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Mama And Her Family
Updated on 01.12.2019 01.12.2019 by Gagis
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8 thoughts on " Mama And Her Family "
Arashisar says:
Jan 22, · Mama's Family originated with Thelma "Mama" Harper, and her younger sister Fran living together in Mama's House/10(K).
Mazuzragore says:
Dec 17, · Directed by Dave Powers. With Vicki Lawrence, Ken Berry, Dorothy Lyman, Beverly Archer. Mama considers selling a brooch that belonged to her late mother, but has second thoughts when the old woman's spirit begins to haunt her in protest/10(35).
Maulrajas says:
May 12, · Mama June is 'rebuilding trust' with her family after their estrangement Credit: Getty Images - Getty 7 Dr. Ish has appeared on the show to help the struggling family June, 40, is currently living Author: Teresa Roca.
Sep 10, · Her mother owned the Regency Travel Agency in Ellicott City for 25 years. "They [photographs] have made a bunch of moves. There has always been someone in our family who has wanted them.
Voodoom says:
Sep 07, · Mama June: From Not to Hot updates show April 24th was the last time any of her family was featured. And, it was a promo for Family Crisis. Since then, Alana Thompson (Honey Boo Boo) and Lauryn "Pumpkin" Shannon have not been seen with their mother. Perhaps, she is in contact with her family but simply chooses not to make it public.
Dazragore says:
Thelma is in her late 70s during "Mama's Family". Vicki Lawrence was in her 30s during this time and would not turn 60 until Thelma's squabbles and offhand disregard for daughter Eunice and Eunice's husband, Ed, and son, Bubba, was the ongoing theme of The Family sketches. In Mama's Family, Thelma lived originally with her sister.
Faezragore says:
Ellen Jackson (née Mary Ellen Harper), who made sporadic appearances in the sketch comedy, The Family, and its spin-off sitcom, Mama's Family, was played by Betty White. Ellen was born on June 30 in Raytown and is the oldest of Carl Harper .
Dinos says:
Sep 05, · Jessica Krug skipped her own mother's funeral — and now family members are suggesting the college professor was a no-show because she didn't want to get caught pretending to be a black.
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Zolomuro on Mama And Her Family


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La  Llei de Gresham  és el principi segons el qual, quan en un país circulen simultàniament dos tipus de monedes, ambdues de curs legal, i una d'elles és considerada pel públic com a "bona" i l'altra com a "dolenta", la moneda dolenta sempre expulsa del mercat a la bona, ja que els consumidors prefereixen estalviar la bona i no utilitzar-la com a mitjà de pagament.

Aquest enunciat és un dels pilars de l'economia de mercat. L'home que va arribar a aquesta conclusió va ser sir Thomas Gresham. Gresham, important financer i mercader de la seva època, es va adonar que, en totes les transaccions que portava a terme, la gent preferia pagar amb la moneda més feble del moment i estalviar la més forta per, arribat el cas, exporta-la o fondre-la, doncs tenia més valor com a divisa o com a metall en lingots.

Aquest fenomen ja s'havia observat per mercaders, financers i homes d'Estat abans del . Quan sir Thomas Gresham va manifestar aquest fet, no va desenvolupar cap formulació teòrica de la seva idea, i no va ser fins a finals del , quan aquest principi es va conèixer com la  llei de Gresham .

El mecanisme es va aplicar durant el període del bimetalisme, al . L'or es va convertir en el principal mitjà internacional de pagament només a partir de finals de segle. Anteriorment, la plata i l'or van competir entre si: el bimetalisme consistia en l'establiment d'una paritat fixa entre l'or i la plata i les monedes d'ambdós metalls, i eren mitjans acceptats tant a nivell nacional com internacional.

La llei de Gresham es compleix en les següents situacions:

 Circulació de monedes del mateix metall. Les monedes més deteriorades desplacen a les més ben conservades.
 Circulació de monedes de diferents metalls. La moneda amb el valor comercial inferior al seu valor monetari, desplaça aquella amb el valor comercial major que el valor monetari.
 Circulació de monedes i bitllets. Tradicionalment el bitllet complia la funció de moneda dolenta enfront de les monedes.

Un exemple d'aquesta llei es va posar de manifest a Espanya durant els anys seixanta del , quan es van encunyar monedes de plata de 100 pessetes, que van desaparèixer de la circulació en apujar el preu de la plata en el mercat internacional.

Aplicació de la llei per a avaluar la recerca científica
En ciència es fa referència a la llei de Gresham quan es creu que la mala ciència produeix resultats. Això és, que les males pràctiques poden portar a nous descobriments científics. Com si la possibilitat d'un accident donés més fruits que l'aplicació correcta del mètode científic o, en un cas més ampli, la ràpida i popular proliferació dels resultats il·lusoris de la pseudociència i de les ciències ocultes, sobre els resultats de l'aplicació del mètode científic.

Referències

Diner
Gresham

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UFC Fight Night Hunt vs. Mir originates from the Brisbane Entertainment Centre in Brisbane, Australia, but you don't have to miss one second of the action from just about anywhere in the world.
Below is a guide so you know exactly when the main card portion of the evening begins in your time zone as well as how you can watch it.
*After-Air Delay: Viewers in Canada will be able to watch the Prelims on UFC FIGHT PASS immediately following the conclusion of the event.


What impact does assisted rental housing have on the nearby community? Not much, according to a new report issued to coincide with the annual Governor's Conference on Housing.
The typical complaint from homeowners that rental assistance being instituted at nearby homes will cause their property values to plummet may be unfounded. A study funded by the Delaware State Housing and the Citi Foundation found that found that in most cases, property values in areas where rental assistance goes into place are already low or on the decline.
The report states, "Assisted rental housing has historically been disproportionately located in low-income neighborhoods, where the housing is relatively smaller, older, more depreciated- and hence, lower valued- than homes elsewhere in Delaware." Homes near assisted rental properties are about 30% lower in price than homes that are further away, but those lower valued homes are also smaller, older and in poorer condition than homes that are not near rental assistance homes.
You can read the full report on the Delaware State Housing Authroity's website.
The report coincides with the 2012 Goveror's Conference on Housing. The crowd in attendance heard from state leaders including members of the state's Congressional Delegation and Governor Markell. They also heard from keynote speaker HUD Secretary Shaun Donovan. You can watch an except of Markell and Donovan's discussion below.


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Future's Nobody Safe Tour to open PNC Bank Arts Center season
Chris Jordan
@ChrisFHJordan
E.E. Cummings, the noted poet of the first half of the last century, was infamous for declaring war on punctuation, including commas.
Hip-hop star Future attacks commas on his smash hit, "(Blank) Up Some Commas." When it comes to Future, his comma reference is about making money.
He stands to make some this year as he headlines the Nobody Safe Tour, which hits amphitheaters and arenas across the country this summer, including a season-opening show Thursday, May 18 at the PNC Bank Arts Center in Holmdel. Young Thug, Tory Lanez, Zoey Dollaz and A$AP Ferg are also on the bill.
MORE: How video saved the Jersey hip-hop star
It's a busy time for the Atlanta emcee, aka Nayvadius Wilburn. He released the self-titled album "Future," in February and a week later, he released "Hndrxx." Both went to No. 1 on the Billboard 200 albums chart.
It came into focus for him when he went off social media, he said to Apple Music's Zane Lowe
"Everything started coming together when I shut down the (social) media." Future said. "I want to give all my attention to my music, my family, and my kids ... It was probably the best thing that I ever done."
Future, whose hits include "Turn On the Lights," "Jumpman," "Used to This," and "Low Life," is known for his slurry rhymes and hazy flow. He was supposed to play two Jersey shows with Drake at the Prudential Center in Newark last October. The shows were canceled because of an ankle injury to Drake, so Future has set up his own headlining Jersey dates this summer, which included including the BB&T Pavilion in Camden on Friday, May 12.
Future's latest single, "Mask Off," featuring a groovy, New Agey flute riff, is a hit. Watch out, commas.
Chris Jordan: cjordan@app.com
NOBODY SAFE TOUR FEATURING FUTURE
With Young Thug, Tory Lanez, Zoey Dollaz and A$AP Ferg
WHEN: 7 p.m. Thursday, May 18
WHERE: PNC Bank Arts Center, Garden State Parkway, Holmdel
TICKETS: $49.50 to $69.50
INFO: www.livenation.com

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Google exposes G Suite issue that stored plain-text passwords on its servers for 14 years
"We apologize to our users and will do better."
Google has begun forcing "a subset of our enterprise G Suite customers" to change their passwords after an issue that inadvertently left passwords exposed for more than a decade.
In a post to its Google Cloud blog Tuesday, the company outlined an error made back in 2005 that stored a copy of actual user passwords rather than the usual scrambled "hashed" version, thus making it possible for an outside attack to gain access to usable passwords. Google explains that the issue has been fixed and the company has "seen no evidence of improper access to or misuse of the affected passwords."
Google says the passwords were still stored on its "secure encrypted infrastructure," so the likelihood of an outside attack was low.
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on LastPass
Google blames a legacy feature set for the issue. Back in 2005, G Suite domain administrators were given the ability to set and recover passwords on the client side for their own users, so they needed access to unhashed passwords. Google has since jettisoned this functionality and requires all G Suite passwords to be reset rather than recovered, just like Gmail.
Additionally, Google unearthed a separate issue that started in January that also led to unhashed passwords being stored for up to 14 days. Like the other issue, Google has fixed the problem and hasn't found any evidence of "improper access to or misuse of the affected password."
As a result, Google is informing all affected clients to change impacted passwords and will reset any that aren't manually changed. Google apologized for the issue and promised it "will do better" in the future.
While this particular issue doesn't affect Gmail users (outside of G Suite subscribers), it drives home the need to use strong, unique passwords for every critical site and service you use. If you aren't using a password manager yet, you should be. Our roundup of the best password managers can get you on the right track if you need help selecting one.
[ Further reading: The best antivirus for Windows PCs ]
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Le Mans: News, notes and how to watch pre-race round-up
By DizbizroundupJun 13, 2014, 11:08 AM EDT
The beauty of 24 Hours of Le Mans week is that there's a lot of news… and the occasional frustration of Le Mans week is that there's a lot of news.
QUALIFYING TIMES, STARTING GRID
But with a week of on-track preparation in the bag, and all the pre-race events out of the way, it's time to analyze where we are and round-up the key items from the time in France:
The LMP1 battle: Fuel. Economy. It's the two words we'll hear a bit and know for certain after the first two stints – so watch carefully to see how Audi, Toyota and Porsche get on in terms of lap count. Project it out, and that's how you'll be able to sort out the pit stop number the remaining 22 hours or so.
Mark Webber's return: The highest profile new addition to the FIA World Endurance Championship, and Le Mans by default, makes his first start here in 15 years aboard the No. 20 Porsche 919 Hybrid he'll share with Timo Bernhard and Brendon Hartley. I'm sure I'm not the first to write that here's to landing and ending on all four wheels this time around, after his 1999 aerial excursion for Mercedes.
Slow zones: New for 2014 are the introduction of designated "slow zones," where certain portions of the track are temporarily speed-restricted to 60 km/hr. There's been some concern in the paddock about speed disparities as cars close up, and whether all drivers will note when the "slow zone" caution lights appear on the dash. Another case of "stay tuned while this gets sorted out early, and we'll figure it out how it affects the race later."
'Merica, on the team front: From the U.S. perspective, Corvette Racing and Dempsey Racing-Proton are the likely contenders in GTE-Pro and GTE-Am for hopeful podium finishes. One for Corvette would tie a nice wrap around its 15th anniversary at Le Mans and be the first for the new C7.R; one for Dempsey would be the first for Patrick Dempsey.
'Merica, on the driving front: There's 18 U.S. drivers in this year's race, although only a handful that are that well-known in the States. Brothers Jordan and Ricky Taylor, Greaves' Chris Dyson and 16-year-old Matt McMurry and the all-American Dempsey lineup of Dempsey, Joe Foster and Patrick Long have some cache though.
GTE scrap: Only four manufacturers are entered but it's hard to separate much of Ferrari, Corvette and Aston Martin, and oddly its defending double class champion Porsche that enters the race on the back foot with their Porsche 911 RSR and older Porsche 911 GT3 RSR models, respectively. LMP1 may be the show, but GTE-Pro and Am are not going to be lacking for action, either.
LMP2's showdown: Chances are a Nissan engine's going to win, as it powers 13 of the 17 cars entered. But the chassis showdown between the venerable Oreca 03, Zytek Z11SN and Morgan cars against the debuting Ligier JS P2 –which thus far has shown impressive pace – is the thing to watch.
"Stig green": Krohn Racing is a cool and popular underdog team to watch this year; Tracy Krohn's team having been able to make it on a tight schedule. Former "Top Gear" "Stig" Ben Collins is a late and valuable add to the driver lineup. "It reminds me of two days as a green stig, when we did the environmentally friendly, very badly executed car we made on Top Gear. It's really useful on the track because the thing stands out by a mile," Collins told MotorSportsTalk.
Pre-race war of attrition: Name a car at random and there's a good chance it's been involved in an incident this week. Most have been in GTE, but there's been a number of LMP1 and LMP2 cars involved too. I'm guessing we haven't heard the last of this theme song thus far, but I'm really hoping the frequency of carnage subsides.
Prayers for safety: From talking to some of those here last year (and I can't say I was one of them), there's the sense that the race carried on after Allan Simonsen's fatal accident just because it had to. No one wants an encore and frankly, we've had too many scary accidents in practice this week – none of them on replay (Loic Duval's, James Calado's and Fernando Rees' all at Porsche Curves) – that puts a freaky sense out there heading into Saturday's race. Even if you're not religious, pray for a safe, clean 24 hours where all 162 drivers, crews and fans come home in one piece.
How to watch: Saturday, June 14 – 8:30 AM to 4:00 PM (FOX Sports 1, LIVE), 4:00 PM to 5:00 PM (FOX Sports 2, LIVE), 6:30 PM to 1:00 AM (FOX Sports 2, LIVE), 1:00 AM to 7:30 AM (FOX Sports 1, LIVE), 7:30 AM to 9:30 AM (FOX Sports 2, LIVE); with the entire race streamed LIVE on FOX Sports GO. All times are ET.
Follow @TonyDiZinno


Published: Nov. 13, 2012 at 06:24 p.m.
Updated: Nov. 13, 2012 at 06:47 p.m.
Gregg Rosenthal will watch every rookie quarterback snap this season, and rank the signal-callers every Tuesday based on that week's performance only. It's a tough job, but he's up for it.
This is a strange week for the rookie quarterback ranks. Two rookies (RG3 and Brandon Weeden) were off and Luck's game against the Jacksonville Jaguars feels like ancient history by now.
Luck's national debut actually wasn't one of his better games. We have it rated below average for his season because of a handful of poor decisions, including one interception overturned by a penalty. It's remarkable that a game from Luck that included an 8.7 yards per attempt average and at least 3 drive-killing drops by his receivers is not a great effort from him.
Luck's terrific rushing season continued with two more scores, and he remains aggressive pushing the ball down the field. He added four plays to his NFL-leading 41 throws over 20 yards this year. Luck is tied for the top spot with ... Peyton Manning. Just two guys with arm strength concerns.
The kid throws such a pretty deep ball. Watch the long scores to Golden Tate and Sidney Rice in the clips below. Wilson has 11 touchdown tosses and no interceptions at home this year. His running was a big positive in this win over the New York Jets. Wilson only got edged out for the top spot because of a lackluster first half.
It was still a strong performance overall and continues Wilson's upward trajectory after a slow start to the season.
Based on the final score, I was expecting a lot worse from Tannehill in a 37-3 loss to the Tennessee Titans. This is why it's so good to watch Game Rewind. Tannehill literally didn't have a bad play on Miami's first three drives while the Dolphins fell behind 14-0. Drops, penalties, a fumble by Reggie Bush and short-yardage running stopped drives. Tannehill had only one bad pass before the score was 21-0. His first interception (returned for a score) came on a tipped pass. Bad luck.
Tannehill's second interception was slightly off target and Anthony Fasano didn't fight for the ball. The third pick was all on Tannehill -- he didn't see linebacker Zack Brown in coverage -- although we were well into garbage time by then. It sounds weird, but this was mostly an accurate game from Tannehill. He saw blitzes coming and went to his second read. Occasionally, Tannehill checked it down too much, which is uncharacteristic for his career. The coaches film showed the Dolphins could not get separation deep. This team needs more speed at wide receiver.
Tannehill wasn't great in this game and didn't deserve to be ahead of Wilson. But he was far from Miami's biggest problem against the Titans. The Dolphins' defense was pathetic.


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BIDBEARE FARMHOUSE
Torridge (District Authority)
SS 66131 05948
WINKLEIGH SS 60 NE 10/124 Bidbeare Farmhouse II Farmhouse. Early C17 possibly with earlier origins, C19 addition, C20 alterations and addition. Plastered cob and rubble walls. Gable-ended asbestos slate roof. Brick stack at left gable-end, rubble rear lateral stack and a similar lateral stack at side of rear wing with a brick shaft. Plan: original plan not entirely clear but either 2 or 3 room-and-through-passage with lower room to the right. The arrangement of the rooms at the higher end is more problematic, it is at present two with the larger room, obviously the hall, at the centre, heated by a rear lateral stack. Beyond it is a very narrow room but this has a very splendid fireplace in its end wall which must have been intended for an important room so it seems the room arrangement must have altered. Behind the hall and passage a large kitchen wing was added which exhibits no features earlier than the C19 but may date back further. The lower end appears to have been rebuilt in the later C19 and a small late C20 addition was erected behind the left-hand end. Internal alterations have also taken place in the C20 such as the insertion of stairs into the passage. Exterior: 2 storeys. Asymmetrical 4-window front of mainly C19 sashes of 6:4:6 panes on the 1st floor and 8 panes on the ground floor to left of centre. There is a large late C20 casement to left on first floor and late C20 French windows have been inserted on the ground floor to the right. Narrow C20 glazed door to the left. To right of centre is a late C19 or early C20 gabled stone porch with segmental arch and C19 panel door behind. Interior: the most impressive feature is the very fine early C17 fireplace with plaster overmantle in the left-hand end room. It has chamfered and ball-stopped granite jamb to the left jowelled at the top to support a hollow chamfered and ogee- stopped wooden lintel. To the right only the top, jowelled section of the jamb survives. The plaster overmantle has a male and female figure to either side with strapwork motifs inbetween and a heraldic shield at the centre which apparently bears the arms of Gidleigh and Northleigh so it may celebrate a wedding (The Gidleigh family were responsible for erecting a memorial chapel in Winkleigh Church (q.v)). This is virtually the only exposed early feature in the house although the hall is likely to have concealed ceiling beams and fireplace, and possible an early doorway according to the present occupants.
Listing NGR: SS6613105948


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Unbreakable (2000)
Watch Unbreakable (2000) Online
An ordinary man makes an extraordinary discovery when a train accident leaves his fellow passengers dead — and him unscathed. The answer to this mystery could lie with the mysterious Elijah Price, a man who suffers from a disease that renders his bones as fragile as glass.
Genre: Drama, Mystery, Science Fiction, Thriller
Director: M. Night Shyamalan
Actors: Bruce Willis, Davis Duffield, Johnny Hiram Jamison, Laura Regan, Robin Wright, Samuel L. Jackson, Spencer Treat Clark
Wonder (2017)
The story of August Pullman – a boy with facial differences – who enters fifth grade, attending a mainstream elementary school for the first time.
Genre: Drama, Family
The Huntsman: Winter's War (2016)
As two evil sisters prepare to conquer the land, two renegades—Eric the Huntsman, who aided Snow White in defeating Ravenna in Snowwhite and the Huntsman, and his forbidden lover, Sara—set…
Genre: Action, Adventure, Drama, Fantasy
Bamboozled (2000)
TV producer Pierre Delacroix becomes frustrated when network brass reject his sitcom idea. Hoping to get fired, Delacroix pitches the worst idea he can think of: a 21st century minstrel…
A white midwestern girl moves to Chicago, where her new boyfriend is a black teen from the South Side with a rough, semi-criminal past.
Genre: Drama, Music, Romance
Grace of Monaco (2014)
The story of former Hollywood star Grace Kelly's crisis of marriage and identity, during a political dispute between Monaco's Prince Rainier III and France's Charles De Gaulle, and a looming…
Country: Belgium, France, Italy, Switzerland
The Family Fang (2015)
Hands of Stone (2016)
The legendary Roberto Duran and his equally legendary trainer Ray Arcel change each other's lives.
Country: Panama, USA
Genre: Biography, Drama, Sport
Son of a Gun (2014)
Locked up for a minor crime, 19 year old JR quickly learns the harsh realities of prison life. Protection, if you can get it, is paramount. JR soon finds himself…
Country: Australia, Canada, UK
Denial (2016)
Acclaimed writer and historian Deborah E. Lipstadt must battle for historical truth to prove the Holocaust actually occurred when David Irving, a renowned denier, sues her for libel.
The Fan (1996)
When the San Francisco Giants pay center-fielder, Bobby Rayburn $40 million to lead their team to the World Series, no one is happier or more supportive than #1 fan, Gil…
Genre: Action, Drama, Sport, Thriller
We Take the Low Road (2019)
A Wiki-Leaks release illuminates the collusion amongst politicians and the medical industry that drives the cost of medical care to an unattainable price for the middle class. With the guilty…
American Pastoral (2016)
Set in postwar America, a man watches his seemingly perfect life fall apart as his daughter's new political affiliation threatens to destroy their family.
Trailer: Unbreakable (2000)


Resumen: Abstract In group decision making (GDM) dealing with Computing with Words (CW) has been highlighted the importance of the statement, words mean different things for different people, because of its influence in the final decision. Different proposals that either grouping such different meanings (uncertainty) to provide one representation for all people or use multi-granular linguistic term sets with the semantics of each granularity, have been developed and applied in the specialized literature. Despite these models are quite useful they do not model individually yet the different meanings of each person when he/she elicits linguistic information. Hence, in this paper a personalized individual semantics (PIS) model is proposed to personalize individual semantics by means of an interval numerical scale and the 2-tuple linguistic model. Specifically, a consistency-driven optimization-based model to obtain and represent the \PIS\ is introduced. A new \CW\ framework based on the 2-tuple linguistic model is then defined, such a \CW\ framework allows us to deal with \PIS\ to facilitate \CW\ keeping the idea that words mean different things to different people. In order to justify the feasibility and validity of the \PIS\ model, it is applied to solve linguistic \GDM\ problems with a consensus reaching process.


Much has been written regarding Munchausen Syndrome, Factitious Disorders and Malingering, focusing upon defining these disorders, as well as diagnosing them. This author suggests the need for further research regarding the etiology of such disorders. Is there a particular background or demographic history, that may result in a predisposition to such disorders? In particular, this author seeks information that may explore the notion that many people suffering from these disorders may be the offspring of medical personnel (such as doctors), and may be seeking attention that they feel had been directed elsewhere (toward the sick) during their childhood or lifetime. This paper will explore these disorders, as well as any information that may point toward this theory.
Much has been written that defines Munchausen Syndrome, factitious disorder and malingering. In fact, there is some conflicting information in the literature in terms of the distinction among these disorders. There are several authors/sources that regard Munchausen Syndrome and factitious disorder as the same (PsychNet UK, 2003). Others distinguish factitious disorder as similar to Munchausen Syndrome (Merck Manual, 2006).
Generally, Munchausen Syndrome is a condition in which a person intentionally fakes, simulates, worsens or self-induces an injury or illness for the main purpose of being treated like a medical patient (eMedicine, 2003). It is a psychiatric disorder in which the physical or psychological symptoms are under the voluntary control of the patient (HealthAtoZ, 2006). It is named after a German military man, Baron von Munchausen, who was reported to travel around telling fantastic tales about his imaginary exploits (eMedicine, 2003). The name was applied in 1951 to persons who traveled around from hospital to hospital, fabricating various illnesses, by Richard Asher (eMedicine, 2003). It is often used interchangeably with factitious disorder, although factitious disorder often refers to any illness that is intentionally produced for the main purpose of assuming the sick role, with that purpose often unknown to the sick person (eMedicine, 2003). It is not a new, modern disorder; the philosopher Galen, in the second century, reported observations of factitious disorder (Feldman & Ford, 1994). Karl Menninger, in 1934, reported on persons with a "doctor addiction", marked by intense aggression against oneself and the physician, whom Menninger believed symbolized the "perceived sadistic parent" (Feldman & Ford, 1994, p.25).
Munchausen Syndrome may then be characterized as a chronic variant of a factitious disorder, with mostly physical signs and symptoms (eMedicine, 2003). There is much literature denoting the psychological or psychiatric Munchausen Syndrome (where persons feign psychiatric symptoms), but this paper will focus upon medical Munchausen and factitious disorder, as well as malingering.
Persons suffering from Munchausen Syndrome will intentionally cause signs and symptoms of an illness or injury by inflicting medical harm to their body, often to the point of having to be hospitalized; these people are often eager to undergo serious and invasive medical interventions (eMedicine, 2003). They are also known to move from doctor to doctor, hospital to hospital, or even town to town, in an effort to find new audiences for their medical claims; once they have exhausted the options available to them regarding treatment and medical workups in one medical setting, they will try others (eMedicine, 2003). It seems to be motivated by a need to be a patient (HealthAtoZ, 2006). Interestingly, persons with Munchausen Syndrome may also make false claims as to their accomplishments, credentials, relations to famous persons, etc. (eMedicine, 2003). A related condition, named Munchausen by Proxy, refers to a caregiver who fakes symptoms in a child or other person under their care, by deliberately causing injury to that person; they then will often want to be with that person in a hospital or similar medical setting (eMedicine, 2003). They may only exaggerate or fabricate their child's symptoms, or they may deliberately induce symptoms through such methods as poisoning, starvation, suffocation or actually infecting a child's bloodstream (HealthAtoZ, 2006).
Persons with Munchausen Syndrome will knowingly fake symptoms, but usually do so for psychological reasons, and not for monetary or other discrete objectives, as in the case of malingering (PsychNet-UK, 2003). Their series of successive hospitalizations tends to become a lifelong pattern, accompanied by internal, psychological motivation, as opposed to external rewards (PsychNet-UK, 2003). They will follow through with medical procedures and are often at risk for drug addiction and for the many complications that might accompany multiple surgeries (PsychNet-UK, 2003). People with factitious disorder are such expert liars that they appear to share characteristics with persons who have an antisocial personality disorder (Healthinmind, 2003). They appear, to an outsider, to share characteristics of a masochist, as they will arrange to cause pain to themselves through surgeries and other treatments (Healthinmind, 2003).
Another interesting manifestation of Munchausen Syndrome is Munchausen by Internet, where persons will utilize the internet to perpetuate their claims of serious illnesses and symptomology (Feldman, 2001). The internet can be a very helpful source of information and support for persons who are suffering from chronic illnesses, particularly those who may be confined to their homes as a result of their illnesses; however, persons who engage in Munchausen by Internet take advantage of this opportunity by going from site to site, support group to support group, telling tales of their grievous afflictions (Feldman, 2001).They can simplify the real-life process of going from hospital to hospital by joining multiple internet groups simultaneously; they can pretend to have several illnesses at once, and can gain a great deal of sympathy as a result (Feldman, 2001). Or, they can even pretend to be the loved one or parent of a person with a serious illness, again gaining sympathy from many others (Feldman, 2001).
There have also been cases of children themselves faking illnesses; there have been cases of children (as young as eight years old) that have convinced their caregivers that they are suffering from chronic illnesses (DeNoon, 2000). One case documents a girl who was thought to have suffered from a mysterious fever from the age of twelve until seventeen; however, it was discovered that she had been faking thermometer readings (DeNoon, 2000).There have also been cases where children had inflicted serious harm upon themselves or fooled doctors into admitting them for prolonged hospital stays or repeated operations (DeNoon, 2000). These children, if left untreated, will go on to become adults who repeatedly fake illness (DeNoon, 2000).
The main or central theme to all definitions of malingering is that the term applies to persons who deliberately pretend to have an illness or disability in order to receive financial or other gain, or to avoid punishment or responsibility (Booth, 2006). Personal gain is always the motivation behind malingering; persons who malinger will feign an illness in order to seek an external reward (Booth, 2006). Examples would be a criminal who wants to avoid punishment, someone who wishes to be paid for a nonexistent disability, or someone who is simply avoiding responsibility (Booth, 2006).
Malingering is the purposeful exaggeration of real symptoms, physical or psychological. in order to receive some kind of reward. Malaingering can take many forms; persons can feign either mental or physical illnesses. In the case of mental illness, with very little coaching, a person can easily simulate the symptoms of major depressive disorder, post-traumatic stress disorder or panic disorder with agoraphobia (Booth, 2006). Regarding more physical disorders, general symptoms such as headaches, dizziness, low back pain and stomach pain are easily manufactured; x-rays, magnetic resonance imaging (MRI), or CAT scans are often unable to determine a physical cause (Booth, 2006).
Interestingly, fakers will use less severe symptoms to escape detection; it is theorized that the feigning of more severe mental and physical disorders is more difficult to maintain. On measures designed to detect malingering, persons who successfully fake symptoms endorse fewer actual symptoms, staying away from unduly strange or bizarre symptoms (Booth, 2006).
Due to the difficulty of detecting malingering, its actual incidence is unknown (Booth, 2006). If a disorder is determined as having no basis in fact, then the diagnostician must consider the possibilities of either malingering or factitious disorder. Factitious disorder is a legitimate malady, where malingering is not; both involve feigned illnesses (Booth, 2006). In the case of factitious disorder, the person produces fake symptoms to fulfill the need to maintain the sick role-they may seek an emotional gain (Booth, 2006).Being sick gives the person with factitious disorder attention from physicians and sympathy from loved ones; this goal is not the same as the malingerer's, whose motivation is always external (Booth, 2006). The malingerer is usually seeking to accomplish one of three things: evade hard or dangerous situations, punishment or responsibility; gain rewards such as free income, source of drugs, sanctuary from police or free hospital care; or avenge a monetary loss, legal ruling or job termination (Booth, 2006). It is usually suspected when a person is referred for evaluation by an attorney, or when there is a noticeable and distinct difference between the level of reported distress or disability and the actual functioning level of the person (observed at work, at leisure or at home) (Booth, 2006).
The person who is malingering frequently is uncooperative for an evaluation. In addition, persons who malinger are also often diagnosed with an antisocial personality disorder (Booth, 2006). In malingering, the person's medical condition, while once existing, or greatly exaggerated (as in the case of low back pain, for which months of chiropractic care or physical therapy results in no improvement) (PsychNet-UK, 2003). Or, an accident is staged so that an injury is either caused, or can be claimed; the malingerer (as opposed to the Munchausen patient) is often unwilling to undergo extensive or painful diagnostic testing, treatment or surgery (PsychNet-UK, 2003). Malingering is often suspected if the patient's symptoms are presented in a medicolegal context, or if there is a marked discrepancy between the person's claimed disability and the objective findings (Wikipedia, 2006).
In the case of medical malingering, it is difficult for doctors who are presented with patients who claim a confusing variety of symptomology, consisting of a confusing collection of musculoskeletal complaints (Kiester & Duke, 1999). Oftentimes, their evaluation does not suggest a definitive diagnosis, but physicians are reluctant to merely pass it off as being "all in their heads", in case they may be missing a genuine injury or disability. For this reason, many doctors are utilizing the eight Waddell signs that are very useful in identifying nonorganic back pain (Kiester & Duke, 1999). It is a systematic approach that appears to be an effective way to help patients receive the best treatment for their true condition, and may avoid long and expensive periods of testing and treatment.
Nonorganic pain can be a deliberate deception or a process that is unknown to the patient (Kiester & Duke, 1999). It includes malingering motivated by secondary gain, Munchausen's Syndrome and psychosomatic disorders.
Through a thorough knowledge of neuroanatomy, as well as the effects of organic pain syndromes upon various nerves, muscles and bodily functions, the physician conducting the examination for Waddell signs can distinguish real from imagined or feigned pain (Kiester & Duke, 1999). An examination for these eight signs include: superficial tenderness; nonanatomic tenderness; axial loading; simulated rotation; distracted straight-leg raise; regional sensory change; regional weakness; and overreaction (Kiester & Duke, 1999). The predictive value of this process is greatly improved when three or more positive signs are present.
The idea behind these signs is that a person who is presenting with back pain will react with pain when many different manipulations are conducted; the average person does not have a sophisticated knowledge of many of the specific neuropathways that certain musculoskeletal pain takes. Therefore, their statement of pain may not always be consistent with the injury they are claiming, and the Waddell Signs are very specific to certain types of back pain. It is a very useful tool to a differential diagnosis of back injury versus nonorganic pain.
The assessment of malingering can be very difficult; for that reason, most clinicians find it helpful and necessary to employ standardized assessments to help them in this most difficult process. Several standardized assessments have been reviewed that might be utilized in the assessment of malingering (Pope, 2005). Those that are cited here might be used to detect medical malingering.
It appears that there are many instruments designed to detect malingering among brain injured claimants and those who may be feigning mental illness. However, there are not as many instruments that assess maligning of other disorders, suggesting that is, indeed, a difficult disorder to diagnose. Assessment instruments that are useful in this respect are often designed to focus upon the person's claims and presentation of symptoms; they appear to be designed to assess consistency in patient response, as well as patterns of exaggeration.
Interestingly, a review in the American Journal of Forensic Psychology in 2002 concluded that the DSM-IV is far too limited in its definition to be considered a reliable method of detecting malingering, and by its language, may frequently lead to false positives (Gerson, 2002). Another review suggests, using data from the TOMM, that malingering tests themselves, though very accurate, can be imperfect, because the test results of honest responders overlap with those of test takers who are feigning or exaggerating (Mossman, 2003).
In order to assess reports of pain, the McGill Pain Questionnaire (MPQ) and the Modified Somatic Perception Questionnaire (MSPQ) were compared (Larrabee, 2003). The study found that the MPQ was better than the MSPQ at detecting exaggerated pain symptoms; however, the author cautions that elevations in scores should not be used independently to detect malingering (Larrabee, 2003). A study of the Lees-Haley Fake Bad Scale and its ability to measure somatic malingering was utilized on 408 persons in a chronic pain group (among other groups) (Butcher, Arbisib, Atlisa & McNulty, 2003). The study found that the FBS is more likely to measure general maladjustment and somatic complaints, rather than malingering. When malingering takes on a legal context, evidence is often gathered by a private investigator (e.g., videotaping a "paralyzed" person dancing at a party, or even walking around their home) (Wikipedia, 2006).
It is very difficult to measure or detect malingering, and there are few standardized instruments available to help in the cases of persons who continually present to doctors with chronic complaints. Therefore, assessment is complex, and must address many facets of the person, including a thorough examination of psychological factors, such as overall maladjustment or personality disorders. Malingering is often thought of as intentional deceptive behavior, and not a medical or psychiatric disorder (Med League Support Services, 2006).
It is often difficult to diagnose or identify persons with Munchausen or factitious disorder because they often move from one doctor or hospital to another, particularly when they feel that they are in danger of being discovered (eMedicine, 2003). One method to track persons who present with chronic appearances at hospitals or clinics has been implemented by the state of Washington; they were able to save $100,000 per patient per year by installing a tracking system that identified persons with factitious disorder and prevented them from being readmitted repeatedly to hospitals for treatment (Healthinmind, 2003). However, in general, persons with factitious disorders usually present with unconventional and fantastic symptoms that are labile and inconsistent; they can change markedly from one day to another (Szoke, 1999). The changes in symptoms are not related to the treatment, but are often influenced by the patient's environment; the patient will increase the mimicry of symptoms if they feel that they are being observed (Szoke, 1999). However, the patient is always seeking psychological incentives, eliciting caregiving behaviors from others (Szoke, 1999).
These patients make the simulation of disease the center of their lives; their constant illnesses result in joblessness and drifting behavior (Feldman & Ford, 1994). Their self-destructive, itinerant behavior often puts them at odds with the law, and can push them over the line that separates Munchausen from malingering; they may use their symptoms to gain room and board, or other types of ill-gotten gain (such as social security payments that allow them to continue to be sick) (Feldman & Ford, 1994).
Munchausen by internet can be suspected if the person's claims mimic the writing of previously published accounts of the disease from journals, books or other health-related websites (Feldman, 2001). If the person feigning the illness emerges as a caricature, or they alternate between near-fatal bouts of illness and miraculous recoveries, or there are continual dramatic events in the person's life, Munchausen by internet can be suspected (Feldman, 2001).
Little is known regarding the etiology or psychopathology of factitious disorders with physical or psychological symptoms (Szoke, 1999).Some possible predisposing factors may include: the presence of other mental disorders or general medical conditions during childhood or adolescence that may have led to extensive medical treatment and hospitalization; family disruption or emotional and/or physical abuse in childhood; a grudge against the medical profession; employment in a medically-related position; and the presence of a severe personality disorder (Feldman, 2004).
Besides the aforementioned difficulties with diagnosis, the reluctance of these patients to undergo psychological testing or treatment make it all the more difficult to associate certain personality characteristics with these disorders (Healthinmind, 2003). Demographically, one study showed that 65% of the persons identified with Munchausen Syndrome and/or factitious disorders (they are used interchangeably in this study) were male (Szoke, 1999). Age of onset for these disorders was 25.8 years, and 83% were single (Szoke, 1999). Of the persons involved in the study, 60% were presenting with factitious physical disorders (Szoke, 1999). Some researchers have suggested that patients with factitious disorder often present in childhood with traumatic events, such as abuse and deprivation, as well as numerous hospitalizations; as adults, they lack support from relatives and friends (Szoke, 1999). Because they lack such support, it has been theorized that hospitalization is unconsciously used to recreate the desired parent-child bond that they lacked in reality (Kaplan, Sadock & Grebb, 1994).
It has also been theorized that a factitious disorder allows the patient to feel in control in a way that they never did in childhood; it is a coping mechanism, learned and reinforced in childhood (Szoke, 1999). These patients often resemble persons with borderline personality in that they manifest identity disturbance, unstable interpersonal relationships and recurrent suicidal or self-mutilating behaviors; in addition, their deceitfulness, lack of remorse, reckless disregard for their own safety and repeated failure to sustain consistent work behavior resemble antisocial personality disorder (Szoke, 1999). It has also been theorized that Munchausen patients are motivated by a desire to be cared for, a need for attention, dependency, an ambivalence toward doctors or an existing personality disorder (HealthAtoZ, 2002). They may delight in outwitting the medical profession, whom they regard as highly trained (Feldman, 2004).
Some persons suggest that Munchausen syndrome is a defense mechanism against sexual and aggressive impulses; others believe that it is a form of self-punishment (eMedicine, 2003). They may hold a positive regard for their own self-inflicted pain as proof of their boundaries and selfhood; it may be the result of a psychic conflict turned outward, or may be a way of expressing abuse and taking control over it (Feldman, 2004). The determination of an exact cause is made more difficult by the fact that those who are afflicted are generally not open and honest (eMedicine, 2003). Often, these persons have an early history of emotional and physical abuse; they have problems with their identity, have intense feelings, inadequate impulse control, a deficient sense of reality, brief psychotic episodes and unstable interpersonal relationships (Merck Manual, 2006). They may have been trained by parents or caregivers to be deceptive or dishonest (Feldman & Eisendrath, 1996). They appear to have a desperate need to find the caring they often had not received elsewhere in their lives; they often learn that whatever nurturance they might receive in life would have to come from doctors and nurses (Feldman & Ford, 1994). Their need to be taken care of may conflict with their inability to trust authority figures, and they continually manipulate and provoke such figures; they may exhibit feelings of guilt and an associated need for punishment (Merck Manual, 2006). Pain may remind them that they are real, and pain may actually organize them; pain results in their becoming patients, giving them a definitive role in life (Feldman, 2004). They may view pain as having spiritually redeeming qualities, and they seek pain as a form of punishment (Feldman, 2004).
Factitious disorders are a natural outgrowth of a relatively harmless, normal behavior, that of "playing sick"; however, persons with factitious disorders take this role to pathological extremes, that profoundly affect their own lives as well as the lives of those around them (Feldman & Ford, 1994). Although it is surmised that many of these persons come from turbulent childhood homes, recent research suggests that these patients may have underlying brain dysfunction that may predispose them to pathological lying and factitious illness behavior (Feldman & Ford, 1994). Or, they may find that the assumption of a sick role effectively permits them to avoid responsibilities and duties of life (Feldman, 2004).
Patients with Munchausen Syndrome are rarely treated successfully; acceding to their manipulations may merely relieve tension temporarily, but their provocations will escalate, and ultimately exceed what physicians are willing to do for them (Merck Manual, 2006). Doctors are advised not to merely dismiss patients who are presenting with nonorganic pain, as these patients are often very psychologically invested in their pain (Kiester & Duke, 1999). They should be confronted with their diagnosis without suggesting guilt or reproach (Merck Manual, 2006). They suggest giving patients a "ladder to climb out of their symptoms," by explaining to them that they do not have a serious physical problem, and then directing them to therapies that can help them (Kiester & Duke, 1999). These therapies may include psychotherapy. Those found to be malingerers should be told outright that they cannot help them; this is useful in maintaining the integrity of the doctor, while not enabling the patient. It is suggested that examining doctors not assume that there are no physical problems co-occurring with a factitious disorder; they also suggest that the patient be kept in the hospital and placed in long-term treatment with a mental health professional, despite the small likelihood that the factitious disorder will be cured (Healthinmind, 2003). It has also been suggested that a child that is being victimized by a case of Munchausen by Proxy be hospitalized in an effort to protect them from the perpetrator (Healthinmind, 2003).
The prognosis for persons with factitious disorder and Munchausen syndrome is not easily known, as these people are often lost to follow-up, since they tend to move around from doctor to doctor; however, the course is often chronic, with numerous hospitalizations, beginning in adolescence or early adulthood, and lasting into the late 40's (Szoke, 1999). Diagnoses of persons older than that are rare; perhaps because they have become so adept at faking symptomology (Szoke, 1999).
Overall, the results of therapy are disappointing; treatment is often focused upon management of symptoms, rather than a cure (Szoke, 1999). Persons afflicted are rarely treated successfully, and they often experience long-term medical complications from induced illnesses or the mechanisms and surgeries used to treat them (eMedicine, 2003). Early recognition of the disorder is important, and just as important is the establishment of an enduring and stable doctor-patient relationship (Szoke, 1999). This can lead to an approach known as a contract conference, whereby the physician or psychiatrist encourages the patient to express themselves in the language of difficult relationships, feelings and problems of living, rather than in the language of illness (Szoke, 1999). Therapy should focus upon the discovery of the underlying emotional problem that has caused such a need for sympathy in the patient (Feldman, 1998). Such strategies as hospitals sharing medical records may reduce the number of hospitalizations for Munchausen patients, but it does not address the underlying disorder; this may also endanger patients who have made themselves ill and may require treatment (HealthAtoZ, 2002).
Medications that have been used with some success have included drugs for depression (such as SSRI's) and antipsychotic drugs (that address symptoms that are consistent with borderline personality disorder) (eMedicine, 2003).
Being knowledgeable about factitious disorder in general and the various motivations behind it is central to any hope of treating these individuals, because they are so good at what they do (Feldman, 2004). In addition, giving the patient information about their actual disorder (factitious disorder or Munchausen Syndrome) can be helpful and liberating for them; it sometimes helps them to know that they actually do have a disorder, and may reduce their need to feign a physical disorder (Feldman, 2004).
However, merely confronting a patient with suspicions of factitious disorder can lead to dire consequences, namely, the threat of malpractice; although it seems unfair, many factitious disorder patients can and do bring malpractice suits against doctors and others (Feldman, 2004). They may sue when doctors refuse to continue treatment, or when they wish to find physicians responsible for the worsening of their symptoms (when they, the patients, are responsible). Occasionally, judgments have been rendered against physicians or other defendants who were involved in these cases (Feldman, 2004). Even more disturbing, a patient once sued 35 doctors (collectively, for 14 million dollars), after feigning cancer for several years, because they had failed to recognize and treat her for factitious disorder; the insurance companies settled out of court for more than a quarter of a million dollars (Feldman, 2004). This does emphasize the fact that early recognition of this disorder is important.
A multimodal approach to treatment has proven to be effective in some cases; such treatment might involve devising a treatment plan that will: increase the patient's self-esteem and sense of control; help to build better interpersonal relationships; and promote other interests that might occupy their time (Feldman, 2004). Recovery can sometimes take place as a result of a fortuitous life change (such as a positive, caring life partner or a job that the person really enjoys); relationships that exist outside of medical settings seem to be a positive influence (Feldman, 2004). However, as with other addictions, the impulse to continue the factitious behaviors still continues, even in the cases of recovery, resulting in ongoing battles against such impulses (Feldman, 2004). The prognosis for persons suffering from Munchausen and factitious disorder is guarded (Feldman, 2004).
It is very difficult to make generalizations about persons with factitious disorders, and medical professionals should look at these individuals in the broadest of terms, overlooking nothing as a possible cause (Feldman, 2004). Very little research has been done regarding the background and family history of persons with factitious disorder, Munchausen Syndrome and malingering. There is a surprising lack of evidence regarding the families of origin of these patients; they come to hospitals, cause uproar and display drama, but disappear just as quickly once they are discovered (Feldman, 2004). This would be an interesting area to research, and many theories regarding the etiology of these disorders point to the possibility that the children of physicians may be prone to this disorder. However, this theory should be used with reservation and restriction; not all children of physicians have been neglected emotionally, but some may have been. If persons with Munchausen Syndrome and factitious disorder are seeking attention and comfort that they did not receive as children, then any person who was neglected emotionally might be at risk. It would appear that the children of physicians might be more prone to these disorders, rather than malingering, as they might be seeking emotional gain, rather than a definitive secondary gain, such as money.
If one wanted to determine how many factitious disorder sufferers are the children of physicians, then one could ask the "frequent flyers" in hospitals and clinics to fill out social history questionnaires. However, since many persons will flee once they are asked for too much information, they may simply avoid filling out the questionnaire, and may go elsewhere. Or, since it has been established that many of these sufferers tend to fabricate the details of their lives, they may not answer such questions truthfully. Only a small percentage of patients will allow medical personnel to contact their families, so not much is known about them (Feldman, 2004).
It appears that it is more accurate to suggest that persons who suffer from Munchausen and factitious disorder have a general history of emotional deprivation, whether it be by a physician parent or anyone else who did not view meeting the emotional needs of their children as a priority. Research ahs shown that rejecting a child may result in the development of a factitious disorder (Feldman & Eisendrath, 1996). However, research has also shown that ignoring a child is even more destructive emotionally than rejection; this occurs when a parent deprives the child of essential stimulation and responsiveness by virtue of parental incapacity or preoccupation (Feldman & Eisendrath, 1996). This, by itself, will not always result in a factitious disorder, however, as not all emotionally neglected persons present with false medical claims. Perhaps a concomitant personality disorder, such as antisocial personality or borderline personality, explains the manifestation of the disorder. But, it does present as an interesting theory to suggest that a person who is neglected emotionally by a doctor might go on to seek the attention of other doctors in order to compensate.
Another interesting area of study might focus upon the fate of persons who present for years with factitious disorders; as mentioned previously, patients who present for multiple surgeries, or who continually harm themselves in order to continue and worsen symptoms, will no doubt suffer dire physical consequences. In one case, a woman who had been feigning many illnesses expired from the use (as prescribed, not abused) of the 21 medications that had been prescribed for her by various doctors; the use and interaction of these medicines caused organ damage that was severe enough to culminate in her death (Feldman, 2004).
Research might also be undertaken regarding the satisfaction of debts, and incidence of fraud prosecution among persons who seek medical treatment under fraudulent circumstances. Many of these patients rely upon private insurance carriers; or, in the case where they have rendered themselves unemployable, they rely upon Medicare, Medicaid or other payers to absorb their costs (Feldman, 2004). Or, they simply do not pay their medical bills. In some states, it is illegal to seek medical treatment fraudulently (such as North Carolina and Arizona); however, there are very few cases of actual prosecution documented (Feldman, 2004).
Information might be gathered, and research programs initiated, regarding prevention of these disorders; perhaps data can be gathered from physicians regarding who the medically needy persons are. Early detection is often difficult, but it would be quite helpful in reducing the emotional neediness of such persons, and diminishing their desperation, in an effort to prevent further physical and emotional harm, cost and devastation.
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Conde Nast Goes Down
By Danica Lo May 14, 2010, 11:20am EDT
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Will publishing giant Conde Nast ditch its iconic 4 Times Square headquarters and head south once 1 World Trade Center is completed? The New York Times certainly thinks so. "According to real estate executives who spoke on the condition of anonymity because the talks were secret, the publisher would take up as much as one million square feet in what is planned to be the country's tallest office tower, a symbolic 1,776 feet." [NYT]


San Diego — Anine-year-old boy is riding with his father south on I-5, headed for a fishing trip in Mexico. A bee flies into the cab of the truck and stings the boy. Within minutes, the boy is slumped on his dad's lap, unconscious, and turning bright red. At first the father considers pulling over and phoning for help. Thinking quickly, he turns off on I-8 and enters Mercy Hospital through the back entrance. The boy, now barely breathing, is taken into the ER. Moments away from death, the boy is revived by Dr. Davis Cracroft and the ER team.
Cracroft has worked in Mercy Hospital's emergency room for 25 years and has noticed a rise in the number of allergy patients. "There is a noted increase -- not just in my own experience, but with other ER doctors I've talked to throughout Southern California and even nationwide.
"If you take asthma as an example, in the United States and in other countries, there's a dramatic increase in asthma deaths. Not only is asthma increasing in its incidence, but it's also increasing in its complications and mortality rate. The statistics I'm familiar with show that in the 1980s there were roughly 1500 asthma deaths per year in the United States. It went up to about 3000, and it's continued to where it's three times the original number at about 5000 deaths per year."
Although no one seems to know the reason for the dramatic rise in allergy fatalities, Cracroft has his own suspicions. "There's a lot of reasons. One of them is that in San Diego's urban areas there is a higher incidence of allergic asthma that's directly related to poverty. Those people tend to use more over-the-counter medicines and have less access to medical care and end up using ERs as their primary source of care. So we see a lot more individuals who are poorly controlled showing up with their asthma in more advanced states. That's very, very common. There's also a higher incidence of asthma and smoke allergies in babies whose mothers smoke when they're in utero or they're exposed to smoke when they're newborns or young. There's also an increasing sensitivity to things like dust mites and cockroaches. They're allergic to those sorts of common inner-city bugs that are around. They're exposed early, they get repeated exposures during childhood, and they end up with asthma problems. Managed care and society has failed to care for a lot of these individuals appropriately, so they end up coming to the ER."
There are also allergy factors that may not necessarily be related to poverty. "We're seeing more exotic foods, different lotions, and people travel all over and get more exposure to these things. That can precipitate allergic reactions, but, fortunately, we're getting better at identifying them and desensitizing patients and treating them with better medicines."
Most people don't think of asthma as an allergy problem, but Cracroft explains that one of the two types of asthma is definitely an allergic reaction. "There's a type of asthma called 'intrinsic asthma' that's an inborn problem. Those individuals are generally not as sensitive to dust or weeds or pollens. Then there's 'extrinsic asthma,' which is triggered by what's around us in the environment. You'll see someone who might be allergic to milk or some sort of stimulant, and they'll come in after being exposed to it. Allergies are a kind of continuum: You can go from having just hives or a little rash, wheezing, and sneezing all the way to anaphylaxis, which is full-blown shock, requiring aggressive treatment to resuscitate the patient."
Sadly, Cracroft sees the "safer" environments for allergy patients disappearing. "The idea used to be that you would go to a climate like Arizona, where the air is clean. That was an ideal place for an asthmatic to go and get out of the inner city, but there's fewer and fewer of those places that don't have the air pollution and other problems."
The tricky (and dangerous) thing about allergies is that they are unpredictable. A person can be exposed to a substance repeatedly for years and, with no warning, have an allergic reaction. "On your next exposure, you can develop full-blown anaphylaxis. The boy who came in with the bee sting was in anaphylactic shock. We gave him epinephrine and got an IV going, ventilated and intubated him, and he began to respond over the next few minutes. As the epinephrine began to work, he blanched his skin in various areas, and they looked geographical -- it looked like a map of South America on his thigh and Antarctica on his chest -- and it all eventually coalesced into normal color. The redness went away, the swelling began to decrease, and he soon opened his eyes. They didn't know he was allergic to bee stings before that. If the father had stopped to call 911, the boy probably would have died."
Cracroft explains anaphylaxis, the worst of all allergic reactions. "There are a number of chemicals -- histamines and others -- that are released into the bloodstream when you have an advanced allergic reaction. They are all vasoactive substances that cause vasodilatation [dilation of the blood vessels], so you get this flushing. This can precipitate a dramatic drop in blood pressure -- which is what happened to this kid -- and the heart rate increases in response to this. Very often the release of these 'mediators' causes all of these problems and, if it persists, you can die a very painful death of hypoxemia -- your oxygen level goes down because you can't ventilate well."
Epinephrine, the drug used to treat anaphylaxis, is more commonly known as adrenaline. It dramatically reverses the dilation of blood vessels, causing vasoconstriction. By raising blood pressure, it brings the pool of blood back into circulation and forces the vessels to "clamp down" and do their job. Epinephrine is often carried in "kits" by allergy patients, so they can inject themselves when they feel anaphylaxis coming on.
"The wife of one of my fellow physicians is extremely allergic to pine nuts. She found out the hard way how frequently pine nuts are used in the preparation of food -- be it pine-nut oil or just the nuts themselves. On at least three occasions that I've taken care of her, she's had near-death experiences because of pine nuts. Everyone in our ER group now knows to tell her what's got pine nuts in it and what to avoid. She is very careful when she goes to a restaurant to inquire, but often people don't know about the presence of pine nuts in some ingredient. Just about every meeting I've gone to where she's shown up, she gets acute closure of the throat and her voice gets hoarse and she swells up. Those are the early warning signs for her. In case there's not a doctor there, she carries what's called an 'Epi-pen kit,' which is an injection of epinephrine. She'll take that as well as steroids and Benedryl, but frequently she still has to go to the hospital. I'm afraid to run into her now!" He laughs. "It's almost become a joke, because our group has had various meetings, and it seems like that happens almost every time we see her. She's had 10 or 15 attacks in the past ten years that have been serious enough for her to go to the ER for treatment. She's a very intelligent lady and asks all the right questions, but she's still vulnerable. It's less frequent now, thank God."
If the patient experiencing anaphylaxis or severe asthma does not get treatment immediately, the results are often fatal. "I've been on the shift when a child came in and was beyond resuscitation. In my experience, this has usually happened because the parents thought the child was doing okay and waited a little longer. I've done some medical-legal review, and there's almost always a lawsuit or investigation that comes out of it when that happens. More often than not, there is an overconfidence [on the part of the patient or parent] that the medicine is going to work for them, and they will get better. That's where access becomes so critical. If they lapse into that end-stage point, it's almost impossible to bring them back."
Cracroft says that the prevalence of medications for every problem also contributes to the rise in allergies. "The more medications we have and the more antibiotics and medications that patients are on, the more likely it is that they will either have a drug-drug interaction or an allergic reaction to the medicine -- especially in the elderly. It's a tremendous problem to try to identify which one is the culprit and eliminate it; sometimes they're essential drugs for their health."
Often finding the cause of a reaction can turn into a "fishing expedition." "When we see an allergic reaction in an adult, most of the time we have no idea what caused it. We'll ask if they've been outside the U.S., is there a change in their diet recently, any exotic foods, new lotions or creams -- it's usually just treated, and we tell them to watch what they eat and what they put on their skin."
Allergic reactions frequently catch their victims by surprise. "I've seen individuals who just put something on their skin and end up with horrendous rashes." Cracroft suggests that people having an allergic reaction for the first time try to be more aware of their environment and think hard about what they have been exposed to -- especially anything new. He recently found this out firsthand. "My wife gave me some moisturizing cream that I took with me to a meeting in San Francisco. Now, I had hay fever as a kid, but no allergic problems. I tried the new cream after a shower when I was getting ready for bed after a meeting. I went to bed and suddenly my skin felt like it was on fire. My lips were tingling and my mouth was getting bigger. Fortunately, the hotel I was staying at had 15 ER doctors staying there, so I called one of them and went down to his room. I had literally blown up, and, fortunately, he had antihistamines and even steroids that he used for his arthritis. I took a whopping dose of steroids and antihistamines, waited an hour, and the symptoms didn't progress, and finally the antihistamines knocked me out. I slept well and when I woke up I was fine. But if a person feels a reaction coming on, they need to seek help and seek it with someone who is responsible. Have someone drive you to the ER or call 911.
"Most people know that if they get stung by a bee and they start to swell a bit, they should put some ice on it. But if you start to get progressive swelling or have trouble swallowing or your voice changes or you have trouble breathing or start wheezing -- those are all signs of a more significant allergic reaction, and you should get to an urgent care or ER immediately."


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text:
Burton brings Alice back to Wonderland
Andrew Huff ('10)/ Eastside Humor Editor
The Cheshire cat's iconic foreboding grin will be reappearing in cinema once more.
Tim Burton helms the multifaceted reimagining of the classic fable written by Lewis Carroll, set to be released in theaters in 2010. Set ten years after the character Alice first traversed through the rabbit hole into the land of bizarre wonder, the film follows a seventeen-year-old Alice returning to the mythical hub where her life turned upside down.
In 1951, Disney released its cinematic take on the story Alice in Wonderland which earned an Oscar nomination for Best Music, and has since become a staple of childhood movies.
Burton utilizes various types of filming, ranging from live action, stop motion, CG animation and three-dimensional imaging to capture the elements of vibrancy and awe of the journey of self discovery through Wonderland. Johnny Depp plays the Mad Hatter, while his fiancée Helena Bonham Carter plays the acerbic Red Queen. The movie will mark the seventh project that Burton and Depp have done together.
Anne Hathaway (Brokeback Mountain, Rachel Getting Married) plays the White Queen, while the equally talented Michael Sheen (The Queen, Frost Nixon) plays the symbol-infused role of the White Rabbit.
The four main stars have all proven their prowess in acting abilities, while the story also retains the status of a legendary work of fiction. Originally published in 1865, the story has maintained its popularity.
Audiences will have to wait, though, to see if Tim Burton can successfully do justice to the classic literature on a modern-day movie screen.
Super Nintendo World comes to Universal Studios Hollywood
"Glass Onion: A Knives Out Mystery" stuns viewers
Netflix introduces a new viewing concept with "Kaleidoscope"
Meghan Trainor initiates her "comeback" to the music industry
"How to Lose a Guy in 10 Days" finds popularity on TikTok
"Enola Holmes 2" serves as an excellent sequel to "Enola Holmes"
Peacock releases a not so "Pitch Perfect" spin-off
East Literature Club December Book Review
Dillon Rosenblatt • Jun 28, 2009 at 1:31 pm
this link has pictures from the movie of Johnny Depp as the Mad Hatter, Anne Hathaway as the White Queen, Helena Bonham Carter as the Red Queen and newer actor Matt Lucas as Tweedledee and Tweedledum…
http://www.comingsoon.net/imageGallery/Alice_in_Wonderland
https://eastside-online.org/entertainment/burton-brings-alice-back-to-wonderland/#comment-6380


grubb1937: A Bit of a Breeze?
A Bit of a Breeze?
The course of life doesn't always run smooth and circumstances can conspire to disturb the settled routine of daily life. This is what has happened with my cycling, not by choice, I might add. So the opportunity to have some 'bike time' awheel with friends, was too good an opportunity to pass up. The date and venue were agreed by phone for the following Saturday as the weather forecast seemed to hint at improving weather. The weather only improved marginally over the unseasonally cold, wet weather, with strong wind and showers on the day in question.
I chose to ride to Central Railway Station, Belfast as the other riders were all arriving by train. The journey into Belfast was uneventful apart from the grind into the headwind and a heavy rain shower as rode past the Harbour Estate. Despite the headwind I arrived 10 mins before the agreed meet up time. I preferred to spin a low gear into the headwind rather than push a much higher gear. Retaining the ability to spin and stay on top of the gear meant I would tire much less quickly during the ride.
Meeting up with the other riders was firstly a chance to admire the various bicycles and secondly to catch up with friends. After the initial pleasantries, our ride leader explained the route would take us through busy traffic for approximately one mile along the busy A20 route Albertbridge Road, onto the Newtownards Road at Holywood Arches, where we would pick up the Comber Greenway route out to Comber. After a gap of around 35 years since cycling these same roads, the volume and density of motor traffic has increased enormously, along with changes to road signage, road junction layout and traffic control.
The one thing which struck me immediately was the vehicle fumes. This of course diminished once we entered onto the Comber Greenway which follows the route of the old Belfast & County Down Railway main line (closed in 1950) out of Belfast. It crosses a number of main roads, the crossings being controlled by traffic lights, but then quickly takes the rider away from the hubbub of urban traffic. The route was fairly well used by cyclists, from groups of mamils, (middle-aged men in lycra) groups of women cyclists, kids on bikes, through to youngsters taking tentative steps on their bikes with dad. The strong wind was not proving to be much of a deterrent to many folk. The Comber Greenway is also used by dog walkers and joggers too, so it is a shared space, not solely for cyclists.
I found the route pleasant and following the former railway track bed the gradient does not rise sharply except where a road has to be crossed and the former railway bridges have long since been demolished. However there are no steep climbs on the route, so the nervous can rest easy. I personally found as a relatively unfit rider after a prolonged lay off I didn't have to change out of the comfortable gear I was spinning once, despite the wind. It was a pleasant run out to Comber and the weather was kind without any heavy rain showers.
The Greenway comes out on the Comber Bypass probably where the old Comber railway station had been. I was immediately aware again of vehicle fumes from the busy road. Our route followed the Comber Bypass to a roundabout where we turned right and proceeded along the road for a short distance before taking a road to the left marked as a part of the National Cycle Network (Route 99) for Castle Espie Wildfowl and Wetland Trust.
This was to be our lunch stop as our ride leader assured us they have a great cafe and you get 15% discount off your meal bill if you cycle there. It was my first visit and I was impressed by the vistors centre and cafe. There are fine views out over Strangford Lough and of Scrabo Tower from the cafe. The food was good as well. There are plenty of bike parking racks at the visitor centre which was nice to see. Plans for the next ride were made over lunch and bicycle topics discussed.
The return was made to Belfast after lunch which was mostly into the wind. The journey became interesting once back in Belfast on roads with traffic. The wind was being funnelled between the buildings and the blast of wind as I crossed the mouth of one or two of the side streets blew the bike out into the centre of the carriageway despite my best efforts. Apart from this, return was made to Central Station in good time for the others to catch their various trains.
After bidding our farewells, I resumed my journey by bike. There was a stand of bicycles for the new Belfast Bike Hire Scheme at Central Station but there were too many cars and taxis dropping off and collecting people to take any photographs. I stopped at the much quieter bike stand outside the Belfast Harbour Commissioner's Offices to take a photograph of the new bike hire scheme. Only one bicycle had been removed from the stand of bikes. I continued the final part of my run, thankful that it was at least a tailwind back.


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PharmaSUG China is the premier event of the year for statistical programmers, statisticians, data managers, researchers, and others who analyze data in the life sciences. The 2019 conference committee is hard at work planning another fabulous event featuring two days of paper presentations, hands-on workshops, live demonstrations, and much more. Our Special Speakers include notable experts from regulatory agencies of several countries. Seminars for pre-conference training include e-submission with eCTD for NDA, and R & Data Management.
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JW3 has a vision for British Jewry to be a proud, vibrant, unified community, that is both inspired by and engaged with Jewish arts, culture, learning and life; and with a high quality, variety and volume of Jewish conversation. We aim to transform the Jewish landscape in London.
Since opening the doors to the public, JW3 has welcomed 200,000-220,000 visitors each year. We pride ourselves on the ability to be inclusive across all backgrounds, regardless of affiliation, belief, gender, race, or religion.
JW3 is a home for all: we have a ground-breaking vocational and educational programme, Gateways, transforming the lives of young orthodox students, who have become alienated from education, family, and who may have experienced additional difficulties. We have an impressive dedicated enrichment programme for Holocaust survivors and refugees, providing an extraordinary programme for both those able to access the many specific events held at JW3 and elsewhere and up to 2700 who receive details of our Holocaust enrichment programme. We are vital to sustaining a rich and varied programme of activities and events for many thousands of our visitors who come to JW3, to make and sustain friendships, and avoid the loneliness and isolation that can become part of later life. We welcome young families and older visitors to dedicated Friday night and festival celebrations, providing a home-from-home.
JW3 is at the forefront of engaging the next generation in a variety of ways: we have dedicated youth programmes and youth training and leadership programmes, we host 100 young Jewish adults at regular Friday night dinners, and other exciting and well-attended events, to promote engagement, and providing a vital link to their Jewish culture, heritage and religious practice.
JW3 is the only dedicated Jewish arts and cultural centre in the UK. We need to be here for future generations, and by leaving a gift in your Will to JW3, no matter how big, or how small, you will be helping to ensure that our commitment to preserving Jewish identity, culture and heritage, providing a Jewish home-from-home for all, and inspiring and connecting the next generation is secured.
For further information about JW3, please visit our website at www.jw3.org.uk. If you would like to discuss the possibility of leaving a gift in your Will to JW3 please telephone Melanie Diamond on 0207 433 8961 ext. 138, or email melanie@jw3development.org.uk. We look forward to you visiting JW3 to experience for yourself the high quality, wide-ranging programme of events, courses, classes and exhibitions, or to sit in our award-winning café and restaurant and enjoy a Kosher snack, drink or meal, make and meet friends.