`(2 - 3i)^6` Use the Binomial Theorem to expand the complex number, then simplify the result.

You need to use the binomial formula, such that:

`(x+y)^n = sum_(k=0)^n ((n),(k)) x^(n-k) y^k`

You need to replace 2 for x, 3i for y and 6 for n, such that:

`(2-3i)^6 = 6C0 2^6 + 6C1 2^5*(-3i)^1 + 6C2 2^4*(-3i)^2 +  6C3 2^3*(-3i)^3 +  6C4 2^2*(-3i)^4 +  6C5 2^1*(-3i)^5 +  6C6 (-3i)^6`

By definition, `nC0 = nCn = 1` , hence `6C0 = 6C6 = 1.`

By definition `nC1 = nC(n-1) = n` , hence `6C1 = 6C5 = 6.`

By definition `nC2 = nC(n-2) = (n(n-1))/2` , hence `6C2 = 6C4 = (6(6-1))/2 = 15`

`(2-3i)^6 = 2^6 - 6*2^5*3i + 15*2^4*3^2*i^2 - (6!)/(3!*(6-3)!)*2^3*3^3*i^3 + 15*2^2*3^4*i^4 - 6*2*3^5*i^5 + 3^6*i^6`

Using the powers of i yields:

`i = i, i^2 = -1, i^3 = -i, i^4 = 1, i^5 = i, i^6 = -1`

`(2-3i)^6=64-576i-2160+4320i+4860-2916i-729`

`(2-3i)^6=2035+828i`

Hence, expanding the complex number using binomial theorem yields the simplified result `(2-3i)^6 = 2035 + 828i.`

What is eye surgery?

Indications and Procedures

Compared to surgery performed on internal organs and any number of outpatient procedures, eye surgery can fill patients with added fears, often concerned with great suffering and the possibility of permanent sight loss. Surgery to an internal organ is usually perceived as happening in a remote location in an unseen portion of the body, and most patients have little idea of the organ’s function. Often, if an internal growth or organ is removed, the body continues to function quite well. Most patients have some knowledge of the eye, unlike most internal organs, and thus are more likely to develop anxiety about even common surgical procedures involving it. Patients know what eyes are and what they are used for and that they are extremely sensitive and painful to touch. A grain of sand or a hair touching the eye is painful, so the thought of contacting the eye with a needle or making an incision in it with a scalpel or laser can be almost unimaginable. Patients with ocular problems requiring surgery fear damage to the eye and know all too well the consequences of removal. In most instances, the general public has little to no knowledge or
understanding of the function and mechanics of eye surgery. Common eye surgeries include, but are not limited to, cataract surgery, corneal transplantation, vision correction, pterygium removal, retinal detachment repair, and tear duct surgery.

A cataract is an opacity on the eye’s lens. A cataract may be minimal in size and low in density, so that light transmission is not appreciably affected, or it may be large and opaque so that light cannot gain entry into the interior eye. When the cataract is pronounced, the interior of the patient’s eye cannot be seen with clarity, and the patient cannot see out clearly. Over time, the lens takes on a yellowish hue and begins to lose transparency. As the lens thus becomes “cloudy,” the patient needs brighter and brighter lights for visual clarity. If the lens becomes completely opaque, then the patient is functionally blind. A cataract is removed when it endangers the health of the eye or interferes with a patient’s ability to function. Conditions such as contrast sensitivity, glare, pupillary constriction, and ambient light may significantly affect a patient’s functionality.

The objective of cataract surgery is to remove the crystalline lens of the eye that has become cloudy. Modern surgical procedures involve removing the lens, either intact or in pieces after shattering it with high-frequency sound. The surgery is usually performed under an operating microscope because magnification is necessary. Many methods are used for cataract surgery, including an extracapsular procedure, an intracapsular procedure, and phacoemulsification. Most surgeons perform cataract surgery in freestanding surgical centers on an outpatient basis.

In extracapsular surgery, an incision is made at the superior limbus and a small opening is made into the anterior chamber. A viscoelastic substance is introduced and then a small, bent needle, or cystotome, is introduced. An incision is made into the anterior capsule in a circular, triangular, or D-shaped fashion. The wound is enlarged to a diameter of 10 to 11 millimeters, allowing removal of the cataractous nucleus.

The most common cataract surgical procedure is phacoemulsification, or small-incision cataract surgery. A stair-stepped incision of between 1.5 and 4.0 millimeters is made in the front of the eye. A cystotome is inserted to cut the anterior capsule of the lens. An emulsifier and aspirator is inserted to remove the collapsed lens. The missing lens is then replaced by an artificial substitute that is folded and inserted through the incision and rotated into place. The wound is sealed with a single suture or no suture at all. This procedure has become favored because it causes less tissue destruction, less wound reaction, and less astigmatism, and patients can resume normal activities immediately after surgery. Vision is then fine-tuned with glasses or contact lenses, if needed.

Another common eye surgery is corneal transplantation.
The cornea is the clear portion in the front part of that eye. When injured, degenerated, or infected, the cornea can become cloudy and vision disrupted. Corneal surgery restores lost vision by replacing a portion of the cornea with a clear window taken from a donor eye. Usually, the donor cornea is taken from a recently deceased person. However, not everyone with corneal disease can be helped by corneal transplantation.

The cornea was one of the first structures of the body to be transplanted. Because the cornea is devoid of blood vessels, it is one of the few tissues in the human body that may be transplanted from one human to another with a high degree of success. The absence of blood vessels in the donor cornea reduces immune system reactions.

Two types of corneal transplants are performed: partial penetration, in which a half thickness of the cornea is transplanted, and penetrating transplantation, which involves the full thickness of the cornea. In partial penetration, the anterior of the eye is not entered; only the outer half or two-thirds of the cornea is transplanted. Union is made by several sutures around the periphery of the donor tissue. Depending on the extent of the disease, the donor tissue may be 6 to 10 millimeters in diameter. In a penetrating transplantation, surgery involves entering the anterior chamber of the eye, inserting the donor cornea, and establishing a tight fit with a continuous suture.

Glaucoma
is an ocular disease affecting roughly 2 percent of the population over forty. The major characteristic of the condition is a sustained increase in intraocular pressure so great that the fibrous scleral coat cannot expand significantly and the eye cannot withstand the increasing pressures against surrounding soft tissue without damage to its structure and vision impairment. The results of this pressure increase include excavation of the optic disc, hardness of the eyeball, reduced vision, the appearance of colored halos around lights, visual field defects, and headaches. Surgical procedures are performed to relieve this pressure. Although many types of surgical procedures are performed to treat glaucoma, they are all basically fistulizing surgeries, attempting to create an opening between the anterior chamber and the subconjunctival space or between the surgically prepared layers of the sclera.

Glaucoma surgery involves a small incision made either directly through the cornea at the upper limbus or under a flap of conjunctival tissue. The iris is grasped with small forceps and pulled out of the eye, and a small portion of the trabecular meshwork is partially removed, allowing the aqueous fluid to filter out of the anterior chamber. The cornea is then sutured and the eye bandaged. The most popular procedure of this type is trabeculectomy. As a whole, glaucoma surgeries are performed less often today because of the success of nonsurgical treatments and management with drug therapies. A major consequence of some glaucoma surgery is the development of cataracts.

A common early stage nonincisive procedure in treating glaucoma is laser trabeculoplasty. This procedure involves lasing the middle to anterior portion of the trabecular meshwork with eighty to one hundred equally spaced burns. The argon laser reopens blocked drainage channels and reduces fluid pressure in the eye. More than 90 percent of patients experience successful outcomes from this treatment. Surgery is performed only if patients continue to lose the visual field.

A pterygium is a fibrovascular membrane that extends from the medial aspect of the bulbar conjunctiva and invades the cornea. It is a progressive growth related to overexposure to ultraviolet (UV) light. In time, it can make its way to the central portion of the cornea and interfere with vision. Pterygia are most common in southern climates, where people have greater exposure to UV light. In northern regions, people who work outdoors, especially in open fields or on open water, are most prone to developing a pterygium growth.

The purpose of removing a pterygium is to excise the membrane before it can interfere with vision. The operation requires incision into the cornea as well as the conjunctiva, then removal of the pterygium tissue or its transplantation to another position to redirect its growth.

In a normal eye, the retina lies against the choroidal layer, from which it receives part of its blood supply and nourishment. The retina is loosely attached to the choroid, but when it becomes separated from the choroid, it flaps and hangs within the eye’s vitreous fluid. Retinal detachment does not allow adequate nutrients to reach the retina and thus causes poor function, and it eventually leads to vision loss. Retinal detachment may be caused by injury, myopia, or previous eye surgeries. Often, a tear or hole permits fluid to collect under the retina, causing the detachment.

Retinal detachment surgery corrects the loose retina by bringing it back to the choroid or by pushing the choroid up to the retina. To bring the retina back into place, scleral punctures are made to drain fluids that lay between the retina and the choroid. When the retina returns to lie against the choroid, either electrocoagulation or cryotherapy with a cold probe against the sclera unites the retina to the choroid. Then the retina and choroid are brought together with a silicone buckling band to exert inward pressure. If the retina is not attached at this point, then air, special gas, or oil is injected into the vitreous fluid to push the retina back against the choroid.

Surgery involving corrective procedures to tear ducts is common, especially in older patients. A blockage in the nasolacrimal passage may result in a condition called epiphora, in which the tear ducts water constantly. Such a blockage of the tear canal may result from some form of obstruction. These obstructions are cleared by a surgical procedure called dacryocystorhinostomy. In this procedure, a large incision of 8 to 10 millimeters is made in the wall of the nose, and a union is created between the mucosal lining of the nose and the lacrimal sac. In this way, the lacrimal sac opens directly into the nose. The operation is usually successful in curing the tearing and infection problems arising from stagnation in the blocked tear duct.

Elective refractive eye surgery
for the purpose of vision correction began in the Soviet Union in the 1970s and gained popularity in the United States in the 1990s with the use of lasers. It is performed for the relief of myopia, hypermyopia, and astigmatism, with the goal of eliminating the need for either eyeglasses or contact lenses. It is also used to correct refractive errors caused by cataract surgery and corneal transplantation.

Two of the most common refractive surgeries are radial
keratotomy (RK) and photorefractive keratectomy (PRK), also known as excimer laser surgery. Myopic patients suffer from a cornea that is either too convex or has an axial length that is too long, causing light to converge at a focal point anterior to the retina. In refractive surgery, corneal reshaping is the important concept. The surgical goal is to flatten the center of the cornea so that light will focus more posteriorly.

RK reshapes the cornea by radial incisions made with a diamond knife. This process weakens the cornea, so normal intraocular pressure pushes the center of the cornea outward, flattening the central cornea. PRK uses a laser to remove the superficial layers of the central cornea, about 50 to 100 microns of tissue, to achieve a similar reshaping of the cornea.

Bartlett, Jimmy D., and Siret D. Jaanus, eds. Clinical Ocular Pharmacology. 5th ed. Boston: Butterworth-Heinemann/Elsevier, 2008.

Berman, Eric L. "Retinal Detachment Repair." Health Library, Feb. 28, 2012.

Cheyer, Christopher. "Cataract Removal." Health Library, Feb. 28, 2012.

Cheyer, Christopher. "Glaucoma Surgery." Health Library, Feb. 28, 2012.

Eden, John. The Physician’s Guide to Cataracts, Glaucoma, and Other Eye Problems. Yonkers, N.Y.: Consumer Reports Books, 1992.

Johnson, Gordon J., et al., eds. The Epidemiology of Eye Disease. 3d ed. New York: Oxford University Press, 2012.

"Laser Eye Surgery." MedlinePlus, Dec. 27, 2012.

Lusby, Franklin W., et al. "Pterygium." MedlinePlus, Nov. 20, 2012.

Newell, F. W. Ophthalmology: Principles and Concepts. 8th ed. St. Louis, Mo.: Mosby, 1996.

Riordan-Eva, Paul, and John P. Whitcher. Vaughan and Asbury’s General Ophthalmology. 18th ed. New York: Lange Medical Books/McGraw-Hill, 2011.

Roche, Kelly de la, and Eric L. Berman. "Corneal Transplant." Health Library, Feb. 28, 2012.

Salvin, Jonathan H. "Tear-Duct Obstruction and Surgery." KidsHealth. Nemours Foundation, July 2011.

Stein, Harold A., Raymond M. Stein, and Melvin I. Freeman. The Ophthalmic Assistant: A Text for Allied and Associated Ophthalmic Personnel. 8th ed. Philadelphia: Mosby/Elsevier, 2006.

What is the basic plot of Langston Hughes' short story, "Salvation"?

The story is a memoir by the author about a particular incident in his life when he was just about to turn thirteen, which made a huge impression on him.

The narrator had attended a revival service at his fanatically religious aunt Reed's church. Before the end of the revival, time was set aside to save the souls of young churchgoers. His aunt had previously told him that he would see Jesus and he would be saved. When the request was made that the youngsters should come forward for redemption, he waited for Jesus to come.

Many of the youngsters got up and were saved, to great praise from the congregation. The narrator, though, was waiting to see Jesus appear for he believed that that would be a sign for him to get up. With him on the bench was another boy, Westley - they were the last of the young ones left. The preacher and others made passionate appeals to the two to get up and be saved. Westley later relented and the narrator was alone on the bench.

He was convinced that he would see Jesus and that he would be saved, but nothing happened and he stayed seated. It was getting late and the cries for him to come to the Lord grew ever more impassioned. Even his aunt came to sit next to him for encouragement. The preacher, who had by know learned his name, begged him directly.

The speaker eventually relented to avoid any more trouble, even though he had not yet seen Jesus. He did what he believed Westley did, he lied. He was saved, much to the joy and relief of all concerned.

Later that night the speaker cried copiously when in bed. His aunt believed that he was tearful because he had found Christ. The speaker confesses, though, that he was crying because he had lied. He had not seen Christ and only got up because of all the pressure and that he did not believe in Jesus anymore since he did not come to help him.

What is tai chi?

Overview

Tai Chi is a traditional form of martial art used to promote health. Its gentle, dancelike moves are said to strengthen and balance the body’s energy. The net results, according to tradition, include increased physical stamina, enhanced sense of well-being and comfort, and improved resistance to illness.

Tai Chi is said to have been developed by the Daoist monk Chang San-Feng sometime in the Middle Ages. (The exact dates and even the existence of this monk are disputed.) Various schools of Tai Chi developed over subsequent centuries, each with its own particular movements and postures, but all conforming to the same underlying principles.

In the 1950s, the Chinese government began to develop a series of standardized Tai Chi forms. One of these has become the most popular form of Tai Chi in the West, a thirty-seven-posture form abbreviated from a traditional approach to Tai Chi called the Yang style.

Uses and Applications

Tai Chi is an extremely popular form of exercise among older Asians in China and other Asian countries. In the United States, it is gaining widespread use as a method of improving balance and preventing falls among the elderly. The slow movements of Tai Chi provide a gentle framework for enhancing physical control and improving balance. Tai Chi is also thought to improve overall health and enhance immunity, but this has not been evaluated scientifically to any significant extent.

Scientific Evidence

Although there is some evidence that Tai Chi may offer medical benefits, in general this evidence is not strong. There are several reasons for this (including funding obstacles), but one is fundamental: even with the best of intentions, it is difficult to properly ascertain the effectiveness of an exercise therapy like Tai Chi.

Only one form of study can truly prove that a treatment is effective: the
double-blind,
placebo-controlled trial. However, it is not possible to fit
Tai Chi into a study design of this type. While it might be possible to design a
placebo form of Tai Chi, it would be quite difficult to keep participants and
researchers “blinded” regarding who is practicing real Tai Chi and who is
practicing fake Tai Chi.

Therefore, some compromise with the highest research standards is inevitable. The compromise used in most studies, however, is less than optimal. In these trials, Tai Chi was compared to no treatment. The problem with such studies is that a treatment, any treatment, frequently appears to be better than no treatment, due to a host of factors. It would be better to compare Tai Chi to generic forms of exercise, such as daily walking, but thus far this method has not seen much use. Given these caveats, the following is a summary of what science knows about Tai Chi.

Most controlled trials of Tai Chi published in English have evaluated its
potential benefits for improving balance in the elderly. Falling is one of the
most common causes of injury in older people, leading to fractures, head injuries,
and even death. Recovery from fall-related injuries may involve extensive
immobilization in bed, which in turn increases the risk of osteoporosis,
pneumonia, and depression. According to most studies, Tai Chi can improve balance
and decrease the risk of falling.

For example, in a ten-week study, twenty-four older persons practiced Tai Chi (one class weekly, plus daily home practice), while a control group of twenty-two volunteers did not change their activity. The results showed that people practicing Tai Chi experienced substantially improved balance (measured by the ability to stand on one leg) compared to the control group. Some studies failed to find benefit; however, this is typical of treatments for which all studies have been small in size. For statistical reasons, small studies commonly fail to identify benefit even when there is one.

Although there is some evidence that Tai Chi can improve balance and reduce the risk of falling, researchers conducting a 2008 review of nine randomized-controlled trials were unable to conclude that Tai Chi or Tai Chi-inspired exercises can effectively prevent fall-related harm in the elderly. The trials were too inconsistent in their methods and quality.

In addition to balance, Tai Chi may mildly improve flexibility and cardiovascular health, presumably because it is a form of moderate exercise. However, one fairly large (207-participant) and long-term (one-year) study that compared Tai Chi to resistance exercise (weight lifting) found that while resistance exercises measurably improved one measure of cardiovascular risk (insulin sensitivity), Tai Chi did not affect any measures of cardiovascular risk. In a review of twenty-six published studies examining the effectiveness of Tai Chi for high blood pressure, 85 percent demonstrated a reduction in blood pressure. However, only five of these twenty-six studies were of acceptable quality.

One study found that persons with congestive heart failure can benefit from Tai
Chi, but the study had no adequate control group. In two controlled studies, Tai
Chi produced some benefit in bone density, suggesting the possibility that it
might be helpful for preventing osteoporosis. A few studies provide inconsistent
evidence for the usefulness of Tai Chi as a treatment for osteoarthritis, and a preliminary study suggests it may be
beneficial for mild to moderate rheumatoid arthritis.

In a small, randomized-controlled trial of sixty-six persons, Tai Chi appeared to
improve symptoms, function, and quality of life for those with fibromyalgia.
In one randomized study, a certain form of Tai Chi was more effective than health
education after twenty-five weeks in persons with moderate insomnia. A review of
seven studies found insufficient evidence to conclude whether or not Tai Chi
improves quality of life or psychological or physical outcomes in persons with
breast cancer.

What to Expect During a Class

A Tai Chi class consists of progressive training in the movements of a Tai Chi form. Each subsequent class adds more moves to the repertoire, until finally one knows how to perform the entire series. The Tai Chi instructor will gently correct the student’s movements, helping to make stances and transitions between them more precise, graceful, and balanced.

Bibliography

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Lee, M. S., T. Y. Choi, and E. Ernst. “Tai Chi for Breast Cancer Patients.” Breast Cancer Research and Treatment 120 (2010): 309–16. Print.

Lee, M. S., M. H. Pittler, and E. Ernst. “Tai Chi for Osteoarthritis.” Clinical Rheumatology 27 (2008): 211–18. Print.

Low, S., et al. “A Systematic Review of the Effectiveness of Tai Chi on Fall Reduction Among the Elderly.” Archives of Gerontology and Geriatrics 48 (2009): 325–31. Print.

Wang, C. “Tai Chi Improves Pain and Functional Status in Adults with Rheumatoid Arthritis.” Medicine and Sport Science 52 (2008): 218–29. Print.

Wang, C., et al. “A Randomized Trial of Tai Chi for Fibromyalgia.” New England Journal of Medicine 363 (2010): 743–54. Print.

Wayne, P. M., et al. “The Effects of Tai Chi on Bone Mineral Density in Postmenopausal Women.” Archives of Physical Medicine and Rehabilitation 88 (2007): 673–80. Print.

Yeh, G. Y., P. M. Wayne, and R. S. Phillips. “T’ai Chi Exercise in Patients with Chronic Heart Failure.” Medicine and Sport Science 52 (2008): 195–208. Print.

Yeh, G. Y., et al. “The Effect of Tai Chi Exercise on Blood Pressure.” Preventive Cardiology 11 (2008): 82–89. Print.

What is a type II superconductor? Give some examples.

Superconductors are materials that lose all resistance to electricity flow below a certain critical temperature. The superconductors of pure metals are known as Type I superconductors. Some examples of type I semiconductors are Uranium Osmium, Cadmium, Gallium, Aluminum, etc. Semiconductors can also be made out of alloys of two or more metals. This provides for better mechanical properties as compared to pure metals. Another advantage of semiconductors made out of alloys is the retention of superconductivity at much higher critical magnetic fields and higher temperatures, as compared to type I superconductors. Such superconductors, which are made out of alloys, are known as type II superconductors. Some examples of such superconductors are Niobium-Titanium (NbTi), Vanadium-Silicon (V3Si), Niobium-aluminum (Nb3Al), etc. Type II superconductors are much better than type I superconductors for a number of applications. One such example is the construction of high field superconducting magnets. 

Hope this helps. 

In most of the United States, people who drink alcohol in public places are required to hide their bottle in a paper bag. In To Kill a Mockingbird,...

Dolphus Raymond is an intriguing minor character in To Kill a Mockingbird. Harper Lee introduces us to him outside the courthouse before the trial as a man "drinkin' out of a sack'" (163) who has "'a colored woman and all sorts of mixed chillun'" (163). In this short description, Lee leads us to believe that Raymond is some sort of social outcast, one who is hopelessly addicted to liquor and who has no part in "civilized" society.

Lee subverts this idea when Dill and Scout actually speak with Raymond later on in the afternoon. At this point, the children discover that Raymond is actually drinking Coca-Cola, rather than whiskey (202), and seems to be a kind, sober, responsible family man. Raymond explains his deception by claiming:

When I come to town, which is seldom, if I weave a little and drink out of this sack, folks can say Dolphus Raymond's in the clutches of whiskey-that's why he won't change his ways. He can't help himself, that why he lives the way he does. (203)

With this explanation, Mr. Raymond gives us an insight into the psyches of the citizens of Maycomb. They can't understand why a sane white person would want to live with the black community, and so they need a reason to explain this "scandalous" lifestyle, such as insanity or, in Raymond's case, drunkenness. By discovering Raymond's carefully veiled lifestyle, we're given yet another example of Maycomb's racism.  

How does Shakespeare show adults having an influence on the life of Juliet?

Juliet, one of the titular characters in William Shakespeare's tragedy Romeo and Juliet, is influenced by the actions and decisions of several adults over the course of the play's development:

The Prince
The Prince, ruler of Verona, creates a law that prohibits public conflict due to the overwhelming violence generated by the Capulets and Montagues. This decision leads to Romeo's banishment, which in turn affects Juliet's decision to escape and join him. This ultimately leads to her fake death and then her real death. 

Lord and Lady Capulet
Juliet's parents want her to marry Paris. Their insistence at this match leads Juliet to decide to run away so that she does not commit adultery and enter into a second marriage, the first of which is a secret. 

Friar Laurence
The Friar's actions and decisions to help Romeo and Juliet, which are altruistic in theory, eventually lead to the couple's marriage, and then to their death. 

 

How did flamethrowers affect WWII and how were they were used?

Flamethrowers were used in WWII mainly by the United States, and mainly in the Pacific.  This is because flamethrowers were mostly useful for attacking strong points like pill boxes in prepared defensive positions.  Their range and the amount of time for which they could be used were both too short to make them useful for other purposes.  They affected WWII mainly by making it somewhat easier (though by no means easy) for American forces to defeat the Japanese on various islands in the Pacific.

The US military did not use flamethrowers in WWI.  Therefore, they did not have a good flamethrower ready by the time WWII started.  Early models did not work well and it was not until 1943 that flamethrowers were used much by the US.  When the US did use them, it was mainly in the Pacific.  There, the US had to invade island after island held by the Japanese.  The Japanese had had time to fortify the islands and had numerous concrete emplacements from which they could fire at US troops.  These emplacements were very hard to defeat.

The flamethrower was used to defeat them because it could reliably fire its flames through the small apertures in the emplacements.  When the flames went through, they would fill the emplacement, killing or wounding everyone inside.  This would not be possible with bullets, which would have a harder time entering the emplacement and would then only go in a straight line.  Therefore, flamethrowers were used against these emplacements.  They had to be supported by infantry because a flamethrower could only throw its flame about 40 yards at the farthest and because they only had less than 10 seconds’ worth of fuel.  This meant that flamethrower operators and support people had to be protected at all times because they would be defenseless much of the time.

The flamethrower was important in WWII because it helped the US crack the defenses of these islands that Japan held.  The flamethrower alone could not make it easy to defeat the Japanese defenses because of its limitations, but it was very useful in certain situations. Without it, the US would have suffered even more casualties than it did.  Thus, this weapon did not determine the outcome of the war, but it reduced casualties on the American side.

I keep praying to God; why isn't he answering me?

Whatever your image of God may be, you know He isn’t deaf to our pleas. Even if you do not feel as though he is answering you the way you would like, the act of talking to Him is in itself beneficial – and His answer to our prayer/request does not come as a “human” voice.  Prayers are not only about requests, especially earthly wants, like physical needs or changes in our social status. Prayers are about connecting, reconnecting with His plan for us. It has been said that there is only one prayer: “Thy will be done.” What may seem like no answer to your problem could actually be the answer you need. Of course, all this is a mystery, but keep praying and feel in your soul what course of direction or action is “God’s will.” You might also seek the guidance of someone in your religion whose calling is to help others.

Closely examine the passage at Madame Forestier’s house when Mathilde discovers and borrows the necklace. What symbolic elements are being used...

First, examine Mathilde's initial response when she sees all the jewelry presented by Madame Forestier--"Haven't you anything else?"  Even faced with all of these riches, it is not good enough for Mathilde--she wants the best of the best.  Next, examine where she finds the necklace that she wants--it is in a black satin case, hidden from view.  It kind of summarizes Mathilde's life; the one thing that she wants is not readily available, and when she sees the unattainable object, she wants it.  Mathilde wants a luxurious lifestyle, but she cannot have it due to her financial situation.  Mathilde wants this necklace, but she cannot have it right away since she has to open the case first.  The very fact that the necklace is hidden away from view gives Mathilde the idea that it is very valuable, and by the end of the story the reader learns that it was not.  

What are two different conflicts in the story "The Scarlet Ibis"?

The two different conflicts in the story "The Scarlet Ibis" by James Hurst are:

a) Man against Man

b) Man against Himself

a) Concerning the first conflict, Man against Man, “The Scarlet Ibis” deals with the older brother and his conflict with his younger brother, Doodle. The conflict here is that Doodle is a bit of “a disappointment” to the family and certainly to the older brother. He does not like that his brother may not have the mental faculties and physical strength that he has, or that other less-challenged people have.

In addition, this older brother harbors resentment, somewhat, because Doodle, as espoused by the mother, may never be able to have boxing matches with him. Moreover, he may never be able to sit atop with him “in the top fork of the great pine behind the barn…”

Essentially the conflict is that this brother wants Doodle to be able to effortlessly do what the brothers of other people he knows can do. Doodle cannot; the older brother cannot really accept Doodle’s imitations. So this is the conflict of the older brother against Doodle.

b) Regarding Man against Himself, Doodle is in conflict with his limitations. He wants to be what the society around him calls ‘normal.’ Doodle wants to please his brother and enjoy life with him uninhibitedly, seizing the day with his brother, to borrow a famous saying. He wants to please his brother despite the mental and physical challenges he must battle with daily.

This is really evidenced toward the climax of “The Scarlet Ibis” when he cannot keep up with the older brother who is running away from him. This leads to his (Doodle’s) death and this is the ultimate price he pays in this battle against himself.

Furthermore, you can also say that a third conflict in this short story is the conflict both characters have - Man against Nature, or Man against his physical environment. Both are battling the deluge of rain that batters them as they struggle to get home.

What is kinesiology?

Science and Profession

In 1989, the American Academy of Physical Education (renamed the National Academy of Kinesiology in 2010) endorsed the term kinesiology to describe the entire field traditionally known as physical education, which includes the following subdisciplines: exercise physiology, biomechanics, motor control and learning, sports nutrition, sports psychology, sports sociology, athletic training programs, pedagogy, adapted physical education, cardiac rehabilitation, and physical therapy.

Exercise physiology describes the body’s muscular, cardiovascular, and respiratory functioning during both short-term and long-term exercise. Research has focused on muscle fiber typing, oxygen uptake assessment, lactic acid metabolism, thermoregulation, body composition, and muscle hypertrophy. Biomechanics applies Isaac Newton’s laws of physics to improve the mechanical efficiency of muscle movement patterns; using high-speed video and computer analysis, flaws in joint and limb dynamics can be assessed and changed to optimize performance. Motor control and learning pinpoint the areas of the brain and spinal cord that are responsible for the acquisition and retention of motor skills. Understanding the neurological basis of reflex and voluntary muscle movements helps to refine teaching strategies and describe the mechanisms of fatigue.

Sports nutrition describes how the body stores, circulates, and converts nutrients for aerobic and anaerobic energy production through carbohydrate loading and other strategies. Sports psychology explores the workings of the mind before, during, and after exercise and competition. Sports sociology examines aspects such as cultural, ethnic, and gender differences; dynamics in small and large groups; and the role of sports in ethical and moral development. Athletic trainers work with sports physicians and surgeons to prevent and rehabilitate injuries caused by overuse, trauma, or disease. Physical therapists use clinical exercise therapy and other modalities in a variety of rehabilitation settings.

Allied health areas under the kinesiology umbrella include pedagogy (teaching progressions for movement skills), adapted physical education (activities for the physically and mentally challenged), and cardiac rehabilitation (recovery stages for those disabled by heart disease). Professional organizations in the field of kinesiology include the American College of Sports Medicine, the American Physical Therapy Association, the National Athletic Trainers' Association, the National Strength and Conditioning Association, and the American Alliance for Health, Physical Education, Recreation, and Dance.

Bibliography

American Kinesiology Association. "Careers in Kinesiology." American Kinesiology, 2010. Web. 17 Feb. 2014.

American Medical Association. "Kinesiotherapist." Health Care Careers Directory 2012–2013. 40th ed. Chicago: American Medical Association, 2012. 15–16. Print.

Brooks, George A., and Thomas D. Fahey. Fundamentals of Human Performance. Mountain View: Mayfield, 2000. Print.

Hamilton, Nancy, Wendi Weimar, and Kathryn Luttgens. Kinesiology: Scientific Basis of Human Motion. 12th ed. New York: McGraw-Hill, 2012. Print.

Hoffman, Shirl J. Introduction to Kinesiology: Studying Physical Activity. 4th ed. Champaign: Human Kinetics, 2013. Print.

Houglum, Peggy, Dolores B. Bertoti, and Signe Brunnstrom. Brunnstrom's Clinical Kinesiology. 6th ed. Philadelphia: Davis, 2012. Print.

Lippert, Lynn. Clinical Kinesiology and Anatomy. 5th ed. Philadelphia: Davis, 2011. Print.

McArdle, William, Frank I. Katch, and Victor L. Katch. Exercise Physiology: Energy, Nutrition, and Human Performance. 8th ed. Boston: Lippincott, 2014. Print.

Oatis, Carol A. Kinesiology: The Mechanics and Pathomechanics of Human Movement. 2nd ed. Philadelphia: Lippincott, 2009. Print.

Peterson, Donald R., and Joseph D Bronzino. Biomechanics: Principles and Practices. Boca Raton: CRC, 2015. Print.

Plowman, Sharon A., and Denise L. Smith. Exercise Physiology for Health, Fitness, and Performance. 4th ed. Philadelphia: Wolters, 2014. Print.

Powers, Scott K., and Edward T. Howley. Exercise Physiology: Theory and Application to Fitness and Performance. 9th ed. New York: McGraw, 2015. Print.

Sharkey, Brian J., and Steven E. Gaskill. Fitness and Health. 7th ed. Champaign: Human Kinetics, 2013. Print.

What is disaster psychology?

Introduction

Disaster psychology deals with the reactions and responses of victims and witnesses of natural and artificial catastrophes, such as earthquakes, tornadoes, hurricanes, airplane crashes, train wrecks, toxic spills, industrial accidents, fires, explosions, terrorism, and school shootings, which often involve mass casualties. In 2011, the American Red Cross (ARC) estimated that it responded to over 70,000 disasters requiring external emergency aid every year, ranging from single-home fires or floods to national catastrophes. In addition, international events such as the 2004 tsunami in Southeast Asia and the 2008 terrorist attacks in Mumbai, India, require the assistance of emergency workers from around the world.

Mental health professionals use their skills to help trauma survivors and relief workers cope with the drastic changes and shock associated with tragedies. Many mental health professionals consider disaster service a social responsibility. Even though people may not have obvious physical wounds, they usually suffer emotional pain. Disaster mental health personnel often serve as media contacts to educate the public about ways to resume normalcy.

Short-term crisis mental health services assess the psychological status of affected populations, provide grief counseling, and initiate individual and community recovery. They provide emotional support when relatives identify bodies at morgues. Volunteers help victims who temporarily suffer survivor guilt, anxiety, mood swings, sleep disturbances, social withdrawal, and depression by reassuring them that they are reacting normally to abnormal, unexpected, and overwhelming situations that have disrupted their lives and that their heightened emotions will eventually lessen.

Long-term disaster psychology recognizes how catastrophes can result in some participants having post-traumatic stress disorder
and other delayed or chronic reactions such as nightmares and flashbacks, which are sometimes triggered by disaster anniversaries or sirens. Therapists also deal with disaster-related conditions such as substance abuse, irrational fears, and self-mutilation.

In addition to providing practical services, some disaster psychologists conduct research to develop more effective methods to help people during disasters. Procedures are developed to be compatible with varying coping styles for adults and children. Disaster psychologists often conduct workshops and conferences to teach techniques based on prior experiences to mental health relief workers, health professionals, and community leaders. Preparation and planning for future disasters is an important component of disaster psychology. Disaster mental health providers educate representatives of schools, municipalities, humanitarian organizations, and corporations about disaster readiness.

Disaster mental health professionals create educational materials to inform people about how to cope with disasters. Most disaster psychology literature addresses how disasters make people feel vulnerable and helpless and suggest practicing psychological skills to acquire some control during volatile situations. For example, after the September 11, 2001, terrorist attacks on the United States, many disaster psychological pamphlets emphasized how to keep in perspective the actual personal risks of unknown threats such as anthrax contamination and biological warfare.

Historical Development

Mental health professionals developed disaster psychology methods based on medical triage techniques and practical experiences with disasters. Several notable disasters were crucial to establishing disaster mental health services. When 491 people died in Boston’s Cocoanut Grove nightclub fire in 1942, Erich Lindemann investigated how survivors reacted emotionally. Disaster mental health authorities often cite Lindemann’s trauma and stress study as the fundamental work addressing disaster crisis theory. Pioneers in this emerging field used studies of military and civilian reactions to war-related stress and anxiety.

In 1972, a dam collapse resulted in the flooding of Buffalo Creek in West Virginia, causing 125 deaths. Approximately five thousand people became homeless. When survivors sued the dam’s owner, attorneys hired mental health consultants, who collected information about the psychological impact of the disaster on the community. This information was evaluated twenty years later, when investigators conducted a follow-up psychological study of survivors. The 1974 Disaster Relief Act stated that Federal Emergency Management Agency (FEMA) emergency funds could be used for mental health services. The Three Mile Island nuclear meltdown in 1979 revealed the need for mental health disaster services to be better coordinated and focused.

A decade later, the ARC emphasized that coordinated professional mental health response procedures comparable to medical health response plans were crucial. Often, ARC nurses who were not qualified to provide psychological services encountered disaster victims and relief workers in need of such help. The situation was exacerbated by the succession of major disasters in 1989: the Sioux City, Iowa, airplane crash in July; Hurricane Hugo in the Caribbean and southeastern United States in September; and the Loma Prieta earthquake in the San Francisco Bay area in October. Psychologists who assisted airplane crash survivors and victims’ families suggested that the American Psychological Association (APA) work with the ARC to establish a national plan for the training of disaster mental health personnel.

Mental health teams were assigned to accompany ARC relief workers when Hurricane Hugo occurred. These volunteers were already exhausted when the San Francisco earthquake took place, but instead of returning home, relief personnel were asked to transfer to San Francisco. Unfamiliarity with inner-city and ethnic cultures, language barriers, and long-duration service assignments intensified relief workers’ stress, and the need for mental health services for relief workers became apparent.

Professional Organization

Although mental health professionals provided disaster services throughout the twentieth century, disaster psychology emerged as a professional field during the 1990s. In 1990, the APA financed a California Psychological Association disaster-response course, and the ARC assisted with the class. Tornadoes in Illinois in the spring of 1991 prompted the Illinois Psychological Association to respond to the ARC’s request for mental health services. The first community request for disaster mental health services occurred after a tornado devastated Sherwood, North Dakota, in September 1991. Citizens sought help for their children in coping with the damage and casualties.

The ARC established the Disaster Mental Health (DMH) services by November 1991 and issued guidelines for training, certification, and service. Psychologists attending ARC disaster training began offering courses in their regions. The APA agreed to collaborate with the ARC the next month. Representatives of the APA and ARC decided that the APA’s Disaster Response Network (DRN) would prepare psychologist volunteers to offer free mental health services to survivors and relief workers at disaster scenes. After Hurricane Andrew hit Florida in 1992, approximately two hundred DRN psychologists helped survivors with the ARC. The APA has established task forces to evaluate mental health responses to various catastrophes.

The APA sponsors a Committee on Psychiatric Dimensions of Disaster (CPDD), formed in 1993 after three years of development as a task force. Members of this committee supply educational information to help psychiatrists provide disaster-related services. The committee seeks to advance the field of disaster psychiatry through training and research to determine the optimum psychiatric treatment for disaster victims. Members distribute materials to district branches to aid local response to potential disaster situations. The American Psychiatric Association also posts information about disaster topics on its website (http://www.psych.org).

The APA’s emergency-services and disaster-relief branch cooperates with other mental health groups and emergency services to prepare professionals to respond appropriately and effectively to psychological aspects of disasters. Multiorganization conferences in 1995 and 1996 clarified mental health professionals’ roles during disasters and approved APA goals. Facing such challenges as 2005’s Hurricane Katrina demonstrated the need for such coordinated efforts to aid victims.

Psychiatrists often feel limited by the ARC's prohibition of psychiatrists from prescribing medications while acting as ARC volunteers, and some mental health professionals formed local groups to intervene during disaster relief. Disaster Psychiatry Outreach (DPO) was established after the 1998 Swissair Flight 111 crash as an effort to provide better disaster mental health services in the New York City vicinity. Most DPO volunteers are qualified to prescribe medications for survivors and their families. Ethical and legal concerns specific to disaster mental health services provided by any source include abandonment of victims and solicitation of patients.

Disaster Procedures

At a disaster scene, mental health professionals aid medical emergency workers in identifying people who are behaving irrationally. Disaster psychologists help people deal with injuries or losses of family members and homes. Specific emotional issues might include disfigurement, loss of body parts, or exposure to grotesque scenes. Psychologists soothe disaster victims undergoing sudden surgical procedures.

Most disaster survivors and relief workers are resilient to permanent emotional damage. Volunteers advise people who seem likely to suffer psychiatric disorders due to the disaster to seek professional treatment. People in denial who ignore disaster-induced psychological damage can develop disorders such as post-traumatic stress disorder (PTSD), which can have a detrimental effect on social and professional interactions. The fourth edition of the APA’s
Diagnostic and Statistical Manual of Mental Disorders
(1994, DSM-IV) was the first to classify acute stress disorder (ASD), which has symptoms resembling PTSD but lasts only a few days to several weeks within one month of trauma. ASD is distinguished from PTSD by the presence of dissociative symptoms beginning either during the disaster or soon after.

Disaster mental health professionals introduce new methods, such as critical incident stress management (CISM) and critical incident stress debriefing (CISD), based on experiences and research. CISM was created to help emergency personnel who undergo stages of demobilization, defusing, debriefing, and education. Debriefing helps people voice their experiences and often provides group support from colleagues. Relief workers immersed in such stressful situations as recovering bodies often seek counseling. Twenty percent of the 1995 Oklahoma City bombing emergency workers received psychological attention. After the September 11, 2001, terrorist attacks, counselors reported that approximately two thousand emergency workers sought their services.

Research topics include evaluation of how PTSD is related to disasters or how heroes react to public attention, disaster-stimulated life changes such as marriage or divorce, stress reactions of secondary victims who are not directly affected by disasters, and variables such as gender, religious affiliation, and ethnicity. Children, adolescents, and elderly victims have unique needs during and after disasters. Other possible research groups include the homeless, the disabled, and people who are medically or mentally ill at the time of the disaster. Researchers use computer and technological advances to enhance studies of data and model disaster scenarios.

Internationally, academic programs, symposiums, and conferences explore disaster-related mental health topics. The University of South Dakota’s Disaster Mental Health Institute (http://www.usd.edu/arts-and-sciences/psychology/disaster-mental-health-institute/) offers a comprehensive curriculum of undergraduate and graduate disaster psychology courses to train ARC-approved disaster mental health personnel.

Bibliography

Austin, Linda S., ed. Responding to Disaster: A Guide for Mental Health Professionals. Washington: Amer. Psychiatric, 1992. Print.

Everly, George S., Jr., and Jeffrey T. Mitchell. Critical Incident Stress Management (CISM): A New Era and Standard of Care in Crisis Intervention. 2nd ed. Ellicot City: Chevron, 1999. Print.

Fullerton, Carol S., and Robert J. Ursano, eds. Posttraumatic Stress Disorder: Acute and Long-Term Responses to Trauma and Disaster. Washington: Amer. Psychiatric, 1997. Print.

Gist, Richard, and Bernard Lubin, eds. Response to Disaster: Psychosocial, Community, and Ecological Approaches. Philadelphia: Brunner, 1999. Print.

Greenstone, James L. The Elements of Disaster Psychology: Managing Psychosocial Trauma; An Integrated Approach to Force Protection and Acute Care. Springfield: Thomas, 2008. Print.

Jacobs, Gerard A. “The Development of a National Plan for Disaster Mental Health.” Professional Psychology: Research and Practice 26.6 (1995): 543–49. Print.

Norwood, Ann E., Robert J. Ursano, and Carol S. Fullerton. “Disaster Psychiatry: Principles and Practice.” Psychiatric Quarterly 71.3 (2000): 207–26. Print.

Luber, Marilyn, ed. Implementing EMDR Early Mental Health Interventions for Man-Made and Natural Disasters: Models, Scripted Protocols and Summary Sheets. New York: Springer, 2014. Print.

Raphael, Beverley, and John P. Wilson, eds. Psychological Debriefing: Theory, Practice and Evidence. New York: Cambridge UP, 2000. Print.

Roeder, Larry W., ed. Issues of Gender and Sexual Orientation in Humanitarian Emergencies: Risks and Risk Reduction. New York: Springer, 2014. Print.

Somasundaram, Daya. Scarred Communities: Psychosocial Impact of Man-Made and Natural Disasters on Sri Lankan Society. New Delhi: SAGE, 2014. Print.

Ursano, Robert J., Brian G. McCaughey, and Carol S. Fullerton, eds. Individual and Community Responses to Trauma and Disaster: The Structure of Human Chaos. New York: Cambridge UP, 1994. Print.

Wilson, John P., and Catherine So-kum Tang, eds. Cross-Cultural Assessment of Psychological Trauma and PTSD. New York: Springer, 2007. Print.

Zaumseil, Manfred, et al., eds. Cultural Psychology of Coping with Disasters: The Case of an Earthquake in Java, Indonesia. New York: Springer, 2014. Print.

How is the creature in Mary Shelley's Frankenstein morally ambiguous? What are some examples of that?

The creature that Victor Frankenstein creates in Shelley's Frankenstein is morally ambiguous because his narrative in the middle of the novel makes him sympathetic, but he is guilty of several violent acts. 

First, let's recall some of the creature's violent actions. The creature kills Victor's younger brother, William, who is only a child. He then frames the Frankenstein's maid, Justine Moritz, who is caring and innocent. He threatens Victor's life as well as that of his soon-to-be-wife, if Victor does not promise to make the creature a female companion. The creature does eventually kill Victor's wife, Elizabeth, on their wedding night. He also kills Victor's best friend, Clerval, and it could be said that Victor's beloved father dies of the grief caused by all of the other losses, an indirect result of the creature's actions (and Victor's actions, of course). From Victor's perspective, the creature terrorizes him and is an evil abomination. 

On the other hand, the creature's narrative, delivered to Victor (and the reader) at the center of the novel, makes him sympathetic. In the narrative, we learn about how Victor's actions have affected the creature, who is likened to an abandoned child. Victor, the father/creator, cast out his offspring/creation, and left him to fend for himself. The creature describes the agony of realizing that he is hideous and threatening to other people. He starts out with basically a good heart; he even tries to help save a drowning child. However, because of his ghastly appearance, people fear him and expect him to do evil. The creature maintains hope, though, and goes on to idolize and learn from the DeLacey family. He learns language and is able to communicate his own story articulately in the novel as a result of his observation of the family; this allows him to make a case to the reader and Victor that could create sympathy for his plight. The creature believes that he can approach the father of the DeLacey family and ask for help or companionship because the father is blind and so does not judge him by his appearance. Unfortunately, other members of the family come in during the creature's encounter with the DeLacey father and are deathly afraid of the creature. This serves as a sort of last straw for the creature. He now must appeal to his creator for help. 

Further, the creature appears sympathetic through contrast with Victor, who is also morally ambiguous. Victor abandons the creature and refuses to perform any sort of parental duty toward him. Victor allows Justine to take the fall for William's murder even though he knows the creature committed the crime (he tries to protect himself, as he does not want to be exposed as having made this monster). When we see Victor's behavior, we understand how the creature feels as a result of Victor's cruel and irresponsible treatment. At the same time, both Victor and the creature take actions that are morally wrong (Victor in making the creature and the creature in murdering others to take revenge on Victor). This makes both characters morally ambiguous.  

How does the fundamental tension between Finny and Gene in A Separate Peace affect their friendship?

This question is not so easy to answer. If I were to only consider Finny's feelings, I would say that the friendship is mostly unaffected throughout the novel. Then, the friendship is completely destroyed and never fixed, because Finny dies. Finny goes through the entire novel thinking the best about people. He not only thinks the best about people, he wants the best for people. He never once considers that Gene might be jealous of him. And because Finny never considers that, he never thinks that Gene might be trying to "one up" him (on test scores, for example). Finny never, ever thinks about people in that kind of way, so he assumes that everybody else is like that too. The friendship is finally ruined at the end of the novel. The mock trial points out to Finny that Gene's actions on the tree branch were not unintentional. Finny can't handle the emotional overload, runs off, trips, breaks his leg again, and dies from complications.

Gene's friendship with Finny, though, is in one continuous downward spiral throughout the novel. Gene's jealousy motivates him to bounce the branch, which, in a way, ultimately leads to Finny's death. Gene's jealousy motivates him to try and outdo Finny as well. It isn't much of a friendship if all that someone is trying to do is win. To Gene, Finny becomes less and less of a friend and more and more of an opponent to be beaten. That unspoken sense of competition Gene feels is what adds tension to the relationship, and that tension builds until it ultimately snaps and leads to Finny's death.

At the end of Monster, who was declared guilty?

At the end of the novel Monster, Steven Harmon was declared not guilty. James King was declared guilty of the felony murder (murder done while committing another felony – the armed robbery) of Alguinaldo Nesbitt. James King goes off to jail and Steve Harmon goes home with his family. 

Even though Steve is not convicted for the murder, the doubts and fears that haunted him throughout the trial don't all go away. He worries about what kind of person he is, what he is capable of. His relationship with his family is messed up too. He says, 

"My father is no longer sure of who I am. He doesn't understand me even knowing people like King or Bobo or Osvaldo. He wonders what else he doesn't know."

Even though Steve did not face any jail time or stain on his official record, he is still punished for his actions at the convenience store. It's clear that these doubts will stay with him for a long time. 

What is heroin?

History of Use

Diacetylmorphine, later named heroin, was originally synthesized in 1874 in London by the English chemist C. R. Alder Wright. However, it was not until 1898 that Bayer Pharmaceutical Company of Germany commercially introduced heroin as a new pain remedy and nonaddictive substitute for morphine. During the next several decades, heroin was sold legally worldwide and aggressively marketed as a cough medicine and as a safer, more potent form of morphine.

By the early twentieth century, heroin’s intense euphoric effects were fully recognized, leading to widespread misuse. Numerous restrictions on the production, use, sale, and distribution of heroin were established to help prevent further abuse. These restrictions included the Harrison Narcotics Act of 1914, the Dangerous Drug Act of 1920, and the Heroin Act of 1924. As a result, heroin consumption briefly declined, but illicit production and trafficking grew. Heroin became one of the most sought after drugs in the world and, by 1970, the US Drug Enforcement Administration classified heroin as a schedule I controlled narcotic. Class I drugs are those with a high abuse potential and no legitimate medical use.

Various methods have been used to gain heroin highs over the years, depending on user preference and drug purity. The most common and economical method of heroin use is injection, or “shooting up.” Popular forms of shooting up include “mainlining” (injecting directly into a vein) and “skin-popping” (injecting directly into a muscle or under the skin).

Snorting and smoking heroin became popular as a result of the availability of higher quality heroin, the fear of contracting blood-borne illnesses through needle sharing, and the erroneous belief that inhaling heroin would not lead to addiction. The best-known method of smoking heroin is “chasing the dragon.” Originating in the 1950s in Hong Kong, this method involves heating and liquefying the drug on tin foil and inhaling the vapors.

Some users crave an even greater high and engage in “speedballing” or “crisscrossing,” which involves simultaneously injecting or snorting alternate lines of heroin and cocaine, respectively. Heroin is considered one of the most dangerous and psychologically and physically addictive drugs available. It remains a serious health issue throughout the world.

Effects and Potential Risks

Heroin is the fastest acting of the opiates; it is three times more potent than morphine. It acts by depressing the central nervous system through an endorphin-like mechanism. Heroin rapidly crosses the blood-brain barrier because of its high lipid solubility. It is quickly metabolized into morphine and binds to the opioid receptors responsible not only for suppressing pain sensation and relieving anxiety but also for critical life processes.

The short-term effects of heroin are attributed to its properties as an opiate. These effects have made heroin one of the most desirable drugs in the world. Heroin produces a warm surge of pleasure and euphoria referred to as a rush. This rush is followed by feelings of peacefulness, well-being, contentment, and physical relaxation. Users go “on the nod,” alternating between wakeful and drowsy states while experiencing little sensitivity to pain.

Minor, negative, short-term effects of heroin use include nausea, vomiting, constipation, severe itching, dry mouth, difficulty urinating, heavy extremities, impaired mental functioning, and constricted pupils. Nonpleasurable sensations, such as irritability and depression, can occur as the high dissipates. However, the most serious side effect of heroin use is respiratory depression, which can be fatal.

The most immediate and intense heroin rush is achieved by intravenous injection. However, this transmission route is the most dangerous. The risk of contracting infectious diseases such as human immunodeficiency virus (HIV) and hepatitis viruses is substantial. Furthermore, illegal street heroin can be contaminated with unknown additives and impurities such as sugar, starch, and poisons, which can cause blood vessel inflammation, blockage, and permanent damage.

Long-term heroin use can lead to adverse physical effects, including collapsed veins, heart and skin infections, liver and kidney disease, and pulmonary complications. Continuous heroin use may affect brain functioning as a result of repeated respiratory suppression and lack of oxygen. However, the most detrimental long-term effect of heroin use is physical and psychological dependence and addiction, which can occur quickly; users crave larger and larger doses of the drug to achieve the original high.

Heroin abuse is a problem that affects people across the world. Afghanistan is the world leading producer of the opium poppies used to make heroin. Opiate use is most prevalent in the Middle East, as a result, but is also a significant problem in the United States. In 2012 the National Survey on Drug Use and Health (NSDUH) found that there were 669,000 heroin users in the United States; 156,000 of those people were new users. Heroin use saw a steady increase between 2006 and 2012; however, use among adolescents decreased during that period.

Bibliography

Brezina, Corona. Heroin: The Deadly Addiction. New York: Rosen, 2009. Print.

Cobb, Allan B., and Ronald J. Brogan. Heroin: Junior Drug Awareness. New York: Chelsea, 2009. Print.

Elliot-Wright, Susan. Heroin. Chicago: Raintree, 2005. Print.

Libby, Therissa A. Heroin: The Basics. Center City: Hazelden, 2007. Print.

Morales, Francis. The Little Book of Heroin. Berkeley: Ronin, 2000. Print.

"The Truth about Heroin." Foundation for a Drug-Free World. Foundation for a Drug-Free World, 2016. Web. 15 Jan. 2016.

"What Is the Scope of Heroin Use in the United States?" National Institute on Drug Abuse. NIH, Nov. 2014. Web. 15 Jan. 2016.

"World Drug Report 2014." United Nations Office on Drugs and Crime. United Nations, June 2014. Web. 15 Jan. 2016.

Websites of Interest

MedlinePlus: “Heroin”

http://www.nlm.nih.gov/medlineplus/heroin.html

National Institute on Drug Abuse

http://www.drugabuse.gov/infofacts/heroin.html

What is a good thesis statement about William Butler Yeats?

In addition to the political situation in Ireland (as with "The Second Coming") and his complicated personal feelings about Maud Gonne (as with "The Two Trees), William Butler Yeats' poetry and plays were deeply concerned with Irish folklore and mythology. He wrote about many figures of folklore and myth, including fairy lore and legends (as seen in "The Stolen Child"), as well as Irish heroes.

Some of his mythological poems also express a romantic and mystical connection to the Irish landscape. These poems steeped in Irish culture have themes of mysticism, magic and the supernatural, themes quite different from the more down to earth subject matter of war and politics. Yeats was also interested in the occult and in ceremonial magic and mysticism, and became a famous member of the Order of the Golden Dawn. These studies also formed the basis for some of his poetic themes and he applied some of the magical techniques he learned to expanding the scope of his writing.

It may be that Yeats' interest in folklore and mythology was in part what inspired him to pursue studies of pagan religion and magic; the Order of the Golden Dawn emerged in response to the occult revival in Great Britain. On some level it could also be said that Irish folklore and mythology, that is, the deep literary and spiritual legacy of Irish culture, was what inspired Yeats' political activism, and the desire to preserve and valorize uniquely Irish narratives was at the heart of Yeats' political leanings. 

What is female infertility?

Causes and Symptoms

Infertility is defined as the failure of a woman to conceive despite regular sexual activity over the course of at least one year. Studies have estimated that in the United States, 10 to 15 percent of couples are infertile. In about half of these couples, it is the woman who is affected.

Female infertility may be caused by hormonal problems, or it may originate in the reproductive organs: the ovaries, oviducts, uterus, cervix, and vagina. The frequency of specific problems among infertile women is as follows: ovarian problems, 20 percent to 30 percent; damage to the Fallopian tubes, 30 percent to 50 percent; uterine problems, 5 percent to 10 percent; and cervical or vaginal abnormalities, 5 percent to 10 percent. Another 10 percent of women have unexplained infertility. Behavioral factors, such as diet and exercise and the use of tobacco, alcohol, or drugs, also play a role in infertility.

The ovaries have two important roles in conception: the production of ova (egg cells), culminating in ovulation, and the production of hormones. Ovulation usually occurs halfway through a woman’s four-week menstrual cycle. In the two weeks preceding ovulation, follicle-stimulating hormone (FSH) from the pituitary gland causes follicles in the ovaries to grow and the ova within them to mature. As the follicles grow, they produce increasing amounts of estrogen. Near the middle of the cycle, the estrogen causes the pituitary gland to release a surge of luteinizing hormone (LH), which causes ovulation of the largest follicle in the ovary.

Anovulation (lack of ovulation) can result either directly, from an inability to produce LH, FSH, or estrogen, or indirectly, because of the presence of other hormones that interfere with the signaling systems between the pituitary and ovaries. For example, the woman may have an excess production of androgen (testosterone-like) hormones, either in her ovaries or in her adrenal glands, or her pituitary may produce too much prolactin, a hormone that is normally secreted in large amounts only after the birth of a child.

Besides ovulation, the ovaries have another critical role in conception, since they produce hormones that act on the uterus to allow it to support an embryo. In the first two weeks of the menstrual cycle, the uterine lining is prepared for a possible pregnancy by estrogen from the ovaries. Following ovulation, the uterus is maintained in a state that can support an embryo by progesterone, which is produced in the ovary by the follicle that just ovulated, now called a corpus luteum. Because of the effects of hormones from the corpus luteum on the uterus, the corpus luteum is essential to the survival of the embryo. If conception does not occur, the corpus luteum disintegrates and stops producing progesterone. As progesterone levels decline, the uterine lining can no longer be maintained and is shed as the menstrual flow.

Failure of the pregnancy can result from improper function of the corpus luteum, such as an inability to produce enough progesterone to sustain the uterine lining. The corpus luteum may also produce progesterone initially but then disintegrate too early. These problems in corpus luteum function, referred to as luteal phase insufficiency, may be caused by the same types of hormonal abnormalities that cause lack of ovulation.

Some cases of infertility may be associated with an abnormally shaped uterus or vagina. Such malformations of the reproductive organs are common in women whose mothers took diethylstilbestrol (DES) during pregnancy. DES was prescribed to many pregnant women from 1941 to about 1970 as a protection against miscarriage; infertility and other problems have occurred in the offspring of these women.

Conception depends on normal function of the oviducts (or Fallopian tubes), thin tubes with an inner diameter of only a few millimeters; they are attached to the top of the uterus and curve upward toward the ovaries. The inner end of each tube, located near one of the ovaries, waves back and forth at the time of ovulation, drawing the mature ovum into the opening of the oviduct. Once in the oviduct, the ovum is propelled along by movements of the oviduct wall. Meanwhile, if intercourse has occurred recently, the man’s sperm will be moving upward in the female system, swimming through the uterus and the oviducts. Fertilization, the union of the sperm and ovum, will occur in the oviduct, and then the fertilized ovum will pass down the oviduct and reach the uterus about three days after ovulation.

Infertility can result from scar tissue formation inside the oviduct, resulting in physical blockage and inability to transport the ovum, sperm, or both. The most common cause of scar tissue formation in the reproductive organs is pelvic inflammatory disease (PID), a condition characterized by inflammation that spreads throughout the female reproductive tract. PID may be initiated by a sexually transmitted disease such as gonorrhea or chlamydia. Physicians in the United States have documented an increase in infertility attributable to tubal damage caused by sexually transmitted diseases.

Damage to the outside of the oviduct can also cause infertility, because such damage can interfere with the mobility of the oviduct, which is necessary to the capture of the ovum at the time of ovulation. External damage to the oviduct may occur as an aftermath of abdominal surgery, when adhesions induced by surgical cutting are likely to form. An adhesion is an abnormal scar tissue connection between adjacent structures.

Another possible cause of damage to the oviduct that can result in infertility is the presence of
endometriosis. Endometriosis refers to a condition in which patches of the uterine lining implant outside the uterus, in or on the surface of other organs. These patches are thought to arise during menstruation, when the uterine lining (endometrium) is normally shed from the body through the cervix and vagina; in a woman with endometriosis, for unknown reasons, the endometrium is carried to the interior of the pelvic cavity by passing up the oviducts. The endometrial patches can lodge in the oviduct itself, causing blockage, or can adhere to the outer surface of the oviducts, interfering with mobility.

Endometriosis can cause infertility by interfering with organs other than the oviducts. Endometrial patches on the outside of the uterus can cause distortions in the shape or placement of the uterus, interfering with embryonic implantation. Ovulation may be prevented by the presence of the endometrial tissues on the surface of the ovary. The presence of endometriosis, however, is not always associated with infertility: Thirty percent to forty percent of women with endometriosis cannot conceive, but the remainder appear to be fertile.

Another critical site in conception is the cervix. The cervix, the entryway to the uterus from the vagina, represents the first barrier through which sperm must pass on their way to the ovum. The cervix consists of a ring of strong, elastic tissue with a narrow canal. Glands in the cervix produce the mucus that fills the cervical canal and through which sperm swim en route to the ovum. The amount and quality of the cervical mucus change throughout the menstrual cycle, under the influence of hormones from the ovary. At ovulation, the mucus is in a state that is most easily penetrated by sperm; after ovulation, the mucus becomes almost impenetrable.

Cervical problems that can lead to infertility include production of a mucus that does not allow sperm passage at the time of ovulation (hostile mucus syndrome) and interference with sperm transport caused by narrowing of the cervical canal. Such narrowing may be the result of a developmental abnormality or the presence of an infection, possibly a sexually transmitted disease.

Treatment and Therapy

The diagnosis of the exact cause of a woman’s infertility is crucial to successful treatment. A complete medical history should reveal any obvious problems of previous infection or menstrual cycle irregularity. Adequacy of ovulation and luteal phase function can be determined from records of menstrual cycle length and changes in body temperature (body temperature is higher after ovulation). Hormone levels can be measured with tests of blood or urine samples. If damage to the oviducts or uterus is suspected, a hysterosalpingography will be performed. In this procedure, the injection of a special fluid into the uterus is followed by x-ray analysis of the fluid movement to reveal the shape of the uterine cavity and the oviducts. Cervical functioning can be assessed with the postcoital test, in which the physician attempts to recover sperm from the woman’s uterus some hours after she has had intercourse with her partner. If a uterine problem is suspected, the woman may have an endometrial biopsy, in which a small sample of the uterine lining is removed and examined for abnormalities. Sometimes, exploratory surgery is performed to pinpoint the location of scar tissue or the location of endometrial patches.

Surgery may be used for treatment as well as diagnosis. Damage to the oviducts can sometimes be repaired surgically, and surgical removal of endometrial patches is a standard treatment for endometriosis. Often, however, surgery is a last resort because of the likelihood of the development of postsurgical adhesions, which can further complicate the infertility. Newer forms of surgery using lasers and freezing offer better success because of a reduced risk of adhesions.

Some women with hormonal difficulties can be treated successfully with so-called fertility drugs, which are intended to stimulate ovulation. There are several different drugs and hormones that fall under this heading: Clomiphene citrate (Clomid), human menopausal gonadotropin (hMG), gonadotropin-releasing hormone (GnRH), and bromocriptine mesylate (Parlodel) are among the medications commonly used, with the exact choice depending on the woman’s particular problem. One problem with some of the drugs is the risk of multiple pregnancy (more than one fetus in the uterus). Other possible problems include nausea, dizziness, headache, and general malaise.

Aside from fertility drugs, there are a variety of methods in use to try to achieve pregnancy with external assistance, known collectively as assisted reproductive technology (ART). One example of this, artificial insemination
, also known as intrauterine insemination (IUI), is an old technique that is still useful in various types of infertility. A previously collected sperm sample is placed in the woman’s vagina or uterus using a special tube. Artificial insemination is always performed at the time of ovulation, in order to maximize the chance of conception. The ovulation date can be determined with body temperature records or by hormone measurements. In some cases, this procedure is combined with fertility drug treatment. Since the sperm can be placed directly in the uterus, it is useful in treating hostile mucus syndrome and certain types of male infertility. The sperm sample can be provided either by the woman’s partner or by a donor. The pregnancy rate after artificial insemination is highly variable (anywhere from 10 to 70 percent), depending on the particular infertility problem in the couple.

Another assisted reproductive technology is
Gamete intrafallopian transfer (GIFT), the surgical placement of ova and sperm directly into the woman’s oviducts. To be a candidate for this procedure, the woman must have at least one partially undamaged oviduct and a functional uterus. Ova are collected surgically from the ovaries after stimulation with a fertility drug, and a semen sample is collected from the male. The ova and the sperm are introduced into the oviducts through the same abdominal incision used to collect the ova. This procedure is useful in certain types of male infertility, if the woman produces an impenetrable cervical mucus, or if the ovarian ends of the oviducts are damaged. The range of infertility problems that may be resolved with GIFT can be extended by using donated ova or sperm. The pregnancy rate is about 33 percent overall, but the rate varies with the type of infertility present.

The most common assisted reproductive technology is in vitro fertilization (IVF), or the fertilization of the sperm and egg outside the woman's body, followed by implantation of the fertilized egg in the woman's uterus. In this procedure, ova are collected surgically after stimulation with fertility drugs and then placed in a laboratory dish and combined with sperm from the man. The actual fertilization, when a sperm penetrates the ovum, will occur in the dish. The resulting embryo is allowed to remain in the dish for two days, during which time it will have grown to two to four cells. Then, the embryo is placed in the woman’s uterine cavity using a flexible tube. In vitro fertilization can be used in women who are infertile because of endometriosis, damaged oviducts, impenetrable cervical mucus, or ovarian failure. As with GIFT, in vitro fertilization may utilize donated ova or donated sperm, or extra embryos that have been produced by one couple may be implanted in a second woman. Embryos created through IVF can either be used immediately or frozen for later implantation. Success rates for in vitro fertilization have improved greatly over time, and in the United States in 2010, the proportion of IVF procedures that resulted in live births was about 56 percent for fresh embryos and 35 percent for frozen embryos, according to the Centers for Disease Control and Prevention.

Some women may benefit from nonsurgical embryo transfer. In this procedure, a fertile woman is artificially inseminated at the time of her ovulation; five days later, her uterus is flushed with a sterile solution, washing out the resulting embryo before it implants in the uterus. The retrieved embryo is then transferred to the uterus of another woman, who will carry it to term. Typically, the sperm provider and the woman who receives the embryo are the infertile couple who wish to rear the child, but the technique can be used in other circumstances as well. Embryo transfer can be used if the woman has damaged oviducts or is unable to ovulate, or if she has a genetic disease that could be passed to her offspring, because in this case the baby is not genetically related to the woman who carries it.

Some infertile women who are unable to achieve a pregnancy themselves turn to the use of a surrogate, a woman who will agree to bear a child and then turn it over to the infertile woman to rear as her own. In the typical situation, the surrogate is artificially inseminated with the sperm of the infertile woman’s husband. The surrogate then proceeds with pregnancy and delivery as normal, but relinquishes the child to the infertile couple after its birth.

Perspective and Prospects

One of the biggest problems that infertile couples face is the emotional upheaval that comes with the diagnosis of infertility, as bearing and rearing children is an experience that most people treasure. In addition to the emotional difficulty that may come with the recognition of infertility, more stress may be in store as the couple proceeds through treatment. The various treatments can cause embarrassment and sometimes physical pain, and fertility drugs themselves are known to cause emotional swings. For these reasons, a couple with an infertility problem is often advised to seek help from a private counselor or a support group.

Along with the emotional and physical challenges of infertility treatment, there is a considerable financial burden. Infertility treatments, in general, are expensive, especially for more sophisticated procedures such as in vitro fertilization and GIFT. Since the chances of a single procedure resulting in a pregnancy are often low, the couple may be faced with submitting to multiple procedures repeated many times. The cost over several years of treatment—a realistic possibility—can be very high. Many health insurance companies in the United States refuse to cover the costs of such treatment and are required to do so in only a few states.

Some of the treatments are accompanied by unresolved legal questions. In the case of nonsurgical embryo transfer, is the legal mother of the child the ovum donor or the woman who gives birth to the child? The same question of legal parentage arises in cases of surrogacy. Does a child born using donated ovum or sperm have a legal right to any information about the donor, such as medical history? How extensive should governmental regulation of infertility clinics be? For example, should there be standards for ensuring that donated sperm or ova are free from genetic defects? In the United States, some states have begun to address these issues, but no uniform policies have been set at the federal level.

The legal questions are largely unresolved because American society is still involved in religious and philosophical debates over the propriety of various infertility treatments. Some religions hold that any interference in conception is unacceptable. To these denominations, even artificial insemination is wrong. Other groups approve of treatments confined to a husband and wife, but disapprove of a third party being involved as a donor or surrogate. Many people disapprove of any infertility treatment to help an individual who is not married. Almost all these issues stem from the fact that these reproductive technologies challenge the traditional definitions of parenthood.

Bibliography

American Society for Reproductive Medicine. http://www.asrm.org/.

"Assisted Reproductive Technology (ART) Report." Centers for Disease Control and Prevention, January 6, 2012.

"Female Infertility." Mayo Clinic, September 9, 2011.

Harkness, Carla. The Infertility Book: A Comprehensive Medical and Emotional Guide. Rev. ed. Berkeley, Calif.: Celestial Arts, 1996.

InterNational Council on Infertility Information Dissemination. http://www.inciid.org.

Phillips, Robert H., and Glenda Motta. Coping with Endometriosis. New York: Avery, 2000.

Quilligan, Edward J., and Frederick P. Zuspan, eds. Current Therapy in Obstetrics and Gynecology. 5th ed. Philadelphia: W. B. Saunders, 2000.

Riley, Julie. "Infertility in Women." Health Library, October 31, 2012.

Speroff, Leon, and Marc A. Fritz. Clinical Gynecologic Endocrinology and Infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins, 2011.

Turkington, Carol, and Michael M. Alper. Encyclopedia of Fertility and Infertility. New York: Facts On File, 2001.

Weschler, Toni. Taking Charge of Your Fertility. Rev. ed. New York: Collins, 2006.

Wisot, Arthur L., and David R. Meldrum. Conceptions and Misconceptions: The Informed Consumer’s Guide Through the Maze of In Vitro Fertilization and Other Assisted Reproduction Techniques. 2d ed. Point Roberts, Wash.: Hartley & Marks, 2004.

Zouves, Christo. Expecting Miracles: On the Path of Hope from Infertility to Parenthood. New York: Berkley, 2003.

What talent did Curley have in the book Of Mice and Men?

Curley's talent is as a fairly good amateur boxer. In Chapter 2, after Curley has made an appearance and behaved in his usual hostile manner, Candy tells George:

"That's the boss's son....Curley's pretty handy. He done quite a bit in the ring. He's a lightweight, and he's handy."

The reader will later see a demonstration of Curley's boxing proficiency when he attacks Lennie in Chapter 3.

Curley was balanced and poised. He slashed at Lennie with his left, and then slashed down his nose with a right....[Lennie] backed until he was against the wall, and Curley followed, slugging him in the face.

We can see that Curley has an inferiority because of his small size. Like a number of such small men, he has made the most of his body. No doubt he lifts weights as well as working out in the ring at the gym. His inferiority complex would explain why he married a girl who is apparently only about sixteen years old. He may feel inadequate to relate to a mature woman. It would also explain his bad temper and his aggressiveness. Candy understands him pretty well.

"Curley's like a lot of little guys. He hates big guys. He's alla time picking scraps with big guys. Kind of like he's mad at 'em because he ain't a big guy. You seen little guys like that, ain't you? Always scrappy?"

Curley's "scrappiness" will explain why he is so anxious to kill Lennie in the most painful way towards the end of the book. Lennie crushed Curley's hand after taking a lot of undeserved punishment. Curley wants revenge. Lennie has put an end to the little man's career as an amateur boxer. In fact, he might never be able to fight with anyone again, either in or out of the ring. Curley's wife will be somewhat attracted to Lennie just because she hates her husband and knows it was Lennie who crushed Curley's hand in their bunkhouse fight. This will explain why she stays to talk to Lennie in the barn and invites him to stroke her soft hair. And stroking her hair arouses Lennie, leading to his accidentally killing her when she starts struggling and trying to scream for help. Eventually this will lead to George shooting Lennie at the riverside and bringing the story to an abrupt end.

All of these events are examples of Steinbeck's "naturalistic" style. There does not seem to be a real plot. Things just happen, and one thing is the result of another. For example, when Carlson shoots Candy's old dog, George sees the gun, sees where Carlson keeps it, and sees how the complicated German Luger works. Carlson tells Candy exactly where he will point the Luger at the back of the old dog's head in order to kill it with a single painless shot. Later George will know exactly where to shoot Lennie in the back of the head with the same stolen Luger. 

What is salmonellosis?

Definition

Salmonellosis is an infection caused by the Salmonella
genus of the bacterial family Enterobacteriaceae. Acute
gastroenteritis is the most common form of salmonellosis.
Other clinical manifestations of salmonellosis include enteric fever and
bacteremia. Hematogenous seeding of other organs may lead to secondary
manifestations of salmonellosis, including endocarditis, pneumonia,
pyelonephritis, septic arthritis, and osteomyelitis.

Causes

Salmonella bacteria live in the intestinal tracts of humans and
of a variety of wild and domestic animals throughout the world. Poultry, cattle,
dairy cows,pigs, sheep, goats, and other agricultural livestock commonly carry
Salmonella. Pet birds, lizards, turtles, iguanas, dogs, and
cats may also carry disease-causing Salmonella species. Bacteria
pass in the feces of infected animals. Fecal contamination of food or water,
unsanitary food-handling practices, and infection of egg-laying hens can lead to
salmonellosis.

In the developing world, lack of sewage systems, inadequate water treatment,
and inconsistent or inadequate sanitation practices may lead to
Salmonella contamination of drinking water or agricultural
fields. Most salmonellosis outbreaks involve acute gastroenteritis, although
typhoid
fever remains a significant health threat in impoverished
parts of the world, including areas of Asia, Africa, Central America, and South
America. S. enterica sub. enterica serovar Typhi
(or S. typhi) and S. enterica sub.
enterica serovar Paratyphi (or S. paratyphi),
the causative agents of typhoid and paratyphoid fever, respectively, live
exclusively in the human intestine. These illnesses pass from one person to
another through human fecal contamination of foodstuffs. S. typhi
carriers can cause community outbreaks, as in the infamous case of
Typhoid
Mary in New York City in the early twentieth century.

Infection of egg-laying hens is a common cause of salmonellosis outbreaks. The bacteria infect the ovaries of hens, contaminating the eggs before shell formation. Infected hens commonly appear healthy, complicating detection of Salmonella-contaminated eggs. Breaks in sanitation or hygiene protocols during food cultivation, processing, and packaging can also lead to salmonellosis outbreaks.

Risk Factors

Ingestion of raw or undercooked eggs is a significant risk factor for eggborne salmonellosis. Unpasteurized milk can also transmit Salmonella. Inadequate handwashing and cross-contamination between meats and uncooked produce during food preparation can potentially lead to salmonellosis.

Because livestock and pets may carry Salmonella bacteria, the failure to wear gloves or thoroughly wash the hands after handling animals or their feces is a risk factor for salmonellosis. Cattle, dairy cows, poultry, turtles, lizards, and snakes are common sources of infection.

Young children, persons with human immunodeficiency virus infection
or acquired
immunodeficiency syndrome, organ transplant recipients, and
those undergoing cancer treatments have an increased risk for salmonellosis
because of their immature or weakened immune systems.

Symptoms

Salmonella gastroenteritis symptoms begin twelve to seventy-two
hours after ingestion of water or food and include nausea, vomiting, diarrhea, and abdominal
cramps, which may be accompanied by a fever of 100° to 102° Fahrenheit (38° to 39°
Celsius), chills, and headache. Fever typically resolves within two to three days;
gastrointestinal symptoms usually abate within seven days. Immunocompromised
persons may develop severe symptoms, bacteremia, and dehydration.

Symptoms of typhoid and paratyphoid fever develop more gradually than those associated with salmonella gastroenteritis. Approximately six to thirty days after infection, a low-grade fever, headache, anorexia, fatigue, and abdominal pain develop, typically accompanied by constipation or diarrhea. Symptoms intensify over three to four days, with fevers typically reaching 101° to 104° F (38.5° to 40° C). Some persons will develop a maculopapular, rose-colored rash on the trunk. Although uncommon, persons with enteric fever may develop neuropsychiatric symptoms, including lethargy, confusion, frank delirium, seizures, and coma.

Screening and Diagnosis

Routine screening is not conducted for salmonellosis, except in outbreak situations wherein carrier identification becomes critical. Isolation of Salmonella from body tissues, fluids, or excretions remains the cornerstone of diagnosis. For acute gastroenteritis, diagnosis is confirmed by isolation of Salmonella from the stool. In persons with bacteremia, isolation of Salmonella from the blood confirms the diagnosis.

Definitive diagnosis of enteric fever is often challenging because of the
limited sensitivity of blood and stool cultures with this form of salmonellosis.
Isolation of S. typhi or S. paratyphi from the
blood, stool, bone marrow, intestinal secretions, urine, or secondary infection
sites confirms the diagnosis; bone marrow cultures are the most sensitive.
Serologic
tests for antibodies to S. typhi
antigens may also aid in the diagnosis of typhoid fever. Polymerase chain
reaction testing for Salmonella is used in
some locales.

Treatment and Therapy

In an otherwise healthy person, nontyphoidal, gastrointestinal salmonellosis is
typically a self-limited illness, resolving spontaneously without antibiotic
therapy. Oral or intravenous fluid replacement may be necessary for persons with
severe symptoms. Antibiotic therapy is commonly prescribed for immunocompromised
persons with gastrointestinal salmonellosis and for those who are otherwise at
high risk for complications. Salmonella bacteremia and enteric fever are treated
with antibiotic therapy, commonly a fluoroquinolone or a third-generation
cephalosporin.

Prevention and Outcomes

Proper food handling and handwashing are key to preventing gastrointestinal salmonellosis. One should wash hands with soap and running water before and after handling food, especially raw meats. Thoroughly cooking meat and eggs kills Salmonella contaminants that may be present. Handwashing after using the toilet, changing diapers, and handling animals also helps prevent salmonellosis.

The Centers
for Disease Control and Prevention recommends typhoid
immunization for travelers visiting areas with a high incidence of S.
typhi. Oral and intramuscular vaccines effectively protect
approximately 50 to 80 percent of persons immunized against typhoid fever.

Bibliography

Fischer Walker, Christa L., David Sack, and Robert E. Black. “Etiology of Diarrhea in Older Children, Adolescents, and Adults.” PLoS Neglected Tropical Diseases 4 (2010): e768. Systematic review of twenty-two studies from around the world, examining the causative agents of infectious diarrhea and demonstrating the ongoing, high incidence of salmonellosis in community settings.

Pegues, David A., and Samuel I. Miller. “ Salmonella Species, Including Salmonella typhi.” In Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, edited by Gerald L. Mandell, John F. Bennett, and Raphael Dolin. 7th ed. New York: Churchill Livingstone/Elsevier, 2010. Infectious disease text withreferenced discussion of salmonellosis epidemiology, microbiology, pathogenesis, treatment, and prevention.

Thaver, Durrane, et al. “A Comparison of Fluoroquinolones Versus Other Antibiotics for Treating Enteric Fever.” British Medical Journal 338 (2009): b1865.Meta-analysis of twenty randomized, controlled trials examining clinical and microbiological failures and relapse rates associated with antibiotics for the treatment of enteric fever.