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The Hundred Years' War was a long struggle between England and France over succession to the French throne. It lasted from 1337 to 1453. The war starts off with several successes on Britain's part, and the English forces dominate France for decades. Then, the struggle goes back and forth. In the 1360s, the French are winning. From 1415-1422, the English are winning. After 1415, King Henry V of England revives the campaign and he conquers large portions of France, winning extraordinary political concessions. From 1422 onward, however, the French crown strikes back. The teenage girl Jeanne d'Arc (Joan of Arc), a remarkable young lady, leads the French troops to reclaim their lands.

Theoretically, the French kings, possessing the financial and military resources of the most populous and powerful state in western Europe, held the advantage over the smaller, more sparsely populated English kingdom. However, the expeditionary English army, well-disciplined and successfully using their longbows to stop cavalry charges, proved repeatedly victorious over much larger French forces. In 1360, King John of France, to save his title, was forced to accept the Treaty of Calais, which granted complete independence to the duchy of Guyenne. However, his son Charles V, with the help of his commander in chief Bertrand du Guesclin, had succeeded in reconquering almost all the ceded territory by 1380, notably by a series of sieges. After a short break, Henry V of England renewed the war and proved victorious at Agincourt, conquered Normandy, and then attempted to have himself crowned as the future king of France by the Treaty of Troyes. His military successes were not matched by political successes. Although allied with the dukes of Burgundy, the majority of the French refused English domination. Thanks to Joan of Arc, the siege of Orleans was lifted. Then Paris and the lle-de-France were liberated, and after the French army had been reorganized and reformed, Charles VII recaptured the duchy of Normandy, and then seized Guyenne. The end of the conflict was never marked by a peace treaty but died out because the English recognized that the French troops were too strong to be directly confronted. France, at last free of the English invaders, resumed its place as the dominant state of western Europe.

This war is significant because of many things. The war gave impetus to ideas of both French and English nationalism. Militarily, it saw the introduction of new weapons and tactics which broke down the older system of feudal armies dominated by heavy cavalry in Western Europe. The first standing armies in Western Europe since the time of the Western Roman Empire were introduced for the war, thus changing the role of the peasantry. For all this, as well as for its long duration, it is often viewed as one of the most significant conflicts in the history of medieval warfare. In France, civil wars, deadly epidemics, famines and marauding mercenary armies turned to banditry reduced the population by about one-half.

The war affects us today in many ways as well. Artillery, like the longbow before it, revolutionized military strategy at the expense of the aristocracy, which became increasingly superfluous. By the end of the Hundred Years War the knights of England and France had relinquished their pre-eminent military positions. Longbows replaced lances, infantry replaced cavalry, and the social contours of military service were redrawn. Unlike people under feudalism before, people were then and now are feeling a great sense of citizenship and duty to their country.

Overall, the Hundred Years’ War has brought many great things. Although a time of headache and suffering, the war proved to be worth it in the end. Perhaps the most lasting impact of the war, especially in England, was the emergence of a much greater sense of patriotism and national identity. This was in part due to publicity spread to gather tax for the fighting, and partly due to generations of people, both English and French, knowing no situation other than war in France. Today, we learn from the mistakes made during the war to avoid making them in the future.

Table of contents

1. Symptoms
Incidence/ Epidemiology
2. Causes of Huntington’s Disease
3. Diagnosis
Treatment Available
4. Conclusion

Huntington's disease (HD) is a rare autosomal dominant inherited progressive neurological disorder characterised by damage neuron cells. Although genes responsible for HD can be found in every individual, but only expanded HD will cause disease. HD occurs due to the presence of HTT gene mutation that generates the CAG trinucleotide repeat expansion. A healthy individual will consist of 10 to 35 CAG repeats, while HD patients normally comprises 40 or more CAG repeats. This leads to the excess production of huntingtin proteins which altered the formation of functional proteins, thus inducing the accumulation of toxic fragments which gradually harms the neurons. Since Huntington’s disease is an autosomal dominant inherited disease, the offspring of the affected individual will have 50% chance to inherit the disease even when only one of the parental gene was affected. The course of this illness is commonly known to be 15 to 20 years. Infections, injuries and heart failure are the most common causes of death for Huntington’s disease patient.

Symptoms

Huntington's disease is characterised by involuntary movements, memory loss, and impaired cognitive, language and coordination abilities. There are 2 main types of the HD which separate based on the age of onset. The early-onset form is also known as the Juvenile Huntington’s disease which the patients start to show symptoms during childhood or adolescence. Juvenile HD is commonly characterized as having the disease symptoms at age 20 or younger. This constitutes nearly 7 per cent of cases. Early signs of juvenile HD are associated with poor performance in learning, seizures and problems in action including, but not limited to, irregular walking and speaking slowly.

Aside from the Juvenile which is rare, the adult-onset is more common as most of the HD symptoms starts to show at age of an individuals from 30 years and above. Basically, HD comes with mild symptoms at first such as difficulty concentrating, behaviour and mood effects or clumsiness. As the time passing, the issues of the memory loss, coordination of limbs, thinking ability, depression or even normal living abilities such as swallowing and breathing will become worse and worse due to the reduced functional on brain to control muscles movements.

Incidence/ Epidemiology

Generally, both men and women have an equal chance of inheriting Huntington’s disease from their ancestor. However, in terms of the seriousness of the disease, an ANCOVA analysis of the motor and functional assessment on 20 to 60 years old Huntington’s disease patients showed that the rate of progression of the disease is slightly higher in women than men. Huntington’s disease is more likely to affect Europe, North America, and Australia descent compared to Asian descent, with an overall prevalence of 5.70 per 100,000 for the former and an overall prevalence of 0.40 per 100,000 for the latter. This finding is supported by Rawlins et al. and Baig et al. in 2016.

Causes of Huntington’s Disease

In 1872, George Huntington was the first person which give a comprehensive description of adult-onset HD. [HeidiIn,2008]. The HD gene, Htt had been mapped out by James F.Gusella to a human chromosome in 1983 [Gusella et al.,1983]. The Htt gene was found on the chromosome 4 (4p16.3) which effecting the neurons production puzzling throughout in the brain while the specific role of Htt in not clear. Different from the normal individuals, HD patients consist of the multiples repeat of trinucleotide that believed to cause toxicity to the brain cells, specifically the basal ganglia and parts of cortexare. This could be proved by the affected motion control and thinking capability are mainly coordinated through basal ganglia and cortex. The aggregation of protein caused by the Htt gene was due to the excess glutamine residues translated by the repeated CAG and caused mHtt to folded abnormally which consequently forms more proteins aggregates. One of the signature sign of HD was the presence of dead neurons mainly found in the striatum. One of the most significant potential pathways for pathogenesis of HD is transglutaminase. Transglutaminase causes neuronal aggregation. The discovery of transglutaminase pathway leads to the introduction of cysteamine which inhibits the pathway.

Diagnosis

Nowadays, the most common and accurate form of diagnosis for Huntington’s disease is by genetic screening of blood sample. People who contain 36 to 39 copies of CAG repeats in the HTT gene are considered at high risk as this group of people might or might not develop the symptoms. On the other hand, a person who contains more than 40 copies of the CAG repeats will develop the disease as they contain a full penetrance gene. Given that huntington’s disease is an inherited neurological disease, neurologists will also investigate the pedigree of the individual, carry out linkage testing, and examine individual’s physical function before leading to a final diagnosis.

Treatment Available

Nowadays, the pathophysiological pathways of the mutated HD that lead to cognitive and psychiatric changes is still unclear. This is the reason why seeking a disease-modifying treatment is very challenging. Hence, there is yet a viable disease-modifying therapy available for HD. Currently, drug prescribed for HD patient only helps to relieve the non-motor symptoms caused by HD. For instance, Tetrabenazine (TBZ) is the only FDA approved drug for HD which relieves chorea symptoms. While other medications such as dopamine antagonists are commonly suggested as a treatment for chorea, neither of the drugs are proven to be effective in randomized, double-blind nor placebo-controlled trials to reduce chorea symptoms. This highlighted the importance of discovering a more effective treatment for this progressive and complex disorder that to be known to cause a range of non-motor issues. All the trial research that aims to identify potential HD therapy mainly focus on targeting mHtt which was proved to be the responding gene. This is important in understanding the signalling pathway that leads to cell death and the pathways that reduce and inhibit mHtt.

During late 90’s, Melino et al. 1998 and Lesort et al., 2000 raised the potential of transglutaminase inhibitor like cysteamine which promotes neuroprotective effect as a disease-modifying treatment for neurological diseases. This statement is enhanced by Institut Curie who demonstrated the potency of cysteamine in treating Huntington’s disease specifically. Cysteamine is a reduced form of cysteamine that can be found in mammalian cell as a product of coenzyme A metabolism. The nature of cysteamine passing through the blood-brain barrier, makes it a high expectancy candidate of HD therapeutic applications. Effect of cysteamine on HD was initially focused on the mechanism to inhibit transglutaminase as this is believed to be the core pathology that causes toxic to the brain cells. Cysteamine functions by catalysing y-glutamyl crosslinks between protein. Despite it was proven in latest studies that inhibiting the transglutaminase does not prevent neurodegeneration in HD, cysteamine is still a strong candidate as a disease-modifying treatment for HD as the majority of the studies showed positive results in terms of neuroprotective, antioxidant and prolonged life-span.

Conclusion

In fact, the uncertain of the ways that how exactly the presence of mutated huntingtin gene that brings in the toxicity to the brain cells is still unclear which make the research on the treatment more challenging. It is also believed that the based on the increased numbers of the CAG repeats, the earlier the onset of the symptoms of disease, known as anticipation phenomenon. Huntington’s disease is an inherited condition characterised by progressive destructive to the brain. The disease is caused by mutated HTT genes. Currently, there is no cure for HD. Tetrabenazine or antipsychotic drugs which associated with significant side effects have been used to control the clinical symptoms of Huntington’s disease by modulating the neurotransmitters. Cysteamine, which is a transglutaminase inhibitor has been proposed as a potential treatment for Huntington’s disease.

Have you ever been present in a category 5 hurricane? If the answer is no let me tell you that I just wish you never had to go through an experience like that. In September 20 Hurricane Maria struck Puerto Rico. All the residents in Puerto Rico were part of a desperate humanitarian crisis. It crosses the whole island with sustained winds of 155mph living Puerto Rico with no electricity, no source of clean water or food and no communication at all.

Hurricane Maria left 60% of people without water and 100% of the island in the dark. It caused 2,975 deaths and ended with telecommunication. The island went back 40 years in time. The hurricane brings torrential rains, all the rivers overflow causing anguish devastation and terror. The Brutal winds that were up to 200 miles per hour broke light towers, remove roofs, bend traffic lights, swallow trees, whatever it finds. María was like a glass crushing machine. Living a furious sea with waves up to 25 feet high. Eats the beach and most of sand went on the most tourist streets of the island.

In the morning it sweeps San Juan, the capital, living them desolate. The catastrophe accelerates more and more. It has been the worst atmospheric event over 100 years. On the Mountain, which was where I was born and lived for 15 years of life was one of the regions most affected by the hurricane, landslides swallow entire neighborhoods. The chaos is total. In less than 8 hours, María has caused damage never seen before in a long time. Despair in people is absolute. At 2 p.m. Maria leaves Puerto Rico, but the tail continues to feel for hours like a whip over the island.

Being without communication with my relatives was one of the worst things that could have happened to us. Making several calls a day and not receiving any answer was the worst. We had no communication with the island after 3 and a half weeks we finally received the most awaited call. Every day my family members walked up to the peak of a mountain to be able to communicate and keep us on track of what was happening and their needs.

“The helicopters began to fly over the neighborhoods. Puerto Rico has changed forever. It has another geography” Luis said. The vegetation is not the same anymore, loses his majestic leafiness its lush green. It seems burned by fire. According to the Department of Natural and Environmental Resources, 98% of adult trees are broken, crushed, obstructed roads and paths. The sea lost its unique color. It looks like a river. Muddy and Dark. Only seven hospitals can be kept running thanks to generators. The water reaches almost to the second floor of the houses. People literally have water around their neck. The authorities arrive in boats to save them, just like a movie.

The airport of San Juan suffer a lot of damages. Nobody can go in or out of the island. Even the aid couldn’t land or disembark. Flights were restricted for more than 2 weeks. Every single person was desperate. Puerto Rico was in a emergency situation.The authorities were focus on saving lives.

On the other hand, 48 hours after the hurricane, The National Meteorological Service transmit an emergency alert for more that 20 cities. The Guajataca dam threatens to break and spill its more than 34,000 acre-feet of water. The nightmare does not end. The governor orders to evacuate the zone immediately. The residents says ‘It is a situation of extreme danger.’ Maria has been the biggest the island has known since 1932.” What they were seeing in Puerto Rico was a catastrophe. Officially, a year after the impact of the hurricane the government reveled that 2,975 people died.

Moreover, Maria caused more damage than expected. Maria left our island split into chunks, pain and chaos. Maria is a name that Puerto Rico will never forget.

Works Cited

1. Coto, D. (2018). Puerto Rico: A Terrifying Timeline of Hurricane Maria. The Washington Post. Retrieved from https://www.washingtonpost.com/graphics/2018/national/puerto-rico-hurricane-maria-timeline/
2. Department of Natural and Environmental Resources. (n.d.). Puerto Rico after Hurricane Maria: Environmental Impacts.
3. Federal Emergency Management Agency. (n.d.). Hurricane Maria.
4. Garcia, M. (2018). Hurricane Maria Was a Man-Made Catastrophe. The Atlantic. Retrieved from https://www.theatlantic.com/ideas/archive/2018/09/hurricane-maria-man-made-disaster/570924/
5. González, L. (2018). Puerto Rico's Hurricane Maria Death Toll Climbed to 2,975 in New Estimate. National Geographic. Retrieved from https://www.nationalgeographic.com/news/2018/08/hurricane-maria-puerto-rico-death-toll-morgue-science-spd/
6. Klein, N. (2018). The Battle for Paradise: Puerto Rico Takes on the Disaster Capitalists. Haymarket Books.
7. Maldonado-Denis, M. (2019). Puerto Rico: What Everyone Needs to Know. Oxford University Press.
8. Rosselló, R., & Bhatia, T. (2019). Hurricane Maria: Puerto Rico's Past, Present, and Future. Public Administration Review, 79(3), 305-311.
9. Sutter, J. D., & Gupta, S. (2017). Puerto Rico's Water Woes Began Before Maria, but Trump Is Making Recovery Harder. CNN.
10. Vicens, A. (2018). Puerto Rico Still Doesn’t Know the True Death Toll from Hurricane Maria. Mother Jones.

Table of contents

1. Abstract
2. Introduction
3. Methodology
Melanoma & Non- Melanoma
4. Related Works
5. Experimental Result
6. References

Abstract

Abstract—In spite of the gargantuan number of patients affected by melanoma every year, its detection at an early stage is still a challenging task. This paper illustrates a method which involves the combination of the existing ABCD (Involving symmetry, border, color, and diameter detections) rule and Gray Level Co-occurrence Matrix (GLCM) along with Local Binary Pattern (LBP) to identify the malignant melanoma skin lesion with greater accuracy. Several steps such as image acquisition technique, pre-processing (RGB to HSV), and segmentation are undertaken for the skin feature selection criteria to successfully determine the lesion characteristics for classification. Texture features such as contrast, energy, entropy, and homogeneity of the skin lesion is extracted using the LBP and GLCM for discriminatory purposes of the two cases (melanoma and non-melanoma). Back Propagation Neural Network (BPN) is used for the process of classification.

Introduction

Cancer is an abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize. It can involve any tissue of the body and have many different forms in each body area. It is a group of more than 100 different and distinctive diseases of varying severity. Most cancers are named for the type of cell or organ in which they start. Out of the various types of cancer, skin cancer is one among the most common. The annual cost of treating skin cancers in the U.S. is estimated at $8.1 billion, of which about $4.8 billion is for nonmelanoma skin cancers and $3.3 billion is for melanoma. As per the studies released by The American Cancer Society in 2018, at least one instance of death is due to melanoma every hour. Despite the instance of high mortality, if diagnosed and detected at an early stage, it can be treated. Early detection techniques involve dermoscopic techniques and image processing techniques such as ABCD rule, pattern feature analysis, and many more. Despite such existing methods the diagnosis of the melanoma at an earlier stage with accuracy is a challenging task.

In the past, a mainly computer-aided pattern classification system for dermoscopy images was used which utilized a pattern classification system. This method was seen to have accuracy and several parametric values for the skin lesion but had a setback of high computational complexity. Later on a more unsupervised approach was desired for the detection. This led to the usage of SVM (Support Vector Machine) which involves a large number of training sets. In contrast to this ABCD rule is seen to have a much lower number of training sets and lower computational complexity if one takes and compares only its most best-performing score parameters into consideration.

Aside from the aforementioned approaches, melanoma detection using Delaunay triangulation is also a popular method which yields decent accuracy results if not for its slow convergence rate. Recently a detection methodology involving the Histogram of Oriented Gradient (HOG) and the Histogram of Oriented Lines (HOL) is employed which extracts the Bagged textural and color features of the skin lesion. This method has a major drawback that it can achieve good results only if there is a high contrast between the lesion areas. In comparison, Gray Level Co-occurrence Matrix (GLCM) coupled with Local Binary Pattern (LBP) extracts texture features of the skin lesions and uses them for the diagnosis of melanoma. It is seen to achieve good results irrespective of the contrast, unlike the histogram method.

Methodology

The existing methodologies only involve the ABCD parameters which is used for classification or the texture features extracted using GLCM and LBP methods. The proposed method is a combination of the ABCD rule and the GLCM coupled with LBP using a Back Propagation Neural Network as a final classifier. This approach is to minimize classification errors and boost the accuracy of the process.

Initially using the segmentation procedure the skin lesion is extracted by employing the adaptive thresholding algorithm. Then the feature extraction takes place giving the texture and color parameters of the image. The input dermoscopic image is subjected to pre-processing techniques such as color space conversion. This step is to extract the characteristic color features of the image subjected to observation. It involves the conversion to find the hue, saturation, and value (HSV) of the image. This gives information such as identity, purity, and intensity of the color.

A local binary pattern operator is outlined as a gray level invariant texture living in a local neighborhood. Then the Local Binary pattern operator labels the pixel of a picture by threshold the 3X3 neighborhood of every pixel and concatenating the results binomially to make a variety. LBP operator helps in classifying the image region as uniform or non-uniform. GLCM considers the relationship between two nearby pixels called reference and neighbor pixel. It is comprised of a matrix which has rows and columns equivalent to the number of gray levels of the image. By assigning the matrix elements with intensity and pixel distance factors various texture features can be computed. Out of the 14 texture features the best-performing texture features with the highest discriminatory factor is considered such as contrast, energy, homogeneity, and entropy which is extracted using GLCM and LBP. These parameters are compared with non-melanoma cases for comparison.

Melanoma & Non- Melanoma

Parallelly the features extracted are used for the ABCD classification which involves giving specific score values to characteristic features such as area, perimeter, major axis length, minor axis length, solidity, centroid, and orientation. These values which significantly depict the symmetry, border, color, and diameter of the skin lesion is used as a comparison between melanoma and non-melanoma cases.

The data from the ABCD methodology and the GLCM methodology is fed to the back propagation neural network which is used to act as a classifier. The experimental data comprises of 120 dermoscopic images of which 20 of them are testing images and 100 are training images. The training sample features with assigned target vectors are fed into the created BPN model for supervised training to get network parameters such as node biases and weighting factors. Finally, the test image features are simulating with trained network to make decision of skin lesion stages like malignant or benign.

Related Works

There are several systems for the identification of melanoma in dermoscopy images. The classification of the skin lesions is done in the global region extracted from the dermoscopy image. In the global method, the process of segmentation is done using a simple adaptive thresholding algorithm. GLCM matrix is used for extracting the texture features in four different orientation angles. There are several systems for the identification of melanoma in dermoscopy images. The classification of the skin lesion is done in the global region extracted from the dermoscopy image. In the global method, the process of segmentation is done using a simple adaptive thresholding algorithm. GLCM matrix is used for extracting the texture features in four different orientation angles. There are several systems for the identification of melanoma in dermoscopy images. The classification of skin lesions is done in the global region extracted from the dermoscopy image. In the global method, the process of segmentation is done using a simple adaptive thresholding algorithm. GLCM matrix is used for extracting the texture features in four different orientation angles. There are several systems for the identification of melanoma in dermoscopy images. The classification of the skin lesions is done in the global region extracted from the dermoscopy image. In the global method, the process of segmentation is done using a simple adaptive thresholding algorithm. GLCM matrix is used for extracting the texture Features in four different orientation angles.

There are several systems for the identification of melanoma in dermoscopy images. The classification of the skin lesion is done in the global region extracted from the dermoscopy image. In the global method, the process of segmentation is done using a simple adaptive thresholding algorithm. GLCM matrix is used for extracting the texture features in four different orientation angles.

In this, segmentation is done using a Gaussian filter and Otsu’s method is used to compute the global threshold. Feature extraction is done using 2D-fast Fourier transform, 2D-Discrete cosine transform, Pigment network feature, and color. The classification is done using SVM-RBF for the detection of melanoma.

This paper presents an automated method for melanoma diagnosis applied on a set of dermoscopy images. Features extracted are based on gray level Co-occurrence matrix (GLCM) and Using multilayer perception classifier (MLP) to classify between melanocytic Nevi and malignant melanoma. MLP classifier was proposed with two different techniques in the training and testing process: Automatic MLP and traditional MLP. Results indicated that texture analysis is a useful method for discriminating of melanocytic skin tumors with high accuracy.

In 2011, Daniel Ruiz, Vicente Berenguer, Antonio Soriano, and Belen Sanchez proposed types of ANN classifiers, which area multilayered perception, a Bayesian classifier, and the algorithm of the k nearest neighbors. These methods work independently and also in combination making a collaborative decision support system. The classification rates obtained are around 87%. An internet-based melanoma screening system was proposed in which ther server is opened for the public to upload the dermoscopy images, In this system, the digital dermoscopic image can be uploaded by the visitor and can register the clinical and pathological data. Once the image is accepted by the server, the tumor area is automatically extracted from the surrounding skin using an automatic threshold decision algorithm.

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Experimental Result

This section consists of the results obtained from the classification of the images by means of the two employed dermoscopic methodologies. The experimental data comprises of 120 dermoscopy images, previously diagnosed, of which 20 of them are testing images and 100 training images. It contains images of 60 melanocytic nevi and 60 melanomas in total. After segmentation, the feature extraction involving the color and its texture is computed by the GLCM and LBP spatial relationship. Using GLCM and LBP a list of four texture parameters which performs the best are updated as weighted values in the table. Table 1 shows the results of both malignant and benign cases. The tabulation which contains a range of the parameters of both instances (melanoma and non-melanoma) is shown in table 2. The ABCD parameters consisting of area, major axis length, minor axis length, eccentricity, solidity, centroid, and orientation are also extracted and tabulated for both cases in table 3. A list portraying the comparison of the average GLCM parametric values obtained from other journals to the proposed methodology is shown in table 4. For the final classification, a BPN classifier is used with the weighted nodes as input. The proposed method is trained with 83.3% and tested with 16.7% of the total number of images.

References

1. Catarina Barata, Margarida Ruela, Mariana Francisco, Teresa Mendonca and Jorge S.Marques, “Two Systems for the Detection of Melanomas in Dermoscopy Images Using Texture and Color Features”, IEEE systems Journal, Vol.8,No.3, Sep.2014.
2. J.C. Kavitha , suruliandi.A , “Texture and color feature extraction for classification of Melanoma Using SVM”, ICCTIDE conference,jan 2016.
3. Omar A., Buket d.Barkana, Non invasive Real Time Automated skin Analysis system for Melanoma Early Detection and prevention”, IEEE Journal of Translation Engineering in Health and Medicine, April 2015.
4. Mariam A. sheha, Mai S.Mabrouk, Amr sharawy “Automatic Detection of Melanoma Skin Cancer using Texture Analysis” International journal of computer applications, vol.42,No.20, March 2012.
5. Daniel Ruiz, Vicente Berenguer, Antonio Soriano and Belen Sanchez “A decision support system for the diagnosis of melanoma.” June 2011.
6. H. Iyatomi, H. oka, M. E. Celebi, M. Hashimoto, M.Hagiwara,” An internet based melanoma Diagnosistic system- Towards the Practical Application” IEEE,2005
7. Catarina Barata, Margarida Ruela, Mariana Francisco “Two Systems for the Detection of Melanomas in Dermoscopy Images Using Texture and Color Features”, IEEE systems Journal, Vol.8,No.3, Sep.2014.
8. G.Di Leo, A.Paollillo, P.Sommella and C.Liguori, “ An improved procedure for the automatic detection of dermoscopic structures in digital elm images of skin lesions, in Proc.2008 IEEE computer soc.
9. Vishaka Sharma, “Melanoma Skin Cancer Detection Using Image Processing”, WCESC (2017), 03–09 pg
10. G.C do Carmo and M. R. e Silva, “Dermoscopy: basic concepts”,vol 47,pg: 712-719 (2008)
11. H. Kittler, H. Pehamberger, K. Wolff, “Diagnostic accuracy of dermoscopy”, Lancet Oncology, vol 3, pg:159-65, (2002)
12. Pehamberger H, Binder M, Steiner A, Wolff K. “In vivo epiluminescence microscopy: improvement of early
13. diagnosis of melanoma” J Invest Dermatol, pg: 56S–62S, (1993)
14. Demyanov S, Chakravorty R, Abedini M, Halpern A, Garnavi R. “Classification of dermoscopy patterns using deep convolutional neural networks”; 2016 IEEE.

Table of contents

1. Summary
2. Introduction
Investigation of route
3. Options ?onsidered
Justification of routesPipe designCostsPumpPressure surge
4. Conclusion

Summary

Drinking water was supplied by WESSEX Water to 2000 new houses in Poundbury. Pipes of 350mm diameter with dimensions 200 x 290 x 280 in the Armstrong power series arrangement were used at a cost of ??7, 503, 927 for both gravitational and pumping mains. The pipe material is made up of ductile iron material largely because of its material strength, they (the pipes) have a power rating of 18.2 kW. The selected route has a span of about 6.11 km. The report analysed various options for the design of pipe mains and eventually arrived at the aforementioned option.

Introduction

Wessex Water has a task of supplying drinking water from a pumping station at Burton from her regional main to a service reservoir at Lambert’s Hill which will then distribute water by gravity to 2000 new houses in Poundbury. This report was borne out of the need to analyse and develop the most feasible option from a few alternatives. Factors considered in the comparative analysis were: route, pipe material, pipe diameter selection, pump arrangement and selection, protection from pressure surge and most importantly cost effectiveness. The report also considered all basic assumptions in design and in line with Wessex Water Design Standards before suggesting the most beneficial/appropriate option. All design calculations, tables and figures are in the appendix of the report.

Investigation of route

The project was limited to 3 routes due to certain criteria/ factors such as system hydraulics (ground elevation and slope), land use, sensitive areas and access for construction and maintenance. The three main routes selected for discussion were 3 gravity and pump mains routes 1, 2, and 3. The plan and sectional views of these routes can be found in the appendices. According to given topographical data, Burton pump station, Lambert’s Hill service reservoir, and the maximum/peak elevation at Poundbury are at elevations of 59.45 m, 155.70 m, 110 m above ordnance datum (AoD) respectively.

Ground conditions played an important role in choice of route. Site investigation revealed that the ground consists mostly of chalk soils which are favourable materials for subsurface pipe works/ pipe lining.

The inconvenience that goes with municipal water reticulation and supply was also put under considerable. Road closures and route diversions, traffic delay and congestion as it affects a reasonable population were put into proper perspective. Construction project design and management regulations were strictly adhered to. However, there were unavoidable major crossings which required painstaking approaches so that the project will be a successful one.

Cost consideration was also an important decision-making factor. Projects are generally successful if allowable starting capital is not exceeded. Long and short-term cost effectiveness are also very important aspects in costing as can be seen in the analysis. According to the pipe design, the routes of the pipes are carried out in certain areas. The choice of the routes of the pipeline will be governed by a number of factors such as system hydraulics (ground elevation and slope), land use (landowners, road/rail and river crossings), sensitive areas (AONB, CWS, SSSI, SAM) and access (construction and maintenance) accordingly. As stated by the data the Burton’s pump station has he elevation of 59.45 metres above ordnance datum (AOD) whereas the Lambert’s hill SR has 155.70 metres above ordnance datum (AOD) and Poundbury has 110 metres above ordnance datum (AOD). The main key for the route selection is to avoid areas of sensitivity. The areas such as areas of natural beauty (AONB), county wildlife sites (CWS), sites of special scientific interest (SSSI) and scheduled ancient monuments (SAM) are all indicated in the map. As for the land use, it could be another influencing factor for landowners as well. In addition, the ground conditions also need to be considered, water and soil that is constructing on providing the condition of the ground on which pipes and other infrastructures will be laid. The cost is another influencing factor due to the fact that every project has starting capital.

Options ?onsidered

Justification of routes

As the pipeline was selected for a suitable route with the length of 6.11km, some factors need to be considered such as sensitivity areas, elevation, major crossings and trench. All sensitivity areas were avoided (SAM, ISSS, CWS) excluding AOND. In particular, in order to protect environment and landscape it is possible extra cost will be earned as a result of locating this sensitive area. The route gives for the increase in the elevation to make it cheaper and easier to pump the water into the reservoir. Major crossing needs to be minimised because it will cross rivers and roads by avoiding traffic which led to disruptions and not to mention costs will be reduced. What’s more, the trench shared is to reduce costs due to no duplication of construction staff trench, lower land take within the road services, it increased efficiently and shorter timeframe, encouraging greater productivity and cost savings.

Pipe design

The pipe design selection for the pumped main, the Darcy equation will be used. As stated by the value of a daily flow, the diameters chosen for the pumped main were 350mm and 400mm. Hf is the head-loss of pipe, f is the friction factor, l is the length of the pipe, d is the diameter of the pipe and g is the acceleration due to gravity 9.81 m^2/s.The head loss due to the fittings were calculated. The chosen entry and exit from the pipe are one of the key factors. The bell mouthed entry and exit was selected for both pumped and gravity main.

To explain the calculations, 350mm diameter pipe is feasible to use, for the velocity of the water in pipe is 0.842 m/s which is smaller than maximum velocity is 2 m/s therefore the retention time is 2hr 1 min that is also smaller than 12hrs retention time. Furthermore, pressure checks for 350mm is 10.7 bar which is less than 16 bars. Thus, it can be concluded that 350mm diameter pipe is feasible for the pumped design. Meanwhile, using the hydraulics gradient from the table 16, design head loss is calculated for gravity distribution pump. Similarly, the maximum velocity is 0.955m/s which is less than actual maximum velocity 1.5m/s. Retention time is 52 mins that is smaller than 12 hrs retention time. Hence, 350mm diameter pipe is feasible to be installed for the gravity distribution pump design. On the other hand, swabbing chamber is a tool that cleans the water from removing waste such as sand, clay and slit before undertaking chlorine testing procedures prior to the activation of the watermain. The process of installing swabbing chambers is one swabbing chamber for every two kilometres. The length of the route is 6.11 km, 4 swabbing chambers were installed. 4 swabbing chambers every 4km is k= 0.96. Another method is used for the in-lined valves where it allows fluid to flow in one direction. There are 3 in-line valves. Air values are installed manually operated which is used to release air from a water pipe or fitting. 3 air-valves were installed for the pipe. The washouts were installed to allow water to flow out during the cleaning of the pipe. The junctions at which a pipe branches out to a washout point thus the number of washouts is 3. With the network of pipelines become more and more complex many pipelines have to cross by open-cut (trench), pipe-laying and directional drilling. Open-cut trenching can be less expensive method than trenchless methods in non-pavement areas. It does not also require debris to be removed from the pipe. Directional drilling is the concept of controlling direction and placing a wellbore inside the pipe at underground location. The number of crossings is 17.

Costs

After building up the pipe design it is feasible to calculate the cost of pumped main and gravity main. From the figure, the costs for the pumped main have the diameters of 350mm, 400mm and 6110 and 3000 metres were calculated. As for the pump main trunk pipe, the scheme 3 is $7,097,943 whereas scheme 1 is $7,215,186 therefore scheme 1 is the most expensive which costs $7,215,186 per 60 years. Scheme 3 and Scheme 2 costs $7,097,943 per 60 years and $7,097,943 per 60 years. The cost needs to be as cheap as possible thus scheme 1 cannot be used. Concluding that, the pipe diameter with 350mm is suitable for scheme 2. For the gravity distribution main pipe, scheme 2 is the most expensive that costs $1,688,500 hence it’s not suitable for the diameter of the pipe. In comparison, scheme 1S is the cheaper than other one which costs $1,576,945. To finalise that, the diameter of 350 from Lambert’s Hill to Poundbury is more feasible to use the 350mm pipe.

Pump

Due to the pipe selection for the trunk pipe, the diameter of 350mm is being used. Firstly, to find the static lift, elevation at Lambert’s Hill is 155.70m, Elevation at Burton PS is 59.45m and freeboard is 0.5m. As a result, ?” z is (155.70-59.45+0.5) = 96.75m. The relative operational point is at the height of 108.94m where the discharge is 0.081 m^3/s. The pipes were supposed to be series or parallel continuation. The parallel for the pipes with the high flow value. Therefore, the Armstrong pump series arrangement should be used. If the efficiency rises as the number of pump rises too. Pump system with 5 or 6 were identified as pumps that require the least amount of power. That rule out the systems with 2, 3 or 4 pumps. The 87% increase in efficiency for the 6-pump system does not explain in the cost of purchasing an extra pump. Hence, the 5-pump option is best suitable for the pipe from Burton PS to Lambert’s Hill. Using the pump performance table, 5 no. 200x290x280 pipes: 75l/s, 21m, 18.5 kW, 85% were used due to lower costs.

Pressure surge

Pressure surge is a transient sudden rise or fall of pressure in a pipeline. Pipeline surges can be positive or negative and are mostly caused by the sudden closure of a block valve or emergency shutdown of a pump. For instance, if the valve is too close or opened rapidly. If the pressure surge is in excess of the rate capacity of a pipeline it can cause splits in the piping system. Negative pressure will develop suddenly downstream of the valve as a result of the fluid being in motion. It was caused by a temporary separation of the liquid column followed by a reverse flow back towards the valve. This may lead to the destruction of both the vale and the pipe. The highest pressure surges often happen when the maximum number of pumps stops as a result of a power failure at a pumping station. As the change in pressure and velocity were not limited to the point of disturbance. It may continue up and downstream at pressure wave propagation velocity. There is another type that provide pressure surge protection which is cathodic protection. It is often used to protect steel from protection. Corrosion is cause when two dissimilar metals are immersed in an electrolytic substance such as water, soil or concrete. Cathodic protection connects steel to preserve the metal by providing a highly active metal can act as an anode and provide free electrons. This is why the active metal sacrifices its ions and keeps the less active steel from corroding.

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Conclusion

In conclusion, various summary of the preferred report is outlined below. This report is the most economically feasible out of the options being analysed. The report also met all of Wessex Water’s design requirements and specifications. As a result, the length of the pumping pipe is 6110 meters and the gravity main is about 3310 meters. Pipes of 350mm diameter with dimensions 200 x 290 x 280 in the Armstrong power series arrangement were used at a cost of ??7, 503, 927 for both gravitational and pumping mains. Thus, it is suitable to use 5 pipes with dimensions 200 x 290 x 280 in the Armstrong power series arrangement. In the future, the work can be undertaken by supplying full pressure surge analysis.

Hydrogen is an environmentally friendly energy carrier. As fuel for fuel cells, there is no emission other than clean water. Fuel cells convert hydrogen and oxygen electrochemically to water, and in this process electricity is generated. Hydrogen is also a flexible energy carrier that can be used in combustion engines with minimal emissions.

Hydrogen is the simplest and smallest element we have. It is therefore so easy that there is no free nature. Other energy carriers such as oil or wood can be found in nature. Hydrogen must therefore be prepared from hydrogen-containing raw materials such as gas or water.Because hydrogen can be relatively easily produced from a variety of different raw materials and with many different methods, the dependence many countries on oil can be reduced. Germany, Japan and the US are major consumers of imported fossil energy. These countries lead in the development of technologies for hydrogen-based transport. Oil dependence in combination with the potential for business development and environmental improvement is the main motivation to invest in hydrogen as an energy carrier worldwide.

Regular gasoline engines can be converted to hydrogen operation, but internal combustion engines have low efficiency. The highly developed combustion engine utilizes only 20-30 percent of the energy in the fuel. A hydrogen fuel cell already has an equivalent efficiency of over 50 percent with Today’s technology and the theoretical possibility of a much higher utilization rate of energy. It also develops airplanes and trains that use hydrogen as fuel.Other usesHydrogen will increasingly be used in stationary turbine and fuel cell power plants. In many fields, hydrogen together with fuel cells will replace the use of batteries. Hydrogen can also be used in most areas where a burner gas is used.

Today, hydrogen is produced mainly from natural gas where the gas is used within or is a residual product from different industries.Of world production today at approx. 500 billion Nm3 H2 (standard cubic meter) comes approximately. 90 percent from fossil material and approx. four percent from electrolysis of water. The largest consumers of hydrogen are the petroleum and fertilizer industry.

About half of world production is produced by steam reforming natural gas. In this process, natural gas is supplied with water vapor at 1100 ° C, the process also produces CO2 which must then be cleaned and deposited.

Hydrogen produced from fossil materials will be the least expensive source of hydrogen for a while. This production generates large amounts of CO2, but punctual emissions from large production plants are easier to clean and deposit than the cleaning of many small emissions (eg from petrol-driven cars).

Table of contents

1. Cognitive Behavior Therapy
2. Treatment of Phobias
3. Ericksonian Therapy
4. Curative Hypnotherapy

In the recent past, with regards to a 2007 which was carried out in the United States, anxiety disorders were the most prevalent form of mental illness, with about 40 million grown-ups aged above 18 years - an equivalent of 18.1% of the total population being affected every year (Anxiety and Depression Association of America). On the other hand, specific phobias affect about 19 million adults, or an equivalent of 8.7% of the total population of the United States, with women having a higher probability of being affected as compared to men. Moreover, according to statistics from the American Psychological Association (APA), in 2015, the levels of stress in overall were reported to have increased with a greater percentage of adults reporting extreme levels than in the past year. Hypnosis is a crucial, alternative and complementary medicinal technique which attempts to solve different psychological problems including managing stress, anxiety, and phobia.

According to Golden (2003), Hypnotherapy can be applied in the treating of comprehensive anxiety disorders including job interview, sexual routine anxiety, and other stresses as a result of post traumatic experiences. This method produced compelling results as far as headaches, and irritable bowel disorders which are all stress-related disorders were concerned. On top of that, hypnotherapy can be utilized in the management of phobias such as agoraphobia among others. Hypnotherapeutic treatments for stress, anxiety and phobias are carried out in five stages including orientation where assessment and collection of historical data on the patient occurs, hypnotic induction where the procedure for hypnotic induction is chosen put into use, the in-depth analysis of the hypnosis where several procedures are used, utilization, and termination of hypnosis – the use of numerous techniques to terminate the hypnosis and the patients return to a completely alert state (pp47-56).

The most commonly used hypnotherapeutic treatments for stress, anxiety, and phobias include cognitive-behavior therapy, Ericksonian therapy, Solution-focused brief therapy, curative hypnotherapy and traditional hypnotherapy.

Cognitive Behavior Therapy

Cognitive Behavior Therapy is a method of managing stress, anxieties, and phobias. With respect to this model, circumstances do not automatically result to anxiety, rather, anxiety-producing feelings are the ones which lead to anxiety. Cognitive and behavioral techniques with the ability to modify patient’s feelings and judgement to provide a way of managing several disorders that might result from anxiety. Such techniques include coping self-statements, logging, the two-column method, and imagery.

Coping self-statements can be utilized in reducing anxiety. According to Beck, Emery & Greenberg, this statements are fruitful or productive ideas that can be used by the patients to make themselves ready to face any demanding or stressful situations that they might encounter in the course of their lives. The authors further highlighted that “through the use of imagery, the individual in their heads practice this statements while at the same time imagining or visualizing in their minds how such can be used to manage any demanding situations, in case faced with one (Beck, Emery & Greenberg, 2005 pp1.).

Moreover, logging, which involves beginning a diary to identify thoughts that might lead to anxiety and trying to evade them, helps in identifying anxiety prompts, giving an individual the ability to monitor their anxiety-producing thoughts.

The Two-column method of managing anxiety involves the patient dividing a page into half. The patient then lists all the anxiety-producing thoughts on one side of the page and then generates a set of ideas (coping thoughts) that can be used to manage the situation on the second half of the page (Golden, 2012 pp263).

Treatment of Phobias

Using the Cognitive-behavior therapy, treatment of phobias occurs through desensitization. Desensitization is an exposure therapeutic procedure established by Wolpe for management of uncertainties and terrors (Wolpe, 2008 pp239). Desensitization equips individual patients by means of providing an opportunity for them to go up against their terrors, usually in a one step at a time manner. Procedures that enable the body to relax are often utilized in a case where moderation of the situation is of high essence especially if the situation is highly terrifying to the patient. The fear is broken down into particular and specific factors that in some way or the other increase the chance of the patient being anxious. The factors are always grouped in such a way that those factors which increase the likelihood or chance of the patient being anxious are at the top of the pyramid, whereas those with little or no effect on the patient are ordered at the bottom of the pyramid.

An assessment of randomized placebo-controlled trials by Hofmann, & Smits indicates that this kind of hypnotherapeutic techniques are awesome in the management of stress, phobias, and adult anxiety disorders (Hofmann & Smits, 2008 pp621). However, CBT has some limitations too. To begin with, it is not suitable for every individual. CBT requires that the patient be devoted and determined in obtaining a solution or overcoming the condition at hand and improving oneself with the guidance of the psychotherapist (Golden & Friedberg, 1986 pp290).

Ericksonian Therapy

The Ericksonian hypnotherapy is a very moderate approach to unresolved problems that contribute to stress, anxiety, and phobias. This model was developed by Milton H. Erickson. As a result of Erickson’s use of an informal conversational approach, complex language patterns in addition to therapeutic strategies, his colleagues disputed his labeling of the approach “hypnosis.” Techniques such as self-hypnosis and the rewind technique are used to treat stress, phobias, and anxieties.

According to Mathews, the Ericksonian approach to therapy is based on assumptions including the belief in a changed form of perception coupled up with factors which indicate interference, the supremacy of factors which indicate indirect suggestion over the direct one; and the patients’ vulnerability. The two types of metaphors involved in this form of treatment include isomorphic and interspersal, depending on their nature (Mathews, 2000 pp418).

In his work, Kraft highlights how isomorphic metaphors control the subconscious of the patient by offering some kind of story which has a lesson (a moral lesson). The subconscious will then induce a one-to-one relationship between the occurrences in the story and the one in the situation at hand which needs to be resolved. On the other hand with the other command called the “Embedded Command” technique, the hypnotist tells a motivating story which is aimed at diverting the conscious mind. More often than not, the story would contain a disguised suggestion meant to trick the subconscious into thinking that the story is true. The story furthermore, is usually indirect. The author further states that process instructions, on the other hand, cause the subconscious to locate any kind of memory which can be used as a template for learning from a previous experience so that, that experience can be used to make a crucial positive change in the present( Kraft, 2011 pp235).

In a study conducted to assess the efficacy of the Ericksonian hypnosis, by Holdevici & Craciun, which aimed to reduce stress among patients suffering from stress, and those suffering from other forms of general anxiety, the results exhibited that using the Ericksonian hypnosis led to a considerable decrease in the levels of stress, anxiety, and phobias among the observed patients. Moreover, the process of training in Ericksonian hypnotherapy and applying the learnt knowledge effectively, a hindrance that only a few individuals who are dedicated and ready to work with their therapists can manage to win can manage (Holdevici & Craciun, 2012 pp75).

This form of technique for the treatment of stress, anxiety, and phobias was developed via a combination of aspects of two different techniques - solution-focused brief therapy (SFBT) and the Ericksonian hypnotherapy. This combination produced a psychotherapy which is more goal dedicated, compared to the initial one which was more focused on the problem. According to Gingerich & Eisengart, the technique focuses on aiding patients obtain long term remedies to their problems rather than solving problems for a specific time without a lasting solution (2000 pp477).

This approach (SFBT) which was developed in a scientific background amongst many unreliable reports of success from both therapists and clients, had not been exposed to any tests to determine its efficacy.

In their work, (Gingerich & Eisengart, 2000 pp477), carried out an in-depths analysis of all the studies with regards to SFBT to find out the extent with which it was accepted among the people (the extent with which it boasted empirical support). However, this model has various limitations including the continuous perpetuation of the belief that a single can be the same to all the different people (Stalker, Levene & Coady, 2009 pp468).

Curative Hypnotherapy

Curative hypnotherapy was first attempted by David Lesser, who wanted to find the causes to people’s symptoms using both, IMR and detailed questioning. The knowledge possessed by Lesser facilitated the creation of the modern day therapy used today. This treatment method is used in the treatment of stress, anxiety and phobias.

Curative hypnotherapy gives the patient the ability to have access to their instinctive mind. During therapy the patient is able to identify the reasons as to why their instinctive mind is reacting in such a way that it is generating negative symptoms. This process is generally achieved by having a look at the initial event which led to those responses from the subconscious mind. The patient then uses all of the knowledge they have gained from the superseding years to decide whether the response at the time of the original event was the most appropriate or not. This makes it possible for the patients to be able to change their responses, leading to the resolution of the problem and all the relevant symptoms. Depending on the wish of the patients, they may then explain to the therapist the causes of their condition (McGuinness, 2004 pp261).

However, Curative therapy has some limitations too. It is not suitable for every individual. Curative therapy just like CBT requires that the patient be devoted and determined in obtaining a solution or overcoming the condition at hand and improving oneself with the guidance of the psychotherapist (Kraft, 2011 pp235).

This method of treatment of stress, anxiety and phobia, is the most practiced form of hypnotherapy by most Victorian hypnotists. Traditional hypnosis involves making direct suggestions to the unconscious mind. This method of treatment works on patients who particularly accept what they are told without questioning. The limitation of this form of treatment is that they are ineffective for people who analytical or critical in their thinking mechanisms.

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In conclusion, hypnotherapeutic treatments for stress, anxiety and phobias involves the use of different techniques such as cognitive-behavior therapy, Ericksonian therapy, Solution-focused brief therapy, curative hypnotherapy, and traditional therapy. Cognitive-behavior therapy is an integrated psychological therapy which utilizes CBH. Ericksonian therapy, on the other hand, was developed by Milton H. Erickson, it has the limitation of requiring several years of training coupled with difficulties in applying the learnt knowledge in real-life as explained. This is a dare that is only acknowledged by the truly dedicated and devoted people. The solution-focused brief therapy was developed via a combination of two techniques (solution-focused brief therapy (SFBT), and the Ericksonian hypnotherapy).Curative hypnotherapy gives patients the ability to have access to their instinctive mind enabling them to identify the factors causing the anxiety after which they are able to focus on how to control them. Finally, there is the traditional hypnotherapeutic treatment in which the patient is required to make direct suggestions to the unconscious mind.

Hypothermia is a life threatening condition that may result in death. A drop in the core body temperature of less than 95 degrees F (35 degrees C). this temperature is below what is required for normal metabolism and bodily function. The normal body temperature is between 97.7 and 99.5 degree Fahrenheit (F) which is the same as 36.5-37.5 degrees Celsius (C). The body’s thermoregulation mechanism adjusts to weather changes.

During extreme cold, the body receives a signal from sensory receptors. The signal will go up to the brain. The brain then sends a signal to the body to respond to the cool temperatures and attempts to maintain the core body temperature. This is necessary in order to provide the vital organs with the necessary heat to function properly. The brain will send a signal to the smooth muscle cells of the blood vessels of the skin and the skeletal muscles.

During the cold, the signal from the brain causes vasoconstriction of the arterioles in the skin which allows the body to shift the blood to more vital areas of the body. Another signal from the brain goes to the skeletal muscles which quickly contracts them causing shivering that helps to keep the body warm. If the body is exposed to cold and the thermoregulation mechanism is unable to preserve the heat, a drop in the core body temperature will occur. As the body temperature drops, characteristic symptoms will occur such as shivering and mental confusion.

Hypothermia can be mild, moderate, severe or profound. Heat is produced by the muscles, by the heart, as well as the liver and the body loses heat through the skin. The body heat increases 2-4 times more with contraction of the muscles from exercises or by shivering. Accurate core body temperature can be measured by a special low body temperature thermometer. Hypothermia may also be associated with frostbite.

Symptoms of hypothermia: depends on the degree of hypothermia:

• Shivering
• Blushed lips and extremities
• Altered mental status due to decreased CNS electrical activity: such as confusion, poor judgment, etc.
• Slowly the patient may lapse into an unconscious state.
• Cold hands, feet or skin, shivering and teeth chattering or feeling cold does not necessarily mean you are experiencing hypothermia. Only a core body temperature below 95 degrees F indicates hypothermia.

Causes of hypothermia include:

• Exposure to low temperatures
• Alcohol use during exposure to cold.
• Poor clothing
• Trauma
• Swimming or diving into cold water: heat is lost more in water than on land.
• A patient who perform outdoor sports such as skiing or mountain climbing.
• Patients who have had a major surgery
• Excessive blood and fluid loss.

Alcohol consumption increase the risk of developing hypothermia does not help with the symptoms. Alcohol is a vasodilator and it increases the blood flow to the skin and extremities. Alcohol may make the patient feel warmer, however it increase the heat loss by vasodilation.

Elderly people are most prone to hypothermia since they are more fragile, lower in body fat content, are prone to worse outcome if they have cardiac history. Keep elderly individuals home and warm.

Children are also susceptible to hypothermia. Children have a smaller size and less body surface area. A child’s head is larger relative to the rest of their body and a lot of heat is lost through their heads. When outside is cold, make sure to cover the heads of children.

Paradoxical undressing: a large percentage of deaths occurs from hypothermia when the patient becomes confused and disoriented, they may remove their own clothing thinking they will feel better. When this occurs it only increases the rate of heat loss and the condition of hypothermia gets worse. The heart rate may slow in patients with hypothermia. It may be difficult to find a pulse, so keep trying. Hypothermia increases the heart’s need for oxygen and lethal cardiac arrhythmia may occur.

Hyperthermia is different from hypothermia. Hyperthermia occurs due to elevated body temperature that is present during heat exhaustion and heat strokes.

Treatment

• Immediate action is required
• Move the patient from water and to a safe place.
• Remove the wet clothing and wrap the patient with a warm, dry blanket.
• Do not massage the patient
• Do not apply dry heat
• Warming of the patient should be done gradually.

Treatment at the hospital or in the field

• Usually begin with warm blankets
• Warm IV fluids
• Warm humidified oxygen
• EKG
• Blood warmer

Conclusion

Any drop in body temperature will make a person feel cold.

If you begin to shiver during exposure to cold, this is the point where you should get out of the weather and warm up.

Prolonged exposure to cold beyond this point can be dangerous and it is not a good idea to remain exposed to these cold temperatures.

So often we hear people talk about broadening that network, nurturing relationships, but never enough about the most important relationship in our lives – the one with ourselves. If you’ve been extra focused on the external factors in your own life, we encourage you to stop every once in a while to practice self-care and develop a better relationship with yourself. Not sure where to start? We have the antidote…

Establishing a big picture goal for yourself is important so that you can identify the path you’re on and understand why you’re on it. If you’re not sure what your deepest desires are, journaling and therapy are great vehicles to becoming more self-aware and understanding the why behind your actions. We all know by now that there are moments when life has us beat – this “big picture goal” will remind you to keep doing what needs to be done.

Nobody is perfect – even the most seemingly perfect people have insecurities. You can’t do much about what you don’t like about yourself (unless you opt for plastic surgery, but even then there are bigger underlying issues); however, you can learn to accept those flaws and love yourself. Remember, those who are self-accepting exude confidence and beauty inside and out, and they wind up attracting more positive experiences as a result.

When you enjoy doing something and you feel confident about doing it, you’re probably exercising your strengths. However, if you don’t enjoy doing something, then there’s probably an opportunity for improvement. Knowing your weaknesses is equally as important as knowing your strengths so you can outreach for help in those areas. It’ll make your life a million times easier and allow you to focus on what you do best.

When you have a strong relationship with yourself, you don’t need validation for your actions, the way you look, or where you are in life. Living in an era where everything appears picture-perfect with the swipe of a screen can draw out our deepest insecurities… We start to compare, obsess, and nitpick. Those are all forms of unnecessary and external validation… Refocus on your efforts on building a strong foundation of yourself and there won’t be a need for “validation”.

Embrace stillness. Being by yourself with no distractions allows you to clear your mind, focus, and think more clearly. It also helps you discover things about yourself you may have never realized, which is so important when we’re in a world that’s feeding us information after information. There is so much relief in unplugging and unwinding!

It may not be possible to put yourself first all the time, but don’t neglect your needs. Putting yourself first means listening to your body and doing what it’s telling you whether that’s sleeping early, exercising more, eating nutrient-laden foods, or quiet time. It also involves outside factors like putting an end to abusive and/or unhealthy relationships and closing your circle to those who take advantage of you.

Works Cited

1. Dweck, C. S. (2008). Mindset: The new psychology of success. Random House.
2. Hayes, S. C., Strosahl, K., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press.
3. Neff, K. D. (2011). Self-compassion: The proven power of being kind to yourself. HarperCollins.
4. Pennebaker, J. W., & Smyth, J. M. (2016). Opening up by writing it down: How expressive writing improves health and eases emotional pain. Guilford Publications.
5. Rosenberg, M. (1965). Society and the adolescent self-image. Princeton University Press.
6. Seligman, M. E. P. (2011). Flourish: A visionary new understanding of happiness and well-being. Free Press.
7. Seltzer, L. F. (2012). Autonomy in middle and late adulthood. In Handbook of autonomy (pp. 495-514). Springer, New York, NY.
8. Van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.
9. Whitbourne, S. K. (2016). Adult development and aging: Biopsychosocial perspectives. John Wiley & Sons.
10. Wood, A. M., Linley, P. A., Maltby, J., Kashdan, T. B., & Hurling, R. (2011). Using personal and psychological strengths leads to increases in well-being over time: A longitudinal study and the development of the strengths use questionnaire. Personality and Individual Differences, 50(1), 15-19.

Giving someone a label based on sexuality is prejudicial, disrespectful and causes bisexual individuals to hide their true selves. I feel like having strict parents cause teenagers at the age of 13, 14 and maybe adults cause silence and makes them keep things to themselves. They feel alone and dont have anyone to talk which cause depression and stress because they feel like they should have a close relationship with their parents. There are alot of people that are judgmental and don’t care about other people feel so they say whatever but not in a kindly way.

The attitude towards LGBT is wrong and I find it disrespectful, if you don’t have anything nice or positive to say then keep your comments to yourself. You have to think about other people feelings and the background behind their life. . “Coming out is a crucial juncture that can often make or break the child-parent relationship”. This gives them a low Self- esteem about themselves. They should feel like they should talk to their parents about anything and have an open conversation and be comfortable about the situation. As a parent see where you child is coming from and see their side of view because if not and you just go straight with your opinions on how they should live their life that will make them feel down and make them not wanna talk to you again about anything because of your comments. Some kids are just scared to come out period because of their religion and some families just don’t support it at all, and they just don’t come out until they feel like it’s a comfortable time or maybe they just hide who they are. Parents play an important role in health of their child. According to USA Today, "because more and more, [are] understanding that that ... acceptance and support from family is the critical mediating variable in terms of risk factors".

Gay marriage should be legal and people should live their lives on how they want to. Everyone makes mistakes and commit sins, what sin is bigger? Everyone is equal. Before 2004, four states had banned gay marriages. In 2004, 13 states saw their constitutions amended by referenda to ban gay marriage. Between 2005 and Sep. 15, 2010, 14 more states followed suit, bringing the total number of states with constitutional bans on gay marriage to 30. People should be comfortable to be around other people without the negative comments and the hate. On July 14, 2004, an effort in the US Senate to pass a constitutional amendment to ban gay marriage received only 48 votes of the necessary 60 votes for the proposal to proceed.

I believe that same-sex couples should be able to get married. To defend the anti-gay marriage measure after it had been ruled unconstitutional by a District Court. The decision was considered to clear the way for gay marriage to become legal again in the state. Everyone shouldn’t have a label on who they are and how they carry themselves. ” “The US Supreme Court hears arguments in the case, Obergefell v. Hodges. The Court’s ruling will decide whether states can constitutionally ban same-sex marriage”.