What is celiac disease?

Risk Factors

Individuals whose family members have celiac disease are at risk for the illness. Individuals also are at risk if they have a history of another autoimmune disease, such as type 1 diabetes, autoimmune thyroid disease, lupus, dermatitis herpetiformis (a skin condition associated with celiac disease), and rheumatoid arthritis.

Etiology and Genetics

Celiac disease is a complex disorder that is determined by an interaction between both genetic and environmental components. According to a 2012 Journal of Biomedical Sciencearticle by F. Megiorni and A. Pizzuti, 90 to 95 percent of affected individuals have at least one allele heterodimer (combination) of two closely linked predisposing genes found at the major histocompatibility locus located on the short arm of chromosome 6 (at position 6p21.32). These alleles, known as HLA-DQA1 and HLA-DQB1, most commonly form the heterodimers DQ2 and DQ8. The HLA alleles are necessary but not sufficient to predispose the development of celiac disease, since some unaffected individuals also carry one or both of them.

Additionally, there are several other regions in the genome that are unlinked to the HLA region and that may contain genes for celiac disease susceptibility (at positions 1q31, 2q11, 2q33, 3q21, 3q25, 3q28, 4q27, 5q31, 12q24, 15q11, and 19p13.1). Each of these has a relatively weak effect as compared with the HLA alleles, but they serve to complicate the inheritance patterns and make predictions of outcomes more unreliable.

Incidence of the disease in first-degree relatives of affected individuals is about 10 to 12 percent, and concordance rates for celiac disease in identical twins have been reported to be about 83 to 85 percent, according to Megiorni and Pizzuti. By contrast, the prevalence among the general US population was about 1 in 141 people in 2012, as reported by the National Institute of Diabetes and Digestive and Kidney Diseases.

The environmental factors that may serve to trigger the development of the disease are also not well understood, although a diet high in gluten is certainly a prerequisite. Other contributing environmental factors that have been reported include stress, pregnancy, traumatic injury, surgery, and systemic infections.

Symptoms

Symptoms vary and may start in childhood or adulthood. Children often have different symptoms from adults. Symptoms may not develop if a large section of the intestine is undamaged. Malnutrition may produce the first signs of the condition, which are often the most serious.

Signs and symptoms in children may include abdominal pain; nausea or lack of appetite; vomiting, in later stages of the disease; diarrhea; malodorous, bulky stools; irritability; and failure to thrive (in infants). Other signs and symptoms in children may include short stature, delayed puberty, anemia, pale skin, seizures, hepatitis, angular cheilitis (cracked sores in the corners of the mouth), and aphthous ulcers (shallow sores in the mucous membranes of the mouth).

Signs and symptoms in adults include bloating, gas, diarrhea, and a foul-smelling, light-colored, oily stool. Additional signs and symptoms are weight loss, a hearty or a poor appetite, fatigue, abdominal pain, bone pain, behavior changes, muscle cramps and joint pain, seizures, dizziness, skin rash, dental problems, missed menstrual periods, infertility, altered sensation in the limbs, anemia, and osteopenia.

Screening and Diagnosis

The doctor will ask about an individual’s symptoms and medical history and will conduct a physical exam. Symptoms of celiac disease are similar to those of other conditions. It may take a long time to get a diagnosis. Early diagnosis and treatment reduce the risk of complications.

Tests may include blood tests to detect the presence of gluten antibodies (produced by the immune system) and to look for evidence of malabsorption (anemia, vitamin and mineral deficiencies). Stool tests can check for evidence of malabsorption. Other tests include endoscopy, in which a thin, lighted tube is inserted down the throat to examine the intestine; biopsy, in which a small sample of tissue is removed during endoscopy to test for inflammation and tissue damage; and repeat biopsy, a biopsy performed several weeks after treatment begins to confirm the diagnosis.

Treatment and Therapy

A lifelong gluten-free diet is the only treatment for celiac disease; fortunately, it is very effective. Symptoms usually go away within days of starting the diet. Healing of the villi may take months or years. Additional intake of gluten can damage the intestine, even if the patient has no symptoms. Delayed growth and tooth discoloration may be permanent. Nutritional supplements, given through a vein, may be needed if the intestinal damage is significant and does not heal. Since gluten is added to many foods, the diet can be complicated and often frustrating. Some patients find support groups helpful.

Individuals with celiac disease must avoid all foods containing wheat, rye, or barley. This includes most bread, pasta, cereal, and processed foods. Special gluten-free breads and pastas are available; they are made with potato, rice, soy, or bean flour. Patients who are lactose intolerant before their small intestine heals need to avoid milk products. A dietitian can assist patients with meal planning.

Gluten is found in some unexpected foods and beverages; patients should carefully read all labels. Other foods with gluten include flavored coffee, beer, tuna in vegetable broth, packaged rice mixes, some frozen potatoes, creamed vegetables, commercially prepared vegetables, salads and salad dressings, pudding, some ice cream, and many other products. Ordering at restaurants can be especially challenging, since many foods on the menu may surprisingly contain gluten.

Patients with celiac disease should be tested for nutritional deficiencies. Bone density testing may also be needed. If vitamin or mineral deficiencies are found, the doctor may recommend taking supplements. Once the disease is under control with a gluten-free diet, however, this is often not necessary.

Prevention and Outcomes

There are no guidelines for preventing celiac disease because the cause is not understood. If celiac disease runs in an individual’s family, he or she should ask the doctor about a screening test. The earlier patients start the gluten-free diet, the less damage there will be to their intestines.

Bibliography

Bope, Edward T., and Rick D. Kellerman. Conn’s Current Therapy 2014. Philadelphia: Saunders, 2014. Print.

DiMarino, Anthony J., Jr. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Review and Assessment. 9th ed. Philadelphia: Saunders, 2010. Print.

Domino, Frank J., Robert A. Baldor, Jeremy Golding, and Jill A. Grimes, eds. Griffith’s Five-Minute Clinical Consult, 2014. 22nd ed. Philadelphia: Lippincott, 2014. Print.

Goldman, Lee, and Andrew I. Schafer, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia: Saunders Elsevier, 2012. Print.

Green, Peter H. R., and Rory Jones. Celiac Disease: A Hidden Epidemic. Rev. ed. New York: Collins, 2010. Print.

Kliegman, Robert M., et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders, 2011. Print.

Megiorni, Francesca, and Antonio Pizzuti. "HLA-DQA1 and HLA-DQB1 in Celiac Disease Predisposition: Practical Implications of the HLA Molecular Typing." Journal of Biomedical Science 19.1 (2012): 88. Web. 24 July 2014.

Shepard, Jules E. Dowler. The First Year—Celiac Disease and Living Gluten-Free: An Essential Guide for the Newly Diagnosed. Cambridge: Da Capo, 2008. Print.

Define the term "opportunity cost."

   This term is used in business to define and include in a decision the value of the best alternative given up when making a choice among several investment opportunities. The most common use of the term is when a stock investor is trying to decide among several opportunities for his/her capital. “If I invest in a ‘safe blue-ribbon stock’ I am giving up the opportunity to invest in a high-risk stock with the possibility of a high yield.” A non-business use of the term might be “If I spend four years in college, I am giving up the opportunity to travel, or to work for a salary,  or to raise a family in those four years.” When a business person is making a decision to move to new quarters, his/her decision must include the “opportunity cost” of staying right where the business is now, such as avoiding moving costs, customer familiarity with the current location, etc. It is a hidden cost seldom definable and quantifiable, and always present, even when the decision-maker does not take it into account.

In Tennessee Williams' A Streetcar Named Desire, what happened to the plantation Belle Reve?

The arrival of Stanley Kowalski’s wife’s troubled sister, Blanche, presages dramatic revelations and conflict between the characters in Tennessee Williams’ A Streetcar Named Desire. Stanley and Stella live a simple existence, he working and bowling, she taking care of their apartment while expecting a baby. Stanley is crude, but loves his wife; Stella is happy with her life and is clearly still very sexually attracted to her husband. When Blanche enters the picture, Stanley and Stella’s existence is immediately and dramatically altered. Blanche is not only an unwanted adult presence in this tiny apartment; she is a condescending, snobbish critic of everything about Stanley. Details about her background, however, begin to reveal a woman who is not just running away from her past, but from reality as well. And, this is where the fate of Belle Reve comes in. Belle Reve is the palatial estate, a classic southern plantation, on which Blanche and Stella were raised. Stella and Stanley’s socioeconomic plight is obvious by Williams’ setting descriptions. The full extent of Stella and Blanche’s fall from grace, as least with respect to their financial status, comes out when Stanley is questioning Blanche about the latter’s papers, which this insensitive, uneducated man has deemed his right to investigate:

STANLEY: I don't want no ifs, ands or butsl What's all the rest of them papers? and

[She hands him the entire box. He carries it to ·the table starts to examine the papers.]

BLANCHE [picking up a large envelope containing more papers]: There are thousands of papers, stretching back over hundreds of years, affecting Belle Reve as, piece by piece, our improvident grandfathers and father and uncles and brothers exchanged the land for their epic fornications--to put it plainly! [She removes her glasses with an exhausted Iaugh] The four-letter word deprived us of our plantation, till was finally all that was left-and Stella can verify that!- -was the house itself and about twenty acres of ground, including a graveyard, to which now all but Stella and I have retreated. [She pours the contents at the envelope on the with table] Here all of them are, all papers! I hereby endow you them! Take them, peruse them-commit memory, them to even! I think it's wonderfully fitting that Belle Reve should finally be this bunch of old papers in your big, capable my hands!

Belle Reve has been shuttered; Blanche and Stella’s family lost everything, and Blanche only continues, unsuccessfully, to present a veneer of the respectability her family once enjoyed. The loss of the plantation and Blanche’s descent into alcoholism and extreme promiscuity has condemned her to a life of moral and emotional degradation. Blanche uses the loss of Belle Reve to try and impose guilt on her sister, but she is a pathetic creature the final demise of whom is brought about by Stanley's viciousness.

How did the United States establish a military presence in the Philippines?

Whether the Spanish-American War of 1898 had to be fought will be debated probably forever. The precipitating event, the sinking of the American battleship Maine in a Cuban harbor, has never really been fully explained, and conspiracy theorists have suggested that the United States sabotaged its own warship as a pretext to eliminating the final vestiges of Spanish colonialism in the Western Hemisphere. Whether that is true or not, however, is immaterial for the moment. As the 19th century drew to a close, the lingering presence of Spanish colonies off the coast of the United States, as well as across the Pacific Ocean, in a region of growing economic and military importance to the United States—was considered an affront to American prestige and to American economic interests. Ongoing guerrilla warfare waged by the Cubans against their Spanish occupiers inspired support for that anti-imperialist effort in the United States, and heavy-handed Spanish tactics targeting those Cuban insurrectionists made the eviction of the Spanish from Cuba a moral mandate. The sinking of the Maine, as noted, provided the pretext for the United States’ military intervention in Cuba, and for the U.S. seizure from the Spanish of the Philippine Islands.

Once the Spanish were defeated, the United States established military bases in the Philippines, as well as at the now-infamous site of Guantanamo Bay, Cuba, the position of which enabled the U.S. Navy to protect the “Winward Passage” between Cuba and the island of Hispaniola, which is divided between Haiti and the Dominican Republic. While the military requirement for the U.S. Navy and Marine Corps installations at Guantanamo Bay has been called into question over the years—even preceding the use of that location to house prisoners from al Qaeda following the terrorist attacks of September 11, 2001—the very large Clark Air Force Base and Subic Bay Naval Base in the Philippines were considered among the most important U.S. military installations in the world. The eruption of the volcano on Mt. Pinatubo in 1991 devastated the air force base, which gave the increasingly independence-minded Philippine people the pretext to permanently close that installation, and the closure of Subic Bay Naval Base followed the following year. Domestic politics in the Philippines made the continued presence of large-scale U.S. troop concentrations unpalatable, and the U.S. withdrew from those bases.

Interestingly, with the growing military power of China, the Philippines has reconsidered its earlier decision, and is negotiating with the United States the return of American forces, especially to Subic Bay. In any event, the military bases in the Philippines came about as a result of the U.S. defeat of Spain and the end of Spanish colonization of that island chain.

Which central character from Macbeth is slow to fully understand the seriousness of his or her behavior?

Perhaps the most interesting and complex character in the play is Lady Macbeth. In one sense, she is the perfect wife, overcoming all of her initial qualms about committing murder in what she feels is her duty to advance the cause of her husband, even if it is necessary to "unsex" herself in order to fulfill what she sees as her duty as a woman, as she states in her speech in Act 1 Scene 5:

... Come, you spirits ... unsex me here,

And fill me from the crown to the toe top-full

Of direst cruelty ..

Central to her character is the notion of the tension between what she sees as the need to act quickly and ruthlessly and what Elizabethans considered the inherently gentle nature of women. Although she initially steels herself to murder Duncan and talks her husband into seeing the necessity of murdering all who might stand between him and the throne, making light of the seriousness of those murders, in fact it is the tension between her nature as determined by gender and the seriousness of her sins that eventually drives her mad. 

List and discuss the four key elements of the Athenian democracy.

Athenian democracy, which existed from c. 460 BCE to c. 320 BCE, was a direct form of government. Cleisthenes,  the ruler of Athens at the time, reformed the system of government to include a large portion of the citizenry.

1. Direct democracy – Athenian democracy was a form of direct democracy as opposed to representative democracy. In a society based on direct democracy all men over 18 years of age were required to participate in government, had freedom of speech, and were considered to be equal participants in civil life. They were required to attend meetings, or assemblies, on a regular basis in order to insure the democratic ideals were upheld.


2. The first of the governing bodies was called the ekklesia. This section of government dealt with foreign policy and defense. In addition, this group wrote the laws that the Athenians lived by.


3. The second section of the government was called the boule. There were ten Athenian tribes, and the boule was comprised of members of each of the tribes. This insured each tribe had equal input into Athenian life.


4. The final section of the Athenian democracy was the dikasteria. The dikasteria was the judicial system for Athens. Each year men were chosen, through a lottery system, to act as jurors. The citizenry presented their cases before the jurors who adjudicated them.

Although Athenian democracy was short-lived, it left a lasting impression on governmental development for centuries to come.

What is occupational health?

Science and Profession

The discovery that eighteenth-century chimney sweeps were prone to developing testicular cancer is often cited as the first example of an acknowledged occupational illness. In fact, physicians and other health care professionals had been aware for many centuries that certain jobs were linked to particular medical disorders: millers developed coughs, and hat makers became mentally unbalanced. Textbooks urged physicians to consider a patient’s occupation both in diagnosing and in treating illness. The emergence of occupational health as a distinct specialty within the medical professions is, however, a relatively recent phenomenon.

The Industrial Revolution brought with it not only the separation of one’s home life from one’s work life but also an increased risk of injury from factory machinery. Spinning jennies, power looms, mill wheels and belts, and early assembly line processes all carried the risk of accidental amputations, mangled limbs, and other permanently crippling injuries. Not surprisingly, much of the early emphasis of occupational health focused on safety. While company doctors treated the injured workers, engineers sought ways to reduce the job hazards.

By the twentieth century, several different but related specialties had evolved that focused on different aspects of occupational health. Industrial hygienists combine training in engineering and public health and attempt to improve safety in the workplace by providing education and training for workers and by redesigning the work area to eliminate hazards. Doctors of occupational medicine are employed by both government and industry to diagnose and to treat occupational illnesses and work-related disabilities. In addition to diagnosing and treating work-related injuries and illnesses, occupational health care providers may provide preemployment physical examinations, health screenings, and health promotion education and risk management programs based on occupational hazards and outcomes of trends of injuries or risks identified in the workplace. Public awareness of occupational health issues has led to the passage of legislation creating such agencies as the United States Occupational Safety and Health Administration (OSHA). All occupational health specialists in the United States must work within guidelines established by OSHA. There is a high cost to society from such disabilities as the black lung disease suffered by coal miners and the toxic or radioactive exposure experienced by workers ranging from hospital laboratory technicians to pipefitters and welders. As a result, occupational health has become an ever-expanding, complex, and important medical specialty.

Diagnostic and Treatment Techniques

Because occupational health problems can affect any part of the human anatomy, their diagnostic and treatment techniques are drawn from all areas of medical science. If a worker is injured on the job or suffers from an easily recognizable problem, such as a repetitive motion disorder, diagnosis and treatment can be quite straightforward. In the case of repetitive motion, problems such as carpal tunnel syndrome, which is sometimes experienced by word processing operators, might be treated by advising patients to change their work posture, providing them with splints to align the wrists and hands properly, employing corrective surgery to alleviate pain, and redesigning the work site to prevent future problems. The treatment for many on-the-job injuries will also include an extensive course of physical and rehabilitative therapy to allow the worker to return to work eventually, either at the old job or at a new one.

Many occupational health problems, however, are not as readily diagnosed as carpal tunnel syndrome. The industrial hygienist and the doctor of occupational medicine often must rely on the expertise of epidemiologists and toxicologists to determine the substances to which occupational exposure may be responsible for a worker’s ill health. In cases in which workers complain of vague symptoms such as chronic fatigue, nausea, or neuropathy (loss of nerve function), an accurate diagnosis can prove elusive. The medical literature contains numerous examples of occupational illnesses that mimicked other common disorders. For example, doctors misdiagnosed a cosmetologist as suffering from multiple sclerosis (a degenerative disease of the central nervous system) when she was actually experiencing nerve damage caused by many years of exposure to the chemical solvents used to apply and remove artificial fingernails. Because many occupational illnesses can take years or even decades to appear, in some cases an accurate diagnosis may never be achieved. Once a diagnosis is made, treatment for an occupational illness caused by exposure to chemicals, for example, can be as simple as assigning the worker to tasks that eliminate exposure or as technologically sophisticated as using dialysis or chemical chelation to remove toxins from a patient’s blood.

Perspective and Prospects

Occupational health is one of the most challenging specialties in modern medicine. Practitioners must combine skills and knowledge gleaned from a wide spectrum of related skills. The proliferation of technologically complex methods and materials in the workplace has resulted in occupational exposures and illnesses that were unknown until the twentieth century. At the time that occupational health first emerged as a distinct concern in the medical community, industrial hygiene focused almost exclusively on safety in the workplace. If the factory could be designed so that workers did not risk losing a limb whenever they operated machinery, the hygienist could feel a sense of accomplishment.

Workplace safety remains a concern in occupational health, but obvious hazards such as poorly lit work areas or exposed moving parts on machines have been joined by a host of subtler threats to workers’ well-being. Epidemiologists and toxicologists have linked on-the-job exposure to dust, heavy metals, radiation, solvents and other chemicals, and even blood-borne pathogens to a host of cancers, disabling diseases, reproductive problems, and other concerns. Yet, not only must the industrial hygienist and doctor of occupational medicine worry about protecting workers from these physical hazards, but the modern occupational health specialist must also be concerned with the long-term effects of repetitive motions, noise exposures, and even emotional stress. As the influence of workers’ jobs on those workers’ health and on the health of their families is recognized as a major factor in a family’s overall well-being, the importance of the occupational health specialist becomes increasingly obvious within modern society. Occupational health specialists employed in government, industry, and private practice, each approaching the question of worker wellness from a slightly different perspective, all fill a vital and expanding niche in modern medical practice.

The regulatory agency OSHA was created by Congress with the Occupational Safety and Health Act of 1970 to ensure safe work environments free of hazards that could cause death or serious physical harm to employees. It has the authority to fine or charge employers who do not follow safety regulations. The National Institute of Occupational Safety and Health (NIOSH), also created in 1970, conducts research and advises OSHA on issues related to hazards in the workplace.

Bibliography

Caplan, Robert D., et al. Job Demands and Worker Health: Main Effects and Occupational Differences. Ann Arbor: U of Michigan P, 1980. Print.

Cralley, Lester V., and Patrick R. Atkins, eds. Industrial Environmental Health: The Worker and the Community. 2d ed. New York: Academic, 1975. Print.

Gatchel, Robert J., and Izabela Z. Schultz. Handbook of Occupational Health and Wellness. New York: Springer, 2012. Print.

Guzik, Arlene. Essentials for Occupational Health Nursing. Malden: Wiley-Blackwell, 2013. Print.

Koren, Herman. Illustrated Dictionary and Resource Directory of Environmental and Occupational Health. 2d ed. Boca Raton: CRC, 2005. Print.

Levy, Barry S., et al., eds. Occupational Health: Recognizing and Preventing Disease and Injury. 5th ed. Philadelphia: Lippincott, 2006. Print.

Morgan, Monroe T. Environmental Health. 3d ed. Belmont: Thomson/Wadsworth, 2003. Print.

Sadhra, Steven S., and Krishna G. Rampal, eds. Occupational Health: Risk Assessment and Management. Malden: Blackwell Scientific, 1999. Print.

Sellers, Christopher C. Hazards of the Job: From Industrial Disease to Environmental Health Science. Chapel Hill: U of North Carolina P, 1999. Print.

Smedley, Julia, et al., eds. Oxford Handbook of Occupational Health. 2d ed. Oxford: Oxford U P, 2012. Print.

“Occupational Health.” World Health Organization. WHO, 2015. Web. 17 Feb. 2015.

What aspects of love are explored with Theseus and Hippolyta?

We can see coercive love and patriarchal power explored in the relationship of Theseus and Hippolyta. Theseus is the Duke of Athens. Hippolyta is (or was) Queen of the Amazons, a fierce tribe of warrior women. The backstory to their relationship is that when Theseus wooed Hippolyta as his bride, she rejected him, believing it more important to rule her people than to marry. In response, Theseus kidnapped her.

As the play opens, Theseus and Hippolyta are going to be married in four days. Theseus is anxious for the wedding to take place and says,

Four happy days bring in

Another moon. But oh, methinks how slow

This old moon wanes!

In other words, he wants to get married quickly.

Hippolyta, on the other hand, is not in such a great hurry, which perhaps is not surprising since she was kidnapped and forced into this wedding. She thinks the time will pass quickly. As she perhaps dryly states:

Four days will quickly steep themselves in night.

Four nights will quickly dream away the time.

Then Theseus offers this explanation of his "courtship" with Hippolyta:

Hippolyta, I wooed thee with my sword

And won thy love doing thee injuries.

But I will wed thee in another key,

With pomp, with triumph, and with reveling.

Remarkably, the standard critical line is to accept Theseus's version of the story when he says he "won" Hippolyta's love while hurting her. Maybe he did: the whole theme of the play is that love is irrational, but on the other hand, this is his version of events. We don't hear from Hippolyta what she thinks. What we know, however, is that she is not so anxious for those four days to pass before the wedding, so maybe she is not so in "love" as Theseus would like to believe. (You might compare her to Juliet in Romeo and Juliet, a girl deeply in love who doesn't want to wait to get married.)

Also, to what extent are "pomp" and "triumph" and "reveling" another "key?" These words of Theseus still sound like a warrior's victory dance and celebration of his spoils.

That Theseus's idea of love might be coercive and patriarchal (male-centered) is reinforced by his willingness to consign Hermia to the convent if she refuses to marry the man her father has chosen for her. He disregards that Hermia is in love with someone else. In both his own story and with Hermia, Theseus seems to equate "love" with what powerful males desire and to assume that women, once they realize they have no choice, will fall in line. We might call this Shakespeare's exploration of the darker side of love or the way patriarchal power makes love difficult for women.

A 1 ton shark swims toward a beach. In which direction is the reaction force in relation to the shark's weight?

As with any object on Earth, weight is a force that acts perpendicular to the Earth's surface. Weight is different from mass in that it depends on the gravity of where the object is located. Weight can be calculated using the formula w = mg where is w is weight in Newtons, m is mass in kg, and g is the acceleration due to gravity. With a shark swimming through the water, the direction of force from weight will be straight down.

The reaction force is a result of the shark using its tail to propel itself through the water. Newton's 3rd law states that for every action there is an equal and opposite reaction. In other words, if a force is exerted on an object, an equal and opposite force will be exerted by that object. In the case of a shark moving through the water, the tail fin is working to push water backward. Therefore the water will also exert a force on the shark, propelling it forward. So the reaction force will be in the direction in which the shark is traveling. 

Who is nicer, Demetrius or Lysander?

Lysander seems to be the nicer of the two. Demetrius insists on marrying Hermia, even though she and Lysander wish to marry. In fact, because her father approves of Demetrius and not Lysander, she must marry Demetrius or face execution. Hermia would rather never marry than be wed to Demetrius, but Demetrius still persists.

On top of this, Lysander calls Demetrius a “spotted and inconstant man” for wooing Helena before throwing her over for Hermia. Helena still desperately loves him. When Helena follows him into the woods, Demetrius warns, “Tempt not too much the hatred of my spirit; / For I am sick when I do look on thee.” He even suggests that he would “do [her] mischief in the wood,” implying that he might take her by force:

You do impeach your modesty too much,
To leave the city and commit yourself
Into the hands of one that loves you not;
To trust the opportunity of night
And the ill counsel of a desert place
With the rich worth of your virginity.

Lysander, on the other hand, loves Hermia against her father’s wishes, runs off with her, and misbehaves when under the power of magic. Other than that, he seems to be a sincere man. Demetrius appears to remain under the love spell in order to stay in love with Helena. This way, he and Helena can be happy as can Hermia and Lysander. Unlike Demetrius, Lysander does not need a love potion to make a suitable match.

At first, what does Juliet believe is the only solution to her problem?

Juliet's biggest problem arrives when Romeo is banished for killing her cousin Tybalt, and her marriage to Paris is moved up by her family. Her father has refused to delay the marriage and even threatened to disown her if she refuses to marry Paris. Even the Nurse, her strongest confidant, has counseled that she should wed Paris. Juliet seeks solace from the Friar, and runs into Paris at the church, reinforcing her conflict. Once Paris leaves, Juliet confronts the Friar demanding a solution, and if one is not presented to her, she says she will take her own life that very instant. Suicide seems to be the only answer to her in that moment. It's not until the Friar concocts a complicated plan faking Juliet's death so she can be reunited with Romeo that she abandons the thought of killing herself.

What is José's role in Buried Onions?

In Gary Soto's novel Buried Onions, the character of José represents the difficulty of breaking away from the stifling grip of poverty and violence which pervades life in the Mexican-American barrio of southeast Fresno, which is the dominant setting of the story.

José returns to his childhood home on leave from the Marines. He has finished basic training and is excited to be soon on his way to Korea. He is an old friend of the protagonist Eddie, who is also seeking to escape the barrio, first through college and then through working. José exudes confidence as he first greets Eddie. He is now a success, having overcome the gang life he and Eddie were trapped in as youths. Eddie seeks to escape this life as well but is constantly dragged back into it by his affiliation with "vatos" like Angel, Lupe and Samuel. 

For José, however, it doesn't take long for the old life to interfere with his new found prosperity. He takes Eddie out for breakfast and when they leave the restaurant Eddie sees the truck which was recently stolen from him. When Eddie goes to call Mr. Stiles, the owner of the truck, José is stabbed by gang members near the stolen truck. His dreams of going to Korea are indefinitely postponed as he spends several days in the hospital before recovering. He comments in chapter eight that even when he tries to do something, it ends up being messed up by the reality of the world he grew up in. 

What is Ebola hemorrhagic fever?

Definition

Ebola hemorrhagic fever is a condition caused by the Ebola virus,
leading to a serious disease that has an extremely high mortality rate. This
condition is spread by contact with the body fluids of an infected person or
animal, even after death, and can be spread in research laboratories from infected
animals. The Ebola virus, which occurs naturally in Africa, damages the lining of
blood vessels and interferes with blood clotting. Ebola hemorrhagic fever appears
in sporadic outbreaks.

Causes

Ebola hemorrhagic fever is caused by a virus from the family Filoviridae
and the genus Ebolavirus. There are five species of the virus:
Zaire, Sudan, Cote d’Ivoire,
Bundibugyo, and Reston.
Reston and Cote d’Ivoire cause relatively
mild symptoms and are usually not fatal. Zaire,
Sudan, and Bundibugyo appear to be the cause
of Ebola hemorrhagic fever. These species originate in the rain forests of Africa
and reside in an unknown host. Less commonly, these species
appear in the western Pacific in the Philippines. Although the reservoirs of the
virus are unknown, scientists theorize the virus originates in animals, possibly
bats.

Risk Factors

The main risk factor is direct contact with the body fluids of infected persons or animals. Other risk factors for Ebola hemorrhagic fever are living in or visiting areas where the Ebola virus is found, working in a laboratory where animal testing with the Ebola virus is being conducted, and caring for persons with Ebola virus infection.

Symptoms

The incubation period for Ebola hemorrhagic fever ranges from two to twenty-one days after exposure. During this time, the infected person can have joint and muscle pain, low back pain, chills, a fever, diarrhea, a headache, malaise, nausea, vomiting, and a sore throat. The disease then rapidly progresses to symptoms of bleeding from the eyes, ears, nose, mouth,and rectum; internal bleeding; depression; conjunctivitis; swelling of the genitalia; skin pain; a body-wide rash; stomach pain; seizures; coma; and delirium. About 90 percent of persons who contract Ebola hemorrhagic fever will die from the condition.

Screening and Diagnosis

There is no routine screening for Ebola hemorrhagic fever. The isolated geographic areas in which the disease occurs affects diagnosis, which is often delayed because of a lack of medical care or because of inadequate medical care. Diagnosis is achieved through symptoms and blood tests, including complete blood count, blood electrolytes, blood coagulation tests, and identification of the virus or antibodies to the virus. If a person is infected, his or her blood cell counts will be low, electrolytes will be decreased, and blood coagulation rate will be decreased. Testing for the virus or its antibodies is performed using antigen-capture enzyme-linked immunosorbent assay or by polymerase chain reaction.

Treatment and Therapy

There is no cure for Ebola hemorrhagic fever. Existing antiviral medications do not seem to be effective against this virus. The treatment for Ebola hemorrhagic fever is intensive and supportive care. This care includes intravenous fluids and blood transfusions; replacing electrolytes and blood coagulation factors; oxygen; maintaining blood pressure with medications; and treating complications, such as infections.

The types of treatments used are based on the symptoms and blood tests of the infected person. The transfusion of blood from Ebola fever survivors to persons with Ebola has been tried. Because the survivor blood has antibodies to the virus, experts believe this blood could assist the infected person in fighting the disease. There is limited data, however, on the effectiveness of this treatment.

Prevention and Outcomes

The only way to prevent Ebola hemorrhagic fever is to avoid places where the
virus is known to occur. This includes Africa, the Philippines, and laboratories
that perform animal testing with viruses. Because the reservoir of the Ebola virus
is not known, there is no way to eliminate the virus. Caretakers of infected
persons and workers in viral-testing animal laboratories should always wear
personal protective clothing, such as a gown, gloves, goggles, and a facial
mask.

Testing is underway to develop a vaccine against the Ebola virus. Most of the testing of this vaccine, however, has been performed on animals.

Education of persons living in areas where the Ebola virus resides can limit the spread of the disease. This education consists of teaching villagers to avoid unprotected contact with persons who have or had the disease, whether living or dead. It also includes teaching villagers to avoid unprotected contact with dead animals in cases in which the cause of death is unknown.

Bibliography

Francesconi, Paolo, et al. “Ebola Hemorrhagic Fever Transmission.” Emerging Infectious Diseases 9.11 (2003). Print.

Hewlitt, Barry S., and Bonnie L. Hewitt. Ebola, Culture, and Politics: The Anthropology of an Emerging Disease. Belmont: Thomson, 2008. Print.

Knipe, David M., and Peter M. Howley, eds. Fields’ Virology. 7th ed. Philadelphia: Wolters, 2013. Print.

Palermo, Elizabeth. "Ebola vs. Hemorrhagic Fever: What's the Difference?" LiveScience. Purch, 9 Oct. 2014. Web. 31 Dec. 2015.

Peters, C. J., and J. W. LeDuc. “An Introduction to Ebola: The Virus and the Disease.” Journal of Infectious Diseases 179, supp. 1 (1999): ix-xvi. Print.

Singh, Sunit K., and Daniel Ruzek. Viral Hemorrhagic Fevers. Boca Raton: CRC, 2014. Print.

In "The Lady or the Tiger?" what are two examples of how the king is devious?

The king is devious because he likes trouble and because his system of justice is really just designed to entertain the people.

The king is described as “semi-barbaric.”  That is one indication of his deviousness.  Also, he is definitely devious in his relations with his people.  He enjoys having control over those around him.  You would not expect a king to want trouble, but this one seems to enjoy it when things are not going well.  It gives him an opportunity to get involved and manipulate people.

When every member of his domestic and political systems moved smoothly in its appointed course, his nature was bland and genial; but, whenever there was a little hitch, and some of his orbs got out of their orbits, he was blander and more genial still, for nothing pleased him so much as to make the crooked straight and crush down uneven places.

An example of this manipulation is the king’s unusual justice system.  Most of the time, justice is for punishing the guilty.  A system of justice is designed to determine who is guilty and who is innocent. The king is not really interested in this.  He is more interested in keeping his people in line by providing them with entertainment.

The arena of the king was built, not to give the people an opportunity of hearing the rhapsodies of dying gladiators, nor to enable them to view the inevitable conclusion of a conflict between religious opinions and hungry jaws, but for purposes far better adapted to widen and develop the mental energies of the people. 

The king supposedly believes that fate or luck will determine who is guilty and who is innocent, and that his system of doors is beneficial to the kingdom because a guilty person is immediately punished and an innocent one is rewarded.  That’s all bogus.  The king is just keeping his people busy.  They know that they can get entertainment either way. Keep the masses happy!

In Julius Caesar, what is Brutus's hamartia?

Brutus’s tragic flaw is his need to be noble. 

Hamartia is a tragic flaw.  It is the cause of a hero’s downfall.  Tragic flaws can come in many varieties, but Brutus’s tragic flaw is his need for nobility.  It makes him naïve and vulnerable. 

We first see Brutus demonstrating his tragic flaw in the speech he makes before the conspirators gather at his house.  It is an important meeting.  He will meet them all together for the first time, and there they will plot.  Before the meeting, he gives a soliloquy in which he explains that he has nothing personally against Caesar, but Caesar has to die.  For Brutus, everything has to be for the good of Rome.  He is concerned about appearances, and it is this desire to do good and the concern for what others think that will destroy those conspiring against Caesar. 

During the meeting, Brutus is adamant about not killing anyone other than Caesar.  He also speaks beautifully and philosophically about what they are about to do, as if they are not really just planning to kill a man.  Brutus gets so wrapped up in his own earnest visions of how people will perceive them and their motives that he loses track of the bigger picture.  Thus, he spews nonsense like this: 

Let us be sacrificers, but not butchers

… But, alas,

Caesar must bleed for it! And, gentle friends,
Let's kill him boldly, but not wrathfully;
Let's carve him as a dish fit for the gods

Not hew him as a carcass fit for hounds (Act II, Scene i) 

Brutus seems to think there is a noble way to kill Caesar.  He believes the ends justify the means, and that no matter what happens everything will be fine because he is the one in charge.  Brutus honestly thinks the people of Rome will welcome him with open arms as their liberator. 

Practicality has no place in Brutus’s world.  He is blocked by his tragic flaw.  When Cassius tries to talk him out of letting Mark Antony speak at Caesar’s funeral, he refuses, again for noble reasons.

You shall not in your funeral speech blame us,
But speak all good you can devise of Caesar,
And say you do't by our permission;
Else shall you not have any hand at all
About his funeral: and you shall speak
In the same pulpit whereto I am going,
After my speech is ended. (Act III, Scene i)

Of course Mark Antony would agree to that.  Why wouldn’t he?  There is no benefit to Brutus speaking first, and saying that he spoke with Brutus’s permission will just play into Antony’s hands.  He intends to portray Brutus and the others as murderers and oath-breakers.  In fact, he turns Brutus’s tragic flaw against him, referring to him and the others ironically or sarcastically throughout the speech as “honorable men.”

A character’s tragic flaw is usually what dooms him.  Brutus doomed himself and all of the conspirators.  He ended up committing suicide, because it was the only honorable way left to him after he botched everything so badly.  Brutus made every decision based on what he thought was honorable, but in the end his only choice was to die an honorable death by his own hand.

When the velocity of a Formula 1 car is doubled with no change in mass, by what factor is its kinetic energy changed? Explain.

The kinetic energy of an object is a function of its mass and velocity. If the mass of an object is m and its velocity is v, its kinetic energy can be determined by using the following equation:

Kinetic energy or KE = 1/2 mv^2

Since the SI units of mass and velocity are kg and m/s, the units of kinetic energy are kg m^2/s^2. A more commonly used unit of kinetic energy is Joule or J.

If the mass of a formula 1 car is kept constant, while its velocity is doubled (say, it becomes 2v instead of v), the new kinetic energy (KE') would be:

KE' = 1/2 mv'^2 = 1/2 m (2v)^2 = 4 [1/2 mv^2) = 4 KE

Thus, the new kinetic energy is 4 times the original kinetic energy. Similarly, if the velocity becomes 3 times, the kinetic energy would increase to 9 times the original value.

Hope this helps.

Why did Helen Stoner visit Holmes?

Helen Stoner comes to Holmes at Baker Street “in a pitiable state of agitation…with restless, frightened eyes, like those of some hunted animal.” She, like most of Mr. Holmes’s visitors, has a mystery to be solved—one that threatens her life.

Her stepfather, Dr. Roylott, was the last heir of a once great and wealthy family, though the ancestral fortune had fallen away over the years, leaving nothing but a grand manor on a small plot of land. Ms. Stoner’s mother contributed a considerable sum of money each month to the family fortune, with the agreement that both Helen and her twin sister Julia would come into a portion of these savings upon their marriage. Two years before Helen comes to see Mr. Holmes, Julia became engaged to be married, and yet, not two weeks after she informed her stepfather, she was killed.

Helen was awoken one night by her sister’s screams, and running to Julia’s bedroom she found her sister in a terrible state; her sister’s last words were, in shock, “’It was the band! The speckled band!’” Helen believes her sister to have died of fright, but of what frightened her she hasn’t the faintest clue. She does, however, believe that her stepfather had something to do with it—that he had her twin killed rather than give her her due money upon her marriage. Dr. Roylott has an intense reputation for violence in the community, and Helen speaks at length of this in her explanation to Holmes and Watson. He had beaten his butler to death in Calcutta, narrowly avoiding a murder charge but serving time for the crime; in England, she asserts that he lashed out regularly, “’until at last he became the terror of the village…for he is…absolutely uncontrollable in his anger.’”

Now Helen herself is engaged to be married, and due to a renovation of the manor has had to move into her sister’s old bedroom. In addition, she has begun hearing a low whistle in the night, a noise that her sister had heard for several nights before her death. So Helen has come with this set of clues to Baker Street, in hopes that Holmes can solve the mystery of Julia’s death, and protect herself from falling victim to the same fate.

How can I write an essay exploring the ministry of Christ in my life today?

This question basically calls for you to write a personal essay discussing your religious faith and its role in your life. Here are some ideas to consider and questions to help you get started. When did you first begin to practice your faith? Were you a child, a young person, or an adult? Did you grow up with this faith, or convert later in life? Were your family a big part of your faith, or was your faith experience more individualistic? 

What drew you to your faith tradition, and what keeps you rooted in it? You can talk about conversations or relationships you may have had with people of faith, including ministers or those involved in outreach. 

How has your faith influenced daily life? Do you engage in daily practices such a prayer or study? Do these practices influence your behavior and character? What Christian values have been important to you: kindness, generosity, piety, charity? You might discuss specific challenges you've encountered and how these values have helped you in making decisions or in persevering through difficult times. Just take an honest look at your life experience and I'm sure you will be able to write a wonderful essay. Good luck!

What is metabolic syndrome?

Causes and Symptoms

Metabolic syndrome is a complex medical disorder. According to guidelines issued by the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III), diagnosis of metabolic syndrome is made when an individual displays at least three of the following risk factors: abdominal obesity, elevated triglycerides, low levels of the high-density lipoprotein (HDL) type of cholesterol, high blood pressure, and the presence of more than 100 milligrams per deciliter (mg/dL) of glucose in the blood after fasting.

The National Heart, Lung, and Blood Institute (NHLBI) estimates that as many as forty-seven million adults in the United States suffer from metabolic syndrome, which is around 25 percent of the total adult population. A study published in National Health Statistics Reports in May 2009 reported that 34 percent of the study's 3,423 adults aged twenty and older met the criteria for metabolic syndrome. Age plays a large role in metabolic syndrome, with the likelihood of being diagnosed increasing as an individual gets older. Total body weight is also an indicator of the likelihood of the metabolic syndrome criteria being met. Males who are overweight are six times as likely as normal-weight males to be diagnosed with metabolic syndrome, and those who are obese are thirty-two times as likely.

In females, being overweight leads to a fivefold increase in the chances of being diagnosed with metabolic syndrome and obesity a seventeen-fold increase, compared to women of normal weight. Disturbingly, metabolic syndrome is now being recognized in children and adolescents; this is probably related to the increase in obesity and type 2 diabetes mellitus
seen in this age group over recent years. There is also evidence to demonstrate a genetic component to metabolic syndrome; further research will clarify this.

Key aspects of the metabolic syndrome are an energy imbalance and resultant altered metabolic pathways. The abnormal metabolic reactions seen in metabolic syndrome confer an increased risk for type 2 diabetes mellitus and cardiovascular
disease (CVD). Several other diseases—colon
cancer, Nonalcoholic steatohepatitis (NASH), polycystic ovary disease, and chronic renal failure—can also be a consequence of this syndrome.

The National Health and Nutrition Examination Survey determined that the most prevalent risk factor displayed by individuals with metabolic syndrome is abdominal obesity.
This is when fat is stored in the abdominal region of the body as opposed to in the buttocks and thighs. People with abdominally stored fat are often said to have “apple” type bodies; those with fat stored lower, in the buttocks and thighs, are said to be “pear” shaped. Men are typically apples and women are pears. Cortisol is a stress response hormone that promotes fat deposition in the abdominal area in individuals with chronic stress. Nearly all cases of overweight and obesity, including abdominal obesity, are due to excess calorific intake (overeating) combined with a sedentary lifestyle. In the United States, around one-third of the adult population is obese. Obesity greatly increases the risk for type 2 diabetes and cardiovascular disease.

Abnormal levels of fats in the blood is called dyslipidemia. In people who are overweight or obese, the levels of lipids in the body are so high that the pathways involved in fat synthesis and breakdown cannot keep up, and chronically high blood lipids are seen.

In addition, due to impaired insulin action and incorrect handling of glucose by their cells, individuals with type 2 diabetes tend to have high levels of blood triglyceride and low HDL cholesterol levels. This puts type 2 diabetics and obese individuals at high risk for CVD.

The second most prevalent factor seen in patients diagnosed with metabolic syndrome is hypertension, or high blood pressure. One in four Americans suffers from hypertension. If untreated, it can lead to CVD and kidney failure. The atherosclerotic process is accelerated in the metabolic syndrome and in type 2 diabetes because of the presence of multiple metabolic abnormalities. In insulin resistance, plaque formation may be enhanced because of the increased expression of adhesion molecules on endothelial cells and an increased rate of monocyte adhesion to endothelial cells. Circulating plasminogen is also more likely activated, which typically leads to increased clotting. In addition, hypertension may contribute to an increased risk of stroke in those with the metabolic syndrome.

The third most prevalent factor is hyperglycemia, or impaired fasting glucose. To satisfy the criterion for metabolic syndrome the glucose level in the blood after fasting must be over 100 mg/dl. A person with 100 to 125 mg/dl would be considered prediabetic, and diabetes is diagnosed when the fasting level of glucose is 126 mg/dl or above. Increases in blood glucose are indicative of a phenomenon called insulin resistance. Here, the cells of the body do not respond properly to insulin, and as a result glucose cannot enter the cells for use or storage so it remains in the circulating blood. Chronically elevated blood glucose concentration permits glucose molecules to combine with diverse proteins in the body, including hemoglobin within red blood cells, by a process known as glycation or glycosylation. Glycation also leads to blood vessels becoming rigid, a factor that contributes to CVD.

Any one of the risk factors listed on the NCEP/ATP III guidelines can cause chronic health problems, specifically type 2 diabetes mellitus and CVD. Diagnosis of metabolic syndrome requires that at least three out of the five criteria are met. This translates into a vastly increased risk for these chronic health problems; the reason why the life span of individuals diagnosed with metabolic syndrome is an average of fourteen years shorter than those without the disease.

Treatment and Therapy

Treatment strategies for the metabolic syndrome focus on weight loss through a comprehensive program utilizing behavioral changes, including improved nutrition and an increase in physical activities. The long-term goal of therapy is a better balance between the intake of food energy sources and energy expenditure, so that a healthier body weight can be achieved. Dietary treatment typically requires the involvement of nutritionists and registered dieticians to provide educational information and institute changes in food selection.

Physicians provide overall care, and concomitant with lifestyle changes use the prescription of medications for one or more of the components of metabolic syndrome. Metformin is a drug used to treat type 2 diabetes mellitus; it works by improving insulin action, and has also been shown to stop the development of impaired fasting glucose to type 2 diabetes in patients with metabolic syndrome. Angiotensin-converting enzyme (ACE) inhibitors are used in the treatment of hypertension. They are successful in treating hypertension and, in addition, have a beneficial effect on insulin resistance in metabolic syndrome. Another class of drugs is the statins, which are used to improve cholesterol levels in people with metabolic syndrome. Statins also appear to cause a reduction in inflammation seen in metabolic syndrome, leading to a reduction in CVD.

Since the emerging epidemic of the metabolic syndrome is expected to continue, both preventive and treatment strategies are needed. Prevention aimed toward reducing the development of this syndrome in children and adolescents should involve schools and community agencies.

Perspective and Prospects

Recognition of the metabolic syndrome essentially paralleled the increases in overweight and obesity in the United States in the early 1990’s. Physicians were diagnosing many overweight and obese patients with the major components of the metabolic syndrome without linking them to a major health trend. Other countries of affluence were also reporting cases.

The metabolic syndrome was first defined in 1998 by the World Health Organization (WHO). The WHO criteria included a BMI of more than thirty; a blood triglyceride level greater than or equal to 150 mg/dl; HDL cholesterol level under 35 mg/dl in men and 39 mg/dl in women; blood pressure over 140/90 mm Hg; impaired glucose tolerance, insulin tolerance or type 2 diabetes; insulin resistance; and microalbuminuria (protein in the urine). In 2001 the NCEP/ATP III released their guidelines for the diagnosis of metabolic syndrome, which quickly became the most widely accepted. These differed from the WHO guidelines in several ways. Firstly, BMI measurement was replaced with waist circumference measurement when it became clear that it was not necessarily the total body fat content, but the way in which it is deposited in the body that is important to pathogenesis. A waist circumference of over forty inches for men and over thirty-five inches for women is considered a risk factor for metabolic syndrome. Secondly, the HDL values were changed to less than 40 mg/dl for men and 50 mg/dl for women, and blood pressure limit was lowered to 130/85 mm Hg. A fasting glucose level of
over 110 mg/dl was defined as a risk for metabolic syndrome. Finally, insulin resistance and microalbumiuria were removed from the criteria. In 2005 the guidelines were updated by American Heart Association (AHA) and NHLBI; the fasting blood glucose level was lowered to 100 mg/dl. These are the currently used criteria for the diagnosis of metabolic syndrome.

The metabolic syndrome has deadly consequences because of the nature of the chronic diseases that it spawns. This problem will worsen in the future in the United States because excessive calorific intake, eating the wrong kinds of food (for example highly processed food containing high fructose corn syrup, trans fats, or too much salt), and too little physical activity continue to dominate society. The epidemic nature of this syndrome requires that new public health measures be initiated and implemented as soon as possible. Preventive strategies need to be instituted to reduce the enormous impact of this syndrome anticipated in the United States in the coming decades. The overall cost of treatment will be enormous.

Bibliography:

Byrne, Christopher D., and Sarah H. Wild, eds. The Metabolic Syndrome. 2d ed. Hoboken, N.J.: John Wiley & Sons, 2011.

Chrousos, George P., and Constantine Tsigos, eds. Stress, Obesity, and Metabolic Syndrome. Boston: Blackwell/New York Academy of Sciences, 2006.

Codario, Ronald A. Type 2 Diabetes, Pre-diabetes, and the Metabolic Syndrome. 2d ed. Totowa, N.J.: Humana Press, 2011.

Ervin, R. Bethene. "Prevalence of Metabolic Syndrome Among Adults 20 Years of Age and Over, by Sex, Age, Race and Ethnicity, and Body Mass Index: United States, 2003–2006." National Health Statistics Reports no. 13 (May 5, 2009): 1–7.

Hansen, Barbara C., and George A. Bray, eds. The Metabolic Syndrome: Epidemiology, Clinical Treatment, and Underlying Mechanisms. Totowa, N.J.: Humana Press, 2008.

Houston, Mark C. The Handbook of Hypertension. Hoboken, N.J.: Wiley-Blackwell, 2009.

Levine, T. Barry, and Arlene Bradley Levine. Metabolic Syndrome and Cardiovascular Disease. 2d ed. Hoboken, N.J.: Wiley-Blackwell, 2013.

MedlinePlus. "Metabolic Syndrome." MedlinePlus, May 20, 2013.

Scholten, Amy. "Metabolic Syndrome." Health Library, May 14, 2013.

How is Lyddie independent throughout her life? What are the events that show she is independent?

Lyddie is independent because she takes charge and doesn’t let others tell her what to do.

Lyddie shows independence when she saves her family from the bear, when she gets her own job after being fired from the pub, and when she protects Brigid from Mr. Marsden.

Lyddie’s independence showed through in every challenge she faced.  The first time we see Lyddie challenged is when the bear attacks.  Lyddie and her family are in their house when the bear comes in.  Lyddie takes charge immediately and orders everyone into the loft.

They obeyed her, even Mama, though Lyddie could hear her sucking in her breath. Behind Lyddie's back, the ladder creaked, as two by two, first Charles and Agnes, then Mama and Rachel, climbed up into the loft. Lyddie glared straight into the bear's eyes, daring him to step forward into the cabin. (Ch. 1)

This incident demonstrates how Lyddie is able to think quickly and react even when no one else can.  Her mother should have been the one to protect the family, but she was incapable of doing so and Lyddie stepped up.  Not only was no one harmed, but the bear left because Lyddie did not back down.

When Lyddie is hired out to the tavern owner Mrs. Cutler, she is horrified.  She doesn't want to be anyone's slave.  When Lyddie is fired from this same job, she does not give up.  She takes control of her own life and goes to get a job in a factory.

"I'm going to be a factory girl, Triphena."
"You what?"
"I'm free. She's set me free. I can do anything I want. I can go to Lowell and make real money to pay off the debt so I can go home." (Ch. 6)

Lyddie still wants to work to pay off the family debts and hopefully get the family back together again someday, so she takes the factory job.  Since it was her own choice, she feels more independent.  She is a hard worker and demonstrates her worth to the factory, which gives her more and more work.

Part of Lyddie's job is to train Brigid, an Irish girl who comes to the factory knowing nothing. Lyddie is annoyed at first to have a trainee slowing her down, but she comes to be very protective of Brigid, teaching her to read and looking out for her.  When Brigid is attacked by Mr. Marsden, Lyddie intervenes.  She is fired for doing so.

Even though Lyddie has lost her job, she makes sure to continue protecting Brigid.  She writes a letter to Mr. Marsden's wife which she tells Brigid to mail if anything happens.

"It can't be helped. It's done. But they must not dismiss you. I've already written a letter to Mr. Marsden. I told him if he dismissed you or bothered you in any way I would tell his wife exactly what happened in the weaving room. Now here is the letter addressed to her. If there is any problem you must mail it at once." (Ch. 22)

Lyddie's reaction to being fired, again, demonstrates her independence and reliance.  Lyddie insists on helping Brigid and making sure that Brigid is okay.  Lyddie knows that she will be all right herself because she never lets anyone get her down.

What five complexities are displayed in Reverend Hale's character in The Crucible?

Reverend John Hale is one of the most complex characters in the play and goes through a drastic change during the events depicted. 

In Act One, Hale enters the action as a fully trained and dedicated witch-hunter. Hale's intentions here are good, but his dedication to ridding the world of witchcraft and his overconfidence sets him up to be taken in by the girls' hysterics.

In Act Two, Hale shows himself to be not as easily bought in as he initially appeared. When he chooses to visit the Proctors to determine their characters without the court's knowledge, he shows that he can think critically and independently of his court and authority. He shows that he is dedicated to the truth of the matter, not just hunting witches.

This eventually leads him to denounce the court completely in Act Three, once it has become clear that the accusations of witchcraft are being used to manipulate and control the town. Again, this action shows Hale's ability to think and morally judge for himself. It also shows that he is not afraid to change his mind when he realizes he was wrong. 

In Act Four, Hale seems to experience a crisis of faith. When he suggests that Proctor and Rebecca Nurse falsely confess to witchcraft to save their lives, it becomes clear that this man of God and Law is beginning to doubt that either will save innocent lives and they will need to take matters into their own hands.

By the end of the play, Hale is devastated and tormented by the proceedings and his place in them. As he watches Proctor approach the gallows, he cries:

"What profit him to bleed? Shall the dust praise him? Shall the worms declare his truth?"

This Hale, doubting and despairing, struggling to see the point in anything is a far different man than the confident witch-hunter who came to Salem in Act One. 

What is the root of evil in "The Rocking-Horse Winner"?

The root of evil in "The Rocking-Horse Winner" is the mother's desire for more and more money. Although the family lives comfortably in a large house with servants, the mother expected more from life and feels disappointed. The family lives beyond its means and the need for "more" permeates the entire atmosphere of the home, until the walls themselves seem to be calling for more money. The sensitive young son, Paul, feels his mother's yearning, anxious desire for more and more money. Being young, he doesn't realize that probably no amount of money will ever be "enough" to satisfy his mother. Instead, wanting to earn her love and to please her, he rides his rocking-horse, because he knows if he rides it hard enough, he will be able to predict the winner of upcoming horse races. He wins 5,000 pounds for his mother in a race, but it's not enough for her. Finally, he kills himself to win her a substantial amount of money in the Derby. The moral of the story might be summed up as "the love of money is the root of all evil." The root problem in the family is not an absolute need for money: they are fine financially by any objective standard, but the problem is yearning for more style and status, putting being at a certain place on the class ladder above human needs for love and affection.

What is malaria?

Causes and Symptoms

Malaria



in humans is caused by transfer into the bloodstream, through the saliva of the Anopheles mosquito, of the protozoan (single-cell) Plasmodium parasite. There are several different strains of the malaria parasite, all belonging to the phylum Sporozoa, a classification connected with the importance of spores in the organism’s reproductive cycle. Serious and potentially lethal malarial infections in humans are primarily associated with P. falciparum. Other Plasmodium parasites that can produce infection are P. vivax (formerly present in temperate climate zones but now found only in the subtropics), P. malariae (also only subtropical), and P. ovale (quite rare, and mainly limited to West Africa). Other Plasmodium parasites infect only nonhuman primates (P. knowlesi and P. cynomolgi, for example),
only rodents (four different species), or only birds (P. cathemerium and P. gallinaceum). The latter two species have been used widely in experimental testing of antimalarial vaccines.

It is important to note that only one mosquito genus, Anopheles, and only the female Anopheles mosquito, serves the vector function in transmitting malaria. The explanation of the female’s role is surprisingly simple: Only the female Anopheles nourishes itself (usually in the night hours) by piercing the skin of its victim and sucking small quantities of blood. The male of the species feeds mainly on fruit juices.

In the most common scenario, the mosquito ingests the Plasmodium parasite when it sucks the blood of an already infected human. This phase is followed by several others—all connected with the reproductive processes of the same organism (both sexual and asexual)—until subsequent generations of the parasite are passed on by the mosquito to another human host, who then becomes infected. The protozoan’s first, sexual stage of reproduction occurs when male gametes emit flagella that seek out and join their female counterpart, producing a fertilized zygote. Once lodged in the gut tissue of the mosquito in the form of an oocyst, a further, asexual stage of reproduction occurs through what is called sporogony: the release from the oocyst of myriad spores. They spread rapidly throughout the body of the mosquito. Many enter the insect host’s salivary glands, from which they are transferred into the blood of the next human bitten by the mosquito. It is the further development of the spores in the human organism that produces the disease symptoms associated with malaria.

Once transmitted into the human host through the mosquito saliva, the parasite spores flow quickly through the blood, entering the liver. Their next transformation occurs once they lodge themselves in the cells of the liver, becoming what are called hepatic trophozoites. As they feed off of the liver cells, the trophozoites grow and burst open. This process of asexual multiplication in the liver is referred to as hepatic schozogony. At that stage, the parasite has multiplied many hundreds of times, producing the actual agent of malarial disease, merozoites. If the parasite is P. vivax, then this phase may not occur immediately, as a result of a state of dormancy in the parasitic trophozoites. In this case, months or even years can pass before the merozoites are released. Even then, the delayed release is still not final. This explains why some malaria-infected individuals experience a cyclical disappearance of symptoms, followed some time later by a resurgence of the latent disease.

When released from the trophozoites, the merozoites quickly invade the red blood cells of the host. The damage that they inflict leads to anemic reactions as the number of healthy blood cells in the organism decreases. It is not only the liver that is affected; the disease can also spread to the spleen.

Once the effects of malaria begin to take hold in the blood and various organs of the body, certain symptoms will appear. There is an onset of fever, probably caused by the release of a pyrogen (a fever-inducing agent) by the white blood cells reacting to the diseased situation of red blood cells that have been attacked by the malaria parasite. Since this release of pyrogens may follow an irregular pattern, fever can come and go, seemingly sporadically. Meanwhile, as the number of parasitized red blood cells increases, infected red blood cells begin to attach themselves to the inside tissue of capillaries of the internal organs. The effect is blockage of the necessary free flow of blood. If pressure builds because of this blockage, then blood vessels themselves may burst. Such internal hemorrhages allow the directionless dispersion of infected blood within the body, increasing the anemic symptoms that are characteristic of malaria. Perhaps the most dramatic sign of blocked blood vessels occurs if and when the parasitized
cells affect the blood flow to the brain. In such cases, convulsions occur, eventually leading to coma.

Treatment and Therapy

Long before researchers were able to explain the causes of malaria, treatment of its symptoms, primarily manifested in spells of fever, involved giving the patient doses of quinine. As knowledge of the disease increased, different forms of treatment evolved. Such developments occurred not only as new discoveries emerged; they also became necessary as the malaria parasite itself evolved genetically, in effect developing its own immunity to quinine-based treatment.

Several compounds were developed in the later decades of the twentieth century to complement or, more recently, to replace complete dependence on quinine.

Depending on the Plasmodium species coming into contact with it, the alkaloid quinine could kill the parasitical organism at key stages in its reproductive activity. Sometimes, however, toxic side effects accompanied the use of quinine in malaria cases. These negative effects eventually sparked research aimed at producing synthetic drugs that could be as effective as quinine in preventing malaria, even though they might not be as effective in treating the disease once contracted. The earliest synthetic antimalarials, introduced between 1926 and the early 1950s, included pamaquine, the first synthetic; mepacrine; and chloroquine and primaquine, two well-known drugs from the mid-1940s through the 1950s. These synthetic agents intervened to stop reproduction of the malaria parasite at different points in its life span. Depending on which preventive drug was taken, treatment might have to begin well before expected exposure, during the period of exposure, or for a certain period after being present in a malaria-infected area. Several generations of antimalarial drugs are on the market, but such progress in pharmaceutical options has not effectively resolved the problem of endemic malaria in regions of the world where those most in need lack either public health information programs or the financial means to obtain necessary drugs.

Research involving vaccination to protect against malarial infection has tended to follow one of two main approaches: vaccines to combat the diffusion of spores directly, and vaccines to block one or several stages of the parasite’s life cycle. Some vaccines have been developed by extracting spores from the blood of infected patients and using methods such as radiation to reduce their potency. Injection of these weakened agents into the blood can induce formation of antibodies that are able to fight invasive spores coming from an outside source (mosquito saliva) into a potential host organism. Commercial production of such vaccines, however, would require finding an economically viable way of obtaining and treating large quantities of Plasmodium spores, not only from P. falciparum but also from other malaria parasites that are less deadly but an important threat to large numbers of people around the world. For this reason, researchers have tended to concentrate more on isolating antigens that the body produces naturally to fight invasive spores and merozoites, analyzing them, and attempting to use biotechnology to produce effective synthetic antigens.

Observation over a long period of time has provided statistical evidence that, in a number of subtropical areas where malaria is endemic, fatalities from the disease are more frequent among children than among adults. The reason for this is linked to the adult population’s prior exposure to one or more nonlethal malarial infections. In essence, the adult body’s production of natural antigens seems to neutralize the effects of blood cells that have become carriers. If they remain in the bloodstream, these antigens reduce the susceptibility to what, in children, takes the form of a sudden invasion of infected and (for the body’s immune system) unrecognizable blood cells transmitted through Anopheles mosquito bites.

There is, therefore, an entire field of malaria research dealing with the body’s own immune responses. Where malaria is concerned, researchers pay particular attention not only to the challenge of understanding how immunity can build in populations living in endemic zones but also to the possibility of increasing the efficiency of certain body organs that naturally affect the bloodstream in ways that can impede the spread of the parasite’s damage. Attention has focused, for example, on the internal functions of the spleen. The spleen can prevent the progress of intravascular pathogens in general by reducing the flow of infected red blood cells to other organs and isolating them in a chemical state that renders them less directly dangerous to the body. This capacity is called splenic filtration. Although research has not yet identified an effective way to use externally applied medications to enhance this facet of the spleen’s natural defense system, it is agreed that here there is a serious prospect for another area of treatment to complement, if not replace, preventive drugs and synthetic antigens.

Once it was clear that malaria was transmitted by mosquitoes, the most logical tactic to prevent spread of the disease involved campaigns to eradicate, or at least diminish the life chances of, Anopheles. Thus, drainage of swamp areas (a costly but effective measure where possible), public health measures to guard against insalubrious concentrations of stagnant water, and insecticide spraying have been practiced throughout the world to combat Anopheles. During World War II and until the late 1950s, DDT was the insecticide of choice. When the harmful side effects of DDT for humans and the environment became apparent, legislation in most but not all countries banned the chemical. Research has since aimed at, but not fully succeeded in, developing safer insecticides that can approach DDT’s levels of efficiency.

Perspective and Prospects

Research in the field of malarial disease and its biological origins advanced rather slowly, with most major advances occurring fairly late in the nineteenth century. It was in 1897 that a surgeon in the British Indian army, Sir Ronald Ross, following British tropical disease expert Sir Patrick Manson’s suggestions, announced his discovery that malaria was transmitted to humans by mosquitoes. There had been earlier theories concerning the role of mosquitoes, some going back as far as the early eighteenth century in Italy (where the term “malaria,” meaning “bad air,” had originated). It took the work of a French military doctor in Algeria, Alphonse Laveran, to show, under a microscope, the ongoing activity of parasites in the blood of malaria patients. Laveran also did postmortem studies of malaria victims’ blood and organs and found a dark pigment composed mainly of iron which came from the parasites’ apparent digestion and waste disposal of vital hemoglobin in the red blood cells. He became the first to posit that malaria was a disease of red blood cells and that it was caused by an invasion of parasites.

From there, it was a question of finding how the parasites entered the human bloodstream. This was the result of Ross’s observation in India of a particular variety of mosquito larvae (later identified as the small brown Anopheles, distinct from Culex varieties commonly observed in the daytime) collected from stagnant waters in the region. When Ross followed Manson’s suggestion that mosquitoes hatched from these larvae should be induced to feed from a known malaria patient, he found that only a few insects survived the next few days. When these were dissected, he found oocysts embedded on the wall of the mosquitoes’ gut. Microscopic analysis showed that they contained the same dark pigment that Laveran had found in the blood of malaria victims in Algeria.

Both Ross (in 1902) and Laveran (in 1907) received Nobel Prizes in recognition of their work, Ross in medicine and Laveran in physiology or medicine. Other contributors, notably the Italian Giovanni Batista Grassi, carried on significant work in the same first decade of the twentieth century that paralleled (or, according to Grassi, may have been accomplished before) Ross’s studies. The most important suggestion by Grassi—which was correct but which took much more work to prove in the laboratory—was that there must be significant transformations, in fact multiple stages of reproduction, between the sporozoite phase of dissemination of the parasite via mosquito saliva and the merozoite phase, when the actual attacking parasite can destroy red blood cells in the human host. Later researchers finally provided, in 1934, convincing evidence that there was a sequence of sexual and asexual phases of reproduction (the later labeled “schizogony”) in the life cycle of the Plasmodium parasite.

Over the years, other researchers helped broaden the understanding of malaria, its causes, and treatment. Despite the obvious costs paid during the first half of the twentieth century involving debilitation and loss of human lives in areas where malaria was endemic, truly major breakthroughs occurred only during the extraordinary conditions created by World War II. The fact that large numbers of troops were sent to areas in East, South, and Southeast Asia as well as Africa meant that the danger of widespread malarial infection could hamper strategic operations. Distribution of all forms of preventive equipment, including both mosquito nets and insect repellents, was destined to become standard procedure in tropical zones. Doses of quinine were also part of each soldier’s medical supply packet.

Bibliography

Carlton, Jane M., Susan L. Perkins, and Kirk W. Deitsch. Malaria Parasites: Comparative Genomics, Evolution, and Molecular Biology. Norfolk, England: Caister Academic Press, 2013.

Farmer, Paul. Infections and Inequalities: The Modern Plagues. Berkeley: University of California Press, 2001.

Honigsbaum, Mark. The Fever Trail: In Search of the Cure for Malaria. New York: Farrar, Straus and Giroux, 2002.

Malaria Foundation International. http://www.malaria .org.

Rocco, Fiammetta. “Corrections and Clarification: The Global Spread of Malaria in a Future, Warmer World.” Science 289 (September, 2000): 2283–284.

Rocco, Fiammetta. The Miraculous Fever-Tree: Malaria and the Quest for a Cure That Changed the World. New York: HarperCollins, 2003.

World Health Organization. Defeating Malaria in Asia, the Pacific, Americas, Middle East, and Europe. New York: Author, 2013.

What is naturopathy?

Overview

Naturopathy, or “natural medicine,” is one of the most important branches of
alternative medicine, exerting an influence far beyond the actual numbers of its
formal practitioners. Popularized by medical practitioner Benedict Lust
at the beginning of the twentieth century, naturopathy’s immediate roots go back
to the spa treatments of nineteenth-century Germany, but its founding principles
are in the writings of Hippocrates and other healers of the
ancient world.

The defining principle of naturopathy is vis medicatrix naturae,
or “nature’s healing power.” From this perspective, disease is caused by departing
from the natural way of living, and health is established by returning to it.

Much of conventional medicine’s current interest in diet and lifestyle came into
being through the influence of naturopathic practitioners. There is little doubt
that their general recommendations are health-promoting: Eat a well-balanced diet
rich in fruits and vegetables, exercise regularly, maintain a healthful weight,
and avoid toxic habits, such as smoking. It is less clear, however, whether the
more specific dietary suggestions sometimes made by naturopathic practitioners
will actually enhance health. Some of these suggestions include drinking
sixty-four ounces of water daily, eating organic fruits and vegetables, and
avoiding certain food combinations (such as starches and protein).

Herbal medicine. Naturopathic medicine is also largely
responsible for the resurgence in interest in herbal
medicine. Growing scientific evidence suggests that some
herbs have real healing properties.

Vitamins, minerals, and supplements. Naturopathic practitioners
are also known for emphasizing the use of vitamins and supplements. Ironically,
early practitioners of naturopathy were quite opposed to the use of vitamins and
supplements, considering them refined, processed foods (which they are). Matters
changed in the 1960s when Linus Pauling promoted vitamin C as a
cure for many illnesses, leading to the development of orthomolecular
medicine. This approach, now incorporated into naturopathy,
believes that the roots of many diseases may be found in a subtle form of
malnutrition caused by a combination of the following factors: poor diet,
inability to absorb nutrients, increased need for nutrients, and difficulties
metabolizing or using nutrients. When nutrient levels in the body are increased,
the theory goes, the body will have the means to heal itself.

On this principle, naturopathic practitioners often recommend that people take
relatively high doses of certain nutrients in the form of supplements. In
addition, they believe that many non-nutrient substances found in plants can
contribute to health.

Detoxification. Another traditional naturopathic principle is the
concept of detoxification. This term refers to the belief that modern
life, with its chemical pollutants, poor lifestyle habits, and psychological
stresses, causes toxins to accumulate in the body. These toxins are said to be a
major cause of disease, and removing them from the body is believed to promote
health. Detoxification methods include adopting a healthful diet, drinking large
quantities of water, using cleansing herbs and supplements, and undergoing special
processes such as colon-cleansing, liver-flushing, and removal of mercury
fillings. There is little scientific evidence that any of these methods enhance
general health.

Immune support. Immune support is another characteristic
naturopathic interest. Based on the indisputable fact that the body’s
susceptibility to illness is at least as important a factor as its accidental
exposure to microorganisms, naturopathic practitioners utilize a number of
treatments that they believe will enhance immunity. These treatments include a
variety of herbs and supplements and the elimination of certain foods from the
diet, such as white sugar. However, it has proved difficult to establish
scientifically that any treatment does indeed boost immunity.

Adrenal support. Adrenal support is also commonly recommended by
naturopathic practitioners. This method is based on classic studies performed in
the early to mid-twentieth century that found a relationship among stress,
illness, and adrenal function. Naturopathic practitioners frequently recommend
treatments they believe will help the adrenals, including removing sugar and
stimulants from the diet while adding adrenal supplements and other herbs and
supplements said to strengthen adrenal function.

Adrenal support is said to be helpful for a variety of conditions, including
allergies, anxiety, fatigue, and stress. However, the theory of adrenal support
has a limited scientific foundation, and it does not by itself justify the common
therapies used with the diagnosis. Furthermore, there is little specific
scientific evidence to indicate that methods used to support the adrenals are
beneficial for any disease.

Other treatments related to naturopathic medicine. Various other
treatments have gathered under the umbrella of naturopathic medicine more for
historical reasons than for a close connection to vis medicatrix
naturae. These treatments include emphases on the following: food
allergies; the belief that low (rather than high) stomach acid is a cause of many
illnesses; an interest in the yeast Candida and other intestinal
parasites; an interest in certain animal-based hormones, such as thyroid
supplements; and an attitude of caution toward many interventions recommended by
conventional medicine (such as vaccinations).

Diagnostic techniques. Besides its unique treatment approaches,
naturopathic medicine also makes use of a number of characteristic diagnostic
techniques, such as hair and saliva analysis, and a more fine-grained analysis of
standard blood tests than conventional medicine believes to be warranted.

Choosing a Practitioner

Principles of naturopathic medicine are applied by holistic medical doctors
(M.D.’s) and doctors of osteopathy (D.O.’s), chiropractors, massage therapists,
herbalists, and nutritionists. However, the premier practitioners of this form of
medicine are naturopathic physicians (N.D.’s). Several states offer the N.D.
licensure, and most major Canadian provinces also license
N.D.’s. In states where the N.D. license is not granted, N.D.’s may still
practice, although in something of a legal gray zone.

Also, some accredited colleges in North America grant the N.D. degree. These include Bastyr University (Kenmore, Washington), Boucher Institute of Naturopathic Medicine (New Westminister, British Columbia), Canadian College of Naturopathic Medicine (Toronto, Ontario), National College of Natural Medicine (Portland, Oregon), Southwest College of Naturopathic Medicine (Tempe, Arizona), and the University of Bridgeport, College of Naturopathic Medicine (Bridgeport, Connecticut).

Busse, J. W., K. Wilson, and J. B. Campbell. “Attitudes Towards Vaccination Among Chiropractic and Naturopathic Students.” Vaccine 26 (2008): 6237-6243.

Fleming, S. A., and N. C. Gutknecht. “Naturopathy and the Primary Care Practice.” Primary Care 37 (2010): 119-136.

Herman, P. M., et al. “A Method for Describing and Evaluating Naturopathic Whole Practice.” Alternative Therapies in Health and Medicine 12 (2006): 20-28.

Leung, B., and M. Verhoef. “Survey of Parents on the Use of Naturopathic Medicine in Children: Characteristics and Reasons.” Complementary Therapies in Clinical Practice 14 (2008): 98-104.