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Alcoholic

Alcoholic

Alcoholism is a dependency on alcoholic beverages characterized by craving (a strong need to drink), loss of control (being unable to stop drinking despite a desire to do so), physical dependence, tolerance (increasing difficulty of becoming drunk), and withdrawal symptoms. drunk] The American Psychiatric Association no longer recognizes the existence of "alcoholism" as a diagnostic category. With the publication of the DSM-III in 1980, two separate syndromes of alcohol dependence and alcohol abuse replace the earlier category. Although the word "alcoholism" survives in popular usage and in the literature of certain groups such as Alcoholics Anonymous, the medical community recognizes the term through those two syndromes. [http://www.psychologynet.org/alcohol.html] The World Health Organization also dropped the diagnostic category "alcoholism" in 1979, replacing it with the diagnostic categories "alcohol dependence" and "harmful use" (ICD-9, ICD-10). [http://alcoholism.about.com/cs/alerts/l/blnaa30.htm] Although acceptance of the disease model is declining, the American Hospital Association, the [http://www.apha.org American Public Health Association], the National Association of Social Workers, and the American College of Physicians classify "alcoholism" as a disease. The American Psychiatric Association recognizes alcohol abuse disorder and alcohol dependence disorder as two separate substance related disorders. The idea that alcoholism is a disease is more in congruence with the beliefs of Alcoholics Anonymous than the consensus of the scientific community. In a 1992 JAMA article, the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published this definition for alcoholism: "Alcoholism is a primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic." It must be borne in mind that the National Council on Alcoholism and Drug Dependence is an organization founded by AA member Marty Mann in order to promote AA's views of alcohol and alcoholism, rather than to further scientific research. American Society of Addiction Medicine The causes for alcohol abuse and dependence cannot be easily explained. However, the unscientific prejudice the roots are from moral or ethical weakness on the part of the sufferer has been largely altered. A recent poll found that 90% of Americans currently believe that "alcoholism" is a disease. Today, alcohol abuse and alcohol dependence are major public health problems in North America, costing the region's inhabitants an estimated US$170 billion annually. Alcohol abuse and alcohol dependence are life-threatening problems that sometimes end in death, particularly through liver, pancreatic, or kidney disease, internal bleeding, brain deterioration, alcohol poisoning, and suicide. Heavy alcohol consumption by a pregnant mother can also lead to fetal alcohol syndrome in the fetus, an uncurable and damaging condition. Additionally, alcohol abuse and alcohol dependence are major contributing factors for head injuries, motor vehicle accidents (MVA), violence and assaults, neurological, and other medical problems ( cirrhosis, etc.). Of the one half of the North American population who consume alcohol, it has been estimated by some that 10% are alcohol abusers and alcohol dependents, and 6% consume more than half of all alcohol. Stereotypes of alcohol abusers and alcohol dependents are often found in fiction and popular culture: for example the "town drunk," or the stereotype of Russians and the Irish as alcoholics. In modern times, the recovery movement has led to more realistic portraits of abusers and dependents and their problems, such as in Charles R. Jackson's The Lost Weekend, or the films Days of Wine and Roses, and My Name is Bill W. Alcohol dependence can be harder to break and significantly more damaging than dependence on most other addictive substances. The physical symptoms when withdrawing from alcohol can be quite severe and dangerous, with death reported in extreme cases.

Screening

Several tools may be used to detect the habitual abuse of alcohol. The CAGE questionnaire, developed by Dr. John Ewing and named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office. Two "yes" responses for a male and one "yes" response for a female indicate that the respondent should be investigated further. The questionnaire asks the following questions: # Have you ever felt you needed to Cut down on your drinking? # Have people Annoyed you by criticising your drinking? # Have you ever felt Guilty about drinking? # Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? Another screening questionnaire is the Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization. The Alcohol Dependence Data Questionnaire [http://eib.emcdda.eu.int/index.cfm?fuseaction=public.Content&nNodeID=3556&sLanguageISO=EN] is a more sensitive diagnostic test than the CAGE test. The Alcohol Dependence Data Questionnaire serves to distinguish a diagnosis of alcohol dependence from one of alcohol abuse.

Blood tests

Although there is no blood test specific for alcohol abuse or alcohol dependence, prolonged heavy alcohol consumption may lead to several abnormalities, including:
- Macrocytosis (enlarged MCV)¹
- Elevated GGT²
- Moderate elevation of AST and ALT and an AST:ALT ratio of 2:1.
- High carbohydrate-deficient transferrin²

Medical effects

The long-term effects of alcohol dependency can include:
- pancreatitis, or inflammation of the pancreas (but the acute and chronic form)
- heart disease, including coronary artery disease and dilated cardiomyopathy
- polyneuropathy, or damage to the nerves leading to poor sensation or pain
- cirrhosis of the liver, a chronic disease characterized by destruction of liver cells and loss of liver function, and its numerous complications, including bleeding from esophageal varices
- depression, insomnia, anxiety, and suicide
- hypertension (high blood pressure)
- increased incidence of many types of cancer, including breast cancer, head and neck cancer, esophageal cancer and colorectal cancer
- nutritional deficiency of folic acid, thiamine (vitamin B1) and several others
- Wernicke-Korsakoff syndrome, a neuropsychiatric disorder caused by thiamine deficiency that results from poor nutrition in alcoholics
- Personality changes toward others, especially those who are close
- significant damage to occupational, social, and interpersonal areas, including sexual dysfunction

Treatments

Treatments for alcohol dependence include detoxification programs run by medical institutions. These may involve stays for a number of weeks in specialized hospital wards where drugs may be used to avoid withdrawal symptoms, which in severe cases may lead to death. After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues leading to alcohol dependence. Aversion therapies may be supported by drugs like Disulfiram, which causes a strong and prompt hangover whenever alcohol is consumed. Naltrexone may improve compliance with abstinence planning. The standard pharmocopoeia of antidepressants, anxiolytics, and other psychotropic drugs treat underlying mood disorders, neuroses, and psychoses associated with alcoholic symptoms. Another treatment program is based on nutritional therapy. Many alcohol dependents have insulin resistance syndrome, a metabolic disorder where the body's difficulty in processing sugars causes an unsteady supply to the blood stream. While the disorder can be treated by a hypoglycemic diet, this can affect behaviour and emotions, side-effects often seen among alcohol dependents in treatment. The metabolic aspects of such dependence are often overlooked, resulting in poor treatment outcomes. See: [http://www.hypoglycemia.asn.au] In the mid-1930s, the mutual-help group-counselling approach to treatment began and has become very popular. Alcoholics Anonymous is possibly the best-known example of this movement. Some programs attempt to help problem drinkers before they become dependents. These programs focus on harm-reduction and reducing alcohol intake as opposed to cold-turkey approaches. One such program is called Moderation Management.

Social impact

Moderation ManagementThe social problems arising from alcohol abuse can include loss of employment, financial problems, marital conflict and divorce, convictions for crimes such as drunk driving or public disorder, loss of accommodation, and loss of respect from others who may see the problem as self-inflicted and easily avoided. Alcohol dependence affects not only the addicted but can profoundly impact the family members around them. Children of alcohol dependents can be affected even after they are grown; the behaviors commonly exhibited by such children are collectively known as Adult Children of Alcoholics Syndrome. Al-Anon/Alateen, a group modelled after Alcoholics Anonymous, offers aid to friends and family members of alcohol dependents. Many people incorrectly assume that once an alcohol dependent stops drinking, all is well. However, many people who have stopped drinking still refer to themselves as "alcoholics" or "recovering alcoholics." Thought patterns may also continue to be impaired as in the Dry drunk syndrome.

Social dependence versus physical dependence

Symptoms of a person's dependence on alcohol may include, but are not limited to, a feeling of necessity in regard to consumption of alcohol, or an inability to resist alcohol if offered. Though these symptoms often arise from a physical dependence on the substance, it is not uncommon for individuals, especially teenagers and adolescents between the ages of fifteen and twenty, to rely on alcohol as a means of social interaction. If a person cannot refuse alcohol in the presence of others, insists on drinking alcohol excessively for fear of alienation and neglect, or feels they cannot socially interact with others unless under the influence then this person is considered socially dependent on the substance. These traits can be noticed in individuals who relocate (such as students attending a new university) whereby an individual with no history of alcohol consumption begins to consume alcohol in order to associate and relate to others. Social dependence, though not physically threatening in early stages, can lead to physical dependence if the person cannot control their urges and more so their reasons for drinking. It should be noted that use of the term urges are not merely to express a sense of want for taste but could also be an urge that is stimulated by an individuals satisfaction in what is often referred to as "the buzz." It is a sense of euphoria brought on by at least in most people bearing a low tolerance to alcohol in about 2-3 standard drinks (100 proof or 50% alcohol) in a given hours time. Individuals bearing a higher tolerance to alcohol usually still crave "the buzz". Over time, the amount of alcohol needed to achieve the same affect increases dramatically as tolerance increases. A persons "social dependence" is by the Prevention Research Institute from Kentucky (www.askpri.com), as a condition that a person experiences and re-experiences in a social setting. It reflects the habitual experiences one has as they enjoy "partying" with the same people. This social dependence tends to accept and encourage high risk drinking as individuals trade in the "buying of rounds," "having drinking contests," and may provide an acceptance of drunken behavior that is usually embarrassing for groups of people who do not drink 5 or more drinks in a setting. In other words, people who have a low tolerance to alcohol and drink in a social setting may express to their social group that may have drunk too much and shouldn't have for example, "drove home." However, in socially dependent groups who experience a higher consumption drinks (more than 5 standard drinks)in a setting such experiences are very common (driving home when they shouldn't have) and their experiences are accepted as normal in the drinking group as they often speak of (blackouts, passing out, forgetting where the keys are or where the car was parked)incidents which are potential dangerous and life threatening. Common phrases heard are, "so you got arrested while driving drunk? Welcome to the club!" This does not mean to implicate individuals who have ever passed out, had a horrible hangover, or drove when they shouldn't are socially dependent on alcohol. It would be a matter the repeated behavior of at least 3 times in a year which may indicate substance abuse. Reflect on your own use: Should a person believe they may be socially dependent or rather their fellow drinkers may be part of the problem is speak with your regular drinking friends and tell them that you are planning to cut down on drinking and cannot have more than 4 drinks on a current drinking occasion (3 drinks is safest). Should they respect it and tend not to push anymore than you desire, your group of friends may not be a risk for your consumption. But if you believe it would be hard to leave with just 4 drinks or stop at 4 without encouragement from them to continue drinking; then you may be involved in a socially dependent group of friends. On the other hand, if such a statement of 4 drinks in a setting is unheard of or unrealistic based on your own drinking experiences, drinking amounts and tolerance to alcohol, you would be advised to make conscious choices to cut down. You should know that in a study of young men drinking 5 or more drinks in a setting within in a 9 year period of time over 60% had serious alcohol related problems within that time period. In a continuation of the study to 12 years discoverd that the number of drinking days in a given week had decreased significantly than the first year but amount consumed increased significantly even though the drinking episodes decreased (www.askpri.org)what also increased was the number of days of missed school or work, blackouts, and shaking of hands and fingers the next morning.

Alcohol politics and public health

Because alcohol abuse affects society as a whole, governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. The World Health Organization, the European Union and other regional bodies are working on alcohol action plans and programs. Organisations working with alcohol abusers include:
- Alcoholics Anonymous (AA)
- IOGT International (IOGT)
- LifeRing Secular Recovery (LifeRing)
- Men For Sobriety (MFS)
- Moderation Management (MM)
- Rational Recovery (RR)
- Secular Organizations for Sobriety (SOS)
- Self-Management and Recovery Training (SMART)
- Women For Sobriety (WFS)

Alcohol withdrawal

There are several distinct but not mutually exclusive clinical alcohol withdrawal syndromes caused by alcohol withdrawal:
- Tremulousness - "the shakes"
- Activation syndrome - characterized by tremulousness, agitation, rapid heart beat and high blood pressure.
- Seizures - acute grand mal seizures can occur in alcohol withdrawal in patients who have no history of seizure or any structural brain disease.
- Hallucinations - usually visual or tactile in alcoholics
- Delirium tremens - can be severe and often fatal. Unlike withdrawal from opioids such as heroin, which can be unpleasant but never fatal, alcohol withdrawal can kill (by uncontrolled convulsions or delirium tremens) if it is not properly managed. The pharmacological management of alcohol withdrawal is based on the fact that alcohol, barbiturates, and benzodiazepines have remarkably similar effects on the brain and can be substituted for each other. Since benzodiazepines are the safest of the three classes of drugs, alcohol consumption is terminated and a long-acting benzodiazepine is substituted to block the alcohol withdrawal syndrome. The benzodiazepine dosage is then tapered slowly over a period of days or weeks.

External links

- [http://atoz.iqhealth.com/HealthAnswers/encyclopedia/HTMLfiles/2790.html Alcohol dependence at iqhealth.com]
- [http://www.mental-health-matters.com/disorders/dis_details.php?disID=4 Mental Health Matters: Alcohol Addiction]
- [http://www.psychforums.com/forums/viewforum.php?f=152 Psych Forums: Alcohol Addiction Forum]
- [http://www.alkoholpolitik.ch: Independent private site in German with some English texts]
- [http://health.dailynewscentral.com/content/view/0001478/31//alcohol_tolerance_genetic.html Alcohol Tolerance May Be Genetic] health.dailynewscentral.com
- [http://www.lifewisewa.com/pdfs/012695.pdf CAGE Questionnaire (PDF)]
- [http://www.alcoholics-anonymous.org/ Alcoholics Anonymous]
- [http://www.nicd.us/ NICD: Alcoholism/addiction resources, treatment locator, family assistance and help]

References

1. Tonnesen H, Hejberg L, Frobenius S, Andersen JR. Erythrocyte mean cell volume--correlation to drinking pattern in heavy alcoholics. Acta Med Scand. 1986;219(5):515-8. ([http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3739755&dopt=Abstract Medline abstract]) 2. Schwan R, Albuisson E, Malet L, Loiseaux MN, Reynaud M, Schellenberg F, Brousse G, Llorca PM. The use of biological laboratory markers in the diagnosis of alcohol misuse: an evidence-based approach. Drug Alcohol Depend. 2004 Jun 11;74(3):273-9. ([http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15194205 Medline abstract]) 3. Ewing, John A. “Detecting Alcoholism: The CAGE Questionaire” JAMA 252: 1905-1907, 1984 Category:Alcohol_abuse Category:Drinking culture Category:Social stigma ko:술 중독 ja:アルコール依存症

Alcoholic beverage

ian alcoholic beverage.]] Alcoholic beverages are drinks containing ethanol. Alcoholic beverages have been widely consumed since prehistoric times by people around the world, seeing use as a component of the standard diet, for hygienic or medical reasons, for their relaxant and euphoric effects, for recreational purposes, for artistic inspiration, as aphrodisiacs, and for other reasons. Some have been invested with symbolic or religious significance suggesting the mystical use of alcohol, e.g., by Greco-Roman religion in the ecstatic rituals of Dionysus (also called Bacchus), god of drink and revelry; in the Christian Eucharist; and at the Jewish Passover. Moderate consumption of alcohol, defined by the U.S. Department of Agriculture and the Dietary Guidelines for Americans as no more than one to two drinks for men and one drink for women per day, is consistently shown as being beneficial for the heart and circulatory system (the UK equivalent is 3-4 units per day for men and 2-3 units for women). Moderate consumers statistically have fewer heart attacks and strokes, live longer, have lower blood pressure, and generally report better overall health. However, some people are prone to developing a chemical dependency to alcohol, alcoholism. The results of alcoholism are considered a major health problem in many nations. Frequent excessive consumption can harmfully interfere with the user's well-being. The neurological effects of alcohol use are often a factor in deadly motor vehicle accidents and fights. People under the influence of alcohol sometimes find themselves in dangerous or compromising situations where they would not be had they remained sober. Operating a motor vehicle or heavy machinery under the influence of alcohol is serious crime in almost all developed nations. Some religions—most notably Islam, Latter-day Saints, the Nikaya and most Mahayana schools of Buddhism and some Protestant sects of Christianity—forbid or discourage the consumption of alcoholic beverages for these and other reasons. Most governments regulate or restrict the sale and use of alcohol.

Chemistry

The ethanol (CH₃CH₂OH) in alcoholic beverages is almost always produced by fermentation, which is the metabolism of carbohydrates (usually sugars) by certain species of yeast in the absence of oxygen. The process of culturing yeast under conditions that produce alcohol is referred to as brewing. It should be noted that in chemistry, alcohol is a general term for any organic compound in which a hydroxyl group (-O H) is bound to a carbon atom, which in turn is bound to other hydrogen and/or carbon atoms. Other alcohols such as propylene glycol and the sugar alcohols may appear in food or beverages regularly, but these alcohols do not make them alcoholic. It has been suggested that alcoholic impurities, congeners, are the cause of hangovers. Alcoholic beverages with a concentration of about 50% ethanol or greater (100 proof) are flammable liquids and easily ignited. See also: ethanol

Alcoholic content

The concentration of alcohol in an alcoholic beverage may be specified in percent alcohol by volume (ABV), in percentage by weight (sometimes abbreviated w/w for weight for weight), or in proof. The 'proof' measurement roughly corresponds in a 2:1 ratio to percent alcoholic content by volume (e.g. 80 proof = 40% ABV). Common distillation cannot exceed 192 proof because at that point ethanol is an azeotrope with water. Alcohols of this purity are commonly referred to as grain alcohol and are not meant for human consumption, with the notable exception of neutral grain spirits. Most yeasts cannot grow when the concentration of alcohol is higher than about 18% by volume, so that is a practical limit for the strength of fermented beverages such as wine, beer, and sake. Strains of yeast have been developed that can survive in solutions of up to 25% alcohol by volume, but these were bred for ethanol fuel production, not beverage production. Liquors are produced by distillation of a fermented product, concentrating the alcohol and eliminating some of the by-products. Many wines are fortified wines with additional grain alcohol to achieve higher ABV than is easily reached using fermentation alone.

Flavoring

Ethanol is a moderately good solvent for many "fatty" substances and essential "oils", and thus facilitates the inclusion of several coloring, flavoring, and aromatic compounds to alcoholic beverages, especially to distilled ones. These flavoring ingredients may be naturally present in the starting material, or may be added before fermentation, before distillation, or before bottling the distilled product. Sometimes the flavor is obtained by allowing the beverage to stand for months or years in barrels made of special wood, or in bottles where scented twigs or fruits — or even insects — have been inserted. A well-stocked bar will include a selection of beers and wines, along with the typical liquors of vodka, rum, gin, tequila, and whisky; each in varying qualities from "well" quality (off brand) to premium quality (name brand) to "top shelf" (usually very expensive, ranging from $50 to several hundred USD per 750 ml bottle). Alcoholic beverages can be combined at the time of serving, sometimes with other ingredients, to create cocktails or mixed drinks. Small servings of pure liquor (shots) are also common, with whisky and tequila being traditionally popular selections.

History

Fermented beverages

Fermented alcoholic beverages have been known since pre-historical times. Beer was certainly known in Mesopotamia before 4000 BC, as attested to by recipes found on clay tablets and art that shows individuals using straws to drink from large vats. Wine was consumed in Classical Greece at breakfast or at symposia, and in the 1st century BC it was part of the diet of most Roman citizens. However, both Greeks and Romans generally consumed their wine watered (from 1 parts of wine to 1 part of water, to 1 part of wine to 4 parts of water). The transformation of water into wine at a wedding feast is one of the miracles attributed to Jesus in the New Testament, and his symbolic use of wine in the Last Supper led to it becoming an essential part of the Catholic Eucharist rite. In spite of the Qur'anic ban on alcoholic beverages, wine (usually sold by Christian tavern-keepers) remained fairly popular in Islamic lands over the centuries, as revealed in the verses of Persian mathematician Omar Khayyám (1040–1131): :"Here with a Loaf of Bread beneath the Bough, :A Flask of Wine, a Book of Verse—and Thou :Beside me singing in the Wilderness— :And Wilderness is Paradise enow." [http://www.armory.com/~thrace/ev/siir/Omar_Khayyam.html] In Europe during the Middle Ages, beer was consumed by the whole family, thanks to a triple fermentation process — the men had the strongest, then women, then children. A document of the times mentions nuns having an allowance of six pints of ale a day. Cider and pomace wine were also widely available, while grape wine was the prerogative of the higher classes. After the collapse of the Roman Empire, wine production in Europe appears to have been sustained chiefly by monasteries. By the time the Europeans reached the Americas in the 15th century, several native civilizations had developed alcoholic beverages. According to a post-Conquest Aztec document, consumption of the local "wine" (pulque) was generally restricted to religious ceremonies, but freely allowed to those over 70 years old (possibly the all-time record for legal drinking age). The natives of South America manufactured a beer-like product from cassava or maize (cauim, chicha), which had to be chewed before fermentation in order to turn the starch into sugars. (Curiously, the same technique was used in ancient Japan to make sake from rice and other starchy crops.) The medicinal use of alcoholic beverages was mentioned in Sumerian and Egyptian texts dated from 2100 BC or earlier. The Hebrew Bible recommends giving alcoholic drinks to those who are dying or depressed, so that they can forget their misery.

Distilled beverages

Main article: Distilled beverage Beer and wine are typically limited to a maximum 15 percent alcohol, although brewers have reached 25% alcohol. Beyond this limit yeast is adversely affected and cannot ferment. Since the fourth millennium BC in Babylonia, higher levels of alcohol have been obtained in a number of ways. It was not until the still was invented by Islamic alchemists in the 8th or 9th centuries that the history of distilled beverages began. Alcohol appeared first in Europe in the mid 12th century and by the early 14th century it had spread throughout Europe. It also spread eastward, mainly by the Mongols, and was practiced in China by the 14th century. However, recent archeological evidence has supported the idea that China has had wines and distilled beverages dating back to 5000 BC. Paracelsus gave alcohol its modern name, taking it from the Arabic word which means "finely divided", a reference to distillation.

Uses

In many countries, alcoholic beverages are commonly consumed at the major daily meals (lunch and dinner). Most early beers were in fact highly nutritional and served as a means of calorie distribution. Beer can be stored longer than grain or bread without fear of pest infestation or rotting, and drinking beer avoided the tooth-destroying grit that was present in hand-ground or early mill-ground flours. In places and eras with poor public sanitation, such as Medieval Europe, consumption of alcoholic beverages (particularly weak or "small" beer) was one method of avoiding water-borne diseases such as the cholera. Though strong alcohol kills bacteria, the low concentration in beer or even wine will have only a limited effect. Probably the boiling of water, which is required for the brewing of beer, and the growth of yeast, which would tend to crowd out other micro-organisms, were more important than the alcohol itself. In any case, the ethanol (and possibly other ingredients) of alcoholic beverages allows them to be stored for months or years in simple wood or clay containers without spoiling, which was certainly a major factor in their popularity. In colder climates, strong alcoholic beverages are popularly seen as a way to "warm up" the body, possibly because ethanol is a quickly absorbed source of food energy and dilates peripheral blood vessels (Peripherovascular dilation). This however is a dangerous myth, and people experiencing hypothermia should avoid alcohol. Although a drunk may feel warmer, the body loses heat and body temperature decreases, which may cause hypothermia, and eventually death. This is because of the dilation of blood vessels not in the core of the body; because of this increased bloodflow, the body loses its heat out of its less protected outer extremities. In many cultures, both contemporary and historical, alcoholic beverages — mostly because of their neurological effects — have also played an important role in various kinds of social interaction, providing a form of "liquid courage" (those who consume it "gain" confidence and lose discretion) While other psychoactive drugs (such as opium, coca, khat, cannabis, kava-kava, etc.) also have millennial traditions of social use, only coffee, tea and tobacco have been as universally used and accepted as ethanol is today.

Legal considerations

tobacco]] Most countries have rules forbidding the sale of alcoholic beverages to children. For example, in the Netherlands and Germany, one has to be 16 to buy beer or wine and 18 to buy distilled alcoholic beverages. However, possession of alcoholic beverages is not illegal for minors in Germany. Law here is directed at the potential sellers of alcoholic beverages and not at the minors. German law puts control concerning the consumption of alcoholic beverage into the hands of custodial persons and persons with parental power. See [http://www.bmfsfj.de/RedaktionBMFSFJ/Abteilung5/Pdf-Anlagen/juSchGenglisch,property=pdf.pdf] In law, sometimes the term "intoxicating agent" is used for a category of substances which includes alcoholic beverages and some drugs. Giving any of these substances to a person to create an abnormal condition of the mind (such as drunkenness), in order to facilitate committing a crime, may be an additional crime. Some countries may forbid the commerce, consumption or advertising of alcoholic beverages, or restrict them in various ways. During the period known as Prohibition, from 1919 to 1933, it was illegal to manufacture, transport, import, export, or sell alcoholic beverages in the United States. Many Muslim countries, such as Saudi Arabia, continue to prohibit alcohol for religious reasons. In the United States there are still communities with a ban on alcohol sales. Most countries have laws against drunk driving, driving with a certain concentration of ethanol in the blood. The legal threshold of blood alcohol content ranges from 0.0% to 0.05% or 0.08%, according to local law. Most countries also specify a legal drinking age, below which the consumption of alcohol is prohibited. In the US, the legal age in every state has been 21 since the passage of the National Minimum Drinking Age Act in 1984, which tied federal highway funds to states' raising their minimum drinking age to 21. In many countries, production of alcoholic beverages requires a license, and alcohol production is taxed. In the U.S., the Bureau of Alcohol, Tobacco, Firearms, and Explosives and the Alcohol and Tobacco Tax and Trade Bureau (formerly one organization known as the Bureau of Alcohol, Tobacco and Firearms) enforce federal laws and regulations related to alcohol, though most regulations regarding serving and selling alcoholic beverages are made by the individual states. For example, in the state of Washington, one can only buy bottles of spirits in state-run stores, whereas in many other states, these can be bought in supermarkets. There also exist intrastate regulatory differences, as between Montgomery County, Maryland and the rest of the state. In the UK the Customs and Excise department issues distilling licences. In New Zealand it is legal to produce alcohol for personal use. This has made the sale and use of home distillation equipment popular.

Types of alcoholic beverages

Alcoholic beverages include low-alcohol-content beverages produced by fermentation of sugar- or starch-containing products, and high-alcohol-content beverages produced by distillation of the low-alcohol-content beverages. Sometimes, the alcohol content of low-alcohol-content beverages is increased by adding distilled products, particularly in the case of wines. Such fortified wines include Port wine and Sherry. The process involved (as well as the resulting alcohol content) defines the finished product. A "beer" involves a relatively short (incomplete) fermentation process and an equally short aging process (a week or two) resulting in an alcohol content generally between 3-8%, as well as natural carbonation. A "wine" involves a longer (complete) fermentation process, and a relatively long aging process (months or years -- sometimes decades) resulting in an alcohol content between 7-18%. (Note that sparkling wine is generally made by adding a small amount of sugar before bottling). Distilled products are generally not made from a "beer" that would normally be palatable as fermentation is normally completed, but no aging is involved until after distillation. Most distilled liquors are 40% alcohol by volume. Standard drinks of alcoholic beverages in the United States all contain equivalent amounts of alcohol, about 0.6 ounce each. A U.S. standard drink is a 12 ounce can or bottle of beer, a five ounce glass of dinner wine, or a 1.5 ounce drink of 80 proof distilled spirits (either straight or in a mixed drink). This means that there is no drink of moderation, only behaviors of moderation. Standard drinks of beer, wine and liquor are all the same to a Breathalyzer.

Non-distilled beverages

- Beer
- Ales
- Barleywine
- Bitter ale
- Mild ale
- Pale ale
- Porter
- Stout
- Real ale
- Stock ale
- Fruit Beer
- Lager beer
- Bock
- Dry beer
- Oktoberfest Märzen
- Pilsener
- Schwarzbier
- Small beer
- Wheat beer
- Cauim
- Chicha
- Cider
- Kumis
- Lappish Hag's Love Potion
- Mead
- Perry
- Pulque
- Sake
- Wine
- Spritzer
- Palm wine
- Wine cooler
- Fruit wine

Distilled beverages

- Cocktails
- Liqueurs
- Spirits The names of some beverages are determined by the source of the material fermented: Note that in common speech, wine or brandy is made from grapes unless the fruit is specified: "plum wine" or "cherry brandy" for example, although in some cases grape-derived alcohol is added. In the USA and Canada, cider often means unfermented apple juice (see the article on cider), while fermented cider is called hard cider. Unfermented cider is sometimes called sweet cider. Also, applejack was originally made by a freezing process described in the article on cider which was equivalent to distillation but more easily done in the cold climate of New England. In the UK, cider is always alcoholic, and in Australia it can be either. Beer is generally made from barley, but can sometimes contain a mix of other grains. Whisky is sometimes made from a blend of different grains, especially Irish whiskey which may contain several different grains. The style of whisky (Scotch, Rye, Bourbon) generally determines the primary grain used, with additional grains usually added to the blend (most often barley, and sometimes oats). Two common distilled beverages are vodka and gin. Vodka can be distilled from any source (grain and potatoes being the most common, also industrial cellulose for the cheapest!) but the main characteristic of vodka is that it is so thoroughly distilled as to exhibit none of the flavors derived from its source material. Gin is a similar distillate which has been flavored by contact with herbs and other plant products, especially juniper berries. The name comes from the Dutch liquor genever, which in turn takes it's name from the Dutch word for juniper.

Drunkenness

Drunkenness, in its most common usage, is the state of being intoxicated with alcohol (i.e. ethanol) to a sufficient degree to impair mental and motor functioning. A person who is habitually intoxicated in this manner is labeled an alcoholic, often referred to as a "drunk" (a shortened form of the more traditional term "drunkard") or colloquially as a "lush" or "jakey".

Cultural attitudes

Many societies have cultural stereotypes associated with drunkenness; some consider the ability to drink vast quantities of alcohol worthy of respect. Arguably, such an attitude can be regarded as pathological, as it may lead to alcoholism. In many public places for alcoholic consumption such as bars, the act of not drinking alcohol and refusing offers of alcoholic drinks may appear to be "spoiling the atmosphere" and be met with social disapproval. However, an intoxicated person is often considered unable to control his/her urges or acknowledging limits of drinking and is thus treated with disrespect, related to annoying, or intrusive behavior. The symptoms of drunkenness are generally reported to be positive, at least initially. As the effects diminish, the associated hangover starts, mostly a result of dehydration and exhaustion. The ancient Greeks believed that putting a piece of amethyst in the glass or in one's mouth while drinking prevented drunkenness, and indeed the name of the gem alludes to this belief (Ancient Greek: "a-methyst" meaning "not intoxicated"). Many religions discourage or prohibit alcohol consumption. The Qur'an, or book of Islam, declares that God prohibits the consumption of alcohol by humankind, because of harmful effects for the body, harmful effects for the consumer's life and family, social problems, and distraction from mindfulness of God. The Catechism of the Roman Catholic Church states in paragraph 2290: "The virtue of temperance disposes us to avoid every kind of excess: the abuse of food, alcohol, tobacco, or medicine. Those incur grave guilt who, by drunkenness or a love of speed, endanger their own and others' safety on the road, at sea, or in the air." The Church does not prohibit the use of alcohol if it is done in moderation. Buddhists abstain from alcohol to avoid unintentionally harming others. The intoxication of the mind also is at odds with the teaching of mindfulness.

American Psychiatric Association

The American Psychiatric Association is a professional organization of psychiatrists whose members are American and international physicians who are trained in psychiatry. The association is responsible for various journals and pamphlets, as well as the book Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM codifies the generally-accepted psychiatric conditions and the guidelines for diagnosing those conditions.

External links

- [http://www.psych.org The American Psychiatric Association]
- (http://www.ips-india.org The Indian Psychiatric Society{

American Hospital Association

Founded in 1898, the American Hospital Association (AHA), located in Chicago, Illinois, is the national organization that represents and serves all types of hospitals, health care networks, and their patients and communities. The AHA provides education for health care leaders and is a source of information on health care issues and trends. Close to 5,000 hospitals, health care systems, networks, other providers of care and 37,000 individual members form the AHA. Category:Hospitals in the United States Category:Professional associations

American College of Physicians

The American College of Physicians (ACP) is a national organization of doctors of internal medicine (internists) -- physicians who specialize in the prevention, detection and treatment of illnesses in adults. With more than 119,000 members, ACP is the largest medical-specialty organization and second-largest physician group in the United States of America. ACP provides information and advocacy for its members as they practice internal medicine and related subspecialties. ACP members are also involved in medical education, research, and administration. Membership also includes medical students, residents, and fellows. History and Mission The American College of Physicians’ mission is to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine. It was founded in 1915 to promote the science and practice of medicine. In 1998, ACP merged with the American Society of Internal Medicine (ASIM), which was established in 1956 to study economic aspects of medicine. Known as ACP-ASIM from 1998 to 2003, the organization then re-adopted American College of Physicians as its corporate name. Structure ACP is governed by an elected Board of Regents. The Board is advised by a network of ACP committees and by the ACP Board of Governors, which is composed of 79 elected Governors in chapters and regions of the United States, Canada, Central and South America, and Japan. ACP sponsors the Council of Subspecialty Societies, which represents 25 subspecialty societies and internal medicine organizations. ACP is represented in the American Medical Association, the Federated Council for Internal Medicine, the Council of Medical Specialty Societies, and other organizations. Membership Internists complete a three-year internal medicine training program after medical school, focusing on how to prevent, diagnose and treat diseases primarily affecting adults. Subspecialty internists complete one to three years of additional training in such fields as cardiology, endocrinology, geriatrics, nephrology, gastroenterology, and infectious diseases. Levels of membership in ACP are Medical Student, Associate, Member, Fellow ("FACP"), Honorary Fellow, and Master ("MACP.") Fellowship and Mastership in the College signify outstanding achievement in internal medicine. Fellows are recommended by their peers, endorsed by their local chapter leadership, and reviewed by a national credentials subcommittee. Masters are nominated from among the Fellows of ACP for annual election to this highly selective group. ACP Affiliate membership is available to physician assistants (PAs) who are Fellow Members of the American Academy of Physician Assistants. Publications Annals of Internal Medicine, published by ACP twice-monthly, is one of the top medical journals in the world. ACP Journal Club summarizes the most important clinical articles for internists from more than 100 medical journals. ACP Observer is the College's award-winning semi-monthly newspaper for internists. ACP Medicine is a continually updated, evidence-based reference of internal medicine. ACP also publishes a variety of books about health care and medical practice. Activities ACP’s Washington, D.C., office monitors and responds to public policy issues that affect public health and the practice of medicine. Activities include development of policy statements and communication with legislative and administrative sectors of government. The ACP Center for Ethics and Professionalism seeks to advance physician and public understanding of ethics and professionalism issues in the practice of medicine, in order to enhance patient care by promoting the highest ethical standards. The ACP Foundation exists to support the mission of the American College of Physicians and to improve the health of the public through the creation and support of programs in education, research, service, and professionalism. Education and Information Resources ACP’s continuing medical education programs for internists include Annual Session, its national scientific meeting featuring more than 260 presentations; the Medical Knowledge Self-Assessment Program (MKSAP), now in its 13th edition; postgraduate board review courses; recertification courses; and chapter/regional meetings. For future internists, ACP provides education and career information, produces MKSAP for Students, and administers an In-Training Examination for residents. ACP Electronic information resources include PIER (Physicians’ Information and Education Resource), a Web-based decision-support tool that delivers evidence-based guidance to physicians in more than 400 modules, or clinical areas. Other resources include MKSAP 13 CD-ROM and MKSAP 13 Update; online Clinical Problem-Solving Cases; and a PDA Portal. Clinical Skills Teaching Modules bring proven teaching techniques to classrooms. The ACP Practice Management Center offers members timely information to succeed in today's health care environment. The Center offers practical written guides, practice management tools, and personalized advice. The Medical Laboratory Evaluation Program (MLE) offers proficiency testing for laboratories in the United States and abroad. ACP maintains the Doctors For Adults® Web site for the public and provides free patient education brochures and videos/DVDs for physicians who wish to raise awareness and educate their patients and communities. All information on the www.doctorsforadults.com Web site is reviewed by ACP physicians and contains no commercial endorsements.

External links

- [http://www.acponline.org/college/pressroom/acpfact.htm?wiki American College of Physicians] - the most current fact sheet about ACP can be found on the organization's Web site
- [http://www.doctorsforadults.com?wiki Doctors for Adults.com] - The American College of Physicians' patient education Web site, with more info about internal medicine and internists
- [http://www.annals.org Annals of Internal Medicine] - the journal of the ACP Category:Medical associations

Disease

A disease is any abnormal condition of the body or mind that causes discomfort, dysfunction, or distress to the person affected or those in contact with the person. Sometimes the term is used broadly to include injuries, disabilities, syndromes, symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts these may be considered distinguishable categories. Pathology is the study of diseases. The subject of systematic classification of diseases is referred to as nosology. The broader body of knowledge about diseases and their treatments is medicine.

Syndromes, illness and disease

Medical usage sometimes distinguishes a disease, which has a known specific cause or causes (called its etiology), from a syndrome, which is a collection of signs or symptoms that occur together. However, many conditions have been identified, yet continue to be referred to as "syndromes". Furthermore, numerous conditions of unknown etiology are referred to as "diseases" in many contexts. Illness, although often used to mean disease, can also refer to a person's perception of their health, regardless of whether they in fact have a disease. A person without any disease may feel unhealthy and believe he has an illness. Another person may feel healthy and believe he does not have an illness even though he may have a disease such as dangerously high blood pressure which may lead to a fatal heart attack or stroke.

Transmission of disease

Some diseases, such as influenza, are contagious or infectious, and can be transmitted by any of a variety of mechanisms, including droplets from coughs and sneezes, by bites of insects or other vectors, from contaminated water or food, etc. Other diseases, such as cancer and heart disease are not considered to be due to infection, although micro-organisms may play a role.

Social significance of disease

The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications. The controversial recognitions as diseases of post-traumatic stress disorder, also known as "shell shock"; repetitive motion injury or repetitive stress injury (RSI); and Gulf War syndrome has had a number of positive and negative effects on the financial and other responsibilities of governments, corporations and institutions towards individuals, as well as on the individuals themselves. The social implication of viewing aging as a disease could be profound, though this classification is not yet widespread. A condition may be considered to be a disease in some cultures or eras but not in others. Oppositional-defiant disorder, attention-deficit hyperactivity disorder, and, increasingly, obesity are conditions considered to be diseases in the United States and Canada today, but were not so-considered decades ago and are not so-considered in some other countries. Conversely, the number of people in the West who consider homosexuality to be a disease became widespread in the 20th century but has been decreasing in the last two decades. To consider a condition to be a disease can sometimes involve a negative social value judgement. Lepers were a group of afflicted individuals who were historically shunned and the term "leper" still evokes social stigma. Fear of disease can still be a widespread social phenomena, though not all diseases evoke extreme social stigma.

Other uses of the term

In biology, disease refers to any abnormal condition of an organism that impairs function. The term disease is often used metaphorically for disordered, dysfunctional, or distressing conditions of other things, as in disease of society.

External links

- [http://www.nlm.nih.gov/medlineplus/healthtopics.html Health Topics], MedlinePlus descriptions of most diseases, with access to current research articles.
- [http://www.cdc.gov/health/default.htm Center for Disease Control Health Topics A-Z], fact sheets about many common diseases
- [http://rarediseases.about.com/ Rare/Orphan Diseases]
- [http://www.national-health.org/rarediseases/ National Organization for Rare Disorders] Extensive, useful information on rare diseases.
- [http://www.merck.com/pubs/mmanual/sections.htm The Merck Manual], detailed description of most diseases, freely searchable online. Category:Diseases Category:Medical terms als:Krankheit zh-min-nan:Pīⁿ ms:Penyakit ja:病気 simple:Disease th:โรค

JAMA

right JAMA is the acronym for the Journal of the American Medical Association, a leading medical journal. Its official name is now JAMA and is referred to by this name in reference lists. It is published weekly by--as its name implies--the American Medical Association.

External links

- [http://jama.ama-assn.org/ JAMA website]
- [http://www.ama-assn.org/ American Medical Association] Category:Medical journals

Disease

Syndromes, illness and disease

Transmission of disease

Social significance of disease

Other uses of the term

External links

North America

North America is a continent in the northern hemisphere bordered on the north by the Arctic Ocean, on the east by the North Atlantic Ocean, on the south by the Caribbean Sea, and on the west by the North Pacific Ocean. It covers an area of 24,497,994 km² (9,458,728 sq mi), or about 4.8% of the Earth's surface. As of July 2002, its population was estimated at more than 514,600,000. It is the third largest continent in area, after Asia and Africa, and is fourth in population after Asia, Africa, and Europe. Both North and South America are named after Amerigo Vespucci, who was the first European to suggest that the Americas were not the East Indies, but a previously undiscovered (by Europeans) New World. North America occupies the northern portion of the landmass generally referred to as the New World, the Western Hemisphere, the Americas, or simply America. North America's only land connection is to South America at the narrow Isthmus of Panama. (For geopolitical reasons, all of Panama – including the segment east of the Panama Canal in the isthmus – is often considered a part of North America alone.) According to some authorities, North America begins not at the Isthmus of Panama but at the Isthmus of Tehuantepec, with the intervening region called Central America and resting on the Caribbean Plate. Most, however, tend to see Central America as a region of North America, considering it too small to be a continent on its own. Greenland, although a part of North America geographically, is not considered to be part of the continent politically.

Physical features

Greenland, plutonic, metamorphic rock types of North America. ]] Plate tectonics recognizes the vast majority of North America as being the surface of the North American Plate. Parts of California and western Mexico are known for being the edge of the Pacific Plate, with the two plates meeting along the San Andreas fault. The continent can be divided into four great regions (each of which contains many sub-regions): the Great Plains stretching from the Gulf of Mexico to the Canadian Arctic; the geologically young, mountainous west, including the Rocky Mountains, the Great Basin, California and Alaska; the raised but relatively flat plateau of the Canadian Shield in the northeast; and the varied eastern region, which includes the Appalachian Mountains, the coastal plain along the Atlantic seaboard, and the Florida peninsula. Mexico, with its long plateaus and cordilleras, falls largely in the western region, although the eastern coastal plain does extend south along the Gulf. The western mountains are split in the middle, into the main range of the Rockies and the coast ranges in California, Oregon, Washington, and British Columbia with the Great Basin – a lower area containing smaller ranges and low-lying deserts – in between. The highest peak is Denali in Alaska. Since 1931, Rugby, North Dakota, has officially been recognized as being at the geographic center of North America. The location is marked by a 4.5 metre (15 foot) field stone obelisk. Image:North america terrain 2003 map.jpg|North America bedrock and terrain. Image:North america basement rocks.png|North American cratons and basement rocks. Image:North America Tectonic Elements.jpg|Tectonic elements of North America Image:North america craton nps.gif|North American craton.

Territories and regions

craton On the main continent landmass, there are three large and relatively populous countries:
- Canada - many large islands off the shore of North America belong to Canada, including Vancouver Island and the Queen Charlotte Islands on the west, Prince Edward Island, Newfoundland and Cape Breton Island on the east, and the Canadian Arctic islands (including Ellesmere Island, Baffin Island, and Victoria Island) in the north
- Mexico - the Revillagigedo archipelago and numerous smaller islands off its coast belong to Mexico
- The United States - the 48 contiguous states and Alaska are part of North America, while the state of Hawaii in the Pacific Ocean is not; the Aleutian Islands south of Alaska also belong to the U.S. At the southern end of the continent, in a relatively small area known as Central America, are the countries of:
- Belize
- Costa Rica
- El Salvador
- Guatemala
- Honduras
- Nicaragua
- Panama ¹ At the southeastern end of the continent lies a chain of islands territories called the Antilles, the Caribbean or the West Indies, which include the countries:
- Antigua and Barbuda
- Bahamas
- Barbados
- Cuba
- Dominica
- Dominican Republic
- Grenada
- Haiti
- Jamaica
- Saint Kitts and Nevis
- Saint Lucia
- Saint Vincent and the Grenadines
- Trinidad and Tobago ¹ And the dependencies:
- Anguilla (British overseas territory)
- Aruba ² (part of the Kingdom of the Netherlands)
- Cayman Islands (British overseas territory)
- Guadeloupe (French région d'outre-mer)
- Martinique (French région d'outre-mer)
- Montserrat (British overseas territory)
- Navassa Island (U.S. territory)
- Netherlands Antilles ¹ (part of the Kingdom of the Netherlands)
- Puerto Rico (U.S. commonwealth)
- Turks and Caicos Islands (British overseas territory)
- British Virgin Islands (British overseas territory)
- U.S. Virgin Islands (territory of the USA) Lying in the Atlantic Ocean but considered part of the continent are the dependencies:
- Bermuda, a British overseas territory found about 1,072 km (670 mi.) southeast of New York City
- Greenland, the largest island in the world and a self-governing dependency of Denmark, which is located in the far north of the continent to the east of Nunavut.
- Saint Pierre and Miquelon, a French collectivité d'outre-mer off the south coast of Newfoundland, is the last of France's once vast possessions in America north of the Caribbean. ¹ These states and dependencies have territory both in North and South America.
² These dependencies lie in South America, but are considered North American because of cultural and historical reasons.
See here for details.

Usage

The United States, Canada, and the other English-speaking nations of the Americas (Belize, Guyana, and the Anglophone Caribbean) are sometimes grouped under the term Anglo-America, while the remaining nations of North and South America are grouped under the term Latin America. Alternatively, Northern America is used to refer to Canada and the U.S. together (plus Greenland and Bermuda), while Central America is mainland North America south of the United States. The West Indies generally include all islands in the Caribbean Sea. In this respect, Latin America generally includes Central America and South America and, sometimes, the West Indies. The term Middle America is sometimes used to refer to Mexico, Central America, and the Caribbean collectively. The term "North America" may mean different things to different people. The term in common usage is often taken to mean "the United States and Canada, only" by some people of the United States and Canada, excluding Mexico and the countries of Central America, unless the context makes it clear that they are to be included (such as with specific reference to Mexico, when talking about NAFTA). For example, guides to wild flora and fauna published by the National Audubon Society for "North America" frequently include only species found in Canada and the U.S. This may be attributed to the fact that culturally and economically, the U.S. and Canada are more alike to each other than they are to the rest of North America. Mexicans, however, are acutely aware that Mexico is a part of North America and object to this usage. Central Americans, however, are generally content to be called Central Americans – largely because of their shared history, which includes several attempts at supranational integration in the region and in which Mexico, their much larger northern neighbor, was never involved.

Political divisions and regions

Notes:
¹ Continental regions as per UN categorisations/map.
² Depending on definitions, Aruba, Netherlands Antilles, Panama, and Trinidad and Tobago have territory in one or both of North and South America.
³ Due to ongoing activity of the Soufriere Hills volcano beginning 1995, much of Plymouth, Montserrat's de jure capital, was destroyed and government offices relocated to Brades.

External links

- http://www.america-norte.com/america-norte-mapa.htm Category:Continents Category:North America zh-min-nan:Pak Bí-chiu ko:북아메리카 ja:北アメリカ simple:North America th:ทวีปอเมริกาเหนือ

Billion

:For the modem manufacturer, see Billion (company). The word "billion" and its equivalents in other languages refer to one of two different numbers.

10^¹²

The original meaning, established in the 15th century, was "a million of a million" (1,000,000², hence the name billion), or 10¹² = 1 000 000 000 000. This system, known in French as the échelle longue ("long scale"), was formerly used in the United Kingdom and is used in most countries where English is not the primary language. 10¹² is referred to as a trillion in the "short scale" system.

10^⁹

In the late 17th century a change was made in the way of writing large numbers. Numbers had been separated into groups of six digits, but at this time the modern grouping of three digits came into use. As a result, a minority of Italian and French scientists began using the word "billion" to mean 10⁹ (one thousand million, or 1 000 000 000), and correspondingly redefined trillion and higher numbers to mean powers of one thousand rather than one million. This is known in French as the échelle courte ("short scale") and is now officially used by English-speaking countries, as well as Brazil, Puerto Rico, Turkey and Greece.

Synonyms

Use of "thousand million" for 10⁹ and "million million" for 10¹² can avoid ambiguity; however, British media, including the BBC, which long used "thousand million" for this reason, use "billion" to mean 10⁹. The old word "milliard", also found in many other languages, can be used for 10⁹ but is unfamiliar even to many native English speakers. See long and short scales for a more detailed discussion and usage advice.

Trivia

The facts below give a sense of how large one billion (taken as 10⁹) is in the context of passage of time.
- About a billion seconds ago, the parents of middle school children were themselves in elementary school. (One billion seconds is roughly 31.7 years.)
- About a billion minutes ago, the Roman Empire was flourishing. (One billion minutes is roughly 1,900 years.)
- About a billion hours ago, modern men and their ancestors were living in the Stone Age (more precisely, the Middle Paleolithic). (One billion hours is roughly 114,000 years.)
- About a billion days ago, Australopithecus, an ape-like creature related to an ancestor of modern humans, roamed the African savannas. (One billion days is roughly 2.7 million years.)
- About a billion months ago, dinosaurs walked the earth during the late Cretaceous. (One billion months is roughly 82 million years.)
- About a billion years ago, the first multicellular organisms appeared on Earth. (The universe is now thought to be about 13.7 billion years old.) In terms of distance:
- A billion centimeters is about the distance from Chicago, Illinois, USA to Tokyo, Japan.
- A billion inches is 15,783 miles, more than halfway around the world and sufficient to reach any point on the globe from any other point.
- A billion meters is almost three times the distance from the Earth to the Moon.

External links

- [http://alt-usage-english.org/excerpts/fxbill00.html alt.usage.english FAQ] Category:Integers Category:Large numbers

Liver

The liver is an organ in vertebrates, including humans. It plays a major role in metabolism and has a number of functions in the body including drug detoxification, glycogen storage, and plasma protein synthesis. It also produces bile, which is important for digestion. Medical terms related to the liver often start in hepato- or hepatic from the Greek word for liver, hepar.

Anatomy

Greek Greek The adult human liver normally weighs between 1.0 - 2.5 kilograms, and is a soft, pinkish-brown "boomerang shaped" organ. It is the largest internal organ (the largest organ being the skin) and sits immediately under the diaphragm on the right side of the upper abdomen. The liver lies on the right of the stomach and makes a kind of bed for the gallbladder (which stores bile). The liver is supplied by two major blood vessels: the hepatic artery and the portal vein. The hepatic artery normally comes off the celiac trunk. The portal vein brings venous blood from the spleen, pancreas, and small intestines, so that the liver can process the nutrients and byproducts of food digestion. The hepatic veins drain directly into the inferior vena cava. The bile produced in the liver is collected in bile canaliculi, which merge to form bile ducts. These eventually drain into the right and left hepatic ducts, which in turn merge to form the common hepatic duct. The cystic duct (from the gallbladder) joins with the common hepatic duct to form the common bile duct. Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored in the gallbladder via the cystic duct. The common bile duct and the pancreatic duct enter the duodenum together at the ampulla of Vater. The branchings of the bile ducts resemble those of a tree, and indeed the term "biliary tree" is commonly used in this setting. The liver is one of the only internal human organs capable of natural regeneration of lost tissue; as little as 25% of remaining liver can regenerate into a whole liver again. This is predominantly due to the hepatocytes acting as unipotential stem cells. There is also some evidence of bipotential stem cells, called oval cells, which can differentiate into either hepatocytes or cholangiocytes (cells that line the bile ducts).

Surface anatomy

Apart from a patch where it connects to the diaphragm, the liver is covered entirely by visceral peritoneum, a thin, double-layered membrane that reduces friction against other organs. The peritoneum folds back on itself to form the falciform ligament and the right and left triangular ligaments. These "ligaments" are in no way related to the true anatomic ligaments in joints, and have essentially no functional importance, but they are easily recognizable surface landmarks. Traditional gross anatomy divided the liver into four lobes based on surface features. The falciform ligament is visible on the front (anterior side) of the liver. This divides the liver into a left anatomical lobe, and a right anatomical lobe. If the liver is flipped over, to look at it from behind (the visceral surface), there are two additional lobes between the right and left. These are the caudate lobe (the more superior), and below this the quadrate lobe. From behind, the lobes are divided up by the ligamentum venosum and ligamentum teres (anything left of these is the left lobe), the transverse fissure (or porta hepatis) divides the caudate from the quadrate lobe, and the right sagittal fossa, which the inferior vena cava runs over, separates these two lobes from the right lobe.

Functional anatomy

For purposes such as advanced liver surgery, it is crucial to understand the organization of liver based on blood supply and biliary drainage. The central area where the common bile duct, portal vein, and hepatic artery enter the liver is the hilum or "porta hepatis". The duct, vein, and artery divide into left and right branches, and the portions of the liver supplied by these branches constitute the functional left and right lobes. The functional lobes are separated by a plane joining the gallbladder fossa to the inferior vena cava. In the widely used Couinaud or "French" system, the functional lobes are further divided into a total of eight segments based on secondary and tertiary branching of the blood supply. The segments corresponding to the surface anatomical lobes are as follows:

Physiology

The various functions of the liver are carried out by the liver cells or hepatocytes.
- The liver produces and excretes bile required for food digestion. Some of the bile drains directly into the duodenum, and some is stored in the gallbladder.
- The liver performs several roles in carbohydrate metabolism:
- Gluconeogenesis (the formation of glucose from certain amino acids, lactate or glycerol)
- Glycogenolysis (the formation of glucose from glycogen)
- Glycogenesis (the formation of glycogen from glucose)
- The breakdown of insulin and other hormones
- The liver also performs several roles in lipid metabolism:
- Cholesterol synthesis
- The production of triglycerides (fats).
- The liver produces coagulation factors I (fibrinogen), II (prothrombin), V, VII, IX, and XI, as well as protein C, protein S and antithrombin.
- The liver breaks down hemoglobin (bile pigments are its metabolites), toxic substances and most medicinal products. This sometimes results in toxication, when the metabolite is more toxic than its precursor.
- The liver converts ammonia to urea.
- The liver stores a multitude of substances, including glucose in the form of glycogen, vitamin B12, iron, and copper.
- In the first trimester fetus, the liver is the main site of red blood cell production. By the 42nd week of gestation, the bone marrow has almost completely taken over that task. Producing an artificial organ or device capable of emulating all functions of the liver is outside the reach of science in the foreseeable future. Some functions can be emulated by liver dialysis, an experimental treatment for liver failure.

Diseases of the liver

Many diseases of the liver are accompanied by jaundice caused by increased levels of bilirubin in the system. The bilirubin results from the breakup of the hemoglobin of dead red blood cells; normally, the liver removes bilirubin from the blood and excretes it through bile.
- Hepatitis, inflammation of the liver, caused mainly by various viruses but also by some poisons, autoimmunity or hereditary conditions.
- Cirrhosis is the formation of fibrous tissue in the liver, replacing dead liver cells. The death of the liver cells can for example be caused by viral hepatitis, alcoholism or contact with other liver-toxic chemicals
- Hemochromatosis, a hereditary disease causing the accumulation of iron in the body, eventually leading to liver damage
- Cancer of the liver (primary hepatocellular carcinoma or cholangiocarcinoma and metastatic cancers, usually from other parts of the gastrointestinal tract)
- Wilson's disease, a hereditary disease which causes the body to retain copper
- Primary sclerosing cholangitis, an inflammatory disease of the bile duct, autoimmune in nature.
- Primary biliary cirrhosis, autoimmune disease of small bile ducts
- Budd-Chiari syndrome, obstruction of the hepatic vein. A number of liver function tests are available to test the proper function of the liver. These are enzymes that are most abundant in liver tissue, metabolites or products.

Liver transplantation

Liver transplantation is an option for those with irreversible liver failure. Most transplants are done for chronic liver diseases leading to cirrhosis, such as chronic hepatitis C, alcoholism, autoimmune hepatitis, and many others. Less commonly, liver transplantation is done for fulminant hepatic failure, in which liver failure occurs over days to weeks. Liver allografts for transplant usually come from non-living donors who have died from fatal brain injury. Living donor liver transplantation is a technique in which a portion of a living person's liver is removed and used to replace the entire liver of the recipient. This was first performed in 1989 for pediatric liver transplantation. Only 20% of an adult's liver (Couinaud segments 2 and 3) is needed to serve as a liver allograft for an infant or small child. More recently, adult-to-adult liver transplantation has been done using the donor's right hepatic lobe which amounts to 60% of the liver. Due to the ability of the liver to regenerate, both the donor and recipient end up with normal liver function if all goes well. This procedure is more controversial as it entails performing a much larger operation on the donor, and indeed there have been at least two donor deaths out of the first several hundred cases.

Development

The liver develops as an endodermal outpocketing of the foregut called the hepatic diverticulum. Its initial blood supply is primarily from the vitelline veins that drain blood from the yolk sac. The superior part of the hepatic diverticulum gives rise to the hepatocytes and bile ducts, while the inferior part becomes the gallbladder and its associated cystic duct

Alcoholic

Screening

Blood tests

Medical effects

Treatments

Social impact

Social dependence versus physical dependence

Alcohol politics and public health

Alcohol withdrawal

See also

External links

References

Alcoholic beverage

Chemistry

Alcoholic content

Flavoring

History

Fermented beverages

Distilled beverages

Uses

Legal considerations

Types of alcoholic beverages

Non-distilled beverages

Distilled beverages

See also

Drunkenness

Cultural attitudes

See also

Further reading

American Psychiatric Association

See also

External links

American Hospital Association

American College of Physicians

External links

Disease

Syndromes, illness and disease

Transmission of disease

Social significance of disease

Other uses of the term

See also

External links

JAMA

External links

Disease

Syndromes, illness and disease

Transmission of disease

Social significance of disease

Other uses of the term

See also

External links

North America

Physical features

Territories and regions

Usage

Political divisions and regions

See also

External links

Billion

10^12

10^9

Synonyms

Trivia

See also

External links

Liver

Anatomy

Surface anatomy

Functional anatomy

Physiology

Diseases of the liver

Liver transplantation

Development

10^¹²

10^⁹