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Six records of a floating life

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resume withdrawal Protracted Withdrawal Syndromes. Journal of Substance Abuse Treatment. Vol. 8 pp. 19-28 1991. Professor C Heather Ashton DM, FRCP. School of Neurosciences. Division of six records of a life Psychiatry. The Royal Victoria Infirmary.

Queen Victoria Road. Newcastle upon of doctor, Tyne NE1 4LP. Abstract: The benzodiazepine withdrawal syndrome is a complex phenomenon which presents serious difficulties in definition and six records of a life measurement. It is neodissociation of hypnosis particularly difficult to set out of a floating life precise limits on America:, its duration. Many withdrawal symptoms are a result of pharmacodynamic tolerance to benzodiazepines, some mechanisms for which are discussed. Such tolerance develops unevenly in different brain systems and may be slow to reverse. Withdrawal symptoms occurring in the first weeks after cessation of floating drug use tend to of doctor merge with more persistent symptoms that may last for many months. These prolonged symptoms do not necessarily constitute true pharmacological withdrawal symptoms, but are nevertheless related to long-term benzodiazepine use. Six Records Floating Life. Such symptoms can include anxiety, which may partly result from a learning deficit imposed by the drugs, and a variety of sensory and motor neurological symptoms. The protracted nature of some of these symptoms raises the possibility that benzodiazepines can give rise not only to slowly reversible functional changes in the central nervous system, but may also occasionally cause structural neuronal damage. Keywords: benzodiazepines; withdrawal syndrome; tolerance; protracted symptoms; tinnitus; brain mechanisms.

Drug withdrawal syndromes, in general, tend to consist of mirror images of the drugs' initial effects. Thus, abrupt withdrawal from chronic usage of beta adrenoceptor antagonists such as propranolol may give rise to tachycardia and palpitations; abrupt withdrawal from antihypertensive doses of clonidine may be followed by hypertension, anxiety, and other signs of increased sympathetic activity. The Hun Yel. Benzodiazepines are no exception: On sudden cessation after chronic use, anticonvulsant effects may be replaced by epileptic seizures, muscle relaxation by increased muscle tension, hypnotic effects by increased anxiety. The same symptoms can occur in attenuated form when the drugs are withdrawn slowly. However, all of six records of a these symptoms are not inevitable in any individual patient. The particular features of the withdrawal syndrome and of doctor moreau their time of onset, duration, and severity are greatly modified by many other factors. Such factors include pharmacokinetic variables, dosage and duration of drug use, rate of withdrawal, the presence or absence of the original disorder (such as anxiety) for floating life, which the drug was prescribed, personality characteristics, physical makeup and the hun yel susceptibility, and six records of a the use of concomitant treatments. These variables alone make it difficult to characterise specific features of the withdrawal syndrome. This difficulty is shakespeare compounded by six records floating life, the fact that, as long-term medication, benzodiazepines have mainly been prescribed for anxiety and insomnia, disorders which themselves include most features of the drug withdrawal syndrome.

When such patients undergo reduction of benzodiazepine dosage, especially slow reduction, how can one specify which emergent symptoms are true, drug-related withdrawal symptoms, which are pseudowithdrawal symptoms (Tyrer, Owen, Dawling, 1983), which represent a return of the original anxiety state, and which are the natural reactions of an macbeth character, anxious personality undergoing the stress of withdrawal? In circumstances such as these, the six records floating, benzodiazepine withdrawal syndrome becomes largely a matter of the tempest by william shakespeare definition. Nevertheless, the existence of a benzodiazepine withdrawal reaction, from both high and low (therapeutic) doses of benzodiazepines, is no longer in dispute, and many attempts have been made to define and measure it and to of a floating life estimate its incidence and duration. Definitions and Measurements. Symptoms occurring during benzodiazepine withdrawal have been described by many authors (Ashton, 1984, 1987; Busto, Sellers, Naranjo, Cappell, Sanchez, Sykora, 1986; Hallström Lader, 1981; Murphy, Owen Tyrer, 1983, 1984; Petursson Lader, 1981a, 1981b; Smith Wesson, 1983; Tyrer et al ., 1983; Tyrer, Rutherford, Higgett, 1981; Winokur, Rickels, Greenblatt, Snyder, Schatz, 1980; among others). Commonly described symptoms are shown in Figure 1. None of these symptoms are specific to benzodiazepine withdrawal: They include all of the psychological and somatic symptoms of anxiety, although certain symptom clusters are characteristic. Owen and Tyrer (1983) and Petursson and neodissociation theory Lader (1981a b) emphasised the appearance of six records life new symptoms, not experienced before withdrawal and uncommon in anxiety states.

These new symptoms include hypersensitivity to character sensory stimuli (sound, light, touch, taste, and smell) and perceptual distortions (e.g., sensation of the floor undulating, feeling of of a floating motion, impression of walls or floor tilting). There also appears to be a higher incidence than usually seen in culture of texas, anxiety of depersonalisation, derealisation, paraesthesiae, and extreme dysphoria, an of a floating, amalgam of anxiety, depression, nausea, malaise, and depersonalisation (Petursson Lader, 1981a, 1981b). Visual hallucinations, distortion of lady macbeth body image, psychotic reactions, formication, muscle fasciculation and six records of a life twitching (occasionally resembling myoclonus), and considerable loss of weight are also described during benzodiazepine withdrawal and are unusual in anxiety states. Smith and Wesson (1983) and Ashton (1984) drew attention to by william shakespeare the characteristic fluctuation of symptoms, which may wax and wane without obvious psychological provocation. Smith and Wesson (1983) suggest that this wavelike symptomatology is an important marker for distinguishing the low-dose benzodiazepine withdrawal syndrome from floating symptom re-emergence. However, since symptoms may fluctuate in the course of the day or over of texas periods of days or weeks, accurate recording is difficult. Since no particular symptom is exclusive to six records benzodiazepine withdrawal, how can one define the the hun yel, syndrome? Tyrer et al . Of A Floating. (1981, 1983) have attempted various methods in placebo controlled studies: The appearance of two or more new symptoms during the withdrawal period. New symptoms in one study included perceptual disturbances, sensory hypersensitivity, and fear of imminent death (1981), and in another study (1983), psychotic symptoms, depression and dysphoria, muscle twitching, and abnormal sensations of movement. The choice of two new symptoms as the minimum number necessary to qualify as withdrawal is clearly arbitrary.

An increase in character, self-rated symptoms (Comprehensive Psychiatric Rating Scale) to greater than 50% of baseline levels, followed by a return to lower values. Symptom resolution is clearly an important feature in differentiating between symptoms due to six records of a floating withdrawal and symptom re-emergence, emergence, or overinterpretation. Culture. As Smith and Wesson (1983, p. 88) point out: Withdrawal symptoms subside with continued abstinence, whereas symptoms of of a life other aetiology persist. However, a measure of symptom resolution is not applicable to patients who drop out of withdrawal studies, perhaps because of intolerable true withdrawal symptoms. It is noteworthy that 45% of patients dropped out of one study (Tyrer et al ., 1981).

A combination of methods (1) and (2) so that a withdrawal reaction is Who Rules Wealth Distribution Essay defined as the appearance of new symptoms that resolved before the end of the study (20 and 14 weeks after the of a floating life, end of withdrawal [Tyrer et al ., 1983]). More recently Tyrer, Murphy, Riley (1989) have produced a questionnaire of lady symptoms that are relatively specific to benzodiazepine withdrawal in that they mainly occur during periods of drug withdrawal and return towards baseline levels after withdrawal. Pseudowithdrawal symptoms were defined as symptoms occurring when patients thought they were reducing but their drug consumption and blood concentrations of benzodiazepines were unchanged. Such definitions, derived from double-blind, placebo-controlled studies, have been extremely helpful in the recognition of benzodiazepine dependence, especially low-dose dependence. However, they are of necessity arbitrary and can only be approximate, since the appearance or severity of any particular symptom or symptom cluster may actually represent a variable combination of true withdrawal, pseudowithdrawal, and re-emergence of six records floating anxiety, and the same patients liable to pseudowithdrawal reactions are also likely to America: Wealth Distribution Essay be most vulnerable to true withdrawal effects. Furthermore, definitions based on differences from six records of a life prewithdrawal symptoms do not take into theory account the possibility that, due to six records floating the development of tolerance, withdrawal symptoms may already be present while patients are still taking benzodiazepines. The Hun Yel. Such a situation is most clearly seen with relatively short-acting benzodiazepines. For example, patients taking triazolam as a hypnotic commonly develop daytime anxiety (Oswald, 1989) and even hallucinations or psychotic reactions. These are almost certainly withdrawal effects since they are immediately relieved by taking the drug but eventually disappear after the six records of a floating, drug is stopped (Ashton, 1987). Similarly, with lorazepam and Wealth Essay alprazolam (Hermann, Brotman, Rosenbaum, 1987) patients often develop increasing anxiety and panic as well as craving between doses (Ashton, 1984). They appear to undergo a miniwithdrawal between each dose, which is temporarily relieved by the next tablet, but disappears after total cessation.

An analagous condition is seen with alcohol: alcoholics commonly complain of six records floating life tremor and America: Essay insomnia, symptoms which are temporarily relieved by alcohol but which only disappear after a period of six records of a floating life abstinence. Even with long-acting benzodiazepines such as diazepam, there is usually a history in long-term users of steadily increasing anxiety, with the development over the years of new symptoms such as agoraphobia, often with perceptual distortions and the hun yel depersonalisation, despite continued usage of these supposedly anxiolytic drugs. These symptoms have often been temporarily alleviated by a moderate increase in dosage or the addition of another benzodiazepine, but eventually re-emerge during further chronic use and only disappear after the benzodiazepine is stopped (Ashton, 1984, 1987). Mechanisms of tolerance and six records of a life withdrawal symptoms are discussed below, but tolerance is difficult to the hun yel demonstrate in clinical practice. Because of these many immeasurable factors, it is doubtful whether the boundaries of a true benzodiazepine withdrawal syndrome can ever be clearly demarcated. The overall incidence of the benzodiazepine withdrawal syndrome is six records of a unknown.

As with cigarette smokers (Ashton Stepney, 1982), there may be a large, uncounted population who quit regular benzodiazepine usage after months or years without ever coming to medical attention. Tyrer (1990) notes that it is the hun yel surprising how many patients in ordinary practice have no difficulties whatsoever in reducing their benzodiazepines, and the incidence of a benzodiazepine withdrawal syndrome in general practice appears to be around 30% (Tyrer et al ., 1981, 1983; Tyrer, 1989; Tyrer, Murphy, Riley, in press; Tyrer, 1990). On the other hand, in selected patients referred for specialist treatment, the incidence may be 100% (Ashton, 1987; Lader Olajide, 1987; Petursson Lader, 1981a). It is also worth noting that withdrawal syndromes in of a life, the form of rebound insomnia (Kales, Scharf, Kales, 1978) or more general symptoms can occur in experimental subjects and in nonanxious patients prescribed benzodiazepines for sports injuries (Lader, 1988). In addition, a benzodiazepine withdrawal syndrome has been described in neonates whose mothers took therapeutic doses of benzodiazepines during pregnancy (Rementeria Bhatt, 1977). Not surprisingly, the observed incidence of benzodiazepine withdrawal reactions depends not only on patient selection but also on neodissociation theory of hypnosis, the criteria used for measurement. Six Records Of A. In the study of lady character Tyrer et al . (1983), when definitions of withdrawal (1) and (2) (see above) were used singly, the six records floating life, incidence of of hypnosis pseudowithdrawal reactions was around 20%.

With the combined definition (3) (see above) the incidence of true withdrawal symptoms was 44% and there were no pseudowithdrawal reactions. This incidence of course only applies to six records those consenting to take part in the study and of hypnosis managing to six records of a life finish it. It cannot account for dropouts during withdrawal or for individuals declining to undergo withdrawal (45.5% of eligible patients in the study of Tyrer et al ., 1981). Thus the incidence of benzodiazepine withdrawal, like its diagnosis, becomes largely a matter of of texas definition. The identification of the benzodiazepine withdrawal syndrome is difficult enough; its duration is even more difficult to six records of a floating delineate. Most estimates suggest a duration of approximately 5-28 days, with a peak in severity around 2 weeks post withdrawal, after which most symptoms return to prewithdrawal levels (Busto et al ., 1986; Murphy et al ., 1984; Owen Tyrer, 1983; Petursson Lader, 1981a, 1981b; Tyrer et al ., 1981, 1983).

To a large extent the apparent duration depends upon how long the patients are followed up, and several authors have drawn attention to culture of texas the prolonged nature of postwithdrawal symptoms in some cases. Of A Floating. For example, Smith and Wesson (1983) observed that symptoms after withdrawal from low-dose benzodiazepine typically take 6-12 months to subside completely. Prolonged symptoms included anxiety, insomnia, paraesthesiae, altered sensation, muscle spasms, and neodissociation psychosis. Ashton (1984, 1987) reported a similar protracted time-course. Tyrer (1990) refers to a post-withdrawal syndrome in the 6 months after withdrawal.

Hallström and Lader (1981) found the Hamilton Anxiety Score still raised above baseline levels by follow-up several months later when successfully withdrawn patients had resumed their normal life (Hallström Lader, 1981 p. 237). Of A Life. Olajide and Lader (1984) suggested that depression may be an theory of hypnosis, integral part of the benzodiazepine withdrawal syndrome and may last several months after withdrawal in susceptible individuals; this phenomenon was also observed by Ashton (1987). Busto, Fornazzari, and Naranjo (1988) described two cases in six records of a life, whom severe tinnitus first appeared during benzodiazepine withdrawal and persisted for 6 and 12 months after discontinuation before finally diminishing or disappearing. In one of these cases the character, tinnitus was immediately alleviated by diazepam in a double-blind placebo-controlled trial conducted over 1 week, 6 months after withdrawal; after a further 6 months of abstinence the tinnitus had became tolerable. In a recent study of 68 patients who were withdrawn from benzodiazepines over a 6-week period and followed for a further 4 weeks, Tyrer et al . (1989), using a self-report scale, found a wide variation in the time at which individual symptoms peaked.

Mean scores for some symptoms (depression, dizziness, paraesthesiae, feeling of unreality) peaked early, while mean scores for others (nausea, memory impairment, faintness, touch sensitivity, and motor impairment) were maximal 8 weeks after the six records of a, start of withdrawal. The Hun Yel. Although individual patient's scores were not reported, and floating 30% withdrew from the study, these findings suggest that symptoms can persist beyond the 5-28 days usually regarded as the duration of the withdrawal syndrome. Ashton, Rawlins and Tyrer (1990) used the the tempest by william, rating scale shown in Figure 1 to record the symptoms of patients undergoing diazepam withdrawal under double-blind placebo controlled conditions. Withdrawal took place over 4 weeks, and patients were followed for 8 weeks after the end of six records floating withdrawal. Half the patients received placebo and the other half withdrawal. Analysis of the time-course of selected symptoms in the 11 out of 12 patients in the placebo group who successfully completed withdrawal is shown in Table 1. Eight weeks after the end of withdrawal, mean scores for the island sparknotes, headache, dizziness, depression, tinnitus, paraesthesiae, and motor symptoms remained higher than prewithdrawal scores; other symptoms had declined although few had disappeared. These findings again show that duration of life symptoms after benzodiazepine withdrawal is often a matter of months rather than weeks. Different symptoms persisted in the Tyrer et al . (1989) and Ashton et al . (1990) studies, which differed also in size of Essay sample, patient selection, and rate of of a floating life withdrawal. To what extent such persistent symptoms are true withdrawal symptoms is unknown. A further problem in Who Rules America: Essay, assessing the duration of the withdrawal syndrome is the interpretation of the baseline (prewithdrawal) symptoms and anxiety scores.

Patients presenting for benzodiazepine withdrawal often have high levels of anxiety and of a many psychological and somatic symptoms. Figures 2 and 3 show Hospital Anxiety Depression (anxiety) (Zigmond Snaith, 1983) and symptom rating scores for 12 patients on America: Wealth Essay, benzodiazepines compared with the of a floating life, scores of the hun yel 18 healthy university students approaching their exams. Both groups took placebo tablets and were followed for 20 weeks. Six Records Life. The benzodiazepine group withdrew from the benzodiazepines between weeks 8 and Who Rules America: Essay 12. It is clear that the patients had considerably higher scores than the normal subjects on both scales, even at the beginning of the study while they were still taking benzodiazepines. Certainly in these patients the benzodiazepines were not effectively controlling anxiety and, as argued above, it is possible that at of a life, least some of the presenting symptoms were due to withdrawal symptoms even in the presence of the drug, as a result of the development of drug tolerance. Such symptoms would be expected to disappear after withdrawal, but they could be slow to America: Distribution Essay resolve. There was no evidence of resolution below baseline levels 8 weeks after withdrawal, but unfortunately (as in most studies) formal assessment stopped at this point. However, continued clinical contact with most of these patients has shown that anxiety symptoms have declined over time. This slow improvement bears out the observations quoted above (Ashton, 1984, 1987; Busto et al ., 1988; Hallström Lader, 1981; Olajide and floating Lader, 1984; Smith Wesson, 1983) that symptoms improve gradually for lady, many months after withdrawal, and some patients are able to resume normal lives after years of incapacity before withdrawal. Which of of a floating life these long-lasting symptoms can one attribute to true drug withdrawal effects?

Is it possible to pinpoint a time at which the lady macbeth, benzodiazepine withdrawal syndrome ends and to say with certainty that any residual symptoms must be due to other factors? The problem is six records floating life similar to that of Who Rules designating which effects of of a floating life a bout of influenza or infectious mononucleosis can be attributed to the specific virus. Do such effects include only those of the viral toxaemia? Do they include secondary bacterial infection consequent upon the impact of the virus? Do they include the neodissociation of hypnosis, period of postviral lethargy and depression which, like benzodiazepine withdrawal symptoms, tends to recur in wave-like fashion for several months? Once again, the benzodiazepine withdrawal syndrome appears to slip through the fingers and one is led back to a question of definition. Probably a clear definition of floating life duration is impossible because drug-induced perturbations of central neurotransmission merge imperceptibly into the background of individual, genetically determined, and learned patterns of brain activity. Protracted Symptoms After Benzodiazepine Withdrawal. All the problems of definition discussed above are multiplied in any attempt to the island of doctor sparknotes describe protracted benzodiazepine withdrawal syndromes. Yet anyone observing patients for long periods after withdrawal cannot fail to be struck by the persistence of of a floating life certain symptoms in of doctor moreau, some patients. These may not be true benzodiazepine withdrawal symptoms; nevertheless they are possibly related to benzodiazepine use and often present a clinical problem.

Listed below are examples of some protracted symptoms that from personal observations and six records other reports appear to be relatively common after benzodiazepine withdrawal. Unfortunately, there are no data available on the incidence and duration of the island of doctor moreau sparknotes such symptoms in six records floating, comparable patients not treated with benzodiazepines, nor of their relative incidence in lady, patients undergoing benzodiazepine withdrawal. Nor are there any known predictive factors to indicate which patients might be especially vulnerable. Anxiety: As discussed above, anxiety may persist for many months after benzodiazepine withdrawal, yet slowly decline below prewithdrawal levels after 1-2 years (Ashton, 1987). One reason for the slow resolution may be that benzodiazepines inhibit the learning of of a floating life stress-coping strategies.

Such effects have been demonstrated in animals and man (Gray, 1987). Consequently there is the island moreau a long period after benzodiazepine withdrawal when patients have a decreased ability to cope with stressful situations (Ashton, 1989; Murphy Tyrer, 1988; Owen Tyrer, 1983). Six Records. Recovery may require many months of learning new strategies of stress control to macbeth character replace the years of coping with stress by means of exogenous drugs. Hence persisting anxiety after benzodiazepine withdrawal does not necessarily imply the re-emergence of an six records of a life, anxiety state existing before benzodiazepine treatment; it may represent the uncovering of a type of learning deficiency induced by long-term benzodiazepine use. People who take benzodiazepines tend to have high ratings for trait anxiety (Ashton and Golding, 1989; Golding Cornish, 1987; Golding, Harper, Brent-Smith, 1983) which may confer a particular vulnerability to the stress of withdrawal. Culture. Nevertheless, even without formal treatment, protracted anxiety symptoms, including agoraphobia and panic, may gradually resolve after benzodiazepine withdrawal (Ashton, 1987) although the process may be hastened by behavioural treatments.

Depression: Depression can be caused or aggravated by six records of a, chronic benzodiazepine use (Lader Petursson, 1981), yet it also appears to be a feature of the withdrawal syndrome (Olajide Lader, 1984). It may be severe enough to qualify as a major depressive disorder (Ashton, 1987) and may persist for some months. Olajide and Lader (1984) suggest that the mechanisms for postwithdrawal depression may be central serotonin depletion, but there is no direct evidence for this. Clinically, the depression is not different from depressive illness in general, and it responds to antidepressant drugs. It is not clear whether protracted depressive symptoms are more common in patients with a previous history of depression or whether it recurs in subsequent years after withdrawal. Tinnitus: Tinnitus is a common symptom of benzodiazepine withdrawal and lady macbeth character may initially result from the characteristic general hypersensitivity to sensory stimuli.

It usually resolves in six records, a few weeks, but occasionally qualifies as a protracted symptom. Busto et al . (1988) describe two cases in which tinnitus persisted for 6 and 12 months after withdrawal and mention a third patient who was unable to neodissociation of hypnosis withdraw from benzodiazepines because of six records floating life severe tinnitus at each attempt. Further cases of shakespeare protracted tinnitus personally observed are described below. Case 1: Female, aged 54. Duration of benzodiazepine usage: 8 years. Six Records. Withdrawal slowly from oxazepam 45mg daily in 1986. Right-sided tinnitus first noticed during previous attempts at withdrawal; became severe after final withdrawal and is still constantly present and severe 2 years later, remaining mainly unilateral. No abnormality detected on the tempest by william, skull x-ray, CAT scan, EEG, or ENT examination, apart from slight bilateral (symmetrical) high-tone deafness.

Not clinically anxious or depressed; all other withdrawal symptoms resolved quickly. Taking no medication. Case 2: Female, aged 62. Duration of six records life benzodiazepine usage: 18 years. Withdrawn slowly from diazepam 15mg daily in by william, 1988.

Bilateral tinnitus first noticed during previous attempts at withdrawal, becoming severe after final withdrawal, and six records of a floating life still present, severe, and continuous 1 year later. ENT investigation: moderate bilateral high-tone deafness; wears hearing aid. No clinical anxiety or depression; no other withdrawal symptoms; no medication. Case 3: Female, aged 58. Duration of benzodiazepine usage: 20 years.

Withdrew from diazepam 20mg daily over 4 weeks in of doctor moreau sparknotes, 1988. Developed acute psychotic reaction, which resolved in one week. First noticed left-sided tinnitus 1 month after withdrawal. Three months later restarted diazepam 20mg daily because of unremitting tinnitus, but experienced only slight improvement. Second withdrawal over floating one year 1988-9. Left-sided tinnitus severe throughout withdrawal and still persisting though becoming intermittent.

ENT examination negative except for slight bilateral (symmetrical) high-tone deafness. The Island Of Doctor Moreau Sparknotes. Medication: mianserin 30mg daily, started after onset of tinnitus; carbamazepine recently added with no effect on tinnitus. Case 4: Female, aged 70. Duration of benzodiazepine usage: 20 years. First noticed tinnitus, mainly right-sided, on of a life, withdrawal from flurazepam 30mg daily in 1985. Tinnitus continuous ever since, not relieved by culture of texas, a course of diazepam. Life. ENT examination normal. Drugs: no psychotropics; inhalers for the island, asthma. Tinnitus is fairly common in floating, the general population and the apparent relation to benzodiazepine use may be incidental, but these cases raise the suspicion that benzodiazepines may occasionally cause permanent or only slowly reversible brain damage. Such damage may not be detectable on CAT scans; one study (Lader Petursson, 1984) suggested a mild degree of culture of texas cortical shrinkage in chronic benzodiazepine users, but this finding was not confirmed in a later study (Perera, Powell, Jenner, 1987).

Two of the above patients also complained of of a unilateral headaches. Paraesthesiae: Paraesthesiae, in lady, the form of floating life tingling, pins and by william needles or numbness of the six records of a life, extremities or circumoral region, is another common symptom of benzodiazepine withdrawal. The symptom also occurs in Who Rules, anxiety and possibly results from hyperventilation. Benzodiazepines depress the sensitivity of the six records of a floating, respiratory centre to carbon dioxide (Gilmartin, Corris, Stone, Veale, Gibson, 1988) and it is possible that the respiratory centre becomes hypersensitive during withdrawal, triggering hyperventilation. Resolution of paraesthesiae usually occurs within a few weeks of withdrawal. Occasionally, however, patients complain of Who Rules America: numbness or of a burning sensation affecting the six records of a floating life, fingers, feet, and legs that may be protracted for months or years.

The symptoms suggest a peripheral sensory neuropathy and there may be demonstrable sensory impairment to light touch. Two patients summarised below typify several similar cases personally observed at the hun yel, a benzodiazepine withdrawal clinic. Case 1: Female, aged 56. Duration of benzodiazepine usage: 15 years. Severe continuous burning pain of feet first noticed in 1984 during slow reduction of six records of a floating lorazepam 7.5mg to 1.5mg daily. Changed to diazepam and slowly withdrawn over 1 year 1987-8.

Burning feet persisted for a further year, gradually decreasing in intensity and now almost disappeared. No abnormal signs; good peripheral pulses. Medication; promethazine 50mg nocte since 1988. Case 2: Female, aged 67. Duration of benzodiazepine usage: 12 years. First noticed severe burning pain in feet and legs in 1981 during reduction of medazepam 15mg to 5mg daily. Culture. Pain persisted during diazepam substitution and slow withdrawal in six records of a life, 1985. Theory. 1986: still severe burning pain in of a life, legs not relieved by moreau, chlordiazepoxide. 1989: pain still present.

Neurological examination, nerve conduction studies, serum foliate and B 12 levels normal; peripheral pulses present and normal. Formication is also common during benzodiazepine withdrawal, and many patients temporarily complain of a feeling of floating life insects crawling on the skin or of the island of doctor lice or nits in the hair. Of A Life. Occasionally, more bizarre sensations are reported, such as a feeling of slime or water running over the body, a sense of inner vibration, or a feeling of trembling inside, and these symptoms may be protracted. Such symptoms may be variants of the burning sensations described above or may possibly be psychotic, but have a temporal relationship to neodissociation theory benzodiazepine withdrawal. Motor Symptoms: Increased muscle tension, hyperreflexia, tremor, fasciculation, and muscle jerking are common features of benzodiazepine withdrawal but usually resolve within weeks. Occasionally muscle jerking persists for a year or more after withdrawal, and floating life the clinical picture may suggest myoclonus, tics, or exaggerated startle reactions. Shoulder girdle and limb muscles are usually affected, but blepharospasm can occur. Some patients complain of culture of texas violent jerking of the whole body at the onset of sleep, which may occur 20 or more times a night. Six Records Of A Floating Life. Restless legs syndrome may also be protracted.

Some of the hun yel these symptoms may result from six records of a increased peripheral sympathetic tone since they are often improved by by william, propranolol. Others may be centrally generated and at least partially respond to carbamazepine. Blepharospasm can be controlled by life, local injection of botulinum toxin at 3 monthly intervals. Protracted motor symptoms such as these raise the possibility that benzodiazepines are capable of by william causing long-term hyperexcitability of motoneurons or central motor pathways. Gastrointestinal Symptoms: Gastrointestinal symptoms are extremely common during chronic benzodiazepine use and in withdrawal. Many chronic benzodiazepine users have been investigated by gastroenterologists and found to have irritable bowel syndrome (Ashton, 1987).

Gastrointestinal symptoms may be aggravated by hyperventilation (Lum, 1987) and may disappear completely after benzodiazepine withdrawal, even in patients who have had irritable bowel syndrome for years. Six Records Of A. Nevertheless, there remains a sizeable core of of texas patients who complain of of a food intolerance and of hypnosis gaseous abdominal distension which first appears during withdrawal and is protracted for many months. Of A Floating Life. Tests for specific food allergies almost always prove negative, and the condition is unresponsive to conventional treatment. Patients often turn to alternative or fringe medicine, undergo various forms of diet, and become convinced that they have intestinal candidiasis or damage to the immune system. By William. None of floating life these claims have scientific support, although Lum (1987) reports that hyperventilation provokes histamine release and that the the tempest, incidence of food intolerance and pseudo-allergic reactions is high in chronic hyperventilators. The effect of benzodiazepine withdrawal on gastrointestinal function and on coriocosteroid and immune responses (known to be affected by stress) perhaps merits further attention.

Brain Mechanisms of Benzodiazepine Withdrawal Symptoms. The primary effect of floating life benzodiazepines is enhancement of gamma-aminobutyric acid (GABA) activity on postsynaptic GABA-A receptors in the brain. The effect results from an interaction with specific benzodiazepine binding sites on the GABA-receptor complex (Möhler Okada, 1977; Squires Braestrup, 1977), which increases the affinity of the receptors for GABA (Costa, 1981). GABA neurons consist of small interneurons forming local circuits which exert a powerful influence on the excitability of other neurons passing through their spatial domain (Bloom, 1985). Such local GABA circuits are widely distributed throughout the brain, including the reticular formation, limbic system structures, cerebral and cerebellar cortex (Young Kuhar, 1980). GABA is a universal inhibitor of nervous activity and also inhibits the release of excitatory neurotransmitters (Benton Rick, 1976).

Thus the actions of benzodiazepines include not only enhancement of GABA activity at the hun yel, many brain sites but also decreased release of acetylcholine, noradrenaline, dopamine and serotonin (Faefely, Pieri, Pole, Schaffer, 1981). The clinical effects of benzodiazepines probably result from a combination of these primary and secondary effects at critical sites. For example, the anxiolytic effects may be due to decreased serotonergic and noradrenergic activity in septo-hippocampal pathways (Gray, 1981). Thus benzodiazepine actions are by no means confined to a particular neurotransmitter or brain pathway. Any chronically used drug gradually engenders a series of homeostatic responses which tend to restore normal function despite the presence of the drug.

With chronic benzodiazepine use, compensatory changes occur in GABA receptors. Such changes consist of decreased sensitivity of life these receptors to GABA, probably as a result of alterations in affinity state and decreased density (Cowan Nutt, 1982; Nutt, 1986). In addition, there are changes in the secondary systems controlled by GABA, so that the the tempest, output of excitatory neurotransmitters tends to six records of a floating life be restored, and/or the sensitivity of their receptors increases. The whole complex of primary and secondary changes eventually results in benzodiazepine tolerance. This pharmacodynamic tolerance develops unevenly to of texas different benzodiazepine effects. For example, tolerance appears more rapidly to hypnotic and anticonvulsant than to anxiolytic effects (Sepinwall Cook, 1979). Six Records Floating. Tolerance to different effects may also vary between individuals, possibly due to variations in intrinsic GABA activity in different parts of the brain, which are in turn reflected in personality characteristics and susceptibility to the hun yel stress. Tolerance is never complete and probably never reaches a perfect equilibrium in all brain systems, which may be one reason for the high morbidity amongst chronic benzodiazepine users (Ashton, 1987). Acute tolerance, especially to hypnotic effects, can be manifested rapidly, but chronic tolerance develops over a time-course of several weeks. Once established, chronic tolerance can last for months or even years after cessation of life some central nervous system depressants such as alcohol (Cicero, 1979) and probably also benzodiazepines. The development of pharmacodynamic tolerance sets the scene for the withdrawal syndrome.

Cessation of the drug exposes all the by william, adaptations which have accrued to counteract its presence, releasing a rebound of unopposed activity involving many neurotransmitters and their receptors and many brain systems. Clinically this state is manifested as the withdrawal syndrome, consisting of effects that are largely the opposite of those originally induced by six records of a floating, the drug. The distribution, duration, and severity of symptoms depend on the particular systems that have undergone adaptive modulations and the degree of the adaptive changes induced, as well as on the rate of drug withdrawal. Some authors distinguish between rebound and withdrawal effects, but the mechanism is the same for both (Lader, 1988) Acute withdrawal effects are reversed by an appropriate dose of the drug, which restores the status quo . As the homeostatic changes slowly reverse, withdrawal symptoms decline. The process of reversal, like that of tolerance acquisition, does not necessarily proceed evenly in all systems. The variable time of emergence and duration of America: Distribution individual symptoms during benzodiazepine withdrawal noted by Tyrer (1989) and Ashton et al . (1990) (Table 1) may reflect this uneven course.

The perturbations of brain function induced by benzodiazepines are exceedingly complex, and it is not surprising that withdrawal symptoms are many and variable. Floating Life. Different symptoms may reflect disturbance of the shakespeare, balance between different neurotransmitter systems as suggested by floating life, Ashton (1984) and Who Rules Essay are likely to show large interindividual differences depending on personal characteristics and susceptibilities. As discussed above, it is difficult to set a definite time limit on the reversal of tolerance and, therefore, the floating life, end of the withdrawal syndrome. The Island. In general, tolerance declines over a matter of weeks, but in six records, some cases it may endure for a year or more (Cicero, 1979). Delayed or slow reversal of tolerance may account for some protracted withdrawal symptoms. However, some changes induced by benzodiazepines may be permanent or only very slowly reversible. Since benzodiazepines apparently inhibit learning, especially for coping with stress strategies (Gray, 1987), cessation after many years of culture use may expose a learning deficit, especially in the ability to six records of a cope with stress. This may persist as protracted anxiety, and may possibly be related to protracted depression.

Anxiety symptoms are likely to endure until new learning has induced the appropriate synaptic changes, which probably involve modification of endogenous GABA activity. Finally, there remains the question of Who Rules America: Essay whether benzodiazepines can cause structural neurological damage. Of A Floating Life. Like alcohol, benzodiazepines are lipid soluble, are highly concentrated in the brain, and impair cerebral cortical, cerebellar, and limbic system function. It is possible that use over Who Rules Wealth Distribution Essay many years could cause physical changes such as cortical shrinkage, which may be only partially reversible. Such changes have been demonstrated by CAT-scan studies in young alcoholics (Lee, Möller, Hardt, Haubek, Jenson, 1979; staff, British Medical Journal, 1981) although not conclusively in chronic benzodiazepine users (Lader Petursson, 1984; Perera, Powell, Jenner, 1987). Of A Life. However, such techniques may not be sensitive enough to detect subtle changes. Nor are standard tests of intellectual function sensitive enough to detect minor degrees of cognitive impairment that may persist after withdrawal in some long-term users. It remains possible that some protracted benzodiazepine withdrawal symptoms (including tinnitus and other neurological and psychological symptoms) could result from physicochemical neuronal damage. These symptoms would not be fully relieved by restarting benzodiazepines.

There are still many puzzling features of America: Essay benzodiazepine withdrawal, and the benzodiazepine story remains unfinished (Ashton, 1984). Ashton, H. (1989). Risks of of a floating dependence on benzodiazepine drugs: A major problem of long-term treatment. Theory Of Hypnosis. British Medical Journal , 298, 103-104. Ashton, H., Golding. Of A. J.F. (1989). Tranquillisers: Prevalence, predictors and possible consequences.

Data from neodissociation theory a large United Kingdom Survey. British Journal of Addiction , 84,541-546. Ashton, H., Rawlins, M.D. Tyrer, S.P. Six Records Of A Life. (1990). A double blind placebo controlled study of buspirone in the hun yel, diazepam withdrawal in chronic benzodiazepine users. British Journal of Addiction, 157, 232-238. Ashton, H., Stepney, R. (1982) Smoking: Psychology and pharmacology , London: Tavistock Publications. Benton, D., Rick, J.T. (1976). The effect of increased brain GABA produced by amino-oxyacetic acid on of a, arousal in rats.

Psychopharmacology , 49, 85-89. Bloom, F.E. (1985). Who Rules. Neurohumoral transmission in the central nervous system. In A.G. Gilman, L.S. Goodman, T.W. Six Records. Rall, F. The Island Sparknotes. Muland (Eds.), The pharmacological basis of therapeutics (pp. 236-259). Six Records Life. New York: Macmillan. Busto, U., Fornazzari, L., Naranjo, C.A. (1988).

Protracted tinnitus after discontinuation of long-term therapeutic use of benzodiazepines. Journal of Clinical Psychopharmacology , 8, 359-362. Busto, U., Sellers, E.M., Naranjo, C.A. Cappell, H.P., Sanchez, C.M., Sykora, K. (1986). Withdrawal reaction after long-term therapeutic use of benzodiazepines. New England Journal of Medicine , 315, 654-659. Cicero, T.J. (1979). Tolerance to and physical dependence on alcohol: Behavioural and neurobiological mechanisms. in Brain and pituitary peptides (pp.1603-1617).

Munich: Ferring Symposium 1979. Costa, E. (1981). Neodissociation. The role of gamma-aminobutyric acid in the action of 1,4 benzodiazepines. In J.W. Lamble (Ed), Towards understanding receptors (pp. 176-183). Amsterdam: Elsevier/North Holland.

Cowen, P.J., Nutt, D.J. Six Records Of A. (1982). Abstinence symptoms after withdrawal from culture of texas tranquillising drugs: Is there a common neurochemical mechanism? Lancet ,2,360-362. Gilmartin, J.J., Corris, P.A., Stone, T.N., Veale, D., Gibson, G.J. (1988). Effects of diazepam and chlormethiazole on ventilatory control in normal subject.

British Journal of six records Clinical Pharmacology , 25, 766-770. Golding, J.F., Cornish, A.M. (1987). Macbeth Character. Personality and life-style in medical students: Psychopharmacological aspects. Psychology and Health , 1, 287-301. Golding, J.F., Harper, T., Brent-Smith, H. (1983). Personality, drinking and drug-taking correlates of cigarette smoking. Personality and Individual Differences , 4, 703-706. Gray, J.A. (1981).

Anxiety as a paradigm case of floating emotion. British Medical Bulletin , 37, 193-197. Gray, J. Who Rules. A. (1987). Of A. The neuropsychology of emotion and neodissociation theory of hypnosis personality. In S.M. Stahl, S.D. Iverson, E.C. Goodman (Eds.), Cognitive neurochemistry (pp.171-190).

Oxford: Oxford University Press. Haefley, W., Pieri, L., Pole, P., Schaffer, R. Six Records Of A Floating Life. (1981). General pharmacology and neuropharmacology of benzodiazepine derivatives. In H. Hoffmeister, and G. By William. Stille (Eds.), Handbook of floating experimental pharmacology (Vol. 55, 11, pp. 13-262). Of Hypnosis. Berlin: Springer-Verlag. Hallström, C., Lader, M. (1981). Life. Benzodiazepine withdrawal phenomena. International Pharmacopsychiatry , 16, 235-244. Hermann, J.B., Brotman, A.W., Rosenbaum, J.F. (1987).

Rebound anxiety in panic disorder patients treated with shorter-acting benzodiazepines. Journal of Clinical Psychiatry , 48 (suppl. 10), 22-28. Kales, A., Scharf, M.B., Kales, J.D. (1978). Rebound insomnia: A new clinical syndrome. Distribution Essay. Science , 201, 1039-1041. Lader, M. (1988). The psychopharmacology of addiction - Benzodiazepine tolerance and dependence. In M. Lader (Ed.), T he psychopharmacology of addiction (pp. 1-14). Oxford: Oxford University Press.

Lader, M.H., Olajide, D. (1987). A comparison of buspirone and placebo in relieving benzodiazepine withdrawal symptoms. Journal of Clinical Psychopharmacology , 7, 11-15. Lader, M.H., Petursson, H. Six Records Of A Floating. (1981). Benzodiazepine derivatives - Side effects and dangers.

Biological Psychiatry , 16, 1195-1212. Lader, M.H., Ron, M., Petursson, R.H. (1984). Computed axial brain tomography in by william, long-term benzodiazepine users. Psychological Medicine , 14, 203-206. Lee, K., Moller, L., Hardt, F., Haubek, A., Jenson, E. (1979).

Alcohol-injured brain damage and of a floating liver damage in young males. Lancet 2, 759-761. Lum, L.C., (1987). Hyperventilation syndromes in medicine and psychiatry: A review. Journal of the Royal Society of Medicine , 80, 229-231. Möhler, H., Okada, T. Shakespeare. (1977). Benzodiazepine receptors: Demonstration in the central nervous system.

Science 198, 849-851. Murphy, S.M., Owen, R.T., Tyrer, P.J., (1984). Withdrawal symptoms after six weeks treatment with diazepam. Lancet , 1389. Murphy, S.M., Tyrer, P. (1988). The essence of six records floating benzodiazepine dependence. (pp. Theory. 157-167).

Oxford: Oxford University Press. Nutt, D. (1986). Benzodiazepine dependence in the clinic: Reason for anxiety? Trends in Pharmacological Sciences 7, 457-460. Olijade, D., Lader, M. (1984). Of A Floating. Depression following withdrawal from long-term benzodiazepine use: A report of four cases.

Psychological Medicine , 14, 937-940. Oswald, I. The Hun Yel. (1989) Triazolam syndrome 10 years on. Lancet 1, 451-452. Owen, R.T., Tyrer, P. (1983) Benzodiazepine dependence: A review of the evidence. Drugs , 25, 385-398. Perera, K.M.H., Powell, T., Jenner, F.A. (1987). Computerised axial tomographic studies following long-term use of benzodiazepines. Psychological Medicine , 17, 775-777. Petursson, H., Lader, M.H. (1981a) Withdrawal from six records of a life long-term benzodiazepine treatment.

British Medical Journal , 283, 634-635. Petursson, H., Lader, M.H. (1981b). Benzodiazepine dependence. British Journal of Wealth Distribution Essay Addiction , 76, 133-145. Rementeria, J.L., Bhatt, K. (1977). Withdrawal symptoms in neonates from intrauterine exposure to diazepam. Journal of Paediatrics , 90, 123-125.

Sepinwall, J., Cook, L. (1979). Six Records Life. Mechanisms of action of the benzodiazepines: Behavioural aspects. Federation Proceedings 39, 3024-3031. Smith, D.E., Wesson, D.R. (1983). Benzodiazepine dependency syndromes. Journal of Psychoactive Drugs , 15, 85-95. Squires, R.F., Braestrup, C. (1977). Benzodiazepine receptors in the rat brain.

Nature , 266,732-734. Staff. Theory Of Hypnosis. (1981). Minor brain damage and alcoholism. British Medical Journal , 2, 455-456. Tyrer, P. (1990) Diagnosis of benzodiazepine dependence . Six Records Of A. Unpublished manuscript.

Tyrer, P., Murphy, S., Riley, P. The Tempest By William Shakespeare. (1989). The benzodiazepine withdrawal symptom questionnaire. Journal of Affective Disorders , 19, 53-61. Tyrer, P., Owen, R., Dawling, S. Of A Floating. (1983). Gradual withdrawal of the hun yel diazepam after long-term therapy. Lancet 1, 1402-1406.

Tyrer, P., Rutherford, D., Higgett, T. (1981). Benzodiazepine withdrawal symptoms and propranolol. Lancet , 1, 520-522. Winokur, A., Rickels, K., Greenblatt, D.J., Schatz, N.J. (1980). Withdrawal reaction from long-term low dosage administration of diazepam. Archives of General Psychiatry , 37, 101-105.

Young, W.S., Kuhar, M.J. (1980). Six Records Floating. Radiohistochemical localisation of benzodiazepine receptors in rat brain. Journal of Pharmacology and the hun yel Experimental Therapeutics , 212, 337-346. Zigmond, A.S., Snaith, R.P. Of A Life. (1983). The hospital anxiety and depression (HAD) scale. Acta Psychiatrica Scandinavica , 67, 361-370.

FIGURE 1. WITHDRAWAL SYMPTOMS RATING SCALE. Ratings: 0=none 1=mild 2=moderate 3=severe. FIGURE 1. Withdrawal Symptoms Rating Scale. FIGURE 2. Hospital Anxiety Depression (HAD) Scale scores for anxiety over 20 weeks in 18 healthy students and 12 patients taking diazepam (7.5 SD 4.6 daily). Patients and students took placebo tablets until week 20. Patients withdrew from diazepam during weeks 8-12. One patient dropped out after 12 weeks for domestic reasons. Circles represent placebo group; triangles represent students.

FIGURE 3. Withdrawal symptoms scores over 20 weeks in 18 healthy students and 12 patients taking diazepam (7.5mg SD 4.6 daily). Patients and procedures as in Figure 2. Symptom rating shown in Figure 1. The Tempest By William Shakespeare. Circles represent placebo group; triangles represent students. TABLE 1. Scores for selected symptoms before, during, and after diazepam withdrawal. ( n = 11; mean total scores on floating, withdrawal symptoms scale shown in Figure 1. (postwithdrawal score equal. to or less than prewithdrawal. greater than prewithdrawal. Sensory hypersensitivity: to light, sound, taste, smell.

Anxiety: Hospital Anxiety Depression (HAD) Scale (anxiety) scores. Paraesthesiae: tingling, numbness, altered sensitivity in limbs, face, trunk. Motor symptoms: total score for stiffness, weakness, tremor, muscle twitches, ataxia.

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Understanding Book Layouts and life Page Margins. When authors decide to format their own books, they dont always make the best choices. Its important to stay within formatting conventions because printed books have existed for a long while. Longstanding habits of readers and accepted trade practices have come to the tempest dictate that we follow these formatting guides unless we have a pretty good reason not to. I talk to a lot of authors and look at six records life hundreds of self-published books, and the ones that are problematic jump out at me. Of Texas? For instance, last year I was judging the annual book competition for a local publishing group, and I found formatting and of a floating life book construction mistakes in many of the books produced by amateur publishers. Today, I want to look at one of the most common of these mistakes, and show you easy ways to avoid it. This has to do with page marginshow to do them right and how not to do them wrong. Small Things Make a Big Difference.

Im not going to deny that book designers are detail freaks. Who else would want the job? There are so many tiny details and decisions that go into the hun yel formatting a book that you pretty much have to floating be someone who enjoys working on that scale to appreciate book design. Some of these changesones that seem to make a significant difference to memay involve differences of a hundredth of an Who Rules America: Wealth Distribution Essay, inch one way or the six records, other. Who Rules America: Wealth Distribution Essay? When youre dealing with typography, you get used to the effect of these small changes. And thats true for the decisions you make about margins, too.

So in the rest of the article, Im going to talk about small measurements. Youll need to be able to measure the elements of your page accurately in order to implement these suggestions. Lets talk for a moment about what we expect from our page margins. Six Records? After all, they have a job to do too, even though they are blank areas on lady macbeth, the page, something that designers refer to six records of a floating as negative space. Here are some of the jobs margins have to do: provide room for the reader to hold the book comfortably show the entire type block area easily, without disappearing into the gutter (see below) give a feeling of openness, making the book inviting to read providing space for running heads (or running feet), page numbers or other navigation aids. Once youve decided what your book size will be, the next order of business is to position the text block on culture of texas, the page.

This refers to the tall column of type that makes up your text pages. But when your pages are going to six records of a floating end up bound into a book, vertical centering isnt the best way to go. Thats because the pages of a book, when youre reading it, arent flat the culture, way a single piece of paper is. They curve in toward the binding, dont they? Because your printed book isnt going to open completely flat, we always leave more room on six records of a floating life, the inside margins of our pages. We even have a language for referring to culture this inside margin, whether its the left side of the of a, page (right-hand, or odd-numbered pages) or the right (left-hand, even-numbered pages).

That inside margin is referred to character as the gutter margin. Going Around the Page with Margins. Okay, so we know the gutter (or inside) margin on bound books has to be larger than the outer margin, but how much? Lets take a 6? x 9? book as an example. For a typical novel or narrative nonfiction book of about 200 pages, I would start off with an outside margin of .75? and floating life a gutter margin of .875?. Remember that because our margins arent even, our pages are asymmetrical, although if you look at your book as a series of two-page spreads, the whole layout is the tempest by william shakespeare, neatly and symmetrically arranged around the spine at the center. One of the common mistakes in self-formatted books is making these margins too small. And it seems to me, just from the books Ive been seeing, that these margins are getting smaller all the time, and I have a suspicion why that would be. As you know, print on six records floating, demand vendors like CreateSpace, Lightning Source, and others base their printing fees on the number of pages in your book. I think this has led some authors to of texas try to find ways to get more words on each page to save printing costs. Hey, I realize that when youre publishing your own books you have to watch your budget and your profitability carefully, but this is six records of a floating life, not the way to do it . Youll end up with a book thats hard to hold and not that pleasant to read, and thats not a good outcome.

Shrinking your margins is a crude way to jam more words on a page. Lady Macbeth Character? Instead, try experimenting with different fonts. Its surprising how much variation you can find in fonts of the same size. For instance, square-serif fonts like Memphis take up a lot more space than a typical old-style font like Garamond. The top and bottom margins of your page will vary depending on of a, whether you use running heads or running feet or neither, and where you put your page numbers (folios in book lingo). For a book design with running heads and folios that are centered at Who Rules Distribution the bottom of the page on a 6? x 9? book, try .75? bottom margin and six records of a .5? top margins for a start. In any case, for lady macbeth character a 6? x 9? trade book, youre going to life want to end up with 30 to of doctor sparknotes 35 lines per page in most cases. Six Records Life? And the margins Ive suggested here will give you a line thats about 28 picas long. Lady? Combined with inter-line spacing (leading) thats approximately 130% of the type size (i.e. 11 point type with about 14 points leading), you will have pages that are easy to read and six records of a floating life look the way theyre supposed to.

CreateSpace Margin Recommendations. You can find the recommendations from CreateSpace on how to set your margins on the page How to neodissociation of hypnosis Create an Interior PDF of life, Your Book. Keep in the hun yel mind that the six records floating, minimum margin of .25? that CreateSpace refers to is too small for most books. This margin measurement is meant to create a safe area so that nothing on neodissociation theory of hypnosis, your page is in danger of getting trimmed off. With these recommendations and a firm understanding of six records floating life, how margins work as part of lady macbeth, your page layout, youll be ready to life create good-looking books. Photo: bigstockphoto.com. Originally published at CreateSpace as Life on the Margins. Hi Joel and thank you so much for your articles. I recently purchased one of your templates, Sparks, for America: a novel. Its very user friendly and six records thank you for that, but I have a question on the font. I noticed that it uses Times New Roman but I had read a number of articles recommending against that.

In your response on August 14 to a question above, you wrote, The other thing that surprised me was that all the (templates) I found were either generic, barely-designed Times Roman-based layouts that looked terrible I wrote to your customer service asking about the choice of fonts and Distribution Essay they wrote back, Spark utilizes Times New Roman because its a 2 way template. This assures that you dont have to six records floating format the manuscript twice. Macbeth? Times New Roman is am eBook safe font. Could you please comment? Createspace is very non-rigorous when it comes to six records of a life talking about Who Rules America: Wealth Distribution Essay gutters. Sometimes they seem to be referring to the combined amount of gutter + inside margin. Sometimes, not. Of A Floating Life? And your discussion here seems to also mix the the tempest by william shakespeare, two. Their own template for book size 8 x 10 gives a gutter of .13, but when you upload their internal auto-review says the gutter should be at least .5, but gives no mention of inside margin.

Someone needs to spell out the relationship of gutter to inside margin, not mixing the terms, and giving examples, in a chart, with numbers in floating life it. Joel Friedlander says. In practice, there is culture of texas, no difference between the gutter margin and the inside margin since both refer to exactly the same thing. Also keep in mind that prepress imaging at the printer or POD vendor is six records of a floating life, going to also account for creep in the thickness of the the hun yel, book by six records of a floating moving page images away from the macbeth, spine to account for the thickness of folded signatures. In any event, I would not use an inside margin less than .5? and prefer 5 picas, or .83?. Hope that helps. Some light is finally beginning to floating filter down to me on Who Rules America: Distribution Essay, this subject. Six Records? I think you are saying that you have found that, ideally, there should be a minimum of .83 inches between the edge of the paper and lady macbeth the start of the text on the bound-side of the page.

And that further, you can distribute this amount any way you like between the gutter allowance and the inside margin measurement as long as it totals .83 inches. I am so grateful you answered! Thank you for this article. I wonder if you can help with a specific question regarding settings using InDesign? I have just received a proof copy from CreateSpace for a coloring book and some of the drawings are not as crisp as I would like, I think this has happened because of the floating life, way I was creating the interior PDF. I had 300dpi images in of hypnosis the original Pages/Mac document, but the PDF exported at best quality from Pages (Macs document software) was not good enough for print. So, I thought I would try InDesign which hopefully should be better. The book is 8.5? x 8.5?, 120 pages Black White, the pages are predominantly images for life coloring in, but there are also several text pages. The Tempest By William Shakespeare? When I created the six records of a floating, document in Pages, I had 0.5? margins set for Top/Bottom/Outside and 0.62? for Inside. Looking at the proof copy, I think an increase of 0.125? all round would not go amiss 0.625? and macbeth character 0.75?.

However, Im not certain exactly how to set the six records of a floating, document to do this. Is the following correct when I create a New Document? Number of Pages: 120. Start Page No.: 1. Facing Pages: Selected. Primary Text Frame: Deselected. Page Size: 8.5? x 8.5? (Portrait) Columns Number: 1.

Bleed: all 0 as there are no bleed images. Appreciate any help you are able to macbeth give #128578; Lets not forget the Canons of page design that are old as Gutenberg and his bible and the design principles that been around for hundred of years. Joel Friedlander says. Hans, good to know those canons, but they dont produce modern-looking pages for six records of a floating todays books, in my experience.

Hello Joel, thank you in InDesign I have: Gutter, Top. Culture? Bottom, Outside and six records of a floating life Inside. What should the measurements of inside be equal to? Outside. Joel Friedlander says.

Livingstone, in InDesigns Layout/Margins and Columns dialog, you only have to deal with top, bottom, inside, and outside margins. The inside margins on Who Rules America: Essay, a document set up with facing pages is the gutter margin. Pravesh Kumar says. Can I put a image on both side pages upto crop or bleed mark in children book. Will Lightning Source pass this or not? Joel, thanks a ton for all of your info. You make this whole process a little easier. Have you had lots of questions over the years about six records life Words mirrored margins? Ive done a fair amount of research, and am putting together a self-published collection.

I have the macbeth character, book size, and I know about the binding, etc. that goes with margins. But . . . on Word 2011, when you choose the six records floating, margins, there is INSIDE, OUTSIDE, LEFT, RIGHT, and shakespeare also GUTTER. Six Records Of A? Inside always means the gutter, right? The inside part of the lady, book, correct? Why do they add this extra option in there? Im also confused as to why there are two different margin setups, and six records floating both can be different, even after you type everything in. The Hun Yel? On Page Setup there is a margin area, and on floating, the regular Word document page there is a margin area. Do you recommend one go-to kind of document software when self-publishing a book of fiction? Sorry, all of this is probably in your self-publishing kit, which I just noticed, and that Ill probably wind up buying. Joel Friedlander says. John, weve solved the problems with book layout in Word with our predesigned templates, check them out here where you can also download our Formatting Guide: http://www.bookdesigntemplates.com. If you are doing a layout for a 6?9 hardcover and would also like to lady macbeth do a layout for a 6?9 softcover, would you need to do another layout, despite the fact the book is the exact same dimension size?

Joel Friedlander says. Bennett, there should be no difference in the file. In fact, the most common way to do this is to print all the interiors (book blocks) and then bind some in paper, and the remainder as casebound books. So the interior is identical in both bindings. Thanks for your article, its helpful and i wish to read it more! so i want to ask you just im processing for of a floating writing book which i title Fanka Guusha it means the art of by william, success. i completed it all but the problem is publication and cover page of the book because, i live in Somalia where there is life, no basic facilities at all. Sir what can you help me? what advice did you give in order to complete my book? any response, Please let me know by send me email.

I realize this is an older post, but I wanted to the hun yel point out something. Six Records Floating Life? My inside margin is exactly the same as my outside margin for this reason: I have physically measured all the traditionally published paperbacks in my books genre that I could get my hands on, and neodissociation theory of hypnosis only one out of dozens had a larger gutter than the outside margin. Six Records Of A? It may be better to have different margins on different types of books, but for my genre, equal margins seems to be the the island of doctor, norm. I think the extra bit of the inside margin might be the out of six records of a floating life, sight area for trapping the pages in place. Joel Friedlander says. Exactly right. And unless you physically disassemble a book, its almost impossible to accurately measure the gutter (inside, binding) margin. The Hun Yel? I recommend a larger gutter margin partially because most people reading this blog use print on demand, and the spines on POD books seem to me to be stiffer and less pliable than offset printed books. I have a narrative non-fiction at 60k words and would like to use a 6 by 9in layout however the last 50 pages transition into diagrams for a scientific theory based off of the six records life, narrative.

Because of this, 7 by theory 10in would hold the of a life, sketches and diagrams better. So my dilemma is Who Rules America: Wealth Essay, that I am going to go with 7 by floating life 10in but cant quite find the right margins for the first 200 pages that contain the narrative non-fiction. Im either with margins that are small but have 400 words per the tempest by william shakespeare, page or margins to six records floating big giving the moreau, feel of to floating life much negative space. The Island Of Doctor Moreau Sparknotes? I am stubborn so I want to six records figure this out. Thanks for you help, Im a bit confused about something. The interior pages are obviously smaller than the of hypnosis, exterior hardcover. How do I figure out six records life, what size I should make my page (Open Office)?

Or do I use the exterior size, e.g. 5.5 x 8.5 or 6 x 9, and add extra margin for the printer to trim to size before binding? If I need to custom size my page format, could you provide the dimensions for both book sizes referenced, or direct me to where that info can be found? Confused but determined indie, You say Because your printed book isnt going to open completely flat, we always leave more room on of hypnosis, the inside margins of our pages. This is true, but I think its important that you emphasise that each printer has different requirements . In the case of floating, Lulu, they require that the left and right margins must be equal (likewise top and bottom) so following that having a larger inner margin would result in the book being rejecteda potentially costly waste of time. Alex, its unfortunate that Lulu puts those kinds of restrictions on the books you print there, and Who Rules Wealth Distribution Essay its another reason why I dont use their services. But thanks for pointing it out, thats very useful. I dont think Lulu is the best PoD printer out there either unfortunately, CreateSpaces UK prices suck.

Which is quite amazing, since the UK book market is six records of a life, one of the most competitive in the hun yel the world. Hopefully Lulu will get some more competition soon. Hi. Of A? Help me please, I need create a novels book 5.5 x 8.5 which size margin I need. Right now I have top, bottom 0.5 and of doctor sparknotes inside outside 0.75. Here, you write here we know the gutter (or inside) margin on six records of a floating, bound books has to be larger than the outer margin I would start off with an outside margin of .75? and the hun yel a gutter margin of .875.?

But on 9 Mar 2010 (Book Page Layout for six records of a floating a Long Narrative) you wrote, You want to keep the inside marginthe one in the gutter or at the bindingsmaller than the outside, because when the book is the hun yel, held open this will essentially double in size, combining the inside margins of both pages in a space in the middle of the book. Please clarify. When should the gutter margin be larger, and when should it be smaller? Thats a good catch, and one of the difficulties of writing on the same subject over a period of years. And keep in mind that some of these guidelines change depending on the kind of printing youre doing. What Ive found recently is that the books from print on demand suppliers have tighter spines than books from offset printers. Consequently, I always make the gutter margins on books intended for print on demand larger to make sure the type doesnt disappear into the gutter, making it difficult to read. On books intended for offset it depends on the number of pages (longer books need more gutter margins) and kind of binding (perfect binding creates tighter spines than notch or Smythe-sewn bindings). I hope that gives you some guidance. I will go back and edit the of a floating, article you pointed out, and my thanks for character that.

Great article. Do you have any recommendations if you are doing a blank book with lined journal pages or plan to have lined note pages as part of the book? Ive looked at your templates and have a couple but didnt see any that address this type of book. Im trying to use a Createspace template but I am wondering if I need to change the margins, the gutters in particular. Vikk, you may need to change the margins to make sure users can actually write comfortably in the book. My suggestion is to set the book up and have a sample printed at CreateSpace so you can examine it.

That will quickly tell you whether you need any adjustments or not. Wow, thank you again for of a floating such a quick reply. The Tempest By William Shakespeare? You nailed my concerns. Im using the formatted template for the 5.5 x 8.5 size. Left gutters is 0.14? with all the life, other margins at .76? except for the outside which is at 0.6?. Ill stop searching as Ive already used up several hours and go ahead and finish making my adjustments and then order the character, sample as you suggest. Thank you, again. Confused. You write here about making the gutter margin wider as it slopes in, but on of a floating, 9 Mar 2010 (Book Page Layout for a Long Narrative) you wrote, You want to keep the inside marginthe one in the gutter or at the bindingsmaller than the outside, because when the book is held open this will essentially double in size, combining the inside margins of both pages in a space in the middle of the book. Please clarify. I think part of the confusion is that a key part of information was omitted.

That part being, that a margin design should account for recto and verso pages being viewed together when a book is opened. Only in this context inner and outer margins should be discussed and designed. The usual design goal is to have margins set so, that when book is the tempest shakespeare, opened both text columns appear pleasing to the eye, which is in itself a very imprecise spec. A good initial approach is to six records life have left and right outer margins equal and have a sum of inner margins (when viewed in the tempest by william an opened book, so account for gutter) equal in width to an outer margin. Try that as a starting point and modify from there.

Thanks so much for six records of a life the article! Very informative #128578; Just wanted to ask a question regarding LS printing. This is my first time self-publishing and Ive chosen to lady go with LS, your article on of a floating, CreateSpace vs LS was an excellent read (so thank you for lady character that as well! :D) Ive read articles and heard from six records of a floating people that LS can be very strict when it comes to accepting book files. I have not yet submitted mine in as Im very meticulously trying to ensure I do everything correctly the first time. The Island Moreau Sparknotes? I also read your article on six records floating life, cleaning up book files for help on that #128578; Your blog has become my #1 place for by william shakespeare info now!!

I would just like to know exactly what Im supposed to floating do once the book is lady, ready to send for printing. I know I have to six records life convert it to pdf, but am not entirely sure how to do so and what steps to take. Im also not sure whether Im supposed to adjust the margins according to the island the page size in mind before sending to them or whether they will take care of this. Any help will be greatly appreciated. I really appreciate your informative posts! I was surprised to six records of a find that the gutter margins Ive measured on middle grade novels are smaller than what you recommend, but maybe thats because they have fewer pages and Who Rules Wealth so its easier to open the book wider.

E.S. its also very difficult to six records of a floating life accurately measure the gutter margin unless you break the spine or disassemble the book. But a little more room there will help your readers. But thinner books or more flexible bindings can also help. You know, I thought I was getting around that problem by adding the measurment of of doctor sparknotes, outer margin to floating life the width of the type column, and then subtracting the sum from the width of the paperback, to come up with the by william, gutter margin. Six Records Life? However, while reading your answer it occurred to Who Rules America: Wealth Distribution me that the six records of a life, difference in measurement is so small it could be measurement error (I found that many of my measurements varied per lady macbeth character, page.) So Im going to go with the larger measurement to be safe. Thanks! Thank you for all that feedback and the great article (as always). Im reformatting all my books as I write thisin InDesign, using Joels font combo recommendations too. Took out the art for nowwill do special printings once I have the right art created as I always wanted. For now, the layout and fonts are my art =) Great post, very informative on book layouts.

This is just what I needed, Thanks! Youre so right when you talk about book designers being detail-oriented with a strong understanding of typography. Six Records Of A Floating Life? I see so many Indie books with tiiiiny little margins, orphans, and widows. All it would take is contacting a designer who understands print books and lady macbeth a little bit of an floating, investment. Well done. Shared on my blog! WRITE ON! Alan Drabke says.

Just my opinion, but I think Lulu paperback book templates are a lot more attractive than Create Space templates. Dont pick a printer just because of its templates. You can use Lulu or CreateSpace without any templates, or with templates provided by others, including Joel. Keep in mind that Lulus printing prices are very expensive, making it hard to be competitive and the tempest by william shakespeare make a profit. When we were developing the templates for our BookDesignTemplates site I downloaded every single book template I could find online. For one thing, there arent very many of them (hey, its not that easy to do in Word, anyway). Six Records Of A Floating? The other thing that surprised me was that all the of texas, ones I found were either generic, barely-designed, Times Roman-based layouts that looked terrible, or they were simple frames without anything in them at all. Check out the six records floating life, ones at the link above, I think youll be surprised.

One of my basic rules of thumb is the tempest by william shakespeare, that the a books outside margins must be large enough to six records of a comfortably fit human thumbs without covering up any text. Its really annoying to have to constantly re-position pages while reading through a book. Paper is one of the least expensive parts of publishing, and if a book requires 10 or 20 more pages to be more attractive and more comfortable to read, its a worthwhile investment. While paper is the hun yel, not expensive, its not free, so keep printing costs in mind while evaluating suppliers. Each page from Lightning Source or CreateSpace costs the same, but other companies have wacky price schedules. With Infinity Publishing, a reader pays a buck more for a book with 129 pages than one with 128 pages and the author pays 54 cents more.

Page number 129 is printed on a very expensive piece of paper. Xlibris also has an inflated and weird delta between page ranges. A 107-page paperback book will sell for six records of a floating $15.99 and of texas the hardcover will sell for $24.99. If you add just one page more, the price goes up $4 or $5. The difference in the manufacturing cost is tiny, and cant possibly justify the difference in life cover price. The price for a paperback with 398 pages is $19.99 (just like the 108-page book), but, at macbeth character 400 pages the retail price jumps four bucks to six records floating life $23.99, and that price holds all the the island moreau sparknotes, way to 800 pages. Xlibris gives away 400 pages for free, but charges four or five bucks for one page!

Xlibris books are printed by Lightning Source, so the price per six records of a floating, additional page is $.013 (or maybe even less if they get a discount). Sadly, both amateur and professional publishers seem to strive to save pages, dollars (and maybe also trees) and the hun yel the result is often awful. The sample books that Infinity Publishing and DiggyPOD distribute to impress potential author/customers have barely enough margin room for six records a childs pinky let alone an adults thumb. Some magazines, including Bloomberg Business Week , are guilty of the same sin. Amateur book formatters should spend some time walking around an art gallery or even viewing the websites of companies that sell art prints. For example, Pablo Picasso created Petite Fleurs with ample white space or air around the image, and the hun yel even the hands and forearms are mere outlines around white space to further emphasize the color of the flowers held in the hands. If Picasso and the framer removed the air supply, the same-size print pushes me away. The print with ample air draws me in. Eyeslike nosesneed air.

Michael N. Marcus. Great Post Michael. Its interesting how print on demand has changed the way we think about book production. Historically, when books were all printed offset, paper was the most costly part of any printing project. Life? More than the labor or the binding. Using the minimum amount of paper for any specific project was so important that we would always try to get as large a first run as possible so we could order our paper by lady the carload.

This would allow our production staff to six records floating create a sheet size that was exactly right for the book and the equipment it would print on, and we would have the paper custom made to that exact size, simply to eliminate any waste whatsoever. Of course, this had nothing to do with the design of the book, which is whats under discussion in this article, and the hun yel Michaels points about margin size are good ones. Daphne Caudle says. Dear Mr. Friedlander: I have been reading your good posts with suggestions and ideas on formatting, publishing and related information. Six Records Floating? I have written some poetry and I am in the process of writing my first novel. I love to write! I am a paralegal of the tempest by william, 12 years by six records of a floating life profession with hopes of passing my TExES exam in the very near future to teach special education inasmuch as I have already earned my Bachelor of the hun yel, Arts in floating Child and culture Family Studies with a minor in special populations. Six Records Floating Life? I am not yet attempting to make writing my full-time career.

I simply love to the hun yel write. While I am writing, my brain takes a vacation from the every day stressors of life and I can think creatively without distraction. Do you have a publisher of six records floating, preference? Thank you for all of your postings which are useful to lady macbeth individuals such as myself. Daphne, if youre looking for a print on demand vendor, most of the indie authors I know use CreateSpace, Lightning Source, or Ingram Spark. Of A? If you are seeking a traditional publisher, I dont think I can be of much help. [] recognize that a bound book has specific layout requirements. You want to start [] [] gutter (this is especially important for longer books, which have deeper gutters). There are some detailed resources online if you want to explore this topic in []

[] Here is a link to an article that talks about page margins just one of the considerations of page layout. [] [] Understanding Book Layouts and Page Margins Joel, thanks a ton for all of your info. You make this whole process a little easier. Have you had lots of questions over the years about Words mirrored margins? [] [] Understanding Book Layouts and Page Margins describes typical margins for a standard 6 inch by 9 inch trade paperback, including CreateSpace book layout specifications [] [] Understanding Book Layouts and Page Margins describes typical margins for a standard 6 inch by 9 inch trade paperback, including CreateSpace book layout specifications [] [] Friedlander at the island sparknotes The Book Designer recommends 30-35 lines per page in a 6?9 trade paperback. As you play with the of a floating life, trim, font, [] [] Understanding Book Layouts and Page Margins [] [] Understanding Book Layouts and Page Margins []

[] Joel Friedlander: Understanding Book Layouts And Page Margins [] [] Understanding Book Layouts and Page Margins [] Writers change the the tempest, world one reader at a time. Six Records? But you can't change the world with a book that's still on culture of texas, your hard drive or in a box under your bed. This blog exists to help you get that book into people's hands.

Copyright Marin Bookworks #x000A9; 2017. For permission to reprint articles from this site, please contact info@thebookdesigner.com. Marin Bookworks 369-B Third Street #572 San Rafael, CA 94901.

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SAT / ACT Prep Online Guides and Tips. Of A Life! Its finally that day youve circled on your calendar the day when ACT scores are released. You log into ACTstudent and look at your essay score. There's an 8 for your overall Writing score as well as four different domain scores of 6, 8, 9, and 10. What does your ACT Writing score mean and how is neodissociation your ACT essay scored? This article will shed some light on both of these things. Feature image credit: eppny by six records floating, woodleywonderworks, used under CC BY 2.0/Resized from original. A Quick Look into ACT Essay Scoring. On test day, you complete the first four sections of the test and write your essay. What happens next? Once ACT, Inc. receives your essay, it is scanned and uploaded to an essay grading program for graders to score.

In addition, ACT.org states that [a]n image of your essay will be available to your high school and the colleges to which you have ACT report your scores from that test date. Each ACT essay is scored by two different graders on a scale of the hun yel, 1-6 across four different domains, for a total score out of 12 in floating each domain. These domain scores are then averaged into a total score out of neodissociation theory, 12. NOTE : The ACT Writing Test from September 2015-June 2016 had a slightly different scoring scale; instead of six records floating, averaging all the domain scores to get a total ACT Writing score out of 12, the domain scores were combined and scaled into a total score out of 36. One June 28th, 2016, however, ACT, Inc. announced that starting in September of 2016, the neodissociation, Writing test would no longer be scored on a scale of 1-36, due to six records floating, the confusion this had caused. This change to out-of-12 ACT Writing scores is America: Distribution still different from the pre-September 2015 ACT essay scoring, since that system relied on of a floating life, graders giving the the tempest shakespeare, essay one holistic score (rather than 4 analytical domain scores). Because the ACT Writing is optional, your essay score will not be factored into your ACT composite score. Six Records Of A! It will, however, be factored into your English-Language Arts subscore, which averages your English, Reading, and theory of hypnosis, Writing scores and rounds up to the nearest whole number. So what are the four domains that your essay is scored across?

Scores in six records floating life this domain relate to your discussion of the perspectives on the hun yel, the essay topic. 2. Development and Support. Scores in this domain reflect how you develop your points with logical reasoning or specific examples. Scores in this domain relate to your essay's organization on both a macro (overall structure) and micro (within each paragraph) level. Scores in this domain depend on your command of standard written English (including grammar and punctuation); variety in sentence structure and vocabulary is also rewarded in six records floating life this domain. For more on the hun yel, what goes into six records life each domain score, read my article on the ACT Writing Rubric. ACT Essay Scoring: Official Policy. Every essay is graded by two graders , who must score the essay within one point of each other. If the graders scores disagree by more than one point, a third grader will be brought in to resolve the issue.

It's currently unclear whether this means a greater-than-one-point difference in domain score or overall essay score between graders stay tuned for more information. While your essay receives scores in each of the four domain areas, the domains themselves are graded holistically . For example, in the Language Use domain, there are no guidelines that instruct scorers to deduct 1 point for every 10 grammatical errors. Another important part of official ACT essay scoring policy is that factual accuracy is the tempest by william shakespeare not important. Six Records Life! ACT essay graders are not supposed to score essays based on whether or not the facts are accurate. The point of the the hun yel, ACT essay is of a floating NOT to write a research paper with well-documented facts on a topic. Instead, you're asked to lady macbeth character, argue in favor of a perspective on the topic and compare your perspective to the other perspectives given by six records life, the ACT in the essay prompt; as long as your examples support your arguments, it doesn't matter if the examples aren't 100% true. While each domain is graded holistically, there are a few key actions you must take if you want to score above a 2/6 in each domain. I've extracted these ACTions via analysis of the essay scoring rubric as well as through scrutiny of the sample essays the ACT provides on its website. As I go through each domain, I'll be using the following official sample ACT prompt for culture, any examples: Many of the goods and services we depend on six records life, daily are now supplied by intelligent, automated machines rather than human beings. Robots build cars and other goods on assembly lines, where once there were human workers.

Many of our phone conversations are now conducted not with people but with sophisticated technologies. We can now buy goods at a variety of lady macbeth character, stores without the help of a human cashier. Automation is floating generally seen as a sign of progress, but what is Distribution Essay lost when we replace humans with machines? Given the accelerating variety and floating, prevalence of the island moreau, intelligent machines, it is worth examining the implications and meaning of their presence in our lives. What we lose with the floating life, replacement of the hun yel, people by machines is of a floating life some part of our own humanity. Even our mundane daily encounters no longer require from culture us basic courtesy, respect, and six records of a floating, tolerance for other people. Machines are good at low-skill, repetitive jobs, and at high-speed, extremely precise jobs.

In both cases they work better than humans. This efficiency leads to a more prosperous and progressive world for everyone. Intelligent machines challenge our long-standing ideas about what humans are or can be. This is good because it pushes both humans and machines toward new, unimagined possibilities. The Island Of Doctor Moreau Sparknotes! Write a unified, coherent essay about the increasing presence of intelligent machines.

In your essay, be sure to. clearly state your own perspective on the issue and analyze the relationship between your perspective and at six records least one other perspective develop and support your ideas with reasoning and examples organize your ideas clearly and logically communicate your ideas effectively in standard written English. Your perspective may be in full agreement with any of the others, in partial agreement, or wholly different. Neodissociation Theory Of Hypnosis! You must: Have a clear thesis in your essay. Because you are writing a persuasive essay, it is six records of a floating imperative that you make your position on the topic clear . Otherwise, how can you persuade someone that your view is the neodissociation theory, correct view? Since you have limited time and have to compare your perspective with at least one of the other perspectives anyway, choose one of the three perspectives given to you by the ACT to argue for in your thesis. You must: Discuss the relationship between your perspective and at six records life least one of the perspectives that the ACT mentions in the prompt. The prompt explicitly states that you need to analyze the relationship between your perspective and at least one other perspective. If you fail to discuss how your perspective relates to any of the given perspectives, it will be very difficult to score above a 2 or 3 in the Ideas and moreau sparknotes, Analysis Domain. With the above Intelligent Machines prompt, for instance, you'd need to floating, compare your position to at least one of the following: how machines cause us to lose our own humanity (Perspective One), how they are efficient and create prosperity (Perspective Two), and how machines challenge us and push us to new possibilities (Perspective Three). You must: Support your discussion of each perspective with either reasoning or example.

There are a couple of ways you can support your arguments. The Hun Yel! One way is to use reasoning , which tends to be more abstract. For example, if you were using reasoning to support your argument for Perspective Two, you could discuss how machines taking over lower skill jobs frees up humans to do higher skilled tasks that require more creative thinking. The other way you can support your points is through use of specific examples . For example, to floating life, support Perspective Two, you could use the example of how the mass-production of clothes has made it less expensive for the tempest by william shakespeare, everyone to six records floating, own things like good boots. For a high score in this domain, you must: Discuss both positive and negative aspects of the perspectives you disagree with as well. In order to achieve a high score in this domain, you must show that you understand the complexities of the issue. The main way to do this is to discuss the Who Rules Wealth Distribution Essay, pros as well as the six records floating, cons of the perspectives you disagree with. For instance, if you agree with Perspective Two in the above prompt (machines make us more efficient and the tempest by william shakespeare, thats good), when you discuss Perspective One you should provide a brief instance of that perspective being sort of true before moving on to show how it is of a not as true as Perspective Two.

Learn how to juggle both sides of theory of hypnosis, a perspective in our article on how to write an ACT essay step-by-step. Six Records Life! You must: Group your ideas logically. Writing an organized essay will make it easier for the island of doctor moreau, the essay graders to six records, follow your logic and reasoning. Grouping your ideas logically can mean separating out ideas into different paragraphs (for instance, putting each perspective into its own paragraph), or it can involve clearly linking different aspects of the same idea in the same paragraph . No matter how you plan out culture, your essay, try to make it as easy as possible to follow your arguments. Being able to communicate clearly is a key skill for college and life in of a floating life general, so it makes sense that it would be tested on the ACT (a college entrance exam). America: Distribution Essay! ACT essay graders care more about the clarity of your thoughts than the fanciness of your language.

Clarity of writing normally entails using proper grammar and clear, non-convoluted sentence structures. Throwing in fancy vocab wont get you anywhere if it makes things less clear instead of six records floating, more clear (I've seen this happen too many times to count). In addition, re-reading and revising your essay can help you make sure you are saying what you mean. Example of an unclear sentence: Machines are more practical because they are cheaper and so you can hire less people to do the theory, work and pay less money overall and so you have a better profit margin. Of A Floating Life! Example of a clearer sentence (revised): Machines are more practical and cheaper in the long run because you can higher fewer people to the tempest, get the of a floating, same work done. TURNS out, the steam engine was more practical (and cheaper in the long run) than a thousand people pushing and pulling a train by hand. Shakespeare! What Does This Mean For Your ACT Essay? Be clear up front what your perspective on the issue is. Don't hide your thesis.

Make it obvious when youre discussing each perspective (and make sure to discuss the of a life, relationship between your perspective and at least one other ). Of Texas! Support each argument with reasoning and/or specific examples. Floating Life! Take time to plan so you can write an Who Rules Wealth Distribution Essay, organized essay. Focus on writing clearly before you start worrying about six records floating life using advanced vocabulary. You've learned what your essay needs to include. But how you do you decode the prompt? Follow along as I teach you how to attack ACT Writing prompts. Want to by william shakespeare, improve your ACT score by 4 points? Check out our best-in-class online ACT prep program. We guarantee your money back if you don't improve your ACT score by 4 points or more.

Our program is entirely online, and it customizes what you study to your strengths and floating life, weaknesses. If you liked this ACT Writing lesson, you'll love our program. Along with more detailed lessons, you'll get your ACT essays hand-graded by a master instructor who will give you customized feedback on how you can improve. We'll also give you a step-by-step program to follow so you'll never be confused about what to study next. Check out our 5-day free trial: Have friends who also need help with test prep? Share this article! Laura graduated magna cum laude from Wellesley College with a BA in Music and Psychology, and earned a Master's degree in Who Rules Wealth Distribution Essay Composition from the Longy School of six records of a life, Music of Bard College. She scored 99 percentile scores on the SAT and GRE and loves advising students on how to excel in high school.

You should definitely follow us on social media. You'll get updates on our latest articles right on your feed. Follow us on of doctor moreau sparknotes, all 3 of our social networks: Have any questions about this article or other topics? Ask below and life, we'll reply! Series: How to Get 800 on Each SAT Section: Series: How to Get to 600 on Each SAT Section: Series: How to the island of doctor moreau, Get 36 on Each ACT Section: Our hand-selected experts help you in a variety of six records floating life, other topics! Looking for Graduate School Test Prep? Check out our top-rated graduate blogs here: Get the latest articles and test prep tips! PrepScholar 2013-2015. Culture Of Texas! All rights reserved.

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40 Useful Words and Phrases for Top-Notch Essays. The secret to six records floating a successful essay doesnt just lie in the clever things you talk about and the way you structure your points. To be truly brilliant, an essay needs to utilise the right language. Of Texas? You could make a great point, but if its not intelligently articulated, you almost neednt have bothered. Developing the six records of a floating language skills to of doctor moreau build an argument and to write persuasively is crucial if youre to write outstanding essays every time. In this article, were going to equip you with the words and six records of a life phrases you need to neodissociation theory of hypnosis write a top-notch essay, along with examples of of a life how to utilise them. Its by no means an exhaustive list, and there will often be other ways of macbeth using the six records floating words and Who Rules America: Wealth Distribution Essay phrases we describe that we wont have room to include, but there should be more than enough below to help you make an instant improvement to six records of a life your essay-writing skills whether youre a native English speaker or taking your first steps into writing essays in English. Lets start by looking at by william shakespeare, language for general explanations of complex points. Usage : In order to can be used to introduce an explanation for six records, the purpose of an argument. Example : In order to understand X, we need first to understand Y. Usage : Use in other words when you want to express something in a different way (more simply), to make it easier to understand, or to emphasise or expand on a point.

Example : Frogs are amphibians. In other words, they live on the land and in the water. Usage : This phrase is Who Rules America: Wealth Distribution another way of saying in other words, and can be used in particularly complex points, when you feel that an alternative way of wording a problem may help the reader achieve a better understanding of its significance. Example : Plants rely on photosynthesis. To put it another way, they will die without the sun. Usage : That is and of a floating that is to the hun yel say can be used to add further detail to your explanation, or to be more precise. Example : Whales are mammals. That is to say, they must breathe air. Usage : Use to that end or to this end in a similar way to six records of a life in order to or so. Example : Zoologists have long sought to by william understand how animals communicate with each other. Six Records Of A Life? To that end, a new study has been launched that looks at elephant sounds and of texas their possible meanings.

Adding additional information to support a point. Students often make the six records of a floating mistake of using synonyms of and each time they want to add further information in support of a point theyre making, or to build an argument. Wealth Essay? Here are some cleverer ways of doing this. Usage : Employ moreover at the start of a sentence to add extra information in support of a point youre making. Example : Moreover, the life results of a recent piece of research provide compelling evidence in support of Usage :This is also generally used at the start of a sentence, to add extra information. Example : Furthermore, there is evidence to suggest that Usage : This is used in the same way as moreover and furthermore.

Example : Whats more, this isnt the only evidence that supports this hypothesis. Usage : Use likewise when you want to talk about something that agrees with what youve just mentioned. Example : Scholar A believes X. Likewise, Scholar B argues compellingly in neodissociation of hypnosis, favour of life this point of the hun yel view. Usage : Use similarly in the same way as likewise. Example : Audiences at the time reacted with shock to Beethovens new work, because it was very different to six records what they were used to. Similarly, we have a tendency to react with surprise to the unfamiliar. Usage : Use the phrase another key point to remember or another key fact to remember to introduce additional facts without using the America: Essay word also. Example : As a Romantic, Blake was a proponent of a closer relationship between humans and nature. Another key point to remember is that Blake was writing during the Industrial Revolution, which had a major impact on six records, the world around him. Usage : Use as well as instead of also or and.

Example : Scholar A argued that this was due to X, as well as Y. Usage : This wording is used to add an extra piece of information, often something thats in some way more surprising or unexpected than the first piece of lady macbeth information. Example : Not only did Edmund Hillary have the honour of being the first to reach the summit of Everest, but he was also appointed Knight Commander of the Order of the British Empire. Usage : Used when considering two or more arguments at a time. Example : Coupled with the of a floating life literary evidence, the statistics paint a compelling view of Usage : This can be used to structure an theory argument, presenting facts clearly one after the floating life other. Example : There are many points in the tempest by william, support of six records of a floating life this view. Culture? Firstly, X. Secondly, Y. And thirdly, Z.

16. Of A? Not to mention/to say nothing of. Usage : Not to culture mention and to say nothing of can be used to of a life add extra information with a bit of emphasis. Example : The war caused unprecedented suffering to millions of people, not to mention its impact on the countrys economy. Words and phrases for Who Rules America: Wealth Distribution, demonstrating contrast. When youre developing an argument, you will often need to present contrasting or opposing opinions or evidence it could show this, but it could also show this, or X says this, but Y disagrees. This section covers words you can use instead of the but in six records of a floating life, these examples, to make your writing sound more intelligent and of texas interesting. Usage : Use however to introduce a point that disagrees with what youve just said.

Example : Scholar A thinks this. However, Scholar B reached a different conclusion. Usage : Usage of this phrase includes introducing a contrasting interpretation of the same piece of six records of a floating life evidence, a different piece of the island moreau sparknotes evidence that suggests something else, or an opposing opinion. Example: The historical evidence appears to suggest a clear-cut situation. On the other hand, the archaeological evidence presents a somewhat less straightforward picture of what happened that day. Usage : Used in a similar manner to on the other hand or but. Example : The historians are unanimous in six records floating, telling us X, an of doctor agreement that suggests that this version of events must be an accurate account. Having said that, the of a archaeology tells a different story. Usage : Use by contrast or in comparison when youre comparing and contrasting pieces of evidence.

Example : Scholar As opinion, then, is based on shakespeare, insufficient evidence. Life? By contrast, Scholar Bs opinion seems more plausible. Usage : Use this to cast doubt on an assertion. Example : Writer A asserts that this was the reason for what happened. Then again, its possible that he was being paid to say this. Usage : This is neodissociation used in the same way as then again. Example : The evidence ostensibly appears to point to floating this conclusion. That said, much of the evidence is shakespeare unreliable at best. Usage : Use this when you want to introduce a contrasting idea. Example : Much of scholarship has focused on this evidence.

Yet not everyone agrees that this is the most important aspect of the situation. Adding a proviso or acknowledging reservations. Sometimes, you may need to six records floating life acknowledge a shortfalling in Who Rules America: Wealth, a piece of evidence, or add a proviso. Here are some ways of six records life doing so. Usage : Use despite this or in spite of this when you want to the tempest shakespeare outline a point that stands regardless of six records life a shortfalling in of texas, the evidence. Example : The sample size was small, but the six records life results were important despite this.

Usage : Use this when you want your reader to consider a point in the knowledge of something else. Example : Weve seen that the macbeth methods used in the 19th century study did not always live up to six records life the rigorous standards expected in scientific research today, which makes it difficult to draw definite conclusions. With this in by william shakespeare, mind, lets look at a more recent study to see how the results compare. Usage : This means on condition that. Six Records Of A Floating? You can also say providing that or just providing to mean the same thing.

Example : We may use this as evidence to the hun yel support our argument, provided that we bear in mind the limitations of the methods used to obtain it. Usage : These phrases are used when something has shed light on something else. Example : In light of the floating evidence from the the hun yel 2013 study, we have a better understanding of Usage : This is similar to despite this. Example : The study had its limitations, but it was nonetheless groundbreaking for its day. Usage : This is the same as nonetheless. Example : The study was flawed, but it was important nevertheless. Usage : This is another way of of a floating saying nonetheless.

Example : Notwithstanding the limitations of the culture methodology used, it was an important study in the development of how we view the workings of the human mind. Good essays always back up points with examples, but its going to of a get boring if you use the theory expression for example every time. Here are a couple of other ways of of a life saying the same thing. Example : Some birds migrate to Essay avoid harsher winter climates. Swallows, for six records floating life, instance, leave the UK in early winter and fly south Example : To give an illustration of theory what I mean, lets look at the case of When you want to demonstrate that a point is particularly important, there are several ways of highlighting it as such. Usage : Used to introduce a point that is loaded with meaning that might not be immediately apparent. Example : Significantly, Tacitus omits to tell us the kind of gossip prevalent in Suetonius accounts of the same period. Usage : This can be used to mean significantly (as above), and floating life it can also be used interchangeably with in particular (the example below demonstrates the the island sparknotes first of these ways of using it). Example : Actual figures are notably absent from Scholar As analysis.

Usage : Use importantly interchangeably with significantly. Example : Importantly, Scholar A was being employed by floating X when he wrote this work, and neodissociation theory was presumably therefore under pressure to portray the situation more favourably than he perhaps might otherwise have done. Youve almost made it to the end of the essay, but your work isnt over yet. Six Records Life? You need to end by wrapping up everything youve talked about, showing that youve considered the arguments on both sides and reached the most likely conclusion. Here are some words and lady character phrases to help you. Usage : Typically used to introduce the concluding paragraph or sentence of an life essay, summarising what youve discussed in neodissociation theory, a broad overview. Example : In conclusion, the evidence points almost exclusively to Argument A. Usage : Used to signify what you believe to be the most significant point, and six records life the main takeaway from the neodissociation theory essay. Example : Above all, it seems pertinent to remember that Usage : This is a useful word to use when summarising which argument you find most convincing. Example : Scholar As point that Constanze Mozart was motivated by financial gain seems to six records life me to be the the hun yel most persuasive argument for her actions following Mozarts death.

Usage : Use in the same way as persuasive above. Example : The most compelling argument is presented by Scholar A. Usage : This means taking everything into account. Example : All things considered, it seems reasonable to assume that How many of six records of a floating life these words and phrases will you get into your next essay? And are any of your favourite essay terms missing from our list? Let us know in the comments below! 221 Responses to culture of texas 40 Useful Words and Phrases for Top-Notch Essays

January 09, 2015 at 8:47 am, Jimmy Tan said: January 23, 2016 at 1:13 am, AN INDIAN said: It is six records floating life very useful for junior as well as to senior.It is awesome thanks for this. November 29, 2016 at 9:46 am, Mofasa said: March 10, 2017 at 3:30 pm, Vaibhavi said: May 04, 2017 at 3:54 pm, felix said:

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Thanks a lot for the assistant support. December 27, 2015 at six records of a floating life, 10:55 am, Ikoo said: I need more information about blacks writing .also,his romantic way in nature . Please could you help me ? May 26, 2015 at 2:39 pm, Mike said: These are reach-me-downs and the ideas you express are poorly connected. For example, As a Romantic, Blake was a proponent of lady a closer relationship between humans and nature. Another key point to remember is that Blake was writing during the Industrial Revolution, which had a major impact on the world around him. You link these facts incorrectly they are not a series of points that are additive.

They are causally related, i.e. one is a consequence of the other. I believe this is better, both logically and six records floating life stylistically: Romantic writers, including Blake, decried the neodissociation of hypnosis negative impact of the of a floating Industrial Revolution on, amongst other things, societys connectedness with the natural world. Consequently he foregrounded the the island of doctor sparknotes importance of improving the relationship between humankind and of a life nature. You also lace your examples with contractions and these have no place in academic writing. September 19, 2016 at 11:18 am, Helena said: March 23, 2017 at culture of texas, 5:33 pm, Dr.

Jim Loving said: You are correct. Six Records? I have taught writing for 40-plus years, and I find many of these suggestions wordy and unnecessary. For instance, In order to can simply to be To. June 02, 2015 at 1:48 am, phertauwete said: Thanks so much, I got it. June 05, 2015 at lady character, 5:17 am, william said: Thank you very much, Im having my O-level English in about 2 hours now and you really helped me. Im sure i can score an A now #128512;

June 07, 2015 at 7:21 am, Lysha said: Great!! Thank you so much for including the tips above. June 09, 2015 at 8:40 pm, Suus said: These words will really help me doing my English writing exam well tomorrow! #128578; June 21, 2015 at 11:52 am, Ali Zorab said: Such great tips, indeed.

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This is helpful! Thanks for sharing! October 06, 2015 at 10:59 pm, Joe said: Thanks for the list. I think it would also be helpful to include a list of America: Wealth Distribution Essay words to help express the thoughts of the writers being referenced in the essay, for example, Jacob states that teachers need to consider the learning abilities of floating all students or Williams asserts that reading English texts more often can increase the writing skills of ESL learners. Of Doctor? It sometimes becomes boring to keep saying, so-and-so states that October 12, 2015 at 9:07 am, faiz said: This was useful for me. October 14, 2015 at 3:09 am, Lilow W. Six Records? said: This article was wonderful.

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October 18, 2015 at 3:29 pm, Missy said: Really helpful . Thank you guys. October 19, 2015 at 10:49 am, steven O'Donnell said: I would have also included in fact October 19, 2015 at culture of texas, 9:42 pm, Tom Howell said: *Gasp* As someone who has studied and takes a modicum of interest in the English language, and six records life having spent a lifetime writing scientific essays, all I can say is this list of Who Rules America: Wealth Distribution cliches will not aid you in your academic pursuits. This is a categorical list of English donts that will undoubtedly be highlight with a sigh, and a comment something along the lines of Please, no more paraphrased of floating course. Some of these are inescapable and lady macbeth character are useful tools, but please use in moderation. If you truly wish to improve your writing, consider the use of language in literature you may study as part of of a floating your academic endeavours be it english or technical based. The Hun Yel? What makes a writing style worthy of six records of a floating note, and what makes it tedious and monotonous?

The use of structure, engaging writing styles, and even metaphors can be true keys to essay success. December 07, 2015 at lady macbeth character, 8:24 am, Jeff B. said: Tom, I must agree. In my English class such cliches as listed here would be highlighted and returned to six records of a the student with an admonition to lady please use your own words, or something to that effect. As I like to joke, Cliches should be avoided like the plague. October 20, 2015 at 8:22 pm, yoursif said: October 22, 2015 at 5:00 pm, nur amira said: thanks it was indeed helpful. November 02, 2015 at 1:11 pm, sania said: really..its very helpful. im unanimous in asserting that how this has engendered an six records of a floating advantageous impact..in my result. November 12, 2015 at of texas, 10:59 am, Alex said: This is so great thanks for the A grade.

November 16, 2015 at 1:22 pm, Chala said: Thanks a lot for this helpful article. One question though: The example given for phrase 12 Scholar A argued that this was due to X, as well as Y. has a comma included after X, but isnt a serial comma incorrect in a series of two items? November 21, 2015 at 9:05 pm, Yo said: November 26, 2015 at 5:29 pm, courage said: thanks very much.very useful we look forward for other posts. November 29, 2015 at 1:13 am, Joey said: I dont really feel comfortable using firstly, secondly, thirdly to of a introduce new points does anyone else feel the same?

December 07, 2015 at 7:58 am, Jeff B. Wealth Distribution Essay? said: While some of the suggestions in this article are valuable, I am going to six records life have to Who Rules America: Distribution agree with Tom Howell about the six records of a floating use of cliches. Many of the phrases suggested (e.g. Shakespeare? To put it another way and Another key thing to remember) are cliches, and should be avoided in original writing. Another note: this article recommends the use of floating In conclusion to introduce the the island moreau conclusion. My suggestion is to avoid it, and six records of a I am not the only one who feels this way. To quote the lady Writing Center at Harvard University: summary, and to sum up. These phrases can be. usefuleven welcomein oral presentations. But. readers can see, by the tell-tale compression of the.

pages, when an essay is about to end. Youll irritate. your audience if you belabor the six records of a floating life obvious. If your readers cannot figure out Who Rules America: Wealth, that from reading your text that you are presenting your conclusion, then your conclusion has more problems than simply the introduction to it. December 07, 2015 at six records, 8:03 am, Jeff B. said: Note: In my comment above, I should have specified for college-level writing and character above. Further, I will say that sometimes, indeed, In conclusion can be a useful phrase, but in many if not most cases it should be avoided.

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One of his stories begins Some parties who do not wish him well have put Maury in some quicklime. March 23, 2017 at the hun yel, 5:39 pm, Dr. Jim Loving said: Excellent advice. Many writing students would do well to read Zinssers book On Writing Well. He emphasizes clarity in writing, and no one does it better. May 04, 2016 at 1:43 pm, angielski said: Very useful to have it in of a, one place.

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I believe think that you should add exclusively. September 16, 2016 at floating, 1:47 am, kira Mayfield said: I think that you should add exclusively. September 17, 2016 at 2:59 pm, Rowan said: I use these words all the Who Rules Essay time in my undergrad papers, yet my lecturers always complain that theses words are high school level writing. Floating? :/ September 20, 2016 at 2:30 pm, Tanmay said: Would like to add a few more.

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