Waching daily Jan 4 2017

So, like, all the stuff that you do, and, you know, things that you want, are, like,

you do them, because something good is going to happen.

And because like, people think good things are going to happen, they like, say, that

all the stuff we do we, like, do for good.

But, umm, there are like differences between the stuff that happens when you do one sort

of stuff, and you do other sorts of stuff.

Sometimes, like, when you do something, you only did something, and, you know, other times,

like, you do stuff, and by doing it, you made something.

So, the stuff you made, like, is better than the stuff you do in making it.

So, like, when that bitch Jessica, who is a total slut by the way, makes those stupid

bracelets, umm, those bracelets are, like, better than all that stuff she does to make

them.

But, you know, there are like all sorts of different stuff you can make and do, so, like,

there are like different things you do them for.

But sometimes, there are like, bigger things you want to do, but like you need to do a

lot of little things first, and, you know, the bigger thing is why you do them.

So, oh my God, let tell you, like, when us girls do our hair, and we do our nails, and

go shopping, we do it, to, like, look fabulous.

So, looking fabulous, is like the reason we do all that stuff and so all the other reasons

are, like totally less important than looking fabulous.

Cos like, we do out hair and nails not cos like we want great hair and nails, but, like

totally to look fabulous!

So, the bigger reason, you know, we do stuff for, it like more important than the smaller

reasons we do stuff for.

So being fabulous, is like more important that having awesome hair, even though, you

know, you need awesome hair to look fabulous.

But, if like, we do our hair to look fabulous, then there is like a reason why we want to

look fabulous.

And, duh, there totally is a reason for why we want to look fabulous.

But, like, oh my God, there can't be, like reasons for reasons why we want to look fabulous,

cos like, then we wouldn't like know why we do stuff.

I mean, as if, can you imagine?

So, there totally has got to be a reason we do stuff we do for like no other reason.

And that like, makes total sense, you know?

And that betch Jessica, she was like, "umm, we totally do stuff cos, like, umm, we want

to feel pleasure."

And I was like, umm, whatever betch!

Not even, like you can do stuff, for not like pleasure but like cos you don't want to

be ignorant and stuff.

Cos like, you want to do stuff for pleasure but then like there is a reason why you want

pleasure.

And so, I was like "umm, we do stuff cos we want to be happy" and like, there is

totally no reason why we want to be happy other than like to be happy.

So like, totally, oh my god, we like do everything cos, like we want to be happy.

Like Seriously.

For more infomation >> If Aristotle Was A Valley Girl - MGTOW - Duration: 2:37.

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Keegan-Michael Key Is Jazzy James | Season 28 Ep. 11 | THE SIMPSONS - Duration: 0:39.

- Hi.

I'm Keegan-Michael Key.

You might remember me from my role

as Reporter Number Three in the great film "Mr. 3000."

But I'm really excited about my big break, which

is coming up in a new episode of "The Simpsons," in which I'm

starring.

I'm sorry, what?

I'm costarring.

I'm guest star--

I'm in it.

[theme music]

For more infomation >> Keegan-Michael Key Is Jazzy James | Season 28 Ep. 11 | THE SIMPSONS - Duration: 0:39.

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Associate Professor Carlos Hoyt Delves into Issues of Race | Wheelock College - Duration: 3:00.

So, the title of the book is "The Arc of a Bad Idea:" (arc meaning shape, trajectory)

"Understanding and Transcending Race."

The book came out of my dissertation research, which was on the development of a non-racial

identity in folks who are typically ascribed to probably what is the most talked about,

and I think in ways, charged, racial identity in our society.

And that is the black, African-American mixture biracial identity.

During my own development, and then into my scholarly life, I have always felt that the

idea of race cuts two ways at once all the time.

It is a source of solidarity and pride and identity for folks who embrace their race

in that way.

It is also a tool of oppression.

And particularly in this country, it sort of grew up as the first one and then was very

naturally and I think understandably reclaimed as something to stand behind and fight for.

So, we live in a racialized society is the way I describe it when I teach, when I talk,

and when I write about it.

Such that it is almost impossible not to negotiate with one another based on our racial identities.

So, the book aims to, I hope, be positively provocative about the unorthodox idea that

if we are ever going to truly get past some of the difficulties that we have with race,

then we have to learn to do two things at once.

One is absolutely acknowledge that we live in a racialized society and that we need to

keep our guard up and we need to be vigilant about institutional, systemic, and inter-personal

bias in the form of racism.

But we also need to move away from perpetuating the very notion of this social construct that

keeps us locked into this binary.

I say in the book, and I know it's a provocative thing to say, that racial equality is actually

an oxymoron.

You can't have both of them because the very idea of race is predicated on somebody being

inferior and somebody being superior.

And if we can move away from that, then we can move towards what it is we're looking for.

For more infomation >> Associate Professor Carlos Hoyt Delves into Issues of Race | Wheelock College - Duration: 3:00.

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Opioid dependence & opioid use disorder - Duration: 14:00.

Worldwide, opioids are the most common cause of drug related deaths.

The number of individuals abusing them has quadrupled in the last 20 years, with an uptick

in heroin use, an even bigger uptick in prescription opioid use, and a large group of folks abusing

both.

Because of their potential for addiction and overdose, opioids are regulated substances

in a lot of countries.

As a class, opioids share one thing in common—they bind to opioid receptors in the brain, spinal

cord, and gastrointestinal tract.

Some are endogenous, meaning that they are produced naturally by the body, like endorphin,

short for endogenous morphine.

But others are exogenous, meaning that they come from the environment, like heroin and

morphine because they come from the opium poppy—a flowering plant that oozes out a

milky white liquid, while others like fentanyl are synthesized in the laboratory.

To understand how opioids work, let's zoom into a region of the brain tissue that has

opioid receptors.

Normally, in the absence of endorphins, inhibitory neurons secrete a neurotransmitter that prevents

nearby neurons from releasing the neurotransmitter dopamine.

Now, let's say someone goes to play a rigorous game of badminton.

Exercise releases endorphins which activate the three major opioid receptors located on

the inhibitory neurons, called the mu, kappa, and delta receptors.

As endorphins binds to these receptors, they block the inhibitory neuron from releasing

neurotransmitters, allowing the dopamine secreting neurons to freely unload dopamine.

The dopamine then gets picked up by a third neuron in the same area.

When dopamine release takes place in pain processing regions of the brain like the thalamus,

brainstem, and spinal cord, the result is feeling less pain.

When dopamine release takes place in reward pathway regions like the ventral tegmental

area, nucleus accumbens, and prefrontal cortex, the result is a calming effect that feels

good.

So that's how it works normally.

But when a powerful exogenous opioid binds to the opioid receptors, the result is a massive

flood of dopamine.

This helps with pain control, but it can also cause an incredible state of euphoria within

the regions of the brain involved in the reward pathway, which is an emotional "high".

Now remember, the purpose of the reward pathway is to train the brain to repeat activities

that cause dopamine-mediated pleasure, so when opioids stimulate this reward pathway,

the brain learns to do that behavior again and again.

With exogenous opioids there are multiple routes to get the drug to the brain.

One way is by ingesting it, but that route is the slowest.

A faster route would be inhalation, because the drug is rapidly absorbed through the lungs.

The fastest route, though, is direct injection of the substance into the blood.

Typically, the faster the exogenous opioid reaches the brain the stronger the relationship

between the behavior and the reward.

Now over time, people that are consistently using a drug, even when taking them as exactly

as prescribed, can develop tolerance which means that with repeated use, they have a

reduced response, and therefore an increased dose is needed to achieve the original response.

At a cellular level, there are two theories that explain why this might happen.

One theory is that opioid receptors might become less sensitive to a drug, and the other

theory is that the neurons may remove opioid receptors from the cell wall in a process

called down-regulation, leaving less receptors available for binding.

In either scenario, tolerance leads to the need for higher and higher doses of a drug,

and often times that tolerance remains for a long time even after tapering from the drug.

Alright, so now let's say that you're at rest, there aren't any drugs or anything

stimulating your reward pathway.

In this situation, your brain keeps your heart rate, blood pressure, and wakefulness in a

normal state, called homeostasis.

Now, let's say that your secret crush sends you a text.

All of a sudden you may feel sweaty and flushed, your heart rate may jump a bit.

You're now above your normal level of homeostasis, because something has changed, right?

But it doesn't stay that way for long, and after the text message, your brain brings

things back down to this baseline.

With repeated drug use, a few things start to happen.

Let's say you take the drug at a specific time and setting, like 3pm in the bedroom,

and, being a depressant, it makes everything go lower, heart rate, blood pressure, and

wakefulness.

Your brain being the smart brain that it is, will pick up on the pattern.

Now, next time, at 3pm in the bedroom, the brain preemptively increases each one, since

it knows that when you take the drug, everything's going to decrease again.

Now, let's say 3pm in the bedroom rolls around, but there's no drug...In that situation,

the brain still increases everything..but the changes aren't countered with the effects

of the drug, and so the person can feel awful, and these are called withdrawal symptoms.

These symptoms can persist to the point where a person may need drugs just to feel normal,

and if that's the case, they are considered to be dependent on that drug.

Now, on the flip side, let's say that you use the drug in an unfamiliar setting, like

at 11pm at a party.

Well in that situation, your body's not ready for the drug and there's no physiologic

"counterbalance" to help offset the effect of the drug.

When that's the case, it can lead to overdose, even on a dose that the person's been normally

taking, and that's often times what happens.

The symptoms of opioid withdrawal include anxiety, shivering, tremors, yawning, body

aches, vomiting, diarrhea, abdominal cramps, runny nose, sneezing, sweating, and an increased

heart rate and blood pressure.

These symptoms can feel really awful, and often prompts people to use opioids again;

a process called negative reinforcement, since you're removing the drug, which causes withdrawal

symptoms which reinforces more drug use to avoid those symptoms.

There is also positive reinforcement from the dopamine-induced euphoria, again leading

to more drug use.

Together this positive and negative reinforcement leads to opioid addiction also known as opioid

use disorder.

The DSM-5 or Diagnostic and Statistical Manual, the 5th edition, defines opioid use disorder

as causing at least two of the following behavior patterns within a year: 1.

Using more opioids or using them for longer than intended.

2.

Being unable to cut down on the use of opioids.

3.

Having opioid use take up a significant amount of time 4.

Having cravings to use opioids.

5.

Having opioid use affect responsibilities at work, school, or home.

6.

Using opioids even if they cause recurrent interpersonal problems 7.

Giving up important activities in order to use opioids.

8.

Using opioids in physically dangerous situations.

9.

Using opioids even if its worsening a physical or psychological problem 10.

Becoming tolerant to the opioids.

And finally 11.

Feeling withdrawal symptoms from opioids.

Having 2 or 3 of these symptoms is considered mild, having 4 or 5 is considered moderate,

and having 6 or more is considered severe.

In addition to ruining a person's life, opioid addiction can also end it in an overdose.

Most often, an opioid overdose causes severe cardiac and respiratory depression, to the

point where a person may have pinpoint pupils and simply stop breathing.

In that situation, the most important thing is to performing rescue breathing, giving

supplemental oxygen, and administering naloxone.

Naloxone is an opioid antagonist that powerfully binds to opioid receptors, and rather than

having a direct effect, it blocks other opioids from binding and activating the receptor.

This works because at any given moment, opioids are binding and unbinding to receptors which

means once an opioid releases its hold on a receptor, the naloxone can simply sneak

in and bind more strongly.

When naloxone given intravenously it can reverse the effects of opioids within minutes, potentially

saving a person's life.

Generally speaking, high doses of strong opioids carry the greatest risk of addiction and death,

and when paired with other substances that can cause respiratory depression, like benzodiazepines,

they're more likely to cause overdose because they can act synergistically to cause respiratory

depression.

It's clear that opioids have strong addictive potential, so their use should be limited

and well defined.

They have a role in controlling acute pain, for example, but the goal should be to use

short-acting opioids at the lowest effective dose for just a few days, and slowly increase

their dose only as needed.

When opioids are used for chronic pain, they should be weaned off as soon as possible,

ideally at a wean rate of 10% of the dose per week.

In general though, chronic pain should be treated with non-opioid approaches.

These include exercise and biofeedback as well as other types of medications such as

acetaminophen and NSAIDs like ibuprofen.

There are also disease-specific treatments, like for migraines use triptans, or for neuropathic

pain use gabapentin, or for joint pain topical pain treatments like capsaicin.

For people with opioid dependence, the most effective treatment is a combination of therapy

with medications.

Specific therapies that work include motivational interviewing, which can be used to understand

why an individual wants to stop using opioids and identify specific barriers to treatment.

Also cognitive-behavioral therapy can help an individual learn about withdrawal, discuss

the thoughts, feelings, and behaviors that lead to opioid usage, and create a plan to

navigate triggers for usage.

Another form of therapy are peer-support programs which use group discussions to help individuals

commit to ending the use of opioids and by holding one another accountable.

In addition, the evidence strongly supports the use of medications, which reliably decrease

cravings and reduce withdrawal symptoms.

Methadone is a full opioid agonist with a long half-life that slowly builds up in the

tissues over time, allowing it to reach a steady-state level within a week.

Steady-state refers to the situation where the overall intake of the drug is more or

less in balance with its elimination, so that the body is exposed to a stable level.

In contrast, buprenorphine is a partial agonist that is sometimes given in combination with

naloxone, forming an agonist/antagonist combination.

Buprenorphine has a ceiling effect, meaning that above a certain dose it does not have

any more of an effect, which reduces the chance of an overdose.

These medications can competitively bind to the opioid receptor without producing the

same euphoria as the opioids they take the place of.

Since they have opioid effects, though, they can cause side effects like constipation,

insomnia, weight gain, hormonal changes, and cardiac arrhythmias.

The good news is that over time, an individual can safely taper their use of opioid treatments

altogether, and this approach is more likely to succeed than simply stopping opioids without

these treatments.

Another medication called naltrexone, can be used for people who are already abstaining

from active opioid use.

Naltrexone is a mu-opioid receptor antagonist that blocks the effects of opioids and helps

maintain abstinence.

Finally, all of these approaches work best when an individual has a strong network of

family and friends offering support.

Opioid use still carries heavy stigma because usage is still tied to a notion of individual

choice and moral failure, even though we now know that opioid use is a consequence of biological,

psychological, and social factors—all of which need to be addressed to maximize the

chances of recovery.

Alright, as a quick recap, opioids stop inhibitory neurons from releasing inhibitory neurotransmitters,

which allows dopamine to flood the ventral tegmental area, nucleus accumbens, and prefrontal

cortex, and causing euphoria.

Long-term use can cause tolerance which is the need for increasing doses to achieve the

same effect, as well as dependence which is the reliance on the opioid to function normally.

The most effective treatment is a combination of therapy and medications, with a lot of

love and support from family and friends.

Thanks for watching, you can help support us by donating on patreon, or subscribing

to our channel, or telling your friends about us on social media.

For more infomation >> Opioid dependence & opioid use disorder - Duration: 14:00.

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