Monday, 17 May 2010

Hillsong - At the Cross - With Subtitles/Lyrics

optometrists

Optometrists

Significant Points

Admission to optometry school is competitive; only about 1 in 3 applicants was accepted in 2007.
Graduation from an accredited college of Optometry and a State license administered by the National Board of Examiners in Optometry are required.
Employment is expected to grow much faster than the average in response to the vision care needs of a growing and aging population.
Job opportunities are likely to be excellent.

Nature of the WorkAbout this section

Optometrists, also known as doctors of optometry, or ODs, are the main providers of vision care. They examine people's eyes to diagnose vision problems, such as nearsightedness and farsightedness, and they test patients' depth and color perception and ability to focus and coordinate the eyes. Optometrists may prescribe eyeglasses or contact lenses, or they may provide other treatments, such as vision therapy or low-vision rehabilitation.

Optometrists also test for glaucoma and other eye diseases and diagnose conditions caused by systemic diseases such as diabetes and high blood pressure, referring patients to other health practitioners as needed. They prescribe medication to treat vision problems or eye diseases, and some provide preoperative and postoperative care to cataract patients, as well as to patients who have had corrective laser surgery. Like other physicians, optometrists encourage preventative measures by promoting nutrition and hygiene education to their patients to minimize the risk of eye disease.

Although most work in a general practice as a primary care optometrist, some optometrists prefer to specialize in a particular field, such as contact lenses, geriatrics, pediatrics, or vision therapy. As a result, an increasing number of optometrists are forming group practices in which each group member specializes in a specific area while still remaining a full scope practitioner. For example, an expert in low-vision rehabilitation may help legally blind patients by custom fitting them with a magnifying device that will enable them to read. Some may specialize in occupational vision, developing ways to protect workers' eyes from on-the-job strain or injury. Others may focus on sports vision, head trauma, or ocular disease and special testing. A few optometrists teach optometry, perform research, or consult.

Most optometrists are private practitioners who also handle the business aspects of running an office, such as developing a patient base, hiring employees, keeping paper and electronic records, and ordering equipment and supplies. Optometrists who operate franchise optical stores also may have some of these duties.

Optometrists should not be confused with ophthalmologists or dispensing opticians. Ophthalmologists are physicians who perform eye surgery, as well as diagnose and treat eye diseases and injuries. Like optometrists, they also examine eyes and prescribe eyeglasses and contact lenses. Dispensing opticians fit and adjust eyeglasses and, in some States, may fit contact lenses according to prescriptions written by ophthalmologists or optometrists. (See the sections on physicians and surgeons; and opticians, dispensing, elsewhere in theHandbook.)

Work environment. Optometrists usually work in their own offices that are clean, well lighted, and comfortable. Although most full-time optometrists work standard business hours, some work weekends and evenings to suit the needs of patients. Emergency calls, once uncommon, have increased with the passage of therapeutic-drug laws expanding optometrists' ability to prescribe medications.

The Doctor of Optometry degree requires the completion of a 4-year program at an accredited optometry school.

Training, Other Qualifications, and AdvancementAbout this section

The Doctor of Optometry degree requires the completion of a 4-year program at an accredited school of optometry, preceded by at least 3 years of preoptometric study at an accredited college or university. All States require optometrists to be licensed.

Education and training. Optometrists need a Doctor of Optometry degree, which requires the completion of a 4-year program at an accredited school of optometry. In 2009, there were 19 colleges of optometry in the U.S. and 1 in Puerto Rico that offered programs accredited by the Accreditation Council on Optometric Education of the American Optometric Association. Requirements for admission to optometry schools include college courses in English, mathematics, physics, chemistry, and biology. Because a strong background in science is important, many applicants to optometry school major in a science, such as biology or chemistry, as undergraduates. Other applicants major in another subject and take many science courses offering laboratory experience.

Admission to optometry school is competitive; about 1 in 3 applicants was accepted in 2007. All applicants must take the Optometry Admissions Test (OAT), a standardized exam which measures academic ability and scientific comprehension. The OAT consists of four tests: survey of the natural sciences, such as biology, general chemistry, and organic chemistry; reading comprehension; physics; and quantitative reasoning. As a result, most applicants take the test after their sophomore or junior year in college, allowing them an opportunity to take the test again and raise their score. A few applicants are accepted to optometry school after 3 years of college and complete their bachelor's degree while attending optometry school. However, most students accepted by a school or college of optometry have completed an undergraduate degree. Each institution has its own undergraduate prerequisites, so applicants should contact the school or college of their choice for specific requirements.

Optometry programs include classroom and laboratory study of health and visual sciences and clinical training in the diagnosis and treatment of eye disorders. Courses in pharmacology, optics, vision science, biochemistry, and systemic diseases are included.

One-year postgraduate clinical residency programs are available for optometrists who wish to obtain advanced clinical competence within a particular area of optometry. Specialty areas for residency programs include family practice optometry, pediatric optometry, geriatric optometry, vision therapy and rehabilitation, low-vision rehabilitation, cornea and contact lenses, refractive and ocular surgery, primary eye care optometry, and ocular disease.

Licensure. All States and the District of Columbia require that optometrists be licensed. Applicants for a license must have a Doctor of Optometry degree from an accredited optometry school and must pass both a written National Board examination and a National, regional, or State clinical examination. The written and clinical examinations of the National Board of Examiners in Optometry usually are taken during the student's academic career. Many States also require applicants to pass an examination on relevant State laws. Licenses must be renewed every 1 to 3 years and, in all States, continuing education credits are needed for renewal.

Other qualifications. Business acumen, self-discipline, and the ability to deal tactfully with patients are important for success. The work of optometrists also requires attention to detail and manual dexterity.

Advancement. Optometrists who wish to teach or conduct research may study for a master's degree or Ph.D. in visual science, physiological optics, neurophysiology, public health, health administration, health information and communication, or health education.

EmploymentAbout this section

Optometrists held about 34,800 jobs in 2008. Salaried jobs for optometrists were primarily in offices of optometrists; offices of physicians, including ophthalmologists; and health and personal care stores, including optical goods stores. A few salaried jobs for optometrists were in hospitals, the Federal Government, or outpatient care centers, including health maintenance organizations. About 25 percent of optometrists are self-employed. According to a 2008 survey by the American Optometric Association, most self-employed optometrists worked in private practice or in partnership with other healthcare professionals. A small number worked for optical chains or franchises or as independent contractors.

Job OutlookAbout this section

Employment of optometrists is expected to grow much faster than the average for all occupations through 2018, in response to the vision care needs of a growing and aging population. Excellent job opportunities are expected.

Employment change. Employment of optometrists is projected to grow 24 percent between 2008 and 2018. A growing population that recognizes the importance of good eye care will increase demand for optometrists. Also, an increasing number of health insurance plans that include vision care should generate more job growth.

As the population ages, there will likely be more visits to optometrists and ophthalmologists because of the onset of vision problems that occur at older ages, such as cataracts, glaucoma, and macular degeneration. In addition, increased incidences of diabetes and hypertension in the general population as well as in the elderly will generate greater demand for optometric services as these diseases often affect eyesight.

Employment of optometrists would grow more rapidly if not for productivity gains expected to allow each optometrist to see more patients. These expected gains stem from greater use of optometric assistants and other support personnel, who can reduce the amount of time optometrists need with each patient.

The increasing popularity of laser surgery to correct some vision problems was previously thought to have an adverse effect on the demand for optometrists as patients often do not require eyeglasses afterward. However, optometrists will still be needed to provide preoperative and postoperative care for laser surgery patients, therefore laser eye surgery will likely have little to no impact on the employment of optometrists.

Job prospects. Excellent job opportunities are expected over the next decade because there are only 19 schools of optometry in the United States, resulting in a limited number of graduates—about 1,200—each year. This number is not expected to keep pace with demand. However, admission to optometry school is competitive.

In addition to job growth, the need to replace optometrists who retire will also create many employment opportunities. According to the American Optometric Association, nearly one-quarter of practicing optometrists are approaching retirement age. As they begin to retire, many opportunities will arise, particularly in individual and group practices.

Projections DataAbout this section

Projections data from the National Employment Matrix
Occupational Title	SOC Code	Employment, 2008	Projected Employment, 2018	Change, 2008-18		Detailed Statistics
Occupational Title	SOC Code	Employment, 2008	Projected Employment, 2018	Number	Percent	Detailed Statistics
Optometrists	29-1041	34,800	43,200	8,500	24	[PDF]	[XLS]
NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.

EarningsAbout this section

Median annual wages of salaried optometrists were $96,320 in May 2008. The middle 50 percent earned between $70,140 and $125,460. Median annual wages of salaried optometrists in offices of optometrists were $92,670. Salaried optometrists tend to earn more initially than do optometrists who set up their own practices. In the long run, however, those in private practice usually earn more.

According to the American Optometric Association, average annual income for self-employed optometrists was $175,329 in 2007.

Self-employed optometrists, including those in individual, partnerships, and group practice, continue to earn higher income than those in other settings. Earnings also vary by group size. For example, practitioners in large groups—six or more—earn $159,300; practitioners in mid-sized groups—three to five people—earn $179,205; those in small practices—two people—earn $176,944; and individual practitioners earn an average of $134,094. Self-employed optometrists must also provide their own benefits. Practitioners associated with optical chains earn $100,704 on average. However, they typically enjoy paid vacation, sick leave, and pension contributions.

Monday, 10 May 2010

sex addictions

The Twelve Steps

"Attending SAA meetings starts us on a new way of life. But while the SAA fellowship supports our recovery, the actual work of recovery is described in the Twelve Steps. Meetings are forums for learning how to integrate the steps into our lives. Working the Twelve Steps leads to a spiritual transformation that results in sustainable relief from our addiction."

— Sex Addicts Anonymous, p. 96

We admitted we were powerless over addictive sexual behavior - that our lives had become unmanageable.
Came to believe that a Power greater than ourselves could restore us to sanity.
Made a decision to turn our will and our lives over to the care of God as we understood God.
Made a searching and fearless moral inventory of ourselves.
Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Were entirely ready to have God remove all these defects of character.
Humbly asked God to remove our shortcomings.
Made a list of all persons we had harmed and became willing to make amends to them all.
Made direct amends to such people wherever possible, except when to do so would injure them or others.
Continued to take personal inventory and when we were wrong promptly admitted it.
Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God's will for us and the power to carry that out.
Having had a spiritual awakening as the result of these steps, we tried to carry this message to other sex addicts and to practice these principles in our lives.

These steps are the heart of our program. They contain a depth that we could hardly have guessed when we started. Over time, we establish a relationship with a Power greater than ourselves, each of us coming to an understanding of a Higher Power that is personal for us.

The SAA program offers a spiritual solution to our addiction, without requiring adherence to any specific set of beliefs or practices.

But the steps are more than a series of exercises. They provide basic principles for living. Most of us find opportunities on a daily basis to apply one or more of the steps to some challenge in our life. Over time, the spiritual principles in the steps become integrated into our thoughts, feelings, and behavior. We find that we are not only working the steps — we are living them

internet addictions

Internet Addiction Guide

John M. Grohol, Psy.D.
February 2, 1999
Last revised: April 16, 2005

A resource for objective, useful information
about Internet addiction, a theorized disorder.
Is the Internet Addiction Test valid?

What is Internet Addiction Disorder (IAD)?

What "Internet addiction disorder" (IAD) is still difficult to define at this time. Much of the original research was based upon the weakest type of research methodology, namely exploratory surveys with no clear hypothesis or rationale backing them. Coming from an atheoretical approach has some benefits, but also is not typically recognized as being a strong way to approach a new disorder. More recent research has expanded upon the original surveys and anecdotal case study reports. However, as I will illustrate below later, even these studies don't support the conclusions the authors claim.

The original research into this disorder began with exploratory surveys, which cannot establish causal relationships between specific behaviors and their cause. While surveys can help establish descriptions of how people feel about themselves and their behaviors, they cannot draw conclusions about whether a specific technology, such as the Internet, has actually caused those behaviors. Those conclusions that are drawn are purely speculative and subjective made by the researchers themselves. Researchers have a name for this logical fallacy, ignoring a common cause. It's one of the oldest fallacies in science, and one still regularly perpetrated in psychological research today.

Do some people have problems with spending too much time online? Sure they do. Some people also spend too much time reading, watching television, and working, and ignore family, friendships, and social activities. But do we have TV addiction disorder, book addiction, and work addiction being suggested as legitimate mental disorders in the same category as schizophrenia and depression? I think not. It's the tendency of some mental health professionals and researchers to want to label everything they see as potentially harmful with a new diagnostic category. Unfortunately, this causes more harm than it helps people. (The road to "discovering" IAD is filled with many logical fallacies, not the least of which is the confusion between cause and effect.)

What most people online who think they are addicted are probably suffering from is the desire to not want to deal with other problems in their lives. Those problems may be a mental disorder (depression, anxiety, etc.), a serious health problem or disability, or a relationship problem. It is no different than turning on the TV so you won't have to talk to your spouse, or going "out with the boys" for a few drinks so you don't have to spend time at home. Nothing is different except the modality.

What some very few people who spend time online without any other problems present may suffer from is compulsive over-use. Compulsive behaviors, however, are already covered by existing diagnostic categories and treatment would be similar. It's not the technology (whether it be the Internet, a book, the telephone, or the television) that is important or addicting -- it's the behavior. And behaviors are easily treatable by traditional cognitive-behavior techniques in psychotherapy.

Case studies, the alternative to surveys used for many conclusions drawn about online overuse, are just as problematic. How can we really draw any reasonable conclusions about millions of people onlinebased upon one or two case studies? Yet media stories, and some researchers, covering this issue usually use a case study to help "illustrate" the problem. All a case study does is influence our emotional reactions to the issue; it does nothing to help us further understand the actual problem and the many potential explanations for it. Case studies on an issue like this are usually a red flag that help frame the issue in an emotional light, leaving hard, scientific data out of the picture. It is a common diversionary tactic.

There is more research that needs to be critically examined here, which I will provide descriptive analyses of shortly.

Why Does the Research Leave Something to Be Desired?

Well, the obvious answer is that many of the original researchers into the phenomenon known as IAD were actually clinicians who decided to conduct a survey. Usually doctoral training is sufficient to create and test a survey, yet the psychometric properties of these surveys are never released. (Perhaps because they were never conducted in the first place? We simply do not know.)

The obvious confounds are never controlled for in most of these surveys. Questions about pre-existing or a history of mental disorders (e.g., depression, anxiety), health problems or disabilities, or relationship problems are absent from these surveys. Since this is one of the most obvious alternative explanations for some of the data being obtained (for example, see Storm King's article, Is the Internet Addictive, or Are Addicts Using the Internet? below), it is very surprising these questions are left off. It taints all the data and make the data virtually useless.

Other factors are simply not controlled for. The current Internet population is nearly 50/50 in terms of proportion of men to women. Yet people are still drawing conclusions about this same group of people based upon survey samples that have 70-80% men, comprised mostly of white Americans. Researchers barely mention these discrepancies, all of which will again skew the results.

Research done in a particular area should also agree about certain very basic things after a time. Years have gone by and there are more than a few studies out there looking at Internet addiction. Yet none of them agree on a single definition for this problem, and all of them vary widely in their reported results of how much time an "addict" spends online. If they can't even get these basics down, it is not surprising the research quality still suffers.

More research has been done since the original surveys were released in 1996. This newer research has been conducted by more independent researchers with clearer hypotheses and stronger, less biased population sets. More about these studies will be discussed in updates to this article.

Where Did It Come From?

Good question. It came from, believe it or not, the criteria for pathological gambling, a single, anti-social behavior that has very little social redeeming value. Researchers in this area believe they can simply copy this criteria and apply it to the hundreds of behaviors carried out everyday on the Internet, a largely pro-social, interactive, and information-driven medium. Do these two dissimilar areas have much in common beyond their face value? I don't see it.

I don't know of any other disorder currently being researched where the researchers, showing all the originality of a trash romance novel writer, simply "borrowed" the diagnostic symptom criteria for an unrelated disorder, made a few changes, and declared the existence of a new disorder. If this sounds absurd, it's because it is.

And this speaks to the larger problem these researchers grapple with... Most have no theory driving their assumptions (see Walther, 1999 for a further discussion of this issue). They see a client in pain (and in fact, I've sat in many presentations by these clinicians where they start it off with just such an example), and figure, "Hey, the Internet caused this pain. I'm going to go out and study what makes this possible on the Internet." There's no theory (well, sometimes there's theory after-the-fact), and while some quasi-theoretical explanations are slowly emerging, it is putting the chicken far before the egg.

Do You Spend Too Much Time Online?

In relation to what or whom? Time alone cannot be an indicator of being addicted or engaging in compulsive behavior. Time must be taken in context with other factors, such as whether you're a college student (who, as a whole, proportionally spend a greater amount of time online), whether it's a part of your job, whether you have any pre-existing conditions (such as another mental disorder; a person with depression is more likely to spend more time online than someone who doesn't, for instance, often in a virtual support group environment), whether you have problems or issues in your life which may be causing you to spend more time online (e.g., using it to "get away" from life's problems, a bad marriage, difficult social relations), etc. So talking about whether you spend too much time online without this important context is useless.

What Makes the Internet So Addictive?

Well, as I have shown above, the research is exploratory at this time, so suppositions such as what makes the Internet so "addictive" are no better than guesses. Since other researchers online have made their guesses known, here are mine.

Since the aspects of the Internet where people are spending the greatest amount of time online have to do with social interactions, it would appear that socialization is what makes the Internet so "addicting." That's right -- plain old hanging out with other people and talking with them. Whether it's via e-mail, a discussion forum, chat, or a game online (such as a MUD), people are spending this time exchanging information, support, and chit-chat with other people like themselves.

Would we ever characterize any time spent in the real world with friends as "addicting?" Of course not. Teenagers talk on the phone for hours on end, with people they see everyday! Do we say they are addicted to the telephone? Of course not. People lose hours at a time, immersed in a book, ignoring friends and family, and often not even picking up the phone when it rings. Do we say they are addicted to the book? Of course not. If some clinicians and researchers are now going to start defining addiction as social interactions, then every real-world social relationship I have is an addictive one.

Socializing -- talking -- is a very "addictive" behavior, if one applies the same criteria to it as researchers looking at Internet addiction do. Does the fact that we're now socializing with the help of some technology (can you say, "telephone"?) change the basic process of socialization? Perhaps, a bit. But not so significantly as to warrant a disorder. Checking e-mail, as Greenfield claims, is not the same as pulling a slot-machine's handle. One is social seeking behavior, the other is reward seeking behavior. They are two very different things, as any behaviorist will tell you. It's too bad the researchers can't make this differentiation, because it shows a significant lack of understanding of basic behavioral theory.

Alternative Hypotheses

In addition to those previously discussed, here is an alternative hypothesis that no research to date has seriously considered -- that the behaviors we are observing are phasic. That is, for most people with "Internet addiction," they are likely newcomers to the Internet. They are going through the first stage of acclimating themselves to a new environment -- by fully immersing themselves in it. Since this environment is so much larger than anything we've ever seen before, some people get "stuck" in the acclimation ( or enchantment) stage for a longer period of time than is typical for acclimating to new technologies, products, or services. Walther (1999) made a similar observation based upon the work of Roberts, Smith, and Pollack (1996). The Roberts et al. study found that online chat activity was phasic -- people first were enchanted by the activity (characterized by some as obsession), followed by disillusionment with chatting and a decline in usage, and then a balance was reached where the level of chat activity normalized.

I hypothesize that this type of model can be more globally applied to online usage in general:

Grohol's Model of Pathological Internet Use

Some people simply get caught in Stage I and never move beyond it. They may need some help to get to Stage III.

For existing online users, my model allows for overuse as well, since the overuse is defined by finding a new online activity. I would argue, though, that existing users have a much more easier time successfully navigating through these stages for new activities they find online than newcomers to the Internet. It is possible, however, for an existing user to find a new activity (such as an attractive chat room or newsgroup or Website) that could lead them back into this model.

Note one important distinction about my model... It makes the assumption that since all online activity is phasic to some degree, all people will eventually get to Stage III on their own. Just like a teenager learns to not spend hours on the telephone every night on their own (eventually!), most adults online will also learn how to responsibly integrate the Internet into their lives. For some, this integration simply takes longer than others.

What Do I Do If I Think I Have It?

First, don't panic. Second, just because there is a debate about the validity of this diagnostic category amongst professionals doesn't mean there isn't help for it. In fact, as I mentioned earlier, help is readily available for this problem without needing to create all this hoopla about a new diagnosis.

If you have a life problem, or are grappling with a disorder such as depression, seek professional treatment for it. Once you admit and address the problem, other pieces of your life will fall back into place.

Psychologists have studied compulsive behaviors and their treatments for years now, and nearly any well-trained mental health professional will be able to help you learn to slowly curve the time spent online, and address the problems or concerns in your life that may have contributed to your online overuse, or were caused by it. No need for a specialist or an online support group.

Recent Research

In the past couple of years, there have been a handful of additional studies which have looked at this issue. The results have been inconclusive and contradictory.

You can read my analysis of a study done a year ago about the psychometric validity (or lack thereof) of the Internet Addiction Test. Needless to say, the research which could validate this disorder remains to be published. All but one of the studies that I'm aware of haven't looked at the effects of time on the reported problems of subjects. Without a short longitudinal study (1 year), one cannot answer whether this problem is situational and phasic or something more serious.

2005 APA Update

Well, as the years pass and more and more research is published claiming to support this theorized disorder, I'm happy to revisit some of the outstanding issues and blatant logical fallacies that researchers into maladaptive Internet use continue to make. You'd think that after a decade of research on this issue, someone would learn.

More Online Resources

I and other professionals have talked about the problems facing the concept of IAD before. We're not saying anything new here. Until there is stronger, more conclusive research in this area, though, you should shy away from anyone looking to treat this problem, since it is a problem that seems to exist more in some professionals' concept of dysfunction than in reality.

Here are some further links you should check out on this issue:

Take the Online Addiction Quiz
From the Center for Online Addiction
Psych Central Editorial
This editorial by Dr. Grohol, written in 1997, examined the usefulness and validity of Internet Addiction Disorder as a diagnosis and something to treat.
Psych Central's Internet Addiction Resources
A listing of Internet resources related to this topic.
Pathological Internet Use
An article by Leonard Holmes, Ph.D. about "Pathological Internet Use." See also What is Normal Internet Use? by the same author.
Why is This Thing Eating My Life? Computer and Cyberspace Addiction
This article, and another one like it, were written by online researcher, John Suler, Ph.D. Another interesting perspective.
Is the Internet Addictive, or Are Addicts Using the Internet?
One of many possible alternative explanations for this phenomenon.
How Much is Too Much When Spending Time Online?
My own ramblings about the problems with this disorder in October, 1997.
Communication Addiction Disorder: Concern over Media, Behavior and Effects (PDF)
Joseph B. Walther Rensselaer Polytechnic Institute, August, 1999
(BTW, if you don't get it, this paper is parodying Internet Addiction Disorder.)
Center for On-Line Addiction
Dr. Kimberly Young's Center (one of the researchers behind the push for this diagnostic category), which, co-incidentally, offers books, workshops for professionals, and online (?!) counseling to treat this "disorder."
The Cause of Internet Addiction?
Christopher McPeck, who holds a BS in Computer Science, has an interesting theory as to this phenomenon's potential cause.
Roberts, L. D., Smith, L. M., & Pollack, C. (1996, September). A model of social interaction via computer-mediated communication in real-time text-based virtual environments. Paper presented at the annual meeting of the Australian Psychological Society, Sydney, Australia.