Rofecoxib
Rofecoxib is a nonsteroidal anti-inflammatory drug (NSAID) marketed by Merck & Co. to treat osteoarthritis, acute pain conditions, and dysmenorrhoea. Rofecoxib was approved as safe and effective by the Food and Drug Administration (FDA) on May 20, 1999, and was subsequently marketed under the brand name Vioxx, Ceoxx and Ceeoxx.
Rofecoxib gained widespread acceptance among physicians treating patients with arthritis and other conditions causing chronic or acute pain. Worldwide, over 80 million people were prescribed rofecoxib at some time.
On September 30, 2004, Merck voluntarily withdrew rofecoxib from the market because of concerns about increased risk of heart attack and stroke associated with long-term, high-dosage use. Rofecoxib was one of the most widely used drugs ever to be withdrawn from the market. In the year before withdrawal, Merck had sales revenue of US$2.5 billion from Vioxx. [1]
Rofecoxib was available on prescription as tablets and as an oral suspension.
Adverse drug reactions
See also: Non-steroidal anti-inflammatory drug
Adverse drug reaction
Aside from the reduced incidence of gastric ulceration, rofecoxib exhibits a similar adverse effect profile to other NSAIDs. Rofecoxib, however, does appear to increase the risk of adverse cardiovascular events.
The chief mechanism proposed to explain rofecoxib's cardiotoxicity is the suppression of prostacyclin, an anti-clotting agent in the blood (Fitzgerald, 2004). COX-2 plays a role in the production of prostacyclin. Because Vioxx inhibits the COX-2 enzyme, prostacyclin production can decrease in endothelial cells and lead to an inefficiency in declumping and vasodilatation. Merck, however, argues that there was no effect on prostacyclin production in blood vessels in animal testing.[3] Other researchers have speculated that the cardiotoxicity may be associated with maleic anhydride metabolites formed when rofecoxib becomes ionized under physiological conditions. (Reddy & Corey, 2005)
Political impact of Vioxx litigation in America
The recall and litigation over rofecoxib has provoked debate over drug safety in the United States. Some[who?] argue that the U.S. Food and Drug Administration does not do enough to monitor product safety and that the rofecoxib withdrawal is an argument against tort reform. It has also been argued[who?] that litigation is an imperfect means of regulation that would overdeter companies for complying with FDA requirements, and that large awards like that in Ernst would inhibit research and development
19.2.09
satellite
Satellite
This article is about artificial satellites. For natural satellites, also known as moons, see Natural satellite.
Satellites and Satalite redirect here. For the Canadian reggae band, see Sattalites.
For other uses, see Satellite (disambiguation).
A full size model of the Earth observation satellite ERS 2
In the context of spaceflight, a satellite is an object which has been placed into orbit by human endeavor. Such objects are sometimes called artificial satellites to distinguish them from natural satellites such as the Moon.
History of artificial satellites
Further information: Timeline of artificial satellites and space probes
See also: Space Race
The first artificial satellite was Sputnik 1, launched by the Soviet Union on 4 October 1957, and initiating the Soviet Sputnik program, with Sergei Korolev as chief designer and Kerim Kerimov as his assistant.[4] This in turn triggered the Space Race between the Soviet Union and the United States.
Sputnik 1 helped to identify the density of high atmospheric layers through measurement of its orbital change and provided data on radio-signal distribution in the ionosphere. Because the satellite's body was filled with pressurized nitrogen, Sputnik 1 also provided the first opportunity for meteoroid detection, as a loss of internal pressure due to meteoroid penetration of the outer surface would have been evident in the temperature data sent back to Earth. The unanticipated announcement of Sputnik 1's success precipitated the Sputnik crisis in the United States and ignited the so-called Space Race within the Cold War.
Sputnik 2 was launched on November 3, 1957 and carried the first living passenger into orbit, a dog named Laika.[5]
In May, 1946, Project RAND had released the Preliminary Design of an Experimental World-Circling Spaceship, which stated, "A satellite vehicle with appropriate instrumentation can be expected to be one of the most potent scientific tools of the Twentieth Century.[6] The United States had been considering launching orbital satellites since 1945 under the Bureau of Aeronautics of the United States Navy. The United States Air Force's Project RAND eventually released the above report, but did not believe that the satellite was a potential military weapon; rather, they considered it to be a tool for science, politics, and propaganda. In 1954, the Secretary of Defense stated, "I know of no American satellite program."[7]
On July 29, 1955, the White House announced that the U.S. intended to launch satellites by the spring of 1958. This became known as Project Vanguard. On July 31, the Soviets announced that they intended to launch a satellite by the fall of 1957.
Following pressure by the American Rocket Society, the National Science Foundation, and the International Geophysical Year, military interest picked up and in early 1955 the Air Force and Navy were working on Project Orbiter, which involved using a Jupiter C rocket to launch a satellite. The project succeeded, and Explorer 1 became the United States' first satellite on January 31, 1958.[8]
In June 1961, three-and-a-half years after the launch of Sputnik 1, the Air Force used resources of the United States Space Surveillance Network to catalog 115 Earth-orbiting satellites.[9]
The largest artificial satellite currently orbiting the Earth is the International Space Station.
Space Surveillance Network
The United States Space Surveillance Network (SSN) has been tracking space objects since 1957 when the Soviets opened the space age with the launch of Sputnik I. Since then, the SSN has tracked more than 26,000 space objects orbiting Earth. The SSN currently tracks more than 8,000 man-made orbiting objects. The rest have re-entered Earth's turbulent atmosphere and disintegrated, or survived re-entry and impacted the Earth. The space objects now orbiting Earth range from satellites weighing several tons to pieces of spent rocket bodies weighing only 10 pounds. About seven percent of the space objects are operational satellites (i.e. ~560 satellites), the rest are space debris.[10] USSTRATCOM is primarily interested in the active satellites, but also tracks space debris which upon reentry might otherwise be mistaken for incoming missiles. The SSN tracks space objects that are 10 centimeters in diameter (baseball size) or larger.
This article is about artificial satellites. For natural satellites, also known as moons, see Natural satellite.
Satellites and Satalite redirect here. For the Canadian reggae band, see Sattalites.
For other uses, see Satellite (disambiguation).
A full size model of the Earth observation satellite ERS 2
In the context of spaceflight, a satellite is an object which has been placed into orbit by human endeavor. Such objects are sometimes called artificial satellites to distinguish them from natural satellites such as the Moon.
History of artificial satellites
Further information: Timeline of artificial satellites and space probes
See also: Space Race
The first artificial satellite was Sputnik 1, launched by the Soviet Union on 4 October 1957, and initiating the Soviet Sputnik program, with Sergei Korolev as chief designer and Kerim Kerimov as his assistant.[4] This in turn triggered the Space Race between the Soviet Union and the United States.
Sputnik 1 helped to identify the density of high atmospheric layers through measurement of its orbital change and provided data on radio-signal distribution in the ionosphere. Because the satellite's body was filled with pressurized nitrogen, Sputnik 1 also provided the first opportunity for meteoroid detection, as a loss of internal pressure due to meteoroid penetration of the outer surface would have been evident in the temperature data sent back to Earth. The unanticipated announcement of Sputnik 1's success precipitated the Sputnik crisis in the United States and ignited the so-called Space Race within the Cold War.
Sputnik 2 was launched on November 3, 1957 and carried the first living passenger into orbit, a dog named Laika.[5]
In May, 1946, Project RAND had released the Preliminary Design of an Experimental World-Circling Spaceship, which stated, "A satellite vehicle with appropriate instrumentation can be expected to be one of the most potent scientific tools of the Twentieth Century.[6] The United States had been considering launching orbital satellites since 1945 under the Bureau of Aeronautics of the United States Navy. The United States Air Force's Project RAND eventually released the above report, but did not believe that the satellite was a potential military weapon; rather, they considered it to be a tool for science, politics, and propaganda. In 1954, the Secretary of Defense stated, "I know of no American satellite program."[7]
On July 29, 1955, the White House announced that the U.S. intended to launch satellites by the spring of 1958. This became known as Project Vanguard. On July 31, the Soviets announced that they intended to launch a satellite by the fall of 1957.
Following pressure by the American Rocket Society, the National Science Foundation, and the International Geophysical Year, military interest picked up and in early 1955 the Air Force and Navy were working on Project Orbiter, which involved using a Jupiter C rocket to launch a satellite. The project succeeded, and Explorer 1 became the United States' first satellite on January 31, 1958.[8]
In June 1961, three-and-a-half years after the launch of Sputnik 1, the Air Force used resources of the United States Space Surveillance Network to catalog 115 Earth-orbiting satellites.[9]
The largest artificial satellite currently orbiting the Earth is the International Space Station.
Space Surveillance Network
The United States Space Surveillance Network (SSN) has been tracking space objects since 1957 when the Soviets opened the space age with the launch of Sputnik I. Since then, the SSN has tracked more than 26,000 space objects orbiting Earth. The SSN currently tracks more than 8,000 man-made orbiting objects. The rest have re-entered Earth's turbulent atmosphere and disintegrated, or survived re-entry and impacted the Earth. The space objects now orbiting Earth range from satellites weighing several tons to pieces of spent rocket bodies weighing only 10 pounds. About seven percent of the space objects are operational satellites (i.e. ~560 satellites), the rest are space debris.[10] USSTRATCOM is primarily interested in the active satellites, but also tracks space debris which upon reentry might otherwise be mistaken for incoming missiles. The SSN tracks space objects that are 10 centimeters in diameter (baseball size) or larger.
Laptop computer
A laptop (also known as a notebook) is a personal computer designed for mobile use small enough to sit on one's lap[1]. A laptop includes most of the typical components of a typical desktop computer, including a display, a keyboard, a pointing device (a touchpad, also known as a trackpad, or a pointing stick) as well as a battery, into a single small and light unit. The rechargeable battery required is charged from an AC/DC adapter (ie, a wll wart) and typically stores enough energy to run the laptop for several hours.
Laptops are usually shaped like a large notebook with thicknesses between 0.7–1.5 inches (18–38 mm) and dimensions ranging from 10x8 inches (27x22cm, 13" display) to 15x11 inches (39x28cm, 17" display) and up. Modern laptops weigh 3 to 12 pounds (1.4 to 5.4 kg); older laptops were usually heavier. Most laptops are designed in the flip form factor to protect the screen and the keyboard when closed. Modern 'tablet' laptops have a complex joint between the keyboard housing and the display, permitting the display panel to twist and then lay flat on the keyboard housing. They usually have a touchscreen display and some include handwriting recognition or graphics drawing capability.
Laptops were originally considered to be "a small niche market"[2] and were thought suitable mostly for "specialized field applications" such as "the military, the Internal Revenue Service, accountants and sales representatives".[2][3] Battery-powered portable computers had just 2% worldwide market share in 1986[4]. But today, there are already more laptops than desktops in businesses, and laptop are becoming obligatory for student use and more popular for general use.[5] According to a forecast by Intel, more laptops than desktops will be sold in the general PC market as soon as 2009Netbook
An Asus Eee PC netbook.
Main article: Netbook
Netbooks are laptops that are light-weight, economical, energy-efficient and especially sutied for wireless communication and Internet access[17][18]. Hence the name netbook (as "the device excels in web-based computing performance")[19] rather than notebook which pertains to size[20].
Especially suited for web browsing and e-mailing, netbooks "rely heavily on the Internet for remote access to web-based applications"[19] and are targeted increasingly at cloud computing users who rely on servers and require a less powerful client computer.[21]. While the devices range in size from below 5 inches[22] to over 12[23], most are between 7 and 11 inches and weigh between 2 and 3 pounds[19].
Netbooks have a wide range of light-weight operating systems including Linux and Windows XP[19] rather than more resource-intensive operating systems like Windows Vista as they have less processing power than traditional laptops[24
[edit] Rugged Laptop
Main article: Rugged computer
A Panasonic Toughbook.
A rugged (or ruggedized) laptop is designed to reliably operate in harsh usage conditions such as strong vibrations, extreme temperatures and wet or dusty environments. Rugged laptops are usually designed from scratch, rather than adapted from regular consumer laptop models. Rugged notebooks are bulkier, heavier, and much more expensive than regular laptops[25], and thus are seldom seen in regular consumer use.
The design features found in rugged laptops include rubber sheeting under the keyboard keys, sealed port and connector covers, passive cooling, superbright displays easily readable in daylight, cases and frames made of magnesium alloys or have a magnesium alloy rollcage[26] that are much stronger than plastic found in commercial laptops and solid-state storage devices or hard disc drives that are shock mounted to withstand constant vibrations. Rugged laptops are commonly used by public safety services (police, fire and medical emergency), military, utilities, field service technicians, construction, mining and oil drilling personnel. Rugged laptops are usually sold to organizations, rather than individuals, and are rarely marketed via retail channels.
Laptops are usually shaped like a large notebook with thicknesses between 0.7–1.5 inches (18–38 mm) and dimensions ranging from 10x8 inches (27x22cm, 13" display) to 15x11 inches (39x28cm, 17" display) and up. Modern laptops weigh 3 to 12 pounds (1.4 to 5.4 kg); older laptops were usually heavier. Most laptops are designed in the flip form factor to protect the screen and the keyboard when closed. Modern 'tablet' laptops have a complex joint between the keyboard housing and the display, permitting the display panel to twist and then lay flat on the keyboard housing. They usually have a touchscreen display and some include handwriting recognition or graphics drawing capability.
Laptops were originally considered to be "a small niche market"[2] and were thought suitable mostly for "specialized field applications" such as "the military, the Internal Revenue Service, accountants and sales representatives".[2][3] Battery-powered portable computers had just 2% worldwide market share in 1986[4]. But today, there are already more laptops than desktops in businesses, and laptop are becoming obligatory for student use and more popular for general use.[5] According to a forecast by Intel, more laptops than desktops will be sold in the general PC market as soon as 2009Netbook
An Asus Eee PC netbook.
Main article: Netbook
Netbooks are laptops that are light-weight, economical, energy-efficient and especially sutied for wireless communication and Internet access[17][18]. Hence the name netbook (as "the device excels in web-based computing performance")[19] rather than notebook which pertains to size[20].
Especially suited for web browsing and e-mailing, netbooks "rely heavily on the Internet for remote access to web-based applications"[19] and are targeted increasingly at cloud computing users who rely on servers and require a less powerful client computer.[21]. While the devices range in size from below 5 inches[22] to over 12[23], most are between 7 and 11 inches and weigh between 2 and 3 pounds[19].
Netbooks have a wide range of light-weight operating systems including Linux and Windows XP[19] rather than more resource-intensive operating systems like Windows Vista as they have less processing power than traditional laptops[24
[edit] Rugged Laptop
Main article: Rugged computer
A Panasonic Toughbook.
A rugged (or ruggedized) laptop is designed to reliably operate in harsh usage conditions such as strong vibrations, extreme temperatures and wet or dusty environments. Rugged laptops are usually designed from scratch, rather than adapted from regular consumer laptop models. Rugged notebooks are bulkier, heavier, and much more expensive than regular laptops[25], and thus are seldom seen in regular consumer use.
The design features found in rugged laptops include rubber sheeting under the keyboard keys, sealed port and connector covers, passive cooling, superbright displays easily readable in daylight, cases and frames made of magnesium alloys or have a magnesium alloy rollcage[26] that are much stronger than plastic found in commercial laptops and solid-state storage devices or hard disc drives that are shock mounted to withstand constant vibrations. Rugged laptops are commonly used by public safety services (police, fire and medical emergency), military, utilities, field service technicians, construction, mining and oil drilling personnel. Rugged laptops are usually sold to organizations, rather than individuals, and are rarely marketed via retail channels.
Consumer credit
Credit
Credit is the provision of resources (such as granting a loan) by one party to another party where that second party does not reimburse the first party immediately, thereby generating a debt, and instead arranges either to repay or return those resources (or material(s) of equal value) at a later date. It is any form of deferred payment.[1] The first party is called a creditor, also known as a lender, while the second party is called a debtor, also known as a borrower.
Movements of financial capital are normally dependent on either credit or equity transfers. Credit is in turn dependent on the reputation or creditworthiness of the entity which takes responsibility for the funds.
Credit need not necessarily be based on formal monetary systems. The credit concept can be applied in barter economies based on the direct exchange of goods and services, and some would go so far as to suggest that the true nature of money is best described as a representation of the credit-debt relationships that exist in society (Ingham 2004 p.12-19).
Credit is denominated by a unit of account. Unlike money (by a strict definition), credit itself cannot act as a unit of account. However, many forms of credit can readily act as a medium of exchange. As such, various forms of credit are frequently referred to as money and are included in estimates of the money supply.
Credit is also traded in the market. The purest form is the credit default swap market, which is essentially a traded market in credit insurance. A credit default swap represents the price at which two parties exchange this risk – the protection "seller" takes the risk of default of the credit in return for a payment, commonly denoted in basis points (one basis point is 1/100 of a percent) of the notional amount to be referenced, while the protection "buyer" pays this premium and in the case of default of the underlying (a loan, bond or other receivable), delivers this receivable to the protection seller and receives from the seller the par amount (that is, is made whole).
Consumer credit
Consumer credit can be defined as ‘money, goods or services provided to an individual in lieu of payment.’ Common forms of consumer credit include credit cards, store cards, motor (auto) finance, personal loans (installment loans), retail loans (retail installment loans) and mortgages. This is a broad definition of consumer credit and corresponds with the Bank of England's definition of "Lending to individuals". Given the size and nature of the mortgage market, many observers classify mortgage lending as a separate category of personal borrowing, and consequently residential mortgages are excluded from some definitions of consumer credit - such as the one adopted by the Federal Reserve in the US.
The cost of credit is the additional amount, over and above the amount borrowed, that the borrower has to pay. It includes interest, arrangement fees and any other charges. Some costs are mandatory, required by the lender as an integral part of the credit agreement. Other costs, such as those for credit insurance, may be optional. The borrower chooses whether or not they are included as part of the agreement.
Interest and other charges are presented in a variety of different ways, but under many legislative regimes lenders are required to quote all mandatory charges in the form of an annual percentage rate (APR). The goal of the APR calculation is to promote ‘truth in lending’, to give potential borrowers a clear measure of the true cost of borrowing and to allow a comparison to be made between competing products. The APR is derived from the pattern of advances and repayments made during the agreement. Optional charges are not included in the APR calculation. So if there is a tick box on an application form asking if the consumer would like to take out payment insurance, then insurance costs will not be included in the APR calculation (Finlay 2009).
Credit is the provision of resources (such as granting a loan) by one party to another party where that second party does not reimburse the first party immediately, thereby generating a debt, and instead arranges either to repay or return those resources (or material(s) of equal value) at a later date. It is any form of deferred payment.[1] The first party is called a creditor, also known as a lender, while the second party is called a debtor, also known as a borrower.
Movements of financial capital are normally dependent on either credit or equity transfers. Credit is in turn dependent on the reputation or creditworthiness of the entity which takes responsibility for the funds.
Credit need not necessarily be based on formal monetary systems. The credit concept can be applied in barter economies based on the direct exchange of goods and services, and some would go so far as to suggest that the true nature of money is best described as a representation of the credit-debt relationships that exist in society (Ingham 2004 p.12-19).
Credit is denominated by a unit of account. Unlike money (by a strict definition), credit itself cannot act as a unit of account. However, many forms of credit can readily act as a medium of exchange. As such, various forms of credit are frequently referred to as money and are included in estimates of the money supply.
Credit is also traded in the market. The purest form is the credit default swap market, which is essentially a traded market in credit insurance. A credit default swap represents the price at which two parties exchange this risk – the protection "seller" takes the risk of default of the credit in return for a payment, commonly denoted in basis points (one basis point is 1/100 of a percent) of the notional amount to be referenced, while the protection "buyer" pays this premium and in the case of default of the underlying (a loan, bond or other receivable), delivers this receivable to the protection seller and receives from the seller the par amount (that is, is made whole).
Consumer credit
Consumer credit can be defined as ‘money, goods or services provided to an individual in lieu of payment.’ Common forms of consumer credit include credit cards, store cards, motor (auto) finance, personal loans (installment loans), retail loans (retail installment loans) and mortgages. This is a broad definition of consumer credit and corresponds with the Bank of England's definition of "Lending to individuals". Given the size and nature of the mortgage market, many observers classify mortgage lending as a separate category of personal borrowing, and consequently residential mortgages are excluded from some definitions of consumer credit - such as the one adopted by the Federal Reserve in the US.
The cost of credit is the additional amount, over and above the amount borrowed, that the borrower has to pay. It includes interest, arrangement fees and any other charges. Some costs are mandatory, required by the lender as an integral part of the credit agreement. Other costs, such as those for credit insurance, may be optional. The borrower chooses whether or not they are included as part of the agreement.
Interest and other charges are presented in a variety of different ways, but under many legislative regimes lenders are required to quote all mandatory charges in the form of an annual percentage rate (APR). The goal of the APR calculation is to promote ‘truth in lending’, to give potential borrowers a clear measure of the true cost of borrowing and to allow a comparison to be made between competing products. The APR is derived from the pattern of advances and repayments made during the agreement. Optional charges are not included in the APR calculation. So if there is a tick box on an application form asking if the consumer would like to take out payment insurance, then insurance costs will not be included in the APR calculation (Finlay 2009).
Acne vulgaris
Acne vulgaris (commonly called acne) is a skin condition caused by changes in the pilosebaceous units (skin structures consisting of a hair follicle and its associated sebaceous gland). Severe acne is inflammatory, but acne can also manifest in noninflammatory forms.[1] Acne lesions are commonly referred to as pimples, blemishes, spots, zits, or acne.
Acne is most common during adolescence, affecting more than 85% of teenagers, and frequently continues into adulthood. The cause in adolescence is generally an increase in male sex hormones, which people of both genders accrue during puberty. [2] For most people, acne diminishes over time and tends to disappear—or at the very least decrease—after one reaches one's early twenties. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will continue to suffer well into their thirties, forties and beyond.[3]
The face and upper neck are the most commonly affected, but the chest, back and shoulders may have acne as well. The upper arms can also have acne, but lesions found there are often keratosis pilaris, not acne. Typical acne lesions are comedones, inflammatory papules, pustules and nodules. Some of the large nodules were previously called "cysts" and the term nodulocystic has been used to describe severe cases of inflammatory acne. [4]
Aside from scarring, its main effects are psychological, such as reduced self-esteem[5] and, according to at least one study, depression or suicide.[6] Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall impact to individuals.[5]
Causes of acne
Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedo (blackhead) or closed comedo (whitehead). Whiteheads are the direct result of skin pores becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions the naturally occurring largely commensal bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedo, which results in redness and may result in scarring or hyperpigmentation.[10]
Treatments
Available treatments
There are many products available for the treatment of acne, many of which are without any scientifically-proven effects. Generally speaking, successful treatments show little improvement within the first two weeks, instead taking a period of approximately three months to improve and start flattening out. Many treatments that promise big improvements within two weeks are likely to be largely disappointing. However, short bursts of cortisone can give very quick results, and other treatments can rapidly improve some active spots, but usually not all active spots.
Modes of improvement are not necessarily fully understood but in general treatments are believed to work in at least 4 different ways (with many of the best treatments providing multiple simultaneous effects):
normalising shedding into the pore to prevent blockage
killing Propionibacterium acnes
anti-inflammatory effects
hormonal manipulation
Contact hyperthermia
A combination of treatments can greatly reduce the amount and severity of acne in many cases. Those treatments that are most effective tend to have greater potential for side effects and need a greater degree of monitoring, so a step-wise approach is often taken. Many people consult with doctors when deciding which treatments to use, especially when considering using any treatments in combination. There are a number of treatments that have been proven effective:
Benzoyl peroxide cream.
Topical bactericidalsWidely available OTC bactericidal products containing benzoyl peroxide may be used in mild to moderate acne. The gel or cream containing benzoyl peroxide is rubbed, twice daily, into the pores over the affected region. Bar soaps or washes may also be used and vary from 2 to 10% in strength. In addition to its therapeutic effect as a keratolytic (a chemical that dissolves the keratin plugging the pores) benzoyl peroxide
Acne is most common during adolescence, affecting more than 85% of teenagers, and frequently continues into adulthood. The cause in adolescence is generally an increase in male sex hormones, which people of both genders accrue during puberty. [2] For most people, acne diminishes over time and tends to disappear—or at the very least decrease—after one reaches one's early twenties. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will continue to suffer well into their thirties, forties and beyond.[3]
The face and upper neck are the most commonly affected, but the chest, back and shoulders may have acne as well. The upper arms can also have acne, but lesions found there are often keratosis pilaris, not acne. Typical acne lesions are comedones, inflammatory papules, pustules and nodules. Some of the large nodules were previously called "cysts" and the term nodulocystic has been used to describe severe cases of inflammatory acne. [4]
Aside from scarring, its main effects are psychological, such as reduced self-esteem[5] and, according to at least one study, depression or suicide.[6] Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall impact to individuals.[5]
Causes of acne
Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedo (blackhead) or closed comedo (whitehead). Whiteheads are the direct result of skin pores becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions the naturally occurring largely commensal bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedo, which results in redness and may result in scarring or hyperpigmentation.[10]
Treatments
Available treatments
There are many products available for the treatment of acne, many of which are without any scientifically-proven effects. Generally speaking, successful treatments show little improvement within the first two weeks, instead taking a period of approximately three months to improve and start flattening out. Many treatments that promise big improvements within two weeks are likely to be largely disappointing. However, short bursts of cortisone can give very quick results, and other treatments can rapidly improve some active spots, but usually not all active spots.
Modes of improvement are not necessarily fully understood but in general treatments are believed to work in at least 4 different ways (with many of the best treatments providing multiple simultaneous effects):
normalising shedding into the pore to prevent blockage
killing Propionibacterium acnes
anti-inflammatory effects
hormonal manipulation
Contact hyperthermia
A combination of treatments can greatly reduce the amount and severity of acne in many cases. Those treatments that are most effective tend to have greater potential for side effects and need a greater degree of monitoring, so a step-wise approach is often taken. Many people consult with doctors when deciding which treatments to use, especially when considering using any treatments in combination. There are a number of treatments that have been proven effective:
Benzoyl peroxide cream.
Topical bactericidalsWidely available OTC bactericidal products containing benzoyl peroxide may be used in mild to moderate acne. The gel or cream containing benzoyl peroxide is rubbed, twice daily, into the pores over the affected region. Bar soaps or washes may also be used and vary from 2 to 10% in strength. In addition to its therapeutic effect as a keratolytic (a chemical that dissolves the keratin plugging the pores) benzoyl peroxide
Alcohol tratment
A directory of public, private and non-profit agencies in the United States that offer various levels of alcoholism and drug abuse rehabilitation and treatment services. Listing in this directory should not be interpreted as a recommendation of the individual facilities or the services they provide.
Effective treatment
Care management. Treatment programs need to be carefully managed every step of the way, sometimes involving family members and friends, from the initial assessment through continued follow-up after the intervention program ends.
Individually delivered, proven professional interventions. Several interventions, based on different treatment philosophies, can be effective in reducing alcohol consumption depending on the patient's gender, severity of dependence and motivation to change. Effective treatment programs will offer more than one approach.
Contracting with patients. Also called contingency management or behavior contracting, contracting with patients to reward good behavior and to punish bad behavior can improve treatment outcomes.
Social skills training. The basis for cognitive behavioral therapy, people with alcohol problems can be taught to recognize stressful situations, in which their drinking has been a problem in the past, and skills to help them cope with those situations.
Medications. Medical treatments cannot "cure" drinking problems, but they can be combined with other interventions and therapies to produce treatment that is even more effective.
Specialized services for medical, psychiatric, employment or family problems. Treatment programs need to be targeted at the individual needs of the patient through "problem-to-service matching."
Continuing care. Most who enter treatment have at least one relapse. Follow-up contact, as well as participation in support groups, have both been shown to improve long-term treatment outcomes.
Strong bond with therapist or counselor. Research shows that counselors and therapists who bond with patients through empathy, rather than confrontation, are powerful motivating influences in alcohol treatment.
Longer duration (for alcohol dependent drinkers). How long a patient stays in treatment matters more in most cases than if a patient is treated in an inpatient or outpatient setting. Studies indicate that outpatient treatment lasting less than 90 days results in poorer outcomes.
Participation in support groups. Project MATCH and other studies in the 1990s definitively proved that participation in support groups, such as Alcoholics Anonymous, can be an active ingredient of treatment-- both during a professional intervention and after.
Strong patient motivation. All approaches to alcoholism recovery depend on the desire of the person to get and remain sober. Effective treatment programs enhance this motivation with intervention and therapy.
Effective treatment
Care management. Treatment programs need to be carefully managed every step of the way, sometimes involving family members and friends, from the initial assessment through continued follow-up after the intervention program ends.
Individually delivered, proven professional interventions. Several interventions, based on different treatment philosophies, can be effective in reducing alcohol consumption depending on the patient's gender, severity of dependence and motivation to change. Effective treatment programs will offer more than one approach.
Contracting with patients. Also called contingency management or behavior contracting, contracting with patients to reward good behavior and to punish bad behavior can improve treatment outcomes.
Social skills training. The basis for cognitive behavioral therapy, people with alcohol problems can be taught to recognize stressful situations, in which their drinking has been a problem in the past, and skills to help them cope with those situations.
Medications. Medical treatments cannot "cure" drinking problems, but they can be combined with other interventions and therapies to produce treatment that is even more effective.
Specialized services for medical, psychiatric, employment or family problems. Treatment programs need to be targeted at the individual needs of the patient through "problem-to-service matching."
Continuing care. Most who enter treatment have at least one relapse. Follow-up contact, as well as participation in support groups, have both been shown to improve long-term treatment outcomes.
Strong bond with therapist or counselor. Research shows that counselors and therapists who bond with patients through empathy, rather than confrontation, are powerful motivating influences in alcohol treatment.
Longer duration (for alcohol dependent drinkers). How long a patient stays in treatment matters more in most cases than if a patient is treated in an inpatient or outpatient setting. Studies indicate that outpatient treatment lasting less than 90 days results in poorer outcomes.
Participation in support groups. Project MATCH and other studies in the 1990s definitively proved that participation in support groups, such as Alcoholics Anonymous, can be an active ingredient of treatment-- both during a professional intervention and after.
Strong patient motivation. All approaches to alcoholism recovery depend on the desire of the person to get and remain sober. Effective treatment programs enhance this motivation with intervention and therapy.
Drug anti cancer
Anti-Cancer Drugs I
Introduction:
The available anticancer drugs have distinct mechanisms of action which may vary in their effects on different types of normal and cancer cells. A single "cure" for cancer has proved elusive since there is not a single type of cancer but as many as 100 different types of cancer. In addition, there are very few demonstrable biochemical differences between cancerous cells and normal cells. For this reason the effectiveness of many anticancer drugs is limited by their toxicity to normal rapidly growing cells in the intestinal and bone marrow areas. A final problem is that cancerous cells which are initially suppressed by a specific drug may develop a resistance to that drug. For this reason cancer chemotherapy may consist of using several drugs in combination for varying lengths of time.
Cancer Chemotherapy:
Chemotherapy drugs, are sometimes feared because of a patient's concern about toxic effects. Their role is to slow and hopefully halt the growth and spread of a cancer. There are three goals associated with the use of the most commonly-used anticancer agents.
1. Damage the DNA of the affected cancer cells.
2. Inhibit the synthesis of new DNA strands to stop the cell from replicating, because the replication of the cell is what allows the tumor to grow.
3. Stop mitosis or the actual splitting of the original cell into two new cells. Stopping mitosis stops cell division (replication) of the cancer and may ultimately halt the progression of the cancer.
Unfortunately, the majority of drugs currently on the market are not specific, which leads to the many common side effects associated with cancer chemotherapy. Because the common approach of all chemotherapy is to decrease the growth rate (cell division) of the cancer cells, the side effects are seen in bodily systems that naturally have a rapid turnover of cells iincluding skin, hair, gastrointestinal, and bone marrow. These healthy, normal cells, also end up damaged by the chemotherapy program.
Click for larger image
Catagories of Chemotherapy Drugs:In general, chemotherapy agents can be divided into three main categories based on their mechanism of action.
Stop the synthesis of pre DNA molecule building blocks:These agents work in a number of different ways. DNA building blocks are folic acid, heterocyclic bases, and nucleotides, which are made naturally within cells. All of these agents work to block some step in the formation of nucleotides or deoxyribonucleotides (necessary for making DNA). When these steps are blocked, the nucleotides, which arethe building blocks of DNA and RNA, can not be synthesized. Thus the cells can not replicate because they can nnot make DNA without the nucleotides.
Introduction:
The available anticancer drugs have distinct mechanisms of action which may vary in their effects on different types of normal and cancer cells. A single "cure" for cancer has proved elusive since there is not a single type of cancer but as many as 100 different types of cancer. In addition, there are very few demonstrable biochemical differences between cancerous cells and normal cells. For this reason the effectiveness of many anticancer drugs is limited by their toxicity to normal rapidly growing cells in the intestinal and bone marrow areas. A final problem is that cancerous cells which are initially suppressed by a specific drug may develop a resistance to that drug. For this reason cancer chemotherapy may consist of using several drugs in combination for varying lengths of time.
Cancer Chemotherapy:
Chemotherapy drugs, are sometimes feared because of a patient's concern about toxic effects. Their role is to slow and hopefully halt the growth and spread of a cancer. There are three goals associated with the use of the most commonly-used anticancer agents.
1. Damage the DNA of the affected cancer cells.
2. Inhibit the synthesis of new DNA strands to stop the cell from replicating, because the replication of the cell is what allows the tumor to grow.
3. Stop mitosis or the actual splitting of the original cell into two new cells. Stopping mitosis stops cell division (replication) of the cancer and may ultimately halt the progression of the cancer.
Unfortunately, the majority of drugs currently on the market are not specific, which leads to the many common side effects associated with cancer chemotherapy. Because the common approach of all chemotherapy is to decrease the growth rate (cell division) of the cancer cells, the side effects are seen in bodily systems that naturally have a rapid turnover of cells iincluding skin, hair, gastrointestinal, and bone marrow. These healthy, normal cells, also end up damaged by the chemotherapy program.
Click for larger image
Catagories of Chemotherapy Drugs:In general, chemotherapy agents can be divided into three main categories based on their mechanism of action.
Stop the synthesis of pre DNA molecule building blocks:These agents work in a number of different ways. DNA building blocks are folic acid, heterocyclic bases, and nucleotides, which are made naturally within cells. All of these agents work to block some step in the formation of nucleotides or deoxyribonucleotides (necessary for making DNA). When these steps are blocked, the nucleotides, which arethe building blocks of DNA and RNA, can not be synthesized. Thus the cells can not replicate because they can nnot make DNA without the nucleotides.
Online Trading
Online Trading
Legend has it that Joseph Kennedy sold all the stock he owned the day before "Black Thursday," the start of the catastrophic 1929 stock market crash. Many investors suffered enormous losses in the crash, which became one of the hallmarks of the Great Depression.
What made Kennedy sell? According to the story, he got a stock tip from a shoeshine boy. In the 1920s, the stock market was the realm of the rich and powerful. Kennedy thought that if a shoeshine boy could own stock, something must have gone terribly wrong.
Now, plenty of "common" people own stock. Online trading has given anyone who has a computer, enough money to open an account and a reasonably good financial history the ability to invest in the market. You don't have to have a personal broker or a disposable fortune to do it, and most analysts agree that average people trading stock is no longer a sign of impending doom
The market has become more accessible, but that doesn't mean you should take online trading lightly. In this article, we'll look at the different types of online trading accounts, as well as how to choose an online brokerage, make trades and protect yourself from fraud.
Review of Stocks & MarketsBefore we look at the world of online trading, let's take a quick look at the basics of the stock market. If you've already read How Stocks and the Stock Market Work, you can go on to the next section.
A share of stock is basically a tiny piece of a corporation. Shareholders -- people who buy stock -- are investing in the future of a company for as long as they own their shares. The price of a share varies according to economic conditions, the performance of the company and investors' attitudes. The first time a company offers its stock for public sale is called an initial public offering (IPO), also known as "going public."
When a business makes a profit, it can share that money with its stockholders by issuing a dividend. A business can also save its profit or re-invest it by making improvements to the business or hiring new people. Stocks that issue frequent dividends are income stocks. Stocks in companies that re-invest their profits are growth stocks.
Brokers buy and sell stocks through an exchange, charging a commission to do so. A broker is simply a person who is licensed to trade stocks through the exchange. A broker can be on the trading floor or can make trades by phone or electronically
Legend has it that Joseph Kennedy sold all the stock he owned the day before "Black Thursday," the start of the catastrophic 1929 stock market crash. Many investors suffered enormous losses in the crash, which became one of the hallmarks of the Great Depression.
What made Kennedy sell? According to the story, he got a stock tip from a shoeshine boy. In the 1920s, the stock market was the realm of the rich and powerful. Kennedy thought that if a shoeshine boy could own stock, something must have gone terribly wrong.
Now, plenty of "common" people own stock. Online trading has given anyone who has a computer, enough money to open an account and a reasonably good financial history the ability to invest in the market. You don't have to have a personal broker or a disposable fortune to do it, and most analysts agree that average people trading stock is no longer a sign of impending doom
The market has become more accessible, but that doesn't mean you should take online trading lightly. In this article, we'll look at the different types of online trading accounts, as well as how to choose an online brokerage, make trades and protect yourself from fraud.
Review of Stocks & MarketsBefore we look at the world of online trading, let's take a quick look at the basics of the stock market. If you've already read How Stocks and the Stock Market Work, you can go on to the next section.
A share of stock is basically a tiny piece of a corporation. Shareholders -- people who buy stock -- are investing in the future of a company for as long as they own their shares. The price of a share varies according to economic conditions, the performance of the company and investors' attitudes. The first time a company offers its stock for public sale is called an initial public offering (IPO), also known as "going public."
When a business makes a profit, it can share that money with its stockholders by issuing a dividend. A business can also save its profit or re-invest it by making improvements to the business or hiring new people. Stocks that issue frequent dividends are income stocks. Stocks in companies that re-invest their profits are growth stocks.
Brokers buy and sell stocks through an exchange, charging a commission to do so. A broker is simply a person who is licensed to trade stocks through the exchange. A broker can be on the trading floor or can make trades by phone or electronically
Bextra
Valdecoxib
Valdecoxib is a prescription drug used in the treatment of osteoarthritis, rheumatoid arthritis, and painful menstruation and menstrual symptoms. It is classified as a nonsteroidal anti-inflammatory drug, or NSAID, and should not be taken by anyone allergic to these types of medications.Valdecoxib was manufactured and marketed under the brand name Bextra by G. D. Searle & Company. It was approved by the United States Food and Drug Administration on November 20, 2001[1], and was available by prescription in tablet form until 2005, when it was removed from the market due to concerns about possible increased risk of heart attack and stroke
UsesSince its registration, Bextra was prescribed for pain associated with arthritis, menstrual discomfort, and other ailments.
Side-effects and withdrawalOn April 7, 2005, Pfizer withdrew Bextra from the U.S. market on recommendation by the FDA, citing an increased risk of heart attack and stroke and also the risk of a serious, sometimes fatal, skin reaction. This was a result of recent attention to prescription NSAIDs, such as Merck's Vioxx. Other reported side-effects were angina and Stevens-Johnson syndrome.Pfizer first acknowledged cardiovascular risks associated with Bextra in October 2004. The American Heart Association soon after was presented with a report indicating patients using Bextra while recovering from heart surgery were 2.19 times more likely to suffer a stroke or heart attack than those taking placebos.Recently in a large study published in JAMA 2006, valdecoxib appears less adverse for renal (kidney) disease and heart arrhythmia compared to Vioxx, however elevated renal risks were slightly suggested. [2]
Valdecoxib is a prescription drug used in the treatment of osteoarthritis, rheumatoid arthritis, and painful menstruation and menstrual symptoms. It is classified as a nonsteroidal anti-inflammatory drug, or NSAID, and should not be taken by anyone allergic to these types of medications.Valdecoxib was manufactured and marketed under the brand name Bextra by G. D. Searle & Company. It was approved by the United States Food and Drug Administration on November 20, 2001[1], and was available by prescription in tablet form until 2005, when it was removed from the market due to concerns about possible increased risk of heart attack and stroke
UsesSince its registration, Bextra was prescribed for pain associated with arthritis, menstrual discomfort, and other ailments.
Side-effects and withdrawalOn April 7, 2005, Pfizer withdrew Bextra from the U.S. market on recommendation by the FDA, citing an increased risk of heart attack and stroke and also the risk of a serious, sometimes fatal, skin reaction. This was a result of recent attention to prescription NSAIDs, such as Merck's Vioxx. Other reported side-effects were angina and Stevens-Johnson syndrome.Pfizer first acknowledged cardiovascular risks associated with Bextra in October 2004. The American Heart Association soon after was presented with a report indicating patients using Bextra while recovering from heart surgery were 2.19 times more likely to suffer a stroke or heart attack than those taking placebos.Recently in a large study published in JAMA 2006, valdecoxib appears less adverse for renal (kidney) disease and heart arrhythmia compared to Vioxx, however elevated renal risks were slightly suggested. [2]
Forex
The foreign exchange (currency, forex or FX) market is where currency trading takes place. FX transactions typically involve one party purchasing a quantity of one currency in exchange for paying a quantity of another. The FX market is one of the largest and most liquid financial markets in the world, and includes trading between large banks, central banks, currency speculators, corporations, governments, and other institutions. The average daily volume in the global forex and related markets is continuously growing. Traditional turnover was reported to be over US$ 3.2 trillion in April 2007 by the Bank for International Settlement. [1] Since then, the market has continued to grow. According to Euromoney's annual FX Poll, volumes grew a further 41% between 2007 and 2008.
Central banks
National central banks play an important role in the foreign exchange markets. They try to control the money supply, inflation, and/or interest rates and often have official or unofficial target rates for their currencies. They can use their often substantial foreign exchange reserves to stabilize the market. Milton Friedman argued that the best stabilization strategy would be for central banks to buy when the exchange rate is too low, and to sell when the rate is too high — that is, to trade for a profit based on their more precise information. Nevertheless, the effectiveness of central bank "stabilizing speculation" is doubtful because central banks do not go bankrupt if they make large losses, like other traders would, and there is no convincing evidence that they do make a profit trading.
Central banks
National central banks play an important role in the foreign exchange markets. They try to control the money supply, inflation, and/or interest rates and often have official or unofficial target rates for their currencies. They can use their often substantial foreign exchange reserves to stabilize the market. Milton Friedman argued that the best stabilization strategy would be for central banks to buy when the exchange rate is too low, and to sell when the rate is too high — that is, to trade for a profit based on their more precise information. Nevertheless, the effectiveness of central bank "stabilizing speculation" is doubtful because central banks do not go bankrupt if they make large losses, like other traders would, and there is no convincing evidence that they do make a profit trading.
The mere expectation or rumor of central bank intervention might be enough to stabilize a currency, but aggressive intervention might be used several times each year in countries with a dirty float currency regime. Central banks do not always achieve their objectives. The combined resources of the market can easily overwhelm any central bank.[5] Several scenarios of this nature were seen in the 1992–93 ERM collapse, and in more recent times in Southeast Asia.
Hedge funds
Hedge funds have gained a reputation for aggressive currency speculation since 1996. They control billions of dollars of equity and may borrow billions more, and thus may overwhelm intervention by central banks to support almost any currency, if the economic fundamentals are in the hedge funds' favor.
Investment management firms
Investment management firms (who typically manage large accounts on behalf of customers such as pension funds and endowments) use the foreign exchange market to facilitate transactions in foreign securities. For example, an investment manager bearing an international equity portfolio needs to purchase and sell several pairs of foreign currencies to pay for foreign securities purchases.
Some investment management firms also have more speculative specialist currency overlay operations, which manage clients' currency exposures with the aim of generating profits as well as limiting risk. Whilst the number of this type of specialist firms is quite small, many have a large value of assets under management (AUM), and hence can generate large trades.
Retail forex brokers
There are two types of retail brokers offering the opportunity for speculative trading: retail forex brokers and market makers. Retail traders (individuals) are a small fraction of this market and may only participate indirectly through brokers or banks. Retail forex brokers, while largely controlled and regulated by the CFTC and NFA might be subject to forex scams[6] [7]. At present, the NFA and CFTC are imposing stricter requirements, particularly in relation to the amount of Net Capitalization required of its members. As a result many of the smaller, and perhaps questionable brokers are now gone. It is not widely understood that retail brokers and market makers typically trade against their clients and frequently take the other side of their trades. This can often create a potential conflict of interest and give rise to some of the unpleasant experiences some traders have had. A move toward NDD (No Dealing Desk) and STP (Straight Through Processing) has helped to resolve some of these concerns and restore trader confidence, but caution is still advised in ensuring that all is as it is presented.
Drug rehabilitation
Drug rehabilitation
Drug rehabilitation (often drug rehab or just rehab) is an umbrella term for the processes of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse
Psychological dependency
Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged or required not to associate with friends who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. Many programs emphasize recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One drink is too many; one hundred drinks is not enough.") Whether moderation is achievable by those with a history of abuse remains a controversial point but is generally considered unsustainable.
Types of treatment
Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centers, and recovery or sober houses. Newer rehab centers offer age and gender specific programs.[1]
Relapse Prevention
An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach. [11]. Marlatt describes four psychosocial processes relevant to the addiction and relapse processes: self-efficacy, outcome expectancies, attributions of causality, and decision-making processes. Self-efficacy refers to one’s ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs relapse to drug use is a result of internal, or rather external, transient causes. Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place the user in a high-risk situation.
Consider Figure 1 as an example. As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual is able to employ successful coping strategies, such as distracting himself from his cravings by turning on his favorite music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse. Figure 1 presents a schematic diagram, adapted from Marlatt & Gordon (p. 38) [11], which has been modified to present examples of the cognitive and behavioral processes that may occur at each juncture of the model.
Cognitive Therapy of Substance Abuse
An additional cognitively-based model of substance abuse recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book, Cognitive Therapy of Substance Abuse.[12] This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as “I am undesirable,” activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs (“I can handle getting high just this one more time”) are facilitated. Once a permissive set of beliefs have been activated, then
the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist’s job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunctionality. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.
Drug rehabilitation (often drug rehab or just rehab) is an umbrella term for the processes of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse
Psychological dependency
Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged or required not to associate with friends who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. Many programs emphasize recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One drink is too many; one hundred drinks is not enough.") Whether moderation is achievable by those with a history of abuse remains a controversial point but is generally considered unsustainable.
Types of treatment
Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centers, and recovery or sober houses. Newer rehab centers offer age and gender specific programs.[1]
Relapse Prevention
An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach. [11]. Marlatt describes four psychosocial processes relevant to the addiction and relapse processes: self-efficacy, outcome expectancies, attributions of causality, and decision-making processes. Self-efficacy refers to one’s ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs relapse to drug use is a result of internal, or rather external, transient causes. Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place the user in a high-risk situation.
Consider Figure 1 as an example. As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual is able to employ successful coping strategies, such as distracting himself from his cravings by turning on his favorite music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse. Figure 1 presents a schematic diagram, adapted from Marlatt & Gordon (p. 38) [11], which has been modified to present examples of the cognitive and behavioral processes that may occur at each juncture of the model.
Cognitive Therapy of Substance Abuse
An additional cognitively-based model of substance abuse recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book, Cognitive Therapy of Substance Abuse.[12] This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as “I am undesirable,” activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs (“I can handle getting high just this one more time”) are facilitated. Once a permissive set of beliefs have been activated, then
the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist’s job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunctionality. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.
Abestos disease
Asbestos Related Disease Facts
Significant exposure to any type of asbestos will increase the risk of lung cancer, mesothelioma and nonmalignant lung and pleural disorders, including asbestosis, pleural plaques, pleural thickening, and pleural effusions.
- When asbestos fibers are inhaled, most fibers are expelled, but some can become lodged in the lungs and remain there throughout life. Fibers can accumulate and cause scarring and inflammation. Enough scarring and inflammation can affect breathing, leading to disease.
- People are more likely to experience asbestos-related disorders when they are exposed to high concentrations of asbestos, are exposed for longer periods of time, and/or are exposed more often.
- Inhaling longer, more durable asbestos fibers (such as tremolite and other amphiboles) contributes to the severity of asbestos-related disorders.
- Exposure to asbestos, including tremolite, can increase the likelihood of lung cancer, mesothelioma, and non-malignant lung conditions such as asbestosis (restricted use of the lungs due to retained asbestos fibers) and changes in the lung lining.
- Changes in the lining of the lungs (pleura) such as thickening, plaques, calcification, and fluid around the lungs (pleural effusion) may be early signs of asbestos exposure. These changes can affect breathing more than previously thought. Pleural effusion can be an early warning sign for mesothelioma (cancer of the lining of the lungs).
- Most cases of asbestosis or lung cancer in workers occurred 15 years or more after the person was first exposed to asbestos.
- Most cases of mesothelioma are diagnosed 30 years or more after the first exposure to asbestos.
- Mesothelioma has been diagnosed in asbestos workers, family members, and residents who live close to asbestos mines.
- Health effects from asbestos exposure may continue to progress even after exposure is stopped.
- Smoking or cigarette smoke, together with exposure to asbestos, greatly increases the likelihood of lung cancer.
Asbestos disease attorney
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It is the extra mile or implied, including merchantability or theater? The creators, Christo and consulting.
And, our builder-ready plans and customization services.
Home Plans at Homeplans.
Minimum purchase of our outstanding home designs, you can find your dream home faster
Alcohol addiction treatment
Programs At Day By Day Treatment Center
The Center is a modern adult residential facility that is Both safe and secure and offers an intensive concentrated program of drug and alsohol addiction recovery experiential and educational treatment. Professional substance abuse and dual diagnosis counseling is augmented by client regular participation in the traditional twelve step programs of © Alcoholics Anonymous and © Narcotics Anonymous throughout treatment. Group and individual counseling is provided by a multidiscipilnary team of licensed, certified, and qualified professionals, trained in area of gender specific addiction treatment, using the latest techniques of group and individual counseling, as well as long standing approaches to multicultural issues. The team of specialists includes substance abuse counselors, case managers, child and family therapists, job readiness counselors, social workers, registerd nurses, spiritual couselors, vocational rehabilitation counselors, and HIV/STD counselors.
Right Drug And Alcohol Rehab Center
When you, a family member or loved one is battling against the demons associated with drug and/or alcohol abuse, rehabilitation is needed to get back on a healthy track. Turning to the healing properties of a drug rehab or alcohol rehab center can bring about the lifestyle and behavioral changes associated with leaving negative influences to the wayside.
There are numerous drug and alcohol rehab centers across the United States. Sometimes, a patient may even choose treatment outside of the country. Rehabilitation is a very emotional and a mental roller coaster that takes every ounce of restraint and focus. It is the responsibility of alcohol and drug rehab centers to find the medium and motivation for each patient to embrace recovery. Each and every individual that walks through the door of a clinic or enters a program is unique.
What to Expect With Treatment
Very rarely do you see drug rehabilitation without some sort of approach towards psychological repair. Even though drugs can be purged from the physical parts of the patient, it is the mental barriers and breakdowns that continue the vicious cycle of drug abuse. Most drug rehab and alcohol rehab programs will treat the mind, body and soul of a patient. This is the best approach towards increasing the success rate for when patients are released onto the world.
It is also much healthier for the patient to receive well-rounded treatment so that they may achieve stronger, more positive outcomes. It is the goal of rehab centers to make sure patients equip themselves with the tools and strength needed to resist temptation and face the threat of relapse.
While at a drug or alcohol rehab center, you will encounter a trained professional who knows the ins and outs of drug addictions. Physicians and therapists become important fixtures on the road to recovery. They will ask you many different questions and may even perform a series of medical tests. This will assist in the accurate assessment of your personal characteristics. It will aid in deciding on the appropriate drug rehabilitation program that you will benefit the most from. You could face inpatient, outpatient, residential, and/or short-stay treatment.
Eloan
E-Loan, Inc. is a Pleasanton, California-based financial services company that offers savings accounts and certificates of deposit (CDs) and access to partners that may be able to assist customers in obtaining loans.
In October 2008, E-Loan's parent company, Popular, Inc. said E-Loan would no longer operate as a direct mortgage lender in 2009, but would continue to provide certificates of deposit and savings accounts. Operational, general and administrative support functions would be transferred to other Popular subsidiaries.[1] [2]
Company officials said customers who have already obtained loans through E-Loan would not be affected.[3]
HistoryE-Loan was founded by Janina Pawlowski and Chris Larsen in 1997 to provide customers with access to mortgage loans over the Internet. In 1998, the company received venture capital funding from Sequoia Capital.[4]
Results of Operations and Financial Condition
Item 2.02 Results of Operations and Financial Condition
On October 22, 2008, Popular, Inc. issued a news release announcing its unaudited operational results for the quarter and nine-months ended September 30, 2008, a copy of which is attached as Exhibit 99.1 to this Current Report on Form 8-K. The information furnished pursuant to this Item 2.02 of this Current Report on Form 8-K, including Exhibit 99.1, shall not be deemed "filed" for purposes of the Securities Exchange Act of 1934, as amended, nor shall it be incorporated by reference into any of the Corporation's filings under the Securities Act of 1933, as amended, unless otherwise expressly stated in such filing.
Item 2.05 Costs Associated with Exit or Disposal Activities
On October 17, 2008, the Board of Directors of Popular, Inc. approved two restructuring plans. The restructuring plan for Banco Popular North America (the BPNA's Restructuring Plan) contemplates the following measures: closing, consolidation or sale of underperforming branches in all existing markets, the shutting down, sale or downsizing of lending businesses that do not generate deposits or fee income, and the reduction of general expenses associated with functions supporting the aforementioned branch and balance sheet initiatives. It is anticipated that the BPNA Restructuring Plan will result in estimated combined charges for the Corporation of $36.5 million, to be recognized during the fourth quarter of 2008 and in 2009, broken down as follows:
Email Hosting
Email Hosting
An email hosting service is an Internet hosting service that runs email servers.
Email hosting services usually offer premium email at a cost as opposed to advertising supported free email or free webmail. Email hosting services thus differ from typical end-user email providers such as webmail sites. They cater mostly to demanding email users and Small and Mid Size (SME) businesses, while larger enterprises usually run their own email hosting service. Email hosting providers allow for premium email services along with custom configurations and large number of accounts. In addition, hosting providers manage user's own domain name, including any email authentication scheme that the domain owner wishes to enforce in order to convey the meaning that using a specific domain name identifies and qualifies email senders.
Most email hosting providers offer advanced premium email solutions hosted on dedicated custom email platforms. The technology and offerings of different email hosting providers can therefore vary with different needs. Email offered by most webhosting companies is usually more basic standardized POP3 based email and webmail based on open source webmail applications like Horde or Squirrelmail. Almost all webhosting providers offer standard basic email while not all email hosting providers offer webhosting.
About Intermedia
Since 1995, Intermedia has been providing small and mid-sized businesses (SMBs) with enterprise-strength hosted IT – at a cost-effective price. We are proud to say that we are the global leader in Microsoft Exchange hosting and Web hosting for SMBs.
We run the same robust IT that large corporations use, but delivered as a service over the Internet for a low monthly fee. With no large upfront investment, SMBs can enjoy the same business email and collaboration that Fortune 500 companies use, plus professional Web hosting and Fax via Email.
Our hosted Microsoft Exchange and Web servers are located in world-class datacenters, constantly managed by our highly-experienced specialist technicians and engineers. We deliver business email with no downtime, plus 24×7 customer support through our Microsoft Gold Certified staff.
Intermedia's years of experience and financial stability, along with our high-quality service, have made us a trusted partner to tens of thousands of SMBs worldwide. As business email becomes increasingly critical, these companies rely on our Microsoft Exchange hosting to provide them with 99.999% guaranteed uptime, something which would be impossible or unaffordable with in-house IT.
For more details, read about our hosted Exchange, Web hosting (including Windows hosting and ColdFusion hosting) or Fax via Email services.
Alcohol abusetreatment centre
Young Adult Addiction Rehabilitation
Change Your Life Today with the help of our Teen Alcohol Abuse or Teen Drug AbuseTreatment Center
Teenagers and young adults curious to experiment or susceptible to peer pressure are more likely to succumb to addiction. Regardless of age, addiction can develop overnight. In fact, some drugs are so addictive that a person can become addicted after just one hit. Methamphetamines, heroin and crack cocaine fall into this category. Club drugs such as Ecstasy (E) and Ketamine (Special K) are especially common at all night rave parties that are popular among young adults. Even over-the-counter drugs such as cough medicine or huffing canisters of whipping cream for the nitrous-oxide high can be precursors to more serious addictions.
Everyone turns to drugs and alcohol for different reasons. Statistics show that the younger a person is when he or she begins using drugs, the more likely they will struggle with addiction. This is an impressionable time when bad habits are more likely to develop that become more and more difficult to change.
Our Young Adult Addiction Treatment Program Works!
At SouthCoast Recovery, we have specialized programs for young adults to help interrupt drug usage and develop healthier ways to cope with life. We’ve designed a personalized alcohol and drug treatment program that involves medical care, clinical therapy and holistic treatments such as acupuncture, massage and meditation to help each person heal on a mind, body and spirit level. All clients entering SouthCoast Recovery undergo a clinical evaluation to determine alcohol and drug history as well as any medical or underlying issues that may contribute to abuse. Our treatment team then develops a plan composed of individual sessions with our clinical therapist, drug and alcohol counselor and holistic practitioners.
Young Adult Addiction Rehabilitation Services/Options:
1. Specific addiction diagnosis
2. Intervention services
3. Medically-supervised, social model and holistic detox options
4. Psychological evaluation for dual diagnosis of problems such as depression and anxiety, which may be underlying causes of abuse
5. Individual psychological treatment
6. Individual counseling
7. Family counseling
8. Hypnotherapy
9. Alcoholism education
10. Health and wellness education
11. Denial management
12. Relapse prevention
13. Anger management and PTSD Support
14. Acupuncture for pain management, stress reduction and decreased cravings
15. Detoxification massage therapy
16. Meditation for stress reduction, a calmer mind, reduced cravings and clarity
17. Fitness sessions at gym (24-Hour Fitness)
18. Integration of 12-step principles and Alcoholics Anonymous meetings
19. Structure, guidance and practice for long-term sobriety
SouthCoast Recovery also offers innovative workshops on the latest discoveries in the mind, body and spirit connection involving addiction as well as values and goal-setting. These are presented with educational modules on the disease model of addiction, effects on the body, restoring family relationships, relapse prevention and introduction to the 12-step model of recovery. This level of commitment to help address and present healthier ways of coping with life is the reason why SouthCoast Recovery is one of the leading drug and alcohol rehab centers in the nation, and the premier recovery center in Orange County, California.
University Degrees Online
Web hosting service
A web hosting service is a type of Internet hosting service that allows individuals and organizations to provide their own website accessible via the World Wide Web. Web hosts are companies that provide space on a server they own for use by their clients as well as providing Internet connectivity, typically in a data center. Web hosts can also provide data center space and connectivity to the Internet for servers they do not own to be located in their data center, called colocation.Service scope
The scope of hosting services varies widely. The most basic is web page and small-scale file hosting, where files can be uploaded via File Transfer Protocol (FTP) or a Web interface. The files are usually delivered to the Web "as is" or with little processing. Many Internet service providers (ISPs) offer this service free to their subscribers. People can also obtain Web page hosting from other, alternative service providers. Personal web site hosting is typically free, advertisement-sponsored, or cheap. Business web site hosting often has a higher expense.
Single page hosting is generally sufficient only for personal web pages. A complex site calls for a more comprehensive package that provides database support and application development platforms (e.g. PHP, Java, Ruby on Rails, ColdFusion, and ASP.NET). These facilities allow the customers to write or install scripts for applications like forums and content management. For e-commerce, SSL is also highly recommended.
The host may also provide an interface or control panel for managing the Web server and installing scripts as well as other services like e-mail. Some hosts specialize in certain software or services (e.g. e-commerce). They are commonly used by larger companies to outsource network infrastructure to a hosting company.
Obtaining hosting
Web hosting is often provided as part of a general Internet access plan; there are many free and paid providers offering these services.
A customer needs to evaluate the requirements of the application to choose what kind of hosting to use. Such considerations include database server software, scripting software, and operating system. Most hosting providers provide Linux-based web hosting which offers a wide range of different software. A typical configuration for a Linux server is the LAMP platform: Linux, Apache, MySQL, and PHP/Perl/Python. The webhosting client may want to have other services, such as email for their business domain, databases or multi-media services for streaming media. A customer may also choose Windows as the hosting platform. The customer still can choose from PHP, Perl, and Python but may also use ASP .Net or Classic ASP.
Web hosting packages often include a Web Content Management System, so the end-user doesn't have to worry about the more technical aspects. These Web Content Management systems are great for the average user, but for those who want more control over their website design, this feature may not be adequate.
Most modern desktop operating systems (Windows, Linux, Mac OS X) are also capable of running web server software, and thus can be used to host basic websites.
One may also search the Internet to find active webhosting message boards and forums that may provide feedback on what type of webhosting company may suit his/her needs. However some of these message boards and forums will require not only registration, but a paid subscription to be able to access the sections and sub forums with such information.
Hosting reliability and uptime
Hosting uptime refers to the percentage of time the host is accessible via the internet. Many providers state that they aim for a 99.9% uptime, but there may be server restarts and planned (or unplanned) maintenance in any hosting environment.
Many providers tie uptime and accessibility into their own service level agreement (SLA). SLAs sometimes include refunds or reduced costs if performance goals are not met.
Online Banking
Online Banking
Online banking (or Internet banking) allows customers to conduct financial transactions on a secure website operated by their retail or virtual bank, credit union or building society
Security token devices
Online banking (or Internet banking) allows customers to conduct financial transactions on a secure website operated by their retail or virtual bank, credit union or building society
Features
Online banking solutions have many features and capabilities in common, but traditionally also have some that are application specific.
- The common features fall broadly into several categories
- Transactional (e.g., performing a financial transaction such as an account to account transfer, paying a bill, wire transfer... and applications... apply for a loan, new account, etc.)
- Electronic bill presentment and payment - EBPP
- Funds transfer between a customer's own checking and savings accounts, or to another customer's account
- Investment purchase or sale
- Loan applications and transactions, such as repayments
- Non-transactional (e.g., online statements, check links, cobrowsing, chat)
- Bank statements
- Financial Institution Administration - features allowing the financial institution to manage the online experience of their end users
- ASP/Hosting Administration - features allowing the hosting company to administer the solution across financial institutions
- Features commonly unique to business banking include
- Support of multiple users having varying levels of authority
- Transaction approval process
- Wire transfer
- Features commonly unique to Internet banking include
- Personal financial management support, such as importing data into personal accounting software. Some online banking platforms support account aggregation to allow the customers to monitor all of their accounts in one place whether they are with their main bank or with other institutions...
History
The precursor for the modern home online banking services were the distance banking services over electronic media from the early '80s. The term online became popular in the late '80s and referred to the use of a terminal, keyboard and TV (or monitor) to access the banking system using a phone line. ‘Home banking’ can also refer to the use of a numeric keypad to send tones down a phone line with instructions to the bank. Online services started in New York in 1981 when four of the city’s major banks (Citibank, Chase Manhattan, Chemical and Manufacturers Hanover) offered home banking services[1] using the videotex system. Because of the commercial failure of videotex these banking services never became popular except in France where the use of videotex (Minitel) was subsidised by the telecom provider and the UK, where the Prestel system was used.
The UK’s first home online banking services[2] was set up by the Nottingham Building Society (NBS) in 1983 ("History of the Nottingham". http://www.thenottingham.com/main.asp?p=1710. Retrieved on 2007-12-14.). The system used was based on the UK's Prestel system and used a computer, such as the BBC Micro, or keyboard (Tandata Td1400) connected to the telephone system and television set. The system (known as 'Homelink') allowed on-line viewing of statements, bank transfers and bill payments. In order to make bank transfers and bill payments, a written instruction giving details of the intended recipient had to be sent to the NBS who set the details up on the Homelink system. Typical recipients were gas, electricity and telephone companies and accounts with other banks. Details of payments to be made were input into the NBS system by the account holder via Prestel. A cheque was then sent by NBS to the payee and an advice giving details of the payment was sent to the account holder. BACS was later used to transfer the payment directly.
Stanford Federal Credit Union was the first financial institution to offer online internet banking services to all of its members in Oct, 1994.[3]
Security
Protection through single password authentication, as is the case in most secure Internet shopping sites, is not considered secure enough for personal online banking applications in some countries. Basically there exist two different security methods for online banking.
- The PIN/TAN system where the PIN represents a password, used for the login and TANs representing one-time passwords to authenticate transactions. TANs can be distributed in different ways, the most popular one is to send a list of TANs to the online banking user by postal letter. The most secure way of using TANs is to generate them by need using a security token. These token generated TANs depend on the time and a unique secret, stored in the security token (this is called two-factor authentication or 2FA). Usually online banking with PIN/TAN is done via a web browser using SSL secured connections, so that there is no additional encryption needed.
- Signature based online banking where all transactions are signed and encrypted digitally. The Keys for the signature generation and encryption can be stored on smartcards or any memory medium, depending on the concrete implementation.
Attacks
Most of the attacks on online banking used today are based on deceiving the user to steal login data and valid TANs. Two well known examples for those attacks are phishing and pharming. Cross-site scripting and keylogger/Trojan horses can also be used to steal login information.
A method to attack signature based online banking methods is to manipulate the used software in a way, that correct transactions are shown on the screen and faked transactions are signed in the background.
A recent FDIC Technology Incident Report, compiled from suspicious activity reports banks file quarterly, lists 536 cases of computer intrusion, with an average loss per incident of $30,000. That adds up to a nearly $16-million loss in the second quarter of 2007. Computer intrusions increased by 150 percent between the first quarter of 2007 and the second. In 80 percent of the cases, the source of the intrusion is unknown but it occurred during online banking, the report states.[4]
Countermeasures
There exist several countermeasures which try to avoid attacks. Digital certificates are used against phishing and pharming, the use of class-3 card readers is a measure to avoid manipulation of transactions by the software in signature based online banking variants. To protect their systems against Trojan horses, users should use virus scanners and be careful with downloaded software or e-mail attachments.
Dedicated Hosting
Dedicated hosting service
A dedicated hosting service, dedicated server, or managed hosting service is a type of Internet hosting in which the client leases an entire server not shared with anyone. This is more flexible than shared hosting, as organizations have full control over the server(s), including choice of operating system, hardware, etc. Server administration can usually be provided by the hosting company as an add-on service. In some cases a dedicated server can offer less overhead and a larger return on investment. Dedicated servers are most often housed in data centers, similar to colocation facilities, providing redundant power sources and HVAC systems. In contrast to collocation, the server hardware is owned by the provider and in some cases they will provide support for your operating system or applications.
Operating system support
Availability, price and employee familiarity often determines which operating systems are offered on dedicated servers. Variations of Linux (open source operating systems) are often included at no charge to the customer. Commercial operating systems include Microsoft Windows Server, provided through a special program called Microsoft SPLA. Red Hat Enterprise is a commercial version of Linux offered to hosting providers on a monthly fee basis. The monthly fee provides OS updates through the Red Hat Network using an application called up2date. Other operating systems are available from the open source community at no charge. These include CentOS, Fedora Core, Debian, and many other Linux distributions or BSD systems FreeBSD, NetBSD, OpenBSD.
Support for any of these operating systems typically depends on the level of management offered with a particular dedicated server plan. Operating system support may include updates to the core system in order to acquire the latest security fixes, patches, and system-wide vulnerability resolutions. Updates to core operating systems include kernel upgrades, service packs, application updates, and security patches that keep server secure and safe. Operating system updates and support relieves the burden of server management from the dedicated server owner.
Security
Dedicated hosting server providers utilize extreme security measures to ensure the safety of data stored on their network of servers. Providers will often deploy various software programs for scanning systems and networks for obtrusive invaders, spammers, hackers, and other harmful problems such as Trojans, worms, eggdrops and crashers (Sending multiple connections). Linux and Windows use different software for security protection.
Software
Providers often bill for dedicated servers on a fixed monthly price to include specific software packages. Over the years, software vendors realized the significant market opportunity to bundle their software with dedicated servers. They have since started introducing pricing models that allow dedicated hosting providers the ability to purchase and resell software based on reduced monthly fees.
Microsoft offers software licenses through a program called the Service Provider License Agreement. The SPLA model provides use of Microsoft products through a monthly user or processor based fee. SPLA software includes the Windows Operating System, Microsoft SQL Server, Microsoft Exchange Server, Microsoft SharePoint and shoutcast hosting, and many other server based products.
Dedicated Server Providers usually offer the ability to select the software you want installed on a dedicated server. Depending on the overall usage of the server, this will include your choice of operating system, database, and specific applications. Servers can be customized and tailored specific to the customer’s needs and requirements.
Other software applications available are specialized web hosting specific programs called control panels. Control panel software is an all inclusive set of software applications, server applications, and automation tools that can be installed on a dedicated server. Control panels include integration into web servers, database applications, programming languages, application deployment, server administration tasks, and include the ability to automate tasks via a web based front end.
Most dedicated servers are packaged with a control panel. Control panels are often confused with management tools, but these control panels are actually web based automation tools created to help automate the process of web site creation and server management. Control panels should not be confused with a full server management solution by a dedicated hosting provider.
Facelift
Consumer Guide to Facelift
Considering a facelift? These articles contain information on the facelift procedure, what makes a good facelift surgery candidate, recovery, several variations on the facelift and other topics related to facelift surgery.
What You Need to Know About Facelifts
Facelift cosmetic surgery (rhytidectomy) is intended to improve your facial appearance and make you look good for your age. Get the details on facelift procedures.
Facelift Clinical Trials
Here we provide a list of current facelift clinical trials from the U.S. National Institutes of Health database.
Facelift Variations
From deep plane lifts to feather lifts, almost any variation and extent of surgery is available to meet the needs of your facial improvement goals. This article can help you find the best treatment for your condition. Learn more about facelift variations.
Facial Implants
Facial implants are inserted into areas of the face to restore a more balanced and youthful appearance. Facial implants can strengthen a weak jaw line or accentuate your cheekbones. They are often used in conjunction with facelift plastic surgery. Learn more about facial implants.
Thread Lifts
You may have heard of the "lunchtime facelift" and wondered what they're talking about. A thread lift is not the same as a facelift, but it is a cosmetic facial procedure that is growing in popularity. Learn more about thread lifts. Also read our roundtable thread lift discussion among leading plastic surgeons on the pros and cons of thread lifts.
Thermage
If you need facial uplifting, but not necessarily a facelift, this procedure may be what you're looking for. Recently approved by the FDA, Thermage is less invasive than a facelift, using radio waves to improve facial contours and reduce wrinkles. Learn more about Thermage.
Depression
Major depressive disorder
Major depressive disorder (also known as clinical depression, major depression, unipolar depression, or unipolar disorder) is a mental disorder characterized by a pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. The term "major depressive disorder" was selected by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) classification, and has become widely used since. The general term depression is often used to describe the disorder, but as it is also used to describe a depressed mood, more precise terminology is preferred in clinical and research use. Major depression is a disabling condition which adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, approximately 3.4% of people with major depression commit suicide, and up to 60% of all people who commit suicide have depression or another mood disorder.
Symptoms and signs
Major depression is a serious illness that affects a person's family, work or school life, sleeping and eating habits, and general health.[1] Its impact on functioning and well-being has been equated to that of chronic medical conditions such as diabetes.[2]
A person suffering a major depressive episode usually exhibits a very low mood pervading all aspects of life and an inability to experience pleasure in previously enjoyable activities. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self hatred.[3] Other symptoms include poor concentration and memory, withdrawal from social situations and activities, reduced sex drive, and thoughts of death or suicide. Insomnia is common: in the typical pattern, a person wakes very early and is unable to get back to sleep.[4] Hypersomnia, or oversleeping, is less common.[4] Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur.[3] The person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries according to the World Health Organization's criteria of depression.[5] Family and friends may notice that the person's behavior is either agitated or lethargic.[4] Older depressed persons may have cognitive symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements.[6] In severe cases, depressed people may have symptoms of psychosis such as delusions or, less commonly, hallucinations, usually of an unpleasant nature.[7]
Depressed children often display an irritable rather than a depressed mood,[3] and show varying symptoms depending on age and situation.[8] Most exhibit a loss of interest in school and a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure.[4] Diagnosis may be delayed or missed when symptoms are interpreted as normal moodiness.[3]
Causes
The biopsychosocial model proposes that biological, psychological, and social factors all play a role to varying degrees in causing depression.[9] The diathesis–stress model posits that depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events. The preexisting vulnerability can be either genetic,[10][11] implying an interaction between nature and nurture, or schematic, resulting from views of the world learned in childhood.[12] These interactive models have gained empirical support. For example, a prospective, longitudinal study uncovered a moderating effect of the serotonin transporter (5-HTT) gene on stressful life events in predicting depression. Specifically, depression may follow such events, but is more likely to appear in people with one or two short alleles of the 5-HTT gene.[10] A Swedish study estimated the heritability of depression (the degree to which individual differences in occurrence are associated with genetic differences) to be approximately 40 percent for women and 30 percent for men.[13]
Monoamine hypothesis
Most antidepressants increase synaptic levels of serotonin, one of a group of neurotransmitters known as monoamines. Serotonin is hypothesized to help regulate other neurotransmitter systems; decreased serotonin activity may allow these systems to act in unusual and erratic ways.[14] According to this "permissive hypothesis", depression arises when low serotonin levels promote low levels of norepinephrine, another monoamine neurotransmitter.[15] Some antidepressants enhance the levels of norepinephrine directly, whereas others raise the levels of dopamine, a third monoamine neurotransmitterSymptoms and signs
Major depression is a serious illness that affects a person's family, work or school life, sleeping and eating habits, and general health.[1] Its impact on functioning and well-being has been equated to that of chronic medical conditions such as diabetes.[2]
A person suffering a major depressive episode usually exhibits a very low mood pervading all aspects of life and an inability to experience pleasure in previously enjoyable activities. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self hatred.[3] Other symptoms include poor concentration and memory, withdrawal from social situations and activities, reduced sex drive, and thoughts of death or suicide. Insomnia is common: in the typical pattern, a person wakes very early and is unable to get back to sleep.[4] Hypersomnia, or oversleeping, is less common.[4] Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur.[3] The person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries according to the World Health Organization's criteria of depression.[5] Family and friends may notice that the person's behavior is either agitated or lethargic.[4] Older depressed persons may have cognitive symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements.[6] In severe cases, depressed people may have symptoms of psychosis such as delusions or, less commonly, hallucinations, usually of an unpleasant nature.[7]
Depressed children often display an irritable rather than a depressed mood,[3] and show varying symptoms depending on age and situation.[8] Most exhibit a loss of interest in school and a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure.[4] Diagnosis may be delayed or missed when symptoms are interpreted as normal moodiness.[3]
Causes
The biopsychosocial model proposes that biological, psychological, and social factors all play a role to varying degrees in causing depression.[9] The diathesis–stress model posits that depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events. The preexisting vulnerability can be either genetic,[10][11] implying an interaction between nature and nurture, or schematic, resulting from views of the world learned in childhood.[12] These interactive models have gained empirical support. For example, a prospective, longitudinal study uncovered a moderating effect of the serotonin transporter (5-HTT) gene on stressful life events in predicting depression. Specifically, depression may follow such events, but is more likely to appear in people with one or two short alleles of the 5-HTT gene.[10] A Swedish study estimated the heritability of depression (the degree to which individual differences in occurrence are associated with genetic differences) to be approximately 40 percent for women and 30 percent for men.[13]
Treatment
For a fuller discussion of standard, rarely used, and more experimental treatments, see Treatment for depression.
The three most common treatments for depression are psychotherapy, medication, and electroconvulsive therapy. Psychotherapy is the treatment of choice for people under 18, while electroconvulsive therapy is only used as a last resort. Care is usually given on an outpatient basis, while treatment in an inpatient unit is considered if there is a significant risk to self or others.Treatment options are much more limited in developing countries, where access to mental health staff, medication, and psychotherapy is often difficult. Development of mental health services is minimal in many countries; depression is viewed as a phenomenon of the developed world despite evidence to the contrary, and not as an inherently life-threatening condition.[103]
Major depressive disorder (also known as clinical depression, major depression, unipolar depression, or unipolar disorder) is a mental disorder characterized by a pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. The term "major depressive disorder" was selected by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) classification, and has become widely used since. The general term depression is often used to describe the disorder, but as it is also used to describe a depressed mood, more precise terminology is preferred in clinical and research use. Major depression is a disabling condition which adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, approximately 3.4% of people with major depression commit suicide, and up to 60% of all people who commit suicide have depression or another mood disorder.
Symptoms and signs
Major depression is a serious illness that affects a person's family, work or school life, sleeping and eating habits, and general health.[1] Its impact on functioning and well-being has been equated to that of chronic medical conditions such as diabetes.[2]
A person suffering a major depressive episode usually exhibits a very low mood pervading all aspects of life and an inability to experience pleasure in previously enjoyable activities. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self hatred.[3] Other symptoms include poor concentration and memory, withdrawal from social situations and activities, reduced sex drive, and thoughts of death or suicide. Insomnia is common: in the typical pattern, a person wakes very early and is unable to get back to sleep.[4] Hypersomnia, or oversleeping, is less common.[4] Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur.[3] The person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries according to the World Health Organization's criteria of depression.[5] Family and friends may notice that the person's behavior is either agitated or lethargic.[4] Older depressed persons may have cognitive symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements.[6] In severe cases, depressed people may have symptoms of psychosis such as delusions or, less commonly, hallucinations, usually of an unpleasant nature.[7]
Depressed children often display an irritable rather than a depressed mood,[3] and show varying symptoms depending on age and situation.[8] Most exhibit a loss of interest in school and a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure.[4] Diagnosis may be delayed or missed when symptoms are interpreted as normal moodiness.[3]
Causes
The biopsychosocial model proposes that biological, psychological, and social factors all play a role to varying degrees in causing depression.[9] The diathesis–stress model posits that depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events. The preexisting vulnerability can be either genetic,[10][11] implying an interaction between nature and nurture, or schematic, resulting from views of the world learned in childhood.[12] These interactive models have gained empirical support. For example, a prospective, longitudinal study uncovered a moderating effect of the serotonin transporter (5-HTT) gene on stressful life events in predicting depression. Specifically, depression may follow such events, but is more likely to appear in people with one or two short alleles of the 5-HTT gene.[10] A Swedish study estimated the heritability of depression (the degree to which individual differences in occurrence are associated with genetic differences) to be approximately 40 percent for women and 30 percent for men.[13]
Monoamine hypothesis
Most antidepressants increase synaptic levels of serotonin, one of a group of neurotransmitters known as monoamines. Serotonin is hypothesized to help regulate other neurotransmitter systems; decreased serotonin activity may allow these systems to act in unusual and erratic ways.[14] According to this "permissive hypothesis", depression arises when low serotonin levels promote low levels of norepinephrine, another monoamine neurotransmitter.[15] Some antidepressants enhance the levels of norepinephrine directly, whereas others raise the levels of dopamine, a third monoamine neurotransmitterSymptoms and signs
Major depression is a serious illness that affects a person's family, work or school life, sleeping and eating habits, and general health.[1] Its impact on functioning and well-being has been equated to that of chronic medical conditions such as diabetes.[2]
A person suffering a major depressive episode usually exhibits a very low mood pervading all aspects of life and an inability to experience pleasure in previously enjoyable activities. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self hatred.[3] Other symptoms include poor concentration and memory, withdrawal from social situations and activities, reduced sex drive, and thoughts of death or suicide. Insomnia is common: in the typical pattern, a person wakes very early and is unable to get back to sleep.[4] Hypersomnia, or oversleeping, is less common.[4] Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur.[3] The person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries according to the World Health Organization's criteria of depression.[5] Family and friends may notice that the person's behavior is either agitated or lethargic.[4] Older depressed persons may have cognitive symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements.[6] In severe cases, depressed people may have symptoms of psychosis such as delusions or, less commonly, hallucinations, usually of an unpleasant nature.[7]
Depressed children often display an irritable rather than a depressed mood,[3] and show varying symptoms depending on age and situation.[8] Most exhibit a loss of interest in school and a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure.[4] Diagnosis may be delayed or missed when symptoms are interpreted as normal moodiness.[3]
Causes
The biopsychosocial model proposes that biological, psychological, and social factors all play a role to varying degrees in causing depression.[9] The diathesis–stress model posits that depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events. The preexisting vulnerability can be either genetic,[10][11] implying an interaction between nature and nurture, or schematic, resulting from views of the world learned in childhood.[12] These interactive models have gained empirical support. For example, a prospective, longitudinal study uncovered a moderating effect of the serotonin transporter (5-HTT) gene on stressful life events in predicting depression. Specifically, depression may follow such events, but is more likely to appear in people with one or two short alleles of the 5-HTT gene.[10] A Swedish study estimated the heritability of depression (the degree to which individual differences in occurrence are associated with genetic differences) to be approximately 40 percent for women and 30 percent for men.[13]
Treatment
For a fuller discussion of standard, rarely used, and more experimental treatments, see Treatment for depression.
The three most common treatments for depression are psychotherapy, medication, and electroconvulsive therapy. Psychotherapy is the treatment of choice for people under 18, while electroconvulsive therapy is only used as a last resort. Care is usually given on an outpatient basis, while treatment in an inpatient unit is considered if there is a significant risk to self or others.Treatment options are much more limited in developing countries, where access to mental health staff, medication, and psychotherapy is often difficult. Development of mental health services is minimal in many countries; depression is viewed as a phenomenon of the developed world despite evidence to the contrary, and not as an inherently life-threatening condition.[103]
medicine
Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness.
Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease, typically through medication, surgery, or some other form of therapy. The word medicine is derived from the Latin ars medicina, meaning the art of healing.[1][2]
Though medical technology and clinical expertise are pivotal to contemporary medicine, successful face-to-face relief of actual suffering continues to require the application of ordinary human feeling and compassion, known in English as bedside manner. [3]Structures
Contemporary medicine is in general conducted within health care systems. Legal, credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations. The characteristics of any given health care system have significant impact on the way medical care is provided.
Advanced industrial countries (with the exception of the United States) [12][13] and many developing countries provide medical services though a system of universal health care which aims to guarantee care for all through a single-payer health care system, or compulsory private or co-operative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities; most commonly by a combination of all three.
Most tribal societies, but also some communist countries (e.g. China) and the United States,[12][13] provide no guarantee of health care for the population as a whole. In such societies, health care is available to those that can afford to pay for it or have self insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.
Modern drug ampoules
Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality and pricing greatly affects the choice by patients / consumers and therefore the incentives of medical professionals. While the US health care system has come under fire for lack of openness [14], new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.
Delivery
See also: clinic, hospital, and hospice
Provision of medical care is classified into primary, secondary and tertiary care categories.
Primary care medical services are provided by physicians or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, clinics, nursing homes, schools, home visits and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes.
Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, emergency rooms, intensive care medicine, surgery services, physical therapy, labor and delivery, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.
Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation oncology, etc.
Modern medical care also depends on information - still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.
Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease, typically through medication, surgery, or some other form of therapy. The word medicine is derived from the Latin ars medicina, meaning the art of healing.[1][2]
Though medical technology and clinical expertise are pivotal to contemporary medicine, successful face-to-face relief of actual suffering continues to require the application of ordinary human feeling and compassion, known in English as bedside manner. [3]Structures
Contemporary medicine is in general conducted within health care systems. Legal, credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations. The characteristics of any given health care system have significant impact on the way medical care is provided.
Advanced industrial countries (with the exception of the United States) [12][13] and many developing countries provide medical services though a system of universal health care which aims to guarantee care for all through a single-payer health care system, or compulsory private or co-operative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities; most commonly by a combination of all three.
Most tribal societies, but also some communist countries (e.g. China) and the United States,[12][13] provide no guarantee of health care for the population as a whole. In such societies, health care is available to those that can afford to pay for it or have self insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.
Modern drug ampoules
Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality and pricing greatly affects the choice by patients / consumers and therefore the incentives of medical professionals. While the US health care system has come under fire for lack of openness [14], new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.
Delivery
See also: clinic, hospital, and hospice
Provision of medical care is classified into primary, secondary and tertiary care categories.
Primary care medical services are provided by physicians or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, clinics, nursing homes, schools, home visits and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes.
Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, emergency rooms, intensive care medicine, surgery services, physical therapy, labor and delivery, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.
Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation oncology, etc.
Modern medical care also depends on information - still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.
insurance
nsurance, in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed small loss to prevent a large, possibly devastating loss. An insurer is a company selling the insurance; an insured is the person or entity buying the insurance. The insurance rate is a factor used to determine the amount to be charged for a certain amount of insurance coverage, called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.
Principles of insurance
Principles of insurance
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Commercially insurable risks typically share seven common characteristics.[1]
- A large number of homogeneous exposure units. The vast majority of insurance policies are provided for individual members of very large classes. Automobile insurance, for example, covered about 175 million automobiles in the United States in 2004.[2] The existence of a large number of homogeneous exposure units allows insurers to benefit from the so-called “law of large numbers,” which in effect states that as the number of exposure units increases, the actual results are increasingly likely to become close to expected results. There are exceptions to this criterion. Lloyd's of London is famous for insuring the life or health of actors, actresses and sports figures. Satellite Launch insurance covers events that are infrequent. Large commercial property policies may insure exceptional properties for which there are no ‘homogeneous’ exposure units. Despite failing on this criterion, many exposures like these are generally considered to be insurable.
- Definite Loss. The event that gives rise to the loss that is subject to the insured, at least in principle, take place at a known time, in a known place, and from a known cause. The classic example is death of an insured person on a life insurance policy. Fire, automobile accidents, and worker injuries may all easily meet this criterion. Other types of losses may only be definite in theory. Occupational disease, for instance, may involve prolonged exposure to injurious conditions where no specific time, place or cause is identifiable. Ideally, the time, place and cause of a loss should be clear enough that a reasonable person, with sufficient information, could objectively verify all three elements.
- Accidental Loss. The event that constitutes the trigger of a claim should be fortuitous, or at least outside the control of the beneficiary of the insurance. The loss should be ‘pure,’ in the sense that it results from an event for which there is only the opportunity for cost. Events that contain speculative elements, such as ordinary business risks, are generally not considered insurable.
- Large Loss. The size of the loss must be meaningful from the perspective of the insured. Insurance premiums need to cover both the expected cost of losses, plus the cost of issuing and administering the policy, adjusting losses, and supplying the capital needed to reasonably assure that the insurer will be able to pay claims. For small losses these latter costs may be several times the size of the expected cost of losses. There is little point in paying such costs unless the protection offered has real value to a buyer.
- Affordable Premium. If the likelihood of an insured event is so high, or the cost of the event so large, that the resulting premium is large relative to the amount of protection offered, it is not likely that anyone will buy insurance, even if on offer. Further, as the accounting profession formally recognizes in financial accounting standards, the premium cannot be so large that there is not a reasonable chance of a significant loss to the insurer. If there is no such chance of loss, the transaction may have the form of insurance, but not the substance. (See the U.S. Financial Accounting Standards Board standard number 113)
- Calculable Loss. There are two elements that must be at least estimable, if not formally calculable: the probability of loss, and the attendant cost. Probability of loss is generally an empirical exercise, while cost has more to do with the ability of a reasonable person in possession of a copy of the insurance policy and a proof of loss associated with a claim presented under that policy to make a reasonably definite and objective evaluation of the amount of the loss recoverable as a result of the claim.
- Limited risk of catastrophically large losses. The essential risk is often aggregation. If the same event can cause losses to numerous policyholders of the same insurer, the ability of that insurer to issue policies becomes constrained, not by factors surrounding the individual characteristics of a given policyholder, but by the factors surrounding the sum of all policyholders so exposed. Typically, insurers prefer to limit their exposure to a loss from a single event to some small portion of their capital base, on the order of 5 percent. Where the loss can be aggregated, or an individual policy could produce exceptionally large claims, the capital constraint will restrict an insurer's appetite for additional policyholders. The classic example is earthquake insurance, where the ability of an underwriter to issue a new policy depends on the number and size of the policies that it has already underwritten. Wind insurance in hurricane zones, particularly along coast lines, is another example of this phenomenon. In extreme cases, the aggregation can affect the entire industry, since the combined capital of insurers and reinsurers can be small compared to the needs of potential policyholders in areas exposed to aggregation risk. In commercial fire insurance it is possible to find single properties whose total exposed value is well in excess of any individual insurer’s capital constraint. Such properties are generally shared among several insurers, or are insured by a single insurer who syndicates the risk into the reinsurance market.
Indemnification
The technical definition of "indemnity" means to make whole again. There are two types of insurance contracts;
- an "indemnity" policy and
- a "pay on behalf" or "on behalf of"[3] policy.
The difference is significant on paper, but rarely material in practice.
An "indemnity" policy will never pay claims until the insured has paid out of pocket to some third party; for example, a visitor to your home slips on a floor that you left wet and sues you for $10,000 and wins. Under an "indemnity" policy the homeowner would have to come up with the $10,000 to pay for the visitor's fall and then would be "indemnified" by the insurance carrier for the out of pocket costs (the $10,000)[4].
Under the same situation, a "pay on behalf" policy, the insurance carrier would pay the claim and the insured (the homeowner) would not be out of pocket for anything. Most modern liability insurance is written on the basis of "pay on behalf" language[5].
An entity seeking to transfer risk (an individual, corporation, or association of any type, etc.) becomes the 'insured' party once risk is assumed by an 'insurer', the insuring party, by means of a contract, called an insurance 'policy'. Generally, an insurance contract includes, at a minimum, the following elements: the parties (the insurer, the insured, the beneficiaries), the premium, the period of coverage, the particular loss event covered, the amount of coverage (i.e., the amount to be paid to the insured or beneficiary in the event of a loss), and exclusions (events not covered). An insured is thus said to be "indemnified" against the loss covered in the policy.
When insured parties experience a loss for a specified peril, the coverage entitles the policyholder to make a 'claim' against the insurer for the covered amount of loss as specified by the policy. The fee paid by the insured to the insurer for assuming the risk is called the 'premium'. Insurance premiums from many insureds are used to fund accounts reserved for later payment of claims—in theory for a relatively few claimants—and for overhead costs. So long as an insurer maintains adequate funds set aside for anticipated losses (i.e., reserves), the remaining margin is an insurer's profit.
Insurers' business model
Underwriting and investing
The business model can be reduced to a simple equation: Profit = earned premium + investment income - incurred loss - underwriting expenses.
Insurers make money in two ways: (1) through underwriting, the process by which insurers select the risks to insure and decide how much in premiums to charge for accepting those risks and (2) by investing the premiums they collect from insured parties.
The most complicated aspect of the insurance business is the underwriting of policies. Using a wide assortment of data, insurers predict the likelihood that a claim will be made against their policies and price products accordingly. To this end, insurers use actuarial science to quantify the risks they are willing to assume and the premium they will charge to assume them. Data is analyzed to fairly accurately project the rate of future claims based on a given risk. Actuarial science uses statistics and probability to analyze the risks associated with the range of perils covered, and these scientific principles are used to determine an insurer's overall exposure. Upon termination of a given policy, the amount of premium collected and the investment gains thereon minus the amount paid out in claims is the insurer's underwriting profit on that policy. Of course, from the insurer's perspective, some policies are winners (i.e., the insurer pays out less in claims and expenses than it receives in premiums and investment income) and some are losers (i.e., the insurer pays out more in claims and expenses than it receives in premiums and investment income).
An insurer's underwriting performance is measured in its combined ratio. The loss ratio (incurred losses and loss-adjustment expenses divided by net earned premium) is added to the expense ratio (underwriting expenses divided by net premium written) to determine the company's combined ratio. The combined ratio is a reflection of the company's overall underwriting profitability. A combined ratio of less than 100 percent indicates underwriting profitability, while anything over 100 indicates an underwriting loss.
Insurance companies also earn investment profits on “float”. “Float” or available reserve is the amount of money, at hand at any given moment, that an insurer has collected in insurance premiums but has not been paid out in claims. Insurers start investing insurance premiums as soon as they are collected and continue to earn interest on them until claims are paid out.
In the United States, the underwriting loss of property and casualty insurance companies was $142.3 billion in the five years ending 2003. But overall profit for the same period was $68.4 billion, as the result of float. Some insurance industry insiders, most notably Hank Greenberg, do not believe that it is forever possible to sustain a profit from float without an underwriting profit as well, but this opinion is not universally held. Naturally, the “float” method is difficult to carry out in an economically depressed period. Bear markets do cause insurers to shift away from investments and to toughen up their underwriting standards. So a poor economy generally means high insurance premiums. This tendency to swing between profitable and unprofitable periods over time is commonly known as the "underwriting" or insurance cycle. [6]
Property and casualty insurers currently make the most money from their auto insurance line of business. Generally better statistics are available on auto losses and underwriting on this line of business has benefited greatly from advances in computing. Additionally, property losses in the United States, due to unpredictable natural catastrophes, have exacerbated this trend.
Claims
Finally, claims and loss handling is the materialized utility of insurance; it is the actual "product" paid for, though one hopes it will never need to be used. Claims may be filed by insureds directly with the insurer or through brokers or agents. The insurer may require that the claim be filed on its own proprietary forms, or may accept claims on a standard industry form such as those produced by ACORD.
Insurance company claim departments employ a large number of claims adjusters supported by a staff of records management and data entry clerks. Incoming claims are classified based on severity and are assigned to adjusters whose settlement authority varies with their knowledge and experience. The adjuster undertakes a thorough investigation of each claim, usually in close cooperation with the insured, determines its reasonable monetary value, and authorizes payment. Adjusting liability insurance claims is particularly difficult because there is a third party involved (the plaintiff who is suing the insured) who is under no contractual obligation to cooperate with the insurer and in fact may regard the insurer as a deep pocket. The adjuster must obtain legal counsel for the insured (either inside "house" counsel or outside "panel" counsel), monitor litigation that may take years to complete, and appear in person or over the telephone with settlement authority at a mandatory settlement conference when requested by the judge.
In managing the claims handling function, insurers seek to balance the elements of customer satisfaction, administrative handling expenses, and claims overpayment leakages. As part of this balancing act, fraudulent insurance practices are a major business risk that must be managed and overcome. Disputes between insurers and insureds over the validity of claims or claims handling practices occasionally escalate into litigation; see insurance bad faith.
History of insurance
In some sense we can say that insurance appears simultaneously with the appearance of human society. We know of two types of economies in human societies: money economies (with markets, money, financial instruments and so on) and non-money or natural economies (without money, markets, financial instruments and so on). The second type is a more ancient form than the first. In such an economy and community, we can see insurance in the form of people helping each other. For example, if a house burns down, the members of the community help build a new one. Should the same thing happen to one's neighbour, the other neighbours must help. Otherwise, neighbours will not receive help in the future. This type of insurance has survived to the present day in some countries where modern money economy with its financial instruments is not widespread (for example countries in the territory of the former Soviet Union).
Turning to insurance in the modern sense (i.e., insurance in a modern money economy, in which insurance is part of the financial sphere), early methods of transferring or distributing risk were practised by Chinese and Babylonian traders as long ago as the 3rd and 2nd millennia BC, respectively.[7] Chinese merchants travelling treacherous river rapids would redistribute their wares across many vessels to limit the loss due to any single vessel's capsizing. The Babylonians developed a system which was recorded in the famous Code of Hammurabi, c. 1750 BC, and practised by early Mediterranean sailing merchants. If a merchant received a loan to fund his shipment, he would pay the lender an additional sum in exchange for the lender's guarantee to cancel the loan should the shipment be stolen.
Achaemenian monarchs of Iran were the first to insure their people and made it official by registering the insuring process in governmental notary offices. The insurance tradition was performed each year in Norouz (beginning of the Iranian New Year); the heads of different ethnic groups as well as others willing to take part, presented gifts to the monarch. The most important gift was presented during a special ceremony. When a gift was worth more than 10,000 Derrik (Achaemenian gold coin) the issue was registered in a special office. This was advantageous to those who presented such special gifts. For others, the presents were fairly assessed by the confidants of the court. Then the assessment was registered in special offices.
The purpose of registering was that whenever the person who presented the gift registered by the court was in trouble, the monarch and the court would help him. Jahez, a historian and writer, writes in one of his books on ancient Iran: "[W]henever the owner of the present is in trouble or wants to construct a building, set up a feast, have his children married, etc. the one in charge of this in the court would check the registration. If the registered amount exceeded 10,000 Derrik, he or she would receive an amount of twice as much."[1]
A thousand years later, the inhabitants of Rhodes invented the concept of the 'general average'. Merchants whose goods were being shipped together would pay a proportionally divided premium which would be used to reimburse any merchant whose goods were jettisoned during storm or sinkage.
The Greeks and Romans introduced the origins of health and life insurance c. 600 AD when they organized guilds called "benevolent societies" which cared for the families and paid funeral expenses of members upon death. Guilds in the Middle Ages served a similar purpose. The Talmud deals with several aspects of insuring goods. Before insurance was established in the late 17th century, "friendly societies" existed in England, in which people donated amounts of money to a general sum that could be used for emergencies.
Separate insurance contracts (i.e., insurance policies not bundled with loans or other kinds of contracts) were invented in Genoa in the 14th century, as were insurance pools backed by pledges of landed estates. These new insurance contracts allowed insurance to be separated from investment, a separation of roles that first proved useful in marine insurance. Insurance became far more sophisticated in post-Renaissance Europe, and specialized varieties developed.
Toward the end of the seventeenth century, London's growing importance as a centre for trade increased demand for marine insurance. In the late 1680s, Edward Lloyd opened a coffee house that became a popular haunt of ship owners, merchants, and ships’ captains, and thereby a reliable source of the latest shipping news. It became the meeting place for parties wishing to insure cargoes and ships, and those willing to underwrite such ventures. Today, Lloyd's of London remains the leading market (note that it is not an insurance company) for marine and other specialist types of insurance, but it works rather differently than the more familiar kinds of insurance.
Insurance as we know it today can be traced to the Great Fire of London, which in 1666 devoured 13,200 houses. In the aftermath of this disaster, Nicholas Barbon opened an office to insure buildings. In 1680, he established England's first fire insurance company, "The Fire Office," to insure brick and frame homes.
The first insurance company in the United States underwrote fire insurance and was formed in Charles Town (modern-day Charleston), South Carolina, in 1732. Benjamin Franklin helped to popularize and make standard the practice of insurance, particularly against fire in the form of perpetual insurance. In 1752, he founded the Philadelphia Contributionship for the Insurance of Houses from Loss by Fire. Franklin's company was the first to make contributions toward fire prevention. Not only did his company warn against certain fire hazards, it refused to insure certain buildings where the risk of fire was too great, such as all wooden houses. In the United States, regulation of the insurance industry is highly Balkanized, with primary responsibility assumed by individual state insurance departments. Whereas insurance markets have become centralized nationally and internationally, state insurance commissioners operate individually, though at times in concert through a national insurance commissioners' organization. In recent years, some have called for a dual state and federal regulatory system (commonly referred to as the Optional federal charter (OFC)) for insurance similar to that which oversees state banks and national banks.
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