Major Depression and other Unipolar Depressions

Everyone has days where they feel blah, down, or sad. Typically, these feelings disappear after a day or two, particularly if circumstances change for the better. People experiencing the temporary "blues" don't feel a sense of crushing hopelessness or helplessness, and are able, for the most part, to continue to engage in regular activities. Prolonged anhedonia (the inability to experience pleasure), hopelessness, and failure to experience an increase in mood in response positive events rarely accompany "normal" sadness. The same may be said for other, more intense sorts of symptoms such as suicidal thoughts and hallucinations (e.g., hearing voices). Instead, such symptoms suggest that serious varieties of depression may be present, including the subject of this document: Major Depressive Disorder (MDD) or (more informally), Major Depression.

For people dealing with Major Depression, negative feelings linger, intensify, and often become debilitating.

Major Depression is a common yet serious medical condition that affects both the mind and body. It is a complex illness, creating physical, psychological, and social symptoms. Although informally, we often use the term "depression" to describe general sadness, the term Major Depression is defined by a formal set of criteria which describe which symptoms must be present before the label may be appropriately used.

Major Depression is a mood disorder. The term "mood" describes one's emotions or emotional temperature. It is a set of feelings that express a sense of emotional comfort or discomfort. Sometimes, mood is described as a prolonged emotion that colors a person's whole psychic life and state of well-being. For example, if someone is depressed, they may not feel like exercising. By not exercising for long periods of time, they will eventually experience the negative effects of a sedentary lifestyle such as fatigue, muscle aches and pains, and in some cases, heart disease.

Many people are puzzled by the term "Unipolar Depression," which is another term for Major Depression. The term "Unipolar Depression" is used here to differentiate Major Depression from the other famous sort of depression, Bipolar (or Manic) Depression, which is a separate illness. It is helpful to think of mood states as occurring on a continuum. During a particular day or week, people can shift from good (or "up") moods, to bad (or "down") moods, or remain somewhere in the middle ("neutral" mood). A person who experiences significant impairment related to shifting between up and down moods often has Bipolar Disorder (discussed in more detail later). Bipolar Disorder can be envisioned as a seesaw movement back and forth between two poles or mood states ("bi" means "two"). In contrast to people with Bipolar Disorder, people with Major Depression remain on the down mood pole; they do not exhibit mood swings. Because they are stuck on the down or depressed end of the mood continuum; they experience a unipolar ("uni" means "one") mood state.

Mood disorders rank among the top 10 causes of worldwide disability, and Major Depression appears first on the list. Disability and suffering is not limited to the individual diagnosed with MDD. Spouses, children, parents, siblings, and friends of people experiencing Major Depression often experience frustration, guilt, anger, and financial hardship in their attempts to cope with the suffering of their friend or loved one.

Major Depression has a negative impact on the economy as well as the family system. In the workplace, depression is a leading cause of absenteeism and diminished productivity. Although only a minority of people seek professional help to relieve a mood disorder, depressed people are significantly more likely than others to visit a physician. Some people express their sadness in physical ways, and these individuals may undergo extensive and expensive diagnostic procedures and treatments while their mood disorder goes undiagnosed and untreated. As a result, depression-related visits to physicians account for a large portion of health care expenditures.

Although the origins of depression are not yet fully understood, we do know that there are a number of factors that can cause a person to suffer from depression. We also know that people who are depressed cannot simply will themselves to snap out of it. Getting better often requires appropriate treatment. Fortunately, there are a wide array of effective treatments available.

The current document provides an in-depth look at Major Depression by summarizing symptoms and diagnostic criteria, prevalence and course, historical and contemporary understandings of the causes of the illness, and assessment and treatment.

RHEUMATOID ARTHRITIS

What is rheumatoid arthritis (RA)?

Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Rheumatoid arthritis can also cause inflammation of the tissue around the joints, as well as in other organs in the body. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly attacked by their own immune system. The immune system contains a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with autoimmune diseases have antibodies in their blood that target their own body tissues, where they can be associated with inflammation. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.

While rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms. However, rheumatoid arthritis is typically a progressive illness that has the potential to cause joint destruction and functional disability.

A joint is where two bones meet to allow movement of body parts. Arthritis means joint inflammation. The joint inflammation of rheumatoid arthritis causes swelling, pain, stiffness, and redness in the joints. The inflammation of rheumatoid disease can also occur in tissues around the joints, such as the tendons, ligaments, and muscles.

In some people with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone, and ligaments, causing deformity of the joints. Damage to the joints can occur early in the disease and be progressive. Moreover, studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness, or swelling present in the joints.

Rheumatoid arthritis is a common rheumatic disease, affecting approximately 1.3 million people in the United States, according to current census data. The disease is three times more common in women as in men. It afflicts people of all races equally. The disease can begin at any age, but it most often starts after 40 years of age and before 60 years of age. In some families, multiple members can be affected, suggesting a genetic basis for the disorder

LEPTOSPIROSIS

What is leptospirosis?

Leptospirosis is an infectious disease caused by a particular type of bacteria called a spirochete. Leptospirosis can be transmitted by many animals such as rats, skunks, opossums, raccoons, foxes, and other vermin. It is transmitted though contact with infected soil or water. The soil or water is contaminated with the waste products of an infected animal. People contract the disease by either ingesting contaminated food or water or by broken skin and mucous membrane (eyes, nose, sinuses, mouth) contact with the contaminated water or soil.

Leptospirosis occurs worldwide, but it is most commonly acquired in the tropics. The U.S. Centers for Disease Control and Prevention states 100-200 cases of leptospirosis are reported each year in the United States, with about 50% of cases occurring in Hawaii.


What are symptoms of leptospirosis?
Leptospirosis symptoms begin from two to 25 days after initial direct exposure to the urine or tissue of an infected animal. This can even occur via contaminated soil or water. Veterinarians, pet shop owners, sewage workers, and farm employees are at particularly high risk. People participating in outdoor sporting activities like canoeing, rafting, hiking, and camping can also come into contact with contaminated water or soil.

The illness typically progresses through two phases:
•The first phase of nonspecific flulike symptoms includes headaches, muscle aches, eye pain with bright lights, followed by chills and fever. Watering and redness of the eyes occurs and symptoms seem to improve by the fifth to ninth day.

•The second phase begins after a few days of feeling well. The initial symptoms recur with fever and aching with stiffness of the neck. Some patients develop serious inflammation of the nerves to the eyes, brain, spinal column (meningitis), or other nerves. Right upper area abdominal pain may occur. Less common symptoms relate to disease of the liver, lungs, kidneys, and heart.

Leptospirosis associated with liver and kidney disease is called Weil's syndrome and is characterized by yellowing of the eyes (jaundice). Patients with Weil's syndrome can also develop kidney disease and have more serious involvement of the organs affected.

How is leptospirosis diagnosed?
The diagnosis of leptospirosis is made by culture of the bacterial organism Leptospira from infected blood, spinal fluid, or urine. However, many doctors must rely upon rising Leptospira antibody levels in the blood in order to make the diagnosis, as the technique required to perform the culturing is delicate and difficult.

More Young Girls Entering Puberty Early, US Study

A new study of breast development in young American girls found that more are entering puberty at age 7 and 8 than in studies done 30 years ago and the largest increase has been among white girls; however in absolute terms more black and Hispanic girls reach puberty early than whites.




You can read how lead author Dr Frank Biro, director of adolescent medicine at Cincinnati Children's Hospital Medical Center, and colleagues reached these conclusions in a paper published online in Pediatrics on 9 August.



Biro told the press that it wasn't clear what was causing these girls to reach puberty earlier, but they were looking at several potential factors, including genes and environment, and how they might interact.



One of the reasons perhaps to be concerned about this trend is that previous studies have shown a link between earlier start of menarche (when a girl gets her first period) and higher risk of breast cancer.



For the study, Biro and colleagues examined data on 1,239 girls between the ages of 6 and 8 from East Harlem in New York; the greater Cincinnati metropolitan area; and the San Francisco Bay area in California.



The girls were recruited by Breast Cancer and the Environment Research Centers set up in 2003 by the National Institute of Environmental Health Science and the National Cancer Institute.



The data came from physical examinations of the girls and interviews with caregivers.



The researchers used a well-established set of guidelines for deciding onset of puberty, including a five-stage system of classifying breast development called Tanner Breast Stages.



They found that a higher proportion of girls, and white girls in particular, were developing breasts earlier at age 7 and 8 than found in studies done 10 and 30 years ago.



The results also showed that:

10.4% of white, 23.4% of black non-Hispanic, and 14.9% of Hispanic girls had reached breast stage 2 or higher at age 7.



At age 8, these figures were: 18.3%, 42.9%, and 30.9%, respectively.

The proportion of girls who had reached breast stage 2 also varied by site and BMI (body mass index), with more obese girls reaching puberty earlier.

Biro and colleagues warned that their study was not representative of all girls in the US, and they will continue to follow this population to see what happens with the girls and what other factors might affect their development.



However, if this is a real trend, it could have important implications for public and individual health.



Biro told Reuter's Health that girls who enter puberty earlier are not only at higher risk of breast cancer later in life, but also more likely to engage in risky behavior.



Girls who enter puberty earlier are psychologically younger than they look, but could be regarded as older, and be expected to behave accordingly, which could affect their mental and emotional development. Studies show that girls who enter puberty earlier are also at higher risk for depression.



Biro said that rising obesity rates could be a reason why girls are entering puberty earlier and like everyone, they should be encouraged to follow a healthy diet high in fruits and vegetables.

BODY IMMUNE

Boost your body’s immune system

Super foods help combat an assortment of ailments

By Cheryl Embrett

One of the best prescriptions for good health is also one of the easiest to follow: watch what you eat. Every day, new studies prove that eating the right foods regularly can help reduce the risk of cancer and heart disease, banish the blues and increase energy and vitality. Here are 10 nutrient-packed “super foods” that should top everyone’s grocery list.

1. Broccoli

This is one mean green! Broccoli is chock-full of the phytochemical sulforaphane, which makes headlines because of its potent anti-cancer properties. It’s also a rich source of beta-carotene (good for the eyes and immune system, among other things), fibre and vitamin C.
Toronto registered dietitian and author Liz Pearson was so convinced of the health benefits of this “King of Cruciferous Vegetables” that she called her first book When in Doubt, Eat Broccoli! But Leave Some Room for Chocolate (Penguin Books, 1998). For fast, easy and delicious ways to add vegetables — including broccoli — to your diet, visit 5 to 10 a day.

2. Blueberries

If you haven’t gone blueberry picking since you were a kid, here’s a reason to start again. In a peer-reviewed study of 100 common fruits, vegetables and nuts in the Journal of Agricultural and Food Chemistry, these blue jewels had one of the highest antioxidant capacities (the ability to combat cell-damaging free radicals that can lead to heart disease and cancer). And, like cranberries, blueberries appear to fight off urinary-tract infections by preventing E. coli bacteria from sticking to cells in the urinary tract.
John Stanton, president of the Running Room Canada, says he always starts his day with a big bowl of fresh fruit, including blueberries when they’re in season. “It’s light, it’s healthy, and then I’m ready to run.” For more on the power of blue, including tasty recipes for everything from wild blueberry chicken breasts to blueberry sorbet, check out Wild Blueberries.

3. Flax

“Ground flaxseed is the one thing I make sure I eat every day,” says Mairlyn Smith, co-author of The Ultimate Healthy Eating Plan That Still Leaves Room for Chocolate (Whitecap Books, 2002). Smith says flax is a great source of both soluble and insoluble fibre (which makes it a natural laxative) as well as plant lignans which may reduce the risk of developing hormone-sensitive cancers, such as prostate and breast cancer.
Flaxseed is also high in Omega-3 fatty acids, which are known to protect against heart disease. Smith eats a flaxseed muffin or sprinkles a tablespoon of ground flaxseed on her cereal every day. For more information on the health benefits of flax, including delicious ways to cook with it, visit the Flax Council of Canada.

4. Garlic

Since ancient times, physicians have used the “stinking rose” to treat health conditions including heart disease. Garlic contains allicin, a phytochemical that may lower cholesterol and make blood platelets less sticky, cutting the risk of clots.
In Mississauga, Ont., naturopath Rana Singh swears by the immune-boosting, cold-fighting power of the humble garlic bulb. He recommends chopping or crushing two or three cloves of fresh, raw garlic and adding them to whatever you’re eating.
For information on the health benefits of garlic and great ways to cook with it, visit The Garlic Information Centre and Garlic Sleuth. (Note: Consult your doctor before including more garlic than is customary in your diet.)

5. Green tea

Green tea is loaded with powerful antioxidants, which may protect against cell damage that leads to aging and help prevent heart disease and cancer. Green tea contains a polyphenol known as epigallocatechin gallate (EGCg), which in animal tests has been shown to prevent the formation of tumors. Researchers at Purdue University found in laboratory tests that EGCg killed human breast cancer cells but did not kill non-cancerous human breast cells.
Paulette Bourgeois, author of the Franklin the Turtle series of kids’ books, drinks green tea several times a day. “It’s not only healthy, it’s soothing,” she says. For more information on the health benefits of tea, visit the Tea Association of Canada.

6. Skim milk

“The one food I consciously remind myself to consume and monitor regularly is milk, since I know that I may not drink enough of it in the course of my regular routine to keep my bones strong,” says food writer and cookbook author Dana McCauley.
She’s not alone. Most women don’t get enough calcium, and one in four white women (the rate is lower in black and Hispanic women) will develop osteoporosis. Studies have found that increasing your calcium intake can also help relieve the symptoms of PMS.
To meet your daily quota, reach for three servings of milk or milk products. After a tough workout, make it low-fat chocolate milk, advises McGill University fitness coordinator Jill Barker. “It has the requisite amount of carbs and protein needed to promote optimal recovery in the working muscles.”
Visit the Dairy Farmers of Canada for more tips on adding calcium to your diet.

7. Salmon

Fresh or canned salmon is one of the best sources of the celebrated Omega-3 fatty acids, which can help prevent heart attacks. Studies have also shown that Omega-3 may have the ability to offset depression as well as protect against inflammatory diseases such as arthritis.
“I try to eat salmon twice a week, as do my kids,” says nutritionist Rosie Schwartz, author of The Enlightened Eater’s Whole Foods Guide.

8. Soy

Protein is one of the nutrients that most women don’t get enough of. They should have a protein-rich food every three to four hours during the day to keep energized, says dietitian Linda Barton.“Soy is perfect since it’s a plant-based protein that’s low in saturated fat.”
Soybeans and soy protein products — including tofu, miso, tempeh and soy drinks — also contain phytoestrogens that may slow the growth of some cancers, lower cholesterol and offer some protection against osteoporosis. Visit the Soyfoods Association of North America for more information and recipes.

9. Spinach

When asked to name one of her favourite super foods, Toronto registered dietician Leslie Beck praised spinach. It’s loaded with energy-promoting iron and folate, a B vitamin that prevents neural-tube defects in the fetus. It is important in red blood cell formation, protein metabolism, growth and cell division. The leafy green is also one of the best sources of lutein, an antioxidant that benefits eye, skin and cardiovascular health. For more information on the health benefits of spinach, visit Wholehealthmd.com.

10. Tomatoes

Research has found that tomatoes, especially cooked or processed ones, can lower the risk of some cancers and heart disease. Experts attribute this to lycopene, a potent antioxidant and the pigment that makes tomatoes red. A Harvard University study found that men who regularly ate tomato-based foods had lower rates of prostate cancer.
“We love tomatoes,” says Diane Clement, who founded the popular Tomato Fresh Food Cafe in Vancouver. She and her husband, Dr. Doug Clement, start their evening meal with their favourite tomato and bocconcini cheese salad. “The juicy tomatoes, loaded with lycopenes galore, are the perfect healthy jumpstart for any body,” she says. For more nutrition facts and recipes, visit California Tomatoes.

some jokes to share..

Good Nurses Humor

A nursing assistant, floor nurse, and charge nurse from a small nursing home were taking a lunch break in the break room. In walks a lady dressed in silk scarfs and wearing large polished stoned jewlery.
"I am ’Gina the Great’," stated the lady. "I am so pleased with the way you have taken care of my aunt that I will now grant the next three wishes!" With a wave of her hand and a puff of smoke, the room was filled with flowers, fruit and bottles of drink, proving that she did have the power to grant wishes before any of the nurses refute her.
The nurses quickly aurgued amongst themselves as to which one would ask for the first wish. Speaking up, the nursing assistant wished first.
"I wish I were on a tropical island beach, with single, well-built men feeding me fruit and tending to my every need." With a puff of smoke, the nursing assistant was gone.
The floor nurse went next."I wish I were rich and retired and spending my days in my own warm cabin at a ski resort with well groomed men feeding me cocoa and doughnuts." With a puff of smoke, she too was gone.
"Now, what is the last wish?" asked the lady.
The charge nurse said," I want those two back on the floor at the end of the lunch break!"

Differences Between Graduate Nurse and Experienced Nurses

A Graduate Nurse throws up when the patient does.
An experienced nurse calls housekeeping when a patient throws up
A Graduate Nurse wears so many pins on their name badge you can’t read it.
An experienced nurse doesn’t wear a name badge for liability reasons
A Graduate Nurse charts too much.
An experienced nurse doesn’t chart enough.
A Graduate Nurse loves to run to codes.
An experienced nurse makes graduate nurses run to codes.
A Graduate Nurse wants everyone to know they are a nurse.
An experienced nurse doesn’t want anyone to know they are a nurse.
A Graduate Nurse keeps detailed notes on a pad.
An experienced nurse writes on the back of their hand, paper scraps, napkins, etc.
A Graduate Nurse will spend all day trying to reorient a patient.
An experienced nurse will chart the patient is disoriented and restrain them.
A Graduate Nurse can hear a beeping I-med at 50 yards.
An experienced nurse can’t hear any alarms at any distance.
A Graduate Nurse loves to hear abnormal heart and breath sounds.
An experienced nurse doesn’t want to know about them unless the patient is symptomatic.
A Graduate Nurse spends 2 hours giving a patient a bath.
An experienced nurse lets the CNA give the patient a bath.
A Graduate Nurse thinks people respect Nurses.
An experienced nurse knows everybody blames everything on the nurse.
A Graduate Nurse looks for blood on a bandage hoping they will get to change it.
An experienced nurse knows a little blood never hurt anybody.
A Graduate Nurse looks for a chance "to work with the family."
An experienced nurse avoids the family.
A Graduate Nurse expects meds and supplies to be delivered on time.
An experienced nurse expects them to never be delivered at all.
A Graduate Nurse will spend days bladder training an incontinent patient.
An experienced nurse will insert a Foley catheter.
A Graduate Nurse always answers their phone.
An experienced nurse checks their caller ID before answering the phone.
A Graduate Nurse thinks psych patients are interesting.
An experienced nurse thinks psych patients are crazy.
A Graduate Nurse carries reference books in their bag.
An experienced nurse carries magazines, lunch, and some "cough syrup" in their bag.
A Graduate Nurse doesn’t find this funny.
An experienced nurse does.

Nursing Humor - Living With a Nurse

It’s hard to live with a nurse because...
1) When you forget to flush the toilet, you get a complete analysis with a plan on how to correct any noted problems.
2) Thanksgiving dinner comes in pre-cut small pieces because she doesn’t want to have to perform the Heimlich maneuver and be reminded of work on the only holiday she’s had off in years.
3) You’ve been awakened from a dead sleep in the middle of the night to find her shaking you because your breathing patterns were a little too close to a Cheyne-Stokes rhythm.

Funny Nurses Joke

Why did the nurse keep the bedpan in the refrigerator?
Because when she kept it in the freezer it took too much skin off.

E-cigarettes not recommended for quitting smoking

Though many smokers believe electronic cigarettes are designed to help them quit, such an assumption may be untrue, federal officials said.
Art senior Adam Pezen said he learned about e-cigarettes from online blogs and first tried them out of curiosity.
“My mom bought them because she had been a hardcore smoker for about 30 years,” Pezen said. “She passed [the habit] on to me.”
Pezen said he and his mother both still smoke tobacco cigarettes on a regular basis.
Smoking an e-cigarette is completely different than smoking the real thing and doesn’t satisfy the feeling smokers want when they have a cigarette, he said.
“You can feel a nicotine rush that is quite stronger than a real cigarette,” Pezen said.
The e-cigarettes are designed for only one long drag, which is different from traditional puffing.
The blogs Pezen read advocated e-cigarettes as the safe way to quit, but he said he doesn’t think they help people kick the habit.
He later tried e-cigarettes in an attempt to quit smoking but was unsuccessful.
The Food and Drug Administration is currently in a lawsuit with two different e-cigarette companies and does not endorse e-cigarettes, spokeswoman Siobhan DeLancey said.
“The most important thing to us is that we do believe that these are drug delivery devices,” said DeLancey. “They have not been through the typical drug review.”
Though e-cigarettes have not been through a drug review, they are still being sold nationwide and online.
Undeclared freshman Julianna Cossman said she saw e-cigarettes being sold in a mall in her home state of Pennsylvania.
“I think it is a silly concept,” said Cossman, a smoker who said she doesn’t think the product serves any purpose other than a new way to smoke.
DeLancey said the FDA would like to see e-cigarette companies come forward and bring their products in for clinical trials.
FDA scientists have bought the e-cigarettes and examined them, finding traces of nitrosamines (tobacco carcinogens) and ethylene glycol (an industrial antifreeze) in the devices studied, she said.
“We’re not sure what the effects of these chemicals would be on the human body,” DeLancey said.
The nitrosamines found in electronic cigarettes could be similar to those found in tobacco that are known to cause cancer, she said.
E-cigarette companies, such as Smoke Anywhere, claim the devices are designed as a tar-and-tobacco-free way to enjoy smoking and not intended to help users stop smoking.
However, Cossman said she feels the products are being marketed that way.
“My mom quit smoking using a similar product,” Cossman said.
However, the product that Cossman said her mother used allowed the smoker to control the nicotine level in the device.
In a July 22 press release, the FDA warned the public about e-cigarettes, saying the product contain toxins and doesn’t have a warning label on it. The release also said that the product comes in many different flavors, something that may appeal to young people.
DeLancey said any regulation of e-cigarettes by the FDA would depend on the outcome of clinical tests at the discretion of the producer.
“Until then, it’s a complete unknown,” she said.

today`s assingment 5/8/2010

Articles


- Type of determine which include words like `this,my,their,each and any` are used at the beginning of a noun phase to identify exactly what or who the noun refer to.

- 3 types:

- I) the definite article `the`

- II) indefinite article `a` or `an`

- III) zero article where neither `the` nor `a` comes before the nouns



Predisposition

- Many verbs, nouns and adjective are followed by specific predisposition. These are referred to as dependent predisposition.



Relatives clause

- I) Defining relative clause – called a ( restrictive clause ) modifies a noun by identifying which person or thing is being referred to. Never use a comma between a defining clause who and the rest of the sentence.

- II) Non-defining clause – called as a ( non-restrictive clause )modifies a noun by giving additional information about the person or thing that being referred to. Always use a comma to separate the non-defining clause from what comes before it and from anything that comes after it.

Eg: defining – my sister who lives in Scotland is coming to visit me at the weekend.

Eg: non defining- my sister , who lives in Scoltland , is coming to visit me at the weekend.



- III) sentential relative clause- refer to whole sentence that comes before them

Eg: they decided against buying a Ferrari , which was a wise decision.



The present perfect tense

- A verb tense that expressed an action that was completed at some time in the past, or that started in the past continuous. The tense is formed by combining the present tense of have and the past participle of verb.

Eg: she has paid the bill

Simple present tense

- Form of verb that expresses what exists now, what is happening now or what happen regularly.


The present participle

- Form or verb that ends in `ing` and expresses continuing action, for example the world ` fishing` . It can sometimes be used as an adjectives, for example : the creaming baby.

The past perfect tense

- Verbs tense performed with `had` and a past participle. It is used to express an action that was completed before a particular time in the past, for example `had finished` in the sentences.

Eg: she offered to help I had already finished

The past tense

- The form of a verb used to express what existed or happened in the past

Eg: we lived in France until I was 18

The past participle

- Form of a verb used to make the perfect tense and passive forms of verbs. Past participle are also sometimes used as adjectives for example `cooked` in the phrase `cooked vegetables`.

Conjunction

- A word that is used to join other word, phrases, clauses, and sentences, for example `and`, `because` and `but`.

- A combination of two or more things.

Pronoun

- A word used to instead of noun for referring to a person or thing that has been mentioned earlier.

Eg: she, they, that, and yourself.

Countable nouns

- Have singular and plural forms : my best friends, all my friends

- Can come after `a` or `an` : a banana, an apple

- Can be used with numbers : three chairs, two tables

Uncountable nouns

- Have plural forms : some information, a lot of furniture

- Never come after `a` or `an` : evidence, luggage

- Never used with numbers

- Are used with the singular form of a verb when they are the subject of that verb : the traffic was very heavy


punctuation



punctuation mark     what it is called               what it does

.                        full stop (br), period ( us)    - this marks the end of a sentence

:                                colon                         -   this introduce lists, explanation and quotation


;                             semicolon                     -  this separates two main clause whose meaning

                                                                         are closely related


?                          question mark                  - this mark the end of a direct question



-                            dash                               - this is used, especially informal writing, to show

                                                                          that what follow is a comment on, or a

                                                                          summary of, what comes before


!                    exclamation mark                    -  this is used at the end of a sentence to show

                                                                          surprise, admiration etc


``                  quotation marks,                       -  these indicator direct speech or show that you are
'                     inverted commas                           repeating a writer`s exact words

`'



( )                     brackets                               -  these enclose part of a sentence that containing extra

                                                                           information that can be considered separately



noun


mankind

internet

users

account

salesperson

british

items

mail

nut

source

overall

increase

all

world

effects

legacy

power

command

audience

fingertips

next

anger

handle

deeds

understanding

tool

levels

government

schools

parents

children

equilibrium

today

minor

can

up

webpage

ideas

dog

business

environment

characters

but

reputation

companies

nation

stake

top

information

net

virus

damage

organisation

crimes

comission

justification

reached

critism

society

cyber

communication

culture

humour

darker

today

library

impact

pornography

irresponsible

champion

causes

spree



articles


the

an

a

the next


predisposition


of

to

over

in

a

around

at

all

from

before

up

but

beside

after

by

via

on

than


pronoun


their

that

all

this

more

it

which

own

who

there

any

some

other

you

 
adjective


defined

smooth

fast

accessible

persistent

linked

that

overall

in

all

this

one`s

worldwide

possibly

greater

powerful

certain

minor

set

up

malicious

erroneous

dangerous

ugly

only

secret

capable

which

only

what

level

inaccurate

larger

irresponsible

incorrect

net

explicit

material

adults

both

selfish

unidentified

japanese

mailing

graphic

violence

ignore

 
conjunction


and

since

how

or

with

 
adverb


virtually

never

before

co

time

too

as

that

overall

in

all

around

however

more

even

up

their

own

regardless

how

where

only

constantly

when

buy

out


singular


arrival

has

deed

is

society

space

tool

individual

one

the air

 
plural


communication

a

parents

children

angers

levels

schools

organisation

others

 
verb


define

have

has

been

source

brought

increase

gives

generated

can

be

inculcate

organisation

reached

even

set

up

own

publish

idea

gets

eat

are

can

be

stake

spreading

done

become

post

circulate

threaten

engulf

net

affect

champion

causes


past participate

been

done

reached

 
present perfect tense

have

is

be

has

created


numbers


1997

794

65%

 
conjunction


that

however

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strike out stress

Everybody gets stressed. Stress can come when you are doing a simple everyday task, such as trying to get a taxicab during rush hour or beating a deadline at work. It can also come during really grave times, when you are resolving a marital conflict or about to lose a loved one.




The lucky ones among us get through their days cheerfully despite the stress. Others are so overwhelmed by it that they cannot function normally.



Many situations create tension and pressure in our lives. The secret is to know how to better cope with them.




Various stress forms

Dr. Bernardino Vicente, director of the National Center for Mental Health in Mandaluyong City, Philippines, says the first step is to know the various forms of these stressors.



Normal, serious


Normal garden-variety stressors include eustress, a productive kind of stress. The pressure parents exert on a child to study is an example. "Parents frequently admonish their children to study more or promise him a bike if he gets good grades--that pressure on the child is productive stress," says Vicente.

Serious but unproductive forms of stress. Examples include losing your job or a death in the family.



Internal, external

Internal stress is psychological. Says Vicente: "[It's up to you.] Your doctor says you have goiter and you may have to undergo an operation. Even if it is not yet confirmed, just the thought of going under the knife already stresses you."

External stressors are evident, such as when you are hurrying to work and get a flat tire. Driving in Manila can be stressful; so is going to malls on weekends.



Based on origins

Biological stressors are illnesses like colds, cough or flu, or changes in the body such as during pregnancy.

Environmental factors, such as air and noise pollutants, can be stressors. A high level of lead in the air may cause road rage, according to Vicente.

Social stress results from interaction with people, such as constant rejection by others, or achieving popularity but always finding yourself talked about negatively.

Personal circumstances and standards, like having financial problems or believing you are unattractive, are great stressors. Your boss may just want a one-page report, but because you expect much of yourself, you become stressed by the assignment.

Traumatic stresses are life-threatening or life-changing situations: seeing a relative die in a traumatic way, being kidnapped or experiencing disaster. "We've seen this kind of stress in Bicol [a southern region in the Philippines], where people get flashbacks of what happened when the supertyphoons hit their homes," says Vicente. "This may cause post-traumatic stress disorders and have a long-lasting effect on people."



Workplace stress

The most prevalent stressors come from the workplace: long working hours, deadlines, unusual demands from bosses.



The nature of one's work also determines how stressful the job is. "Rescue and emergency workers, police officers, surgeons--these [people] are all [exposed to] very stressful work," says Vicente.



Some big stressors are easier to handle, while small stressors that people sometimes take for granted can cause injury. Often, if left unmanaged, stressful events pile up and lead to chronic fatigue syndrome, also known as burnout or overstress.



Chronic fatigue syndrome

Chronic fatigue syndrome is similar to depression. "A person suffering from the syndrome is often tired and [no] drive," relates Vicente.



"One symptom of burnout is a change in values. You see this in government agencies, where there is too much frustration in the bureaucracy," he adds. "Employees lose their initiative and idealism. They just go through the motions of working."



Constant stress also manifests physically, says Vicente. "Many illnesses, like asthma, migraines, ulcers and certain skin disorders, are exacerbated or made worse by stress."



The notion that too much stress can kill also has basis. "There are people with what is called a cardiac personality--aggressive, hostile, very competitive," says Vicente. "Because they want to do a lot of things in a short period of time and their lifestyle is very stressful, there is often that possibility of a heart attack."