A gold coin is a coin made mostly or entirely of gold. Gold has been for coins practically since the invention of coinage, originally because of gold's intrinsic value. In modern times, most gold coins sold either to collectors, or to be used as bullion coins— coins whose nominal value is irrelevant and which serve primarily as a method of investing in gold. Gold has been as money for many reasons. It is fungible, meaning that it trades easily, with a low spread between the prices to buy and sell. Gold is also easily transportable, as it has a high value to weight ratio, compared to other commodities, such as silver. Gold can be into smaller units, without destroying its value; it melts into ingots, and re-coined. The density of gold is higher than most other metals, making it difficult to pass counterfeits. Gold is extremely un-reactive. The scarcity of gold stabilizes its value. Precious metals in bulk form are bullion, and trade on commodity markets. Bullion metals cast into ingots, or minted into coins. The defining attribute of bullion is that it is valued by its mass and purity rather than by a face value as money. While obsolete gold coins are primarily collected for their numismatic value, gold bullion coins today derive their value from the metal (gold) content — and as such are viewed by some investors as a "hedge" against inflation or a store of value. Many nations mint bullion coins. Investment quality coins minted after 1800 have a purity of not less than 900 thousands and are legal tender in its country of origin. Although nominally issued as legal tender, these coins' face value as currency is far below that of their value as bullion. The European Commission publishes annually a list of gold coins, which are as investment gold coins in all EU Member States. The list has legal force and supplements the law. In the United Kingdom, HM Revenue and Customs have added an additional list of gold coins alongside the European Commission list. These are gold coins that HM Revenue & Customs recognize as falling within the exemption for investment gold coins. This second list does not have legal force. South Africa introduced the Krugerrand in 1967 to cater to this market; this was the reason for its convenient and memorable gold content — exactly one troy ounce. It was the first modern, low premium (i.e. priced only slightly above the bullion value of the gold) gold bullion coin. Bullion coins are also in fractions of an ounce – typically half ounce, quarter ounce, and one-tenth ounce. Bullion coins sometimes carry a face value as legal tender, the face value is on the coin, and in order to bestow legal tender status on a coin, which generally makes it easier to import or export across national borders, as well as subject to counterfeiting. However, their real value is as dictated by their troy weight, the current market price of the precious metal contained, and the prevailing premium that market wishes to pay for those particular bullion coins. The face value is always significantly less than the bullion value of the coin. Legal tender bullion coins are a separate entity to bullion gold. One enjoys legal tender status; the latter is merely a raw commodity. Gold has an international currency code of XAU under ISO 4217. ISO 4217 includes codes not only for currencies, but also for precious metals and certain other entities used in international finance, e.g. Special Drawing Rights. Coins are usually made of an alloy as other metals are into the coin to make it more durable. Fineness is the actual gold content in a coin or bar and expressed in grams or troy ounces. Karat weight is a unit of fineness for gold equal to 1/24 part of pure gold in an alloy. Pure gold is 1000 fine. Below is a karat weight to fineness conversion chart. There is a correlation between karats and fineness: 24 karats = 1000 fine, 23 karats = 958.3 fine, 22 karats = 916.6 fine, 21 karats = 875.0 fine, 20 karats = 833.3 fine, 18 karats = 750.0 fine, 16 karats = 666.7 fine, 14 karats = 583.3 fine, 10 karats = 416.6 fine. The fineness converts to a percent, as well. If a gold coin has a fineness of .900, the decimal point is moved two places to the right and that number is expressed as a percent - that is 90.0% pure gold. If a gold coin has a fineness of .850, then the gold coin is 85.0% pure, etc. Coins have varied greatly in fineness through history. Notable historical standards that were closely adhered-to include the crown gold (22 karat) used in all English gold coins intended for circulation from 1526 onward, and 0.900 fine (21.6 kt), the standard for all American circulation-coins from 1837 onward. Fineness is not the only way to value a gold coin; a great deal of value in collector coins comes from condition and rarity. To a far lesser extent, even the value of gold bullion coins is influenced by their physical condition.

Effective Treatment Principles

Addiction is a complex but treatable condition that affects brain function and behavior. The abuse of drugs alters the structure and function of the brain, resulting in changes that persist long after drug use. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences. No single treatment is appropriate for every user in recovery. Matching treatment settings, interventions and services to the particular problems and needs of a patient is critical to achieving success in returning to productive functioning in the family, workplace and society. Treatment needs to be readily available. Because individuals addicted to drugs may be uncertain about entering treatment, it is critical to take advantage of available services the moment people are ready for treatment. Patients can be lost if treatment is not immediately available or readily accessible. As with other chronic conditions, the earlier the user seeks treatment, the greater the likelihood of positive outcomes. Effective treatment addresses the multiple needs of the individual, not just drug abuse. To be effective, treatment must address the drug abuse and any associated medical, psychological, social, vocational and legal problems. It is also important that treatment be appropriate to the age, gender, ethnicity and culture of the user. It is critical that the user remain in treatment for an adequate recovery period. The appropriate duration for an individual depends on the type and degree of problems and needs. Research indicates that most addicted individuals need at least three months in treatment to significantly reduce or stop drug use. Studies also suggest that the best recovery outcomes occur with longer durations of treatment. Recovery from drug addiction is a long process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and signifies that treatment should be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment. The most commonly used forms of drug abuse treatment are counseling in individual and or groups and other behavioral therapies. Behavioral therapies vary in focus and may involve addressing a the motivation of a user to change, providing incentives for abstinence, building skills to resist drug use, replacing activities involving drugs with constructive and rewarding activities, improving problem solving skills and facilitating better interpersonal relationships. Participation in group therapy and other peer support programs during and following treatment can help maintain abstinence from drugs. Medications can be an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone and buprenorphine are effective in helping individuals addicted to heroin or other opioids stabilize and reduce illicit drug use. Naltrexone is also an effective medication for some individuals addicted to opioids and some patients with alcohol dependence. Other medications for alcohol dependence include acamprosate, disulfiram and topiramate. For persons addicted to nicotine, a nicotine replacement product such as patches, gum or lozenges or an oral medication such as bupropion or varenicline can be an effective component of treatment when part of a comprehensive behavioral rehab program. Doctors must modify and monitor the treatments and services for each patient to ensure that the rehabilitation meets the changing needs of the addict in recovery. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation and or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to changing needs. Many individuals addicted to drugs also have other mental disorders. Because drug abuse and addiction, which are both mental disorders, often occur together with additional mental illnesses, doctors should carefully assess patients that present with one condition for the other. When these problems occur together, treatment should address both by the use of medication. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change the effects of drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and, for some, can pave the way for effective addiction treatment in the end, detoxification alone is rarely sufficient to help addicted individuals achieve a new lifestyle of abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement. Specialists must continually monitor drug use during treatment, as patients can lapse during treatment. Another powerful motivator to get clean is if patients know that doctors monitor the drug intake of each patient. Monitoring also provides an early indication of a return to drug use, signaling the possible need to adjust the treatment plan of an individual to better meet changing needs. Drug abuse treatment can facilitate adherence to other medical treatments. Patients may be reluctant to accept screening for HIV and other infectious conditions. Specialists should encourage and support HIV screening and inform patients that highly active antiretroviral therapy can be effective in combating HIV. Treatments vary, depending on the type of drug and the characteristics of the patient. The best programs provide a combination of therapies and other services.

Keloids

A keloid is a type of hypertrophic scar. Keloids are made up of type I (and some type III) collagen that results in an overgrowth of tissue at the site of a healed skin injury. Keloids are firm, rubbery lesions or shiny, fibrous nodules and can vary from pink to flesh-colored or red to dark brown in color. A keloid scar is benign, non-contagious and usually accompanied by severe itchiness, sharp pains and changes in texture. In severe cases, it can affect movement of skin. Keloids expand in claw-like growths over normal skin. They have the capability to hurt with a needle-like pain or to itch without warning, although the degree of sensation varies from patient to patient.

Acne Vulgaris

Changes in the pilosebaceous units (skin structures consisting of a hair follicle and the associated subcutaneous gland) result in acne vulgaris. Severe acne is inflammatory, but acne can also manifest in non-inflammatory forms. Acne lesions are pimples, spots or zits. Acne is most common during adolescence, affecting more than affecting more than 85 percent of teenagers, and frequently continues into adulthood. For most people, acne diminishes over time and tends to disappear, or at the very least decrease after the early twenties. There is, however, no way to predict how long acne can take to disappear entirely, and some individuals continue to suffer well into their thirties, forties and beyond. Most commonly, the face and upper neck regions are affected, but there may be acne on the chest, back and shoulders as well. Acne may appear on the upper arms, but lesions found there are often keratosis pilaris, not acne. Typical acne lesions are comedones, inflammatory papules, pustules and nodules. Some of the large nodules are cysts and nodulocystic describes severe cases of inflammatory acne.