173-407: Anesthesia ( American English ) or anaesthesia ( British English ) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain ), paralysis (muscle relaxation), amnesia (loss of memory), and unconsciousness . An individual under the effects of anesthetic drugs
346-707: A cot–caught merger , which is rapidly spreading throughout the whole country. However, the South, Inland North, and a Northeastern coastal corridor passing through Rhode Island, New York City, Philadelphia, and Baltimore typically preserve an older cot–caught distinction. For that Northeastern corridor, the realization of the THOUGHT vowel is particularly marked , as depicted in humorous spellings, like in tawk and cawfee ( talk and coffee ), which intend to represent it being tense and diphthongal : [oə] . A split of TRAP into two separate phonemes , using different
519-555: A hazard ratio of 2.12 (95% confidence interval, 1.26–3.54). The immediate time after anesthesia is called emergence . Emergence from general anesthesia or sedation requires careful monitoring because there is still a risk of complication. Nausea and vomiting are reported at 9.8% but will vary with the type of anesthetic and procedure. There is a need for airway support in 6.8%, there can be urinary retention (more common in those over 50 years of age) and hypotension in 2.7%. Hypothermia , shivering and confusion are also common in
692-520: A pronunciations for example in gap [æ] versus gas [eə] , further defines New York City as well as Philadelphia–Baltimore accents. Most Americans preserve all historical /r/ sounds, using what is known as a rhotic accent . The only traditional r -dropping (or non-rhoticity) in regional U.S. accents variably appears today in eastern New England , New York City , and some of the former plantation South primarily among older speakers (and, relatedly, some African-American Vernacular English across
865-494: A "quasi-therapeutic" function, enabling the dreamer to process trauma in a safe place. Revonsuo's 2000 threat simulation hypothesis, whose premise is that during much of human evolution, physical and interpersonal threats were serious, giving reproductive advantage to those who survived them. Dreaming aided survival by replicating these threats and providing the dreamer with practice in dealing with them. In 2015, Revonsuo proposed social simulation theory, which describes dreams as
1038-511: A Public Safety Communication warning that "repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children's brains." The warning was criticized by the American College of Obstetricians and Gynecologists, which pointed out the absence of direct evidence regarding use in pregnant women and
1211-477: A coding system to study 1,000 dream reports from college students. Results indicated that participants from varying parts of the world demonstrated similarity in their dream content. The only residue of antiquity's authoritative dream figure in the Hall and Van de Castle listing of dream characters is the inclusion of God in the category of prominent persons. Hall's complete dream reports were made publicly available in
1384-631: A complex phenomenon of "both convergence and divergence": some accents are homogenizing and leveling , while others are diversifying and deviating further away from one another. Having been settled longer than the American West Coast, the East Coast has had more time to develop unique accents, and it currently comprises three or four linguistically significant regions, each of which possesses English varieties both different from each other as well as quite internally diverse: New England ,
1557-447: A consonant, such as in pearl , car and fort . Non-rhotic American accents, those that do not pronounce ⟨r⟩ except before a vowel, such as some accents of Eastern New England , New York City , and African-Americans , and a specific few (often older ones) spoken by Southerners , are often quickly noticed by General American listeners and perceived as sounding especially ethnic, regional, or antiquated. Rhoticity
1730-411: A diary. This prevented the selective memory effect, and the dreams no longer seemed accurate about the future. Another experiment gave subjects a fake diary of a student with apparently precognitive dreams. This diary described events from the person's life, as well as some predictive dreams and some non-predictive dreams. When subjects were asked to recall the dreams they had read, they remembered more of
1903-496: A difficult airway ) and any coexisting diseases (especially cardiac and respiratory diseases ) that might impact the anesthetic. The physical examination helps quantify the impact of anything found in the medical history in addition to lab tests. Aside from the generalities of the patient's health assessment, an evaluation of specific factors as they relate to the surgery also need to be considered for anesthesia. For instance, anesthesia during childbirth must consider not only
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#17327798391362076-692: A divine revelation. For example, the Hebrew prophet Samuel would "lie down and sleep in the temple at Shiloh before the Ark and receive the word of the Lord", and Joseph interpreted a Pharaoh's dream of seven lean cows swallowing seven fat cows as meaning the subsequent seven years would be bountiful, followed by seven years of famine. Most of the dreams in the Bible are in the Book of Genesis . Christians mostly shared
2249-427: A dream is one of three states that the soul experiences during its lifetime, the other two states being the waking state and the sleep state. The earliest Upanishads , written before 300 BCE, emphasize two meanings of dreams. The first says that dreams are merely expressions of inner desires. The second is the belief of the soul leaving the body and being guided until awakened. In Judaism, dreams are considered part of
2422-514: A dream of a dim star high in the night sky indicated problems in the head region, while low in the night sky indicated bowel issues. Greek philosopher Plato (427-347) wrote that people harbor secret, repressed desires, such as incest, murder, adultery, and conquest, which build up during the day and run rampant during the night in dreams. Plato's student, Aristotle (384–322 BCE), believed dreams were caused by processing incomplete physiological activity during sleep, such as eyes trying to see while
2595-424: A drop in blood pressure is common. This drop is largely dictated by the venous side of the circulatory system which holds 75% of the circulating blood volume . The physiologic effects are much greater when the block is placed above the 5th thoracic vertebra . An ineffective block is most often due to inadequate anxiolysis or sedation rather than a failure of the block itself. Nociception (pain sensation)
2768-546: A formula which he named tsūsensan (also known as mafutsu-san), which combined Korean morning glory and other herbs. Hanaoka's success in performing this painless operation soon became widely known, and patients began to arrive from all parts of Japan. Hanaoka went on to perform many operations using tsūsensan, including resection of malignant tumors , extraction of bladder stones , and extremity amputations. Before his death in 1835, Hanaoka performed more than 150 operations for breast cancer. However, this finding did not benefit
2941-591: A merger with the THOUGHT ( caught ) set. Having taken place prior to the unrounding of the cot vowel, it results in lengthening and perhaps raising, merging the more recently separated vowel into the THOUGHT vowel in the following environments: before many instances of /f/ , /θ/ , and particularly /s/ (as in Austria, cloth, cost, loss, off, often, etc.), a few instances before /ŋ/ (as in strong, long, wrong ), and variably by region or speaker in gone , on , and certain other words. Unlike American accents,
3114-636: A nice day , for sure); many are now distinctly old-fashioned (swell, groovy). Some English words now in general use, such as hijacking, disc jockey , boost, bulldoze and jazz , originated as American slang. American English has always shown a marked tendency to use words in different parts of speech and nouns are often used as verbs . Examples of nouns that are now also verbs are interview, advocate, vacuum, lobby, pressure, rear-end, transition, feature, profile, hashtag, head, divorce, loan, estimate, X-ray, spearhead, skyrocket, showcase, bad-mouth, vacation , major, and many others. Compounds coined in
3287-599: A painless operation. However, Long did not announce his discovery until 1849. Horace Wells conducted the first public demonstration of the inhalational anesthetic at the Massachusetts General Hospital in Boston in 1845. However, the nitrous oxide was improperly administered and the person cried out in pain . On 16 October 1846, Boston dentist William Thomas Green Morton gave a successful demonstration using diethyl ether to medical students at
3460-497: A person's memories and experiences, but conversation can take on highly exaggerated and bizarre forms. Some dreams may even tell elaborate stories wherein the dreamer enters entirely new, complex worlds and awakes with ideas, thoughts and feelings never experienced prior to the dream. People who are blind from birth do not have visual dreams. Their dream contents are related to other senses, such as hearing , touch , smell , and taste , whichever are present since birth. Dream study
3633-573: A physician from Hamburg, was the first who suggested that dreams are a need and that they have the function to erase (a) sensory impressions that were not fully worked up, and (b) ideas that were not fully developed during the day. In dreams, incomplete material is either removed (suppressed) or deepened and included into memory. Freud , whose dream studies focused on interpreting dreams, not explaining how or why humans dream, disputed Robert's hypothesis and proposed that dreams preserve sleep by representing as fulfilled those wishes that otherwise would awaken
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#17327798391363806-442: A positive dream about a friend to be meaningful than a positive dream about someone they disliked, for example, and were more likely to view a negative dream about a person they disliked as meaningful than a negative dream about a person they liked. According to surveys, it is common for people to feel their dreams are predicting subsequent life events. Psychologists have explained these experiences in terms of memory biases , namely
3979-480: A process of extensive dialect mixture and leveling in which English varieties across the colonies became more homogeneous compared with the varieties in Britain. English thus predominated in the colonies even by the end of the 17th century's first immigration of non-English speakers from Western Europe and Africa. Additionally, firsthand descriptions of a fairly uniform American English (particularly in contrast to
4152-599: A quicker recovery. A combination of drugs was later shown to result in lower odds of dying in the first seven days after anesthetic. For instance, propofol (injection) might be used to start the anesthetic, fentanyl (injection) used to blunt the stress response, midazolam (injection) given to ensure amnesia and sevoflurane (inhaled) during the procedure to maintain the effects. More recently, several intravenous drugs have been developed which, if desired, allow inhaled general anesthetics to be avoided completely. The core instrument in an inhalational anesthetic delivery system
4325-514: A regional or national anesthesiologist-led framework. The same minimum standards for patient safety apply regardless of the provider, including continuous clinical and biometric monitoring of tissue oxygenation, perfusion and blood pressure; confirmation of correct placement of airway management devices by auscultation and carbon dioxide detection; use of the WHO Surgical Safety Checklist ; and safe onward transfer of
4498-528: A result of observation of his dreams. Ignorant as he was, he could have come to no other conclusion but that, in dreams, he left his sleeping body in one universe and went wandering off into another. It is considered that, but for that savage, the idea of such a thing as a 'soul' would never have even occurred to mankind.... In the Mandukya Upanishad , part of the Veda scriptures of Indian Hinduism ,
4671-575: A rite of passage, fasting and praying until an anticipated guiding dream was received, to be shared with the rest of the tribe upon their return. Beginning in the late 19th century, Austrian neurologist Sigmund Freud , founder of psychoanalysis , theorized that dreams reflect the dreamer's unconscious mind and specifically that dream content is shaped by unconscious wish fulfillment. He argued that important unconscious desires often relate to early childhood memories and experiences. Carl Jung and others expanded on Freud's idea that dream content reflects
4844-465: A sedative, the effect is a feeling of general relaxation, amnesia (loss of memory) and time passing quickly. Many drugs can produce a sedative effect including benzodiazepines , propofol , thiopental , ketamine and inhaled general anesthetics. The advantage of sedation over a general anesthetic is that it generally does not require support of the airway or breathing (no tracheal intubation or mechanical ventilation ) and can have less of an effect on
5017-465: A selective memory for accurate predictions and distorted memory so that dreams are retrospectively fitted onto life experiences. The multi-faceted nature of dreams makes it easy to find connections between dream content and real events. The term "veridical dream" has been used to indicate dreams that reveal or contain truths not yet known to the dreamer, whether future events or secrets. In one experiment, subjects were asked to write down their dreams in
5190-406: A series of activity clusters, or "hubs" on its way back to consciousness. Andrew Hudson, an assistant professor in anesthesiology states, "Recovery from anesthesia is not simply the result of the anesthetic 'wearing off,' but also of the brain finding its way back through a maze of possible activity states to those that allow conscious experience. Put simply, the brain reboots itself." Long-term POCD
5363-680: A series of other vowel shifts in the same region, known by linguists as the " Inland North ". The Inland North shares with the Eastern New England dialect (including Boston accents ) a backer tongue positioning of the GOOSE /u/ vowel (to [u] ) and the MOUTH /aʊ/ vowel (to [ɑʊ~äʊ] ) in comparison to the rest of the country. Ranging from northern New England across the Great Lakes to Minnesota, another Northern regional marker
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5536-524: A simulation for training social skills and bonds. Eagleman's and Vaughn's 2021 defensive activation theory, which says that, given the brain's neuroplasticity , dreams evolved as a visual hallucinatory activity during sleep's extended periods of darkness, busying the occipital lobe and thereby protecting it from possible appropriation by other, non-vision, sense operations. Erik Hoel proposes, based on artificial neural networks, that dreams prevent overfitting to past experiences; that is, they enable
5709-525: A survey, completed in 2003, polling English speakers across the United States about their specific everyday word choices, hoping to identify regionalisms. The study found that most Americans prefer the term sub for a long sandwich, soda (but pop in the Great Lakes region and generic coke in the South) for a sweet and bubbly soft drink , you or you guys for the plural of you (but y'all in
5882-453: A variation of American English in these islands. In 2021, about 245 million Americans, aged 5 or above, spoke English at home: a majority of the United States total population of roughly 330 million people. The United States has never had an official language at the federal level, but English is commonly used at the federal level and in states without an official language. 32 of the 50 states, in some cases as part of what has been called
6055-519: Is a "one-shot" injection that provides rapid onset and profound sensory anesthesia with lower doses of anesthetic, and is usually associated with neuromuscular blockade (loss of muscle control). Epidural anesthesia uses larger doses of anesthetic infused through an indwelling catheter which allows the anesthetic to be augmented should the effects begin to dissipate. Epidural anesthesia does not typically affect muscle control. Because central neuraxial blockade causes arterial and venous vasodilation ,
6228-444: Is a subtle deterioration in cognitive function, that can last for weeks, months, or longer. Most commonly, relatives of the person report a lack of attention, memory and loss of interest in activities previously dear to the person (such as crosswords). In a similar way, people in the workforce may report an inability to complete tasks at the same speed they could previously. There is good evidence that POCD occurs after cardiac surgery and
6401-654: Is also associated with the United States, perhaps mostly in the Midwest and the South. American accents that have not undergone the cot–caught merger (the lexical sets LOT and THOUGHT ) have instead retained a LOT – CLOTH split : a 17th-century distinction in which certain words (labeled as the CLOTH lexical set ) separated away from the LOT set. The split, which has now reversed in most British English, simultaneously shifts this relatively recent CLOTH set into
6574-664: Is also home to a creole language known commonly as Hawaiian Pidgin , and some Hawaii residents speak English with a Pidgin-influenced accent. American English also gave rise to some dialects outside the country, for example, Philippine English , beginning during the American occupation of the Philippines and subsequently the Insular Government of the Philippine Islands ; Thomasites first established
6747-420: Is an anesthetic machine . It has vaporizers , ventilators , an anesthetic breathing circuit, waste gas scavenging system and pressure gauges. The purpose of the anesthetic machine is to provide anesthetic gas at a constant pressure, oxygen for breathing and to remove carbon dioxide or other waste anesthetic gases. Since inhalational anesthetics are flammable, various checklists have been developed to confirm that
6920-538: Is common in most American accents despite being now rare in England because, during the 17th-century British colonization, nearly all dialects of English were rhotic, and most North American English simply remained that way. The preservation of rhoticity in North America was also supported by continuing waves of rhotic-accented Scotch-Irish immigrants, most intensely during the 18th century (and moderately during
7093-507: Is freed from the body during slumber to journey in a dream realm, while the other remained in the body. This belief and dream interpretation had been questioned since early times, such as by the philosopher Wang Chong (27–97 CE ). The Babylonians and Assyrians divided dreams into "good," which were sent by the gods, and "bad," sent by demons. A surviving collection of dream omens entitled Iškar Zaqīqu records various dream scenarios as well as prognostications of what will happen to
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7266-414: Is high and resembles that of being awake. Because REM sleep is detectable in many species, and because research suggests that all mammals experience REM, linking dreams to REM sleep has led to conjectures that animals dream. However, humans dream during non-REM sleep, also, and not all REM awakenings elicit dream reports. To be studied, a dream must first be reduced to a verbal report, which is an account of
7439-399: Is not hard-wired into the body. Instead, it is a dynamic process wherein persistent painful stimuli can sensitize the system and either make pain management difficult or promote the development of chronic pain. For this reason, preemptive acute pain management may reduce both acute and chronic pain and is tailored to the surgery, the environment in which it is given (in-patient/out-patient) and
7612-420: Is often identified by Americans as a "country" accent, and is defined by the /aɪ/ vowel losing its gliding quality : [aː] , the initiation event for a complicated Southern vowel shift, including a " Southern drawl " that makes short front vowels into distinct-sounding gliding vowels . The fronting of the vowels of GOOSE , GOAT , MOUTH , and STRUT tends to also define Southern accents as well as
7785-451: Is popular with scientists exploring the mind–brain problem . Some "propose to reduce aspects of dream phenomenology to neurobiology." But current science cannot specify dream physiology in detail. Protocols in most nations restrict human brain research to non-invasive procedures. In the United States, invasive brain procedures with a human subject are allowed only when these are deemed necessary in surgical treatment to address medical needs of
7958-443: Is referred to as being anesthetized. Anesthesia enables the painless performance of procedures that would otherwise require physical restraint in a non-anesthetized individual, or would otherwise be technically unfeasible. Three broad categories of anesthesia exist: In preparing for a medical or veterinary procedure, the clinician chooses one or more drugs to achieve the types and degree of anesthesia characteristics appropriate for
8131-580: Is the common language at home, in public, and in government. Dream A dream is a succession of images , ideas , emotions , and sensations that usually occur involuntarily in the mind during certain stages of sleep . Humans spend about two hours dreaming per night, and each dream lasts around 5–20 minutes, although the dreamer may perceive the dream as being much longer than this. The content and function of dreams have been topics of scientific, philosophical and religious interest throughout recorded history . Dream interpretation , practiced by
8304-478: Is the injection of local anesthetic around the spinal cord to provide analgesia in the abdomen , pelvis or lower extremities . It is divided into either spinal (injection into the subarachnoid space ), epidural (injection outside of the subarachnoid space into the epidural space) and caudal (injection into the cauda equina or tail end of the spinal cord). Spinal and epidural are the most commonly used forms of central neuraxial blockade. Spinal anesthesia
8477-464: Is the true dream (al-ru’ya), then the false dream, which may come from the devil ( shaytan ), and finally, the meaningless everyday dream (hulm). This last dream could be brought forth by the dreamer's ego or base appetite based on what they experienced in the real world. The true dream is often indicated by Islam's hadith tradition. In one narration by Aisha , the wife of the Prophet, it is said that
8650-469: Is the variable fronting of /ɑ/ before /r/ , for example, appearing four times in the stereotypical Boston shibboleth Park the car in Harvard Yard . Several other phenomena serve to distinguish regional U.S. accents. Boston , Pittsburgh , Upper Midwestern , and Western U.S. accents have fully completed a merger of the LOT vowel with the THOUGHT vowel ( /ɑ/ and /ɔ/ , respectively):
8823-425: Is unique in that it is not a direct means of treatment; rather, it allows the clinician to do things that may treat, diagnose, or cure an ailment which would otherwise be painful or complicated. The best anesthetic, therefore, is the one with the lowest risk to the patient that still achieves the endpoints required to complete the procedure. The first stage in anesthesia is the pre-operative risk assessment consisting of
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#17327798391368996-459: Is usually overlap in the contributing factors that lead to morbidity and mortality between the health of the patients, the type of surgery being performed and the anesthetic. To understand the relative risk of each contributing factor, consider that the rate of deaths totally attributed to the patient's health is 1:870. Compare that to the rate of deaths totally attributed to surgical factors (1:2860) or anesthesia alone (1:185,056) illustrating that
9169-473: The Babylonians in the third millennium BCE and even earlier by the ancient Sumerians , figures prominently in religious texts in several traditions, and has played a lead role in psychotherapy. The scientific study of dreams is called oneirology . Most modern dream study focuses on the neurophysiology of dreams and on proposing and testing hypotheses regarding dream function. It is not known where in
9342-482: The English-only movement , have adopted legislation granting official or co-official status to English. Typically only "English" is specified, not a particular variety like American English. (From 1923 to 1969, the state of Illinois recognized its official language as "American", meaning American English.) Puerto Rico is the largest example of a United States territory in which another language – Spanish –
9515-622: The Mid-Atlantic states (including a New York accent as well as a unique Philadelphia–Baltimore accent ), and the South . As of the 20th century, the middle and eastern Great Lakes area , Chicago being the largest city with these speakers, also ushered in certain unique features, including the fronting of the LOT /ɑ/ vowel in the mouth toward [a] and tensing of the TRAP /æ/ vowel wholesale to [eə] . These sound changes have triggered
9688-551: The Native American languages . Examples of such names are opossum , raccoon , squash , moose (from Algonquian ), wigwam , and moccasin . American English speakers have integrated traditionally non-English terms and expressions into the mainstream cultural lexicon; for instance, en masse , from French ; cookie , from Dutch ; kindergarten from German , and rodeo from Spanish . Landscape features are often loanwords from French or Spanish, and
9861-465: The Salerno school of medicine in the late 12th century and by Ugo Borgognoni (1180–1258) in the 13th century. The sponge was promoted and described by Ugo's son and fellow surgeon, Theodoric Borgognoni (1205–1298). In this anesthetic method, a sponge was soaked in a dissolved solution of opium, mandragora , hemlock juice, and other substances. The sponge was then dried and stored; just before surgery
10034-570: The Society for Neuroscience , "Because no adequate alternatives exist, much of this research must [sic] be done on animal subjects." However, since animal dreaming can be only inferred, not confirmed, animal studies yield no hard facts to illuminate the neurophysiology of dreams. Examining human subjects with brain lesions can provide clues, but the lesion method cannot discriminate between the effects of destruction and disconnection and cannot target specific neuronal groups in heterogeneous regions like
10207-819: The battle of the Milvian Bridge if he adopted the Chi-Rho as his battle standard ." In Buddhism, ideas about dreams are similar to the classical and folk traditions in South Asia. The same dream is sometimes experienced by multiple people, as in the case of the Buddha-to-be , before he is leaving his home . It is described in the Mahāvastu that several of the Buddha's relatives had premonitory dreams preceding this. Some dreams are also seen to transcend time:
10380-503: The cardiovascular system which may add to a greater margin of safety in some patients. When pain is blocked from a part of the body using local anesthetics , it is generally referred to as regional anesthesia. There are many types of regional anesthesia either by injecting into the tissue itself, a vein that feeds the area or around a nerve trunk that supplies sensation to the area. The latter are called nerve blocks and are divided into peripheral or central nerve blocks. The following are
10553-722: The francophile tastes of the 19th century Victorian era Britain (for example they preferred programme for program , manoeuvre for maneuver , cheque for check , etc.). AmE almost always uses -ize in words like realize . BrE prefers -ise , but also uses -ize on occasion (see: Oxford spelling ). There are a few differences in punctuation rules. British English is more tolerant of run-on sentences , called " comma splices " in American English, and American English prefers that periods and commas be placed inside closing quotation marks even in cases in which British rules would place them outside. American English also favors
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#173277983913610726-507: The medical history , physical examination and lab tests . Diagnosing the patient's pre-operative physical status allows the clinician to minimize anesthetic risks. A well completed medical history will arrive at the correct diagnosis 56% of the time which increases to 73% with a physical examination. Lab tests help in diagnosis but only in 3% of cases, underscoring the need for a full history and physical examination prior to anesthetics. Incorrect pre-operative assessments or preparations are
10899-470: The opium poppy ( Papaver somniferum ) in lower Mesopotamia as early as 3400 BCE . The ancient Egyptians had some surgical instruments, as well as crude analgesics and sedatives, including possibly an extract prepared from the mandrake fruit. In China, Bian Que ( Chinese : 扁鹊, Wade–Giles : Pien Ch'iao , c. 300 BCE ) was a legendary Chinese internist and surgeon who reportedly used general anesthesia for surgical procedures. Despite this, it
11072-445: The surgical stress response. Anesthesia is a combination of the endpoints (discussed above) that are reached by drugs acting on different but overlapping sites in the central nervous system . General anesthesia (as opposed to sedation or regional anesthesia) has three main goals: lack of movement ( paralysis ), unconsciousness , and blunting of the stress response . In the early days of anesthesia, anesthetics could reliably achieve
11245-764: The 18th century; apartment , shanty in the 19th century; project, condominium , townhouse , mobile home in the 20th century; and parts thereof ( driveway , breezeway, backyard ) . Industry and material innovations from the 19th century onwards provide distinctive new words, phrases, and idioms through railroading (see further at rail terminology ) and transportation terminology, ranging from types of roads ( dirt roads , freeways ) to infrastructure ( parking lot , overpass , rest area ), to automotive terminology often now standard in English internationally. Already existing English words—such as store , shop , lumber —underwent shifts in meaning; others remained in
11418-546: The 20th century. The use of English in the United States is a result of British colonization of the Americas . The first wave of English-speaking settlers arrived in North America during the early 17th century, followed by further migrations in the 18th and 19th centuries. During the 17th and 18th centuries, dialects from many different regions of England and the British Isles existed in every American colony, allowing
11591-627: The British form is a back-formation , such as AmE burglarize and BrE burgle (from burglar ). However, while individuals usually use one or the other, both forms will be widely understood and mostly used alongside each other within the two systems. While written American English is largely standardized across the country and spoken American English dialects are highly mutually intelligible, there are still several recognizable regional and ethnic accents and lexical distinctions. The regional sounds of present-day American English are reportedly engaged in
11764-661: The Buddha-to-be has certain dreams that are the same as those of previous Buddhas , the Lalitavistara states. In Buddhist literature, dreams often function as a "signpost" motif to mark certain stages in the life of the main character. Buddhist views about dreams are expressed in the Pāli Commentaries and the Milinda Pañhā . In Chinese history, people wrote of two vital aspects of the soul of which one
11937-413: The East Coast (perhaps in imitation of 19th-century London speech), even the East Coast has gradually begun to restore rhoticity, due to it becoming nationally prestigious in the 20th century. The pronunciation of ⟨r⟩ is a postalveolar approximant [ ɹ̠ ] or retroflex approximant [ ɻ ] , but a unique "bunched tongue" variant of the approximant r sound
12110-571: The Inland North. Rather than one particular accent, General American is best defined as an umbrella covering an American accent that does not incorporate features associated with some particular region, ethnicity, or socioeconomic group. Typical General American features include rhoticity , the father–bother merger , Mary–marry–merry merger , pre-nasal "short a " tensing , and other particular vowel sounds . General American features are embraced most by Americans who are highly educated or in
12283-748: The Looking-Glass . Unlike many dream worlds, Carroll's logic is like that of actual dreams, with transitions and flexible causality. Other fictional dream worlds include the Dreamlands of H. P. Lovecraft 's Dream Cycle and The Neverending Story ' s world of Fantastica, which includes places like the Desert of Lost Dreams, the Sea of Possibilities and the Swamps of Sadness. Dreamworlds, shared hallucinations and other alternate realities feature in
12456-471: The MAC, generally, the less potent the anesthetic. The ideal anesthetic drug would provide hypnosis, amnesia, analgesia, and muscle relaxation without undesirable changes in blood pressure, pulse or breathing. In the 1930s, physicians started to augment inhaled general anesthetics with intravenous general anesthetics. The drugs used in combination offered a better risk profile to the subject under anesthesia and
12629-505: The Prophet's dreams would come true like the ocean's waves. Just as in its predecessors, the Quran also recounts the story of Joseph and his unique ability to interpret dreams. In both Christianity and Islam dreams feature in conversion stories. According to ancient authors, Constantine the Great started his conversion to Christianity because he had a dream which prophesied that he would win
12802-488: The Solms 2000 paper that certified the separability of REM sleep and dream phenomena, many studies purporting to uncover the function of dreams have in fact been studying not dreams but measurable REM sleep. Theories of dream function since the identification of REM sleep include: Hobson's and McCarley's 1977 activation-synthesis hypothesis , which proposed "a functional role for dreaming sleep in promoting some aspect of
12975-573: The South), sneakers for athletic shoes (but often tennis shoes outside the Northeast), and shopping cart for a cart used for carrying supermarket goods. American English and British English (BrE) often differ at the levels of phonology, phonetics, vocabulary, and, to a much lesser extent, grammar and orthography. The first large American dictionary, An American Dictionary of the English Language , known as Webster's Dictionary ,
13148-528: The U.S. Several verbs ending in -ize are of U.S. origin; for example, fetishize, prioritize, burglarize, accessorize, weatherize , etc.; and so are some back-formations (locate, fine-tune, curate, donate, emote, upholster and enthuse). Among syntactic constructions that arose are outside of, headed for, meet up with, back of, etc. Americanisms formed by alteration of some existing words include notably pesky, phony, rambunctious, buddy, sundae , skeeter, sashay and kitty-corner. Adjectives that arose in
13321-570: The U.S. are for instance foothill , landslide (in all senses), backdrop , teenager , brainstorm , bandwagon , hitchhike , smalltime, and a huge number of others. Other compound words have been founded based on industrialization and the wave of the automobile: five-passenger car, four-door sedan, two-door sedan, and station-wagon (called an estate car in British English). Some are euphemistic ( human resources , affirmative action , correctional facility ). Many compound nouns have
13494-676: The U.S. are, for example, lengthy, bossy, cute and cutesy, punk (in all senses), sticky (of the weather), through (as in "finished"), and many colloquial forms such as peppy or wacky . A number of words and meanings that originated in Middle English or Early Modern English and that have been in everyday use in the United States have since disappeared in most varieties of British English; some of these have cognates in Lowland Scots . Terms such as fall ("autumn"), faucet ("tap"), diaper ("nappy"; itself unused in
13667-530: The U.S. while changing in Britain. Science, urbanization, and democracy have been important factors in bringing about changes in the written and spoken language of the United States. From the world of business and finance came new terms ( merger , downsize , bottom line ), from sports and gambling terminology came, specific jargon aside, common everyday American idioms, including many idioms related to baseball . The names of some American inventions remained largely confined to North America ( elevator [except in
13840-427: The U.S.), candy ("sweets"), skillet , eyeglasses , and obligate are often regarded as Americanisms. Fall for example came to denote the season in 16th century England, a contraction of Middle English expressions like "fall of the leaf" and "fall of the year." Gotten ( past participle of get ) is often considered to be largely an Americanism. Other words and meanings were brought back to Britain from
14013-597: The U.S., especially in the second half of the 20th century; these include hire ("to employ"), I guess (famously criticized by H. W. Fowler ), baggage , hit (a place), and the adverbs overly and presently ("currently"). Some of these, for example, monkey wrench and wastebasket , originated in 19th century Britain. The adjectives mad meaning "angry", smart meaning "intelligent", and sick meaning "ill" are also more frequent in American (and Irish) English than British English. Linguist Bert Vaux created
14186-538: The United States and the United Kingdom suggest that, while spoken American English deviated away from period British English in many ways, it is conservative in a few other ways, preserving certain features 21st-century British English has since lost. Full rhoticity (or "R-fulness") is typical of American accents, pronouncing the phoneme /r/ (corresponding to the letter ⟨r⟩ ) in all environments, including in syllable-final position or before
14359-524: The United States. English is the most widely spoken language in the United States ; the de facto common language used in government, education, and commerce; and an official language in 32 of the 50 U.S. states . Since the late 20th century, American English has become the most influential form of English worldwide. Varieties of American English include many patterns of pronunciation, vocabulary, grammar and particularly spelling that are unified nationwide but distinct from other English dialects around
14532-605: The West and Midwest, and New York Latino English , spoken in the New York metropolitan area . Additionally, ethnic varieties such as Yeshiva English and " Yinglish " are spoken by some American Orthodox Jews , Cajun Vernacular English by some Cajuns in southern Louisiana , and Pennsylvania Dutch English by some Pennsylvania Dutch people. American Indian Englishes have been documented among diverse Indian tribes. The island state of Hawaii , though primarily English-speaking,
14705-555: The accents spoken in the " Midland ": a vast band of the country that constitutes an intermediate dialect region between the traditional North and South. Western U.S. accents mostly fall under the General American spectrum. Below, ten major American English accents are defined by their particular combinations of certain vowel sounds: In 2010, William Labov noted that Great Lakes, Philadelphia, Pittsburgh, and West Coast accents have undergone "vigorous new sound changes" since
14878-505: The aeronautical sense ], gasoline ) as did certain automotive terms ( truck , trunk ). New foreign loanwords came with 19th and early 20th century European immigration to the U.S.; notably, from Yiddish ( chutzpah , schmooze, bupkis, glitch ) and German ( hamburger , wiener ). A large number of English colloquialisms from various periods are American in origin; some have lost their American flavor (from OK and cool to nerd and 24/7 ), while others have not ( have
15051-597: The beliefs of the Hebrews and thought that dreams were of a supernatural character because the Old Testament includes frequent stories of dreams with divine inspiration. The most famous of these dream stories was Jacob's dream of a ladder that stretches from Earth to Heaven . Many Christians preach that God can speak to people through their dreams. The famous glossary, the Somniale Danielis , written in
15224-433: The best way to receive divine revelation, and thus they would induce (or "incubate") dreams. They went to sanctuaries and slept on special "dream beds" in hope of receiving advice, comfort, or healing from the gods. From a Darwinian perspective dreams would have to fulfill some kind of biological requirement, provide some benefit for natural selection to take place, or at least have no negative impact on fitness. Robert (1886),
15397-773: The blood (pulse oximetry), and temperature. In the UK the Association of Anaesthetists (AAGBI) have set minimum monitoring guidelines for general and regional anesthesia. For minor surgery, this generally includes monitoring of heart rate , oxygen saturation , blood pressure , and inspired and expired concentrations for oxygen , carbon dioxide , and inhalational anesthetic agents. For more invasive surgery, monitoring may also include temperature, urine output, blood pressure, central venous pressure , pulmonary artery pressure and pulmonary artery occlusion pressure , cardiac output , cerebral activity , and neuromuscular function. In addition,
15570-411: The brain dreams originate, if there is a single origin for dreams or if multiple regions of the brain are involved, or what the purpose of dreaming is for the body or mind. The human dream experience and what to make of it has undergone sizable shifts over the course of history. Long ago, according to writings from Mesopotamia and Ancient Egypt , dreams dictated post-dream behaviors to an extent that
15743-446: The brain involves significant neural activity downstream from eye intake, and it is theorized that "the visual imagery of dreams is produced by activation during sleep of the same structures that generate complex visual imagery in waking perception." Dreams present a running narrative rather than exclusively visual imagery. Following their work with split-brain subjects, Gazzaniga and LeDoux postulated, without attempting to specify
15916-467: The brain stem. Denied precision tools and obliged to depend on imaging, much dream research has succumbed to the law of the instrument . Studies detect an increase of blood flow in a specific brain region and then credit that region with a role in generating dreams. But pooling study results has led to the newer conclusion that dreaming involves large numbers of regions and pathways, which likely are different for different dream events. Image creation in
16089-647: The brain's effort to make sense of sparse and distorted information.... The cortex combines this haphazard input with whatever other activity was already occurring and does its best to synthesize a story that makes sense of the information." Neuroscientist Indre Viskontas is even more blunt, calling often bizarre dream content "just the result of your interpreter trying to create a story out of random neural signaling." For many humans across multiple eras and cultures, dreams are believed to have functioned as revealers of truths sourced during sleep from gods or other external entities. Ancient Egyptians believed that dreams were
16262-433: The central nervous system. For instance, the immobilizing effect of inhaled anesthetics results from an effect on the spinal cord whereas sedation, hypnosis and amnesia involve sites in the brain. The potency of an inhalational anesthetic is quantified by its minimum alveolar concentration (MAC). The MAC is the percentage dose of anesthetic that will prevent a response to painful stimulus in 50% of subjects. The higher
16435-464: The combined alkaloids proved a mainstay of anesthesia until the 19th century. Local anesthetics were used in Inca civilization where shamans chewed coca leaves and performed operations on the skull while spitting into the wounds they had inflicted to anesthetize. Cocaine was later isolated and became the first effective local anesthetic. It was first used in eye surgery in 1884 by Karl Koller , at
16608-406: The country), though the vowel-consonant cluster found in "bird", "work", "hurt", "learn", etc. usually retains its r pronunciation, even in these non-rhotic American accents. Non-rhoticity among such speakers is presumed to have arisen from their upper classes' close historical contact with England, imitating London's r -dropping, a feature that has continued to gain prestige throughout England from
16781-614: The diverse regional dialects of British English) became common after the mid-18th century, while at the same time speakers' identification with this new variety increased. Since the 18th century, American English has developed into some new varieties, including regional dialects that retain minor influences from waves of immigrant speakers of diverse languages, primarily European languages. Some racial and regional variation in American English reflects these groups' geographic settlement, their de jure or de facto segregation, and patterns in their resettlement. This can be seen, for example, in
16954-742: The double quotation mark ("like this") over the single ('as here'). Vocabulary differences vary by region. For example, autumn is used more commonly in the United Kingdom, whereas fall is more common in American English. Some other differences include: aerial (United Kingdom) vs. antenna, biscuit (United Kingdom) vs. cookie/cracker, car park (United Kingdom) vs. parking lot, caravan (United Kingdom) vs. trailer, city centre (United Kingdom) vs. downtown, flat (United Kingdom) vs. apartment, fringe (United Kingdom) vs. bangs, and holiday (United Kingdom) vs. vacation. AmE sometimes favors words that are morphologically more complex, whereas BrE uses clipped forms, such as AmE transportation and BrE transport or where
17127-402: The dreamer to learn from novel situations. Dreams figure prominently in major world religions. The dream experience for early humans, according to one interpretation, gave rise to the notion of a human " soul ," a central element in much religious thought. J. W. Dunne wrote: But there can be no reasonable doubt that the idea of a soul must have first arisen in the mind of primitive man as
17300-501: The dreamer's unconscious desires. Dream interpretation can be a result of subjective ideas and experiences. One study found that most people believe that "their dreams reveal meaningful hidden truths". The researchers surveyed students in the United States, South Korea, and India, and found that 74% of Indians, 65% of South Koreans and 56% of Americans believed their dream content provided them with meaningful insight into their unconscious beliefs and desires. This Freudian view of dreaming
17473-530: The dreamer. Freud wrote that dreams "serve the purpose of prolonging sleep instead of waking up. Dreams are the GUARDIANS of sleep and not its disturbers. " A turning point in theorizing about dream function came in 1953, when Science published the Aserinsky and Kleitman paper establishing REM sleep as a distinct phase of sleep and linking dreams to REM sleep. Until and even after publication of
17646-436: The dreamers, where they entered through a keyhole, exiting the same way after the divine message was given. Antiphon wrote the first known Greek book on dreams in the 5th century BCE. In that century, other cultures influenced Greeks to develop the belief that souls left the sleeping body. The father of modern medicine, Hippocrates (460–375 BCE ), thought dreams could analyze illness and predict diseases. For instance,
17819-525: The early 19th century, ether was being used by humans, but only as a recreational drug . Meanwhile, in 1772, English scientist Joseph Priestley discovered the gas nitrous oxide . Initially, people thought this gas to be lethal, even in small doses, like some other nitrogen oxides . However, in 1799, British chemist and inventor Humphry Davy decided to find out by experimenting on himself. To his astonishment he found that nitrous oxide made him laugh, so he nicknamed it "laughing gas". In 1800 Davy wrote about
17992-457: The endpoints differently. Regional anesthesia , for instance, affects analgesia; benzodiazepine -type sedatives (used for sedation, or " twilight anesthesia ") favor amnesia ; and general anesthetics can affect all of the endpoints. The goal of anesthesia is to achieve the endpoints required for the given surgical procedure with the least risk to the subject. To achieve the goals of anesthesia, drugs act on different but interconnected parts of
18165-416: The exception of minimal sedation or superficial procedures performed under local anesthesia. A trained, vigilant anesthesia provider should continually care for the patient; where the provider is not an anesthesiologist, they should be locally directed and supervised by an anesthesiologist, and in countries or settings where this is not feasible, care should be led by the most qualified local individual within
18338-552: The experience of the world that can be interpreted and from which lessons can be garnered. It is discussed in the Talmud, Tractate Berachot 55–60. The ancient Hebrews connected their dreams heavily with their religion, though the Hebrews were monotheistic and believed that dreams were the voice of one God alone. Hebrews also differentiated between good dreams (from God) and bad dreams (from evil spirits). The Hebrews, like many other ancient cultures, incubated dreams in order to receive
18511-484: The first post-operative week). Although the three entities (delirium, early POCD and long-term POCD) are separate, the presence of delirium post-operatively predicts the presence of early POCD. There does not appear to be an association between delirium or early POCD and long-term POCD. According to a recent study conducted at the David Geffen School of Medicine at UCLA , the brain navigates its way through
18684-414: The first two, allowing surgeons to perform necessary procedures, but many patients died because the extremes of blood pressure and pulse caused by the surgical insult were ultimately harmful. Eventually, the need for blunting of the surgical stress response was identified by Harvey Cushing , who injected local anesthetic prior to hernia repairs . This led to the development of other drugs that could blunt
18857-517: The following two centuries) when this ethnic group eventually made up one-seventh of the colonial population. Scotch-Irish settlers spread from Delaware and Pennsylvania throughout the larger Mid-Atlantic region, the inland regions of both the South and North, and throughout the West: American dialect areas that were all uninfluenced by upper-class non-rhoticity and that consequently have remained consistently rhotic. While non-rhoticity spread on
19030-415: The formation of long-term memories. Nevertheless, a person can dream under anesthesia or are conscious of the procedure despite giving no indication of this during it. An estimated 22% of people do dream under general anesthesia , and one or two cases in a thousand have some consciousness, termed " anesthesia awareness ". It is not known whether animals dream while under general anesthesia. Anesthesia
19203-944: The hospital , BrE to hospital ; contrast, however, AmE actress Elizabeth Taylor , BrE the actress Elizabeth Taylor ). Often, these differences are a matter of relative preferences rather than absolute rules; and most are not stable since the two varieties are constantly influencing each other, and American English is not a standardized set of dialects. Differences in orthography are also minor. The main differences are that American English usually uses spellings such as flavor for British flavour , fiber for fibre , defense for defence , analyze for analyse , license for licence , catalog for catalogue and traveling for travelling . Noah Webster popularized such spellings in America, but he did not invent most of them. Rather, "he chose already existing options on such grounds as simplicity, analogy or etymology." Other differences are due to
19376-583: The immediate post-operative period because of the lack of muscle movement (and subsequent lack of heat production) during the procedure. Furthermore, the rare manifestation in the post-anesthetic period may be the occurrence of functional neurological symptom disorder (FNSD). Postoperative cognitive dysfunction (also known as POCD and post-anesthetic confusion) is a disturbance in cognition after surgery. It may also be variably used to describe emergence delirium (immediate post-operative confusion) and early cognitive dysfunction (diminished cognitive function in
19549-798: The individual. Pain management is classified into either pre-emptive or on-demand. On-demand pain medications typically include either opioid or non-steroidal anti-inflammatory drugs but can also make use of novel approaches such as inhaled nitrous oxide or ketamine . On demand drugs can be administered by a clinician ("as needed drug orders") or by the patient using patient-controlled analgesia (PCA). PCA has been shown to provide slightly better pain control and increased patient satisfaction when compared with conventional methods. Common preemptive approaches include epidural neuraxial blockade or nerve blocks. One review which looked at pain control after abdominal aortic surgery found that epidural blockade provides better pain relief (especially during movement) in
19722-674: The influence of 18th-century Protestant Ulster Scots immigrants (known in the U.S. as the Scotch-Irish ) in Appalachia developing Appalachian English and the 20th-century Great Migration bringing African-American Vernacular English to the Great Lakes urban centers. Any phonologically unmarked North American accent falls under an umbrella known as General American. This section mostly refers to such General American features. Studies on historical usage of English in both
19895-423: The influence of diethyl ether. He immediately thought of its potential in surgery. Conveniently, a participant in one of those "ether frolics", a student named James Venable, had two small tumors he wanted excised. But fearing the pain of surgery, Venable kept putting the operation off. Hence, Long suggested that he have his operation while under the influence of ether. Venable agreed, and on 30 March 1842 he underwent
20068-641: The jurisdiction, and include anesthetic nurses , nurse anesthetists , anesthesiologist assistants , anaesthetic technicians , anaesthesia associates , operating department practitioners and anesthesia technologists . International standards for the safe practice of anesthesia, jointly endorsed by the World Health Organization and the World Federation of Societies of Anaesthesiologists , highly recommend that anesthesia should be provided, overseen or led by anesthesiologists, with
20241-616: The king of the Sumerian city-state of Lagash (reigned c. 2144–2124 BCE), rebuilt the temple of Ningirsu as the result of a dream in which he was told to do so. After antiquity, the passive hearing of visitation dreams largely gave way to visualized narratives in which the dreamer becomes a character who actively participates. From the 1940s to 1985, Calvin S. Hall collected more than 50,000 dream reports at Western Reserve University . In 1966, Hall and Robert Van de Castle published The Content Analysis of Dreams , in which they outlined
20414-438: The late 18th century onwards, but which has conversely lost prestige in the U.S. since at least the early 20th century. Non-rhoticity makes a word like car sound like cah or source like sauce . New York City and Southern accents are the most prominent regional accents of the country, as well as the most stigmatized and socially disfavored. Southern speech, strongest in southern Appalachia and certain areas of Texas,
20587-439: The learning process...." In 2010 a Harvard study was published showing experimental evidence that dreams were correlated with improved learning. Crick's and Mitchison's 1983 " reverse learning " theory, which states that dreams are like the cleaning-up operations of computers when they are offline, removing (suppressing) parasitic nodes and other "junk" from the mind during sleep. Hartmann's 1995 proposal that dreams serve
20760-423: The machine is ready for use, that the safety features are active and the electrical hazards are removed. Intravenous anesthetic is delivered either by bolus doses or an infusion pump . There are also many smaller instruments used in airway management and monitoring the patient. The common thread to modern machinery in this field is the use of fail-safe systems that decrease the odds of catastrophic misuse of
20933-533: The machine. Patients under general anesthesia must undergo continuous physiological monitoring to ensure safety. In the US, the American Society of Anesthesiologists (ASA) has established minimum monitoring guidelines for patients receiving general anesthesia, regional anesthesia, or sedation. These include electrocardiography (ECG), heart rate, blood pressure, inspired and expired gases, oxygen saturation of
21106-701: The main they are related to three factors: the health of the individual, the complexity and stress of the procedure itself, and the anaesthetic technique. Of these factors, the individual's health has the greatest impact. Major perioperative risks can include death, heart attack , and pulmonary embolism whereas minor risks can include postoperative nausea and vomiting and hospital readmission . Some conditions, like local anesthetic toxicity, airway trauma or malignant hyperthermia , can be more directly attributed to specific anesthetic drugs and techniques. The purpose of anesthesia can be distilled down to three basic goals or endpoints: Different types of anesthesia affect
21279-497: The major reason for its occurrence is the formation of microemboli . POCD also appears to occur in non-cardiac surgery. Its causes in non-cardiac surgery are less clear but older age is a risk factor for its occurrence. The first attempts at general anesthesia were probably herbal remedies administered in prehistory . Alcohol is one of the oldest known sedatives and it was used in ancient Mesopotamia thousands of years ago. The Sumerians are said to have cultivated and harvested
21452-413: The maximum dose of local anesthetic has to be considered. Nerve blocks are also used as a continuous infusion, following major surgery such as knee, hip and shoulder replacement surgery, and may be associated with lower complications. Nerve blocks are also associated with a lower risk of neurologic complications compared to the more central epidural or spinal neuraxial blocks. Central neuraxial anesthesia
21625-458: The mid-1990s by his protégé William Domhoff . More recent studies of dream reports, while providing more detail, continue to cite the Hall study favorably. In the Hall study, the most common emotion experienced in dreams was anxiety . Other emotions included abandonment , anger , fear , joy , and happiness . Negative emotions were much more common than positive ones. The Hall data analysis showed that sexual dreams occur no more than 10% of
21798-427: The mid-nineteenth century onwards, so they "are now more different from each other than they were 50 or 100 years ago", while other accents, like of New York City and Boston, have remained stable in that same time-frame. However, a General American sound system also has some debated degree of influence nationwide, for example, gradually beginning to oust the regional accent in urban areas of the South and at least some in
21971-617: The most formal contexts, and regional accents with the most General American native features include North Midland, Western New England, and Western accents. Although no longer region-specific, African-American Vernacular English , which remains the native variety of most working- and middle-class African Americans , has a close relationship to Southern dialects and has greatly influenced everyday speech of many Americans, including hip hop culture . Hispanic and Latino Americans have also developed native-speaker varieties of English. The best-studied Latino Englishes are Chicano English , spoken in
22144-438: The mother but the baby. Cancers and tumors that occupy the lungs or throat create special challenges to general anesthesia . After determining the health of the patient undergoing anesthesia and the endpoints that are required to complete the procedure, the type of anesthetic can be selected. Choice of surgical method and anesthetic technique aims to reduce risk of complications, shorten time needed for recovery and minimize
22317-518: The name of Daniel , attempted to teach Christian populations to interpret their dreams. Iain R. Edgar has researched the role of dreams in Islam . He has argued that dreams play an important role in the history of Islam and the lives of Muslims, since dream interpretation is the only way that Muslims can receive revelations from God since the death of the last prophet, Muhammad . According to Edgar, Islam classifies three types of dreams. Firstly, there
22490-594: The narrative; The Book of the Duchess and The Vision Concerning Piers Plowman are two such dream visions . Even before them, in antiquity, the same device had been used by Cicero and Lucian of Samosata . Dreams have also featured in fantasy and speculative fiction since the 19th century. One of the best-known dream worlds is Wonderland from Lewis Carroll 's Alice's Adventures in Wonderland , as well as Looking-Glass Land from its sequel, Through
22663-401: The nerve and position of the needle is localized with ultrasound or electrical stimulation. Evidence supports the use of ultrasound guidance alone, or in combination with peripheral nerve stimulation, as superior for improved sensory and motor block, a reduction in the need for supplementation and fewer complications. Because of the large amount of local anesthetic required to affect the nerve,
22836-479: The nervous system. Hypnosis , for instance, is generated through actions on the nuclei in the brain and is similar to the activation of sleep . The effect is to make people less aware and less reactive to noxious stimuli . Loss of memory ( amnesia ) is created by action of drugs on multiple (but specific) regions of the brain. Memories are created as either declarative or non-declarative memories in several stages ( short-term , long-term , long-lasting )
23009-411: The neural mechanisms, a " left-brain interpreter " that seeks to create a plausible narrative from whatever electro-chemical signals reach the brain's left hemisphere. Sleep research has determined that some brain regions fully active during waking are, during REM sleep, activated only in a partial or fragmentary way. Drawing on this knowledge, textbook author James W. Kalat explains, "[A] dream represents
23182-433: The night before flying (while awake), and that they would be as likely to miss their flight if they dreamt of their plane crashing the night before their flight as if there was an actual plane crash on the route they intended to take. Participants in the study were more likely to perceive dreams to be meaningful when the content of dreams was in accordance with their beliefs and desires while awake. They were more likely to view
23355-443: The operating room environment must be monitored for ambient temperature and humidity, as well as for accumulation of exhaled inhalational anesthetic agents, which might be deleterious to the health of operating room personnel. Sedation (also referred to as dissociative anesthesia or twilight anesthesia ) creates hypnotic , sedative , anxiolytic , amnesic , anticonvulsant , and centrally produced muscle-relaxing properties. From
23528-402: The past forms of a few verbs (for example, AmE/BrE: learned / learnt , burned / burnt , snuck/sneaked , dove/dived ) although the purportedly "British" forms can occasionally be seen in American English writing as well; different prepositions and adverbs in certain contexts (for example, AmE in school, BrE at school ); and whether or not a definite article is used, in very few cases (AmE to
23701-412: The patient at 2.3 times greater risk than someone less than 60 years old. Having an ASA score of 3, 4 or 5 places the person at 10.7 times greater risk than someone with an ASA score of 1 or 2. Other variables include age greater than 80 (3.3 times risk compared to those under 60), gender (females have a lower risk of 0.8), urgency of the procedure (emergencies have a 4.4 times greater risk), experience of
23874-681: The patient's care following the procedure. One part of the risk assessment is based on the patient's health. The American Society of Anesthesiologists has developed a six-tier scale that stratifies the patient's pre-operative physical state. It is called the ASA physical status classification . The scale assesses risk as the patient's general health relates to an anesthetic. The more detailed pre-operative medical history aims to discover genetic disorders (such as malignant hyperthermia or pseudocholinesterase deficiency ), habits ( tobacco , drug and alcohol use ), physical attributes (such as obesity or
24047-501: The patient's health prior to surgery and the complexity of the surgical procedure can also contribute to the risks. Prior to the introduction of anesthesia in the early 19th century, the physiologic stress from surgery caused significant complications and many deaths from shock . The faster the surgery was, the lower the rate of complications (leading to reports of very quick amputations). The advent of anesthesia allowed more complicated and life-saving surgery to be completed, decreased
24220-546: The period up to three postoperative days. It reduces the duration of postoperative tracheal intubation by roughly half. The occurrence of prolonged postoperative mechanical ventilation and myocardial infarction is also reduced by epidural analgesia. Risks and complications as they relate to anesthesia are classified as either morbidity (a disease or disorder that results from anesthesia) or mortality (death that results from anesthesia). Quantifying how anesthesia contributes to morbidity and mortality can be difficult because
24393-458: The person completing the procedure (less than 8 years experience and/or less than 600 cases have a 1.1 times greater risk) and the type of anesthetic (regional anesthetics are lower risk than general anesthetics). Obstetrical , the very young and the very old are all at greater risk of complication so extra precautions may need to be taken. On 14 December 2016, the Food and Drug Administration issued
24566-632: The person who experiences each dream, apparently based on previous cases. Some list different possible outcomes, based on occasions in which people experienced similar dreams with different results. The Greeks shared their beliefs with the Egyptians on how to interpret good and bad dreams, and the idea of incubating dreams. Morpheus , the Greek god of dreams, also sent warnings and prophecies to those who slept at shrines and temples. The earliest Greek beliefs about dreams were that their gods physically visited
24739-409: The perspective of the person giving the sedation, the patient appears sleepy, relaxed and forgetful, allowing unpleasant procedures to be more easily completed. Sedatives such as benzodiazepines are usually given with pain relievers (such as narcotics , or local anesthetics or both) because they do not, by themselves, provide significant pain relief . From the perspective of the subject receiving
24912-446: The physiologic stress of the surgery, but added an element of risk. It was two years after the introduction of ether anesthetics that the first death directly related to the use of anesthesia was reported. Morbidity can be major ( myocardial infarction , pneumonia , pulmonary embolism , kidney failure / chronic kidney disease , postoperative cognitive dysfunction and allergy ) or minor (minor nausea , vomiting, readmission). There
25085-432: The possibility that "this warning could inappropriately dissuade providers from providing medically indicated care during pregnancy." Patient advocates noted that a randomized clinical trial would be unethical, that the mechanism of injury is well-established in animals, and that studies had shown exposure to multiple uses of anesthetic significantly increased the risk of developing learning disabilities in young children, with
25258-466: The potential anesthetic properties of nitrous oxide in relieving pain during surgery, but nobody at that time pursued the matter any further. On 14 November 1804, Hanaoka Seishū , a Japanese doctor, became the first person to successfully perform surgery using general anesthesia . Hanaoka learned traditional Japanese medicine as well as Dutch-imported European surgery and Chinese medicine. After years of research and experimentation, he finally developed
25431-539: The response, leading to lower surgical mortality rates . The most common approach to reach the endpoints of general anesthesia is through the use of inhaled general anesthetics. Each anesthetic has its own potency, which is correlated to its solubility in oil. This relationship exists because the drugs bind directly to cavities in proteins of the central nervous system, although several theories of general anesthetic action have been described. Inhalational anesthetics are thought to exact their effects on different parts of
25604-618: The rest of the world until 1854 as the national isolation policy of the Tokugawa shogunate prevented Hanaoka's achievements from being publicized until after the isolation ended. Nearly forty years would pass before Crawford Long , who is titled as the inventor of modern anesthetics in the West , used general anesthesia in Jefferson, Georgia . Long noticed that his friends felt no pain when they injured themselves while staggering around under
25777-415: The root cause of 11% of all adverse anesthetic events. Safe anesthesia care depends greatly on well-functioning teams of highly trained healthcare workers. The medical specialty centred around anesthesia is called anesthesiology , and doctors specialised in the field are termed anesthesiologists. Additional healthcare professionals involved in anesthesia provision have varying titles and roles depending on
25950-407: The same human subject. Non-invasive measures of brain activity like electroencephalogram (EEG) voltage averaging or cerebral blood flow cannot identify small but influential neuronal populations. Also, fMRI signals are too slow to explain how brains compute in real time. Scientists researching some brain functions can work around current restrictions by examining animal subjects. As stated by
26123-458: The same venue. Morton, who was unaware of Long's previous work, was invited to the Massachusetts General Hospital to demonstrate his new technique for painless surgery. After Morton had induced anesthesia, surgeon John Collins Warren removed a tumor from the neck of Edward Gilbert Abbott . This occurred in the surgical amphitheater now called the Ether Dome . The previously skeptical Warren
26296-419: The single greatest factor in anesthetic mortality is the health of the patient. These statistics can also be compared to the first such study on mortality in anesthesia from 1954, which reported a rate of death from all causes at 1:75 and a rate attributed to anesthesia alone at 1:2680. Direct comparisons between mortality statistics cannot reliably be made over time and across countries because of differences in
26469-519: The sleeper's eyelids were closed. Marcus Tullius Cicero , for his part, believed that all dreams are produced by thoughts and conversations a dreamer had during the preceding days. Cicero's Somnium Scipionis described a lengthy dream vision, which in turn was commented on by Macrobius in his Commentarii in Somnium Scipionis . Herodotus in his The Histories , writes "The visions that occur to us in dreams are, more often than not,
26642-452: The sponge was moistened and then held under the patient's nose. When all went well, the fumes rendered the individual unconscious. The most famous anesthetic, ether , may have been synthesized as early as the 8th century, but it took many centuries for its anesthetic importance to be appreciated, even though the 16th century physician and polymath Paracelsus noted that chickens made to breathe it not only fell asleep but also felt no pain. By
26815-414: The stratification of risk factors, however, there is evidence that anesthetics have made a significant improvement in safety but to what degree is uncertain. Rather than stating a flat rate of morbidity or mortality, many factors are reported as contributing to the relative risk of the procedure and anesthetic combined. For instance, an operation on a person who is between the ages of 60–79 years old places
26988-441: The strength of which is determined by the strength of connections between neurons termed synaptic plasticity . Each anesthetic produces amnesia through unique effects on memory formation at variable doses. Inhalational anesthetics will reliably produce amnesia through general suppression of the nuclei at doses below those required for loss of consciousness. Drugs like midazolam produce amnesia through different pathways by blocking
27161-579: The subject's memory of the dream, not the subject's dream experience itself. So, dreaming by non-humans is currently unprovable, as is dreaming by human fetuses and pre-verbal infants. Preserved writings from early Mediterranean civilizations indicate a relatively abrupt change in subjective dream experience between Bronze Age antiquity and the beginnings of the classical era . In visitation dreams reported in ancient writings, dreamers were largely passive in their dreams, and visual content served primarily to frame authoritative auditory messaging. Gudea ,
27334-936: The successful predictions than unsuccessful ones. Graphic artists, writers and filmmakers all have found dreams to offer a rich vein for creative expression. In the West, artists' depictions of dreams in Renaissance and Baroque art often were related to Biblical narrative. Especially preferred by visual artists were the Jacob's Ladder dream in Genesis and St. Joseph's dreams in the Gospel according to Matthew . Many later graphic artists have depicted dreams, including Japanese woodblock artist Hokusai (1760–1849) and Western European painters Rousseau (1844–1910), Picasso (1881–1973), and Dalí (1904–1989). In literature, dream frames were frequently used in medieval allegory to justify
27507-451: The suggestion of Sigmund Freud . German surgeon August Bier (1861–1949) was the first to use cocaine for intrathecal anesthesia in 1898. Romanian surgeon Nicolae Racoviceanu-Piteşti (1860–1942) was the first to use opioids for intrathecal analgesia; he presented his experience in Paris in 1901. The "soporific sponge" ("sleep sponge") used by Arabic physicians was introduced to Europe by
27680-484: The surgeries and regional anesthesia techniques reviewed. When local anesthetic is injected around a larger diameter nerve that transmits sensation from an entire region it is referred to as a nerve block or regional nerve blockade. Nerve blocks are commonly used in dentistry, when the mandibular nerve is blocked for procedures on the lower teeth. With larger diameter nerves (such as the interscalene block for upper limbs or psoas compartment block for lower limbs)
27853-504: The things we have been concerned about during the day." The Dreaming is a common term within the animist creation narrative of indigenous Australians for a personal, or group, creation and for what may be understood as the "timeless time" of formative creation and perpetual creating. Some Indigenous American tribes and Mexican populations believe that dreams are a way of visiting and having contact with their ancestors . Some Native American tribes have used vision quests as
28026-491: The time and are more prevalent in young to mid-teens. Another study showed that 8% of both men's and women's dreams have sexual content. In some cases, sexual dreams may result in orgasms or nocturnal emissions . These are colloquially known as "wet dreams". The visual nature of dreams is generally highly phantasmagoric; that is, different locations and objects continuously blend into each other. The visuals (including locations, people, and objects) are generally reflective of
28199-570: The traditional standard accent of (southern) England, Received Pronunciation (RP), has evolved a trap–bath split . Moreover, American accents preserve /h/ at the start of syllables, while perhaps a majority of the regional dialects of England participate in /h/ dropping , particularly in informal contexts. However, General American is also innovative in a number of its own ways: The process of coining new lexical items started as soon as English-speaking British-American colonists began borrowing names for unfamiliar flora, fauna, and topography from
28372-403: The type of procedure and the particular patient. The types of drugs used include general anesthetics , local anesthetics , hypnotics , dissociatives , sedatives , adjuncts , neuromuscular-blocking drugs , narcotics , and analgesics . The risks of complications during or after anesthesia are often difficult to separate from those of the procedure for which anesthesia is being given, but in
28545-429: The types of regional anesthesia: A 2018 Cochrane review found moderate quality evidence that regional anesthesia may reduce the frequency of persistent postoperative pain (PPP) from 3 to 18 months following thoracotomy and 3 to 12 months following caesarean . Low quality evidence was found 3 to 12 months following breast cancer surgery. This review acknowledges certain limitations that impact its applicability beyond
28718-417: The verb-and-preposition combination: stopover, lineup, tryout, spin-off, shootout , holdup, hideout, comeback, makeover , and many more. Some prepositional and phrasal verbs are in fact of American origin ( win out, hold up, back up/off/down/out, face up to and many others). Noun endings such as -ee (retiree), -ery (bakery), -ster (gangster) and -cian (beautician) are also particularly productive in
28891-775: The word corn , used in England to refer to wheat (or any cereal), came to denote the maize plant, the most important crop in the U.S. Most Mexican Spanish contributions came after the War of 1812 , with the opening of the West, like ranch (now a common house style ). Due to Mexican culinary influence, many Spanish words are incorporated in general use when talking about certain popular dishes: cilantro (instead of coriander), queso, tacos, quesadillas, enchiladas, tostadas, fajitas, burritos, and guacamole. These words usually lack an English equivalent and are found in popular restaurants. New forms of dwelling created new terms ( lot , waterfront) and types of homes like log cabin , adobe in
29064-609: The world. Any American or Canadian accent perceived as lacking noticeably local, ethnic, or cultural markers is known in linguistics as General American ; it covers a fairly uniform accent continuum native to certain regions of the U.S. but especially associated with broadcast mass media and highly educated speech. However, historical and present linguistic evidence does not support the notion of there being one single mainstream American accent . The sound of American English continues to evolve, with some local accents disappearing, but several larger regional accents having emerged in
29237-486: Was believed significantly more than theories of dreaming that attribute dream content to memory consolidation, problem-solving, or as a byproduct of unrelated brain activity. The same study found that people attribute more importance to dream content than to similar thought content that occurs while they are awake. Americans were more likely to report that they would intentionally miss their flight if they dreamt of their plane crashing than if they thought of their plane crashing
29410-458: Was impressed and stated, "Gentlemen, this is no humbug." In a letter to Morton shortly thereafter, physician and writer Oliver Wendell Holmes Sr. proposed naming the state produced "anesthesia", and the procedure an "anesthetic". American English American English , sometimes called United States English or U.S. English , is the set of varieties of the English language native to
29583-460: Was sharply reduced in later millennia. These ancient writings about dreams highlight visitation dreams, where a dream figure, usually a deity or a prominent forebear, commands the dreamer to take specific actions, and which may predict future events. Framing the dream experience varies across cultures as well as through time. Dreaming and sleep are intertwined. Dreams occur mainly in the rapid-eye movement (REM) stage of sleep —when brain activity
29756-524: Was the Chinese physician Hua Tuo whom historians considered the first verifiable historical figure to develop a type of mixture of anesthesia, though his recipe has yet to be fully discovered. Throughout Europe, Asia, and the Americas, a variety of Solanum species containing potent tropane alkaloids was used for anesthesia. In 13th-century Italy, Theodoric Borgognoni used similar mixtures along with opiates to induce unconsciousness, and treatment with
29929-469: Was written by Noah Webster in 1828, codifying several of these spellings. Differences in grammar are relatively minor, and do not normally affect mutual intelligibility; these include: typically a lack of differentiation between adjectives and adverbs, employing the equivalent adjectives as adverbs he ran quick / he ran quickly ; different use of some auxiliary verbs ; formal (rather than notional) agreement with collective nouns ; different preferences for
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