is burglary, and the individuals who accept document sharing of copyrighted material is their privilege in the data age.â Although the computerized age has made cutting edge innovation accessible to everybody, the standards of equity and decency should in any case win. As an IT proficient, we have the ethical duties to bring up when essential about copyrights. We ought to know that copyrighted material on the Internet is accessible for nothing download just if the makers offer agree to its distribution and circulation. It tends to be sure that the discussion on copyright in the computerized age will proceed, and that a complete arrangement will require a significant stretch of time to go after each side.â Technology will consistently be here and will keep on progressing, yet the enterprises must be eager to work with the innovation to fulfill the needs of the purchaser in the data age. Hacking is likewise one of the most critical issues these days, which includes pretty much every part of IT morals. Second article I have submitted for hacking morals subject is â€Å"Under the skin of advanced crime† from BBC News. The article talks about issues of â€Å"positive† and â€Å"negative† hacking. It asserts that sometime in the past hacking was something positive. It was done for the sake of scholarly interest instead of money related prize. Presently hacking has become an action that holds two positions and is in this manner both solemnized for its smart imagination and maligned for its naughty demonstrations. Article asserts that the morals behind hacking and the activities taken by programmers establish a pronouncement that rises above standard comprehension of this movement. Programmers contend that their activities advance a methods for more tight security

New Cuban Cuisine :: Cuban Food

Incorporates Recipes New Cuban Cuisine The Cuban style of cooking is basic in idea yet complex in flavor. Much Cuban food owes its legacy and custom from Africa and neighboring, Caribbean societies. Be that as it may, there are two unmistakable styles of cooking: the work of art whose methods and fixings have been being used for quite a while over the island, and the new, named nuevo Cubano, which changes it up of herbs and flavors from other food and underscores introduction. For instance, the region of Oriente, in eastern Cuba, is notable for its commitment of spicier and increasingly powerful dishes to the food of the island because of the convergence of Haitian and Jamaican workers to the island starting in the 1790's. In the states, Cubans, as well, have picked to pick hot peppers, such as bursting scotchbonnets and serranos, to get ready plans, for example, dark bean salsa. Cubans who showed up in the United States in the late 50's and 60's needed to make a few adjustments to their cooking. Numerous business sectors didn't convey the vegetables, organic products or cuts of meat that they were acquainted with utilizing in their island kitchens. Grease and olive oil, which are commonly utilized in Cuban cooking, must be supplanted by other cooking oils. Grease was too hard to even consider finding and olive oil was excessively costly; a substitute must be found. Cooks began utilizing vegetable oil, which was promptly accessible and reasonable. These days, safflower and canola oils have become progressively ideal since they are more beneficial. Numerous things are presently likewise accessible in low-fat variants. The utilization of salt has excessively been curtailed on account of low-sodium items. Numerous Cubans estranged abroad, for example, my neighbor, Roca Beiro, an expert food provider whom I had the chance to meet, educated me that numerous Cubans have eliminated the starches they devour and that they attempt to follow a more advantageous eating routine. Because of the absence of time in their everyday life, many purchase items, for example, dark beans, in light of the fact that setting them up without any preparation is very tedious. Moreover, Cubans have added more servings of mixed greens to their eating routine, utilize less sauces, and get ready less potajes (stews). They have likewise adjusted progressively American nourishments into their day by day life since their youngsters are presented to them at school and through their associate with unlimited chains of drive-through joints in their networks. For instance, breakfast in Cuba for the most part comprises of cafã © con leche and tostada (espresso with milk and Cuban toast).

Top Innovation Sins and How to Avoid Them

Top Innovation Sins and How to Avoid Them © Shutterstock.com | Ruslan GrumbleIn this article, we will start with 1) an introduction to innovation and continue then with 2) a list of innovation sins.INTRODUCTION TO INNOVATIONIf you can take anything away from Moore’s law and the rate of growth in computers, it would seem that some innovation is perpetual. With the speed of developing technologies now reaching breakneck speeds, it seems as though humanity is now entering the true age of innovation and productivity. Never before has the world witnessed so many new and different products and technologies as the ones that are available at this very moment.While technology itself will continue to grow at an extraordinary rate, the way and speed at which humans provide new and useful innovation does not have the same luxury. The innovation created by people is different to that which is created by machines. People are limited by their cognition, their circumstances and their creativity.Innovators today are subject to what many r efer to as the sins of innovation. Despite the most earnest intentions, people and companies are excellent at creating the own biggest barriers to productivity, creativity and innovation all on their own. Whether they are too quick to give up or standing to close to see the real problem, the issues that many innovators face do not lie within the technology itself. The problems are part of the way technology is approached.The following article contains a list of the top sins that anyone could commit while trying to create and build new technologies, services and products. From spending too much time on useless products to making a problem more complicated than it needs to be, here are the top innovation sins that you can commit and how to avoid them.Innovation Sin #1: GIVING UP TOO EARLYWhether in life or in innovation, people often feel like they are traveling down a fruitless path that is about to come to an end. The path to creation is often filled with blockades, twists, turns an d forks in the road. With so many choices to make and obstacles to overcome, it sometimes feels like it would be much easier simply to start from the beginning and find a different path.Sometimes you can have an idea or create a product that seems like an amazing opportunity upon conception. But when you begin to sort out the details, problems arise at every opportunity. It is easy to believe that these problems exist because the idea is ridden with faults and is not worth pursuing.Other times, everything seems to be going well but for some reason, your business is just not seeing the results you want. Whether there has been a change in the consumer market or you find yourself with more competition, there are plenty of highly successful products that fall off the face of the Earth.The key to being a great business is to recognize perceived failure as an opportunity to do better and try again. Instead of giving up in a difficult climate, taking a successful product or brand and adapt ing it to a new market can turn a difficult situation around.From technology companies to websites to retail chains, the market is full of examples of companies that were wildly successful before dropping off the map. Motorola’s mobile devices are the perfect example of a company that gave up too early.The Motorola Razr dominated the mobile phone markets from 2004 onwards. The only Americans who did not own at least one Razr were ones who were still saving their money for a new one. The Razr sold 50 million units between its launch in 2004 and summer in 2006.Customers marveled at how thin the phone was. They loved the slight but functional design and the Razr was the signal the market needed that customers wanted smaller phones. However, the user interface was not innovative and it did not offer any new features that similar phones didn’t have.When Apple came along with the iPhone, Motorola had the opportunity to step up its game and take its much loved design into the smart pho ne market. However, instead of putting in the work to maintain its huge market share, Motorola continued to release slightly varied versions of its signature. Motorola left a gap in the market that Apple greedily snapped up while still leaving space for Samsung, Sony and even Nokia.It’s true that the MotoQ signaled a return of Motorola’s popularity. However, instead of indulging in Android, Motorola turned to Window’s failing attempt at a mobile operating system rather than what the market wanted.Innovation Sin #2: CREATING PRODUCTS THE CUSTOMER DOESN’T NEEDMarket research and planning is an essential part of creating an innovative product. It provides valuable insight into what the customer both wants and needs. There is little point in creating a product that you consider to be innovative if it is never adopted by your market.Almost every company struggles with the how much influence market research and planning should have on the innovation of its products. Some companies have taken a Steve Jobs approach and insisted that customers have no idea what they want until you show it to them.This approach is useful in some cases but it cannot be universally applied to every scenario. Not only is it bad for innovation and productivity, it is bad for the brand. The kind of brand power that Apple has been able to manifest for itself in the last 15 years is a rare luxury afforded only to certain super brands. The damage that this thinking can do is astounding, even within popular consumer technology. The well-documented struggles that Microsoft has faced to force its Xbox One to compete with Sony’s PlayStation 4 is the perfect example of this.There is a fine balance between showing customers what they never knew they needed and handing them something they never needed at all. The latest incarnation of Microsoft’s Xbox console was innovative and there is little evidence to dispute about this fact. However, the hardcore gamer market that Microsoft has previo usly served so well had no interest in the mandatory Kinect device. When they learned that the Kinect was always on in some form, the customers were more than happy to let Microsoft know how unhappy they were.The mandatory Kinect device was included in the bundle to encourage customers to take advantage of the voice and motion activated functions that were built into the new Xbox. These functions are certainly innovative. The new Kinect was so well designed that the company would demonstrate its capabilities by printing images of faces captured by the Kinect with a 3D printer.The Kinect was also to signal a key turn from Microsoft’s hardcore gamer customer base towards a more family-oriented entertainment console. However, instead of picking up millions of new customers with its innovative technology, Microsoft alienated its main clientele who then kicked up such a storm that before they knew it, most of the world believed that Microsoft was spying on them through the Kinect that was always listening.The backlash was so intense that Microsoft ended up removing the technology that they had spent years building. Even after Microsoft announced the responsive changes, the Xbox One’s sales suffered significantly at launch. In this case, showing their customers something they never knew they wanted drove a huge portion of their customers straight into Sony’s waiting arms. Sony, on the other hand, had created the innovations that their customers wanted. They made certain that their product was ready for a heavy influx of former Xbox customers.Innovation Sin #3: LETTING BUREAUCRACY STAND IN THE WAY OF PROGRESSRules and bureaucracy are not designed to inherently stand in the way of progress â€" but the way some people use them can make them do just that. Organizations that continue to operate with a top-down management strategy often stifle innovation because there is no space for ideas to be heard. When bureaucracy remains interested in control rather than chang e, progress takes a back seat.In these cases, employees have to go through red tape and several committees to express ideas for innovative change. The processes in place to control quality end up taking up a huge amount of time. When the path to innovation has so many roadblocks, it is hard to maximize innovation. If an idea has to move through several committees to be considered, it can take weeks to move from the “projected start time” to the actual start time.Preventing bureaucracy is the battle cry of many of today’s tech startups. Silicon Valley’s biggest, brightest and most disruptive startups have worked hard to alleviate the problems inherent in the top down management style.Setting up open campuses and using collaborative online tools to create projects are more than just side effects of the explosive technology industry. They are symptoms of a bigger movement within modern business.Today’s tech companies do not offer huge benefits to the brightest minds only to m ake them suffer archaic boardroom battles of seniority and due process. They work to create open and collaborative environments that encourage employees to take ownership of their ideas and projects.When people feel as though their work makes a difference to the success of the company, they are more likely to work harder, remain satisfied and put forward innovative ideas designed to propel the company forward.Innovation Sin #4: BEING TOO ANALYTICALHaving an analytical mind is a huge asset in business. It’s a huge benefit in assessing the value of ideas and figuring out how to turn dreams into a reality. However, you can be to analytical. Just like in your personal life, overanalyzing a business deal can kill innovation before it even starts.When your analytical schemes cause innovation to grind to a halt, you are suffering from analysis paralysis. When a bare bones idea is accompanied by dozens of charts, predictions and measurements, it is hard for anyone to see past the vast amo unt of numbers and into the original idea. All of a sudden, the project is paralyzed because the team has lost sight of the goals.Too much data stifles creativity. While multi-tasking is a great way to boost productivity, you cannot be creative and analytical at the same time. These methods of thinking are very different from each other and they need to be kept separate. As a rule, companies should always avoid mixing the creative process with the analytical process.Innovation Sin #5: NOT BEING EMOTIONAL ENOUGHWhen a customer buys into your product or service, they are not buying into the functionality of the product itself. People do not buy plastic food containers with no spill features because it is a great function. Someone who invests in this product usually does it for a personal and emotional reason. For example, they might choose that functionality over a basic container because they can then begin to bring their lunch to work and finally work on losing weight and having the body they always wanted.The key to selling functionality is making it emotionally appealing. This is why advertisements work so well. People want to buy an experience and not just a thing, no matter how innovative it is. Creating an emotional narrative behind the function of your product creates brand identity and allows customers to identify with the brand.Even though you might be very proud of the innovative materials or processes that went into your product, as a whole, your customers won’t have that same amount of pride. In fact, much of your market may find it irrelevant or confusing.Thinking emotionally when you are creating a product will help drive innovation. When you think about the things in your life that a product might improve, it will be easier to find innovative ways to create, manufacture and sell the product.A great example of an emotional product is the recent trends towards sustainable, green and eco-friendly products. The main coffee drinking customer base do es not purchase Fair Trade Coffee because of the way it tastes or because it comes from a specific farm. Instead, the customers think about the farmers and growers that benefit from Fair Trade. They think about how the farmers earn a fair wage and can work in better conditions when they sell their coffee with Fair Trade organizations.This experience makes people feel as though they are doing their part to make the world a better place just by purchasing coffee with the Fair Trade label. That feel good experience is the reason that customers will pay more money for a fair, sustainable product than they will for a similar product that does not offer that same personal experience.Innovation Sin #6: OVERCOMPLICATING PRODUCTSOvercomplicating your product is another innovation sin. This is a sin for two reasons. The first is that thinking too much about the details will blur the bigger picture. The second reason that it is a sin is because it will often turn customers off from your produc t.Businesses working towards innovation need to focus on functionality but functionality does not mean making the new product that industry’s version of a Swiss Army knife. The majority of your customers won’t care if your tooth brush has Bluetooth. Customers in the larger market want a product that fits their needs but does not require a science degree to use.Sometimes innovation comes from the search to make a product work better rather than forcing it to do more work. If you focus on doing one or two things really well and becoming the leader innovation in these specialist processes, then your product will become well known for what it does. Not only is it easier to increase your productivity and innovation but you can increase your brand power this way as well.Fast-food giant McDonald’s is a good example of a company whose product suffered when they overcomplicated it. The McDonald’s menu expanded from 69 items to 121 items between 2004 and 2014. That equates to a 75% in crease in the menu size in a short period of time.McDonald’s added confusing options like the McDouble alongside the standard Double Cheeseburger. The price difference between the two sandwiches was significant; yet the only difference between the products was a slice of cheese.The company’s Chief Operating Officer admitted that it had overcomplicated its menu by adding too many new products at a pace its stores could not keep up with. Not only that, but the new menu was no longer in line with the brand. This resulted in a loss of relevance and revenue for the fast food giant.Although McDonald’s is far from any existential trouble, if such a stable and profitable brand can suffer from an overcomplicated product, less visible products can certainly suffer as well.CONCLUSIONInnovation may come naturally to computer hardware but it is not as straightforward for people who do not run on algorithms. There are many sins that can get in the way of creativity, productivity and innovat ion. While it is comforting to know that even the most successful and established brands can fall prey to these innovation sins, it is also important to learn from their mistakes.Learning how to avoid these top innovation sins will not just save you from creating mistakes with future products. It can help you salvage your current ideas as well. Overcoming roadblocks to progress has little to do with the roadblock itself but rather how you approach it.

Hair Extension Application - Free Essay Example

Sample details Pages: 5 Words: 1643 Downloads: 10 Date added: 2018/12/17 Category Fashion Essay Type Research paper Level High school Did you like this example? At some point in a womans life many of them believes that performing hair extension services does not need some profession, the woman in charge must have some decline in the changes. As it is opposed in the hair style, the appearance, temperament and personality should coarse with the course curly hair which is the consultation based on the client under one of the most important steps in assessing the woman profession as in hair dresser its all about to get into a decent state. Think of she as a painter and then ensure that you practice your profession in a precise way when she is about to begin painting on a canvas, wouldnt one want to know what the canvas was made out of, or if she is in a state which does satisfy her personality then it is good to look for a technical foundation to design your hair which will sooth your stimuli and raise your emotions. Don’t waste time! Our writers will create an original "Hair Extension Application" essay for you Create order As we begin to consultation with the client one need to have access of the condition of their hair. Is their hair compromised in any way, meaning, has it been damaged, are they losing and hair? Do they have maintained hair, meaning, do they come in for color, haircuts or perms on a regular basis? These are important things to find out before beginning any services, because she need to know not only what kind of condition the hair is in, but she should also need to have consistent view of the different designs. According to most of the clients we should know where we can have the basic foundation as well to adjust and discuss on hair vision. I am going to dwell back to the idea of the painter, what does my client want her to paint? We will need to ask the client based on we will vision her hair to look like once one has finished applying the hair extensions. The best way to do this is having most of the client having the potential to bring in some pictures so that we can really see wh at kind of vision she has in her head. Moreover most of the vison are based in a move that will leave them deserving for a return back. Most of the client should focus on having a decent made hair based on his decision. For one to be creative in his view, we need to emulate on how the we can paint with the colors we already have. Despite all of this we have to give some focus on the hair as it is discussed by different clients vision of the finished look we will then match her hair color, so that one can order the correct shade. This is one of the most important steps, because if the shade it is not right, the finished look will not be right. Shade matching is best done with a color that satisfies the client from the company we may plan on ordering hair from. Their color will have a variety of shades from white, to black and to every color in between. They do not recommend purchasing hair extensions if she do not have a color ring. According to this we are sure that most design do not begin their artwork with dirty brushes and neither should he decide on the same. Once we begin the application process one will want to start by shampooing and blow drying clients hair to ensure it is clean and free of any oil that may compromise her adhesive. She will want to use an oil free clarifying shampoo, because this will remove all excess oil without compromising the integrity of her clients hair. In vision the hair dresser paint based on where one should decide to begin. If her hair is completely blown dry, she will section the hair in four large sections. Two vertical sections on the right side, and two vertical sections on the left side. According to the client decision we shall start at the head and also this can hide the ear and the peck of the occipital bone at the nape of the neck. We all know that she have her four large sections, we will then make smaller horizontal sections starting at the nape of the neck. Once done we will section a one inch section horizontally, but ensuring that we stay within her vertical sections. We must give a clear understand to most of the people based on our vison which is clear and precise to most of the canvas and how we can begin the submission. On that view her sectioning is complete once we begin the application process. Application is key, now that we have nice clean sections this step will be a breeze. We will take a small sections from one of the horizontal sectioning, on more than twelve to fifteen pieces of hair. Once we have that small section isolated in her hand, we will be in position to will place one hair extension under her isolated section, take one of his heating tool and carefully place the small section of hair and hair extension between the heating tool, after five to ten seconds we will have adhesive which will be pliable enough for full rolling it into the hair. We will then take your index finger, and her thumb, rolling the hair extension back and forth until the adhesive has cooled. Once we shall repeat this process until her hair is at the end o f her horizontal section. One shall repeat your one inch horizontal sectioning methods in all four vertical sections, until you have reached the crown of the head. According, to the clients views the blow drying are mostly based on the horizontal index. Once this its done it will ensure that it the duration of the client back into the extension has been prolonged and may be composed of a vertical and horizontal sectioning. One need to be keen on the client that you are handling in order to ensure that no interference at all occurs. In conclusion one will also ensure that all of his ideas to make sure the client knows how to maintain her master piece she has worked so hard on. When one wouldnt want to hang it up on the wall and let dust accumulate. Maintenance is key in the hair extension maintenance is when your client will need you to remove the hair extensions. One will need to remove the hair extensions every three to six months depending on how rapidly her clients hair grows. If the hair extension is one inch from the scalp you will need to remove them, the reasoning is that his is naturally and she will lose fifty to one hundred hair a day naturally, so think of how many hairs have naturally let go, but they are trapped within the bond adhesive. The twelve to fifteen pieces of hair are approximately attached to ten to eight pieces of hair, she do not want stress to the hair if she do it could compromise the hair by making it false. In this essay there are some views which can give some technical outcome an d needs to be addressed in a good framework. Process Peer Review Sheet Does the paper have a title? If so, is the title interesting? It is better to avoid the phrase How To in the title, so if the paper has this phrase, suggest something different. The title is a little bland and too straightforward. Hair extension application does not really capture the readers attention try something like flawless extension application or something that is more interesting. Does the paper have a thesis statement in the introduction that tells which process the paper will analyze? Yes, I think there was a thesis statement but it was not clearly expressed in the paper. Is the introduction interesting? Is there a hook that grabs the readers attention? The introduction was not very interesting. There wasnt really a part that grabbed the readers attention. How many steps does the process have? I believe there was 6 or 7 steps to the paragraph. There were three steps in what I believe was the thesis statement but those steps all were preapplication steps and then there was more steps to the process scattered in to the paragraphs. The paper was hard to follow. Is each step described in a separate paragraph? The steps are not clear in the paragraphs. Does the author use transition words to help the reader move through the process? Mark the transition words and phrases that you see. If you find places that need more transitions, let the author know. Yes, but more are needed. Transition words marked in yellow. Has the author used descriptive language to make his/her writing interesting? Yes, but it did not necessarily make the paper interesting. The paper was hard to follow and some descriptions lacked relevancy. Does each body paragraph have a topic sentence and concluding sentence? No, this was addressed in comments. Mark the papers best paragraph and explain why you feel that it is the best. Is the paper formatted in MLA? Yes, but there are some mistakes. Is the paper written in third person? Mark any first and/or second person pronouns that you see in the paper (I, me, you, we, us, your, our) MARKED IN RED Are there errors in grammar, punctuation, diction, or syntax? If so, mark a few of the errors and let the author know that more editing is needed. Addressed in comments. No indent in paragraphs, unclear where paragraphs start and stop. Use the Plus/Delta Sheet below to list the three things that the author has done well (Plus) and the three things that the author most needs to change or improve (Delta)

The Famous Architecture of Celebration, Florida

Nursing Epidemiology and Health Free Essays

U N I T Concepts of Health and Disease arly peoples were considered long-lived if they reached 30 years of age—that is, if they survived infancy. For many centuries, infant mortality was so great that large families became the tradition; many children in a family ensured that at least some would survive. Life expectancy has increased over the centuries, and today an individual in a developed country can expect to live about 71 to 79 years. We will write a custom essay sample on Nursing: Epidemiology and Health or any similar topic only for you Order Now Although life expectancy has increased radically since ancient times, human longevity has remained fundamentally unchanged. The quest to solve the mystery of human longevity, which appears to be genetically programmed, began with Gregor Mendel (1822–1884), an Augustinian monk. Mendel laid the foundation of modern genetics with the pea experiments he performed in a monastery garden. Today, geneticists search for the determinant, or determinants, of the human life span. Up to this time, scientists have failed to identify an aging gene that would account for a limited life span. However, they have found that cells have a ? nite reproductive capacity. As they age, genes are increasingly unable to perform their functions. The cells become poorer and poorer at making the substances they need for their own special tasks or even for their own maintenance. Free radicals, mutation in a cell’s DNA, and the process of programmed cell death are some of the factors that work together to affect a cell’s functioning. I E CHAPTER Concepts of Health and Disease Georgianne H. Heymann Carol M. Porth 1 ogy. There has been an increased knowledge of immune mechanisms; the discovery of antibiotics to cure infections; and the development of vaccines to prevent disease, chemotherapy to attack cancers, and drugs to control the manifestations of mental illness. The introduction of the birth control pill and improved prenatal care have led to decreased birth rates and declines in infant and child mortality. The bene? ts of science and technology also have increased the survival of infants born prematurely and of children with previously untreatable illnesses, such as immunode? ciency states and leukemia. There also has been an increase in the survival of very seriously ill and critically injured persons of all age groups. Consequently, there has been an increase in longevity, a shift in the age distribution of the population, and an increase in age-related diseases. Coronary heart disease, stroke, and cancer have now replaced pneumonia, tuberculosis, and diarrhea and enteritis—the leading causes of death in the 1900s. This chapter, which is intended to serve as an introduction to the book, is organized into four sections: health and society, historical perspectives on health and disease, perspectives on health and disease in individuals, and perspectives on health and disease in populations. The chapter is intended to provide the reader with the ability to view within a larger framework the historical aspects of health and disease and the relationship of health and disease to individuals and populations, and to introduce the reader to terms, such as etiology and pathogenesis, that are used throughout this text. HEALTH AND SOCIETY HEALTH AND DISEASE: A HISTORICAL PERSPECTIVE The In? ence of Early Scholars The Nineteenth Century The Twentieth Century The Twenty-First Century PERSPECTIVES ON HEALTH AND DISEASE IN INDIVIDUALS Health Health and Disease as States of Adaptation Disease Etiology Pathogenesis Morphology Clinical Manifestations Diagnosis Clinical Course PERSPECTIVES ON HEALTH AND DISEASE IN POPULATIONS Epidemiology and Patterns of Disease Prevalence and Incidence Morbidity and Mortality Determination of Risk Factors The Framingham Study The Nurses’ Health Study Natural History Levels of Prevention Evidence-Based Practice and Practice Guidelines e concepts o f what constituted health and disease at the beginning of the last century were far different from those of this century. In most of the industrialized nations of the world, people now are living longer and enjoying a healthier lifestyle. Much of this has been made possible by recent advances in science and technol- T Health and Society Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obligated, at least for a spell, to identify ourselves as citizens of that other place. 3 4 UNIT I Concepts of Health and Disease After completing this section of the chapter, you should be able to meet the following objectives: ? Describe the concepts used to establish belief systems within a community and the effects on its health care practices ? Identify a disease believed to be generated by speci? c emotions and the characteristics ascribed to it ? Explain how m ythologizing disease can be detrimental to individuals in a society There is a long history that documents the concern of humans for their own health and well-being and that of their community. It is not always evident what particular beliefs were held by early humans concerning health and disease. Still, there is evidence that whenever humans have formed social groups, some individuals have taken the role of the healer, responsible for the health of the community by preventing disease and curing the sick. In prehistoric times, people believed that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be paci? ed or the evil spirits driven from the body. In time, this task became the job of the ealers, or tribal priests. They tried to pacify the gods or drive out the evil spirits using magic charms, spells, and incantations. There also is evidence of surgical treatment. Trephining involved the use of a stone instrument to cut a hole in the skull of the sick person. It is believed that this was done to release spirits responsible for illness. Prehistoric healers probably also discovered that many plants can be used as drugs. The communit y as a whole also was involved in securing the health of its members. It was the community that often functioned to take care of those considered ill or disabled. The earliest evidence of this comes from an Old Stone Age cave site, Riparo del Romio, in southern Italy. There the remains of an adolescent dwarf were found. Despite his severe condition, which must have greatly limited his ability to contribute to either hunting or gathering, the young man survived to the age of 17 years. He must have been supported throughout his life by the rest of the community, which had incorporated compassion for its members into its belief system. Communities such as this probably existed throughout prehistory; separated from each other and without any formal routes of communication, they relied on herbal medicines and group activity to maintain health. Throughout history, peoples and cultures have developed their health practices based on their belief systems. Many traditions construed sickness and health primarily in the context of an understanding of the relations of human beings to the planets, stars, mountains, rivers, spirits, and ancestors, gods and demons, the heavens and underworld. Some traditions, such as those re? ected in Chinese and Indian cultures, although concerned with a cosmic scope, do not pay great attention to the supernatural. Over time, modern Western thinking has shed its adherence to all such elements. Originating with the Greek tradition—which dismissed supernatural powers, although not environmental in? uences—and further shaped by the In? uences of zodiac signs on the human body. (Courtesy of the National Library of Medicine) ourishing anatomic and physiologic programs of the Renaissance, the Western tradition was created based on the belief that everything that needed to be known essentially could be discovered by probing more deeply and ever more minutely into the ? esh, its systems, tissues, cells, and DNA. 3 Through Western political and economic domination, these health beliefs now have powerful in? uence worldwide. Every society has its own ideas and beliefs about life, death, and disease. It is these perceptions that shap e the concept of health in a society. Although some customs and beliefs tend to safeguard human communities from disease, others invite and provoke disease outbreaks. The beliefs that people have concerning health and disease can change the destiny of nations. The conquering of the Aztec empire may be one example. Historians have speculated how Hernando Cortez, starting off with fewer than 600 men, could conquer the Aztec empire, whose subjects numbered millions. Historian William H. McNeill suggests a sequence of events that may explain how a tiny handful of men could subjugate a nation of millions. Although the Aztecs ? rst thought the mounted, gunpowered Spaniards were gods, experience soon showed CHAPTER 1 Concepts of Health and Disease 5 otherwise. Armed clashes revealed the limitations of horse? esh and of primitive guns, and the Aztecs were able to drive Cortez and his men from their city. Unbeknownst to the Aztecs, the Spaniards had a more devastating weapon than any ? rearm: smallpox. An epidemic of smallpox broke out among the Aztecs after their skirmishes with the Spaniards. Because the population lacked inherited or acquired immunity, the results were catastrophic. It is presumed that a quarter to a third of the population died from the initial onslaught. Even more devastating were the psychological implications of the disease: it killed only American Indians and left Spaniards unharmed. A way of life built around the old Indian gods could not survive such a demonstration of the superior power of the God the Spaniards worshipped. It is not hard to imagine then that the Indians accepted Christianity and submitted meekly to Spanish control. Although we live in an age of science, science has not eliminated fantasies about health; the stigmas of sickness and the moral meanings that they carry continue. Whereas people in previous centuries wove stories around leprosy, plague, and tuberculosis to create fear and guilt, the modern age has created similar taboos and mythologies about cancer and acquired immunode? ciency syndrome (AIDS). The myth of tuberculosis (TB) was that a person who suffered from it was of a melancholy, superior character— sensitive, creative, a being apart. Melancholy, or sadness, made one â€Å"interesting† or romantic. The general perception of TB as â€Å"romantic† was not just a literary device. It was a way of thinking that insinuated itself into the sensibilities and made it possible to ignore the social conditions, such as overcrowding and poor sanitation and nutrition, that helped breed tuberculosis. The infusion of beliefs into public awareness often is surreptitious. Just as tuberculosis often had been regarded sentimentally, as an enhancement of identity, cancer was regarded with irrational revulsion, as a diminution of the self. Current accounts of the psychological aspects of cancer often cite old authorities, starting with the Greek physician Galen, who observed that â€Å"melancholy women† are more likely to get breast cancer than â€Å"sanguine women. † Grief and anxiety were cited as causes of cancer, as well as personal losses. Public ? gures such as Napoleon, Ulysses S. Grant, Robert A. Taf t, and Hubert Humphrey have all had their cancers diagnosed as the reaction to political defeat and the end to their political ambitions. Although distress can affect immunologic responsiveness, there is no scienti? evidence to support the view that speci? c emotions, or emotions in general, can produce speci? c diseases—or that cancer is the result of a â€Å"cancer personality,† described as emotionally withdrawn, lacking self-con? dence, and depressive. These disease mythologies contribute to the stigmatizing of certain illnesses and, by extension, of those who are ill. The beliefs about health and disease have the power to trap or empower people. They may inhibit people from seeking early treatment, diminish personal responsibility for practicing healthful behaviors, or encourage fear and social isolation. Conversely, they also can be the impetus for compassion to those who are ill, for commitment to improving one’s own health, and for support of efforts to improve the health status of others. In summary, what constitutes health and disease changes over time. Prehistoric times were marked by beliefs that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be paci? ed or the evil spirits driven from the body. Tribal healers, or priests, emerged to accomplish this task. Prehistoric healers used a myriad of treatments, including magic charms, spells, and incantations; surgical treatment; and plant medicines. Throughout history, the concept of health in a society has been shaped by its beliefs about life, death, and disease. Some beliefs and customs, such as exhibiting compassion for disabled community members, tend to safeguard human communities and increase the quality of life for all community members. Others invite and provoke disease outbreaks, such as myths about the causes of disease. Even though science and technology have advanced the understanding and treatment of disease, misconceptions and fantasies about disease still arise. In previous centuries, diseases such as leprosy, plague, and tuberculosis were fodder for taboos and mythologies; today, it is cancer and AIDS. The psychological effects of disease mythologies can be positive or negative. At their worst, they can stigmatize and isolate those who are ill; at their best, they can educate the community and improve the health of its members. Health and Disease: A Historical Perspective After completing this section of the chapter, you should be able to meet the following objectives: Describe the contributions of the early Greek, Italian, and English scholars to the understanding of anatomy, physiology, and pathology ? State two important advances of the nineteenth century that helped to pave the way for prevention of disease ? State three signi? cant advances of the twentieth century that have revolutionized diagnosis and treatment of disease ? Propose developments that will both hamper and contribute to the promotion of health and the elimination of dis ease in the twenty-? rst century It has been said that those who do not know history are condemned to repeat it. There are many contributors to the understanding of how the body is constructed and how it works, and what disease is and how it can be treated, which in turn leads to an understanding of what health is and how can it be maintained. Much of what we take for granted in terms of treating the diseases that af? ict humankind has had its origin in the past. Although they are seemingly small contributions in terms of today’s scienti? c advances, it is the knowledge 6 UNIT I Concepts of Health and Disease produced by the great thinkers of the past that has made possible the many things we now take for granted. THE INFLUENCE OF EARLY SCHOLARS Knowledge of anatomy, physiology, and pathology as we now know it began to emerge with the ancient Greeks. They were the ? rst to recognize the distinction between internal and external causes of illness. To Hippocrates and his followers, we owe the foundations of the clinical principles and the ethics that grew into modern medical science. Hippocrates (460–377 BC) was a blend of scientist and artist. He believed that disease occurred when the four humors—blood from the heart, yellow bile from the liver, black bile from the spleen, and phlegm from the brain—became out of balance. These humors were said to govern character as well as health, producing phlegmatic, sanguine, choleric, and melancholic personalities. This belief paralleled the even older Chinese tradition, which was founded on the complementary principles of yin (female principle) and yang (male), whose correct proportions were essential for health. Hippocrates is identi? ed with an approach to health that dictated plenty of healthy exercise, rest in illness, and a moderate, sober diet. It was Aristotle (384–322 BC) who, through his dissection of small animals and description of their internal Hippocrates: A blend of scientist and scholar. Courtesy of the National Library of Medicine) anatomy, laid the foundations for the later scrutiny of the human body. For Aristotle, the heart was the most important organ. He believed it to be the center of the blood system as well as the center of the emotions. However, Aristotle’s main contributions were made to science in general. The person wh o took the next major step was Galen (AD 129–199), a physician to the emperors and gladiators of ancient Rome. Galen expanded on the Hippocratic doctrines and introduced experimentation into the study of healing. His work came to be regarded as the encyclopedia of anatomy and physiology. He demoted the heart—in his view, the liver was primary for venous blood, whereas the seat of all thought was the brain. He described the arteries and veins and even revealed the working of the nervous system by severing a pig’s spinal cord at different points and demonstrating that corresponding parts of the body became paralyzed. According to Galen, the body carried three kinds of blood that contained spirits charged by various organs: the veins carried â€Å"natural spirit† from the liver; the arteries, â€Å"vital spirit† from the lungs; the nerves, â€Å"animal spirit† from the brain. The heart merely warmed the blood. After Galen’s death, however, anatomic research ceased, and his work was considered infallible for almost 1400 years. As the great medical schools of universities reformed the teaching of anatomy in the early 1500s and integrated it into medical studies, it became apparent to anatomists that Galen’s data—taken from dogs, pigs, and apes—often were riddled with error. It was only with the work of Andreas Vesalius (1514–1564) that Galen’s ideas truly were challenged. Vesalius, professor of anatomy and surgery at Padua, Italy, dedicated a lifetime to the study of the human body. Vesalius carried out some unprecedentedly scrupulous dissections and used the latest in artistic techniques and printing for the more than 200 woodcuts in his De Humani Corporis Fabrica (â€Å"On the Fabric [Structure] of the Human Body†). He showed not only what bodily parts looked like but also how they worked. The book, published in 1543, set a new standard for the understanding of human anatomy. With this work, Vesalius became a leading ? gure in the revolt against Galen’s teachings. One of the most historically significant discoveries was made by William Harvey (1578–1657), an English physician and physiologist. He established that the blood circulates in a closed system impelled mechanically by a â€Å"pumplike† heart. He also measured the amount of blood in the circulatory system in any given unit of time—one of the ? rst applications of quantitative methods in biology. Harvey’s work, published in On the Motion of the Heart and Blood in Animals (1628), provided a foundation of physiologic principles that led to an understanding of blood pressure and set the stage for innovative techniques such as cardiac catheterization. With the re? ement of the microscope by the Dutch lens maker Anton van Leeuwenhoek (1632–1723), the stage was set for the era of cellular biology. Another early user of the microscope, English scientist Robert Hooke (1635–1703), published his Micrographia in 1665 in which CHAPTER 1 Concepts of Health and Disease 7 William Harvey’s most eminent patient, King Charles I, and the future King Charles II look on as Harvey displays a diss ected deer heart. (Courtesy of the National Library of Medicine) he formally described the plant cells in cork and presented his theories of light and combustion and his studies of insect anatomy. His book presented the great potential of the microscope for biologic investigation. In it, he inaugurated the modern biologic usage of the word cell. A century later, German-born botanist Mathias Schleiden (1804–1881) and physiologist Theodor Schwann (1810–1882) observed that animal tissues also were composed of cells. Although Harvey contributed greatly to the understanding of anatomy and physiology, he was not interested in the chemistry of life. It was not until French chemist Antoine Lavoisier (1743–1794), who was schooled as a lawyer but devoted to scienti? pursuits, overturned 100year-old theories of chemistry and established the basis of modern chemistry that new paths to examine body processes, such as metabolism, opened up. His restructured chemistry also gave scientists, including Louis Pasteur, the tools to develop organic chemistry. In 1796, Edward Jenner (1749–1823) conducted the ? rst vaccination by injecting the ? uid from a dairymaidâ€⠄¢s cowpox lesion into a young boy’s arm. The vaccination by this English country doctor successfully protected the child from smallpox. Jenner’s discovery led to the development of vaccines to prevent many other diseases as well. Jenner’s classic experiment was the ? rst of? cially recorded vaccination. Painting by Georges-Gaston Melingue (1894). The ? rst vaccination. Here Dr. Jenner introduces cowpox taken from dairymaid Sarah Nelmes (right) and introduces it into two incisions on the arm of James Phipps, a healthy 8-year-old boy. The boy developed cowpox, but not smallpox, when Jenner introduced the organism into his arm 48 days later. (Courtesy of the National Library of Medicine) THE NINETEENTH CENTURY The nineteenth century was a time of spectacular leaps forward in the understanding of infectious diseases. For many centuries, rival epidemiologic theories associated disease and epidemics like cholera with poisonous fumes given off from dung heaps and decaying matter (poisons in the air, exuded from rotting animal and vegetable material, the soil, and standing water) or with contagion (person-to-person contact). In 1865, English surgeon Joseph Lister (1827–1912) concluded that microbes caused wound infections. He began to use carbolic acid on wounds to kill microbes and reduce infection after surgery. However, Lister was not alone in identifying hazards in the immediate environment as detrimental to health. English nurse Florence Nightingale (1820–1910) was a leading proponent of sanitation and hygiene as weapons against disease. It was at the English base at Scutari during the Crimean War (1854–1856) that Nightingale waged her battle. Arriving at the army hospital with a party of 38 nurses, Nightingale found nearly 2000 wounded and sick inhabiting foul, rat-infested wards. The war raged on, deluging the hospital with wounded as Nightingale not only organized the nursing care of the wounded but also provided meals, supplied bedding, and saw to the laundry. Within 6 months, she had brought about a transformation and slashed the death rate from approximately 40% to 2%. 3 8 UNIT I Concepts of Health and Disease Florence Nightingale caring for wounded at Scutari, Turkey, during the Crimean War. (Courtesy of the National Library of Medicine) From the 1860s, the rise of bacteriology, associated especially with chemist and microbiologist Louis Pasteur in France and bacteriologist Robert Koch in Germany, established the role of microorganismal pathogens. Almost for the ? rst time in medicine, bacteriology led directly to dramatic new cures. The technique of pasteurization is named after Louis Pasteur (1822–1895). He introduced the method in 1865 to prevent the souring of wine. Pasteur’s studies of fermentation convinced him that it depended on the presence of microscopic forms of life, with each fermenting medium serving as a unique food for a speci? c microorganism. He developed techniques for culturing microbes in liquid broths. Through his work, he was able to dispel the disease theory that predominated in the mid-nineteenth century, attributing fevers to â€Å"miasmas,† or fumes, and laid the foundation for the germ theory of disease. The anthrax bacillus, discovered by Robert Koch (1843–1910), was the ? rst microorganism identi? ed as a cause of illness. Koch’s trailblazing work also included identifying the organism responsible for tuberculosis and the discovery of a tuberculosis skin-testing material. In 1895, German physicist Wilhelm Rontgen (1845– 1923) discovered X rays. For the ? rst time without a catastrophic event, the most hidden parts of a human body were revealed. Even though he understood that it was a signi? cant discovery, Rontgen did not initially recognize the amazing diagnostic potential of the process he had discovered. THE TWENTIETH CENTURY The twentieth century was a period of revolutionary industry in the science and politics of health. Concerns about the care of infants and children and the spread of infectious disease became prevailing themes in public and political arenas alike. It was during this time that private duty and public health nursing emerged as the means of delivering health care to people in their homes and in their communities. Social service agencies like the Henry Street Settlement in New York, founded by Lillian Wald, sent nurses into tenements to care for the sick. The placement of nurses in schools began in New York City in 1902 at the urging of Wald, who offered to supply a Henry Street nurse for 1 month without charge. 5 Efforts to broaden the delivery of health care from the city to rural areas also were initiated during the early 1900s. The American Red Cross, which was reorganized and granted a new charter by Congress in 1905, established a nursing service for the rural poor that eventually expanded to serve the small town poor as well. 5 Scienti? c discoveries and innovations abounded in the twentieth century. In the early 1900s, German bacteriologist Paul Ehrlich (1854–1915) theorized that certain substances could act as â€Å"magic bullets,† attacking disease-causing microbes but leaving the rest of the body undamaged. In 1910, he introduced his discovery: using the arsenic compound Salvarsan, he had found an effective weapon against syphilis. Through his work, Ehrlich launched the science of chemotherapy. CHAPTER 1 Concepts of Health and Disease 9 The operating room. With the advent of anesthesia, knowledge of how microbes cause disease, and availability of incandescent lighting in the operating room, surgery became an option for treating disease. Rubber gloves had not yet been invented and the surgical team worked with bare hands to perform surgery. (Hahnemann Hospital, Chicago, IL. Courtesy Bette Clemons, Phoenix, AZ) The ? rst antibiotic was discovered in 1928 by English bacteriologist Sir Alexander Fleming (1881–1955). As he studied the relationship between bacteria and the mold Penicillium, he discovered its ability to kill staphylococci. However, it was not until the 1940s that later researchers, who were searching for substances produced by one microorganism that might kill other microorganisms, produced penicillin as a clinically useful antibiotic. By the 1930s, innovative researchers had produced a cornucopia of new drugs that could be used to treat many of the most common illnesses that left their victims either severely disabled or dead. The medical community now had at its disposal medications such as digoxin to treat heart failure; sulfa drugs, which produced near-miraculous cures for infections such as scarlet fever; and insulin to treat diabetes. At the turn of the century, social service agencies like Henry Street Settlement in New York sent nurses into tenements to care for the sick. (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 12]. Philadelphia: Lippincott Williams Wilkins) 10 UNIT I Concepts of Health and Disease With the discovery of insulin, a once-fatal disease known from antiquity no longer carried a death sentence. Working together, Canadian physician Sir Frederick Banting (1891–1941) and physiologist Charles Best (1899–1978) isolated insulin from the pancreas of a dog in 1921. The extract, when given to diabetic dogs, restored their health. In January 1922, they successfully treated a young boy dying of diabetes with their pancreatic extracts. Although still incurable, it became possible to live with diabetes. One disease that remained not only incurable but untreatable through much of the twentieth century was tuberculosis. With no cure or preventive vaccine forthcoming, efforts at the turn of the century were dedicated to controlling the spread of tuberculosis. It was then that an alliance between organized medicine and the public resulted in the formation of voluntary local organizations to battle the disease. These organizations focused on education to counteract the fear of tuberculosis; at the same time, they warned against the disease. In 1904, the local organizations joined together to form a national organization, the National Association for the Study and Prevention of Tuberculosis. In 1918, the name was changed to the National Tuberculosis Association, which was renamed the American Lung Association in 1973. 6 The national and local tuberculosis associations played a vital role in educating the public by running campaigns urging people to have skin tests and chest x-rays as a means of diagnosing tuberculosis. Once tuberculosis was diagnosed, an individual was likely to be sent to a sanatorium or tuberculosis hospital. There, good nourishment, fresh air, and bed rest were prescribed in the belief that if the body’s natural defenses were strengthened, they would be able to overcome the tuberculosis bacillus. For almost half a century, this would be the prevailing treatment. It was not until 1945, with the introduction of chemotherapy, that streptomycin was used to treat tuberculosis. Outbreaks of poliomyelitis, which had increased in the early decades of the 1900s, served as the impetus for the work of American microbiologist Jonas Salk (1914–1995). At its peak, the virus was claiming 50,000 victims annually in the United States. 3 Test trials of Salk’s vaccine with inactivated virus began in 1953, and it proved to prevent the development of polio. By 1955, the massive testing was complete, and the vaccine was quickly put into wide use. Surgical techniques also flourished during this time. A single technical innovation was responsible for opening up the last surgical frontier—the heart. Up to this time, the heart had been out of bounds; surgeons did not have the means to take over the function of the heart for long enough to get inside and operate. American surgeon John Gibbon (1903–1973) addressed this problem when he developed the heart-lung machine. Dramatic advances followed its successful use in 1953—probably none more so than the ? rst successful heart transplantation performed in 1967 by South African surgeon Christiaan Barnard (1922–2001). For centuries, the inheritance of traits had be en explained in religious or philosophical terms. Although English naturalist Charles Darwin’s (1809–1882) work dispelled long-held beliefs about inherited traits, it was Austrian bo- A tuberculosis skin testing clinic. (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 49]. Philadelphia: Lippincott Williams Wilkins) CHAPTER 1 Concepts of Health and Disease 11 The â€Å"iron lung,† which used negative pressure to draw air into the lungs, was used to provide ventilatory support for persons with â€Å"bulbar polio. † (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 91]. Philadelphia: Lippincott Williams Wilkins) anist Gregor Mendel’s (1822–1884) revolutionary theories on the segregation of traits, largely ignored until 1902, that laid the groundwork for establishing the chromosome as the structural unit of heredity. Many other scientists and researchers contributed to the storehouse of genetic knowledge. With the work by American geneticist James Watson (1928–) and British biophysicists Francis Crick (1916–) and Maurice Wilkins (1916–) in the early 1950s, which established the double-helical structure of DNA, the way to investigating and understanding our genetic heritage was opened. It is dif? cult, if not impossible, to single out all the landmark events of the twentieth century that contributed to the health of humankind. Among the other notable achievements are the development of kidney dialysis, oral contraceptives, transplant surgery, the computed axial tomography (CAT) scanner, and coronary angioplasty. Not all of the important advances in modern medicine are as dramatic as open-heart surgery. Often, they are the result of dogged work by many people and yield results only after a number of years, and then they frequently go unheralded. For example, vaccination programs, control of infectious diseases through improvements in sanitation of water and waste disposal, safer and healthier foods free from microbial contamination, identi? cation of health risks from behaviors such as smoking, and improved prenatal care all have saved many lives in the twentieth century. THE TWENTY-FIRST CENTURY The twenty-? rst century reveals new horizons, but also new problems. In greater numbers than ever, goods and people travel the world. There is unprecedented physical mobility—travel and migration from villages to cities and country to country—and interconnectedness. However, the bene? ts of physical mobility and interconnectedness are accompanied by risks. Diseases such as AIDS remind us that nothing is regional, local, or limited in its reach: contagious illness has a worldwide arena. The challenges of maintaining health and well-being in this global community are increasingly apparent. The inadvertent introduction of pathogens poses an unrelenting threat to public health, as does the deliberate use of microorganisms as weapons (see Chapter 18 for a discussion of bioterrorism and emerging global infectious diseases). In February 2003, the viral respiratory illness named severe acute respiratory syndrome (SARS) by the World Health Organization was ? rst recognized in China. 8 In the next few months, the illness swept through parts of Asia and spread to more than two dozen countries in North America, South America, and Europe. The disease was characterized by rapid onset and variable severity, ranging from mild illness to death. The prevention of SARS was a particular challenge because preventive interventions (e. g. , vaccines and antibiotics) were unavailable. Containment became a global collaboration, with public health authorities utilizing isolation and quarantine to focus delivery of health care to people who were ill and to protect healthy people from getting sick. During the February to July outbreak, more than 8000 people worldwide became infected, and more than 900 died. Commerce also is an integral part of the growing world community, bringing goods and services once unobtainable into the global marketplace. Expanded international trade also provides the vehicle for the unwitting introduction or transmission of disease. One such instance occurred in the spring of 2003 in the United States. A multistate outbreak of human monkeypox, ? rst identi? ed in the Democratic Republic of the Congo in 1970, was traced by investigators to pet prairie dogs. The prairie dogs became infected when they were housed or transported along with infected Gambian giant rats, dormice, and rope squirrels that were part of a shipment of small mammals from G hana. Spread of nonindigenous zoonotic pathogens to indigenous susceptible animal populations can be rapid and deadly. With such outbreaks lurks an additional danger—the potential for interspecies exchange, including between humans and animals such as pets. The widespread distribution of infected and potentially infected animals allowed epizootic spread of monkeypox through several states before effective interventions could be put into place. One of the challenges to the world health community will be to study the role of international travel and commerce in the emergence of infectious diseases through the dissemination of pathogens and their vectors throughout the world and then to develop long-term strategies of surveillance and intervention with the ultimate goal of curtailing their occurrence. In 1976, the World Health Organization (WHO) actually succeeded in eliminating smallpox from the face of the earth. 10 This triumph gave substance to the idea that other infections, like measles, also might disappear if suf? cient efforts were directed at worldwide campaigns to isolate and cure them. However, new infectious diseases, such as Lyme disease and Legionnaire’s disease, and new forms of old diseases, such as resistant strains of tuberculosis and malaria, have emerged and are readily spread 12 UNIT I Concepts of Health and Disease ing on Hippocratic doctrines and introducing experimentation into the study of healing. His work, gleaned through his role as physician to the emperors and gladiators of Rome and animal dissections, came to be regarded as the encyclopedia of anatomy and physiology and was considered infallible for almost 1400 years. Signi? cant challenges to long-held beliefs began with the work of Andreas Vesalius (1514–1564), professor of anatomy and surgery at Padua, Italy. His published work, On the Fabric [Structure] of the Human Body, showing how the parts of the body looked and worked, set a new standard for the understanding of human anatomy. Other significant early contributions were made by scholars such as William Harvey (1578–1657), the English physician and physiologist, who in his book, On the Motion of the Heart and Blood in Animals, provided a physiologic framework for the circulation of blood; Anton van Leeuwenhoek (1632–1723), the Dutch lens maker who refined the microscope and set the stage for the era of cellular biology; and Edward Jenner (1749–1823), the English country physician who conducted the first successful vaccination. The nineteenth century was a time of major discoveries that paved the way for understanding infectious diseases. Signi? cant contributions were made by such scientists as Joseph Lister, the English surgeon who concluded that microbes caused wound infections; German bacteriologist Robert Koch, who discovered the anthrax bacillus, thus identifying for the ? rst time a microorganism and the illness it caused; and French chemist and microbiologist Louis Pasteur, who developed the technique of pasteurization. Perhaps the most notable technical innovation of the century was the discovery of X rays by German physicist Wilhelm Rontgen. The scienti? undertakings and discoveries of the twentieth century were revolutionary. In 1910, Paul Ehrlich introduced chemotherapy, and in 1928, Sir Alexander Fleming discovered the ? rst antibiotic as he studied the relationship between bacteria and the mold Penicillium. Diseases that had once been fatal or crippling were managed or prevented by new advances, such as the discovery of insulin by Sir Frederick Banting and Charles Best in 1922 and the development of the polio vaccine by Jonas Salk in 1953. Technical innovations set the stage for new surgical techniques. The creation of the heartlung machine by American surgeon John Gibbon paved the way for coronary bypass surgery and the ? rst successful heart transplantation in 1967, which was performed by Christiaan Barnard, a South African surgeon. Other important advances included kidney dialysis, oral contraceptives, the CAT scanner, and coronary angioplasty. Public health programs also were responsible for greatly affecting the health of populations, such as those dedicated to increasing vaccination, improving sanitation of water and waste disposal, and identifying health risks. Knowledge about the in? uence of heredity on health and disease originated with Charles Darwin’s (1809–1882) evolutionary theories about inherited traits and with Gregor Mendel’s (1822–1884) theories on the segregation of traits, which laid the groundwork for establishing the chromosome as the structural unit of heredity. In the early 1950s, geneticist James Watson of the United States and British biophysicists Francis Crick and Maurice Wilkins presented their ? ndings on the double-helical structure of DNA. worldwide. The powerful interventions used to ? ght these infections have had the unexpected effect of accelerating their biologic evolution and making them impervious to one after another form of chemical attack. Pathogens also can be introduced into the food chain and travel worldwide. The discovery that beef from cattle infected with bovine spongiform encephalopathy (BSE) may be the source of Creutzfeldt-Jakob disease led many countries to ban beef products from the United Kingdom when BSE was found to be prevalent in English herds. The introduction of such pathogens can be the result of ignorance, carelessness, or greed. Tobacco is a product that serves as a pathogen. In a quest for ever-increasing pro? ts, the tobacco industry created a demand for its product by arti? cially raising the nicotine content of cigarettes so as to increase their addictive potential. This was done with the knowledge of the health risks of tobacco products, thanks to experiments conducted by the tobacco companies’ own medical scientists, but kept secret. If there is a blueprint for future advances, it is in the genes. The twenty-? rst century is destined to be dominated by advances in genetics. With the mapping of the human genome comes hope of cure for some of the most dreaded crippling and fatal diseases. The mapping of the human genome also has posed new ethical dilemmas, for with it comes the potential to predict the future health of persons based on their genes. It soon may be possible to differentiate between persons who will develop certain debilitating diseases and those who will not. Although advances in science and technology will continue to provide new treatments for many diseases, it has become apparent that there are more impressive rewards to be had by preventing diseases from becoming established in the ? rst place. Ultimately, maintaining health is more resource conservative and cost effective than relying on the treatment of disease. Many decades ago, we learned that even though the â€Å"magic bullets† such as antibiotics had the ability to cure what was once considered incurable, much of our freedom from communicable disease is due to clean water, ef? ient sanitation, and good nutrition. We have become increasingly aware of the importance of preventive measures against noninfectious conditions, especially cancer and coronary heart disease. There is no better way to prevent disease and maintain health than by leading a healthy life, and increasingly, it will be the individual who is responsible for ensuring a healthy passage through life. In summ ary, Greek scholars were responsible for establishing the fundamentals of anatomy, physiology, and pathology that served as the earliest knowledge base for understanding health and disease. It was Hippocrates (460–377 BC) and his followers who laid the foundations of the clinical principles and ethics that grew into modern science. Although his belief that disease occurred when the four humors—blood, yellow and black bile, and phlegm—became out of balance was disproved, his approach to health that dictated plenty of healthy exercise, rest in illness, and a moderate, sober diet remains valid. Galen (AD 129–199) took the next major step, expand- CHAPTER 1 The twenty-? rst century is predicted to be a time of great advances in the ? ld of genetics, already evidenced by the substantial mapping of the human genome that has taken place. Scientists look to genetic research to provide advances that not only will predict who may develop disease but also will provide new treatments for those diseases. However promising future advances may appear, it is readily apparent that prevention is an equally important tool in maintaining health. Concepts of Heal th and Disease 13 Perspectives on Health and Disease in Individuals After completing this section of the chapter, you should be able to meet the following objectives: ? State the World Health Organization de? nition of health ? Describe the function of adaptation as it relates to health and disease ? State a de? nition of pathophysiology ? Characterize the disease process in terms of etiology, pathogenesis, morphology, clinical manifestations, and prognosis ? Explain the meanings of reliability, validity, sensitivity, speci? city, and predictive value as they relate to observations and tests used in the diagnosis of disease What constitutes health and disease often is dif? cult to determine because of the way different people view the topic. What is de? ned as health is determined by many factors, including heredity, age and sex, cultural and ethnic differences, as well as individual, group, and governmental expectations. HEALTH The World Health Organization (WHO) in 1948 de? ned health as a â€Å"state of complete physical, mental, and social well-being and not merely the absence of disease and in? rmity. †10 Although ideal for many people, this was an unrealistic goal. At the World Health Assembly in 1977, representatives of the member governments of WHO agreed that their goal was to have all citizens of the world reach a level of health by the year 2000 that allows them to live a socially and economically productive life. 10 The U. S. Department of Health and Human Services in Healthy People 2010 described the determinants of health as an interaction between an individual’s biology and behavior, physical and social environments, government policies and interventions, and access to quality health care. 1 with which the need to adapt occurs (see Chapter 9). Generally speaking, adaptation affects the whole person. When adapting to stresses that are threats to health, the body uses those behaviors that are the most ef? cient and effective. It does not use long-term mechanisms when short-term adaptation is suf? cient. The increase in heart rate that accompanies a febrile illness is a temporary response designed to deliver additional oxygen to ti ssues during the short period that the elevated temperature increases metabolic needs. On the other hand, hypertrophy of the left ventricle is a long-term adaptive response that occurs in persons with chronic hypertension. Adaptation is further affected by the availability of adaptive responses and the ability of the body to select the most appropriate response. The ability to adapt is dependent on the availability of adaptive responses—the greater number of available responses, the more effective the capacity to adapt. Adaptive capacity is decreased with extremes of age and with disease conditions that limit the availability of adaptive responses. The immaturity of the infant impairs the ability to adapt, as does the decline in functional reserve that occurs in the elderly. For example, infants have dif? culty concentrating urine because of the immaturity of their renal tubular structures and therefore are less able than an older child or adult to cope with decreased water intake or exaggerated water losses. Similarly, persons with preexisting heart disease are less able to adapt to health problems that require recruitment of cardiovascular responses. Adaptation also is less effective when changes in health status occur suddenly rather than gradually. For instance, it is possible to lose a liter of blood through chronic gastrointestinal bleeding without developing signs of shock. On the other hand, a sudden hemorrhage that causes the loss of an equal amount of blood is apt to produce hypotension and circulatory shock. Even in advanced disease states, the body retains much of its adaptive capacity and is able to maintain the internal environment within relatively normal limits. DISEASE The term pathophysiology, which is the focus of this book, may be de? ned as the physiology of altered health. The term combines the words pathology and physiology. Pathology (from the Greek pathos, meaning â€Å"disease†) deals with the study of the structural and functional changes in cells, tissues, and organs of the body that cause or are caused by disease. Physiology deals with the functions of the human body. Thus, pathophysiology deals not only with the cellular and organ changes that occur with disease but also with the effects that these changes have on total body function. Pathophysiology also focuses on the mechanisms of the underlying disease and provides the background for preventive as well as therapeutic health care measures and practices. A disease has been de? ned as any deviation from or interruption of the normal structure or function of a part, organ, or system of the body that is manifested by a characteristic set of symptoms or signs; the etiology, pathology, and prognosis may be known or unknown. 12 The aspects HEALTH AND DISEASE AS STATES OF ADAPTATION The ability of the body to adapt both physically and psychologically to the many stresses that occur in both health and disease is affected by a number of factors, including age, health status, psychosocial resources, and the rapidity 14 UNIT I Concepts of Health and Disease f the disease process include the etiology, pathogenesis, morphologic changes, clinical manifestations, diagnosis, and clinical course. ity, the progression from fatty streak to the occlusive vessel lesion seen in persons with coronary heart disease represents the pathogenesis of the disorder. The true etiology of atherosclerosis remains largely uncertain. Etiology The causes of disease are known as etiologic factors. Among the recognized etiologic agents are biologic agents (e. g. , bacteria, viruses), physical forces (e. g. , trauma, burns, radiation), chemical agents (e. g. , poisons, alcohol), and nutritional excesses or de? its. At the molecular level, it is important to distinguish between sick molecules and molecules that cause disease. 13 This is true of diseases such as cystic ? brosis, sickle cell anemia, and familial hypercholesterolemia, in which genetic abnormality of a single amino acid, transporter molecule, or receptor protein produces widespread effects on health. Most disease-causing agents are nonspeci? c, and many different agents can cause disease of a single organ. For example, lung disease can result from trauma, infection, exposure to physical and chemical agents, or neoplasia. With severe lung involvement, each of these agents has the potential to cause respiratory failure. On the other hand, a single agent or traumatic event can lead to disease of a number of organs or systems. For example, severe circulatory shock can cause multiorgan failure. Although a disease agent can affect more than a single organ, and a number of disease agents can affect the same organ, most disease states do not have a single cause. Instead, most diseases are multifactorial in origin. This is particularly true of diseases such as cancer, heart disease, and diabetes. The multiple factors that predispose to a particular disease often are referred to as risk factors. One way to view the factors that cause disease is to group them into categories according to whether they were present at birth or acquired later in life. Congenital conditions are defects that are present at birth, although they may not be evident until later in life. Congenital malformation may be caused by genetic in? uences, environmental factors (e. g. , viral infections in the mother, maternal drug use, irradiation, or intrauterine crowding), or a combination of genetic and environmental factors. Not all genetic disorders are evident at birth. Many genetic disorders, such as familial hypercholesterolemia and polycystic kidney disease, take years to develop. Acquired defects are those that are caused by events that occur after birth. These include injury, exposure to infectious agents, inadequate nutrition, lack of oxygen, inappropriate immune responses, and neoplasia. Many diseases are thought to be the result of a genetic predisposition and an environmental event or events that serve as a trigger to initiate disease development. Morphology Morphology refers to the fundamental structure or form of cells or tissues. Morphologic changes are concerned with both the gross anatomic and microscopic changes that are characteristic of a disease. Histology deals with the study of the cells and extracellular matrix of body tissues. The most common method used in the study of tissues is the preparation of histologic sections that can be studied with the aid of a microscope. Because tissues and organs usually are too thick to be examined under a microscope, they must be sectioned to obtain thin, translucent sections. Histologic sections play an important role in the diagnosis of many types of cancer. A lesion represents a pathologic or traumatic discontinuity of a body organ or tissue. Descriptions of lesion size and characteristics often can be obtained through the use of radiographs, ultrasonography, and other imaging methods. Lesions also may be sampled by biopsy and the tissue samples subjected to histologic study. Clinical Manifestations Disease can be manifest in a number of ways. Sometimes, the condition produces manifestations, such as fever, that make it evident that the person is sick. Other diseases are silent at the onset and are detected during examination for other purposes or after the disease is far advanced. Signs and symptoms are terms used to describe the structural and functional changes that accompany a disease. A symptom is a subjective complaint that is noted by the person with a disorder, whereas a sign is a manifestation that is noted by an observer. Pain, dif? culty in breathing, and dizziness are symptoms of a disease. An elevated temperature, a swollen extremity, and changes in pupil size are objective signs that can be observed by someone other than the person with the disease. Signs and symptoms may be related to the primary disorder, or they may represent the body’s attempt to compensate for the altered function caused by the pathologic condition. Many pathologic states are not observed directly—one cannot see a sick heart or a failing kidney. Instead, what can be observed is the body’s attempt to compensate for changes in function brought about by the disease, such as the tachycardia that accompanies blood loss or the increased respiratory rate that occurs with pneumonia. It is important to recognize that a single sign or symptom may be associated with a number of different disease states. For example, an elevated temperature can indicate the presence of an infection, heat stroke, brain tumor, or any number of other disorders. A differential diagnosis that describes the origin of a disorder usually requires information regarding a number of signs and symptoms. For example, the presence of fever, a reddened sore throat, and positive throat culture describe a â€Å"strep throat† infection. A syndrome is a compilation of signs and symptoms (e. g. , chronic fatigue syndrome) that are characteristic of a speci? c disease state. Complications are possible adverse ex- Pathogenesis Pathogenesis is the sequence of cellular and tissue events that take place from the time of initial contact with an etiologic agent until the ultimate expression of a disease. Etiology describes what sets the disease process in motion, and pathogenesis, how the disease process evolves. Although the two terms often are used interchangeably, their meanings are quite different. For example, atherosclerosis often is cited as the cause or etiology of coronary heart disease. In real- CHAPTER 1 Concepts of Health and Disease 15 ensions of a disease or outcomes from treatment. Sequelae are lesions or impairments that follow or are caused by a disease. Diagnosis A diagnosis is the designation as to the nature or cause of a health problem (e. g. , bacterial pneumonia or hemorrhagic stroke). The diagnostic process usually requires a careful history and physical examination. The history is used to obtain a person’s account of his or her symptoms, their progression, and the fa ctors that contribute to a diagnosis. The physical examination is done to observe for signs of altered body structure or function. The development of a diagnosis involves weighing competing possibilities and selecting the most likely one from among the conditions that might be responsible for the person’s clinical presentation. The clinical probability of a given disease in a person of a given age, sex, race, lifestyle, and locality often is in? uential in arriving at a presumptive diagnosis. Laboratory tests, radiologic studies, CT scans, and other tests often are used to con? rm a diagnosis. Normality. An important factor when interpreting diagnostic test results is the determination of whether they are normal or abnormal. Is a blood count above normal, within the normal range, or below normal? Normality usually determines whether further tests are needed or if interventions are necessary. What is termed a normal value for a laboratory test is established statistically from test results obtained from a selected sample of people. The normal values refer to the 95% distribution (mean plus or minus two standard deviations [mean  ± 2 SD]) of test results for the reference population. 14 Thus, the normal levels for serum sodium (135 to 145 mEq/L) represent the mean serum level for the reference population  ± 2 SD. The normal values for some laboratory tests are adjusted for sex or age. For example, the normal hemoglobin range for women is 12. 0 to 16. 0 g/dL and for men, 14. 0 to 17. 4 g/dL. 15 Serum creatinine level often is adjusted for age in the elderly (see Chapter 36), and normal values for serum phosphate differ between adults and children. Reliability, Validity, Sensitivity, Speci? city, and Predictive Value. The quality of data on which a diagnosis is based may be judged for its reliability, validity, sensitivity, speci? city, and predictive value. 6,17 Reliability refers to the extent to which an observation, if repeated, gives the same result. A poorly calibrated blood pressure machine may give inconsistent measurements of blood pressure, particularly of pressures in either the high or low range. Reliability also depends on the persons making the measurements. For example, blood pressure measurements may vary from one observer to another because of the technique that is used (e. g. , different observers may de? ate the cuff at a different rate, thus obtaining different values), the way the numbers on the manometer are read, or differences in hearing acuity. Validity refers to the extent to which a measurement tool measures what it is intended to measure. This often is assessed by comparing a measurement method with the best possible method of measure that is available. For example, the validity of blood pressure measurements ob- tained by a sphygmomanometer might be compared with those obtained by intraarterial measurements. Measures of sensitivity and speci? city are concerned with determining how well the test or observation identi? es people with the disease and people without the disease. Sensitivity refers to the proportion of people with a disease who are positive for that disease on a given test or observation (called a true-positive result). Speci? city refers to the proportion of people without the disease who are negative on a given test or observation (called a true-negative result). A test that is 95% speci? c correctly identi? es 95 of 100 normal people. The other 5% are false-positive results. A false-positive test result, particularly for conditions such as human immunodeficiency virus (HIV) infection, can be unduly stressful for the person being tested (see Chapter 22). In the case of HIV testing, a positive result on the initial antibody test is followed up with a more sensitive test. On the other hand, false-negative test results in conditions such as cancer can delay diagnosis and jeopardize the outcome of treatment. Predictive value is the extent to which an observation or test result is able to predict the presence of a given disease or condition. A positive predictive value refers to the proportion of true-positive results that occurs in a given population. In a group of women found to have â€Å"suspect breast nodules† in a cancer-screening program, the proportion later determined to have breast cancer would constitute the positive predictive value. A negative predictive value refers to the true-negative observations in a population. In a screening test for breast cancer, the negative predictive value represents the proportion of women without suspect nodules who do not have breast cancer. Although predictive values rely in part on sensitivity and speci? city, they depend more heavily on the prevalence of the condition in the population. Despite unchanging sensitivity and speci? ity, the positive predictive value of an observation rises with prevalence, whereas the negative predictive value falls. Clinical Course The clinical course describes the evolution of a disease. A disease can have an acute, subacute, or chronic course. An acute disorder is one that is relatively severe, but selflimiting. Chronic disease implies a continu ous, long-term process. A chronic disease can run a continuous course, or it can present with exacerbations (aggravation of symptoms and severity of the disease) and remissions (a period during which there is a lessening of severity and a decrease in symptoms). Subacute disease is intermediate or between acute and chronic: it is not as severe as an acute disease and not as prolonged as a chronic disease. The spectrum of disease severity for infectious diseases such as hepatitis B can range from preclinical to persistent chronic infection. During the preclinical stage, the disease is not clinically evident but is destined to progress to clinical disease. As with hepatitis B, it is possible to How to cite Nursing: Epidemiology and Health, Essay examples