title: Where No Man Has Gone Before

text: Apart from Captain Kirk, the episode introduced two other regular characters to the show: James Doohan, a friend of director James Goldstone, was cast as the Chief Engineer Montgomery Scott (the name chosen after Doohan had tried various accents, and had decided that an engineer ought to be Scottish) and George Takei was cast as the ship's physicist. Sulu would become the helmsman in the regular series. Lieutenant Uhura and Dr. Leonard McCoy do not feature; the ship's doctor is instead Mark Piper (Paul Fix), who lost the role to DeForest Kelley.


title: Where No Man Has Gone Before

text: Gary Lockwood, as Lt. Commander Gary Mitchell, had starred in the title role of Roddenberry's earlier series on NBC, "The Lieutenant"; Sally Kellerman was cast as Dr. Elizabeth Dehner. Both actors needed silver eyes and scleral lenses were called for, which were produced by expert contact lens fabricator, John Roberts, who laminated wrinkled tinfoil between layers of the scleral lenses which covered the entire eye. These, outdated by the 1960s, could be painful, perhaps dangerous to the actors' eyes (modern scleral lenses can "breathe" and are oxygen permeable). Although Kellerman could insert and remove the prosthetics easily with no discomfort, Lockwood found them difficult to see through. He needed to raise his face and sight along his nose in order to see through tiny holes in the foil. He was able to use this to enhance his performance as the mutating Mitchell, the unusual gaze giving him an arrogant and haughty demeanor.


title: Where No Man Has Gone Before

text: Other cast members included Paul Carr as Navigator Lee Kelso, Lloyd Haynes as Communications Officer Alden and Andrea Dromm as Yeoman Smith (Alden and Smith were intended to be regulars in the show, but were replaced by Uhura and Janice Rand, respectively). The episode also is the first time long-running background actor Eddie Paskey appeared; his character would later be identified as Lt. Leslie.


title: Where No Man Has Gone Before

text: The costumes from the first pilot were used in "Where No Man Has Gone Before" with the exception of the insignias in two respects – the outlines were gold in the first pilot but black in the second, and the insignia symbols for engineering and sciences were reversed for the series proper. Completely new uniforms and insignia would be unveiled when the series was green-lighted, with the colors altered and black collars introduced. Most of the "Enterprise" sets were also reused from "The Cage", while Sickbay was the only major set constructed for the episode. Like "The Cage", the episode was shot at Desilu's Culver City studios.


title: Where No Man Has Gone Before

text: The episode was directed by James Goldstone. He was hired primarily to get his opinion on which of the first three scripts should be the second pilot. While his best friend Stephen Kandel wrote "Mudd's Women", Goldstone agreed "Where no man has gone before" was the right choice. Ernest Haller, who had won the Oscar for Best Color Cinematography on the movie "Gone with the Wind" (1939), served as director of photography for the episode. He had been brought in out of semi-retirement at Goldstone's recommendation at the last minute, after attempts to locate a cameraman had proved problematic. Robert H. Justman was credited as assistant director.


title: Where No Man Has Gone Before

text: Shooting started on July 19, 1965, several days later than originally scheduled. During the filming of this episode, a wasp's nest high in the rafters of the studio was somehow disturbed, and many cast and crew members suffered stings as a result. As this happened on a Friday, the weekend break allowed time for the swelling to go down; Shatner, however, required additional makeup to hide the stings during shooting the following Monday. Filming finished late on July 28, 1965; the final footage filmed was part of the fight between Kirk and Mitchell. While the schedule allowed seven days to shoot the episode, it required nine, which was Justman's original estimate. The episode cost around $300,000, around half the money spent on making "The Cage".


title: Where No Man Has Gone Before

text: In a 1988 TV special, "The Star Trek Saga: From One Generation to the Next", series creator Gene Roddenberry said that, as with the first pilot, this one still had a lot of science fiction elements in it, but at least it ended with Kirk in a bare-knuckle fistfight with Mitchell and that's what sold NBC on "Star Trek".


title: Where No Man Has Gone Before

text: Post-production on the episode was delayed by Roddenberry's involvement in another pilot, "Police Story". Post-production finished in January 1966 and the episode was presented to NBC for approval (which finally came in February 1966). This original version (production number 02a) differed from the later final broadcast cut (production number 02b, airing on September 22, 1966) in that each of the four acts had on-screen titles ("Act I", "Act II", etc.), as well as an epilogue. It also featured a much longer opening narration by Shatner. In some places alternate musical scores were used. In total almost five minutes of footage was removed to accommodate the original series' 50-minute network broadcast format to allow for commercials. The episode in its original version was seen by the public before the aired version, having been shown at the 24th World Science Fiction Convention in Cleveland, Ohio, on September 3, 1966—shortly before the premiere broadcast of "Star Trek" on NBC.


title: Where No Man Has Gone Before

text: The studio did not retain a print of this original version, and it was officially thought to be lost. In 2009, a German film collector discovered a print of it and brought it to the attention of CBS/Paramount, which then released it under the title ""Where No Fan Has Gone Before" – The Restored, Unaired Alternate Pilot Episode" as part of the "TOS" season 3 box set on Blu-ray.


title: Where No Man Has Gone Before

text: The episode was adapted into a short story by James Blish for "Star Trek 8", published by Bantam in 1972. It also became the second in Bantam's series of Fotonovels, published in 1977.


title: Where No Man Has Gone Before

text: The Galactic Barrier is later associated with the Q, in the 1994 novel "Q-Squared" by Peter David, and Greg Cox's 1998 trilogy.


title: Where No Man Has Gone Before

text: Gary Mitchell does not appear again in the show. Several books, including Michael Jan Friedman's "My Brother's Keeper", Vonda N. McIntyre's "Enterprise: The First Adventure", and Margaret Wander Bonanno's "Strangers from the Sky", feature the character in adventures set before the events of the episode. The 2005 "" book "Harbinger" is set immediately after the events of "Where No Man Has Gone Before" and features a troubled Kirk musing on his friend's death. Friedman's "" book "The Valiant" features two people who claim to be descended from the "Valiant"s crew.


title: Where No Man Has Gone Before

text: Gary Mitchell (portrayed by Daamen J. Krall) appears in the alternate timeline depicted in the 2006-2008 mini-series "".


title: Where No Man Has Gone Before

text: In 2013, "Wired" magazine ranked this episode one of the top ten episodes of the original television series. They note famous lines such as Kirk's plea for compassion, and the absence of series regulars such as Dr. McCoy, Uhura, and Chekov.


title: Where No Man Has Gone Before

text: Zack Handlen of "The A.V. Club" gave the episode a 'B+' rating, describing it as "an awkward episode" but that "it's not without its charms."


title: Where No Man Has Gone Before

text: In 2016, IGN ranked "Where No Man Has Gone Before" number six in a top ten list of original series episodes. They also ranked it the 17th best episode of all "Star Trek" series.


title: Where No Man Has Gone Before

text: "Where No Man Has Gone Before" was released on PAL-format LaserDisc in the United Kingdom as part of "The Pilots" collection, in April 1996"." This included the color version of "", "Where No Man Has Gone Before", "Encounter at Farpoint", "", and "" with a total runtime of 379 minutes.


title: Mark Schwahn

text: Mark Schwahn (born July 5, 1966) is an American former screenwriter, director, and producer. He is best known as the creator of the WB/CW teen drama series "One Tree Hill". His career largely ended in 2018 following widespread sexual harassment accusations.


title: Mark Schwahn

text: Schwahn has co-written "Coach Carter" (2005), "The Perfect Score" (2004), "Whatever It Takes" (2000) and "35 Miles from Normal" (1997). In addition, he was creator of the TV series "One Tree Hill", for which he also wrote and directed.


title: Mark Schwahn

text: He served as producer for "Whatever It Takes" and "One Tree Hill". He also directed "35 Miles from Normal", which he filmed in his hometown of Pontiac, Illinois.


title: Mark Schwahn

text: He emerged as a top candidate to write a planned spin-off of "Melrose Place" shortly after the network and CBS Paramount Television announced it in late October 2008. Schwahn signed a two-year deal with CPT in early October 2008, but it had not started until June 2009. Until then, he was under a pact with Warner Bros. Television, where he ran "One Tree Hill." His agreement with Warner Bros. called for him to continue as executive producer and showrunner on "One Tree Hill" returning for the ninth and final season in January 2012. The move to tap Schwahn to conceive a contemporary version of "Melrose Place" resembles The CW and CPT's decision to have "Veronica Mars" creator Rob Thomas pen the original script for "90210". In early 2009, it was announced Schwahn would not be working on the project.


title: Mark Schwahn

text: On November 12, 2017, TV writer Audrey Wauchope wrote on Twitter that she and her female writing partner were sexually harassed by Schwahn while working on "One Tree Hill". Female cast members supported the allegations, and Hilarie Burton and Danneel Harris alleged that they had also been sexually harassed by Schwahn. The male stars of "One Tree Hill" released their own statements supporting their female co-stars and crew members. Schwahn was also accused by cast members of "The Royals". Twenty-five female cast and crew members of the show released their own open letter stating that they, too, had been subjected to sexual harassment by Schwahn throughout the run of the show. In light of the allegations, Schwahn was suspended and ultimately fired from "The Royals".


title: Long-term effects of cannabis

text: The long-term effects of cannabis have been the subject of ongoing debate. Because cannabis is illegal in most countries, clinical research presents a challenge and there is limited evidence from which to draw conclusions. In 2017, the U.S. National Academies of Sciences, Engineering, and Medicine issued a report summarizing much of the published literature on health effects of cannabis, into categories regarded as conclusive, substantial, moderate, limited and of no or insufficient evidence to support an association with a particular outcome.


title: Long-term effects of cannabis

text: Cannabis is the most widely used illicit drug in the Western world. In the United States, 10-20% of those who begin the use of cannabis daily will later become dependent. Cannabis use can lead to addiction, which is defined as "when the person cannot stop using the drug even though it interferes with many aspects of his or her life." Cannabis use disorder is defined in the fifth revision of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) as a condition requiring treatment. A 2012 review of cannabis use and dependency in the United States by Danovitch "et al" said that "42% of persons over age 12 have used cannabis at least once in their lifetime, 11.5% have used within the past year, and 1.8% have met diagnostic criteria for cannabis abuse or dependence within the past year. Among individuals who have ever used cannabis, conditional dependence (the proportion who go on to develop dependence) is 9%." Although no medication is known to be effective in combating dependency, combinations of psychotherapy such as cognitive behavioural therapy and motivational enhancement therapy have achieved some success.


title: Long-term effects of cannabis

text: Cannabis dependence develops in 9% of users, significantly less than that of heroin, cocaine, alcohol, and prescribed anxiolytics, but slightly higher than that for psilocybin, mescaline, or LSD. Dependence on cannabis tends to be less severe than that observed with cocaine, opiates, and alcohol. A 2018 academic review, published in partnership with Canopy Growth, discussed the limitations of current studies of therapeutic and non-therapeutic cannabis use, and further stated that the nature of dependence formation among regular marijuana consumers has declined since 2002.


title: Long-term effects of cannabis

text: Cambridge University published a study in 2015 that showed the surprising fact that in England and Wales, the use of cannabis had decreased. Although there was a reported decrease in use, the need for addiction treatment was surging. The study looked more in depth on how the potency of the cannabis affected someone's dependence on the drug. They tested three different levels of potency and found that the most potent cannabis had the highest amount of dependence. Researchers believe that this is because of the high that the participants felt after using. The lower potent strands did not give users the same high, which made them not desire or in turns depend on that strand as much.


title: Long-term effects of cannabis

text: Acute cannabis intoxication has been shown to negatively affect attention, psychomotor task ability, and short-term memory. Studies of chronic cannabis users have demonstrated, although inconsistently, a long-lasting effect on the attention span, memory function, and cognitive abilities of moderate-dose long-term users. Once cannabis use is discontinued for several months, these effects disappear, unless the user started consuming during adolescence. It is speculated that this is due to neurotoxic effects of cannabis interfering with critical brain development.


title: Long-term effects of cannabis

text: Chronic use of cannabis during adolescence, a time when the brain is still developing, is correlated in the long term with lower IQ and cognitive deficits. It is not clear, though, if cannabis use causes the problems or if the causality is in the reverse. Recent studies have shown that IQ deficits existed in some subjects before chronic cannabis use, suggesting that lower IQ may instead be a risk factor for cannabis addiction.


title: Long-term effects of cannabis

text: A prospective cohort study that took place between 1972 and 2012 investigated the association between cannabis use and neuropsychological decline. Subjects were tested at various points in their life administering multiple different neuropsychological tests. The authors concluded that:


title: Long-term effects of cannabis

text: Cannabis intoxication was not only found to affect attention, psychomotor task ability, and short-term memory. It was also found that intoxicated users were facing the difficulty of having false memories.


title: Long-term effects of cannabis

text: The use of cannabis has been heavily shown to affect the working-memory network function. Using large amounts of cannabis at a time is associated with hyperactivity of the network during a working-memory task. Most of these findings are showing that people who use cannabis on a daily basis will need additional effort in order to perform certain tasks.


title: Long-term effects of cannabis

text: Cannabis contains over 100 different cannabinoid compounds, many of which have displayed psychoactive effects. The most distinguished cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD), with THC being the primary psychoactive agent. The effects of THC and CBD are salient regarding psychosis and anxiety.


title: Long-term effects of cannabis

text: According to the National Academies of Sciences, Engineering and Medicine, there is substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other chronic psychoses, with the highest risk potentially among the most frequent users. A possible connection between psychosis and cannabis is controversial because observational studies suggest a correlation but do not establish any causative effect of cannabis on long-term psychiatric health. Medical evidence strongly suggests that the long-term use of cannabis by people who begin use at an early age display a higher tendency towards mental health problems and other physical and development disorders, although a causal link could not be proven by the available data. The risks appear to be most acute in adolescent users.


title: Long-term effects of cannabis

text: In one 2013 review, the authors concluded long-term cannabis use "increases the risk of psychosis in people with certain genetic or environmental vulnerabilities", but does not cause psychosis. Important predisposing factors were genetic liability, childhood trauma and urban upbringing. Another review that same year concluded that cannabis use may cause permanent psychological disorders in some users such as cognitive impairment, anxiety, paranoia, and increased risks of psychosis. Key predisposing variables included age of first exposure, frequency of use, the potency of the cannabis used, and individual susceptibility. Nevertheless, some researchers maintain there exists "a strong association between schizophrenia and cannabis use...", while cannabis use alone does not predict the transition to subsequent psychiatric illness. Many factors are involved, including genetics, environment, time period of initiation and duration of cannabis use, underlying psychiatric pathology that preceded drug use, and combined use of other psychoactive drugs.


title: Long-term effects of cannabis

text: The temporal relationship between cannabis and psychosis was reviewed in 2014, and the authors proposed that "[b]ecause longitudinal work indicates that cannabis use precedes psychotic symptoms, it seems reasonable to assume a causal relationship" between cannabis and psychosis, but that "more work is needed to address the possibility of gene-environment correlation."


title: Long-term effects of cannabis

text: In 2016 a meta-analysis was published on associations studies covering a range of dosing habits, again showing that cannabis use is associated with a significantly increased risk of psychosis, and alleged that a dose–response relationship exists between the level of cannabis use and risk of psychosis. The risk was increased 4-fold with daily use, though the analysis was not adequate to establish a causal link. Another 2016 meta-analysis found that cannabis use only predicted transition to psychosis among those who met the criteria for abuse of or dependence on the drug.Another 2016 review concluded that the existing evidence did not show that cannabis caused psychosis, but rather that early or heavy cannabis use were among many factors more likely to be found in those at risk of developing psychosis. An opposing view was expressed by Suzanne Gage and coauthors reviewing the literature available in 2016, who regarded the epidemiologic evidence on cannabis use and psychosis strong enough "to warrant a public health message that cannabis use can increase the risk of psychotic disorders," but also cautioning that additional studies are needed to determine the size of the effect. Such a public health message was subsequently issued in August 2019 by the Surgeon General of the United States. The review by Gage et al. also stated "If the association between cannabis and schizophrenia is causal and of the magnitude estimated across studies to date, this would equate to a schizophrenia lifetime risk of approximately 2% in regular cannabis users (though risk for broader psychotic outcomes will be greater). This implies that about 98% of regular cannabis users will not develop schizophrenia...[and that] risk could be much greater in those at a higher genetic risk, or in those who use particularly potent strains of cannabis. Expressed in terms of odds ratio, another study found that "Daily cannabis use was associated with increased odds of psychotic disorder compared with never users (adjusted odds ratio [OR] 3.2, 95% CI 2.2–4.1), increasing to nearly five-times increased odds for daily use of high-potency types of cannabis (4.8, 2.5–6.3)." To calculate what the increased odds ratio means for schizophrenia specifically, a 2005 review placed the lifetime morbid risk of narrowly defined schizophrenia at 0.72%. For some locations, this translates into a substantial population attributable risk, such that "assuming causality, if high-potency cannabis types were no longer available, then 12% of cases of first-episode psychosis could be prevented across Europe, rising to 30% in London and 50% in Amsterdam."


title: Long-term effects of cannabis

text: A 2019 meta-analysis found that 34% of people with cannabis-induced psychosis transitioned to schizophrenia. This was found to be comparatively higher than hallucinogens (26%) and amphetamines (22%).


title: Long-term effects of cannabis

text: In spite of all of this supposed evidence of a causal relationship - or suggestion of a causal relationship - between cannabis and psychosis, the general population statistics shows no increase in psychosis incidence rates in any developed country over the last 50 years, in spite of a five-fold increase in cannabis use rates. To quote Macleod et al. 2004: "Cannabis use appears to have increased substantially amongst young people over the past 30 years, from around 10% reporting ever use in 1969–70, to around 50% reporting ever use in 2001, in Britain and Sweden. If the relation between use and schizophrenia were truly causal and if the relative risk was around five-fold then the incidence of schizophrenia should have more than doubled since 1970. However population trends in schizophrenia incidence suggest that incidence has either been stable or slightly decreased over the relevant time period."


title: Long-term effects of cannabis

text: Of note, cannabis with a high THC to CBD ratio produces a higher incidence of psychological effects. CBD may show antipsychotic and neuroprotective properties, acting as an antagonist to some of the effects of THC. Studies examining this effect have used high ratios of CBD to THC, and it is unclear to what extent these laboratory studies translate to the types of cannabis used by real life users. Research has suggested that CBD can safely reduce some symptoms of psychosis in general.


title: Long-term effects of cannabis

text: A 2014 review examined psychological therapy as add-on for people with schizophrenia who are using cannabis:


title: Long-term effects of cannabis

text: As of 2017 there was clear evidence that long-term use of cannabis increases the risk of psychosis, regardless of confounding factors, and particularly for people who have genetic risk factors, but see previous section. Even in those with no family history of psychosis, the administration of pure THC in clinical settings has been demonstrated to elicit transient psychotic symptoms.


title: Long-term effects of cannabis

text: Cannabis use may precipitate new-onset panic attacks and depersonalization/derealization symptoms simultaneously. The association between cannabis use and depersonalisation/derealisation disorder has been studied. Depersonalization is defined as a dissociative symptom in which one feels like an outside observer with respect to one's thoughts, body, and sensations. While derealization is marked by feelings of unreality and detachment from one's surroundings, such that one's environment is experienced as remote or unfamiliar.


title: Long-term effects of cannabis

text: Some individuals experiencing depersonalisation/derealisation symptoms prior to any cannabis use have reported the effects of cannabis to calm these symptoms and make the depersonalisation/derealisation disorder more manageable with regular use.


title: Long-term effects of cannabis

text: Less attention has been given to the association between cannabis use and depression, though according to the Australian National Drug & Alcohol Research Centre, it is possible this is because cannabis users who have depression are less likely to access treatment than those with psychosis. The findings on marijuana's relationship to depressive disorder are scattered, showing that cannabis use has benefits, but can also be detrimental to overall mental health. However, sufficient evidence exists showing reductions in cannabis use improve anxiety, depression, and sleep quality. A 2017 review suggests that cannabis has been shown to improve the mood of depression-diagnosed patients. This is indicative of a longitudinal relationship between cannabis reduction and improvements in anxiety and depression.


title: Long-term effects of cannabis

text: Anxiety and depression have been found to increase susceptibility to marijuana use. This is due to a desire to alleviate the symptoms of these experiences through marijuana use. Chronic users who use for anxiolytic purposes will even develop dependencies on cannabis, making it difficult to cope with anxiety when the drug is absent.


title: Long-term effects of cannabis

text: Teenage cannabis users show no difference from the general population in incidence of major depressive disorder (MDD), but an association exists between early exposure coupled with continued use into adult life and increased incidence of MDD in adulthood. Among cannabis users of all ages, there may be an increased risk of developing depression, with heavy users seemingly having a higher risk. Heavy marijuana use in adolescence has also been associated with deficits in cognition. A recent study assessing changes in neuropsychological functioning resulting from long-term cannabis use followed a group of adolescents (ages 12 –15 at baseline) over a 14-year period. Researchers found that more days of use were correlated with decreases in inhibitory control, and visuospatial ability. Contrary to existing cross-sectional studies showing marijuana use in adolescence is associated with poor cognitive functioning, there were no associations between long-term cannabis use and memory and processing speed. While this study showed no correlations between memory and cannabis use, others have found that there is. It is important to know that studies looking at associations between cannabis use and poor neurocognitive functioning have found that extended abstinence from marijuana leads to improvements in cognitive deficits. Decreases in cognition resulting from marijuana use are indeed reversible.


title: Long-term effects of cannabis

text: A February 2019 systematic review and meta-analysis found that cannabis consumption during adolescence was associated with an increased risk of developing depression and suicidal behavior later in life, while finding no effect on anxiety. In a longitudinal study assessing the associations between long term use and mental health in a group of individuals participating in a drug-based treatment for depression, researchers found that, compared to non-users, patients using both medically and non-medically experienced less improvement in depressive symptoms and an increase in suicidal ideation. Additionally, those who used non-medically, were less likely to visit the psychiatrist. Further research should investigate this finding to see whether non-medical marijuana use serves as a barrier to treatment seeking behavior.


title: Long-term effects of cannabis

text: Mania is a mental illness marked by periods of great excitement or euphoria, delusions, and overactivity. This is common in cannabis users when they hit a point of their high that could lead to paranoia, anxiety, increased heart rate. Some strands of the drug can have these effects on the individuals that use them, but no effects are guaranteed when used. A case review reported that an adult user had marijuana-induced mania even though they had no previous psychiatric history. However, some participants that have been previously diagnosed with bipolar disorder, had a worsen occurrence with mania symptoms. This showed that anyone, diagnosed or psychiatrically stable, can develop mania symptoms when under the influence of cannabis.


title: Long-term effects of cannabis

text: Adolescent cannabis users show no difference from their peers in suicidal ideation or rate of suicide attempts, but those who continue to use cannabis into adult life exhibit an increased incidence of both, although multiple other contributory factors are also implicated.


title: Long-term effects of cannabis

text: In the general population a weak (indirect) association appears to exist between suicidal behaviour and cannabis consumption in both psychotic and non-psychotic users, although it remains unclear whether regular cannabis use increases the risk of suicide. Cannabis use is a risk factor in suicidality, but suicide attempts are characterized by many additional risk factors including mood disorders, alcohol use, stress, personal problems and poor support.


title: Long-term effects of cannabis

text: The gateway drug hypothesis asserts that the use of soft drugs such as cannabis, tobacco or alcohol may ultimately lead to the use of harder drugs. The release of dopamine at CB1 receptors when cannabinoids enter the body can enforce drug seeking behavior. In addition to the gateway framework, there is also the peer clustering theory which says that friendship associations influence drug seeking behaviors. Friends who use can influence one another to take drugs that are more rewarding and have a higher potential for abuse.


title: Long-term effects of cannabis

text: However, whether the role of cannabis in other drug use is causative or simply the result of the same influencing factors of drug use in general is debated.


title: Long-term effects of cannabis

text: Large-scale longitudinal studies in the UK and New Zealand from 2015 and 2017 showed an association between cannabis use and an increased probability of later disorders in the use of other drugs.


title: Long-term effects of cannabis

text: Over time, the marijuana gateway hypothesis has been studied more and more. In one published study, the use of marijuana was shown not a reliable gateway cause of illicit drug use.


title: Long-term effects of cannabis

text: However, social factors and environment influence drug use and abuse, making the gateway effects of cannabis different for those in differing social circumstances. A study looking at associations between drug injection and cannabis use in street-involved youth found that cannabis use was associated with slower time to injection initiation. Injection initiation leads to further patterns of injection initiation which will eventually lead to addiction. These findings go against the claims that cannabis serves as a gateway to drugs with higher abuse liability. Further studies should investigate the ways that social factors play a role in the gateway framework.


title: Long-term effects of cannabis

text: A 2013 literature review said that exposure to cannabis was "associated with diseases of the liver (particularly with co-existing hepatitis C), lungs, heart, and vasculature". The authors cautioned that "evidence is needed, and further research should be considered, to prove causal associations of marijuana with many physical health conditions".


title: Long-term effects of cannabis

text: Researchers are concerned that with the increase in legalization will lead towards an increase of use which will in turn call for new strategies as well as rehabilitation to minimize the harm that cannabis can do on someone's body.


title: Long-term effects of cannabis

text: Studies conflict on whether long-term cannabis use causes persistent structural changes in humans. Twin studies have shown no significant difference between users and non-users in twin pairs, but other studies have demonstrated that chronic use affects white matter and hippocampal volume in the brains of healthy (non-psychotic) patients, which is where large amounts of cannabinoid-1 receptors are present.


title: Long-term effects of cannabis

text: Long term cannabis users are at risk for developing cannabinoid hyperemesis syndrome (CHS), characterized by recurrent bouts of intense vomiting. The mechanism behind CHS is poorly understood and is contrary to the antiemetic properties of cannabis and cannabinoids.


title: Long-term effects of cannabis

text: The acute effects of cannabis use in humans include a dose-dependent increase in heart rate, typically accompanied by a mild increase in blood pressure while lying down and postural hypotension - a drop in blood pressure when standing up. These effects may vary depending on the relative concentration of the many different cannabinoids that can affect the cardiovascular function, such as cannabigerol. Smoking cannabis decreases exercise tolerance. Cardiovascular effects may not lead to serious health issues for the majority of young, healthy users; on the contrary, heart attack, that is myocardial infarction, stroke, and other adverse cardiovascular events, have occurred in association with its use. Cannabis use by people with cardiovascular disease poses a health risk because it can lead to increased cardiac work, increased catecholamine levels, and impaired blood oxygen carrying capacity due to the production of carboxyhemoglobin.


title: Long-term effects of cannabis

text: A 2012 review examining the relation of cancer and cannabis found little direct evidence that cannabinoids found in cannabis, including THC, are carcinogenic. Cannabinoids are not mutagenic according to the Ames test. However, cannabis "smoke" has been found to be carcinogenic in rodents and mutagenic in the Ames test. Correlating cannabis use with the development of human cancers has been problematic due to difficulties in quantifying cannabis use, unmeasured confounders, and cannabinoids' potential as cancer treatment.


title: Long-term effects of cannabis

text: According to a 2013 literature review, cannabis could be carcinogenic, but there are methodological limitations in studies making it difficult to establish a link between cannabis use and cancer risk. The authors say that bladder cancer does seem to be linked to habitual cannabis use, and that there may be a risk for cancers of the head and neck among long-term (more than 20 years) users. Gordon and colleagues said, "there does appear to be an increased risk of cancer (particularly head and neck, lung, and bladder cancer) for those who use marijuana over a period of time, although what length of time that this risk increases is uncertain."


title: Long-term effects of cannabis

text: There have been a limited number of studies that have looked at the effects of smoking cannabis on the respiratory system. Chronic heavy cannabis smoking is associated with coughing, production of sputum, wheezing, and other symptoms of chronic bronchitis. Regular cannabis use has not been shown to cause significant abnormalities in lung function.


title: Long-term effects of cannabis

text: Regular cannabis smokers show pathological changes in lung cells similar to those that precede the development of lung cancer in tobacco smokers. Gordon and colleagues in a 2013 literature review said: "Unfortunately, methodological limitations in many of the reviewed studies, including selection bias, small sample size, limited generalizability, and lack of adjustment for tobacco smoking, may limit the ability to attribute cancer risk solely to marijuana use." Reviewing studies adjusted for age and tobacco use, they said there was a risk of lung cancer even after adjusting for tobacco use, but that the period of time over which the risk increases is uncertain.


title: Long-term effects of cannabis

text: A 2013 review which specifically examined the effects of cannabis on the lung concluded "[f]indings from a limited number of well-designed epidemiological studies do not suggest an increased risk for the development of either lung or upper airway cancer from light or moderate use, although evidence is mixed concerning possible carcinogenic risks of heavy, long-term use."


title: Long-term effects of cannabis

text: In 2013 the International Lung Cancer Consortium found no significant additional lung cancer risk in tobacco users who also smoked cannabis. Nor did they find an increased risk in cannabis smokers who did not use tobacco. They concluded that "[o]ur pooled results showed no significant association between the intensity, duration, or cumulative consumption of cannabis smoke and the risk of lung cancer overall or in never smokers." They cautioned that "[o]ur results cannot preclude the possibility that cannabis may exhibit an association with lung cancer risk at extremely high dosage." The same authors supported further study, and called attention to evolving means of cannabis consumption: "Specifically, respiratory risks may differ with the use of water pipes and vaporizers or with consuming oral preparations."


title: Long-term effects of cannabis

text: Cannabis smoke contains thousands of organic and inorganic chemicals, including many of the same carcinogens as tobacco smoke. A 2012 special report by the British Lung Foundation concluded that cannabis smoking was linked to many adverse effects, including bronchitis and lung cancer. They identified cannabis smoke as a carcinogen and also said awareness of the danger was low compared with the high awareness of the dangers of smoking tobacco particularly among younger users. They said there was an increased risk from each cannabis cigarette due to drawing in large puffs of smoke and holding them. Cannabis smoke has been listed on the California Proposition 65 warning list as a carcinogen since 2009, but leaves and pure THC are not.


title: Long-term effects of cannabis

text: A 2013 literature review by Gordon and colleagues concluded that inhaled cannabis is associated with lung disease, although Tashkin's 2013 review has found "no clear link to chronic obstructive pulmonary disease".


title: Long-term effects of cannabis

text: Smoking cannabis has been linked to adverse respiratory effects including: chronic coughing, wheezing, sputum production, and acute bronchitis. It has been suggested that the common practice of inhaling cannabis smoke deeply and holding breath could lead to pneumothorax. In a few case reports involving immunocompromised patients, pulmonary infections such as aspergillosis have been attributed to smoking cannabis contaminated with fungi. The transmission of tuberculosis has been linked to cannabis inhalation techniques, such as sharing water pipes and 'Hotboxing'.


title: Long-term effects of cannabis

text: Of the various methods of cannabis consumption, smoking is considered the most harmful; the inhalation of smoke from organic materials can cause various health problems (e.g., coughing and sputum). Isoprenes help to modulate and slow down reaction rates, contributing to the significantly differing qualities of partial combustion products from various sources.


title: Long-term effects of cannabis

text: Male cannabis use has been associated with reduced fertility and decreased sperm counts. Initial epigenetic studies have shown that male cannabis use cause widespread DNA methylation changes in sperm, resulting in lower rates of fertilization and higher rates of miscarriage. Sperm DNA methylation alterations from cannabis extract exposure are evident in the offspring of rats. This is important as prenatal cannabis exposure has been associated with neuropsychiatric disorders, and rates of autism have increased in the U.S., particularly in states where cannabis is legal.


title: Long-term effects of cannabis

text: A study released by the National Academies of Sciences, Engineering, and Medicine cited significant evidence for a statistical link between mothers who smoke cannabis during pregnancy and lower birth weights of their babies. Cannabis consumption in pregnancy is associated with restrictions in growth of the fetus, miscarriage, and cognitive deficits in offspring. Although the majority of research has concentrated on the adverse effects of alcohol, there is now evidence that prenatal exposure to cannabis has serious effects on the developing brain and is associated with "deficits in language, attention, areas of cognitive performance, and delinquent behavior in adolescence". A report prepared for the Australian National Council on Drugs concluded cannabis and other cannabinoids are contraindicated in pregnancy as it may interact with the endocannabinoid system.


title: Long-term effects of cannabis

text: No fatal overdoses associated with cannabis use have ever been reported. Due to the small number of studies that have been conducted, the evidence is insufficient to show a long-term elevated risk of mortality from any cause. Motor vehicle accidents, suicide, and possible respiratory and brain cancers are all of interest to many researchers, but no studies have been able to show a consistent increase in mortality from these causes.


title: Nika Futterman

text: Nika Futterman (born October 25, 1969) is an American voice and television actress. She is known for her voices in various animated series, including Asajj Ventress in "" and Adam Lyon in "My Gym Partner's a Monkey". She has voiced many characters for Nickelodeon, including Chum Chum in "Fanboy & Chum Chum", Omnia in the Nickelodeon version of "Winx Club", and Luna Loud in "The Loud House".


title: Nika Futterman

text: Among her first professional acting roles were single episode appearances on "Chicago Hope" and "Murphy Brown".


title: Nika Futterman

text: Futterman has provided her voice in many cartoons, including recurring roles on animated adventure and superhero series such as "", "", and "".


title: Nika Futterman

text: Futterman is the voice of Asajj Ventress in the 2008 animated film "" and as well as several related video games. She has provided the voice for Sy Snootles among other characters. She attended her first "Star Wars" Weekend on the last weekend of June 2012. She was on the show Behind the Force along with her cast members Ashley Eckstein and James Arnold Taylor with Supervising Director Dave Filoni. Futterman also voices Sticks the Jungle Badger in the "Sonic Boom" TV series and its associated video games, "" and "".


title: Nika Futterman

text: Futterman performed the vocals "Give it to me, baby" in The Offspring hit single "Pretty Fly (For a White Guy)" and cameo backup vocals for a performance of Wham!'s "Careless Whisper" on an episode of "Kids Incorporated". Some of Futterman's animated characters sing songs within the soundtrack of a show, as well. She sings the theme song of "My Gym Partner's A Monkey" in-character as Adam Lyon, Sandy of "Bubble Guppies" sang a song about coconut water several times in the episode she was featured in, Kip Ling of "Histeria!" usually only shows up in the songs on the show, the second title character of "Fanboy & Chum Chum" sings many times (Futterman is also often accompanied on lead vocals during the "FB&CC" songs by David Hornsby, who voices Fanboy), Stretch and Squeeze of "Handy Manny" sing two songs called "We Work Together" and "Hop Up, Jump In" alongside the other tools, and Luna Loud of "The Loud House" is a musician, and frequently sings. Futterman also performed the vocals as Catwoman for the song, "Birds of Prey" in the "" episode, "The Mask of Matches Malone," along with Grey DeLisle and Tara Strong, who voiced Black Canary and Huntress respectively.


title: Mohamed A. El-Erian

text: Mohamed Aly El-Erian (; born August 19, 1958) is an Egyptian-American economist and businessman. He is President of Queens' College, Cambridge, and chief economic adviser at Allianz, the corporate parent of PIMCO where he was CEO and co-chief investment officer (2007–14). He was chair of President Obama's Global Development Council (2012–17), and is a columnist for Bloomberg View, and a contributing editor to the "Financial Times".


title: Mohamed A. El-Erian

text: Dr. El-Erian is a regular contributor to Project Syndicate, Yahoo! Finance, "Business Insider" as well as Fortune/CNN and "Foreign Policy". Named for four years in a row as one of "Foreign Policy"'s "Top 100 Global Thinkers," he has written two New York Times Best Sellers, including, "" published in January 2016 by Random House. Together with Sir Harvey McGrath, he co-chairs the capital campaign for Cambridge University. On July 1, 2019, El-Erian was appointed Senior Global Fellow at The Lauder Institute and part-time Professor of Practice at The Wharton School.


title: Mohamed A. El-Erian

text: El-Erian was born in New York City on August 19, 1958, to Egyptian parents, Abdullah El-Erian, and Nadia Shoukry, a cousin of Egyptian politician Ibrahim Shoukry. Shortly after his birth, the family moved back to Egypt, where El-Erian spent some of his early childhood along with short periods in Europe where his father attended meetings of the UN law commission. In 1968, the family moved back to New York when his father took a position at the United Nations. From 1971–73, they lived in France, where El-Erian's father was the Egyptian Ambassador to France.


title: Mohamed A. El-Erian

text: After attending St John's School, Leatherhead, a boarding school in England, he gained a scholarship to Queens' College, Cambridge, and received a bachelor's degree in economics in 1980. He later obtained a master's degree (1983) and a doctorate (1985) in economics from St Antony's College, Oxford. In June 2011, El-Erian received an honorary doctorate degree from the American University in Cairo. In December 2013, he became an honorary fellow of Queens' College, Cambridge.


title: Mohamed A. El-Erian

text: El-Erian has served on the boards of trustees of several educational institutions, including Pegasus, St. Margaret School, Cambridge in America and KAUST. He co-chairs the capital campaign for Cambridge University.


title: Mohamed A. El-Erian

text: After his studies at Oxbridge, El-Erian settled in the US in 1983, taking a position at the International Monetary Fund in Washington, D.C., where he rose to become deputy director. He moved to the private sector in January 1998, working in London at Salomon Smith Barney/Citigroup before being recruited by PIMCO to lead its work on emerging markets.


title: Mohamed A. El-Erian

text: El-Erian worked for several years at PIMCO as a managing director and head of the emerging market portfolio team, where he earned notoriety by avoiding the 2001 bond default by Argentina that otherwise stung the international bond market. Subsequently, he was appointed CEO and president of Harvard Management Company, the entity that manages Harvard's endowment and related accounts. He also served as a member of the faculty of Harvard Business School. As of 2020, he is a member of the Harvard Global Advisory Council.


title: Mohamed A. El-Erian

text: After twenty months at Harvard, El-Erian returned to PIMCO in December 2007 as CEO and co-CIO. As CEO of PIMCO, El-Erian was responsible for setting the strategic direction of the firm and leading its operations globally. As co-CIO with PIMCO co-founder Bill H. Gross, El-Erian oversaw investment policies and strategies for all the company's portfolio management activities. He helped deliver investment performance for clients and grow PIMCO's assets under management from under $1 trillion to $2 trillion.


title: Mohamed A. El-Erian

text: On December 21, 2012, President Obama announced the appointment of El-Erian as the chair of the president's Global Development Council, leading the council in its role of informing and providing advice to the president and other senior U.S. officials on global development policies and practices.


title: Mohamed A. El-Erian

text: On January 21, 2014, El-Erian resigned from PIMCO effective March of that year, stating he decided to leave after receiving a letter from his daughter outlining important events in her life that he missed. However, it was widely reported that his resignation was triggered by conflicts with Gross, raising questions about the company's succession plan as El-Erian was widely perceived as heir apparent to the 69-year-old Gross. Despite this, El-Erian praised Gross as "a brilliant investor ... anchored by three things that you hardly ever find in an investor: Strong fundamentals including economics, a really good feel for the market and strong bond math" when Gross departed Pimco.


title: Mohamed A. El-Erian

text: El-Erian remains a member of the parent company's (Allianz) international executive committee, chairs its International Advisory Committee, and is an advisor to the management board.


title: Mohamed A. El-Erian

text: El-Erian has published widely on international economic and finance topics. He is a member of the "Financial Times" "A-List" of writers, has a monthly column in "Foreign Policy" and is a contributing editor at the FT. He is also a regular op-ed contributor to Project Syndicate. His columns have appeared in The Atlantic, Bloomberg, "The Economist", "Business Insider", "Financial Times", "Fortune, "Newsweek", "The Wall Street Journal", "The Washington Post", "The Financial Express", and other outlets. He is a columnist for Bloomberg. His first book "When Markets Collide" was a "New York Times" and "Wall Street Journal" bestseller. The book won the Financial Times and Goldman Sachs Business Book of the Year Award in 2008, was named a book of the year by "The Economist", and called one of the best business books of all time by "The Independent". His second book, "", was also a "New York Times" bestseller.


title: Mohamed A. El-Erian

text: El-Erian was named to "Foreign Policy"<nowiki>'</nowiki>s list of Top 100 Global Thinkers four years in a row: for 2009, 2010, 2011, and 2012. He appears regularly on CNN, CNBC, and Bloomberg as well as other media outlets.


title: Mohamed A. El-Erian

text: In April 2013, "Foreign Policy" named him as one of the 500 most powerful people on the planet. In 2017, he again was listed on Worth's "power 100." He was inducted into the Fixed Income Analysts Society Hall of Fame on April 14, 2011. In 2011, 2012, and 2013, he was included in "Investment Advisor" annual IA 25 list honoring the most influential people in and around the advisor community. In December 2012, Marketwatch named him one of "30 leaders who will set the agenda in 2013" – the publication's annual list of the people who will shape economic currents in the coming year. In September 2013, he was recognized as the Capital Markets Personality of the Year by "Africa Investor", an international investment and communications group that publishes a leading magazine for Africa's investment decision makers.


title: Mohamed A. El-Erian

text: "Worth" Magazine, a publication focused on high-net-worth individuals, named El-Erian to its Power 100 list – "The 100 Most Powerful People in Finance" – in 2011, 2012, 2013, 2016 and 2017. In September 2012, he was given the Creative Leadership Award by the Louise Blouin Foundation. In February 2014, the Ukleja Center honored him with the 2014 Nell and John Wooden Ethics in Leadership award. In July 2014, the Egyptian Cancer Network gave him the Lifetime Achievement Award for his support of cancer treatment and cures for children in Egypt. In November 2015, The Middle East Institute in Washington DC honored him with their Visionary Award. The award recognizes outstanding leadership in international economic and financial policy, melding creativity and vision with expertise to promote global prosperity.


title: Mohamed A. El-Erian

text: In February 2017, Richtopia ranked him 23rd in its list of top 100 economists in the world. In both 2016 and 2017, Linked-In recognized him as one of its top 3 "voices" among its "influencers." In 2017, he was named to "Investment News" list of 20 market "Icons and Innovators." He has appeared regularly on the "Orange County Business Journal" list of most influential personalities.


title: Mohamed A. El-Erian

text: El-Erian has served on several boards and committees, including the U.S. Treasury Borrowing Advisory Committee, the International Center for Research on Women, the IMF's Committee of Eminent Persons, and the Peterson Institute for International Economics. He is currently a board member of the Carnegie Endowment for International Peace (Vice Chair), the NBER(Executive Committee), co-chair of the Capital Campaign for the University and Colleges of Cambridge and Cambridge in America. On March 18, 2015, El-Erian was admitted as Companion of the Guild of Benefactors, Cambridge University. He is also a board member of New America, King Abdullah University of Science and Technology (KAUST) and The Pegasus School. Since 2007, he has served as chair of the Microsoft Investment Advisory Committee. He is also a member of the Council on Foreign Relations and serves on the international advisory committees of Allianz and Investcorp. He is a member of the Council of Foreign Relations.


title: Mohamed A. El-Erian

text: His philanthropic efforts over the years have emphasized education and health, including major gifts to the Children's Cancer Hospital in Egypt as well as the University of Cambridge and Queens' College. In October 2015, it was announced that, together with funding for studentships and new faculty positions, the El-Erian Institute for Human Behavior and Economic Policy would be established in partnership with Queens' College and the Faculty of Economics at Cambridge. The work of the institute will look to appropriately combine economics and finance with neuroscience, psychology, politics and behavioral finance to better understand how people actually make decisions rather than how narrow theory assumes they will.


title: Mohamed A. El-Erian

text: El-Erian is a widely recognized thought leader and is credited with developing the post-global financial crisis concept of the "New Normal". Having first come up with the concept in January 2009 and after discussions with PIMCO, he wrote about it in May 2009 and presented it in several forums, including as the 2010 Per Jacobsson Foundation Lecture in Washington D.C. He has published numerous articles and commentaries on topics related to the New Normal, the sovereign debt crisis in Europe, the transformative changes occurring in the Middle East, and other matters related to the global economy, policy and markets.


title: Mohamed A. El-Erian

text: El-Erian has spoken at many universities, public institutions and other organizations, including the University of California, Irvine, the New York Public Library, the University of Southern California, Cambridge, Oxford, the Newport Beach Public Library, the BIS, CFA Society of Chicago, HSBC, Barclays Bank, the UK Parliament’s House of Lords, SALT, Rand Merchant Bank, Marcus Evans, Mortgage Bankers Association, Insurance Bureau of Canada, World 50, and the 92nd Street Y. He has also spoken at CFA, "FT", and "Economist" conferences. In November 2007, El-Erian was the series kick-off speaker of the MIT Egyptian Club. In 2010, he delivered the Per Jacobsson Foundation Lecture in Washington, D.C. In 2012 he was chosen to present the Homer Jones Memorial Lecture at the Federal Reserve Bank of St. Louis. In October 2012, he delivered the keynote Bagehot at "The Economist" Buttonwood Gathering in New York. In November 2013, he delivered the luncheon speech at the IMF's Annual Research Conference that also featured Ben Bernanke, Olivier Blanchard, Stanley Fischer, Ken Rogoff, and Larry Summers. In October 2014, he spoke at HSBC and RBS. He participated in the international symposium of the Banque de France.


title: Mohamed A. El-Erian

text: He was also the keynote speaker at the 2014 CME Conference along with Ben Bernanke and Colin Powell. He has also spoken before the Economic Club of Canada, Soka University, ProBono Economics, Boston Security Analysts, Rabobank, Citadel, ETF, National Rural Utilities Cooperative, Cisco, BTG Pactual, Euromoney, NMS, Mortgage Bankers Association, CME, Rabobank, the Global Financial Forum and many others. In March 2015 he was a featured speaker at the Egypt Economic Development Conference in Sharm El-Sheikh, Egypt. He also is a contributor to LinkedIn's Influencer series and was ranked third on their top 10 influencers of the year. In November 2015, he participated in the Fortune CEO Global Summit and was the keynote speaker at the CFA Society of Chicago. In December 2015, El-Erian was the keynote speaker at the Information Management Network Conference in Scottsdale, Arizona.


title: Mohamed A. El-Erian

text: On July 1, 2019, El-Erian was appointed Senior Global Fellow at The Lauder Institute and Part-Time Professor of Practice at The Wharton School. On October 1, 2020, he took up office as President of Queens' College, Cambridge.


title: Mohamed A. El-Erian

text: He is married to Anna Stylianides, who is from South Africa and the executive director of Eco Oro Minerals Corp. He was formerly married to Jamie Walters.


title: Eosinophilic esophagitis

text: Eosinophilic esophagitis (EoE) is an allergic inflammatory condition of the esophagus that involves eosinophils, a type of white blood cell. In healthy individuals, the esophagus is typically devoid of eosinophils. In EoE, eosinophils migrate to the esophagus in large numbers. When a trigger food is eaten, the eosinophils contribute to tissue damage and inflammation. Symptoms include swallowing difficulty, food impaction, vomiting, and heartburn.


title: Eosinophilic esophagitis

text: Eosinophilic esophagitis was first described in children but also occurs in adults. The condition is not well understood, but food allergy may play a significant role. The treatment may consist of removal of known or suspected triggers and medication to suppress the immune response. In severe cases, it may be necessary to enlarge the esophagus with an endoscopy procedure.


title: Eosinophilic esophagitis

text: While knowledge about EoE has been increasing rapidly, diagnosis of EoE can be challenging because the symptoms and histo-pathologic findings are not specific.


title: Eosinophilic esophagitis

text: The prevalence of eosinophilic esophagitis has increased over time and currently ranges from 1 to 6 per 10,000 persons. Gender and ethnic variations exist in the prevalence of EoE, with the majority of cases reported in Caucasian males.


title: Eosinophilic esophagitis

text: In addition to gender (male predominance) and race (mainly a disease of Caucasian individuals), established risk factors for EoE include atopy and other allergic conditions. Other recognized genetic and environmental risk factors for EoE include alterations in gut barrier function (e.g. GERD), variation in the nature and timing of oral antigen exposure, lack of early exposure to microbes, and an altered microbiome. A study comparing active EoE children to non EoE children found an altered microbiome due to a positive correlation between a relatively high abundance of Haemophilus and disease activity seen through an increasing Eosinophilic Esophagitis Endoscopic Reference Score and Eosinophilic Esophagitis Histologic Scoring System (q value = 5e-10). Measuring the relative abundance of specific taxa in children’s salivary microbiome could serve as a noninvasive marker for eosinophilic esophagitis.


title: Eosinophilic esophagitis

text: EoE often presents with difficulty swallowing, food impaction, stomach pains, regurgitation or vomiting, and decreased appetite. Although the typical onset of EoE is in childhood, the disease can be found in all age groups, and symptoms vary depending on the age of presentation. In addition, young children with EoE may present with feeding difficulties and poor weight gain. It is more common in males, and affects both adults and children.


title: Eosinophilic esophagitis

text: Predominant symptoms in school-aged children and adolescents include difficulty swallowing, food impaction, and choking/gagging with meals- particularly when eating foods with coarse textures. Other symptoms in this age group can include abdominal/chest pain, vomiting, and regurgitation. The predominant symptom in adults is difficulty swallowing; however, intractable heartburn and food avoidance may also be present. Due to the long-standing inflammation and possible resultant scarring that may have gone unrecognized, adults presenting with EoE tend to have more episodes of esophageal food impaction as well as other esophageal abnormalities such as Schatzki ring, esophageal webs, and in some cases, achalasia.


title: Eosinophilic esophagitis

text: Although many of these symptoms overlap with the symptoms of GERD, the majority of patients with EoE exhibit a poor response to acid-suppression therapy. Many people with EoE have other autoimmune and allergic diseases such as asthma and celiac disease. Mast cell disorders such as Mast Cell Activation Syndrome or Mastocytosis are also frequently associated with it.


title: Eosinophilic esophagitis

text: Eosinophils are inflammatory cells that release a variety of chemical signals which inflame the surrounding esophageal tissue. This results in the signs and symptoms of pain, visible redness on endoscopy, and a natural history that may include stricturing. Eosinophils are normally present in other parts of a healthy gastrointestinal tract, these white blood cells are not normally found in the esophagus of a healthy individual. The reason for the migration of eosinophils to the tissue of the esophagus is not fully understood but is being studied extensively. It is thought the migration of eosinophils to the esophagus may be due to genetic, environmental, and host immune system factors.


title: Eosinophilic esophagitis

text: At a tissue level, EoE is characterized by a dense infiltrate with white blood cells of the eosinophil type into the epithelial lining of the esophagus. This is thought to be an allergic reaction against ingested food, based on the important role eosinophils play in allergic reactions. The eosinophils are recruited into the tissue in response to local production of eotaxin-3 by IL-13 stimulated esophageal epithelial cells.


title: Eosinophilic esophagitis

text: The diagnosis of EoE is typically made on the combination of symptoms and findings on diagnostic testing. To properly diagnose EoE, various diseases such as GERD, esophageal cancer, achalasia, hypereosinophilic syndrome, infection, Crohn's disease, and drug allergies need to be ruled out.


title: Eosinophilic esophagitis

text: Prior to the development of the EE Diagnostic Panel, EoE could only be diagnosed if gastroesophageal reflux did not respond to a six-week trial of twice-a-day high-dose proton-pump inhibitors (PPIs) or if a negative ambulatory pH study ruled out gastroesophageal reflux disease (GERD).


title: Eosinophilic esophagitis

text: Radiologically, the term "ringed esophagus" has been used for the appearance of eosinophilic esophagitis on barium swallow studies to contrast with the appearance of transient transverse folds sometimes seen with esophageal reflux (termed "feline esophagus").


title: Eosinophilic esophagitis

text: Endoscopically, ridges, furrows, or rings may be seen in the esophageal wall. Sometimes, multiple rings may occur in the esophagus, leading to the term "corrugated esophagus" or "feline esophagus" due to similarity of the rings to the cat esophagus. Presence of white exudates in esophagus is also suggestive of the diagnosis. On biopsy taken at the time of endoscopy, numerous eosinophils can be seen in the superficial epithelium. A minimum of 15 eosinophils per high-power field are required to make the diagnosis. Eosinophilic inflammation is not limited to the esophagus alone, and does extend through the whole gastrointestinal tract. Profoundly degranulated eosinophils may also be present, as may micro-abscesses and an expansion of the basal layer.


title: Eosinophilic esophagitis

text: Patients found to have signs of EoE on endoscopy should undergo an empiric 8-week trial of high-dose proton pump inhibitor therapy (twice daily) before repeat endoscopy in order to rule out GERD. Although endoscopic findings are helpful in identifying patients with EoE, they are not diagnostic of the disease if the patient has no clinical symptoms.


title: Eosinophilic esophagitis

text: Currently, endoscopic mucosal biopsy remains the most important diagnostic test for EoE, and is required to confirm the diagnosis. Biopsy specimens from both the proximal/mid and distal esophagus should be obtained regardless of the gross appearance of the mucosa. Specimens should also be obtained from areas revealing endoscopic abnormalities. At least four biopsies are required to obtain adequate sensitivity for the detection of EoE. A definitive diagnosis of EoE is based on the presence of at least 15 eosinophils/HPF in the esophageal biopsies of patients despite treatment with high-dose PPI. GERD can increase eosinophilic infiltration in the distal esophagus, however, eosinophils associated with GERD generally occur at a lower density (i.e. < 15/HPF).


title: Eosinophilic esophagitis

text: A thorough personal and family history of other atopic conditions is recommended in all patients with EoE. Testing for allergic sensitization may be considered using skin prick testing or blood testing for allergen-specific IgE. This is particularly important for the 10–20% of EoE patients who also have symptoms of immediate IgE-mediated food allergy. Atopy patch testing has been used in some cases for the potential identification of delayed, non-IgE (cell-mediated) reactions.


title: Eosinophilic esophagitis

text: The goal of EoE treatment is to control the symptoms by decreasing the number of eosinophils in the esophagus and, subsequently, reducing the esophageal inflammation. Management consists of dietary, pharmacological, and endoscopic treatment.


title: Eosinophilic esophagitis

text: Dietary treatment can be effective, as there does appear to be a role of allergy in the development of EOE. Allergy testing is not particularly effective in predicting which foods are driving the disease process. If no specific allergenic food or agent is present, a trial of the six food elimination diet (SFED) can be pursued. Various approaches have been tried, where either six food groups (cow's milk, wheat, egg, soy, nuts and fish/seafood), four groups (animal milk, gluten-containing cereals, egg, legumes) or two groups (animal milk and gluten-containing cereals) are excluded for a period of time, usually six weeks. A "top down" (starting with six foods, then reintroducing) approach may be very restrictive. Four- or even two-group exclusion diets may be less difficult to follow and reduce the need for many endoscopies if the response to the limited restriction is good.


title: Eosinophilic esophagitis

text: Alternative options to SFED includes the elemental diet, which is an amino acid based diet. The elemental diet demonstrates a high rate of response (almost 90% in children, 70% in adults), with a rapid relief of symptoms associated with histological remission. This diet involves using amino-acid based liquid formulas for 4-6 wk, followed by the histological evaluation of response. If remission is achieved, foods are slowly reintroduced.


title: Eosinophilic esophagitis

text: In patients diagnosed with EoE, a trial of proton-pump inhibitors (PPI), such as esomeprazole 20 mg to 40 mg oral daily or twice daily as a first line therapy is a reasonable option. Nexium®, brand name esomeprazole, may be preferred as these tablets can be dispersed in half a glass of water and drank for those with difficulty swallowing pills. Those who respond to PPI therapy with symptomatic improvement, should have endoscopy with esophageal biopsy should be repeated. If no eosinophils are present in the repeat biopsy, the diagnosis is either acid mediated GERD with eosinophilia or non GERD PPI responsive EoE with unknown mechanism. If both symptoms and eosinophils persists after treatment with PPI, the diagnosis is immune mediated EoE.


title: Eosinophilic esophagitis

text: Medical therapy for immune mediated EoE primarily involves using corticosteroids. Systemic (oral) corticosteroids were one of the first treatment options shown to be effective in patients with EoE. Both clinical and histologic improvement have been noted in approximately 95% of EoE patients using systemic corticosteroids. However, upon discontinuation of therapy, 90% of patients using corticosteroids experience a recurrence in symptoms. In May 2022, U.S. Food and Drug Administration approved dupilumab (Dupixent) to treat eosinophilic esophagitis (EoE) in adults and pediatric patients 12 years and older weighing at least 40 kilograms (which is about 88 pounds) making it the first US FDA approved treatment for EoE.


title: Eosinophilic esophagitis

text: In patients who present with food impaction, flexible upper endoscopy is recommended to remove impacted food. Dilation is deferred in EoE until patients are adequately treated with pharmacological or dietary therapy, and the result of a response to therapy is available. The goals of therapy for treating EoE is to improve the patient's symptoms as well as to reduce the number of eosinophils on biopsy. This procedure is effective in 84% of people who require it.


title: Eosinophilic esophagitis

text: Esophageal strictures and rings can be safely dilated in EoE. It is recommended to use a graduated balloon catheter for gradual dilation. The patient should be informed that after dilation they might experience chest pain and in addition risk of esophageal perforation and bleeding.


title: Eosinophilic esophagitis

text: The long-term prognosis for patients with EoE is unknown. Some patients may follow a “waxing and waning” course characterized by symptomatic episodes followed by periods of remission. There have also been reports of apparent spontaneous disease remission in some patients; however, the risk of recurrence in these patients is unknown. It is possible that long-standing, untreated disease may result in esophageal remodeling, leading to strictures, Schatzki ring and, eventually, achalasia.


title: Eosinophilic esophagitis

text: There are many environmental factors that can increase the risk of developing EoE along with genetic factors for the disorder. The prevalence of EoE seems to be trending and there are many ongoing studies to try and find out why this may be. Risk factors for EoE include autoimmune conditions such as, inflammatory bowel disease and rheumatoid arthritis. Those with celiac disease, another autoimmune condition, are at higher risk of developing EoE as well. Individuals living in dry or cold climates as well as those living in areas of low population density are associated with higher rates of EoE. Food allergens are a risk factor of EoE and can often be directly attributed to the disease. Often times removing these food allergens from the diet can resolve EoE symptoms.


title: Eosinophilic esophagitis

text: The first case of eosinophilic esophagitis was reported in 1978. In the early 1990s, it became recognized as a distinct disease.


title: Psychological resilience

text: Psychological resilience is the ability to cope mentally or emotionally with a crisis or to return to pre-crisis status quickly. The term was coined in the 1970s by a psychologist named Emmy E. Werner as she conducted a forty year long study of a cohort of Hawaiian children who came from low, socioeconomical back grounds. Resilience exists when the person uses "mental processes and behaviors in promoting personal assets and protecting self from the potential negative effects of stressors". In simpler terms, psychological resilience exists in people who develop psychological and behavioral capabilities that allow them to remain calm during crises/chaos and to move on from the incident without long-term negative consequences. A lot of criticism of this topic comes from the fact that it is difficult to measure and test this psychological construct because resiliency can be interpreted in a variety of ways. Most psychological paradigms (biomedical, cognitive-behavioral, sociocultural, etc.) have their own perspective of what resilience looks like, where it comes from, and how it can be developed. Despite numerous definitions of psychological resilience, most of these definitions center around two concepts: adversity and positive adaptation. Many psychologists agree that positive emotions, social support, and hardiness can influence an individual to become more resilient.


title: Psychological resilience

text: Resilience is generally thought of as a "positive adaptation" after a stressful or adverse situation. When a person is "bombarded by daily stress, it disrupts their internal and external sense of balance, presenting challenges as well as opportunities." However, the routine stressors of daily life can have positive impacts which promote resilience. It is still unknown what the correct level of stress is for each individual. Some people can handle greater amounts of stress than others. A portion of psychologists believe that it is not the stress itself that promotes resilience but rather the individual's perception of their stress and their perceived personal level of control. The presence of stress allows people to practice this process. According to Germain and Gitterman (1996), stress is experienced in an individual's life course at times of difficult life transitions, involving developmental and social change; traumatic life events, including grief and loss; and environmental pressures, encompassing poverty and community violence. Resilience is the integrated adaptation of physical, mental and spiritual aspects in a set of "good or bad" circumstances, a coherent sense of self that is able to maintain normative developmental tasks that occur at various stages of life.


title: Psychological resilience

text: The Children's Institute of the University of Rochester explains that "resilience research is focused on studying those who engage in life with hope and humor despite devastating losses".


title: Psychological resilience

text: It is important to note that resilience is not only about overcoming a deeply stressful situation, but also coming out of the said situation with "competent functioning". Resiliency allows a person to rebound from adversity as a strengthened and more resourceful person. Some characteristics of psychological resilience include: an easy temperament, good self-esteem, planning skills, and a supportive environment inside and outside of the family. Aaron Antonovsky in 1979 stated that when an event is appraised as comprehensible (predictable), manageable (controllable), and somehow meaningful (explainable) a resilient response is more likely.


title: Psychological resilience

text: Psychological resilience is most commonly understood as a process. It is a tool a person can use and it is something that an individual develops overtime. Others assume it to be a trait of the individual, an idea more typically referred to as "resiliency". Most research now shows that resilience is the result of individuals being able to interact with their environments and participate in processes that either promote well-being or protect them against the overwhelming influence of risk factors. This research could be used in support of psychological resilience being a process rather than a trait. Resilience is seen as something to develop. Making it something to pursue and not an endpoint.


title: Psychological resilience

text: Ray Williams (Canadian businessman and author) saw that resilience comes from people able to effectively cope with their environment. He believed that there are three basic ways individuals could react when faced with a difficult situation.


title: Psychological resilience

text: The third option is the one he believed that truly helps an individual promote wellness. Individuals that follow this pattern are people who show resilience. Their resilience comes from coping with the situation. People who follow the first and second option tend to label themselves as victims of their circumstance or they may blame others for their misfortune. They do not effectively cope with their environment, they become reactive, and they tend to cling to negative emotions. This often makes it difficult to focus on problem solving or bounce back. Those that are more resilient will respond to their conditions by coping, bouncing back, and looking for a solution. Along with continual coping methods, William believed that the resilience process can be aided by good environments. These environments include supportive social environments (such as families, communities, schools) and social policies.


title: Psychological resilience

text: Like other psychological phenomena, by defining specific psychological and affective states in certain ways, controversy over meaning will always ensue. How the term resilience is defined affects research focuses; different or insufficient definitions of resilience will lead to inconsistent research about the same concepts. Research on resilience has become more heterogeneous in its outcomes and measures, convincing some researchers to abandon the term altogether due to it being attributed to all outcomes of research where results were more positive than expected.


title: Psychological resilience

text: There is also some disagreement among researchers in the field as to whether psychological resilience is a character trait or state of being. Psychological resilience has also been referred to as ecological concept, ranging from micro to macro levels of interpretation. However, it is generally agreed upon that resilience is a buildable resource.


title: Psychological resilience

text: Recently there has also been evidence that resilience can indicate a capacity to resist a sharp decline in other harm even though a person temporarily appears to get worse.<ref name="doi10.1177/0044118X03257030"></ref> Similarly, studies have shown that adolescents who have a high level of adaptation (i.e resilience) tend to struggle with dealing with other psychological problems later on in life. This is due to an overload of their stress response systems. There is evidence that the higher one's resilience is, the lower their vulnerability.


title: Psychological resilience

text: The first research on resilience was published in 1973. The study used epidemiology, which is the study of disease prevalence, to uncover the risks and the protective factors that now help define resilience. A year later, the same group of researchers created tools to look at systems that support development of resilience.


title: Psychological resilience

text: Emmy Werner was one of the early scientists to use the term "resilience" in the 1970s. She studied a cohort of children from Kauai, Hawaii. Kauai was quite poor and many of the children in the study grew up with alcoholic or mentally ill parents. Many of the parents were also out of work. Werner noted that of the children who grew up in these detrimental situations, two-thirds exhibited destructive behaviors in their later teen years, such as chronic unemployment, substance abuse, and out-of-wedlock births (in case of teenage girls). However, one-third of these youngsters did not exhibit destructive behaviors. Werner called the latter group "resilient". Thus, resilient children and their families were those who, by definition, demonstrated traits that allowed them to be more successful than non-resilient children and families.


title: Psychological resilience

text: Resilience also emerged as a major theoretical and research topic from the studies of children with mothers diagnosed with schizophrenia in the 1980s. In a 1989 study, the results showed that children with a schizophrenic parent may not obtain an appropriate level of comforting caregiving—compared to children with healthy parents—and that such situations often had a detrimental impact on children's development. On the other hand, some children of ill parents thrived well and were competent in academic achievement, and therefore led researchers to make efforts to understand such responses to adversity.


title: Psychological resilience

text: Since the onset of the research on resilience, researchers have been devoted to discovering the protective factors that explain people's adaptation to adverse conditions, such as maltreatment, catastrophic life events, or urban poverty. The focus of empirical work then has been shifted to understand the underlying protective processes. Researchers endeavor to uncover how some factors (e.g. connection to family) may contribute to positive outcomes.


title: Psychological resilience

text: However, these factors vary among different age groups. For example, these factors among older adults are external connections, grit, independence, self-care, self-acceptance, altruism, hardship experience, health status, and positive perspective on life.


title: Psychological resilience

text: Resilience is negatively correlated with personality traits of neuroticism and negative emotionality, which represents tendencies to see and react to the world as threatening, problematic, and distressing, and to view oneself as vulnerable. Positive correlations stands with personality traits of openness and positive emotionality, that represents tendencies to engage and confront the world with confidence in success and a fair value to self-directedness.


title: Psychological resilience

text: There is significant research found in scientific literature on the relationship between positive emotions and resilience. Studies show that maintaining positive emotions whilst facing adversity promote flexibility in thinking and problem solving. Positive emotions serve an important function in their ability to help an individual recover from stressful experiences and encounters. That being said, maintaining a positive emotionality aids in counteracting the physiological effects of negative emotions. It also facilitates adaptive coping, builds enduring social resources, and increases personal well-being.


title: Psychological resilience

text: The formation of conscious perception and the monitoring of one's own socioemotional factors is considered a stabile aspect of positive emotions. This is not to say that positive emotions are merely a by-product of resilience, but rather that feeling positive emotions during stressful experiences may have adaptive benefits in the coping process of the individual. Empirical evidence for this prediction arises from research on resilient individuals who have a propensity for coping strategies that concretely elicit positive emotions, such as benefit-finding and cognitive reappraisal, humor, optimism, and goal-directed problem-focused coping. Individuals who tend to approach problems with these methods of coping may strengthen their resistance to stress by allocating more access to these positive emotional resources. Social support from caring adults encouraged resilience among participants by providing them with access to conventional activities.


title: Psychological resilience

text: Positive emotions not only have physical outcomes but also physiological ones. Some physiological outcomes caused by humor include improvements in immune system functioning and increases in levels of salivary immunoglobulin A, a vital system antibody, which serves as the body's first line of defense in respiratory illnesses. Moreover, other health outcomes include faster injury recovery rate and lower readmission rates to hospitals for the elderly, and reductions in a patient's stay in the hospital, among many other benefits. A study was done on positive emotions in trait-resilient individuals and the cardiovascular recovery rate following negative emotions felt by those individuals. The results of the study showed that trait-resilient individuals experiencing positive emotions had an acceleration in the speed in rebounding from cardiovascular activation initially generated by negative emotional arousal, i.e. heart rate and the like.


title: Psychological resilience

text: Forgiveness is also said to play a role in predicting "resilience", among patients with chronic pain (but not the severity of the pain).


title: Psychological resilience

text: Many studies show that the primary factor for the development of resilience is social support. While many competing definitions of social support exist, most can be thought of as the degree of access to, and use of, strong ties to other individuals who are similar to one's self. Social support requires not only that you have relationships with others, but that these relationships involve the presence of solidarity and trust, intimate communication, and mutual obligation both within and outside the family.


title: Psychological resilience

text: In military studies it has been found that resilience is also dependent on group support: unit cohesion and morale is the best predictor of combat resiliency within a unit or organization. Resilience is highly correlated to peer support and group cohesion. Units with high cohesion tend to experience a lower rate of psychological breakdowns than units with low cohesion and morale. High cohesion and morale enhance adaptive stress reactions. Post-war veterans who had more social support were less likely to develop post-traumatic stress disorder.


title: Psychological resilience

text: A study was conducted among high-achieving professionals who seek challenging situations that require resilience. Research has examined 13 high achievers from various professions, all of whom had experienced challenges in the workplace and negative life events over the course of their careers but who had also been recognized for their great achievements in their respective fields. Participants were interviewed about everyday life in the workplace as well as their experiences with resilience and thriving. The study found six main predictors of resilience: positive and proactive personality, experience and learning, sense of control, flexibility and adaptability, balance and perspective, and perceived social support. High achievers were also found to engage in many activities unrelated to their work such as engaging in hobbies, exercising, and organizing meetups with friends and loved ones.


title: Psychological resilience

text: Additional factors are also associated with resilience, like the capacity to make realistic plans, having self-confidence and a positive self image, developing communications skills, and the capacity to manage strong feelings and impulses.


title: Psychological resilience

text: Temperamental and constitutional disposition is considered as a major factor in resilience. It is one of the necessary precursors of resilience along with warmth in family cohesion and accessibility of prosocial support systems. There are three kinds of temperamental systems that play part in resilience, they are the appetitive system, defensive system and attentional system.


title: Psychological resilience

text: Another protective factor is related to moderating the negative effects of environmental hazards or a stressful situation in order to direct vulnerable individuals to optimistic paths, such as external social support. More specifically a 1995 study distinguished three contexts for protective factors:


title: Psychological resilience

text: Furthermore, a study of the elderly in Zurich, Switzerland, illuminated the role humor plays as a coping mechanism to maintain a state of happiness in the face of age-related adversity.


title: Psychological resilience

text: Besides the above distinction on resilience, research has also been devoted to discovering the individual differences in resilience. Self-esteem, ego-control, and ego-resiliency are related to behavioral adaptation. For example, maltreated children who feel good about themselves may process risk situations differently by attributing different reasons to the environments they experience and, thereby, avoid producing negative internalized self-perceptions. Ego-control is "the threshold or operating characteristics of an individual with regard to the expression or containment" of their impulses, feelings, and desires. Ego-resilience refers to "dynamic capacity, to modify his or her model level of ego-control, in either direction, as a function of the demand characteristics of the environmental context"


title: Psychological resilience

text: Maltreated children who experienced some risk factors (e.g., single parenting, limited maternal education, or family unemployment), showed lower ego-resilience and intelligence than nonmaltreated children. Furthermore, maltreated children are more likely than nonmaltreated children to demonstrate disruptive-aggressive, withdraw, and internalized behavior problems. Finally, ego-resiliency, and positive self-esteem were predictors of competent adaptation in the maltreated children.


title: Psychological resilience

text: Demographic information (e.g., gender) and resources (e.g., social support) are also used to predict resilience. Examining people's adaptation after disaster showed women were associated with less likelihood of resilience than men. Also, individuals who were less involved in affinity groups and organisations showed less resilience.


title: Psychological resilience

text: Certain aspects of religions, spirituality, or mindfulness may, hypothetically, promote or hinder certain psychological virtues that increase resilience. Research has not established connection between spirituality and resilience. According to the 4th edition of "Psychology of Religion" by Hood, et al., the "study of positive psychology is a relatively new development...there has not yet been much direct empirical research looking specifically at the association of religion and ordinary strengths and virtues". In a review of the literature on the relationship between religiosity/spirituality and PTSD, amongst the significant findings, about half of the studies showed a positive relationship and half showed a negative relationship between measures of religiosity/spirituality and resilience. The United States Army has received criticism for promoting spirituality in its new Comprehensive Soldier Fitness program as a way to prevent PTSD, due to the lack of conclusive supporting data.


title: Psychological resilience

text: Three notable bases for resilience—self-confidence, self-esteem and self-concept—all have roots in three different nervous systems—respectively, the somatic nervous system, the autonomic nervous system and the central nervous system.


title: Psychological resilience

text: Research indicates that like trauma, resilience is influenced by epigenetic modifications. Increased DNA methylation of the growth factor Gdfn in certain brain regions promotes stress resilience, as does molecular adaptations of the blood brain barrier.


title: Psychological resilience

text: The two primary neurotransmitters responsible for stress buffering within the brain are dopamine and endogenous opioids as evidenced by current research showing that dopamine and opioid antagonists increased stress response in both humans and animals. Primary and secondary rewards reduce negative reactivity of stress in the brain in both humans and animals. The relationship between social support and stress resilience is thought to be mediated by the oxytocin system's impact on the hypothalamic-pituitary-adrenal axis. "Resilience, conceptualized as a positive bio-psychological adaptation, has proven to be a useful theoretical context for understanding variables for predicting long-term health and well-being".


title: Psychological resilience

text: In cognitive behavioral therapy (CBT), building resilience is a matter of mindfully changing basic behaviors and thought patterns. The first step is to change the nature of self-talk. Self-talk is the internal monologue people have that reinforce beliefs about the person's self-efficacy and self-value. To build resilience, the person needs to eliminate negative self-talk, such as "I can't do this" and "I can't handle this", and to replace it with positive self-talk, such as "I can do this" and "I can handle this". This small change in thought patterns helps to reduce psychological stress when a person is faced with a difficult challenge. The second step a person can take to build resilience is to be prepared for challenges, crises, and emergencies. In business, preparedness is created by creating emergency response plans, business continuity plans, and contingency plans. For personal preparedness, the individual can create a financial cushion to help with economic crises, he/she can develop social networks to help him/her through trying personal crises, and he/she can develop emergency response plans for his/her household.


title: Psychological resilience

text: Resilience is also enhanced by developing effective coping skills for stress. Coping skills help the individual to reduce stress levels, so they remain functional. Coping skills include using meditation, exercise, socialization, and self-care practices to maintain a healthy level of stress, but there are many other lists associated with psychological resilience.


title: Psychological resilience

text: The Besht model of natural resilience building in an ideal family with positive access and support from family and friends, through parenting illustrates four key markers. They are:


title: Psychological resilience

text: In this model, self-efficacy is the belief in one's ability to organize and execute the courses of action required to achieve necessary and desired goals and hardiness is a composite of interrelated attitudes of commitment, control, and challenge.


title: Psychological resilience

text: A number of self-help approaches to resilience-building have been developed, drawing mainly on the theory and practice of CBT and rational emotive behavior therapy (REBT). For example, a group cognitive-behavioral intervention, called the Penn Resiliency Program (PRP), has been shown to foster various aspects of resilience. A meta-analysis of 17 PRP studies showed that the intervention significantly reduces depressive symptoms over time.


title: Psychological resilience

text: The idea of 'resilience building' is debatably at odds with the concept of resilience as a process, since it is used to imply that it is a developable characteristic of oneself. Those who view resilience as a description of doing well despite adversity, view efforts of 'resilience building' as method to encourage resilience. Bibliotherapy, positive tracking of events, and enhancing psychosocial protective factors with positive psychological resources are other methods for resilience building. In this way, increasing an individual's resources to cope with or otherwise address the negative aspects of risk or adversity is promoted, or builds, resilience.


title: Psychological resilience

text: Contrasting research finds that strategies to regulate and control emotions, in order to enhance resilience, allows for better outcomes in the event of mental illness. While initial studies of resilience originated with developmental scientists studying children in high-risk environments, a study on 230 adults diagnosed with depression and anxiety that emphasized emotional regulation, showed that it contributed to resilience in patients. These strategies focused on planning, positively reappraising events, and reducing rumination helped in maintaining a healthy continuity. Patients with improved resilience were found to yield better treatment outcomes than patients with non-resilience focused treatment plans, providing potential information for supporting evidence based psychotherapeutic interventions that may better handle mental disorders by focusing on the aspect of psychological resilience.


title: Psychological resilience

text: As the world globalizes, language learning and communication have proven to be helpful factors in developing resilience in people who travel, study abroad, work internationally, or in those who find themselves as refugees in countries where their home language is not spoken.


title: Psychological resilience

text: Research conducted by the British Council ties a strong relationship between language and resilience in refugees. Their language for resilience research conducted in partnership with institutions and communities from the Middle East, Africa, Europe and the Americas claims that providing adequate English-learning programs and support for Syrian refugees builds resilience not only in the individual, but also in the host community. Their findings reported five main ways through which language builds resilience: home language and literacy development; access to education, training, and employment; learning together and social cohesion; addressing the effects of trauma on learning; and building inclusivity.


title: Psychological resilience

text: The language for resilience research suggests that further development of home language and literacy helps create the foundation for a shared identity. By maintaining the home language, even when displaced, a person not only learns better in school, but enhances the ability to learn other languages. This enhances resilience by providing a shared culture and sense of identity that allows refugees to maintain close relationships to others who share their identity and sets them up to possibly return one day. Thus, identity is not stripped and a sense of belonging persists.


title: Psychological resilience

text: Access to education, training, and employment opportunities allow refugees to establish themselves in their host country and provides more ease when attempting to access information, apply to work or school, or obtain professional documentation. Securing access to education or employment is largely dependent on language competency, and both education and employment provide security and success that enhance resilience and confidence.


title: Psychological resilience

text: Learning together encourages resilience through social cohesion and networks. When refugees engage in language-learning activities with host communities, engagement and communication increases. Both refugee and host community are more likely to celebrate diversity, share their stories, build relationships, engage in the community, and provide each other with support. This creates a sense of belonging with the host communities alongside the sense of belonging established with other members of the refugee community through home language.