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Cell fusion experiments between a normal cell and an immortal cell indicate that (ii)Increase in number of cell surface receptors generic 60 mg evista mastercard womens health center 95th western, abnormal structure of receptor or loss of receptors these genes can ‘remember’ the Hayfick number of the normal cell buy discount evista 60 mg on-line womens health horizons. Initally this is thought to be a point mutaton with possible subsequent loss of the remaining normal allele buy 60 mg evista overnight delivery menopause xerostomia. At the adenoma-carcinoma interface point mutatons of p53 with subsequent (i)Increased protease actvity (including collagenases and plasminogen actvator) loss of the wild type allele occurs best 60mg evista women's health center at mercy. Abnormalites of nm23, rb and chromosomes 1, 3, 12 and 22 (ii)Increased release of alkaline phosphatase and glycosyl transferase may also occur. Transport The complete dissecton of these multple events requires further research but it is a good example Increased uptake of sugars and amino acids of the multstep pathway of neoplasia. Loss of senescence Morphological observatons on cancer cells have revealed a number of diferences from normal Whilst normal somatc cells can only undergo a fnite number of divisions (Hayfick number), cells but these are non-specifc: neoplastc cells will proliferate ad infnitum under ideal culture conditons 1. Loss of contact inhibiton the nuclear-cytoplasmic rato When normal cells which are proliferatng and spreading come into contact, a ‘cut-out’ mechanism operates and mitosis and movement ceases. Increased motlity 246 247 Compared with normal cells, it is claimed that neoplastc cells migrate more rapidly, probably as a (iii) A possible increase in tumours in patents with growth hormone overproducton (acromegaly) consequence of altered cytoskeletal functon 4. This ability to recognise macromolecules at the cell surface may serve as a mechanism for cellular recogniton and mutant cells is termed ‘immunological surveillance’. Disturbances in the arrangement of macromolecules on tumour cells may explain the presumes that there are antgenic diferences between normal and neoplastc cells. Evidence breakdown in cell-to-cell signals that underlie such phenomena as contact inhibiton and mutual for the development of tumour antgens and immune reactons to them has been drawn from adhesiveness animals and humans. Loss of substrate dependency Most normal cells require atachment to a suitable substrate before proliferaton can occur; this Evidence in animals atachment being mediated by binding proteins such as fbronectn and laminin. Neoplastc cells show a greatly diminished dependence on substrate atachment for proliferaton. Syngeneic animals can reject transplanted tumour if previously immunised against it (e. The presence of circulatng antbodies cytotoxic to tumour cells in vitro has been demonstrated in viral-induced animal leukaemias Whilst it is well known that hormones can greatly modify the producton and growth of tumours, their role in the causaton of tumours is less clear. Immune lymphocytes produced in one animal will cause regression of chemically-induced of malignant change already initated by some other factor such as a virus or chemicals. Afer a primary solid tumour has been removed from an animal, it is more difcult to re-establish the tumour and a large inoculum must be given Examples 5. Animals rendered immunodefcient by neonatal thymectomy or made tolerant to tumour 1. Oestrogens antgens are more susceptble to oncogenesis (i)In mice oestrogens promote the development of mammary cancer which has been initated by 6. Vaccinaton against an animal oncogenic virus (turkey herpes virus) can prevent tumour the Bitner virus development in chickens (ii)Administraton of artfcial oestrogens to trans-sexual men has resulted in a few cases of mammary carcinoma Evidence in man (iii) Breast carcinoma in women may undergo regression afer adrenalectomy and oophorectomy 1. Cell-mediated immunity can be demonstrated to tumour specifc antgens by macrophage (vi) Oral contraceptves giving rise to liver cell adenomas and a few cases of hepatocellular migraton inhibiton, etc. Trophic hormones With certain tumours, those that have a prominent lymphocytc stromal infltrate (‘host reacton’) (i)Gonadotrophins will bring about proliferaton and in some cases malignant change in the ovaries have a beter prognosis of experimental animals which have been transplanted into the spleen. Correlaton between prognosis and the number and reactvity of circulatng lymphocytes released by the ovary are inactvated by the liver and there is reduced feed-back to the pituitary which responds by excessive producton of gonadotrophins (feed-back deleton) 5. Tumour cells which have been inadvertently transplanted into the recipients of renal homografs taken from cancer patents have grown successfully because of immunosuppression of the host 248 249 7. In some cases relapse has followed an alteraton in immune status resultng from immunosuppressive treatment, irradiaton, etc. Development of tumour antgens Alteraton of the genome by an oncogenic agent may lead to the formaton of new antgens at the cell surface. These might not respond to cytokines and contact stmuli appropriately and react by excessive proliferaton or tssue invasion. Virus alteratons result in a new surface antgen which is characteristc of the infectng virus and common to all tumours produced by that virus 2. Chemical carcinogens also induce new surface antgens but these difer from tumour to tumour (idiotypic) 3. Macrophage killing following: (i)Antbody atachment (Fc) (ii)Cytokine actvaton Failure of the immune response Immune surveillance may fail if the 1. Immune system is inefcient because of (i)Increasing age (ii)Human immunodefciency virus infecton (iii) Immune suppression in transplant recipients 3. Adenocarcinoma of the colon and rectum (ii)Blocking of cytotoxic efects on tumour cells by 4. Formaton of soluble Ag/Ab complexes (shedding of tumour antgens leads to producton of 5. Localized concentraton of surface antgens (antgen ‘capping’) leads to aggregaton of Ag/Ab 10. Adenocarcinoma of the ovary complexes so that steric hindrance prevents complement binding b. Lymphoma (10%) Other factors in tumour formaton (i)Non-Hodgkin’s lymphoma including Burkit’s lymphoma (5%) Tumour formaton is also infuenced by: (ii)Hodgkin’s disease (5%) 1. Brain tumours (25%) including Carcinoma of the bronchus, colorectum, stomach and pancreas all increase with age whereas carcinoma of the breast and cervix occur earlier with only a small increase with age. Hodgkin’s (i)Medulloblastoma (cerebellum) (5%) disease and osteogenic sarcoma occur with a bimodal distributon, in young adults and the elderly. Neuroblastoma (6%) Variability in incidence between sexes for most major types of cancer From sympathetc ganglia and adrenal medulla Some mature into ganglioneuroma 3. Nephroblastoma (Wilm’s tumour) (5%) Family history of tumours strongly afects predispositon to specifc types of tumour Composed of tubules and immature glomeruli in a mesenchymal stroma which may contain 4. Osteogenic sarcoma (3%) Most commonly at the lower end of the femur, then the upper part of the tbia 11. Dermatomyosits with carcinoma of bronchus, breast, ovary and lymphomas about 15% of cases associated with malignancy 8. Necrolytc migratory erythema may accompany some other neuromuscular lesion with glucagonoma 9. Exfoliatve dermatts very rare; associaton with lymphoma with lymphomas and leukaemias 5. Pigmentaton (i)Venous thrombosis in carcinomatosis especially carcinoma of the pancreas and mucinproducing carcinomas 7. Pruritus (ii)Non-bacterial thrombotc endocardits in lymphomas and some carcinomas (iii) Disseminated intravascular coagulaton - prostate, 8. Herpes zoster bronchus, stomach, pancreas in Hodgkin’s lymphomas (iv) Microangiopathic haemolytc anaemia, usually advanced carcinoma of stomach, pancreas, colon, lung and breast 9. Hypertrichosis (iii) Sideroblastc anaemia (iv) Thrombocytopenia (v)Red cell aplasia associated with thymoma B. Mixed neuropathy (sensory and motor) carcinoma of the thyroid with many types of carcinoma, e. Hypercalcaemia (parathyroid hormone related peptde) carcinoma of the bronchus and cervix, 5. Prostatc cancerprostatc acid phosphatase, prostate renal carcinoma, lymphomas, small cell carcinoma of the ovary and breast carcinoma specifc antgen 5. Rate of metabolic breakdown A tumour marker is a substance, usually detected in the serum, whose concentraton can be 5.
Thus 60mg evista free shipping womens health uf, in addition to characteristic B-cell antigens discount evista 60mg on-line womens health professionals, the cells show a high density of surface immunoglobulin and clonal rearrangements of both heavy and light chain immunoglobulin genes order evista 60mg overnight delivery menopause gag gift ideas. Infection cheap evista 60 mg line women's health clinic fort lauderdale, the main cause of morbidity and mortality, and bleeding are other possible presentations. The spleen is the probable site of origin of the Clinical features and diagnosis malignant clone and splenomegaly is found in over 80% of cases. The characteristic blood abnormality is a marked lymphocytosis (normally greater than 100 x 109/l). Prolymphocytes are large cells recognised by their condensed nucleus with a single prominent nucleolus surrounded by abundant cytoplasm. Neutropenia is often particularly marked accounting for the frequency of infection. Most patients are elderly and the disease is frequently refractory to chemotherapy. The bone marrow is normally difficult to aspirate because of increased fibrosis; the Palliation of symptoms is the usual priority. Options include splenic irradiation, splenectomy and leucapheresis to trephine will show a variable number of infiltrating hairy cells. Where splenectomy is performed, the sinuses and control the high white cell count. In the most acute form presentation is with a This is most helpful in patients with significant splenomegaly and limited bone marrow involvement. The malignant cells in the blood are pleomorphic but often have very irregular polylobulated provides rapid palliation and improves survival. Even within the leukaemic group there is great heterogeneity with chronic and smouldering forms. Where tolerated, treatment should be 168 169 from Sezary syndrome, a lymphoproliferative disorder with circulating T-cells and skin changes including erythroderma and exafoliative dermatitis. Their common feature is that the clone of cells derived from an abnormal stem cell Management maintains the capacity to differentiate, but this Treatment has been unsatisfactory and the median survival less than one year. Acute forms are frequently resistant to conventional high grade bone marrow and peripheral blood cytopenia. The zidovudine is a novel treatment which may give responses where chemotherapy has failed. The chronic and ineffective haematopoiesis also causes characteristic smouldering - leukaemia forms can run a protracted course but eventually transform to an acute phase. Skin lesions morphological abnormalities in the marrow and blood which may be helped by extracorporeal photochemotherapy. The classification relies chiefly on the number of blast cells in the bone marrow and peripheral blood (Table 1). Where symptoms do occur they range from a mild anaemia to the consequences of severe marrow failure with profound anaemia, leucopenia and thrombocytopenia. Abnormal haematopoiesis can cause functional abnormalities of cells and infection and haemorrhage may be more severe than would be predicted from the degree of cytopenia. The bone marrow trephine biopsy usually confirms marrow hypercellularity, although fibrosis and even hypocellularity may occur. Common changes include monosomy 7 or 7q-, trisomy 8, monosomy 5 or 5q-, and loss of the Y chromosome. The 5q- abnormality is associated with a particular syndrome characterised by anaemia, macrocytosis, thrombocytosis and a relatively good prognosis. Monosomy 7 in children and young adults may represent a specific preleukaeinic disorder with defective neutrophil function. Prognostic scoring systems have been devised which include severe blood cytopenia as an adverse factor. Regular blood transfusion is necessary to control symptoms of anaemia, and haemorrhage is managed with platelet transfusions. This deficit may be exacerbated by an abnormality in the marrow The elderly (over 60 years) microenvironment or an autoimmune reaction against the abnormal haematopoietic tissue. More specific treatments are designed to Aplastic anaemia is uncommon (approximately 2-5 cases/ million/year worldwide), has a slight male predominance reduce cytopenia and slow progression to leukaemia, but real successes are rare. For more aggressive disease has improved with the introduction of both immunosuppressive treatment and bone marrow transplantation. Low dose cytosine may partly work by inducing differentiation of clinical characteristics, the management problems of marrow failure (including fulminating septicaemia and the malignant clone, but its major action is probably as a cytotoxic agent. Complete remissions are unusual but up haemorrhage) and the possible evolution to a clonal marrow disorder dictate its inclusion in this section of the book. Oral cytotoxic drugs including hydroxyurea, busulphan and etoposide have been used as single agents but with limited impact. The best chance of a prolonged remission follows an allogeneic bone marrow transplant. It has been suggested that in patients aged less than 40 years this procedure should be performed early before the development of a high leukaemic blast cell count or life threatening blood cytopenia. Diagnosis depends on the presence of characteristic morphological changes in the blood and marrow. Classification into subtypes relies on quantitation of blast cells in the blood and marrow. In younger patients chemotherapy and allogeneic bone marrow transplantation may be justified. Dyskeratosis congenital another form of constitutional aplasia, is distinguished by a later onset, nail dystrophy, leukoplasia of mucosal surfaces and a high incidence of epithelial tumours. Improved haematopoiesis following immunosuppression suggests that in at least some cases the abnormal stem cell compartment is further compromised by poorly defined immune phenomena. An exhaustive history, including drug and occupational exposure, and a thorough examination are mandatory. The marrow aspirate can be highly suggestive of aplasia with grossly hypocellular particles but a trephine biopsy is necessary to confirm the diagnosis and quantify the degree of hypocellularity. Aplasia may be patchy and if the trephine is surprisingly cellular in the context of the blood count, then further samples should be obtained. In practice the only likely confusion is with hypocellular myelodysplastic syndrome or an atypical presentation of acute leukaemia, the latter particularly in childhood. Other Aplastic anaemia Ferrokinetic studies will neatly demonstrate the marrow deficit but are rarely performed in practice. Prognosis relates to severity which is defined from blood and bone marrow indices. Evolution This is crucial as the severity defined from peripheral blood and bone marrow measurements predicts the response to to a clonal marrow disorder such as leukaemia may occur. Restoring normal haematopoiesis There are two major options, immunesuppression and bone marrow transplantation. Oxymethalone also has side-effects including virulisation, salt retention and liver damage.
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For blinded buy 60 mg evista fast delivery menopause problems, placebo-controlled randomized clinical trials only safe evista 60 mg menstruation quotes funny, evidence to support their use in the treatment of chronic wounds buy discount evista 60 mg on-line menopause 10 day period. The 95% confdence intervals did not In 2000 generic 60mg evista amex women's health vitamins and minerals, Shefet and colleagues authored a review on electric and electromagnetc energy as overlap when all 15 studies were analyzed. The 95% confdence intervals did overlap when the adjuvant treatment for pressure ulcers. These trials provided no evidence of a beneft of electromagnetc In 2001, Cullum and colleagues published a technology assessment that was commissioned therapy for venous leg ulcers. The Medicare Coverage Advisory Commitee authors reported the following: (1) For the treatment of chronic wounds, “the two small trials identfed suggest a beneft associated with electrotherapy compared with sham electrotherapy On October 17th, 2000 the Medical Surgical Procedures Panel of the Medicare Coverage Advisory or no electrotherapy to heal chronic wounds. In preparaton for this meetng the panel was sent the following materials: be made. To identfy additonal evidence on the efectveness of electromagnetc therapy for the treatment of 2. Is the evidence adequate to draw conclusions about the efectveness of electrical stmulaton therapy and electromagnetc with wound(s) or ulcer(s). Searches were limited to human subjects as an adjunctve therapy for chronic arterial/diabetc ulcers? The research on electromagnetc feld has been more limited partcularly in humans……studies • Adequacy of study design –– Is there evidence that the studies do not over or underestmate done do not provide us with much informaton about what this electromagnetc feld might do in the efect of the interventon? The panel decided not to vote on the various types of delivery systems for electrical stmulaton. The panel appeared to believe that it could not get into great detail about the diferences between • Consistency of results –– Are the results of the studies consistent or are they contradictory? The panel ultmately concluded that they remained uncertain about whether there • Expert testmony –– Public comments, etc. In order to be covered by Medicare, an item or service must fall pressure, venous, and arterial ulcers? The panel decided not to distnguish between the types of within one or more beneft categories contained within Part A or Part B, and must not be otherwise wounds. Several panel members believed there was adequate evidence, at least in the aggregate, excluded from coverage. Moreover, with limited exceptons, the expenses incurred for items or to draw a conclusion as to the efectveness of electrical stmulaton used for the treatment of services must be “reasonable and necessary for the diagnosis or treatment of illness or injury or chronic, non-healing pressure ulcers. In additon, some members of the panel stated that the to improve the functoning of a malformed body member. Is there evidence on the efectveness of electrical stmulaton on the healing of chronic With regards to the second queston, the panel concluded that the use of electrical stmulaton for wounds, such as chronic pressure, venous, arterial and diabetc wounds? Is there evidence on the most efectve type of device and form of electrical stmulaton? Is there evidence on the efectveness of electromagnetc therapy on healing of chronic Issue of diferent types of devices wounds? Specifcally, the studies have focused almost entrely on several types of chronic wounds: pressure ulcers, diabetc ulcers and ulcers Dr. Frantz, “you do see an occasional reference to 240 241 studies reviewed had important limitatons, the large body of evidence as a whole is adequate to healing is generally demonstrated by decrease in wound size in surface area or volume, decrease conclude that electrical stmulaton is clinically efectve, and therefore, reasonable and necessary, in amount of exudates, and decrease in amount of necrotc tssue. Chronic ulcers are defned as “open lesions Unlike the situaton with electrical stmulaton, we did not identfy any new studies on the that have not healed within 30 days of their occurrence. Based on these reports, the evidence is adequate example, the etology of a pressure ulcer relates to pressure whereas the etology of arterial ulcers to conclude that electromagnetc therapy is not clinically efectve, and therefore, not reasonable ulcers is vascular. A therapy that reduces pressure, such as pressure-reducing air matresses, are and necessary, for the treatment of chronic wounds. Thus, Medicare will not cover any form of clinically efectve for some decubit ulcers but not for arterial ulcers. Therefore, it is difcult electromagnetc therapy for the treatment of chronic wounds. Further primary research is needed to generalize the fndings from studies on clinically efectve therapies for one type of ulcer to to fully evaluate this treatment modality. Separate safety and efcacy data should be submited for each wound type for which reviewed in this mater, it is our intenton to issue a positve coverage decision only on the an indicaton is sought. All other uses of electrical stmulaton for the treatment performed by a licensed therapist trained in wound care management. Chronic ulcers are defned as ulcers that have not healed within adequately evaluate unsupervised home use of the device by a patent. Electrical stmulaton for the treatment of wounds will not be covered Is there evidence on the most efectve type of device and form of electrical stmulaton? The use of electrical stmulaton will be covered as adjunctve therapy only afer there are no measurable signs of healing for at least 30-days of treatment There was insufcient evidence to determine the best type of device and most efectve form with standard wound therapy and must be used in additon to standard wound care. There appears to be no signs of improved healing include a decrease in wound size either in surface area or volume, standard type, waveform, or frequency of electrical stmulaton. The treatments varied between decrease in amount of exudates and decrease in amount of necrotc tssue. Wounds must be evaluated at least every 30 days during administraton of electrical inital ulcer and rate of healing. In the majority of clinical trials, electrical stmulaton was given stmulaton therapy. Contnued treatment with electrical stmulaton is not covered if measurable 3 tmes per week untl the chronic ulcer healed. There was no direct evidence to determine the signs of healing have not been demonstrated within any 30-day period of treatment. However, it would be clinically ratonal and appropriate to discontnue treatment with electrical stmulaton if the ulcer is not healing. Medicare will not cover any form of electromagnetc therapy for the treatment of chronic wounds. Guidance for Industry: Chronic Cutaneous Ulcer and Burn Wounds –– Developing Products for 2. The Medical Device Amendments of 1976 to the Federal Food, Drug, and Cosmetc Act (the 24. Houghton and Campbell, 1999 on the degree of control necessary to assure that the various types of devices are safe and 26. The efect of high voltage galvanic stmulaton on the rate of healing efectve for its intended use. Am J Surg 1968 devices and “new” devices (described in the paragraph above) are automatcally classifed into May;115(5):683-7. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, December 1994. Electrotherapy for acceleraton of wound healing: low intensity direct controlled trials in an animal model provide indirect support. The Health Technology Assessment conducted by the Natonal Health Service was not sent to the panel, since it had not yet been published. Medicare Coverage Advisory Commitee Executve Commitee, Recommendatons for voltage pulsed monophasic current. Efect of electrical stmulaton on chronic wound healing: a treatment of chronic venous ulceraton.
It is designed to measure reactons for allergy buy evista 60 mg mastercard menstruation cycle calendar, homeopathy evista 60 mg cheap women's health northeast, nutriton discount evista 60 mg fast delivery women's health center kirkland wa, 712 713 sarcodes discount 60mg evista free shipping breast cancer 5k atlanta 2014, nosodes, vitamins, minerals, enzymes and many more items. Biofeedback is used for Important Questons :these are the key questons of the study pre-diagnostc work and or therapy. Percentage of Improvement in Stress Reducton testng and rectfcaton of subtle abnormalites of the body electric. Many reports of the success of the subspace have been reported and thus the efectveness and the safety of the 7. Hahnemann said that the worst way to interfere with the healing Before we review the direct disease improvement profles, we need to review the overall results. Theses upset the natural healing process by The frst most basic of queston in the results is the basic feedback of the generic patent conditons. Other ways to Suppress or Obstruct the Cure With over 96,000 patents and 256,800 patent visits we have direct evidence of the safety and are smoking, mercury amalgams, stress, lack of water, exercise and many others. Percentage of Improvement in Symptoms The scores relate to the risk of Suppression and Obstructon to the natural Cure. Percentage of Improvement in Feeling Beter scores the more the Suppression and or Obstructon. As a general index scores of 200 + where much less Medical University of Natural Educaton. America and elsewhere were enlisted to perform the study according to the Helsinki study ethics regulatons. Then the study technician is to inquire on any disclosed observatons during the There were no cases of patents who reported a negatve Improvement. These two 19 cases reportng no improvement of Symptoms, 30% of group blind therapists were then assigned 35 patents each (only 63 showed). This was to assess the 12 cases reportng no improvement in feeling beter, 19% of group double blind factor of the placebo efect as compared to the device. Thus the studied groups were 13 cases reportng no improvement in stress reducton 20% of group A. Subspace Treatment 75,688 patent visits 48%-- Percentage of Improvement in Stress Reducton There were 45 cases of patents who reported a negatve Improvement. A Xrroid is the rapid 52%-- Percentage of Improvement in Stress Reducton testng of homeopathic medicines by an electrical reactvity device. Analysis of the trivector feld of a homeopathic is developed in this work and patented in Ireland in 1995. By descripton of the right Discussion: hand rule all electrical actvity takes place in three dimensions, Conductvity, Statc, and Magnetc. There is an insignifcant report of negatve results and no reports of any signifcant problems. Since the measure of galvanic skin resistance requires a applied current, the applied current could be of the trivector analysis variety. Second the diference in the placebo group versus the subspace group is signifcant although Aberrant electrical paterns of the patent could be corrected by applicaton of electro-dynamic minimal. Providing a The signifcant measured criteria of the diseases will take volumes in reportng. When this is done at biological speeds of about one hundredth of a second it is studies and measured criteria that will be presented. The defniton of biofeedback is measuring a physiological response and feeding it back to the patent. It can measure changes system measures a combinaton of the following physiological functons, voltage potental, current of electrical nature such as electro-potental, micro-amperage, voltage, galvanic skin resistance. These are the raw readings made at the extremites and the electromagnetc potental, susceptance, reactance, micro-watage, resonant frequency, oxidaton head harness. Correcton of aberrant body electric profles such as proton pressure, electron pressure, reactvity paterns, oscillaton disorders, trivector imbalance. The type intensity and style of reactvity evoked potental ofers insight into the patent health. Provocatve allergy tests show how a patent reacts electro physiologically to an item. These are paterns of reactons to Sarcodes, Nosodes, Allersodes, Isodes, Nutritonal, Acupuncture points, Herbal, Imponderable and Classic Homeopathics. Biofeedback is the operatonthat allows for the cybernetc loop of systemic feedback. Body measured reacton and bio-varied resonance response allow for a true feedback for self correctve Press,1989. Full Spectrum Micronutrient Treatment of Bacteria (Homeopathic Treatment of Bacterial Infectons). Homeopathic Stmulaton of White Blood Cell Motlity as Analyzed under the Microscope (A 3. Chiropractc Analysis and Therapy 720 721 Law of Interpretation not Attraction The Movie “The Secret” is wrong. You do completely control your interpretaton of the world and the events around you. The Law of Interpretaton says that any verbal human will interpret what has happened to him based on his experiences, beliefs, and philosophies. We have the “observer efect” and the mind has been proven to be able to efect things. Telekinesis, remote viewing, Extra-Sensory Percepton etc are all proven to be possible, but the efect is weak. But we have great and complete control over how we interpret the objects, the world, and the events around us. All of the people in Hiroshima did not wake up that August morning and create the bomb, nor did they deserve it. Nelson Mandela came out of jail afer more than two decades and saw it as a positve thing. We completely control the interpretaton of the objects, the world, and the events around us. Some use negatvity to describe the events, some use positvity but all interpret the events. The state of your brain determines the state of your interpretaton of the world around you. Some people are always happy and they learn to fnd the silver lining in every cloud. We do have some limited control of the world around us but we will never have complete control.