Monday, November 30, 2009

What does John Donne mean with regard to the first sentence in "Meditation 17”?

With regard to the first sentence in "Meditation 17”, John Donne means that someone may have death at their door and not even really know it. The first line of Meditation 17 reads:


“Perchance he for whom this bell tolls may be so ill as that he knows not it tolls for him.”


Donne is saying that someone may be very ill - this could be physically and/or mentally, as Donne does not specify here. He leaves it up to the reader to decide in this very first line, although the typical reasoning here would probably be thinking of someone who has an injury or disease or serious sickness. Nonetheless, mental illness can lead to a person’s death as well.


Regardless, Donne is saying that often we think that serious sicknesses, diseases, and death are something that happens to others. Sometimes we think we are invincible and that death is far away from us. We carry on with our lives as if every day will be the same, whereby we will (without hindrances) pursue our dreams and passions, without anything stopping us or slowing down our plans.


The introduction to Donne’s Meditation 17 states:


“Now this bell tolling softly for another,


says to me, Thou must die.”


Here, it is saying that as death quietly comes to another person’s door, it is also on its way to someone else’s. We can be caught up in our lives and not know that we are courting death by what we are doing. Conversely, we may have a sickness, injury, or disease, and be using all our might to fight it (which is a good thing) but may not realize that even in our fight, death may still be near and be the victor in this struggle.


It doesn’t mean that a person should not do all he or she can to improve their health situation. It’s just that Donne is saying that despite human efforts we may not know that the bells tolling are for us and that we may be closer to death than we think. The opening line of Mediation 17, then, is a prod to human beings to live life to the fullest – one day at a time -  and to make the most of the time we’ve been given as our days are indeed numbered.

Sunday, November 29, 2009

How do Cassius and the audience react to Portia's death in Julius Caesar?

Cassius is upset and surprised when he learns how Portia died, and the audience probably is too.


Portia’s death probably came as a shock to everyone.  Brutus’s wife was a strong woman.  She was Cato’s daughter, and she considered herself a part of her husband’s war effort.  When things did not go well for her husband, it was too much for her.  She took her own life in the most spectacular way.



BRUTUS


Impatient of my absence,
And grief that young Octavius with Mark Antony
Have made themselves so strong:--for with her death
That tidings came;--with this she fell distract,
And, her attendants absent, swallow'd fire.


CASSIUS


And died so?


BRUTUS


Even so.


CASSIUS


O ye immortal gods! (Act 4, Scene 3) 



When Brutus tells Cassius that Portia is dead, it is a reminder that things are not going well for them.  To the audience, it likely seems like everything for Brutus and Cassius’s side is going very poorly.  Portia’s bizarre death may lead the audience to pity Brutus, but Brutus’s reaction to it is a little odd.  He might be in a state of shock or denial. 


He doesn’t want to talk about it anymore.  Cassius tries to bring up the subject again.



CASSIUS


Portia, art thou gone?


BRUTUS


No more, I pray you.
Messala, I have here received letters,
That young Octavius and Mark Antony
Come down upon us with a mighty power,
Bending their expedition toward Philippi. (Act 4, Scene 3)



Cassius may be trying to bring Brutus back down to Earth and help him accept what really happened.  He may he trying to accept it himself.  Shakespeare also might be using this incident as a reminder of how long the war has gone on and how it has affected the families of the men involved.  The war goes poorly for Brutus and Cassius, and it is not about to get any better. 

What is pityriasis rosea?


Causes and Symptoms


Pityriasis rosea is primarily a skin

disease of children and young adults, with females being more commonly affected than males. The initial lesion is a characteristic eruption seen on the trunk called the herald or mother patch, as it signals the onset of lesions to come. This is a scaly pink plaque which is around one to two centimeters in diameter, slightly raised above the surface, with central salmon-colored wrinkles. This lesion should be differentiated from that of syphilis and ringworm.




The herald patch is followed in about two weeks by a crop of similar but smaller lesions all over the trunk. The pink scaly oval papules are distributed along the skin tension lines in the trunk and result in a so-called Christmas tree distribution. The lesions may be mild to moderately pruritic (itchy) and will resolve spontaneously in four to six weeks, without any specific treatment. Other symptoms may involve mild aches and fatigue.


The exact cause of this exanthem (eruptive disease) is not known, but it is believed to result from exposure to various viruses. Most patients appear to have a positive recent history of influenza or an upper respiratory tract infection. The eruption typically appears in spring and fall and appears to cluster among close contacts; however, it is not believed to be highly contagious.




Treatment and Therapy

There is no specific treatment for pityriasis rosea, and usually none is required, as the disease is self-limited and resolves without treatment in four to six weeks. Pruritus is usually mild and can be treated with antihistamines and calamine lotion. If itching is severe, then topical steroids and a short, tapered dose of systemic
steroids may be administered. Ultraviolet B (UVB) radiation is another treatment option. Patients are also advised to avoid hot showers and strenuous activity, as sweat and water appear to exacerbate the rash.




Perspective and Prospects

The term pityriasis is derived from the Greek pityron, meaning “scales.” The term, initially applied to include all those skin disorders that were characterized by fine scales, is presently used only with modifiers such as rosea, alba, or versicolor. Rosea means “pink,” and therefore pityriasis rosea describes pink-colored, fine, scaly lesions.


It is important clinically to distinguish the herald patch from other skin conditions. Therefore, a blood test for syphilis should be included for differential diagnosis. Also, ringworm, which requires treatment with antifungal agents, should be ruled out.


About 3 percent of the patients with pityriasis rosea experience recurrences, and no systemic manifestations have been demonstrated.




Bibliography


Chuh, Antonio A. T. “Pityriasis Rosea: Roles of the Dermatology Nurse.” Dermatology Nursing 16, no. 2 (April 1, 2004): 130–136.



Parker, James N., and Philip M. Parker. Pityriasis Rosea: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: ICON Health Publications, 2004.



Kasper, Dennis L., et al., eds. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw-Hill, 2012.



Montemayor-Quellenberg, Marjorie. "Pityriasis Rosea." Health Library, September 26, 2012.



Rakel, Robert E., ed. Textbook of Family Practice. 8th ed. Philadelphia: W. B. Saunders, 2011.



Tapley, Donald F., et al., eds. The Columbia University College of Physicians and Surgeons Complete Home Medical Guide. Rev. 3d ed. New York: Crown, 1995.



Vorvick, Linda J. "Pityriasis Rosea." MedlinePlus, October 14, 2012.

How does Atticus say he feels about Mayella Ewell?

In Chapter 20, Atticus gives his summation at the end of the trial. He says that he pities Mayella, but does not condone the lies she has told about Tom: 



I have nothing but pity in my heart for the chief witness for the state, but my pity does not extend so far as to her putting a man’s life at stake, which she has done in an effort to get rid of her own guilt. 



Atticus goes on to discuss the "code" that Mayella broke. She, a white girl, attempted to seduce a black man. This went against the racist code of the south in the 1930s, the time in which this novel is set. Mayella, feeling embarrassed and guilty for breaking this code, chose to incriminate Tom instead of telling the truth about what she did. Atticus recognizes the guilt she felt, but he says it doesn't justify putting Tom's life in jeopardy. Atticus also blames the society itself for allowing such a code to continue to exist.


In the end, even though Mayella and Bob conspired to ruin Tom, Atticus still has pity for Mayella. She is the victim of a poor, ignorant father who mentally and physically abuses her. In Chapter 23, we learn that Bob Ewell has spit in Atticus' face. When Jem asks him if he's worried about more retaliation from Bob, Atticus explains how his refusal to fight back is based upon sympathy for Mayella:



Jem, see if you can stand in Bob Ewell’s shoes a minute. I destroyed his last shred of credibility at that trial, if he had any to begin with. The man had to have some kind of comeback, his kind always does. So if spitting in my face and threatening me saved Mayella Ewell one extra beating, that’s something I’ll gladly take. He had to take it out on somebody and I’d rather it be me than that houseful of children out there.


What is dwarfism? What role do genetics play?


Risk Factors

Having a parent with a form of dwarfism, such as achondroplasia, a parent who carries a mutated FGFR3 gene, or parents of advanced age can increase the risk of inheriting dwarfism. Other abnormalities such as damage or conditions of the pituitary gland, hormonal disorders, problems with absorption, malnutrition, kidney disease, or extreme emotional distress can increase the risk of developing dwarfism.







Etiology and Genetics

Dwarfism, of which there are several hundred forms, occurs in approximately one in every ten thousand births. Approximately 85 percent of little people are born to parents of average height. The most common type of dwarfism, achondroplasia, is an autosomal dominant trait, but in 80 percent of cases it appears in children born to normal parents as a result of mutations in the sperm or egg.


Dwarfisms in which body proportions are normal usually result from metabolic or hormonal disorders in infancy or childhood. Chromosomal abnormalities, pituitary gland disorders, problems with absorption, malnutrition, kidney disease, and extreme emotional distress can also interfere with normal growth. When body parts are disproportioned, the dwarfism is usually due to a genetic defect.


Skeletal dysplasias
are the most common causes of dwarfism and are the major cause of disproportionate types of dwarfism. More than five hundred skeletal dysplasias have been identified. Chondrodystrophic dwarfism occurs when cartilage cells do not grow and divide as they should and cause defective cartilage cells. Most chondrodystrophic little people have abnormal body proportions. The defective cells occur only in the spine or only in the arms and legs. Short-limb dwarfism includes individuals with achondroplasia, diastropic dysplasia, and Hunter-Thompson chondrodysplasia.


Achondroplasia is the most common skeletal dysplasia and affects more than 70 percent of all dwarfs. It occurs in every 26,000 to 40,000 babies born of all races and ethnicities. Achondroplasia is caused by an autosomal dominant allele and is identified by a disproportionate short stature consisting of a long trunk and short upper arms and legs. Eighty percent of all cases of achondroplasia result from a mutation on chromosome 4 in a gene that codes for a fibroblast growth factor receptor. Achondroplasia is seen in both males and females, occurs in all races, and affects approximately one in every twenty thousand births. If one parent has achondroplasia and the other does not, then a child born to them would have a 50-percent chance of inheriting achondroplasia. On the other hand, if both parents have achondroplasia, their offspring have a 50 percent chance of inheriting achondroplasia, a 25-percent chance of being normal, and a 25-percent chance of inheriting the abnormal allele from each parent and suffering often fatal skeletal abnormalities. Children who do not inherit the defective gene will never have achondroplasia and cannot pass it on to their offspring, unless a mutation occurs in the sperm or egg of the parents. Geneticists have observed that fathers who are forty years of age or older are more likely to have children with achondroplasia as a result of mutations in their sperm.



Diastrophic dysplasia
is a relatively common form of short-limb dwarfism that occurs in approximately one in 100,000 births and is identified by the presence of short arms and calves, clubfeet, and short, broad fingers with a thumb that has a hitchhiker type appearance. Infant mortality can be high as a result of respiratory complications, but if they survive infancy, short-limbed dwarfs have a normal life span. Orthopedic dislocations of joints are common. Scoliosis is seen especially in the early teens, and progressive cervical kyphosis and partial dislocation of the cervical spine eventually cause compression of the spinal cord. Diastrophic dysplasia is an inherited autosomal recessive condition linked to chromosome 5. Parents have a 25-percent chance that each additional child will get diastrophic dysplasia.


Short-trunk dwarfism includes individuals with spondyloepiphyseal dysplasia, which results from abnormal growth in the spine and long bones that leads to a shortened trunk. It occurs in one of every 95,000 births. In spondyloepiphyseal dysplasia tarda, the lack of growth may not be recognized until five to ten years of age. Those affected have progressive joint and back pain and eventually develop osteoarthritis. Spondyloepiphyseal dysplasia congenita is caused by autosomal dominant gene mutations and is evidenced by a short neck and trunk, and barrel chest at birth. It is not uncommon for cleft palate, hearing loss, myopia, and retinal detachment to be present.


Morquio syndrome, which was first described in 1929, is classified as a mucopolysaccharidosis (MPS) disease caused by the body’s inability to produce enzymes that help to break down and recycle dead cells. Consequently, wastes are stored in the body’s cells.


Hunter-Thompson chondrodysplasia is a form of dwarfism caused by a mutation in growth factor genes. Affected individuals have shortened and misshapened bones in the lower arms, the legs, and the joints of the hands and feet. Fingers are shortened and toes are ball-shaped.


Growth hormone, a protein that is produced by the pituitary (“master”) gland, is vital for normal growth. Hypopituitarism results in a deficiency of growth hormone and afflicts between ten thousand and fifteen thousand children in the United States. In panhypopituitarism, the gland does not produce any hormones. The pituitary gland shuts down and growth is stunted.



Turner syndrome
affects one in every two thousand female infants and is characterized by the absence of or damage to one of the X chromosomes in most of the cells in the body. Short stature and the failure to develop sexually are hallmarks of Turner syndrome. Learning difficulties, skeletal abnormalities, heart and kidney problems, infertility, and thyroid dysfunction may also occur. Turner syndrome can be treated with human growth hormones and by replacing sex hormones.




Symptoms

For inherited disorders at birth, a long trunk and shortened limbs will be noticeable. A child born with dwarfism may go on to exhibit delayed gross motor development and skills, breathing and neurologic problems, hydrocephalus (water on the brain), increased susceptibility to ear infections and hearing loss, weight problems, curvature of the spine (scoliosis), bowed legs, stiff arms, joint and back pain or numbness, and crowding of teeth. Portions of the face may be underdeveloped. Sleep apnea can develop as a result of compression of the spine. Adult height will be stunted (usually reaching 42-52 inches). Seeking proper medical care can help to relieve some of these symptoms and complications.




Screening and Diagnosis

Close monitoring by parents and doctors is necessary to record the constellation of symptoms for each unique case of dwarfism. Often an initial diagnosis can be made by observing physical characteristics. Magnetic resonance imaging (MRI) and computed tomography (CT) scans can illustrate spinal and other structural abnormalities before serious complications arise. Imaging techniques can also help to determine the type of dwarfism present. Molecular genetic testing can be done to detect a FGFR3 mutation. Genetic testing is 99-percent sensitive and available in clinical laboratories. The Human Genome Project continues to investigate genetic links to dwarfism. Prenatal counseling and screening for traits of dwarfism, along with genetic counseling and support groups, are avenues to pursue for family and individual physical, psychological, and social well-being and to make informed choices.




Treatment and Therapy

Some forms of dwarfism can be treated through state-of-the-art surgical and medical interventions such as bone-lengthening procedures, reconstructive surgery, and growth and sex hormone replacement.


Short stature is the one quality all people with dwarfism have in common. After that, each of the many conditions that cause dwarfism has its own set of characteristics and possible complications. Fortunately, many of these complications are treatable, so that people of short stature can lead healthy, active lives. Continued follow-up with the physician team is essential.


For example, some babies with achondroplasia may experience hydrocephalus (excess fluid around the brain). They may also have a greater risk of developing sleep apnea—a temporary stop in breathing during sleep—because of abnormally small or misshapen airways or, more likely, because of airway obstruction by the adenoids or the tonsils. Occasionally, a part of the brain or spinal cord is compressed. With close monitoring by doctors, however, these potentially serious problems can be detected early and surgically corrected.




Prevention and Outcomes

Genetic counseling as well as family and public education regarding dwarfism and growth problems can bring greater awareness of dwarfism to communities and allow parents to make good choices. Inherited dwarfism is not preventable, but some cases caused by malnutrition, injury, absorption, or kidney conditions may be prevented.


The type, symptoms, and severity of complications vary from person to person, but most little people have an average life span. With a sense of support, self-esteem, and independence, a person with dwarfism can lead a very satisfying and productive life.




Bibliography


Ablon, J. Living with Difference: Families with Dwarf Children. Westport: Greenwood, 1988. Print.



Alan, Rick. "Achondroplasia." Health Library. EBSCO Information Services, 11 May 2013. Web. 21 July 2014.



Apajasalo, M., et al. “Health-Related Quality of Life of Patients with Genetic Skeletal Dysplasias.” European Journal of Pediatrics 157.2 (1998): 114–21. Print.



"Diseases and Conditions: Dwarfism." Mayo Clinic. Mayo Foundation, 27 Aug. 2011. Web. 21 July 2014.



"Dwarfism." MedlinePlus. US Natl. Lib. of Medicine, 20 June 2014. Web. 21 July 2014.



Krakow, D., et al. “Use of Three-Dimensional Ultrasound Imaging in the Diagnosis of Prenatal-Onset Skeletal Dysplasias.” Ultrasound in Obstetrics and Gynecology 21.5 (2003): 4676–78. Print.



Page, Nick. Lord Minimus: The Extraordinary Life of Britain’s Smallest Man. New York: St. Martin’s, 2002. Print.



Ranke, M., and G. Gilli. Growth Standards, Bone Maturation, and Idiopathic Short Stature. Farmington: Karger, 1996. Print.



Richardson, John H. In the Little World: A True Story of Dwarfs, Love, and Trouble. San Francisco: HarperCollins, 2001. Print.



Thorner, M., and R. Smith. Human Growth Hormone: Research and Clinical Practice. Vol. 19. Totowa: Humana, 1999. Print.



Ulijaszek, J. S., Francis E. Johnston, and Michael A. Preece. Cambridge Encyclopedia of Human Growth and Development. New York: Cambridge UP, 1998. Print.



Vajo, Zoltan, Clair A. Francomano, and Douglas J. Wilkin. “The Molecular and Genetic Basis of Fibroblast Growth Factor Receptor 3 Disorders: The Achondroplasia Family of Skeletal Dysplasias, Muenke Craniosynostosis, and Crouzon Syndrome with Acanthosis Nigricans.” Endocrine Reviews 21.1 (2000): 23–39. Print.



Zelzer, Elazar, and Bjorn R. Olsen. “The Genetic Basis for Skeletal Diseases.” Nature 15 May 2003): 343–8. Print.

Saturday, November 28, 2009

In Harper Lee's To Kill a Mockingbird, who does Mayella say she is afraid of and why?

Chapter 18 of Lee's To Kill a Mockingbird is mostly about Mayella Ewell's testimony on the witness stand and how the two attorneys question her. Mr. Gilmer barely asks her two questions when she bursts out in tears. Judge Taylor waits for a minute and then tells her to calm down and that she has nothing to be afraid of if she tells the truth. Then the judge asks her what she is scared of and she says, "Him," and points to Atticus. Shocked, Judge Taylor asks, "Mr. Finch?" Scout describes Mayella's response as follows:



"She nodded vigorously, saying, "Don't want him doin' me like he done Papa, tryin' to make him out lefthanded. . ." Judge Taylor scratched his thick white hair. It was plain that he had never been confronted with a problem of this kind" (179).



Mayella is afraid of Atticus because he made Bob Ewell, her father, look like a the sniveling liar that he is. In retaliation, Mayella does the only things she knows how to do--lie and cry. She must figure that she can draw a sympathy card if she makes Atticus look bad or feel awkward. It doesn't work.

Friday, November 27, 2009

In Fahrenheit 451, who gets incinerated by Guy Montag?

Guy Montag is a fireman who burns people's houses when they are reported to authorities for owning books. When he turns away from that life to preserve books, he gets caught by his boss, Captain Beatty. Not only that, but his wife Mildred reports her own husband and Beatty forces Montag to burn his own house down as part of his punishment. While Montag is burning his house down, Captain Beatty spouts off condescending verbal attacks at him. He quotes Shakespeare and continues to provoke Montag by calling him a snob. With incinerator in hand, and Beatty smugly looking on and provoking him verbally, Montag turns the flames on his boss and incinerates Captain Beatty. The way Bradbury describes the scene is incredible:



"And then he was a shrieking blaze, a jumping, sprawling, gibbering mannikin, no longer human or known, all writhing flame on the lawn as Montag shot one continuous pulse of liquid fire on him. There was a hiss like a great mouthful of spittle banging a red-hot stove, a bubbling and frothing as if salt had been poured over a monstrous black snail to cause a terrible liquefaction and a boiling over of yellow foam. . . Beatty flopped over and over and over, and at last twisted in on himself like a charred wax doll and lay silent" (119).



Bradbury employs similes, along with visual and auditory images, to describe the horrific scene of Beatty's body igniting instantly. There are black, red and yellow colors coupled with action verbs to create images with sound. Then, the descriptions of the reactionary movements of the body are chilling as it chemically changes in moments. 

What role does Immortality play in Joseph Conrad's Heart of Darkness?

Conrad's story has to do with the essential, and eternal, savagery of the world. When you think about the idea of "immortality" in this text you tend to think about Kurtz, and his ambition to be a "god" to his "people," but actually what is "immortal" in the book has nothing to do with gods, or men -- it is the spirit of wildness, the irrefutable and unchangeable reality of things, that is at issue. Compared to this timeless reality, man doesn't count for much. No matter what humanity (especially the West, as represented by "the company") tries to do to transform nature or exploit it, the essential nature of the wild remains immutable and fixed, eternal and eternally indifferent to the ambitions of humans, Kurtz included. This is what Marlow means when he talks about the "fascination of the abomination" -- the "abomination" is the absolute indifference of the world, and the "fascination" is man's unquenchable desire to make an enduring mark.

Thursday, November 26, 2009

Can I have a detailed analysis on the poem "The Border Builder" by Carol Rumens?

“The Border Builder” by Carol Rumens makes a powerful statement about the problem many countries have with immigration. Especially in the climate of the U.S. where border management has become a central issue among potential presidential candidates, Rumens' poem really resonates.


In this poem, she depicts a scene of someone building a border and someone questioning the validity of another person. In the third and fourth line, the speaker says that the bricks are made of his blood. This suggests that not only is the physical labor very intensive and requires blood and sweat in a metaphorical way, but it also may cost the speaker his “blood” meaning part of his ethnicity. He is, in a way, rejecting his ethnicity to build a wall that may keep out some of his distant family members. The question, “What would we be without borders?” is a rhetorical one that is meant to convey both sarcasm and reality. The speaker suggests that sometimes borders are necessary but at the same time are exclusionary and problematic.


The other questions that follow are of someone questioning another person's birth place, passport, qualifications, and color. Clearly the person working on the wall looks as though he might be of a minority ethnicity, so the person questioning him is suspicious about whether he has a right to be there. Furthermore, the questioner is aggressive towards him because of his appearance. When the questioner slams the man's hand and says a border likes blood, he show his hate and prejudice for minorities, even legal, hard working people like the speaker. This shows that racism is prevalent and it is a difficult road for minorities in the face of such aggression.

What is Gatsby doing at the end of Chapter VII and why?

In Chapter VII, Daisy, confronted with the choice between Tom and Gatsby, chooses Tom and accidentally kills Myrtle, Tom's mistress. Later that night, Nick and Gatsby find themselves outside the Buchanan's house.  Nick encourages Gatsby to go home, but Gatsby wants to stay until Daisy goes to bed. He is worried about the earlier scene with Tom, since Tom is a brute and could harm Daisy. Nick is not concerned, as he is able to see Tom and Daisy through the window. He observes these two careless people go about their lives, happily eating dinner, with Tom covering Daisy's hand with his own at one point. Clearly they have have retreated into their insulated and irresponsible existence.  Nick leaves Gatsby there, on this moonlit night by the house, "watching over nothing" (Fitzgerald 153). This is an echo of the opening of the book, in which Nick observes Gatsby gazing longingly at the green light on another moonlit night. 

Wednesday, November 25, 2009

In "The Bride Comes to the Yellow Sky," what type of characters are the men in the saloon?

In “The Bride Comes to Yellow Sky” by Stephen Crane, five of the six men in the “Weary Gentleman” saloon represent the norms of the Old West. They are silent, stoic men. The narrator explains the three men from Texas choose not to talk in the saloon. They are strong, silent types who hold their thoughts close to them. They speak when they feel it is necessary. The Mexicans are silent in the bar by their own choosing. They do not share their thoughts with others because they are outsiders in the town. They go to the bar to drink, not to socialize. When it becomes evident that Scratchy is on a rampage, they fade out the back door not wanting to be part of trouble. The drummer represents the eastern encroachment on the Wild West. He is talkative in a way that shows he does not understand the social norms of Yellow Sky. The bar keeper acts as the go between by attempting to explain Scratchy’s actions to the drummer and to keep him safe. He represents the bridge between the Old West and spread of eastern ideology brought about by the extension of railroads to the outermost western towns of the United States.

Which version is grammatically correct: "She was admitted to practice law in 2001" or "She was admitted to practice law on 2001"?

The difficulty here is the ambiguity of prepositions in English.  “In” generally refers to the question “where?” (Where is the cinnamon?  In the cupboard.”)  “On” also usually refers to the question of “where?” (Where is the cinnamon?  On the shelf.”)  These prepositional phrases both refer to a physical location.  But in your example, “in” and “on” both refer to a time of occurrence (When is your 75th birthday?  In 2017.) (When is your birthday? On the 24th of November.)  So your choice depends on whether the object of the preposition is exact (She was admitted…on Jan. 1, 2001) or within a range of times (She was admitted… sometime in 2001).  So in your example, “She was admitted to practice law in 2001” is correct if the speaker is referring to the first time she was admitted.  There could be a case where the speaker is referring to a past event:  “While she is not permitted now to practice law, she was permitted to do so in 2001, a privilege since revoked.” Better grammar would refer to a more exact time:  She was admitted to practice law on this exact date:  January 1, 2001.”

Tuesday, November 24, 2009

What is halitosis?


Causes and Symptoms

The primary cause of halitosis stems from anaerobic
bacteria that reside in the back of the mouth, particularly on the back of the tongue. These bacteria break down proteins and generate smelly gases, especially hydrogen sulfide and methyl mercaptan. More than twenty-two different bacteria have been identified as producing bad odors in the mouth. Periodontal disease, decayed teeth, and infected tonsils are also sources of bad breath. Dry mouth caused by a decreased flow of saliva can produce halitosis. Foods such as onions, garlic, and hot peppers produce chemical odors that are expelled in the breath. In general, particles of food that remain in the mouth on the tongue or between teeth collect bacteria and can cause bad breath. Tobacco products cause halitosis, stain teeth, and irritate gum tissues.


Outside the mouth, chronic infections of the sinuses or lungs can also cause halitosis. Kidney failure has been associated with ammonia-smelling breath, while inadequate diabetic control results in sweet-smelling breath. Halitosis originating from the stomach is very rare, since the esophagus is a closed tube that connects the stomach with the mouth.


Symptoms associated with halitosis include foul-smelling breath, a bad taste in the mouth, a white-to-yellow coating on the tongue, and bleeding gums. For many people, the problem of bad breath is manifest only when they begin to talk. To detect bad breath, one should ask a family member, close friend, or dentist how one’s breath smells.




Treatment and Therapy

The basic treatment for halitosis includes brushing the teeth, tongue, and gums properly after each meal; flossing the teeth at least once a day; visiting the dentist regularly; drinking adequate fluids; and eating fresh, fibrous fruits and vegetables. Although it may take time and patience to overcome the gagging reflex, it is important periodically to clean the back of the tongue thoroughly and gently with a toothbrush or a scraper.


Some mouthwashes have been clinically proven to reduce bad breath effectively, as have some toothpastes. Chewing sugarfree gum, mint, cloves, or fennel seeds for a short time can likewise reduce the odor. Dentures should be cleaned properly every day and should not be kept in the mouth overnight. Nose and throat infections resulting in halitosis may need medical treatment.




Perspective and Prospects

Although Islamic and Jewish teachings implicate the stomach as a source of bad breath, it almost never originates there. In almost all cases, halitosis is treatable. Rarely is it an indication of a significant general health problem.




Bibliography


Franklin, D. "Good Bacteria for Bad Breath." Scientific American 308, 5 (January 2013): 30, 32.



Icon Health. Halitosis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: Author, 2004.



Kohnle, Diana. "Health Tip: What's Behind Bad Breath?" MedlinePlus, May 28, 2013.



Mayo Clinic. "Bad Breath." Mayo Clinic, December 18, 2012.



MedlinePlus. "Bad Breath." MedlinePlus, July 1, 2013.



Miller, Richard A. Beating Bad Breath: Your Complete Guide to Eliminating and Preventing Halitosis. Baltimore: Noble House, 1995.



Rosenberg, Mel, and Daniel van Steenberghe, eds. Bad Breath: A Multidisciplinary Approach. Leuven, Belgium: Leuven University Press, 1996.

Why did prohibition seem to fail during the 1920's? a. Prohibition increased alcoholism in the US. b. Prohibition led to increased racial...

The 18th amendment to Constitution banned the manufacture, transportation, and sale of alcohol. This was known as prohibition. While many people indicated they were in favor of prohibition, their actions suggested otherwise. People formed secret clubs, called speakeasies, where they were able to get and drink alcohol. Some people made their own alcoholic beverages. Prohibition eventually ended with the passage of the 21st amendment to the Constitution.


Prohibition failed because it was so difficult to enforce. So many people were drinking, it wasn’t possible to have enough police officers to stop the drinking from occurring. While many people indicated they thought prohibition was a good idea, they really didn’t want to stop drinking. Organized crime got involved in the alcohol business because demand for alcohol was so high. Mayor LaGuardia of New York City was known to have said that in order to enforce prohibition, he would have needed about 250,000 police officers just to police the police. This showed how difficult it was to enforce prohibition, which is a major reason for its failure and its eventual repeal. Most people had no intention of stopping the consumption of alcoholic beverages.


Therefore, the correct answer to question you asked is answer D.

What is vaginal yeast infection?


Definition

A vaginal yeast infection is caused by the fungus
Candida albicans. Although yeast is common in the vagina, it can cause problems when it grows excessively. This excess growth causes the uncomfortable symptoms of a yeast infection.













Causes

Yeast grows in conditions that are less acidic. Vaginal fluids are most often mildly acidic, but this fact can change. For example, acid levels can decrease during menstrual flow. Good bacteria also helps keep yeast levels in check. Conditions that decrease levels of good bacteria will also increase the chance of a yeast infection.




Risk Factors

Factors that can increase the chance of a yeast infection include situations
that can cause hormonal changes, such as the use of birth control pills; pregnancy; menopause;
steroid use; broad-spectrum antibiotics; diabetes,
especially when blood sugar is not well-controlled; a compromised immune
system, such as with human immunodeficiency virus infection;
perfumed feminine hygiene sprays, deodorant tampons, or bubble bath; tight jeans,
synthetic underwear, or a wet swimsuit; and douching.




Symptoms

Symptoms of yeast infection include vaginal itching, ranging from mild to severe; a clumpy, vaginal discharge that may look like cottage cheese; vaginal soreness, irritation, or burning; rash or redness on the skin outside the vagina; painful urination; and painful sexual intercourse.




Screening and Diagnosis

A doctor will perform a pelvic exam. Vaginal discharge, if any, will be tested.
One should consult a doctor at the first onset of symptoms. Other infections have
symptoms that are like those of a yeast infection. These other infections include
bacterial
vaginosis and trichomoniasis.


If a woman has had a yeast infection, she may be able to recognize the signs of a new infection. In this case, over-the-counter medications are safe to use.




Treatment and Therapy

Treatment for vaginal yeast infection includes the use of medications. Various
antifungal drugs are available as intravaginal creams, tablets, or suppositories.
These drugs include Monistat (miconazole nitrate), Gyne-Lotrimin (clotrimazole
vaginal), Fem-stat (butoconazole vaginal), Terazol (terconazole vaginal), and
Mycelex (clotrimazole vaginal). The treatments come in one-day, three-day, and
seven-day packs. Some of these are over-the-counter, and others (such as Terazol)
may require a prescription. A doctor also can prescribe fluconazole (Diflucan), an
oral medication. It is a single-dose treatment. If pregnant, one should consult a
doctor before any treatment.




Prevention and Outcomes

To help reduce the chance of getting a yeast infection, one should take the
following steps: Dry outside the vaginal area thoroughly after a shower, bath, or
swim; remove a wet bathing suit or damp workout clothes as soon as possible; wear
cotton underwear; avoid tight clothing; avoid douching unless instructed to do so
by a health care provider (douching decreases vaginal acidity); avoid bubble
baths, perfumed feminine hygiene sprays, and scented soap; and avoid frequent or
prolonged use of antibiotics, if possible. Persons with diabetes should
control their blood sugar levels.




Bibliography


Berek, Jonathan S., ed. Berek and Novak’s Gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2007.



EBSCO Publishing. DynaMed: Candida Vulvovaginitis. Available through http://www.ebscohost.com/ dynamed.



National Institute of Allergy and Infectious Diseases. “Vaginal Yeast Infection.” Available at http://www.niaid.nih.gov/topics/vaginalyeast.



National Institutes of Health, Medline Plus. “Yeast Infections.” Available at http://www.nlm.nih.gov/medlineplus/yeastinfections.html.



Richardson, Malcolm D., and Elizabeth M. Johnson. Pocket Guide to Fungal Infection. 2d ed. Malden, Mass.: Blackwell, 2006.



Stewart, Elizabeth Gunther, and Paula Spencer. The V Book: A Doctor’s Guide to Complete Vulvovaginal Health. New York: Bantam Books, 2002.

Monday, November 23, 2009

What author's craft (like symbolism or perspective) does Harper Lee use to show moral courage in To Kill a Mockingbird?

One symbol of moral courage found in Harper Lee's To Kill a Mockingbird is the white camellia.

In Scout and Jem's neighborhood, Mrs. Dubose lives two doors to the north of the Finches and tends white camellia bushes in her garden. She is hated and feared by all the neighborhood children as the "meanest old woman who ever lived," and the children avoid going near her house like the plague (Ch 4). Yet, by Chapter 11, Scout and Jem grow old enough to decide it is time to walk into town by themselves, and they must bravely pass Mrs. Dubose's house in order to do so. Each time they pass, Mrs. Dubose hurls insults at the children. In Jem's mind, the worst insult she hurls is when she one day says, "Your father's no better than the niggers and trash he works for!" (Ch. 11). Jem grows so angry that he whacks all the white camellias off of Mrs. Dubose's bushes.

As recompense, Jem must go to Mrs. Dubose's house and read to her every afternoon. On his final day of reading to her, Mrs. Dubose says something very fascinating and unexpected to Jem:



Thought you could kill my Snow-on-the-Mountain, did you? Well, Jessie says the top's growing back out. Next time you'll know how to do it right, won't you? You'll pull it up by the roots, won't you? (Ch. 11)



One would not expect such a cantankerous old woman to give advice on how to kill her beloved flowers "next time," which leads the reader to wonder what her purpose was in saying the above.

Later, we find out exactly why Atticus wanted Jem to begin reading to Mrs. Dubose. Atticus explains that Mrs. Dubose had developed a morphine addiction due to the pain of her illness but felt determined to rid herself of her addiction before her death and wanted Jem to read to her as a distraction from her withdrawal symptoms. Due to her dedication to rid herself of her addiction, Atticus sees Mrs. Dubose as the "bravest person [he] ever knew" and wanted Jem to read to her so that he could "see what real courage is" (Ch. 11).

Interestingly, white camellias symbolize steadfastness and excellence, both qualities that are necessary in a brave person. In addition, camellias symbolize perfection and are given to someone you adore. Also, interestingly, Mrs. Dubose gives Jem a white camellia upon her deathbed. Hence, she is giving Jem a camellia to show that she appreciates his potential for steadfastness, excellence, and even bravery. Moreover, her gift to Jem of the camellia makes it evident that she advised Jem to pull the bushes up by the roots "next time" in order to encourage him to act upon his bravery to the fullest of his abilities, "next time."

Sunday, November 22, 2009

What is failure to thrive?


Causes and Symptoms

Failure to thrive may be organic or inorganic; in many children, the etiology is
multifactorial. The onset of growth problems may be prenatal as a result of
maternal substance abuse, most notably alcohol use resulting in fetal alcohol
syndrome, or of maternal infection or undernutrition during
pregnancy. Chromosome problems, such as Down syndrome and Turner
syndrome, are also a medical cause of failure to thrive.
Other causes include gastrointestinal disease resulting in poor micronutrient
intake, endocrine disease, kidney disease, and heart and lung disease, all of
which may decrease a child's appetite and how they process food and thus impair
growth. Small size in infants secondary to prematurity resolves by two to three
years of age unless there are complications. Undernutrition during infancy or
childhood can also cause failure to thrive; undernutrition may result from
inadequate protein and energy intake due to food insecurity and poverty,
breastfeeding difficulties, or child neglect or
abuse.


Many children with failure to thrive are both stunted (height-affected) and wasted
(weight-affected). Assessing which of the two conditions predominates can be done
using the body
mass index (BMI), which is calculated by dividing weight in
kilograms by height in meters squared. A low BMI is a sign of malnutrition.
Children with environmental failure to thrive fall into this category.


A child who is small but has an appropriate BMI has short stature rather than failure to thrive. The two leading causes of short stature are familial short stature and constitutional delay.




Treatment and Therapy

The treatment for failure to thrive depends on the underlying disorder or cause.
The most common focus of the medical intervention with failure to thrive is to
ensure a nurturing environment and adequate nutrition.
Nutritional intervention can be achieved in many ways, such as by securing
adequate access to food for the family and offering concentrated formulas,
nutritional supplementation, and calorie-dense food, depending on the age of the
child. Developmental intervention should also be provided if delay is detected.
Likewise, family counseling, especially focusing on parenting skills, may be
indicated. Other treatment options include treating the underlying medical
condition that is contributing to failure to thrive, such as gastrointestinal
disease, kidney disease, or HIV and other infectious diseases.




Perspective and Prospects

The term “failure to thrive” originated in 1933; it replaced the term “cease to thrive,” which appeared in 1889. Initially, the condition was reported in institutionalized children, including those in orphanages. In the 1940s, however, it was recognized as a condition that could also affect children living at home with their biological or adoptive parents.


Although the list of conditions that can cause growth impairment in children is
quite extensive, a systematic approach using history and both physical and
psychosocial assessment will provide clues to the diagnosis. Intervention ensures
an adequate outcome, with improved prospects for physical growth and brain
development.




Bibliography


Berk, Laura E.
Child Development. 9th ed. Boston: Pearson, 2012.
Print.



Geissler, Catherine
A., and Hilary J. Powers, eds. Human Nutrition. 12th ed.
New York: Churchill Livingstone/Elsevier, 2010. Print.



Kreutler, Patricia A.,
and Dorice M. Czajka-Narins. Nutrition in Perspective. 2nd
ed. Englewood Cliffs: Prentice Hall, 1987. Print.



Nathanson, Laura
Walther. The Portable Pediatrician: A Practicing Pediatrician’s
Guide to Your Child’s Growth, Development, Health, and Behavior from
Birth to Age Five
. 2nd ed. New York: HarperCollins, 2002.
Print.



Reading, Richard. "Weight
Faltering and Failure to Thrive in Infancy and Early Childhood."
Child: Care, Health and Development 39.1 (2013): 151.
Print.



Shore, Rima.
Rethinking the Brain: New Insights into Early
Development
. Rev. ed. New York: Families and Work Institute,
2003. Print.



Whitney, Ellie, and
Sharon Rady Rolfes. Understanding Nutrition. 13th ed.
Belmont: Wadsworth, 2012. Print.



Winick, Myron, et al.
The Columbia Encyclopedia of Nutrition. New York:
Putnam, 1988. Print.

What is maple syrup urine disease (MSUD)?


Causes and Symptoms

As a result of deficient branched-chain alpha-ketoacid dehydrogenase (BCKD), the essential branched chain amino acids leucine, isoleucine, and valine are not metabolized in patients with maple syrup urine disease (MSUD). The branched-chain amino acids and their ketoacid products accumulate in the blood and interfere with brain function. High levels of leucine are especially toxic. The classic form of the disease results in little (less than 2 percent) or no BCKD activity. Symptoms develop within three to seven days after birth and include poor weight gain, a high-pitched cry, irritability, lethargy, and a characteristic maple-syrup smell to the urine. If the disease is untreated, then intellectual and developmental disabilities, various neurological symptoms such as seizures, and even death can result.



Variant forms of the disease, in which there is some (3 to 12 percent) BCKD activity, result in milder symptoms. A rare variant form of the disease called thiamine-responsive MSUD responds to high doses of thiamine.




Treatment and Therapy

The treatment of severe MSUD, which should begin immediately after diagnosis, involves a special diet with controlled amounts of isoleucine, leucine, and valine to ensure metabolic control. Enfamil, a special dietary formula, provides leucine but may have to be supplemented with isoleucine and valine to provide adequate intake of all three amino acids and permit normal growth and development.


Treatment of the milder forms of MSUD also involves management through diet therapy. Diet therapy should be continued throughout life, and the levels of the branched-chain amino acids should be monitored often.




Perspective and Prospects

MSUD was first described in 1954. The name derives from the sweet, maple-syrup smell of the patient’s urine. Because MSUD is caused by a recessive gene, there is a one in four chance that two heterozygous carriers will have an affected child. MSUD affects about 1 in 185,000 newborns in the United States, but in some populations, such as Mennonites, it may be as high as 1 in 176.


Some hospitals test for the disease in their newborn screening programs. Testing should be done within the first twenty-four hours after birth, since early diagnosis is essential. Some of the milder variant forms are missed in the screening programs. The detection of alloisoleucine is diagnostic for MSUD but may not appear until the sixth day of life. Carrier testing is available for the Mennonite variant of the disease.




Bibliography:


Clarke, Joe T. R. A Clinical Guide to Inherited Metabolic Diseases. 3d ed. New York: Cambridge University Press, 2006.



Icon Health. Maple Syrup Urine Disease: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: Author, 2004.



Jorde, Lynn B., et al. Medical Genetics. 4th ed. St. Louis, Mo.: Mosby, 2009.



Mescka, Caroline P., et al. "Protein and Lipid Damage in Maple Syrup Urine Disease Patients: l-Carnitine Effect." International Journal of Developmental Neuroscience 31, no. 1 (February, 2013): 21–24.



Pritchard, Dorian J., and Bruce R. Korf. Medical Genetics at a Glance. 2d ed. Malden, Mass.: Blackwell Science, 2008.



Scaini, Giselli, et al. "DNA Damage in an Animal Model of Maple Syrup Urine Disease." Molecular Genetics and Metabolism 106, no. 2 (June, 2012): 169–174.



VeriMed Healthcare Network. "Maple Syrup Urine Disease." Medline Plus, May 15, 2011.

Saturday, November 21, 2009

`(3a - 4b)^5` Use the Binomial Theorem to expand and simplify the expression.

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 3a for x, 4b for y and 5 for n, such that:


`(3a - 4b)^5 = 5C0 (3a)^5+5C1 (3a)^4*(-4b)^1+5C2 (3a)^3*(-4b)^2+5C3 (3a)^2*(-4b)^3 + 5C4 3a*(-4b)^4 + 5C5 (-4b)^5`


By definition, nC0 = nCn = 1, hence `5C0 = 5C5 = 1.`


By definition nC1 = nC(n-1) = n, hence `5C1 = 5C4 = 5.`


By definition `nC2 = (n(n-1))/2` , hence `5C2 = 5C3 = 10.`


`(3a- 4b)^5 = 243a^5 - 1620a^4*b+4320a^3*b^2-5760a^2*b^3 + 3840a*b^4 - 1024b^5`


Hence, expanding the complex number using binomial theorem yields the simplified result `(3a- 4b)^5 = 243a^5 - 1620a^4*b+4320a^3*b^2-5760a^2*b^3 + 3840a*b^4 - 1024b^5.`

What is the meaning of the following quotation from Macbeth: "Hie thee hither, / That I may pour my spirits in thine ear and chastise with the...

These words are an expression of Lady Macbeth's thoughts during a soliloquy in Act l, scene V. She has just received word from her husband about his meeting with the witches, their predictions and that one of these - obtaining the title, thane of Cawdor - had actually come true.


She here expresses the wish that Macbeth should rush home so that she may lambaste him with brave and powerful words to encourage him to do that which he may be too afraid to do, which is to usurp the throne and claim it as his own.


The metaphor, 'pour my spirits in thine ear' suggests that she wishes to share her innermost thoughts and desires with her husband. She is keen to tell him about her passionate impulse for him to become king. 'The valour of my tongue' implies that she wishes to ply him with encouraging words which stem from her own courage to speak her mind. She wishes to spur him on into performing a most malicious and immoral act: obtaining the 'golden round,' which is the metaphoric description for the crown, by fighting and overcoming all the obstacles which may stand in his way.


Before saying the above, Lady Macbeth expressed uncertainty about her partner being ruthless enough to commit a heinous crime to get what he wants. She believes that he is 'too full of the milk of human kindness' i.e. that he is too soft and kindhearted to do anything rash or brutal to quickly and illegitimately obtain what he wants. The metaphor is apt since it alludes to a mother's softness and love when she is tenderly taking care of her baby.


In addition, she furthermore declares that her husband is ambitious but that he lacks 'the illness that should attend it.' This emphasizes the previous point. She is stating that Macbeth does not possess the insidious malevolence to act remorselessly in trying to achieve what he wants. In her contention, Macbeth deems certain things too sacred and with too much respect to commit evil.


It is, therefore, in her estimation, quite ironic that Macbeth should hold certain things (such as the crown and what it stands for) in such great regard and not try to obtain it by foul means but, paradoxically, still wish to win it (the crown) 'wrongly,' i.e. without following proper procedure.


For these reasons it is, therefore, imperative that Macbeth should haste home so that she may fervently speak to him.

What is endocarditis?


Causes and Symptoms

The lesions of endocarditis may be noninfective, as in some autoimmune conditions, or infective. The latter are characterized by direct invasion of the endocardium by microorganisms, most often bacteria.
Bacterial endocarditis may occur on normal or previously damaged heart
valves and also on artificial (prosthetic) heart valves. Rarely, endocarditis may occur on the wall (mural surface) of the heart or at the site of an abnormal hole between the pumping chambers of the heart, called a ventricular septal defect.



In areas of turbulent blood flow, platelet-fibrin deposition can occur, providing a nidus for subsequent bacterial colonization. Transient bacteremia may accompany infection elsewhere in the body or some medical and dental procedures, and these circulating bacteria can adhere to the endocardium, especially at platelet-fibrin deposition sites, and produce endocarditis. Intravenous drug abusers using unsterile equipment and drugs often inject bacteria along with the drugs, which can result in endocarditis. The lesions produced by these depositions plus bacteria are called vegetations. Clinical symptoms and signs usually begin about two weeks later.


Bacterial endocarditis usually involves either the mitral or the aortic heart valve. In intravenous drug abusers, the tricuspid heart valve is more commonly affected because it is the first valve to be reached by the endocardium-damaging drugs and contaminating bacteria. The pulmonic valve is only rarely the site of endocarditis. Occasionally, more than one heart valve is infected; this occurs most often in intravenous drug abusers or patients with multiple prosthetic heart valves.


Gram-positive cocci are the most common cause of bacterial endocarditis. Different species predominate in various conditions or situations: Streptococcus viridans in native valves, Staphylococcus aureus in the valves of intravenous drug abusers, and Staphylococcus epidermidis in prosthetic heart valves. Gram-negative bacilli are found in association with prosthetic heart valves or intravenous drug addiction.


The clinical manifestations of endocarditis are varied and often nonspecific. Early symptoms are similar to those encountered in most infections: fever, malaise, and fatigue. As the disease progresses, more cardiovascular and renal-related symptoms may appear: dyspnea, chest pain, and stroke. Fever and heart murmurs are found in most patients. Enlargement of the spleen, skin lesions, and evidence of emboli are commonly present.


The key to the diagnosis of bacterial endocarditis is to suspect the presence of the illness and obtain blood cultures. Febrile patients who have a heart murmur, cardiac failure, a prosthetic heart valve, history of intravenous drug abuse, preexisting valvular disease, stroke (especially in young adults), multiple pulmonary emboli, sudden arterial occlusion, unexplained prolonged fever, or multiple positive blood cultures are likely to have endocarditis. The hallmark of bacterial endocarditis is continuous bacteremia; thus, nearly all blood cultures will be positive. Other nonspecific blood tests, such as an erythrocyte
sedimentation rate, or specific blood tests, such as tests for teichoic acid antibodies, may be helpful in establishing a diagnosis.




Treatment and Therapy

Endocarditis may be prevented by administering prophylactic antibiotics to patients with preexisting heart abnormalities that predispose them to endocarditis when they are likely to have transient bacteremia. An example would be a patient with an artificial heart valve scheduled to have a dental cleaning.


Endocarditis is one of the few infections that is nearly always fatal if mistreated. Antibacterial therapy with agents capable of killing the offending bacteria, along with supportive medical care and cardiac surgery when indicated, cures most patients.




Perspective and Prospects

The first demonstration of bacteria in vegetations associated with endocarditis was by Emmanuel Winge of Oslo, Norway, in 1869. Fifty years later, a fresh section was cut from the preserved heart valve described by Winge, and staining by modern methods revealed a chain of streptococci verifying his discovery. It was not until 1943, when Leo Loewe successfully treated seven cases of bacterial endocarditis with penicillin, that the era of modern therapy of this serious illness began.


While the incidence of endocarditis remained fairly constant between the 1960s and the early 1990s, the patient profile changed: heroin addicts, the elderly, and those with prosthetic heart valves. Since the late 1990s there has been a steady increase in the number of heart valve infections. Recent studies have found that 40 percent of those who end up with endocarditis acquire their infections in health care facilities. Most of these patients are elderly, are suffering from other illnesses, and have received cardiac implants such as prosthetic heart valves, pacemakers, and defibrillators.




Bibliography:


"What is Infective Endocarditis?" American Heart Association, 2012. PDF.



Carson-DeWitt, Rosalyn, and Michael J. Fucci. "Endocarditis." Health Library, Mar. 20, 2013.



Crawford, Michael, ed. Current Diagnosis and Treatment—Cardiology. 3d ed. New York: McGraw-Hill Medical, 2009.



Durack, David T., and Michael H. Crawford, eds. Infective Endocarditis. Philadelphia: W. B. Saunders, 2003.



Eagle, Kim A., and Ragavendra R. Baliga, eds. Practical Cardiology: Evaluation and Treatment of Common Cardiovascular Disorders. 2d ed. Philadelphia: Lippincott Williams & Wilkins, 2008.



"Endocarditis." MedlinePlus, Apr. 16, 2013.



Giessel, Barton E., Clint J. Koenig, and Robert L. Blake, Jr. “Information from Your Family Doctor: Bacterial Endocarditis, a Heart at Risk.” American Family Physician 61, no. 6 (March 15, 2000): 1705.



Magilligan, Donald J. Jr., and Edward L. Quinn, eds. Endocarditis: Medical and Surgical Management. New York: Marcel Dekker, 1986.



Muirhead, Greg. “Targeting Therapy for Infective Endocarditis.” Patient Care 33, no. 16 (October 15, 1999): 127–149.



Preidt, Robert. "Steady Rise in Heart Valve Infections Noted in US." HealthDay. MedlinePlus, Mar. 22, 2013.



"What is Endocarditis?" National Heart, Lung, and Blood Institute, Oct. 1, 2010.

Friday, November 20, 2009

Write your response to Brent Staples's essay, "Just Walk On By: Black Men and Public Space."

In this essay, Staples, a black man, acknowledges the fear his presence evokes in people on the street and talks about the measures he takes to avoid alarming strangers, especially whites who might form the wrong ideas about him. For example, he will drop back if he is behind a woman on the sidewalk so that she doesn 't think he is going to mug her, and he will hum classical music, such as Beethoven, to help convince people he is not a "thug." He says he engages in these behaviors because too many innocent black men he knows have been shot or killed due to having their actions or appearance interpreted as hostile or criminal. He is trying to illustrate for white audiences how racism works in very real ways as black men navigate public spaces. He is showing that black men have to take precautions all the time that whites never have to think about. By describing his strategies in such detail, he hopes for whites to get inside his skin and see what it feels like to be him.


This essay raises two issues for me: First, it was written decades ago. Have things changed at all for black men in public spaces? Have they gotten worse? What does it say about our society if the treatment of black men has not changed or has worsened?


Second, is Staples doing the right thing in being so accommodating to white fears? Doesn't he have the same rights as other people to dress the way he wants, listen to the music he wants and walk where he wants? Isn't he giving in to racism by letting it dictate his behavior? Or is he simply wise and practical given the racial climate in which he lives?

What do the chains in the "three estate" cartoon signify?

There was a very famous political cartoon produced in the years immediately prior to the French Revolution that depicted two French noblemen and a bishop sitting on the back of an emaciated, shirtless figure shackled hand and feet with chains. The poor figure having to carry the bloated noblemen and clergy represents the Third Estate (the clergy was the First and the nobles were the Second Estates). His shackles represent the complex system of laws and cultural traditions that "bound" the Third Estate. These included especially the unequal tax codes--a "head" tax that vexed the bourgeoisie, the comfortable middle classes that nevertheless lacked titles and the privileges that went along with them. It also included the gabelle, a tax on salt that affected the poorest Frenchmen (also part of the Third Estate) hardest. Additionally, the Third Estate resented royally granted monopolies that tended to favor nobles over those without titles. So the "chains" that shackle the Third Estate are legal and traditional ones imposed by the so-called ancien régime, the system under the Bourbon monarchs. It was anger at these restrictions, in addition to the fiscal crisis that gripped the country in the late 1780s, that sparked the French Revolution.

What is androgen insensitivity syndrome?


Risk Factors

Individuals whose mothers carry a mutated copy of the AR gene on one of their two X chromosomes are at risk for androgen insensitivity syndrome. About 70 percent of all cases of this disorder are inherited from mothers with this altered gene. The remaining cases result from a new mutation that can occur in the mother’s egg cell before the child’s conception or during early fetal development.











Etiology and Genetics

Introductory biology courses teach that a fertilized egg that receives two X chromosomes at conception will be a girl, whereas a fertilized egg that receives an X and a Y chromosome will become a boy. However, other factors can also affect the development of a person’s sex. Sex development in mammals begins at conception with the establishment of chromosomal sex (the presence of XX or XY chromosomes). Even twelve weeks into development, male and female embryos have the same external appearance. Internal structures for both sexes are also similar. However, the machinery has been set in motion to cause the external genitals to become male or female, with corresponding internal structures of the appropriate sex. The baby is usually born with the proper phenotype to match its chromosomal sex. However, development of the sex organs is controlled by several genes. This leaves a great deal of room for developmental errors to occur.


The AR gene, the primary gene involved in sex determination, is carried on the Y chromosome. This gene is responsible for converting the early unisex gonads into testes. Once formed, the testes then produce the balance of androgen and estrogen that pushes development in the direction of the male phenotype. In the absence of this gene, the undetermined gonads become ovaries, and the female phenotype emerges. Therefore, the main cause of sex determination is not XX or XY chromosomes, but rather the presence or absence of the gene that promotes testis differentiation.


In order for the male hormones to have an influence on the development of the internal and external reproductive structures, the cells of those structures must receive a signal that they are part of a male animal. The androgens produced by the testes are capable of entering a cell through the cell membrane. Inside the cell, the androgens attach to specific protein receptor molecules (androgen receptors). Attachment causes the receptors to move from the cytoplasm into the nucleus of the cell. Once in the nucleus, the receptor-steroid complexes bind to DNA near genes that are designed to respond to the presence of these hormones. The binding event is part of the process that turns on specific genes—in this case, the genes that direct the process of building male genitals from the unisex embryonic structures, as well as those that suppress the embryonic female uterus and tubes present in the embryo’s abdomen.


In cases of complete androgen insensitivity syndrome (CAIS), androgen receptors are missing from male cells. This is the result of a recessive allele located on the X chromosome. Because normal males have only one X, the presence of a recessive allele on that X will result in no production of the androgen receptor in that individual. The developing embryo is producing androgen in the testes; without the receptor molecules, however, the cells of the genitals are unable to sense the androgen and respond to it. In partial androgen insensitivity syndrome (PAIS), some androgen is received and responded to, leading to the development of mostly male or ambiguous genitals. CAIS and PAIS are believed to be equally common.




Symptoms

In individuals with CAIS, the cells of the genitals are still capable of responding to estrogen from the testes. As a result, the genitals become feminized: labia and clitoris instead of a scrotum and penis, and a short, blind vagina. To the obstetrician and parents, the baby appears to be a healthy girl. An internal examination would show the presence of testes rather than ovaries and the lack of a uterus and fallopian tubes, but there would normally be no reason for such an examination.


In cases of PAIS, the affected individual may have mostly female, mostly male, or ambiguous genitals, depending upon the degree to which the cells of genitals are capable of responding to androgen from the testes. Those who appear mostly female may have an enlarged clitoris, fused labia, or testes in the labia or elsewhere in the groin. Those with a mostly male appearance may have a penis of either average or below average size with a urethral opening not at the tip (hypospadias), a cleft scrotum, descended or undescended testes, and breast development in puberty (gynecomastia). Those with ambiguous genitalia may have a micropenis, a cleft scrotum, descended or undescended testes, scrotal hypospadias or a single vaginal-urinary tract, and gynecomastia.




Screening and Diagnosis

Cases of PAIS are usually evident at birth, whereas CAIS may not be detected for many years. Several events may lead to the diagnosis of this condition. The attempted descent of the testes into a nonexistent scrotum will cause pain that may be mistaken for the pain of a hernia; the presence of testes in the child with CAIS will be discovered when the child undergoes repair surgery. In other cases, the child may seek medical help in the midteen years because she does not menstruate. Exploratory surgery would then reveal the presence of testes and the absence of a uterus. Androgen insensitivity syndrome can be detected by blood tests, which check levels of testosterone and other hormones, pelvic ultrasound, and genetic testing.




Treatment and Therapy

As a general rule, the testes are left in the abdomen until after puberty because they are needed as a source of estrogen to promote the secondary sex characteristics, such as breast development. Without this estrogen, the girl would remain childlike in body form. After puberty, the testes are usually removed because they have a tendency to become cancerous. Bone density scans may also be recommended in order to prevent osteoporosis.


As a result of its phenotypic sex, an infant with CAIS is normally raised as a girl whose only problem is an inability to bear children. If the girl has athletic ability, however, other problems may arise. Suspicions of so-called gender fraud by two female Olympians first arose at the Berlin Olympics in 1936; later examinations indicated that they both had intersex conditions. Beginning in 1966, female Olympic athletes were required to submit to a test for the presence of the correct chromosomal sex. In the past, this has meant microscopic examination of cheek cells to count X chromosomes. In 1992, this technique was replaced by a test for the Y chromosome. Individuals who fail the “sex test,” including those with androgen insensitivity syndrome, could not compete against other women. Proponents of such testing have argued that androgens aid muscle development, and the extra testosterone produced by the testes of a normal male would provide an unfair physical advantage. However, because people with androgen insensitivity syndrome are lacking androgen receptors, their muscle development would be unaffected by the extra androgen produced by the testes, and thus they would not be any stronger than well-conditioned women. The International Olympic Committee ended so-called gender verification testing in 2000, but debate over the participation of women with higher testosterone levels in elite women's sports remains.


Those with PAIS may be raised as boys or girls, based on the maleness or femaleness of their external genitals. The families of children with ambiguous genitals typically assign a sex (and corresponding gender) to the child in consultation with medical professionals. Hormonal and prepubertal surgical treatments, such as hypospadias repair and urethroplasty, may be considered.




Prevention and Outcomes

There currently is no cure for or way in which to prevent this condition. However, the prognosis for CAIS is good if the testes are removed before they become cancerous.




Bibliography


"Androgen Insensitivity Syndrome." MedlinePlus. US National Library of Medicine, 19 July 2012. Web. 15 July 2014.



Callahan, Gerald N. Between XX and XY: Intersexuality and the Myth of Two Sexes. Chicago: Chicago Review, 2009. Print.



Chen, Harold. “Androgen Insensitivity Syndrome.” Atlas of Genetic Diagnosis and Counseling. 2nd ed. New York: Springer, 2012. Digital file.



Goodall, J. “Helping a Child to Understand Her Own Testicular Feminisation.” Lancet 337.8732 (1991): 33. Print.



Gottlieb, Bruce, Lenore K. Beital, and Mark A. Trifiro. "Androgen Insensitivity Syndrome." GeneReviews. U of Washington, Seattle, 10 July 2014. Web. 15 July 2014.



Heggie, Vanessa. "Sex Testing and the Olympics: Myths, Rumours and Confirmation Bias." Guardian. Guardian News and Media, 2 Aug. 2012. Web. 16 July 2014.



International Cooperation and Development Department, International Olympic Committee. Together Stronger—The Future of Sport.. 5th IOC World Conference on Women and Sport, 16–18 Feb. 2012. Los Angeles. N.p.: International Olympic Committee, n.d. PDF file.



Lemonick, Michael. “Genetic Tests under Fire.” Time 24 Feb. 1992: 65. Print.



Mange, Elaine Johansen, and Arthur P. Mange. Basic Human Genetics. 2nd ed. Sunderland: Sinauer Associates, 1999. Print.



Wieacker, Peter F., Hermann M. Behre, and Eberhard Nieschlag. “Disorders of the Androgen Target Organs.” Andrology: Male Reproductive Health and Dysfunction. Ed. Eberhard Nieschlag, Hermann M. Behre, and Susan Nieschlag. 3rd rev. ed. New York: Springer, 2010. 323–38. Print.

Wednesday, November 18, 2009

If the text is in first person, then in which person should the summary be written?

Even when a text is written in the first person perspective, your summary should be written in the third person perspective unless otherwise specified.


A summary should relate your understanding of the themes and events which occurred in the text. Try to imagine you are writing to someone who has not read the text before, and you'd like to give them a description of what the story was about. Think "short and sweet!" What are the most important points of the text?


If your teacher has specified that the summary ought to be written in first person, or from the perspective of the narrator of the text, then it is okay to write in first person. Try to put yourself in the narrator's shoes, but still relate the most important points of the text.

What is Walt Whitman's tone in his poem "O Captain! My Captain!"?

Walt Whitman's tone in "O Captain! My Captain!" is largely elegiac, in that it resembles an elegy. The poem was written in honor of President Lincoln following his assassination, and it also has celebratory passages that mark the end of the Civil War.


The poem starts with a tone of praise and commendation, as "our fearful trip is done." Whitman praises Lincoln's efforts during the Civil War, stating that "the port is near." In other words, Lincoln led the ship of state through the war, and the ship is about to safely be led to port. Then, the poem has a more mournful tone in the second part of each stanza (the second half of each stanza is indented). For example, the second part of the first stanza reads, "But O heart! heart! heart!" The repetition of the word "heart" and the reference to "bleeding drops of red" refer to the nation's grief over Lincoln's assassination.


The second stanza mentions the celebrations that are being conducted to commemorate the end of the war. The poem mentions the ways in which the nation is celebrating, including bells, bugle calls, and "bouquets and ribbon’d wreaths." In the midst of this celebration, mourners are grieving for Lincoln, who is commemorated in a more somber tone in the second half of the stanza, which begins "Here Captain! dear father!" 


The third stanza begins with an elegiac tone. It starts, "My Captain does not answer, his lips are pale and still." The second half of the stanza is both celebratory and somber. It begins, "Exult O shores, and ring O bells!" In other words, the poet wants the celebrations of the war's end to continue, but he says he will be in mourning: "But I with mournful tread, Walk the deck my Captain lies." This goes back to the metaphor of the ship of state, on whose deck Lincoln lies slain. 

Tuesday, November 17, 2009

Does the mother change in D. H. Lawrence's "The Rocking-Horse Winner"?

The mother in D. H. Lawrence's "The Rocking-Horse Winner" changes twice throughout the story. The first time, she changes for the worse since she grows more wildly obsessed with money than ever before. The second time, she starts changing for the better as she begins feeling, for the first time in her life, motherly concern for her first-born child, Paul.

We see her change the first time after Paul arranges through the family lawyer for her to have a gift of 1,000 pounds for her birthday for the next 5 years. Paul was expecting his mother to feel ecstatically happy and relieved when she read the letter about the money; instead, she only grows more greedy, as we see when her face and voice become hardened when Paul asks if she received anything nice in the mail for her birthday:



"Quite moderately nice," she said, her voice cold and hard and absent.



She soon arranges with the lawyer to be given all 5,000 pounds at once. After she does this, Paul begins hearing the house screaming for more money, which reflects his mother's new uncontrollable desires for money:



And yet the voices in the house, behind the sprays of mimosa and almond-blossom, and from under the piles of iridescent cushions, simply trilled and screamed in a sort of ecstasy: "There must be more money! Oh-h-h; there must be more money. Oh, now, now-w! Now-w-w—there must be more money!—more than ever! More than ever!"



Whereas before Paul's mother was only obsessed with money and constantly worried, now she has an insatiable addiction for more and more money.

The more Paul's mother grows wild over money, the more Paul grows frenzied over successfully winning money. He becomes so obsessed about winning money that he begins making mistakes and losing money, which gives him a "wild-eyed and strange" look. His mother begins noticing his odd behavior and feeling worried. Whereas at the start of the story she only saw her children as a burden she bears, her new feelings of concern for Paul show she is beginning to change a second time. She grows so worried about him that she leaves a party toward the end of the story to find him madly riding on his rocking-horse. Soon afterward, he dies, leaving her with feelings of regret.

What is anatomy?


Structure and Functions

The body’s parts can be categorized either regionally or functionally. Regionally, the body consists of a trunk to which are attached two upper extremities, two lower extremities, and a head that is attached by means of a neck. Functionally, the body consists of a digestive system, a circulatory system, an excretory system, a respiratory system, a reproductive system, a nervous system, an endocrine system, an integument (skin), a skeleton, and a series of muscles.



Regionally, the trunk can be divided into an upper portion called the chest or thorax, containing ribs, and a lower, rib-free portion called the abdomen. Internally, the thorax and abdomen are separated by a muscular sheet called the diaphragm. The upper extremities of the trunk include the arms, forearms, and hands; the lower extremities include the thighs, lower legs, and feet. The head includes the brain and the major sense organs, such as the eyes and ears; the neck is the narrower, flexible part that connects the head to the trunk. The ventral (front) surface of the abdomen is often divided around the umbilicus into upper-left, upper-right, lower-left, and lower-right quadrants.


Functionally, the body consists of a number of organ systems. The digestive system breaks down foods into simpler substances and absorbs them. The circulatory system transports oxygen and other materials around the body. The excretory system rids the body of many waste products, while the respiratory system rids the body of carbon dioxide and adds oxygen to the blood. The reproductive system produces sex cells and, in females, provides an environment for the development of an embryo. The nervous system sends signals in the form of nerve impulses from one part of the body to another, and the endocrine organs send chemical messengers (hormones) through the bloodstream. The integument, or skin, protects the outer surface of the body from infection, injury, and desiccation (drying out); it also maintains the body’s internal temperature by providing insulation and preventing the body from overheating during exercise through sweating. The skeleton serves as the body’s framework and consists of 206 separate bones; these bones support the body’s other organs and also protect the heart, the lungs, and especially the central nervous system, including the brain and the spinal cord. The muscles contract and produce movements.


Each major organ system is constructed of several major organs. The major organs contained within the thorax, for example, are the heart, lungs, and thymus. The major organs contained within the abdomen include the stomach, spleen, liver, pancreas, small intestine (consisting of the duodenum, ileum, and jejunum), large intestine (consisting of the cecum, colon, and rectum, with the colon further divided into an ascending colon, transverse colon, descending colon, and sigmoid colon), and bladder. The kidneys and urinary ducts lie along the dorsal body wall of the abdomen. Also contained within the lower abdomen are the uterus, ovaries, and fallopian tubes in the female and the vas deferens and prostate gland in the male. In males, two downward extensions of the abdominal cavity form the scrotal sacs that surround the testes.


The thoracic and abdominal cavities, and the scrotal cavities in males, are all considered part of the general body cavity, or coelom. Each part of the coelom is lined on all sides with a thin, single layer of flat (squamous) cells known as the peritoneum. The peritoneum forming the outer wall of these cavities is called the parietal peritoneum; the peritoneum on the outer surface of the internal organs, or viscera, is called the visceral peritoneum.


Each type of organ is made of a number of different tissues. The four major types of tissues are epithelial tissues, connective tissue, muscle tissue, and nervous tissue. Epithelial tissues, or epithelia, include those tissues that originate in broad, flat surfaces; their functions include protection, absorption, and secretion. Epithelia can be single layered (simple) or many layered (stratified). Their cells can be flat (squamous), tall and skinny (columnar), or equal in height and width (cuboidal). Some simple epithelia have nuclei at two different levels, giving the false appearance of different layers; these tissues are called pseudostratified. Some simple squamous epithelia have special names: the inner lining of most blood vessels is called the endothelium, while the lining of the body cavities (including all parts of the coelom) is called the mesothelium. Kidney tubules and most small ducts are also lined with simple squamous epithelia. The pigmented layer of the eye's retina and the front surface of the lens are examples of simple cuboidal epithelia. Simple columnar epithelia form the inner lining of most digestive organs and the linings of the small bronchi and the gallbladder. The epithelia lining the fallopian tubes, nasal cavities, and bronchi are ciliated, meaning that the cells have small, hairlike extensions called cilia.


The outer layer of skin
is a stratified squamous epithelium; other stratified squamous epithelia line the inside of the mouth, esophagus, and vagina. Sweat glands and other glands in the skin are lined with stratified cuboidal epithelia. Most of the urinary tract is lined with a special kind of stratified cuboidal epithelium, called a transitional epithelium, that allows a large amount of stretching. Parts of the pharynx, the larynx, the urethra, and the ducts of the mammary glands are lined with stratified columnar epithelium.


Glands are composed of epithelial tissues that are highly modified for secretion. They may be either exocrine glands, whose secretions exit by ducts to targets nearby, or endocrine glands, whose secretions are carried by the bloodstream to targets some distance away. The salivary glands in the mouth, the glandular lining of the stomach, and the sebaceous glands of the skin are examples of exocrine glands. The thyroid gland, the adrenal gland, and the pituitary gland are examples of endocrine glands. The pancreas has both exocrine and endocrine portions; the exocrine parts secrete digestive enzymes, while the endocrine parts, called the islets of Langerhans, secrete the hormones insulin and glucagon.



Connective tissues are tissues containing large amounts of material called extracellular matrix, located outside the cells. The matrix may be a liquid such as blood plasma, a solid containing fibers of collagen and related proteins, or an inorganic solid containing calcium salts, as in bone. Blood and lymph are connective tissues with a liquid matrix (plasma) that can solidify when the blood clots. In addition to plasma, blood contains red cells (erythrocytes), white cells (leukocytes), and the tiny platelets that help form clots. The many kinds of leukocytes include granular types (basophils, neutrophils, and eosinophils, all named according to the staining properties of their granules), monocytes, and several types of lymphocytes. Lymph contains lymphocytes and plasma only.


Most connective tissues have a solid matrix, which includes fibrous proteins such as collagen and elastic fibers in some cases. If all the fibers are arranged in the same direction, as in ligaments and tendons, the tissue is called regular connective tissue. The dermis of the skin is an example of an irregular connective tissue in which the fibers are arranged in all directions. Loose connective tissue and adipose (fat) tissue both have very few fibers. The simplest type of loose connective tissue with the fewest fibers is sometimes called areolar connective tissue. Adipose tissue is a connective tissue in which the cells are filled with fat deposits.


Hemopoietic (blood-forming) tissue occurs in bone marrow and the thymus, and it contains the immature cell types that develop into most connective tissue cells, including blood cells. Cartilage tissue matrix contains a shock-resistant complex of protein and sugar-like (polysaccharide) molecules. Cartilage cells usually become trapped in this matrix and eventually die, except for those closest to the surface. Bone tissue gains its supporting ability and strength from a matrix containing calcium salts. Its typical cells, called osteocytes, contain many long strands by which these cells exchange nutrients and waste products with other osteocytes and ultimately with the bloodstream. Bone also contains osteoclasts, large cells responsible for bone resorption and the release of calcium into the bloodstream.


Mesenchyme is an embryonic connective tissue made of wandering, amoeba-like cells. During embryological development, the mesenchyme cells develop into many different cell types, including hemocytoblasts, which give rise to most blood cells, and fibroblasts, which secrete protein fibers and then usually differentiate into other cell types.


Muscle tissues are specially modified for contraction. When a nerve impulse is received, overlapping fibers of the proteins actin and myosin slide against one another to produce the contraction. The three types of muscle tissue are smooth muscle, cardiac muscle, and skeletal muscle. The term striated muscle is sometimes used to refer to cardiac and skeletal muscle, both of which have cylindrical fibers marked by cross-bands, which are also called cross-striations. The striations are caused by the lining up of the contractile proteins actin and myosin. Smooth muscle contains cells with tapering ends and centrally located nuclei. Muscular contractions are smooth, rhythmic, and involuntary, usually not subject to fatigue. The cells are not cross-banded. Smooth muscle occurs in many digestive organs, reproductive organs, and skin, as well as in many other organs. Cardiac muscle occurs only in the heart. Its cross-striated fibers branch and come together repeatedly. Contractions of these fibers are involuntary, rhythmic, and without fatigue. Nuclei are located in the center of each cell; cell boundaries are marked by dark-staining structures called intercalated disks. Skeletal muscle occurs in the voluntary muscles of the body. Their cylindrical, cross-striated fibers contain many nuclei but no internal cell boundaries; a multinucleated fiber of this type is called a syncytium. Skeletal muscle is capable of rapid, forceful contractions, but it fatigues easily. Skeletal muscle tissue always attaches to connective tissue structures.


Nervous tissues contain specialized nerve cells called neurons that respond rapidly to stimulation by conducting nerve impulses. All neurons contain RNA-rich granules, called Nissl granules, in the cytoplasm. Neurons with a single long extension of the cell body are called unipolar, those with two long extensions are called bipolar, and those with more than two long extensions are called multipolar. There are two types of extensions: dendrites conduct impulses toward the cell body, while axons generally conduct impulses away from the cell body. Many axons are surrounded by a multilayered fatty substance called the myelin sheath, which is composed of many layers of cell membrane wrapped around the axon.


Nervous tissues also contain several types of neuroglia, cells that hold nervous tissue together. Many neuroglia cells have projections that wrap around the neurons and help nourish them. The many types of neuroglia include the tiny microglia and the larger protoplasmic astrocytes, fibrous astrocytes, and oligodendroglia.


Two major tissue types make up most of the brain and spinal cord, or central nervous system. The first type, gray matter, contains the cell bodies of many neurons, along with smaller amounts of axons, dendrites, and neuroglia cells. The second type, white matter, contains mostly the axons (and sometimes also the dendrites) of neurons whose cell bodies lie elsewhere along with the myelin sheaths that surround many of the axons. Clumps of cell bodies are called nuclei when they are found within the brain and ganglia when they occur elsewhere. Bundles of axons are called tracts within the central nervous system and nerves when they appear peripherally.


The body can be described by the use of directional terms, which are defined in a relative manner according to the location of a given body part or segment. Some important directional terms are superior, inferior, cranial, caudal, dorsal, ventral, medial, lateral, radial, ulnar, anterior, and posterior.



Disorders and Diseases

Diseases or disorders that affect the entire body are called systemic or multisystem diseases. For example, fevers or febrile diseases raise the body’s temperature. Many fevers are caused by infectious diseases such as influenza (actually a series of different viral infections). Influenzas cause fever, sore throat, muscle aches, coughs, headache, fatigue, and a general feeling of malaise.



Edema, or tissue swelling, is marked by an increase in the amount of extracellular fluid in several parts of the body at once. In the case of pulmonary edema, the fluid stains pink and fills the usually empty lung spaces (alveoli).


Most cancers are recognized by abnormalities of the cells in which they occur. The most dangerous cancers are marked by large tumors with ill-defined, irregular margins. If the cancer tumor is well defined, is small, and has a smooth, circular margin, then it is much less of a threat. Cancers are especially dangerous when they undergo metastasis, a process by which they produce wandering cells that spread throughout the body.


Juvenile diabetes mellitus (also called diabetes mellitus, type 1, and insulin-dependent diabetes mellitus, or IDDM), like most endocrine disorders, has systemic consequences throughout the body, including damage to nearly all the blood vessels. The primary defect in this disorder is a lack of insulin, which impairs the body’s ability to use glucose. Another endocrine disorder with systemic consequences is Addison’s disease, caused by a deficiency of adrenocorticotropic hormone (ACTH), which normally stimulates the cortex of the adrenal gland. Symptoms include weakness, loss of appetite, fatigue, weight loss, and reduced tolerance to cold. These symptoms result from imbalances in the levels of glucose and mineral salts throughout the body.



Systemic lupus erythematosus, a connective tissue disease, often produces red skin lesions marked by degeneration and flattening of the lower layers of the epidermis, drying and flaking of the outermost layer, dilation of the blood vessels under the skin, and the leakage of red blood cells out of these vessels, adding to the red color. (The word “erythematosus” means “red.”)



Muscular dystrophy has several forms; the most common is marked in its advanced stages by enlarged muscles in which the muscle tissue is replaced by a fatty substance. Another muscular disease, myasthenia gravis, is often marked by overall enlargement of the thymus and an increase in the number of thymus cells. Myocardial infarction, a form of heart disease marked by damage to the heart muscle, is noticed in histological section by dead, fibrous scar tissue replacing the muscle tissue in the heart wall. In patients with arteriosclerosis, the usually elastic walls of the arteries become thicker and more fibrous and rigid; many of the same patients also suffer from atherosclerosis, a buildup of deposits on the inside of the blood vessel, partially or completely blocking blood flow.


In nervous tissue, damage to peripheral nerves often results in a process called chromatolysis in the cell bodies of the neurons from which these axons arise. The nuclei of these cells enlarge and become displaced to one side, while the Nissl granules disperse and the cell body as a whole undergoes swelling. Increased deposits of fibrous tissue characterize multiple sclerosis and certain other disorders of the nervous system. Some of these diseases are also marked by a degeneration of the myelin sheath around nerve fibers. In the case of a cerebrovascular stroke, impaired blood supply to the brain causes degeneration of the neuroglia and is followed by general tissue death and the replacement of the neuroglia by fibrous tissue. Cranial hematoma (abnormal bleeding) results in the presence of blood clots, complete with blood cells and connective tissue fibers, in abnormal locations. Alzheimer’s disease is marked by granules of a protein-like substance called amyloid, often containing aluminum, surrounded by additional concentric layers of similar composition.



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How does the choice of details set the tone of the sermon?

Edwards is remembered for his choice of details, particularly in this classic sermon. His goal was not to tell people about his beliefs; he ...