WordNet

very high frequency sound; used in ultrasonography
the 21st letter of the Roman alphabet (同)u

PrepTutorEJDIC

unserviceable
(金属のひずみなどを調べる)超音波
United States Mail 米国郵便[制度]
United States 合衆国
uraniumの化学記号
上流の,上流階級にふさわしい / (映画が)児童観覧用の
《we の目的格》『我々を(に)』,『私たちを(に)』

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/01/13 13:22:37」(JST)

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US（ユーエス）

合衆国 (United States)
- アメリカ合衆国
USエアウェイズのIATA航空会社コード。
US（ユーエス） - 坂本龍一のベスト・アルバムの一つ
テレビ埼玉 (JOUS-TV / JOUS-DTV)
ウサハナ (Usahana) - サンリオのキャラクター
ユニバーサル・スタジオ (Universal Studios) - ユニバーサル映画の名でも知られる、アメリカの映画会社。
- Universal Studios Theme Parks - ユニバーサル・スタジオが手がける、ハリウッド映画を中心としたテーマパーク群のブランド名。
  - ユニバーサル・スタジオ・ハリウッド (Universal Studios Hollywood)
  - ユニバーサル・スタジオ・フロリダ (Universal Studios Florida) - ユニバーサル・オーランド・リゾート内。
  - ユニバーサル・スタジオ・ジャパン (Universal Studios Japan, USJ)
  - ユニバーサル・スタジオ・シンガポール (Universal Studios Singapore)
  - ユニバーサル・スタジオ・ドバイランド (Universal Studios Dubailand)
  - ユニバーサル・スタジオ・コリア (Universal Studios Korea)
超音波 (ultrasound)
- エコー検査
PC-9801US - NECのパソコン
USスチール (US Steel) - アメリカの大手鉄鋼会社。
ユーエスマート (U.S.MART) - 三重県に本社・FC本部を置く100円均一コンビニエンスストアチェーン。

us（アス）

「私たち」英語の一人称複数目的格代名詞
- CHEMISTRYの両A面シングル「アシタヘカエル/us」。usの意味は上記の英単語から。
- Us (ピーター・ガブリエルのアルバム) - ピーター・ガブリエルのアルバム

1 Etymology
2 History
- 2.1 Native American and European settlement
- 2.2 Independence and expansion
- 2.3 Slavery, civil war and industrialization
- 2.4 World War I, Great Depression, and World War II
- 2.5 Cold War and protest politics
- 2.6 Contemporary era
3 Geography, climate, and ecology
4 Political divisions
5 Government and politics
- 5.1 Parties and ideology
6 Foreign relations and military
7 Economy
- 7.1 Income and human development
8 Infrastructure
- 8.1 Science and technology
- 8.2 Transportation
- 8.3 Energy
- 8.4 Education
- 8.5 Health
9 Crime and law enforcement
10 Demographics
- 10.1 Language
- 10.2 Religion
- 10.3 Family structure
11 Culture
- 11.1 Popular media
- 11.2 Literature, philosophy, and the arts
- 11.3 Food
- 11.4 Sports
- 11.5 Measurement systems
12 See also
13 References
14 External links

Etymology

See also: Names for United States citizens

In 1507, German cartographer Martin Waldseemüller produced a world map on which he named the lands of the Western Hemisphere "America" after Italian explorer and cartographer Amerigo Vespucci.^[14]

The first documentary evidence of the phrase "United States of America" was in an anonymously written essay published in the Virginia Gazette newspaper in Williamsburg, Virginia on April 6, 1776.^[15]^[16] In June 1776, Thomas Jefferson included the phrase "UNITED STATES OF AMERICA" in all capitalized letters in the headline of his "original Rough draught" of the Declaration of Independence.^[17]^[18] In the final Fourth of July version of the Declaration, the pertinent section of the title was changed to read, "The unanimous Declaration of the thirteen united States of America".^[19]

In 1777 the Articles of Confederation announced, "The Stile of this Confederacy shall be 'The United States of America'".^[20]

The short form "United States" is also standard. Other common forms include the "U.S.", the "USA", and "America". Colloquial names include the "U.S. of A." and, internationally, the "States". "Columbia", a name popular in poetry and songs of the late 1700s,^[21] derives its origin from Christopher Columbus; it appears in the name "District of Columbia".

The standard way to refer to a citizen of the United States is as an "American". "United States", "American" and "U.S." are used to refer to the country adjectivally ("American values", "U.S. forces"). "American" is rarely used in English to refer to subjects not connected with the United States.^[22]

The phrase "United States" was originally treated as plural, a description of a collection of independent states—e.g., "the United States are"—including in the Thirteenth Amendment to the United States Constitution, ratified in 1865. It became common to treat it as singular, a single unit—e.g., "the United States is"—after the end of the Civil War. The singular form is now standard; the plural form is retained in the idiom "these United States".^[23] The difference has been described as more significant than one of usage, but reflecting the difference between a collection of states and a unit.^[24]

In non-English languages, the name is frequently translated as the translation of either the "United States" or "United States of America", and colloquially as "America". In addition, an initialism is sometimes used.^[25]

History

Main article: History of the United States

Native American and European settlement

The indigenous peoples of the U.S. mainland, migrated from Asia, beginning between 40,000 and 12,000 years ago.^[26] Some, such as the pre-Columbian Mississippian culture, developed advanced agriculture, grand architecture, and state-level societies. After European explorers and traders made the first contacts, many millions died from epidemics of imported diseases such as smallpox.^[27]


Plymouth, New England 1620. The Mayflower Compact made by Pilgrim settlers brought democratic forms of government to the new land.		Columbia was a poetic image of America, largely displaced after 1920 by the Statue of Liberty

The first Spanish explorers landed in "La Florida" in 1513. Spain set up settlements in California and New Mexico that were eventually merged into the U.S. There were also some French settlements along the Mississippi River.

The English settlements up and down the Atlantic coast were by far the most important in shaping the history of the United States. The Virginia Colony began 1607 and the Pilgrims' Plymouth Colony in 1620. Some 100,000 Puritans came to New England, especially the Massachusetts Bay Colony. Beginning in 1614, the Dutch settled in modern New York State; their colony of New Netherland was taken over by England in 1674, but a strong Dutch influence persisted in the Hudson Valley north of New York City for generations. Many new immigrants, especially to the South, were indentured servants—some two-thirds of all Virginia immigrants between 1630 and 1680.^[28] By the turn of the 18th century, African slaves were becoming the primary source of bonded labor in many regions.^[29]

With the 1729 division of the Carolinas and the 1732 colonization of Georgia, the thirteen British colonies that would become the United States of America were established.^[30] All had local governments with elections open to most free men, with a growing devotion to the ancient rights of Englishmen and a sense of self-government stimulating support for republicanism. All legalized the African slave trade.^[31] With high birth rates, low death rates, and steady immigration, the colonial population grew rapidly. The Christian revivalist movement of the 1730s and 1740s known as the Great Awakening fueled interest in both religion and religious liberty.

In the French and Indian War, British forces seized Canada from the French, but the francophone population remained politically isolated from the southern colonies. Excluding the Native Americans, who were being displaced, those thirteen colonies had a population of 2.6 million in 1770, about one-third that of Britain. Nearly one-fifth of those living in what would become the United States were black slaves.^[32]

English expansion westward saw incorporation of disparate pre-established cultures it met. But it also found Amerindian resistance to that settlement. Their opposition took various forms across the continent, as allies with Europeans, multi-tribe nations, and alone—by relocation and warring, by treaties and in court. On the other hand, English North American colonials were subject to British taxation, they had no representation in the Parliament of Great Britain.

Independence and expansion

The American Revolution was the first successful colonial war of independence against a European power. Americans had developed a democratic system of local government and a an ideology of "republicanism that held government rested on the will of the people (not the king), which strongly opposed corruption and demanded civic virtue. They demanded their rights as Englishmen and rejected British efforts to impose taxes without the approval of colonial legislatures. The British insisted and the conflict escalated to full-scale war in 1775, the American Revolutionary War.^[33] On June 14, 1775, the Continental Congress, convening in Philadelphia, established a Continental Army under the command of George Washington.^[34] Proclaiming that "all men are created equal" and endowed with "certain unalienable Rights", the Congress adopted the Declaration of Independence, drafted largely by Thomas Jefferson, on July 4, 1776. That date is now celebrated annually as America's Independence Day. In 1777, the Articles of Confederation established a weak government that operated until 1789.^[35]


Declaration of Independence, 1776. By authority of the people, thirteen states were freed from the British Crown		U.S. acquired territory governed by Congress, then settlers were admitted as states on the basis of equal citizenship

After the British defeat at Yorktown by American forces assisted by the French the United States was independent. In the Peace treaty OF 1783 Britain recognized American sovereignty over most territory east of the Mississippi River. Nationalists calling for a much stronger federal government with powers of taxation led the constitutional convention in 1787. After intense debate the United States Constitution was ratified in 1788 by all 13 states. The first Senate, House of Representatives, and president—George Washington—took office in 1789.The Bill of Rights, forbidding federal restriction of personal freedoms and guaranteeing a range of legal protections, was adopted in 1791. ^[36]

Attitudes toward slavery were shifting; all states outlawed the international slave trade,^[37] and the federal government criminalized the import or export of slaves in 1807.^[38] All the Northern states abolished slavery between 1780 and 1804, leaving the slave states of the South as defenders of the "peculiar institution". With cotton a highly profitable plantation crop after 1820, Southern whites increasingly decided slavery was a positive good for everyone, including the slaves.^[39] The Second Great Awakening, beginning about 1800, converted millions to evangelical Protestantism. In the North energized multiple social reform movements, including abolitionism.^[40]

Americans' eagerness to expand westward prompted a long series of Indian Wars.^[41] The Louisiana Purchase of French-claimed territory under President Thomas Jefferson in 1803 almost doubled the nation's size.^[42] The War of 1812, declared against Britain over various grievances and fought to a draw, strengthened U.S. nationalism.^[43] A series of U.S. military incursions into Florida led Spain to cede it and other Gulf Coast territory in 1819.^[44]

President Andrew Jackson took office in 1829, and began a set of reforms which led to the era of Jacksonian democracy, which is considered to have lasted from 1830 to 1850. This included many reforms, such as wider male suffrage, and various adjustments to the power of the Federal government. This also led to the rise of the Second Party System, which refers to the dominant parties which existed from 1828 to 1854.

The Trail of Tears in the 1830s exemplified the Indian removal policy that moved Indians to their own reservations with annual government subsidies. The United States annexed the Republic of Texas in 1845, amid a period when the concept of Manifest Destiny was becoming popular.^[45] The 1846 Oregon Treaty with Britain led to U.S. control of the present-day American Northwest.^[46] The U.S. victory in the Mexican-American War resulted in the 1848 cession of California and much of the present-day American Southwest.^[47]

The California Gold Rush of 1848–49 further spurred western migration.^[48] New railways made relocation easier for settlers and increased conflicts with Native Americans.^[49] Over a half-century, up to 40 million American bison, or buffalo, were slaughtered for skins and meat and to ease the railways' spread.^[50] The loss of the buffalo, a primary resource for the plains Indians, was an existential blow to many native cultures.^[50]

Slavery, civil war and industrialization

Tensions between slave and free states mounted with arguments about the relationship between the state and federal governments, as well as violent conflicts over the spread of slavery into new states.^[51] Abraham Lincoln, candidate of the largely antislavery Republican Party, was elected president in 1860.^[52] Before he took office, seven slave states declared their secession—which the federal government maintained was illegal—and formed the Confederate States of America.^[53]


Battle of Gettysburg. The Civil War cemented the Union; spurred steel industry and intercontinental railroad construction		Ellis Island east coast immigrants worked in factories, railroads and mines; created demand for industrialized agriculture

With the Confederate attack upon Fort Sumter, the Civil War began and four more slave states joined the Confederacy.^[53] Lincoln's Emancipation Proclamation in 1863 declared slaves in the Confederacy to be free. Following the Union victory in 1865, three amendments to the U.S. Constitution ensured freedom for the nearly four million African Americans who had been slaves,^[54] made them citizens, and gave them voting rights. The war and its resolution led to a substantial increase in federal power.^[55] The war remains the deadliest conflict in American history, resulting in the deaths of 620,000 soldiers.^[56]

After the war, the assassination of Abraham Lincoln radicalized Republican Reconstruction policies aimed at reintegrating and rebuilding the Southern states while ensuring the rights of the newly freed slaves.^[57] The resolution of the disputed 1876 presidential election by the Compromise of 1877 ended Reconstruction; Jim Crow laws soon disenfranchised many African Americans.^[57]

In the North, urbanization and an unprecedented influx of immigrants from Southern and Eastern Europe hastened the country's industrialization. The wave of immigration, lasting until 1924, provided labor and transformed American culture.^[58] National infrastructure development spurred economic growth. The end of the Civil War spurred greater settlement and development of the American Old West. This was due to a variety of social and technological developments, including the completion of the First Transcontinental Telegraph in 1861 and the First Transcontinental Railroad in 1869.

The 1867 Alaska Purchase from Russia completed the country's mainland expansion. The Wounded Knee Massacre in 1890 was the last major armed conflict of the Indian Wars. In 1893, the indigenous monarchy of the Pacific Kingdom of Hawaii was overthrown in a coup led by American residents; the United States annexed the archipelago in 1898. Victory in the Spanish–American War the same year demonstrated that the United States was a world power and led to the annexation of Puerto Rico, Guam, and the Philippines.^[59] The Philippines gained independence a half-century later; Puerto Rico and Guam remain U.S. territories.

The emergence of many prominent industrialists at the end of the 19th Century gave rise to the Gilded Age, a period of growing affluence and power among the business class. This helped to produce the Progressive Era, a period of great reforms in many societal areas, including regulatory protection for the public, greater antitrust measures, and attention to living conditions for the working classes. President Theodore Roosevelt was one leading proponent of progressive reforms

World War I, Great Depression, and World War II

At the outbreak of World War I in 1914, the United States remained neutral. Most Americans sympathized with the British and French, although many opposed intervention.^[60] In 1917, the United States joined the Allies, and the American Expeditionary Forces helped to turn the tide against the Central Powers. President Woodrow Wilson took a leading diplomatic role at the Paris Peace Conference of 1919 which helped to shape the post-war world. Wilson advocated strongly for the U.S. to join the League of Nations. However, the Senate refused to approve this, and did not ratify the Treaty of Versailles, which established the League of Nations.^[61]


The 'Dust Bowl' brought agricultural depression, impacted industrial markets and led to large relocation out of the Great Plains		WWII invasion of Europe required war industry, accelerating migration to big cities and large scale manufacturing

The country pursued a policy of unilateralism, verging on isolationism.^[61] In 1920, the women's rights movement won passage of a constitutional amendment granting women's suffrage. The prosperity of the Roaring Twenties ended with the Wall Street Crash of 1929 that triggered the Great Depression.

After his election as president in 1932, Franklin D. Roosevelt responded with the New Deal, a range of policies increasing government intervention in the economy, including the establishment of the Social Security system.^[62] The Dust Bowl of the mid-1930s impoverished many farming communities and spurred a new wave of western migration.

The United States, effectively neutral during World War II's early stages after Nazi Germany's invasion of Poland in September 1939, began supplying material to the Allies in March 1941 through the Lend-Lease program. On December 7, 1941, the Empire of Japan launched a surprise attack on Pearl Harbor, prompting the United States to join the Allies against the Axis powers as well as the internment of Japanese Americans by the thousands.^[63] Participation in the war spurred capital investment and industrial capacity. Among the major combatants, the United States was the only nation to become richer—indeed, far richer—instead of poorer because of the war.^[64]

Allied conferences at Bretton Woods and Yalta outlined a new system of international organizations that placed the United States and Soviet Union at the center of world affairs. As victory was won in Europe, a 1945 international conference held in San Francisco produced the United Nations Charter, which became active after the war.^[65] The United States, having developed the first nuclear weapons, used them on the Japanese cities of Hiroshima and Nagasaki in August. Japan surrendered on September 2, ending the war.^[66]

Cold War and protest politics

Martin Luther King, Jr. delivering his "I Have a Dream" speech, 1963.

The United States and the Soviet Union jockeyed for power after World War II during the Cold War, dominating the military affairs of Europe through NATO and the Warsaw Pact, respectively. While they engaged in proxy wars and developed powerful nuclear arsenals, the two countries avoided direct military conflict. The U.S. often opposed Third World left-wing movements that it viewed as Soviet-sponsored. American troops fought Communist Chinese and North Korean forces in the Korean War of 1950–53. The House Un-American Activities Committee pursued a series of investigations into suspected leftist subversion, while Senator Joseph McCarthy became the figurehead of anticommunist sentiment.

The 1961 Soviet launch of the first manned spaceflight prompted President John F. Kennedy's call for the United States to be first to land "a man on the moon", achieved in 1969. Kennedy also faced a tense nuclear showdown with Soviet forces in Cuba. Meanwhile, the United States experienced sustained economic expansion. Amidst the presence of various white nationalist groups, particularly the Ku Klux Klan, a growing civil rights movement used nonviolence to confront segregation and discrimination. This was symbolized and led by black Americans such as Rosa Parks and Martin Luther King, Jr.. On the other hand, some black nationalist groups such as the Black Panther Party had a more militant scope.

Following Kennedy's assassination in 1963, the Civil Rights Act of 1964 and Voting Rights Act of 1965 were passed under President Lyndon B. Johnson.^[67]^[68] He also signed into law the Medicare and Medicaid programs.^[69] Johnson and his successor, Richard Nixon, expanded a proxy war in Southeast Asia into the unsuccessful Vietnam War. A widespread countercultural movement grew, fueled by opposition to the war, black nationalism, and the sexual revolution. Betty Friedan, Gloria Steinem, and others led a new wave of feminism that sought political, social, and economic equality for women.

As a result of the Watergate scandal, in 1974 Nixon became the first U.S. president to resign, to avoid being impeached on charges including obstruction of justice and abuse of power. The Jimmy Carter administration of the late 1970s was marked by stagflation and the Iran hostage crisis. The election of Ronald Reagan as president in 1980 heralded a rightward shift in American politics, reflected in major changes in taxation and spending priorities. His second term in office brought both the Iran-Contra scandal and significant diplomatic progress with the Soviet Union. The subsequent Soviet collapse ended the Cold War.

Contemporary era

September 11 attacks on World Trade Center

Under President George H. W. Bush, the United States took a lead role in the UN–sanctioned Gulf War. The longest economic expansion in modern U.S. history—from March 1991 to March 2001—encompassed the Bill Clinton administration and the dot-com bubble.^[70] A civil lawsuit and sex scandal led to Clinton's impeachment in 1998, but he remained in office. The 2000 presidential election, one of the closest in American history, was resolved by a U.S. Supreme Court decision—George W. Bush, son of George H. W. Bush, became president.

On September 11, 2001, al-Qaeda terrorists struck the World Trade Center in New York City and The Pentagon near Washington, D.C., killing nearly three thousand people. In response, the Bush administration launched the global War on Terror, invading Afghanistan and removing the Taliban government and al-Qaeda training camps. Taliban insurgents continue to fight a guerrilla war. In 2002, the Bush administration began to press for regime change in Iraq on controversial grounds.^[71]

Forces led by the U.S. invaded Iraq in 2003, ousting Saddam Hussein. In 2005, Hurricane Katrina caused severe destruction along much of the Gulf Coast, devastating New Orleans. In 2008, amid a global economic recession, the first African American president, Barack Obama, was elected. Major health care and financial system reforms were enacted two years later. In 2011, a raid by Navy SEALs in Pakistan killed al-Qaeda leader Osama bin Laden. The Iraq War officially ended with the pullout of the remaining U.S. troops from the country in December 2011.

Geography, climate, and ecology

Main articles: Geography of the United States, Climate of the United States, and Environment of the United States

Composite satellite image of the contiguous United States

The land area of the contiguous United States is 2,959,064 square miles (7,663,941 km²). Alaska, separated from the contiguous United States by Canada, is the largest state at 663,268 square miles (1,717,856 km²). Hawaii, occupying an archipelago in the central Pacific, southwest of North America, is 10,931 square miles (28,311 km²) in area.^[72]

The United States is the world's third or fourth largest nation by total area (land and water), ranking behind Russia and Canada and just above or below China. The ranking varies depending on how two territories disputed by China and India are counted and how the total size of the United States is measured: calculations range from 3,676,486 square miles (9,522,055 km²)^[73] to 3,717,813 square miles (9,629,091 km²)^[74] to 3,794,101 square miles (9,826,676 km²).^[1] Measured by only land area, the United States is third in size behind Russia and China, just ahead of Canada.^[75]

The coastal plain of the Atlantic seaboard gives way further inland to deciduous forests and the rolling hills of the Piedmont. The Appalachian Mountains divide the eastern seaboard from the Great Lakes and the grasslands of the Midwest. The Mississippi–Missouri River, the world's fourth longest river system, runs mainly north–south through the heart of the country. The flat, fertile prairie of the Great Plains stretches to the west, interrupted by a highland region in the southeast.

The Bald Eagle, the national bird of the United States since 1782.

The Rocky Mountains, at the western edge of the Great Plains, extend north to south across the country, reaching altitudes higher than 14,000 feet (4,300 m) in Colorado. Farther west are the rocky Great Basin and deserts such as the Chihuahua and Mojave. The Sierra Nevada and Cascade mountain ranges run close to the Pacific coast, both ranges reaching altitudes higher than 14,000 feet.

The lowest and highest points in the continental United States are in the state of California, and only about 80 miles apart. At 20,320 feet (6,194 m), Alaska's Mount McKinley is the tallest peak in the country and in North America. Active volcanoes are common throughout Alaska's Alexander and Aleutian Islands, and Hawaii consists of volcanic islands. The supervolcano underlying Yellowstone National Park in the Rockies is the continent's largest volcanic feature.^[76]

The United States, with its large size and geographic variety, includes most climate types. To the east of the 100th meridian, the climate ranges from humid continental in the north to humid subtropical in the south. The southern tip of Florida is tropical, as is Hawaii. The Great Plains west of the 100th meridian are semi-arid. Much of the Western mountains are alpine. The climate is arid in the Great Basin, desert in the Southwest, Mediterranean in coastal California, and oceanic in coastal Oregon and Washington and southern Alaska. Most of Alaska is subarctic or polar. Extreme weather is not uncommon—the states bordering the Gulf of Mexico are prone to hurricanes, and most of the world's tornadoes occur within the country, mainly in the Midwest's Tornado Alley.^[77]

The U.S. ecology is considered "megadiverse": about 17,000 species of vascular plants occur in the contiguous United States and Alaska, and over 1,800 species of flowering plants are found in Hawaii, few of which occur on the mainland.^[78] The United States is home to more than 400 mammal, 750 bird, and 500 reptile and amphibian species.^[79] About 91,000 insect species have been described.^[80]

The Endangered Species Act of 1973 protects threatened and endangered species and their habitats, which are monitored by the United States Fish and Wildlife Service. There are fifty-eight national parks and hundreds of other federally managed parks, forests, and wilderness areas.^[81] Altogether, the government owns 28.8% of the country's land area.^[82] Most of this is protected, though some is leased for oil and gas drilling, mining, logging, or cattle ranching; 2.4% is used for military purposes.^[82]

Political divisions

Main articles: Political divisions of the United States, U.S. state, and Territories of the United States

Further information: Territorial evolution of the United States and United States territorial acquisitions

The United States is a federal union of fifty states. The original thirteen states were the successors of the thirteen colonies that rebelled against British rule. Early in the country's history, three new states were organized on territory separated from the claims of the existing states: Kentucky from Virginia; Tennessee from North Carolina; and Maine from Massachusetts. Most of the other states have been carved from territories obtained through war or purchase by the U.S. government. One set of exceptions includes Vermont, Texas, and Hawaii: each was an independent republic before joining the union. During the American Civil War, West Virginia broke away from Virginia. The most recent state—Hawaii—achieved statehood on August 21, 1959.^[83] The states do not have the right to unilaterally secede from the union.

The states compose the vast bulk of the U.S. land mass; the two other areas considered integral parts of the country are the District of Columbia, the federal district where the capital, Washington, is located; and Palmyra Atoll, an uninhabited but incorporated territory in the Pacific Ocean. The United States also possesses five major overseas territories: Puerto Rico and the United States Virgin Islands in the Caribbean; and American Samoa, Guam, and the Northern Mariana Islands in the Pacific.^[84] Those born in the major territories (except for American Samoa) possess U.S. citizenship.^[85] American citizens residing in the territories have many of the same rights and responsibilities as citizens residing in the states; however, they are generally exempt from federal income tax, may not vote for president, and have only nonvoting representation in the U.S. Congress.^[86]

The United States also observes tribal sovereignty of the Native Nations. Though reservations are within state borders, the reservation is a sovereign. While the United States recognizes this sovereignty, other countries may not.^[87]

Government and politics

Main articles: Federal government of the United States, state governments of the United States, and elections in the United States


U.S. Capitol seats the Congress: the Senate, left; the House, right		The White House used by the U.S. President		Supreme Court and offices for nine Justices

Political system of the United States

The United States is the world's oldest surviving federation. It is a constitutional republic and representative democracy, "in which majority rule is tempered by minority rights protected by law".^[88] The government is regulated by a system of checks and balances defined by the U.S. Constitution, which serves as the country's supreme legal document.^[89]

In the American federalist system, citizens are usually subject to three levels of government, federal, state, and local; the local government's duties are commonly split between county and municipal governments. In almost all cases, executive and legislative officials are elected by a plurality vote of citizens by district. There is no proportional representation at the federal level, and it is very rare at lower levels.

The federal government is composed of three branches:

Legislative: The bicameral Congress, made up of the Senate and the House of Representatives, makes federal law, declares war, approves treaties, has the power of the purse,^[90] and has the power of impeachment, by which it can remove sitting members of the government.^[91]

Executive: The president is the commander-in-chief of the military, can veto legislative bills before they become law (subject to Congressional override), and appoints the members of the Cabinet (subject to Senate approval) and other officers, who administer and enforce federal laws and policies.^[92]

Judicial: The Supreme Court and lower federal courts, whose judges are appointed by the president with Senate approval, interpret laws and overturn those they find unconstitutional.

The House of Representatives has 435 voting members, each representing a congressional district for a two-year term. House seats are apportioned among the states by population every tenth year. As of the 2000 census, seven states have the minimum of one representative, while California, the most populous state, has fifty-three.^[93]

The Senate has 100 members with each state having two senators, elected at-large to six-year terms; one third of Senate seats are up for election every other year. The president serves a four-year term and may be elected to the office no more than twice. The president is not elected by direct vote, but by an indirect electoral college system in which the determining votes are apportioned to the states and the District of Columbia.^[94] The Supreme Court, led by the Chief Justice of the United States, has nine members, who serve for life.^[95]

The state governments are structured in roughly similar fashion; Nebraska uniquely has a unicameral legislature.^[96] The governor (chief executive) of each state is directly elected. Some state judges and cabinet officers are appointed by the governors of the respective states, while others are elected by popular vote.

The original text of the Constitution establishes the structure and responsibilities of the federal government and its relationship with the individual states. Article One protects the right to the "great writ" of habeas corpus, and Article Three guarantees the right to a jury trial in all criminal cases. Amendments to the Constitution require the approval of three-fourths of the states. The Constitution has been amended twenty-seven times;^[97] the first ten amendments, which make up the Bill of Rights, and the Fourteenth Amendment form the central basis of Americans' individual rights. All laws and governmental procedures are subject to judicial review and any law ruled in violation of the Constitution is voided. The principle of judicial review, not explicitly mentioned in the Constitution, was declared by the Supreme Court in Marbury v. Madison (1803).^[98]

Parties and ideology

Main articles: Politics of the United States and Political ideologies in the United States

Current president Barack Obama taking the presidential oath from Chief Justice John Roberts, January 20, 2009

The United States has operated under a two-party system for most of its history.^[99] For elective offices at most levels, state-administered primary elections choose the major party nominees for subsequent general elections. Since the general election of 1856, the major parties have been the Democratic Party, founded in 1824, and the Republican Party, founded in 1854. Since the Civil War, only one third-party presidential candidate—former president Theodore Roosevelt, running as a Progressive in 1912—has won as much as 20% of the popular vote. The third-largest political party is the Libertarian Party.

Within American political culture, the Republican Party is considered center-right or conservative and the Democratic Party is considered center-left or liberal.^[100] The states of the Northeast and West Coast and some of the Great Lakes states, known as "blue states", are relatively liberal. The "red states" of the South and parts of the Great Plains and Rocky Mountains are relatively conservative.

The winner of the 2008 presidential election, Democrat Barack Obama, is the 44th U.S. president; although, he is the 43rd person sworn into office, as Grover Cleveland served two non-consecutive terms and is counted chronologically as both the 22nd and 24th president.

The 2010 midterm elections saw the Republican Party take control of the House and make gains in the Senate, where the Democrats retain the majority. In the 112th United States Congress, the Senate consists of 51 Democrats, two independents who caucus with the Democrats, and 47 Republicans; the House consists of 242 Republicans and 192 Democrats—one seat is vacant. There are 29 Republican and 20 Democratic state governors, as well as one independent.^[101]

Since the founding of the United States until 2000s, the country's governance has been primarily dominated by White Anglo-Saxon Protestants (WASPs). However, the situation has changed recently and of the top 17 positions (four national candidates of the two major party in the 2012 U.S. presidential election, four leaders in 112th United States Congress, and nine Supreme Court Justices) there is only one WASP.^[102]^[103]^[104]

Foreign relations and military

Main articles: Foreign relations of the United States, Foreign policy of the United States, and United States Armed Forces

British Foreign Secretary William Hague and U.S. Secretary of State Hillary Clinton, May 2010

The United States exercises global economic, political, and military influence. It is a permanent member of the United Nations Security Council and New York City hosts the United Nations Headquarters. It is a member of the G8,^[105] G20, and Organisation for Economic Co-operation and Development. Almost all countries have embassies in Washington, D.C., and many have consulates around the country. Likewise, nearly all nations host American diplomatic missions. However, Cuba, Iran, North Korea, Bhutan, and the Republic of China (Taiwan) do not have formal diplomatic relations with the United States (although the US still supplies Taiwan with military equipment).

The United States has a "special relationship" with the United Kingdom^[106] and strong ties with Canada,^[107] Australia,^[108] New Zealand,^[109] the Philippines,^[110] Japan,^[111] South Korea,^[112] and Israel^[113] and several European countries such as France and Germany. It works closely with fellow NATO members on military and security issues and with its neighbors through the Organization of American States and free trade agreements such as the trilateral North American Free Trade Agreement with Canada and Mexico. In 2008, the United States spent a net $25.4 billion on official development assistance, the most in the world. As a share of America's large gross national income (GNI), however, the U.S. contribution of 0.18% ranked last among twenty-two donor states. By contrast, private overseas giving by Americans is relatively generous.^[114]

The president holds the title of commander-in-chief of the nation's armed forces and appoints its leaders, the secretary of defense and the Joint Chiefs of Staff. The United States Department of Defense administers the armed forces, including the Army, Navy, Marine Corps, and Air Force. The Coast Guard is run by the Department of Homeland Security in peacetime and the Department of the Navy in time of war. In 2008, the armed forces had 1.4 million personnel on active duty. The Reserves and National Guard brought the total number of troops to 2.3 million. The Department of Defense also employed about 700,000 civilians, not including contractors.^[115]

The USS Abraham Lincoln aircraft carrier.

Military service is voluntary, though conscription may occur in wartime through the Selective Service System.^[116] American forces can be rapidly deployed by the Air Force's large fleet of transport aircraft, the Navy's eleven active aircraft carriers, and Marine Expeditionary Units at sea with the Navy's Atlantic and Pacific fleets. The military operates 865 bases and facilities abroad,^[117] and maintains deployments greater than 100 active duty personnel in 25 foreign countries.^[118] The extent of this global military presence has prompted some scholars to describe the United States as maintaining an "empire of bases".^[119]

Total U.S. military spending in 2010, almost $700 billion, was 43% of global military spending and greater than the next fourteen largest national military expenditures combined. At 4.8% of GDP, the rate was the second-highest among the top fifteen military spenders, after Saudi Arabia.^[120] US defense spending as a percentage of GDP ranks 24th globally as of 2010 according to the CIA.^[121] Defense's share of US spending has generally declined in recent decades, from Cold War peaks of 14.2% of GDP in 1953 and 69.5% of federal outlays in 1954 to 4.7% of GDP and 18.8% of federal outlays in 2011.^[122] The proposed base Department of Defense budget for 2012, $553 billion, is a 4.2% increase over 2011; an additional $118 billion is proposed for the military campaigns in Iraq and Afghanistan.^[123] The last American troops serving in Iraq departed in December 2011;^[124] 4,484 servicemen were killed during the Iraq War.^[125] Approximately 90,000 U.S. troops were serving in Afghanistan as of April 2012;^[126] as of April 4, 1,924 had been killed during the War in Afghanistan.^[127]

Economy

Main article: Economy of the United States

The United States has a capitalist mixed economy, which is fueled by abundant natural resources, a well-developed infrastructure, and high productivity.^[135] According to the International Monetary Fund, the U.S. GDP of $15.1 trillion constitutes 22% of the gross world product at market exchange rates and over 19% of the gross world product at purchasing power parity (PPP).^[3] Though larger than any other nation's, its national GDP was about 5% smaller at PPP in 2011 than the European Union's, whose population is around 62% higher.^[136] The country ranks ninth in the world in nominal GDP per capita and sixth in GDP per capita at PPP.^[3] The U.S. dollar is the world's primary reserve currency.^[137]

The United States is the largest importer of goods and second largest exporter, though exports per capita are relatively low. In 2010, the total U.S. trade deficit was $635 billion.^[138] Canada, China, Mexico, Japan, and Germany are its top trading partners.^[139] In 2010, oil was the largest import commodity, while transportation equipment was the country's largest export.^[138] China is the largest foreign holder of U.S. public debt.^[140]

New York Stock Exchange on Wall Street, world's largest stock exchange per total market capitalization of its listed companies.^[141]

In 2009, the private sector was estimated to constitute 86.4% of the economy, with federal government activity accounting for 4.3% and state and local government activity (including federal transfers) the remaining 9.3%.^[142] While its economy has reached a postindustrial level of development and its service sector constitutes 67.8% of GDP, the United States remains an industrial power.^[143] The leading business field by gross business receipts is wholesale and retail trade; by net income it is manufacturing.^[144]

Chemical products are the leading manufacturing field.^[145] The United States is the third largest producer of oil in the world, as well as its largest importer.^[146] It is the world's number one producer of electrical and nuclear energy, as well as liquid natural gas, sulfur, phosphates, and salt. While agriculture accounts for just under 1% of GDP,^[143] the United States is the world's top producer of corn^[147] and soybeans.^[148] Coca-Cola and McDonald's are the two most recognized brands in the world.^[149]

In August 2010, the American labor force consisted of 154.1 million people. With 21.2 million people, government is the leading field of employment. The largest private employment sector is health care and social assistance, with 16.4 million people. About 12% of workers are unionized, compared to 30% in Western Europe.^[150] The World Bank ranks the United States first in the ease of hiring and firing workers.^[151]

The 2008-2012 global recession affected the United States quite badly. For example, persistent high unemployment remains, along with low consumer confidence, the continuing decline in home values and increase in foreclosures and personal bankruptcies, an escalating federal debt crisis, inflation, and rising petroleum and food prices. In fact, a 2011 poll found that more than half of all Americans think the U.S. is still in recession or even depression, despite official data that shows a historically modest recovery.^[152] In 2009, the United States had the third highest labor productivity per person in the world, behind Luxembourg and Norway. It was fourth in productivity per hour, behind those two countries and the Netherlands.^[153] Compared to Europe, U.S. property and corporate income tax rates are generally higher, while labor and, particularly, consumption tax rates are lower.^[154]

In 2013 the United States ranks equal 16th in the best-country-to-be-born-in list.^[155]

Income and human development

Main article: Income in the United States

See also: Income inequality in the United States, Poverty in the United States, and Affluence in the United States

According to the United States Census Bureau, the pretax median household income in 2010 was $49,445. The median ranged from $64,308 among Asian American households to $32,068 among African American households.^[131] Using purchasing power parity exchange rates, the overall median is similar to the most affluent cluster of developed nations. As of 2007, Americans had the second highest median equivalised disposable household income among OECD nations, behind only Luxembourg, and the highest average disposable income and employee earnings.^[156]^[157] After declining sharply during the middle of the 20th century, poverty rates have plateaued since the early 1970s, with 11–15% of Americans below the poverty line every year, and 58.5% spending at least one year in poverty between the ages of 25 and 75.^[158]^[159] In 2010, 46.2 million Americans lived in poverty, a figure that rose for the fourth year in a row.^[131]

A middle-class suburban housing development in San Jose, California.

The U.S. welfare state is one of the least extensive in the developed world, reducing both relative poverty and absolute poverty by considerably less than the mean for rich nations,^[160]^[161] though combined private and public social expenditures per capita are relatively high.^[162] While the American welfare state effectively reduces poverty among the elderly,^[163] it provides relatively little assistance to the young.^[164] A 2007 UNICEF study of children's well-being in twenty-one industrialized nations ranked the United States next to last.^[165]

Between 1947 and 1979, real median income rose by over 80% for all classes, with the incomes of poor Americans rising faster than those of the rich.^[166] However, income gains since then have been slower, less widely shared, and accompanied by increased economic insecurity.^[166]^[167] Median household income has increased for all classes since 1980,^[168] largely owing to more dual-earner households, the closing of the gender pay gap, and longer work hours, but the growth has been strongly tilted toward the very top.^[160]^[166]^[169]

Consequently, the share of income of the top 1%—21.8% of total reported income in 2005—has more than doubled since 1980,^[170] leaving the United States with the greatest income inequality among developed nations.^[160]^[171] The United States has a progressive tax system which equates to higher income earners paying a larger percentage of their income in taxes.^[172] The top 1% pays 27.6% of all federal taxes, while the top 10% pays 54.7%.^[173]

Wealth, like income and taxes, is highly concentrated: The richest 10% of the adult population possesses 69.8% of the country's household wealth, the second-highest share among developed nations.^[174] The top 1% possesses 33.4% of net wealth.^[175] In 2011 the United Nations Development Programme ranked the United States 23rd among 139 countries on its inequality-adjusted human development index (IHDI), nineteen places lower than in the standard HDI.^[176]

Infrastructure

Science and technology

Main article: Science and technology in the United States

See also: Technological and industrial history of the United States

Neil Armstrong was the first person to walk on the Moon.

The United States has been a leader in scientific research and technological innovation since the late 19th century. In 1876, Alexander Graham Bell was awarded the first U.S. patent for the telephone. Thomas Edison's laboratory developed the phonograph, the first long-lasting light bulb, and the first viable movie camera.^[177] Nikola Tesla pioneered alternating current, the AC motor, and radio. In the early 20th century, the automobile companies of Ransom E. Olds and Henry Ford popularized the assembly line. The Wright brothers, in 1903, made the first sustained and controlled heavier-than-air powered flight.^[178]

The rise of Nazism in the 1930s led many European scientists, including Albert Einstein, Enrico Fermi, and John von Neumann, to immigrate to the United States. During World War II, the Manhattan Project developed nuclear weapons, ushering in the Atomic Age. The Space Race produced rapid advances in rocketry, materials science, and computers. IBM, Apple Computer, and Microsoft refined and popularized the personal computer.

The United States largely developed the ARPANET and its successor, the Internet. Today, 64% of research and development funding comes from the private sector.^[179] The United States leads the world in scientific research papers and impact factor.^[180] As of April 2010, 77% of American households owned at least one computer, and 68% had broadband Internet service.^[181] 85% of Americans also own a mobile phone as of 2011.^[182] The country is the primary developer and grower of genetically modified food, representing half of the world's biotech crops.^[183]

Transportation

Main article: Transportation in the United States

The Interstate Highway System, which extends 46,876 miles (75,440 km)^[184]

Personal transportation is dominated by automobiles, which operate on a network of 13 million roads,^[185] including one of the world's longest highway systems.^[186] The world's second largest automobile market,^[187] the United States has the highest rate of per-capita vehicle ownership in the world, with 765 vehicles per 1,000 Americans.^[188] About 40% of personal vehicles are vans, SUVs, or light trucks.^[189] The average American adult (accounting for all drivers and nondrivers) spends 55 minutes driving every day, traveling 29 miles (47 km).^[190]

Mass transit accounts for 9% of total U.S. work trips.^[191]^[192] While transport of goods by rail is extensive, relatively few people use rail to travel,^[193] though ridership on Amtrak, the national intercity passenger rail system, grew by almost 37% between 2000 and 2010.^[194] Also, Light rail development has increased in recent years.^[195] Bicycle usage for work commutes is minimal.^[196]

The civil airline industry is entirely privately owned and has been largely deregulated since 1978, while most major airports are publicly owned. The three largest airlines in the world by passengers carried are U.S.-based; Delta Air Lines is number one.^[197] Of the world's thirty busiest passenger airports, sixteen are in the United States, including the busiest, Hartsfield-Jackson Atlanta International Airport.^[198]

Energy

See also: Energy policy of the United States

The United States energy market is 29,000 terawatt hours per year. Energy consumption per capita is 7.8 tons of oil equivalent per year, the 10th highest rate in the world. In 2005, 40% of this energy came from petroleum, 23% from coal, and 22% from natural gas. The remainder was supplied by nuclear power and renewable energy sources.^[199] The United States is the world's largest consumer of petroleum.^[200] For decades, nuclear power has played a limited role relative to many other developed countries, in part due to public perception in the wake of a 1979 accident. In 2007, several applications for new nuclear plants were filed.^[201] The United States has 27% of global coal reserves.^[202]

Education

Main article: Education in the United States

See also: Educational attainment in the United States and Higher education in the United States

Some 80% of U.S. college students attend public universities such as the University of Virginia, founded by Thomas Jefferson.^[203]

American public education is operated by state and local governments, regulated by the United States Department of Education through restrictions on federal grants. Children are required in most states to attend school from the age of six or seven (generally, kindergarten or first grade) until they turn eighteen (generally bringing them through twelfth grade, the end of high school); some states allow students to leave school at sixteen or seventeen.^[204] About 12% of children are enrolled in parochial or nonsectarian private schools. Just over 2% of children are homeschooled.^[205]

The United States has many competitive private and public institutions of higher education. According to prominent international rankings, 13 or 15 American colleges and universities are ranked among the top 20 in the world.^[206]^[207] There are also local community colleges with generally more open admission policies, shorter academic programs, and lower tuition. Of Americans twenty-five and older, 84.6% graduated from high school, 52.6% attended some college, 27.2% earned a bachelor's degree, and 9.6% earned graduate degrees.^[208] The basic literacy rate is approximately 99%.^[1]^[209] The United Nations assigns the United States an Education Index of 0.97, tying it for 12th in the world.^[210]

Health

See also: Health care in the United States, Health care reform in the United States, and Health insurance in the United States

The Texas Medical Center in Houston, the world's largest medical center^[211]

The United States life expectancy of 78.4 years at birth ranks it 50th among 221 nations.^[212] Increasing obesity in the United States and health improvements elsewhere have contributed to lowering the country's rank in life expectancy from 1987, when it was 11th in the world.^[213] Obesity rates in the United States are among the highest in the world.^[214] Approximately one-third of the adult population is obese and an additional third is overweight;^[215] the obesity rate, the highest in the industrialized world, has more than doubled in the last quarter-century.^[216] Obesity-related type 2 diabetes is considered epidemic by health care professionals.^[217] The infant mortality rate of 6.06 per thousand places the United States 176th out of 222 countries.^[218]

The US is a global leader in medical innovation. America solely developed or contributed significantly to 9 of the top 10 most important medical innovations since 1975 as ranked by a 2001 poll of physicians, while the EU and Switzerland together contributed to five. Since 1966 Americans have received more Nobel Prizes in Medicine than the rest of the world combined. From 1989 to 2002 four times more money was invested in private biotechnology companies in America than in Europe.^[219]^[220]

The U.S. health care system far outspends any other nation's, measured in both per capita spending and percentage of GDP.^[221] Health care coverage in the United States is a combination of public and private efforts, and is not universal as in all other developed countries. In 2004, private insurance paid for 36% of personal health expenditures, private out-of-pocket payments covered 15%, and federal, state, and local governments paid for 44%.^[222]

In 2005, 46.6 million Americans, 15.9% of the population, were uninsured, 5.4 million more than in 2001. The main cause of this rise is the drop in the number of Americans with employer-sponsored health insurance.^[223] The subject of uninsured and underinsured Americans is a major political issue.^[224]^[225] In 2006, Massachusetts became the first state to mandate universal health insurance.^[226] Federal legislation passed in early 2010 would ostensibly create a near-universal health insurance system around the country by 2014, though the bill and its ultimate impact are issues of controversy.^[227]^[228]

Crime and law enforcement

Main articles: Law enforcement in the United States and Crime in the United States

See also: Law of the United States, Incarceration in the United States, Capital punishment in the United States, and Second Amendment to the United States Constitution

Law enforcement in the U.S. is maintained primarily by local police departments. The New York City Police Department (NYPD) is the largest in the country.^[229]

Law enforcement in the United States is primarily the responsibility of local police and sheriff's departments, with state police providing broader services. Federal agencies such as the Federal Bureau of Investigation (FBI) and the U.S. Marshals Service have specialized duties.^[230] At the federal level and in almost every state, jurisprudence operates on a common law system.

State courts conduct most criminal trials; federal courts handle certain designated crimes as well as certain appeals from the state criminal courts. Federal law prohibits a variety of drugs, although states sometimes pass laws in conflict with federal regulations. The smoking age is generally 18, and the drinking age is generally 21.

Among developed nations, the United States has above-average levels of violent crime and particularly high levels of gun violence and homicide.^[231] There were 5.0 murders per 100,000 persons in 2009, 10.4% fewer than in 2000.^[232] Gun ownership rights are the subject of contentious political debate.

The United States has the highest documented incarceration rate^[233] and total prison population^[234] in the world. At the start of 2008, more than 2.3 million people were incarcerated, more than one in every 100 adults.^[235] The current rate is about seven times the 1980 figure,^[236] and over three times the figure in Poland, the Organisation for Economic Co-operation and Development (OECD) country with the next highest rate.^[237] African American males are jailed at about six times the rate of white males and three times the rate of Hispanic males.^[233] The country's high rate of incarceration is largely due to sentencing and drug policies.^[233]^[238]

Capital punishment is sanctioned in the United States for certain federal and military crimes, and used in thirty-three states.^[239] No executions took place from 1967 to 1977, owing in part to a U.S. Supreme Court ruling striking down arbitrary imposition of the death penalty. In 1976, that Court ruled that, under appropriate circumstances, capital punishment may constitutionally be imposed; since the decision there have been more than 1,300 executions, a majority of these taking place in three states: Texas, Virginia, and Oklahoma.^[240] Four state legislatures in the modern era have abolished the death penalty, though two of those laws (in New Mexico and Connecticut) were not retroactive. Additionally, state courts in Massachusetts and New York struck down death penalty statutes and their legislatures took no action in response. In 2010, the country had the fifth highest number of executions in the world, following China, Iran, North Korea, and Yemen.^[241]

Demographics

Main articles: Demographics of the United States and Americans

Largest ancestry groups by county, 2000.

The U.S. Census Bureau estimates the country's population now to be 315,108,000,^[2] including an estimated 11.2 million illegal immigrants.^[243] The U.S. population almost quadrupled during the 20th century, from about 76 million in 1900.^[244] The third most populous nation in the world, after China and India, the United States is the only major industrialized nation in which large population increases are projected.^[245]

With a birth rate of 13 per 1,000, 35% below the world average, its population growth rate is positive at 0.9%, significantly higher than those of many developed nations.^[246] In fiscal year 2011, over 1 million immigrants (most of whom entered through family reunification) were granted legal residence.^[247] Mexico has been the leading source of new residents for over two decades; since 1998, China, India, and the Philippines have been in the top four sending countries every year.^[248] 9 million Americans identify as lesbian, gay, bisexual or transgender, making up 4% of the population.^[249] A 2010 survey found that 7 percent of men and 8 percent of women identified as gay, lesbian or bisexual.^[250]

The United States has a very diverse population—thirty-one ancestry groups have more than one million members.^[251] White Americans are the largest racial group; German Americans, Irish Americans, and English Americans constitute three of the country's four largest ancestry groups.^[251] Black Americans are the nation's largest racial minority and third largest ancestry group.^[251] Asian Americans are the country's second largest racial minority; the two largest Asian American ethnic groups are Chinese Americans and Filipino Americans.^[251]

In 2010, the U.S. population included an estimated 5.2 million people with some American Indian or Alaska Native ancestry (2.9 million exclusively of such ancestry) and 1.2 million with some native Hawaiian or Pacific island ancestry (0.5 million exclusively).^[252] The census counted more than 19 million people of "Some Other Race" who were "unable to identify with any" of its five official race categories in 2010.^[252]

The population growth of Hispanic and Latino Americans (the terms are officially interchangeable) is a major demographic trend. The 50.5 million Americans of Hispanic descent^[252] are identified as sharing a distinct "ethnicity" by the Census Bureau; 64% of Hispanic Americans are of Mexican descent.^[253] Between 2000 and 2010, the country's Hispanic population increased 43% while the non-Hispanic population rose just 4.9%.^[242] Much of this growth is from immigration; as of 2007, 12.6% of the U.S. population was foreign-born, with 54% of that figure born in Latin America.^[254]

Fertility is also a factor; as of 2010 the average Hispanic (of any race) woman gave birth to 2.35 children in her lifetime, compared to 1.97 for non-Hispanic black women and 1.79 for non-Hispanic white women (both below the replacement rate of 2.1).^[255] Minorities (as defined by the Census Bureau as all those beside non-Hispanic, non-multiracial whites) constituted 36.3% of the population in 2010,^[256] and over 50% of children under age 1,^[257] and are projected to constitute the majority by 2042.^[258] This contradicts the report by the National Vital Statistics Reports, based on the US census data, which concludes that, 54% (2,162,406 out of 3,999,386 in 2010) of births were non-Hispanic white.^[255]

About 82% of Americans live in urban areas (including suburbs);^[1] about half of those reside in cities with populations over 50,000.^[259] In 2008, 273 incorporated places had populations over 100,000, nine cities had more than 1 million residents, and four global cities had over 2 million (New York City, Los Angeles, Chicago, and Houston).^[260]

There are fifty-two metropolitan areas with populations greater than 1 million.^[261] Of the fifty fastest-growing metro areas, forty-seven are in the West or South.^[262] The metro areas of Dallas, Houston, Atlanta, and Phoenix all grew by more than a million people between 2000 and 2008.^[261]

Leading population centers					view talk edit
Rank	Core city	Metro area pop.^[263]	Metropolitan Statistical Area	Region^[264]	New York City Los Angeles Chicago
1	New York	19,015,900	New York–Northern New Jersey–Long Island, NY–NJ–PA MSA	Northeast
2	Los Angeles	12,944,801	Los Angeles–Long Beach–Santa Ana, CA MSA	West
3	Chicago	9,504,753	Chicago–Joliet–Naperville, IL–IN–WI MSA	Midwest
4	Dallas	6,526,548	Dallas–Fort Worth–Arlington, TX MSA	South
5	Houston	6,086,538	Houston–Sugar Land–Baytown, TX MSA	South
6	Philadelphia	5,992,414	Philadelphia–Camden–Wilmington, PA–NJ–DE–MD MSA	Northeast
7	Washington, D.C.	5,703,948	Washington, DC–VA–MD–WV MSA	South
8	Miami	5,670,125	Miami–Fort Lauderdale–Pompano Beach, FL MSA	South
9	Atlanta	5,359,205	Atlanta–Sandy Springs–Marietta, GA MSA	South
10	Boston	4,591,112	Boston–Cambridge–Quincy, MA–NH MSA	Northeast
based on the 2011 U.S. Population Estimate

Language

Main article: Languages of the United States

See also: Language Spoken at Home and List of endangered languages in the United States

Languages (2010)^[265]
English (only)	229.7 million
Spanish, incl. Creole	37.0 million
Chinese	2.8 million
French, incl. Creole	2.1 million
Tagalog	1.6 million
Vietnamese	1.4 million
Korean	1.1 million
German	1.1 million

English is the de facto national language. Although there is no official language at the federal level, some laws—such as U.S. naturalization requirements—standardize English. In 2010, about 230 million, or 80% of the population aged five years and older, spoke only English at home. Spanish, spoken by 12% of the population at home, is the second most common language and the most widely taught second language.^[265]^[266] Some Americans advocate making English the country's official language, as it is in at least twenty-eight states.^[5] Both Hawaiian and English are official languages in Hawaii by state law.^[267]

While neither has an official language, New Mexico has laws providing for the use of both English and Spanish, as Louisiana does for English and French.^[268] Other states, such as California, mandate the publication of Spanish versions of certain government documents including court forms.^[269] Many jurisdictions with large numbers of non-English speakers produce government materials, especially voting information, in the most commonly spoken languages in those jurisdictions.

Several insular territories grant official recognition to their native languages, along with English: Samoan and Chamorro are recognized by American Samoa and Guam, respectively; Carolinian and Chamorro are recognized by the Northern Mariana Islands; Spanish is an official language of Puerto Rico and is more widely spoken than English there.

Religion

Main article: Religion in the United States

See also: History of religion in the United States, Freedom of religion in the United States, Separation of church and state in the United States, and List of religious movements that began in the United States

A pie chart of religious groups in the US (2007)

The United States is officially a secular nation; the First Amendment of the U.S. Constitution guarantees the free exercise of religion and forbids the establishment of any religious governance. In a 2002 study, 59% of Americans said that religion played a "very important role in their lives", a far higher figure than that of any other wealthy nation.^[270] According to a 2007 survey, 78.4% of adults identified themselves as Christian,^[271] down from 86.4% in 1990.^[272]

Protestant denominations accounted for 51.3%, while Roman Catholicism, at 23.9%, was the largest individual denomination.^[271] The total reporting non-Christian religions in 2007 was 4.7%, up from 3.3% in 1990.^[272] Other religions include Judaism (1.7%), Buddhism (0.7%), Islam (0.6%), Hinduism (0.4%), and Unitarian Universalism (0.3%).^[271] The survey also reported that 16.1% of Americans described themselves as agnostic, atheist, or simply having no religion, up from 8.2% in 1990.^[271]^[272]

There are also Baha'i, Wiccan, Druid, Jain, Native American, humanist and deist communities.^[273] Doubt about the existence of a god or gods is growing rapidly among Americans under 30.^[274] Polls show that overall American confidence in organized religion is declining,^[275] and that younger Americans in particular are becoming increasingly irreligious.^[276]

Family structure

Main article: Family structure in the United States

In 2007, 58% of Americans age 18 and over were married, 6% were widowed, 10% were divorced, and 25% had never been married.^[277] Women now mostly work outside the home and receive a majority of bachelor's degrees.^[278]

The U.S. teenage pregnancy rate, 79.8 per 1,000 women, is the highest among OECD nations.^[279] Abortion policy was left to the states until the Supreme Court legalized the practice in 1973. The issue remains highly controversial, with public opinion closely divided for many years. Many states ban public funding of the procedure and restrict late-term abortions, require parental notification for minors, and mandate a waiting period. While the abortion rate is falling, the abortion ratio of 241 per 1,000 live births and abortion rate of 15 per 1,000 women aged 15–44 remain higher than those of most Western nations.^[280]

Same-sex marriage is a contentious issue. Some states permit civil unions or domestic partnerships in lieu of marriage. Since 2003, several states have legalized gay marriage as the result of judicial or legislative action. Meanwhile, the federal government and a majority of states define marriage as between a man and a woman and/or explicitly prohibit same-sex marriage. Public opinion on the issue has shifted from general opposition in the 1990s to a statistical deadlock, to a majority in support.^[281]

Culture

Main article: Culture of the United States

See also: Social class in the United States

The Statue of Liberty in New York City is a symbol of both the US and ideals of freedom, democracy, and opportunity.^[282]

The United States is a multicultural nation, home to a wide variety of ethnic groups, traditions, and values.^[6]^[283] Aside from the now small Native American and Native Hawaiian populations, nearly all Americans or their ancestors immigrated within the past five centuries.^[284] Mainstream American culture is a Western culture largely derived from the traditions of European immigrants with influences from many other sources, such as traditions brought by slaves from Africa.^[6]^[285] More recent immigration from Asia and especially Latin America has added to a cultural mix that has been described as both a homogenizing melting pot, and a heterogeneous salad bowl in which immigrants and their descendants retain distinctive cultural characteristics.^[6]

American culture is considered the most individualistic in the world.^[286] The American Dream, or the perception that Americans enjoy high social mobility, plays a key role in attracting immigrants.^[287] While the mainstream culture holds that the United States is a classless society,^[288] scholars identify significant differences between the country's social classes, affecting socialization, language, and values.^[289]

The American middle and professional class has initiated many contemporary social trends such as modern feminism, environmentalism, and multiculturalism.^[290] Americans' self-images, social viewpoints, and cultural expectations are associated with their occupations to an unusually close degree.^[291] While Americans tend greatly to value socioeconomic achievement, being ordinary or average is generally seen as a positive attribute.^[292]

Popular media

Main articles: Cinema of the United States, Television in the United States, and Music of the United States

The Hollywood Sign in Los Angeles, California.

The world's first commercial motion picture exhibition was given in New York City in 1894, using Thomas Edison's Kinetoscope. The next year saw the first commercial screening of a projected film, also in New York, and the United States was in the forefront of sound film's development in the following decades. Since the early 20th century, the U.S. film industry has largely been based in and around Hollywood, California.

Director D. W. Griffith was central to the development of film grammar and Orson Welles's Citizen Kane (1941) is frequently cited as the greatest film of all time.^[293] American screen actors like John Wayne and Marilyn Monroe have become iconic figures, while producer/entrepreneur Walt Disney was a leader in both animated film and movie merchandising. The major film studios of Hollywood have produced the most commercially successful movies in history, such as Star Wars (1977) and Titanic (1997), and the products of Hollywood today dominate the global film industry.^[294]

Americans are the heaviest television viewers in the world,^[295] and the average viewing time continues to rise, reaching five hours a day in 2006.^[296] The four major broadcast networks are all commercial entities. Americans listen to radio programming, also largely commercialized, on average just over two-and-a-half hours a day.^[297] Aside from web portals and search engines, the most popular websites are Facebook, YouTube, Wikipedia, Blogger, eBay, and Craigslist.^[298]

The rhythmic and lyrical styles of African-American music have deeply influenced American music at large, distinguishing it from European traditions. Elements from folk idioms such as the blues and what is now known as old-time music were adopted and transformed into popular genres with global audiences. Jazz was developed by innovators such as Louis Armstrong and Duke Ellington early in the 20th century. Country music developed in the 1920s, and rhythm and blues in the 1940s.^[299]

Elvis Presley and Chuck Berry were among the mid-1950s pioneers of rock and roll. In the 1960s, Bob Dylan emerged from the folk revival to become one of America's most celebrated songwriters and James Brown led the development of funk. More recent American creations include hip hop and house music. American pop stars such as Presley, Michael Jackson, and Madonna have become global celebrities.^[299]

Literature, philosophy, and the arts

Main articles: American literature, American philosophy, Visual art of the United States, and American classical music

In the 18th and early 19th centuries, American art and literature took most of its cues from Europe. Writers such as Nathaniel Hawthorne, Edgar Allan Poe, and Henry David Thoreau established a distinctive American literary voice by the middle of the 19th century. Mark Twain and poet Walt Whitman were major figures in the century's second half; Emily Dickinson, virtually unknown during her lifetime, is now recognized as an essential American poet.^[300] A work seen as capturing fundamental aspects of the national experience and character—such as Herman Melville's Moby-Dick (1851), Twain's The Adventures of Huckleberry Finn (1885), and F. Scott Fitzgerald's The Great Gatsby (1925)—may be dubbed the "Great American Novel".^[301]

Mark Twain, famous American author and humourist.

Eleven U.S. citizens have won the Nobel Prize in Literature, most recently Toni Morrison in 1993. William Faulkner and Ernest Hemingway are often named among the most influential writers of the 20th century.^[302] Popular literary genres such as the Western and hardboiled crime fiction developed in the United States. The Beat Generation writers opened up new literary approaches, as have postmodernist authors such as John Barth, Thomas Pynchon, and Don DeLillo.

The transcendentalists, led by Thoreau and Ralph Waldo Emerson, established the first major American philosophical movement. After the Civil War, Charles Sanders Peirce and then William James and John Dewey were leaders in the development of pragmatism. In the 20th century, the work of W. V. O. Quine and Richard Rorty, and later Noam Chomsky, brought analytic philosophy to the fore of American philosophical academia. John Rawls and Robert Nozick led a revival of political philosophy.

In the visual arts, the Hudson River School was a mid-19th-century movement in the tradition of European naturalism. The realist paintings of Thomas Eakins are now widely celebrated. The 1913 Armory Show in New York City, an exhibition of European modernist art, shocked the public and transformed the U.S. art scene.^[303] Georgia O'Keeffe, Marsden Hartley, and others experimented with new, individualistic styles. Major artistic movements such as the abstract expressionism of Jackson Pollock and Willem de Kooning and the pop art of Andy Warhol and Roy Lichtenstein developed largely in the United States. The tide of modernism and then postmodernism has brought fame to American architects such as Frank Lloyd Wright, Philip Johnson, and Frank Gehry.

Times Square in New York City, part of the Broadway theater district.

One of the first major promoters of American theater was impresario P. T. Barnum, who began operating a lower Manhattan entertainment complex in 1841. The team of Harrigan and Hart produced a series of popular musical comedies in New York starting in the late 1870s. In the 20th century, the modern musical form emerged on Broadway; the songs of musical theater composers such as Irving Berlin, Cole Porter, and Stephen Sondheim have become pop standards. Playwright Eugene O'Neill won the Nobel literature prize in 1936; other acclaimed U.S. dramatists include multiple Pulitzer Prize winners Tennessee Williams, Edward Albee, and August Wilson.

Though little known at the time, Charles Ives's work of the 1910s established him as the first major U.S. composer in the classical tradition, while experimentalists such as Henry Cowell and John Cage created a distinctive American approach to classical composition. Aaron Copland and George Gershwin developed a new synthesis of popular and classical music. Choreographers Isadora Duncan and Martha Graham helped create modern dance, while George Balanchine and Jerome Robbins were leaders in 20th-century ballet. Americans have long been important in the modern artistic medium of photography, with major photographers including Alfred Stieglitz, Edward Steichen, and Ansel Adams. The newspaper comic strip and the comic book are both U.S. innovations. Superman, the quintessential comic book superhero, has become an American icon.^[304]

Food

Main article: Cuisine of the United States

Mainstream American cuisine is similar to that in other Western countries. Wheat is the primary cereal grain. Traditional American cuisine uses indigenous ingredients, such as turkey, venison, potatoes, sweet potatoes, corn, squash, and maple syrup, which were consumed by Native Americans and early European settlers.

Slow-cooked pork and beef barbecue, crab cakes, potato chips, and chocolate chip cookies are distinctively American foods. Soul food, developed by African slaves, is popular around the South and among many African Americans elsewhere. Syncretic cuisines such as Louisiana creole, Cajun, and Tex-Mex are regionally important.

Characteristic dishes such as apple pie, fried chicken, pizza, hamburgers, and hot dogs derive from the recipes of various immigrants. French fries, Mexican dishes such as burritos and tacos, and pasta dishes freely adapted from Italian sources are widely consumed.^[305] Americans generally prefer coffee to tea. Marketing by U.S. industries is largely responsible for making orange juice and milk ubiquitous breakfast beverages.^[306]

The American fast food industry, the world's largest, pioneered the drive-through format in the 1930s. Fast food consumption has sparked health concerns. During the 1980s and 1990s, Americans' caloric intake rose 24%;^[305] frequent dining at fast food outlets is associated with what public health officials call the American "obesity epidemic".^[307] Highly sweetened soft drinks are widely popular, and sugared beverages account for 9% of American caloric intake.^[308]

Sports

Main article: Sports in the United States

Swimmer Michael Phelps is the most decorated Olympic athlete of all time

Baseball has been regarded as the national sport since the late 19th century, while American football is now by several measures the most popular spectator sport.^[309] Basketball and ice hockey are the country's next two leading professional team sports. These four major sports, when played professionally, each occupy a season at different, but overlapping, times of the year. College football and basketball attract large audiences. Boxing and horse racing were once the most watched individual sports,^[310] but they have been eclipsed by golf and auto racing, particularly NASCAR. While soccer is much less popular in the United States than many other nations (where it is called football), it is played widely at the youth and amateur levels. Tennis and many outdoor sports are popular as well.

While most major U.S. sports have evolved out of European practices, basketball, volleyball, skateboarding, snowboarding, and cheerleading are American inventions, which have become popular in other countries. Lacrosse and surfing arose from Native American and Native Hawaiian activities that predate Western contact. Eight Olympic Games have taken place in the United States. The United States has won 2,301 medals at the Summer Olympic Games, more than any other country,^[311] and 253 in the Winter Olympic Games, the second most by 2006.^[312]

Measurement systems

Main articles: United States customary units and Metrication in the United States

Although the United States authorized the metric system in 1866 and was one of the original 17 signatory nations to the Metre Convention of 1875, the nation primarily relies on the United States customary units, very similar to the British imperial units system and also derived from the historical English units system. Lengths and distances are stated mostly in inches, feet and miles, weight in pounds and tons of 2,000 pounds, and temperatures in degrees Fahrenheit. Most units are the same as the imperial units of the same name, but measurements of capacity differ; the U.S. gallon and U.S. pint are about 83% of their Imperial equivalent, while the US fluid ounce is about 4% larger than the imperial fl.oz. According to the CIA Factbook, the United States is one of three countries that has not adopted the International System of Units (SI) metric system as their official system of weights and measures. However, SI predominates in science, medicine, technology, and international commerce.^[313]

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Setup for investigating gold nanoparticle penetration through reconstructed skin and comparison to published human skin data.

Labouta HI, Thude S, Schneider M.SourceHelmholtz Center for Infection Research, Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany.
Journal of biomedical optics.J Biomed Opt.2013 Jun;18(6):061218. doi: 10.1117/1.JBO.18.6.061218.
Owing to the limited source of human skin (HS) and the ethical restrictions of using animals in experiments, in vitro skin equivalents are a possible alternative for conducting particle penetration experiments. The conditions for conducting penetration experiments with model particles, 15-nm gold na
PMID 23203297

Viscoelastic properties of oat β-glucan-rich aqueous dispersions.

Xu J, Inglett GE, Chen D, Liu SX.SourceNational Center for Agricultural Utilization Research, Agricultural Research Service, US Department of Agriculture, 1815 North University Street, Peoria, IL 61604, USA. Electronic address: james.xu@ars.usda.gov.
Food chemistry.Food Chem.2013 May 1;138(1):186-91. doi: 10.1016/j.foodchem.2012.10.049. Epub 2012 Nov 8.
C-trim is a healthy food product containing soluble dietary fibre β-glucan. The dispersion of C-trim in water is a hydrocolloid biopolymer. The linear and non-linear rheological properties of dispersions of C-trim biopolymers were investigated. The linear viscoelastic behaviours for C-trim dispersi
PMID 23265475

Japanese Journal

アメリカにおける押井守『GHOST IN THE SHELL 攻殻機動隊』の受容-文化交流・インターフェイス・翻訳の場としてのアニメーション-

芳賀理彦,ハガタダヒコ,HAGA Tadahiko
千葉大学比較文化研究 3, 82-113, 201508-21-00
NAID 120005649187

IPOs, growth, and the impact of relaxing listing requirements

Takahashi Hidenori,Yamada Kazuo
Journal of Banking & Finance 59, 505-519, 2015-10
… years, which enables us to compare the firms' operating growth around IPOs as well as to compare the growth under both strict and relaxed listing requirements. …
NAID 120005649226

Idea Watch : DEFEND YOUR RESEARCH 企業のウェルネス・プログラムは社員を不健康にする

スパイサーアンドレ
Harvard business review 40(9), 104-107, 2015-09
NAID 40020555161

Related Pictures

★リンクテーブル★

リンク元	「100Cases 33」「100Cases 16」「超音波法」「超音波」「合衆国」
拡張検索	「IVUS」「FUS」「Arabidopsis AGAMOUS protein」「RNA結合タンパク質FUS」
関連記事	「U」

「100Cases 33」

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　　[★]

☆case33　頭痛と混乱

■glossary

accompany

vt.

(人)と同行する、(人)に随行する。(もの)に付随する。～と同時に起こる。～に加える(添える、同封する)(with)

slurred n. 不明瞭

強直間代痙攣 tonic-clonic convulsion

　意識消失とともに全身の随意筋に強直痙攣が生じ(強直痙攣期tonic convulsion)、次いで全身の筋の強直と弛緩とが律動的に繰り返される時期(間代痙攣期clonic convulsion)を経て、発作後もうろう状態を呈する一連の発作。

■症例

28歳、女性　黒人　南アフリカ　手術室看護師　ロンドン住在

主訴：頭痛と混乱

現病歴：過去3週間で頭痛が続いており、ひどくなってきた。現在も頭痛が持続しており、頭全体が痛い。友人曰く「過去六ヶ月で体重が10kg減っていて、最近、混乱してきたようだ」。発話は不明瞭。救急室にいる間に強直間代痙攣を起こした。

・診察 examination

やせている。55kg。38.5℃。口腔カンジダ症(oral candidiasis)。リンパ節腫脹無し。心血管、呼吸器系、消化器系正常。痙攣前における神経検査では時間、場所、人の見当識無し。神経局所症状無し(no focal neurological sign)。眼底両側に乳頭浮腫有り。

・検査 investigation

血算：白血球増多

血液生化学：ナトリウム低下

CT：供覧

■キーワード＆着目するポイント

・口腔カンジダ症(oral candidiasis)

・頭痛、精神症状、強直間代痙攣

・眼底両側に乳頭浮腫

・CT 所見

・低ナトリウム血症は二次的なもの

■アプローチ

・口腔カンジダ症(oral candidiasis)　→　細胞免疫低下状態(DM、免疫抑制、AIDSなど) or 常在細菌叢の攪乱(長期の抗菌薬の使用)

　・The occurrence of thrush in a young, otherwise healthy-appearing person should prompt an investigation for underlying HIV infection.(HIM.1254)

　・More commonly, thrush is seen as a nonspecific manifestation of severe debilitating illness.(HIM.1254)

・精神症状、強直間代痙攣　→　一次的、あるいは二次的な脳の疾患がありそう

・頭痛　→　漠然としていて絞れないが、他の症状からして機能性頭痛ではなく症候性頭痛っぽい。

・眼底両側に乳頭浮腫　→　脳圧亢進の徴候　→　原因は・・・脳腫瘍、ことにテント下腫瘍と側頭葉の腫瘍、クモ膜下出血、脳水腫など、そのほか、眼窩内病変、低眼圧などの局所的要因、悪性高血圧、血液疾患、大量出血、肺気腫などの全身的要因 (vindicate本のp342も参考になる)

　・頭痛と脳圧亢進　→　頭蓋内圧占拠性病変、脳炎(IMD.274)

・CT 所見　→　ringformの病変、脳浮腫、脳圧亢進

・低ナトリウム血症　→　脳ヘルニアに続発して起こることがあるらしい。実際には下垂体にトキソプラズマによる病変が形成されることにより起こりうる。

・そのほか出身地、体重減少もHIVを疑わせる点

パターン認識でHIV + 精神症状 + てんかん発作(強直間代痙攣) + 脳圧亢進 + CT 所見 = 一番ありそうなのはToxoplasma gondiiによるトキソプラズマ脳症 cerebral toxoplasosis (トキソプラズマ脳炎 toxoplasmic encephalitis)

■Toxoplasma gondii

　原虫　胞子原虫類

(感染予防学 080521のプリント、CASES p,92、HIM p.1305-)

・疫学：西洋では30-80%の成人がトキソプラズマの感染の既往がある・・・うぇ(CASES)。日本では10%前後(Wikipedia)。

・生活環

　・終宿主：ネコ：ネコの小腸上皮細胞で有性・無性生殖　糞便にオーシストの排泄

　・中間宿主：ヒト.ブタを含むほ乳類と鳥類：無性生殖で増殖、シストの形成

　　　急性期の増殖盛んな急増虫体 tachyzoiteとシスト内の緩増虫体 bradyzoite

・病原、病因 phathogenesis

　・緩増虫体(bradyzoite)、接合子嚢(oocyst)

・感染経路

　1. オーシストの経口摂取

　2. 中間宿主の生肉中のシストの経口摂取

　3. 初感染妊婦からの経胎盤感染。既感染なら胎盤感染しないらしい(HIM.1306)

　(4)移植臓器、輸血。確率は低い(at low rate)(HIM.1306)

・病態

　1. 先天性トキソプラズマ症　congenital toxoplasmosis

　　　①網脈絡膜炎、 ②水頭症、 ③脳内石灰化、 ④精神・運動障害

　2. 後天性トキソプラズマ症　acquired toxoplasmosis

　　(1) 健常者

　　　・多くは不顕性感染。発熱、リンパ節腫脹、皮疹(rash)

　　　・(少数例)筋肉痛、暈疼痛、腹痛、斑状丘疹状皮疹(maculopapular rash)、脳脊髄炎、混乱(HIM.1308)

　　　・(まれ)肺炎、心筋炎、脳症、心膜炎、多発筋炎

　　　・網膜、脈絡叢に瘢痕や、脳に小さい炎症性の病変を残すことあり(CASES)。

　　　・急性感染の症状は数週間で消失　筋肉や中枢神経系に緩増虫体が残存

　　(2)HIV 感染者、臓器移植例、がん化学療法例

　　　シスト内緩増虫体→急増虫体→播種性の多臓器感染

　　　AIDSでは、トキソプラズマ性脳炎が指標疾患 AIDS-defineing illness(CASES)

・治療

　(日本)アセチルスピラマイシン、ファンシダール(感染予防学 080521)

■トキソプラズマ脳炎 toxoplasmic encephalitis、トキソプラズマ脳症 cerebral toxoplasosis

・症状

　発熱、頭痛、混乱ｍ、痙攣、認知の障害、局所神経徴候(不全片麻痺、歯垢、脳神経損傷、視野欠損、感覚喪失)(CASES)

・画像検査

　(CT,MRI)多発性、両側性、ring-enhancing lesion、特に灰白質-白質境界、大脳基底核、脳幹、小脳が冒されやすい(CASES)

・鑑別診断(臨床症状・画像診断の所見で)

　リンパ腫、結核、転移性脳腫瘍(CASES)

・病歴と画像所見からの鑑別診断

　リンパ腫、結核、転移性腫瘍

？

このCTがcerebral toxoplasmosisに特徴的かは不明

□最後に残る疑問

　AIDSでWBC(leukocyte)の数はどうなるんだろう？？？AIDSの初診患者ではWBCが低い人が多いらしいし()、HIVはCD4+ T cellとmacrophageに感染して殺すから、これによってB cellは減るだろうし、CD8+ T cellも若干減少するだろうからWBCは減るんじゃないか？！好中球はAIDSとは関係ない？好中球は他の感染症に反応性に増加している？ちなみに、好酸球は寄生虫(原虫)の感染のために増える傾向にあるらしい(HIMのどこか)。

葉酸拮抗剤である。

サルファ剤と併用され、抗トキソプラズマ薬、抗ニューモシチス・カリニ薬として相乗的に働く。

ST 合剤

SMX-TMP

スルファメトキサゾール・トリメトプリム合剤 sulfamethoxazole and trimethoprim mixture

□AIDSの定義(http://en.wikipedia.org/wiki/CDC_Classification_System_for_HIV_Infection_in_Adults_and_Adolescents)

According to the US CDC definition, one has AIDS if he/she is infected with HIV and present with one of the following:

A CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

or he/she has one of the following defining illnesses:

01. Candidiasis of bronchi, trachea, or lungs
02. Candidiasis esophageal
03. Cervical cancer (invasive)
04. Coccidioidomycosis, disseminated or extrapulmonary
05. Cryptococcosis, extrapulmonary
06. Cryptosporidiosis, chronic intestinal for longer than 1 month
07. Cytomegalovirus disease (other than liver, spleen or lymph nodes)
08. Encephalopathy (HIV-related)
09. Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
10. Histoplasmosis, disseminated or extrapulmonary
11. Isosporiasis, chronic intestinal (for more than 1 month)
12. Kaposi's sarcoma
13. Lymphoma Burkitt's, immunoblastic or primary brain
14. Mycobacterium avium complex
15. Mycobacterium, other species, disseminated or extrapulmonary
16. Pneumocystis carinii pneumonia
17. Pneumonia (recurrent)
18. Progressive multifocal leukoencephalopathy
19. Salmonella septicemia (recurrent)
20. Toxoplasmosis of the brain
21. Tuberculosis
22. Wasting syndrome due to HIV

People who are not infected with HIV may also develop these conditions; this does not mean they have AIDS. However, when an individual presents laboratory evidence against HIV infection, a diagnosis of AIDS is ruled out unless the patient has not:

undergone high-dose corticoid therapy or other immunosuppressive/cytotoxic therapy in the three months before the onset of the indicator disease
OR been diagnosed with Hodgkin's disease, non-Hodgkin's lymphoma, lymphocytic leukemia, multiple myeloma, or any cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphoadenopathy
OR a genetic immunodeficiency syndrome atypical of HIV infection, such as one involving hypogamma globulinemia

AND

the individual has had Pneumocystis carinii pneumonia
OR one of the above defining illnesses AND a CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

□AIDSのステージング

Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)

http://en.wikipedia.org/wiki/WHO_Disease_Staging_System_for_HIV_Infection_and_Disease_in_Adults_and_Adolescents

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「100Cases 16」

　　[★]

☆case16　膝の痛み

■glossary

indigestion 消化障害、消化不良

■症例

80歳　男性

主訴：左膝の痛みと腫脹

現病歴：左膝の痛みを2日前から認めた。膝は発熱・腫脹しており、動かすと疼痛を生じる。時々胸焼けと消化不良が見られる。6ヶ月前のhealth checkで、高血圧(172/102mmHg)と血中クレアチニンが高い(正常高値)こと以外は正常といわれた。その4週間数回血圧を測定したが、高値が継続したため、2.5mg bendrofluamethizide(UK)/ベンドロフルメチアジド bendroflumethiazide(US)で治療を開始した。最近の血圧は138/84 mmHgであった。

喫煙歴：なし。

飲酒歴：一週間に平均4unit。

既往歴：股関節に中程度(mild)の変形性関節症

家族歴：特記なし

服薬歴：アセトアミノフェン(股関節の疼痛に対して)

身体所見 examination

　血圧 142/86mmHg。体温37.5℃。脈拍88/分。grade 2 hypertensive retinopathy(高血圧症性網膜症)。心血管系、呼吸器系に検査場異常なし。手にDIPにヘバーデン結節なし。

　左膝が発熱し腫脹している。関節内に液、patellar tap陽性。90℃以上膝関節を屈曲させると痛みを生じる。右の膝関節は正常に見える。

検査　 investigation

　生化学：白血球増多、ESR 上昇、尿素高値、グルコース高値

　単純X線：関節間隙やや狭小。それ以外に異常は認めない。

■problem list

　#1 左膝の痛み

　#2 胸焼け

　#3 消化不良

　#4 高血圧

　#5 クレアチニン正常高値

　#6 股関節の変形性リウマチ

　#7 高血圧性網膜症

■考え方

　・関節痛の鑑別診断を考える。

　・VINDICATEで考えてみてもよいでしょう。

　・関節痛の頻度としては　外傷＞慢性疾患(OAなど)＞膠原病＞脊椎疾患＞悪性腫瘍

■関節痛の鑑別疾患

DIF 282

V Vascular 血友病 hemophilia, 壊血病 scurvy, 無菌性骨壊死 aseptic bone necrosis (Osgood-Schlatter diseaseとか)

I Inflammatory 淋疾 gonorrhea, ライム病 lyme disease, 黄色ブドウ球菌 Staphylococcus, 連鎖球菌 Streptococcus, 結核 tuberculosis, 梅毒 syphilis, 風疹 rubella, 単純ヘルペス herpes simplex, HIV human immunodeficiency virus, サイトメガロウイルス cytomegalovirus

N Neoplastic disorders 骨原性肉腫 osteogenic sarcoma, 巨細胞腫 giant cell tumors

D Degenerative disorders degenerative joint disease or 変形性関節症 osteoarthritis

I Intoxication 痛風 gout (uric acid), 偽痛風 pseudogout (calcium pyrophosphate), ループス症候群 lupus syndrome of hydralazine (Apresoline) and procainamide, gout syndrome of diuretics

C Congenital and acquired malformations bring to mind the joint deformities of tabes dorsalis and syringomyelia and congenital dislocation of the hip. Alkaptonuria is also considered here.

A Autoimmune indicates (多い)関節リウマチ RA (可能性)血清病 serum sickness, 全身性エリテマトーデス lupus erythematosus, リウマチ熱 rheumatic fever, ライター症候群 Reiter syndrome, 潰瘍性大腸炎 ulcerative colitis, クローン病=限局性回腸炎 regional ileitis, 乾癬性関節炎 psoriatic arthritis (老人であり得る)リウマチ性多発筋痛症 polymyalgia rheumatica

T Trauma 外傷性滑膜炎 traumatic synovitis, tear or rupture of the collateral or cruciate ligaments, 亜脱臼 subluxation or laceration of the meniscus (semilunar cartilage), 脱臼 dislocation of the joint or patella, a 捻挫　 sprain of the joint, and fracture of the bones of the joint.

E Endcrine 先端肥大症 acromegaly, 閉経 menopause, 糖尿病 diabetes mellitus

■答え

　骨格筋系-関節炎-単関節炎-急性単関節炎

　痛風　尿酸　→　発熱、ESR↑、白血球↑

　偽痛風　ピロリン酸カルシウム

　高齢女性でチアジド系利尿薬の使用により痛風が誘発されやすい。特に腎機能低下、糖尿病の人はこのリスクが高まる。

■(BSTからの知識「)循環器領域での利尿薬

・心不全の治療において、循環血漿量を減らし、心臓の前負荷を軽減する。

・利尿薬は高尿酸血症を起こす。(けど、心不全の治療において高尿酸血症になったからといって痛風を発症している患者はみたことない)

・電解質異常を起こしやすいので、血液生化学の検査でモニタして注意する。たとえば低Kで不整脈のリスクが高まる。

・チアジド系の利尿薬は血糖を上げるし、尿酸を上げる

・長期の使用で腎機能を低下させる

■initial plan

　Dx 1. 関節液の吸引：関節液の一般検査、生化学検査、培養検査、

　　　　・白血球が増加していれば急性炎症性であることを示す。

　　　　・偏光顕微鏡で関節液を検鏡する。

　　　　　・尿酸の結晶：針状結晶。negatively birefringent

　　　　　・ピロリン酸カルシウムの結晶：positively birefringent

　Tx 1. 関節液の吸引：炎症が軽度改善

　　 2. NSAIDによる疼痛管理

　　 3. PPI：NSAID 潰瘍を予防するため

　　 4. ACE inhibitorの導入

「超音波法」

　　[★]

英: ultrasonography、US
関: 超音波検査、超音波診断、超音波検査法、超音波断層法、超音波

「超音波」

　　[★]

英: ultrasound US, high frequency sound
同: high frequency sound
関: 心エコー、ピエゾ電気効果

「合衆国」

　　[★]

英: United States、US
関: アメリカ合衆国、超音波法

「IVUS」

　　[★]

intravascular ultrasound 血管内超音波血管内超音波検査

関: intravascular ultrasonography、intravascular ultrasound

「FUS」

　　[★]

「Arabidopsis AGAMOUS protein」

　　[★]

シロイヌナズナタンパク質AGAMOUS

「RNA結合タンパク質FUS」

　　[★]

英: RNA-binding protein FUS

「U」

　　[★]

[WF-1] "United States". The World Factbook. CIA. September 30, 2009. https://www.cia.gov/library/publications/the-world-factbook/geos/us.html. Retrieved January 5, 2010 (area given in square kilometers).

[POP-2] "U.S. POPClock Projection". U.S. Census Bureau. http://www.census.gov/population/www/popclockus.html. Figure updated automatically.

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Economic indicators
Unemployment	7.8% (September 2012)	^[128]
GDP growth	1.3% (2Q 2012), 1.7% (2011)	^[129]
CPI inflation	1.7% (May 2011 – May 2012)	^[130]
Poverty	15.1% (2010)	^[131]
Public debt	$15.78 trillion (June 25, 2012)	^[132]
External debt	$15.41 trillion (September 28, 2012)	^[133]
Household net worth	$58.5 trillion (4Q 2011)	^[134]

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