The network in Fig. 4.124 models a bipolar transistor common-emitter amplifier connected to a load. Find the Thevenin resistance seen by the load.
Exam 3 Study Guide Chapter Eight: Complimentary and Alternative Medicine ( CAM) What is the different between alternative medicine and integrative medicine • Alternative medicine would be a completely separate form of treatment that is used alone, while integrative/complimentary medicine would be different methods used in conjunction to each other to help the patient. Who has the highest rate of usage of complementary and alternative medicine in the US • In US, Caucasian, well-educated women • And Chinese-Americans How are the biopsychosocial view of health and CAM related • Both take into consideration more than just the physical pain one may be feeling. They target other parts of a healthy person, versus just the pain or pathogen How effective are alternative treatments - Evidence for chiropractic care o Small to moderate effects for neck and low back pain o Modest effects for back pain, when compared to sham spinal manipulation and ineffective treatments. o Equal effectiveness to standard of care § e.g., meds, general practitioner care, PT, etc. - Evidence for acupuncture o Evidence is mixed for effectiveness of acupuncture in treatment of pain o There has been difficulty demonstrating superiority over placebo What does chiropractic care involve • Spinal manipulation • Diet changes • Exercise • Stretching Which CAM approaches are used in managing pain • Acupuncture • Chiropractic Care • Massage • Mindful Meditation What is the primary purpose of mindfulness meditation • The mind is just as important as the body for a healthy being, so mindful meditation helps engage some peaceful awareness of the present moment. Define: • CAM - group of medical and health care approaches not considered part of ‘conventional’ medicine • Acupuncture - Involves inserting needles into specific points on skin and applying stimulation (i.e., by electrical current or spinning the needle) o Used to treat pain, anxiety, depression and many other conditions • Acupressure - massage that unblocks flow of qi by applying pressure to meridians on the body • Qi -(“chee”) flows along meridians, or channels, in body and can become blocked; what’s targeted during acupuncture • Meridians in acupuncture – the channels, or points on your body, that have connection to different organs. • Spinal manipulation - apply force to joint in spine to reduce joint restriction and increase range of motion. • Biofeedback – Provides feedback on biological systems to help people gain information on relaxed and tense states in the body • Electromyography biofeedback – provides feedback through muscle tension • Thermal biofeedback – provides feedback through skin temperature (relaxation opens blood vessels, raising temperature) • Mindfulness meditation – Enhance awareness of perceptions in non-judgmental way. • Tai chi – A “moving meditation;” Controlled breathing, fluid, gentle movements and postures; Low impact alternative to brisk walking • Qui Gong – Uses posture, breathing and movements to cultivate Qi and restore balance in the body. Chapter Nine: Cardiovascular Disease What is the difference between systolic and diastolic blood pressure • Systolic Blood Pressure = A measure of blood pressure generated by the heart’s contraction o The beat • Diastolic Blood Pressure = A measure of blood pressure between contractions of the heart o When heart is resting and refilling with blood What is the general cutoff for high blood pressure • For Systolic = 120 is the high end of regular pressure • For Diastolic = 80 is the high end of regular pressure Understand the basic process through which our cardiovascular system delivers oxygen rich blood to the body. o Consists of § Heart § Arteries § Veins o Oxygenated blood is pumped from the lungs to left atrium of the heart § Oxygenated – Oxygen Rich o The heart pumps this oxygenated blood to the body through arteries into smaller capillaries o The body’s cells uses the oxygen § Then send deoxygenated blood back to the heart (right atrium) via veins o Right ventricles of the heart send blood to lungs for re-oxygenated § Carbon Dioxide is expelled (bi-product) o Two branches off the aorta supply blood to the heart § Aorta = main artery that carried oxygenated blood from the hear Why is hypertension called the “silent killer” o You usually will not know until it is serious § Especially if you are not getting regular checks • Not easily detectable What are the warning signs/symptoms of a heart attack § Dizziness § Nausea § Cold Sweats § Crushing sensation in chest § Pain in • Chest • Jaw • Arms • Back • Shoulders What is the leading cause of death for both men and women • Heart Disease What has been the trend in heart disease in the US over the past 20 years or so Why have we observed this trend (i.e. what is driving this trend) • There has been a decline in deaths due to CVD, but is still the leading cause • Why have we seen a decline o Better and faster healthcare (50%) § Improved technologies o Lifestyle changes (50%) § Decrease in smoking rates in US § Public and physician education efforts • Cardiologists do a great job in getting those at risk into preventative programs to help with lifestyle changes How do cardiovascular disease death rates differ between men and women in the US • Men are more likely to develop and die from CVD than are women Are these differences between men and women the same in all countries around the world • Men have higher rate of death from CVD than women o Differences are less later in life (75+) o In Russia, gap in life expectancy § 71 for women § 58 for men § Mostly due to CVD o Gap is much smaller in other countries § EX: Iceland Why or why not • Different cultures account more different behaviors, but generally men are at higher risk than women around the world. What is the strongest risk factor for CVD Hint: it is the strongest risk factor for most diseases. • Age Understand the inherent risk factors of cardiovascular disease: -Age • Risk sharply increases with age -Family History • Increases risk, but risk can be modified with lifestyle changes -Gender • Men are at higher risk due to behavioral differences -Ethnicity (How does risk for African Americans differ from that of European Americans Why) • African Americans have 30% increased risk for death from CVD, compares to European Americans o Attributed to: § Higher blood pressure § Lower SES and access to care § Discrimination threat • Shown to raise BP Understand the behavioral risk factors of cardiovascular disease: -Smoking 1. Leading behavioral risk factor for CVD a. Smoking increases BP b. Smoking can damage artery walls, leading to atherosclerosis and increased risk for blood clot c. Smoking decreases exercise tolerance 2. Secondhand smoke also increase CVD risk 3. Current smokers are 3X more likely to have a heart attack than non-smokers 4. Risk is reduced after you quit a. 3 years after quitting your risk of heart attack is 2X that of never-smokers -Diet and Weight (What kind of diet can lower risk) 1. Foods linked to CVD b. Red meat c. Whole milk d. Butter i. Leads to build up of plaques e. Sodium i. Leads to increased BP 2. Beneficial diet f.Fruits i. Fish g.Vegetables j. Low-fat h.Whole Dairy Grain -Exercise a. Physical activity can lower risk of CVD b. 150 minutes of moderate physical activity or an hour of vigorous physical activity every week can reduce risk of CVD by 30% Understand the psychosocial risk factors of cardiovascular disease: -Social support (How does social support relate to cardiovascular disease risk) o Generally, more is better § Older men who are more socially involved are less likely to die of CVD than those who are socially isolated. § Married men are half as likely to die from CVD as unmarried men at 10- year follow-up • Benefit for women depends on communication -Negative emotion and the D-Scale o Depression and anxiety have been identified as risk factors for CVD o Some evidence that negative emotion is also a risk factor § Especially non-expressed and when combined with social isolation • Type D personality o “Distressed” Personality o Strongest research evidence to be linked to CVD - SES o Low Income and low Education at greater risk for heart disease o Campbell Article: § Children randomly assigned to early childhood group (ages 0-5) had significantly lower prevalence of risk factors for cardiovascular disease in their 30s • Hypertension • Obesity • Metabolic • Syndromes § Difference in systolic BP was 143 vs. 126 § Interventions: • Nutrition and healthcare • Math tutoring • Social skills training • Supervised play • ETC. About how much of your CVD risk can be reduced by following by not smoking and following a healthy diet and exercise regimen • Over 80% of stroke avoidable through lifestyle changes How does the risk for heart attack compare between smokers and non-smokers Can this risk be reduced after quitting • Secondhand smoke also increase CVD risk • Current smokers are 3X more likely to have a heart attack than non-smokers o Risk is reduced after you quit § 3 years after quitting your risk of heart attack is 2X that of never- smokers How does marriage relate to cardiovascular disease risk for men and women • As with other diseases, men’s risks seem to decrease if they’re married o So do women’s § However, women have less of a decrease than men do § Married men are half as likely to die from CVD as unmarried men at 10-year follow-up • Benefit for women depends on communication Know the basic methods and main conclusions from the assigned Campbell et al. article. a. Campbell Article: i. Children randomly assigned to early childhood group (ages 0-5) had significantly lower prevalence of risk factors for cardiovascular disease in their 30s 1. Hypertension 2. Obesity 3. Metabolic 4. Syndromes ii. Difference in systolic BP was 143 vs. 126 iii. Interventions: 1. Nutrition and healthcare 2. Math tutoring 3. Social skills training 4. Supervised play 5. ETC. What steps can a person take to reduce hypertension • Get vital stats checked regularly • Clean up your diet • Start exercising about 3 times a week • Quit smoking; reduce drinking Define: • Cardiovascular system - The system of the body that includes the heart, arteries, and veins • Atheroscerosis - The formation of plaque within the arteries • Arteriosclerosis - A condition marked by loss of elasticity and hardening of arteries • Myocardial Infarction - Heart Attack • Hypertension - Abnormally high blood pressure, with either a systolic reading in excess of 160, or a diastolic reading in excess of 105. • Stroke - Damage to the brain resulting from lack of oxygen; typically the result of cardiovascular disease • Arteries - Vessels carrying blood away from the heart • Veins – Vessels that carry blood to the heart • Capillaries - Very small vessels that connect arteries and veins • Ischemia - Restriction of blood flow to tissue or organs; often used with reference to the heart Chapter Ten: Cancer Explain the reasons for the declining rates in cancer deaths (we talked about this in class) • Increased awareness about dangers and risks • Smoking decreased, so less cancer death o Bigger decline for men because more men smoked than women • EARLY DETECTION o We do a better job of catching cancer development early o Leads to over-diagnosis § Some people are diagnosed too early and their “cancer” cell/none-cancer cells would have never grown into full-blown cancer § Gives the false appearance of curing more cancer • Skews mortality rates Which two cancers have the highest incidence in the US for men • Skin • Prostate • Lung/Bronchus How about for women • Skin • Breast • Lung/Bronchus Which cancers account for the most cancer deaths in the US for men • Lung/Bronchus • Prostate • Colon/Rectum Women • Lung/Bronchus • Breast • Colon/Rectum Explain patterns of tobacco use in the US and how this relates to lung cancer death rates • Men tended to smoke more than women, putting them at higher risk for lung cancer o Use has gone down in recent years o Women started smoking later than men, so the data is still catching up What is the lifetime risk of cancer (all-sites) for men and women • Men: 1 in 2 • Women: 1 in 3 What cancers have seen in decline in mortality in the US over the past few decades • Lung o Among men, but not women § Smoking rates have declined • Men tended to smoke more than women • Women took up smoking later, and began decreasing later o Results have not caught up with that decrease yet • Prostate o Over-diagnosis § Men are treated for prostate cancer when they did not really have it, so more people entered into the survivor category skews the data if they were not truly at risk. • Stomach o Why § Refrigeration was developed and become a more common fixture in homes § Cured meats have become less common thanks to fridges What are the inherent risk factors for cancer -Age o The strongest risk factor § As you get older, the more likely you are to be diagnosed -Genetics (e.g., BRCA1 and BRAC2) 1. Mutations are rare (<1% of population) 2. Account for 5-10% of breast cancer and 10-15% of ovarian cancers 3. BRCA mutations: 55-65% 4. Options for women with BRCA 1,2 a. Watch and monitor b. Prophylactic mastectomy c. Chemoprevention i. Tamoxifen approved for chemoprevention ii. Early trials suggest may be nearly as effective as mastectomy -Environmental risks (BPA, air pollution). How does bisphenol A (BPA) impact cancer growth Understand the main points from the clip of Under the Dome that we watched in class. o Air Pollution § Consists of solid particles and gasses in the air from car emissions, industrial pollutants, dust, pollen, etc § Exhaust from vehicles accounts for 30% of cancer risk from air pollutants • Ex: Benzene (known carcinogen) in vehicle emissions o Air Pollution Globally § Measurement: concentration of fine particulate matter in the air • Measurement instruments and scales vary widely • US: 18 ug/m^3 o Micrograms per cubic meter of air • Concentration of fine particulate matter, that is particles smaller than 10 or 2.5 microns - called PM10 and PM2.5. • Average: 71 ug/m3 § Data released by WHO • Issues: some differences in measurement across countries o (e.g: frequency and location) o Air Pollution in China § 98 ug/m^3 • Data is unsure of where the number came from • It most likely is much higher • Bisphenol A (BPA) o Found in numerous products, including baby bottles and food and beverage can liners o Acts as a weak estrogen o Linked to § Breast cancer § Obesity § Early puberty § Diabetes o 93% of Americans have BPA in their Urine o Consumer concerns have led some companies to eliminate use of BPA, although safety profile of BPA substitutes is unknown o Companies can label products BPA free, but there is usually still one or more products similar to it in the products o BPA: Recommendations § Reduce use od plastics • Substitute with glass § If you do use plastic, don’t heat it • BPA leaches into foods when plastic is heated o Difficult to establish link between environmental carcinogens and cancer. § Why • It’s hard to pinpoint a specific cause • Everyone has hundreds of behaviors a day • Hard to isolate or control for everything since humans are so complicated • We DO KNOW that eating right and exercising, and reducing sun exposure will decrease risk of cancer -Ethnicity (Who is at the highest risk Know the findings on incidence, stage of diagnosis and mortality of breast cancer among African American and Caucasian women) • Cancer Health Disparities o Defined by the NCI as: § …differences in the incidences, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific population groups in the United States o The American Cancer Society (ACS) defines these population groups in terms of: § Socioeconomic Status § Race/Ethnicity § Residence § Sex § Sexual orientation • EXAMPLE: Health Disparities in Breast Cancer o Caucasian women have higher breast cancer incidence o African American women have higher mortality rate o What might explain these differences § White women tend to have better access to health care in general before the cancer may develop • Better preventative resources available on average What are the behavioral risk factors for cancer -Smoking § Implicated cancers in • Kidney • Head • Neck • Lungs • And Leukemia § Men who smoke are 23.3x more likely to die from lung cancer than those who do not smoke - UV exposure (UV exposure and skin cancer risk; UV exposure and vitamin D production; What is the recommended amount of sun exposure) § Exposure to UVA and UVB radiation from the sun and tanning beds is the major cause of melanoma, squamous cell carcinoma, and basal cell carcinoma • Skin cancers are on the rise! § Total protection is also harmful • UVB facilitates production of vitamin D o Recommendations: 5-10 minutes of sun exposure 3 times per week - Diet, obesity o High fat diet and obesity are risk factors for cancer, but obesity is a stronger risk factor o Protective Diets and Foods: Green Tea § Green tea acts against cancer cells in cell cultures § Regular green tea though • Black tea is helpful; just not as effective § Acts as an ant-inflammatory, which slows cancer cell ability to spread § Clinical trial among early CLL leukemia patients found reduction in cancer cells § Epidemiological findings are inconclusive o Protective Diets and Food: Bottom Line § Very difficult to isolate specific effects of specific food and nutrients § “Synergy of Foods” • How certain foods work together for benefits • Your best bet: Eat them all and incorporate into your everyday diet! How much of cancer risk is attributable to lifestyle factors of diet, exercise, and smoking • Lifestyle factors such as diet, physical activity, and smoking account for about 2/3 of all cancer deaths in the US Research has most strongly linked red meat consumption to which cancer • High levels of red meat consumption leads to colorectal cancer Define: • Benign - Limited in cell growth to a single tumor • Malignant - Having the ability not only to grow but also to spread to other parts of the body • Metastases - To undergo metastasis, the spread of malignancy from one part of the body to another by way of the blood or lymph systems • Neoplasm- Characterized by new, abnormal growth of cells; Meaning they divide irregularly and more rapidly because some mutation has occurred • Carcinomas - Cancer of the epithelial tissues • Sarcomas - Cancer of the connective tissues • Leukemia - Cancer originating in blood and blood-producing cells • Lymphoma - Cancer of the lymphoid tissues, including lymph nodes • Bisphenol A (BPA) – o Found in numerous products, including baby bottles and food and beverage can liners o Acts as a weak estrogen • Cancer health disparity - o Defined by the NCI as: § …differences in the incidences, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific population groups in the United States Chapter Twelve: Tobacco Smoking (pgs. 283-295) How does nicotine act on the brain • Nicotine acts as a stimulant in moderate doses • Binds to a particular type of acetylcholine receptor known as the nicotinic receptor • Activates reward system o Release of endorphins (endogenous opioids) and dopamine (among others) Other compounds in cigarettes/cigarette smoke (arsenic, methane, formaldehyde, benzene) - Over 60 carcinogens o Formaldehyde – linked to lung cancer o Arsenic – used in rat poison o Carbon Monoxide – linked to lung cancer o Benzene – linked to leukemia - Compounds found in cigarettes o Cadmium = Batteries o Stearic Acid = Candle Wax o Hexamine = Barbecue Lighter o Toluene = Industrial Solvent o Nicotine = Insecticide o Butane = Lighter Fluid o Acetic Acid = Vinegar o Methane = Sewer Gas o Arsenic = Poison o Carbon Monoxide = Car Exhaust o Methanol = Rocket Fuel o Ammonia = Toilet Cleaner o Paint Current rate of smoking in US. How does this compare to the smoking rate 50 years ago When was smoking at its highest in the US o 21% = percentage of US adults who are current smokers § Compared to 44% in 1966 § At its height in 1964 There was a time in our history was smoking was very uncommon. What were some of the reasons smoking started to gain popularity in the US • In the 1880s, smoking began to be more popular when ready made cigarettes hit the market • Smoking was then more normalized during WWII when cigarettes were passed out to soldiers as part of their rations as a form of stress control The use of smoking in weight control - Who is most likely to use smoking as weight control o Caucasian Women - What is average weight gain after quitting o About 6 pounds – Women o About 11 pounds – Men o However, ex-smokers tend to be able to lose the new weight within a few years of quitting and gaining. States with lowest and highest rates of smoking - Highest: o Indiana o Kentucky o West Virginia o Mississippi o Oklahoma o Missouri - Lowest: o California o Utah Disparities in smoking by race, gender, income, education, and sexual orientation - Native Americans o Highest rate of smoking among races § 24% - LGBTQ Persons o Have highest rate of smoking § 25% - Men smoke at higher rates than women o Men: 24% o Women: 18% - Smoking is highest among those living below the poverty line o 30% vs. 16% for above the poverty line - Smoking is more common among those with lower education o GED = 49% o Rates of smoking decrease the higher the level of education Role of advertisement and social (peer) pressure in starting smoking • Advertising and Children o Research found that children who could name a cigarette brand whose advertisements had caught their attention were 3x more likely smoke 4 years later o Cigarette advertising is banned on television, radio, sporting events, and print media with an audience under the age of 21 § Where else might children gain exposure to advertising • Convenience Stores and Gas Stations o Tobacco companies now spend more than 90 percent of their marketing budget to saturate convenience stores § Nearly $10 billion a year § Almost their entire budget • Advertising Today o 80-90% of tobacco industry advertising money today is spent in convenience stores and gas stations What complicates assessment of smoking among college students o College students tend to smoke only socially; so data is hard to gather on them since they do participate in smoking but do not identify as a smoker. First Report of the Surgeon General’s Advisory Committee on Smoking and Health - What was it o The first official report about some of the health risks that are related to smoking - When did this happen o 1964 1998 Master Settlement Agreement • “An accord reached in November 1998 between the state Attorneys General of forty-six states, five U.S. territories, the District of Columbia and the five largest tobacco companies in America concerning the advertising, marketing and promotion of tobacco products. In addition to requiring the tobacco industry to pay the settling states approximately $10 billion annually for the indefinite future, the MSA also set standards for, and imposed restrictions on, the sale and marketing of cigarettes by participating cigarette manufacturers.” • http://publichealthlawcenter.org/topics/tobacco-control/tobacco-control-litigation/master- settlement-agreement Define: • Optimistic bias in smoking – That the smoker will not personally be the one to get cancer from doing so; believes it could happen to someone, but won’t happen to them. • Acetylcholine – One of the major neurotransmitters of the autonomic nervous system • Nicotinic receptor – An acetylcholine receptor that actives the reward system; releases endorphins and dopamine • Emphysema - A chronic lung disease in which scar tissue and mucus obstruct the respiratory passage