In Chapter 1 of the novel To Kill a Mockingbird, how did Jem, Scout, and Dill pass the summer hours?

In Chapter 1, Jem and Scout meet Dill Harris, who spends the summers with his Aunt Rachel. After a short introduction, the children become close friends and begin to play together each day. Scout describes how they passed the summer hours by explaining their everyday routine. The children would work on improving their treehouse, act out plays, and attempt to make the notorious Boo Radley come out of his house. Scout refers to Dill Harris as a "pocket Merlin" who is capable of playing numerous characters and coming up with eccentric plans. Some of the plays the children would act out included Tarzan, Tom Swift, and The Rover Boys. Dill Harris becomes fascinated with the Radley house and bets Jem that he won't touch it. At the end of Chapter 1, Jem builds up enough courage to run into the yard and slap the side of the Radley house. Throughout the novel, the children go on numerous adventures and experience life changing events that shape the way they view the world around them.

How does Hurston reveal Nanny's motivation for forcing Janie to marry? Is that motivation pure, malevolent, or something in between in Their Eyes...

Nanny's motivation is out of love and concern for her granddaughter. It is not entirely pure, but it is certainly not malevolent.

When she sees "Johnny Taylor lacerating Janie with a kiss," Nanny calls Janie to her and takes action. She tells Janie that she is a woman now; further, she explains to Janie that she is now old and she wants Janie married so that she will be protected from harm. She explains that she does not want Janie to go the way of her mother, who became wild and ran away. In her frustration and worry, she slaps Janie, but then she weeps with Janie. She tells Janie that she would not hurt Janie for any reason; she is just so worried that Janie will act irresponsibly upon her sexual urges. Nanny rocks with Janie in her arms, saddened that Janie has begun to mature, and worried for her safety.

"'Tain't Login Killicks Ah wants you to have, baby, it's protection. Ah ain't gittin' ole, honey....Mah daily prayer now is tuh let dese golden moments rolls a few days longer till Ah see you safe in life."

Her grandmother tells Janie both her personal history and that of her mother. Because they were both abused by men, Nanny wants to protect her granddaughter and ensure that nothing like hers and her daughter's experiences happen. Her motivation is good, but the arrangement with the older man, Logan Killicks, is not wise because, while he may be able to protect Janie, he is too old to relate well to Janie and too old for Janie to love. 

List and explain the four major causes of World War I.

There were several causes of World War I. Some had been building up for decades and just needed a spark to start a huge conflict. One cause of World War I was imperialism. Countries like Germany and Italy, that became unified countries around 1870, wanted to gain colonies. However, by the time they united into a country, most of the land available for colonization was already gone. Thus, one way to get colonies was by going to war.

Another cause was nationalism. People within various countries began to develop intense feelings of pride. They believed they could do whatever they wanted because their way of life was the best. They weren’t worried about what other countries might think or do because they felt they were better than any other country. If a war started, they believed they would win the war because of these strong feelings of pride.

Entangling alliances and militarism also led to World War I. Countries were building up their militaries throughout Europe. This was an ominous sign because usually there is a reason for a building up of the military. Since countries had formed alliances with other countries to protect themselves in the case of an attack, a situation developed where a conflict between a country in one alliance against a country in another alliance could easily escalate into a multi-nation war. This is what happened in World War I, when Austria-Hungary, a member of the Triple Alliance, declared war on Serbia, a country that was closely allied with Russia, which was a member of the Triple Entente.

The assassination of Franz Ferdinand was the spark that ignited World War I. There were people in Europe that were being ruled by people who weren’t of the same nationality as they were. For example, some Serbians were ruled by Austria-Hungary. These Serbians wanted Austria-Hungary to give the area where these Serbians lived to Serbia so that Serbians would rule Serbians. This concept of self-determination existed in many places in Europe. When Austria-Hungary refused to do this, a plot was developed and carried out to kill Franz Ferdinand, the next King of Austria-Hungary. This assassination set in motion a series of events that led to the start of World War I when Austria-Hungary declared war on Serbia, and Russia, a close ally of Serbia, declared war on Austria-Hungary. Other joined the war because of the alliances they had with each other. World War I had begun.

What is group B streptococcal infection?

Definition

Group B streptococcal (GBS) disease is a bacterial
infection. These bacteria live in the gastrointestinal and
genitourinary tracts and are found in the vaginal or rectal areas of 10 to 35
percent of all healthy adult women.

GBS can cause illness in newborns, pregnant women, the elderly, and adults with
other chronic medical conditions, such as diabetes or liver disease. In newborns, GBS is the most common cause of bacteremia or
septicemia (blood infection) and meningitis
(infection of the fluid and lining surrounding the brain). GBS in pregnant women
and their fetuses and newborns are discussed here.

Causes

GBS is caused by the bacterium
Streptococcus agalactiae. Not all fetuses and babies who are exposed to the bacterium will become infected, but those who have become infected with GBS got the infection in one of three ways: before birth, during delivery, and after birth. Before birth, bacteria in the vagina spread up the birth canal into the uterus and infect the amniotic fluid surrounding the fetus. The fetus becomes infected by ingesting the infected fluid. During delivery, the fetus can become infected by contact with bacteria in the birth canal; after birth, the newborn can be infected through physical contact with the mother.

Risk Factors

Factors that increase the risk of a baby contracting GBS are the mother having
already had a baby with GBS disease, the presence of GBS bacteria in the current
pregnancy, the mother having a urinary tract infection caused by GBS,
going through labor or experiencing a rupture of the membranes before thirty-seven
weeks gestation, experiencing a rupture of the membranes for eighteen hours or
more before delivery, and the mother having a fever during labor.

Symptoms

In pregnant women, GBS infections can cause endometritis, amnionitis, and septic abortion. In newborns, two forms of infection occur: early-onset and late-onset. Early-onset GBS disease usually causes illness within the first twenty-four hours of life. However, illness can occur up to six days after birth. Late-onset disease usually occurs at three to four weeks of age; it can occur any time from seven days to three months of age. Symptoms of both kinds of GBS include breathing problems, not eating well, irritability, extreme drowsiness, unstable temperature (low or high), and weakness or listlessness (in late-onset disease).

Screening and Diagnosis

GBS can be diagnosed in a pregnant woman at a doctor’s office. Testing for GBS should be done about one month before the baby is due. The doctor swabs the pregnant woman’s vagina and rectum and sends these samples to a laboratory to test for GBS. Test results are available in twenty-four to forty-eight hours. The doctor may also order blood tests.

Treatment and Therapy

Women who test positive for GBS or who are at high risk may receive intravenous
antibiotics during labor and delivery. Penicillin or
ampicillin is usually used. Women who are allergic to penicillin or ampicillin may
be given clindamycin or erythromycin instead. It is generally not recommended that
women take antibiotics before labor to prevent GBS (unless GBS is identified in
the urine). Studies have shown that antibiotics are not effective at earlier
stages.

If the doctor suspects strep B infection in the newborn, the newborn might be kept in the hospital for observation by staff. If the baby is diagnosed with GBS, he or she will be treated with intravenous antibiotics for ten days. Even with the existence of screening tests and antibiotic treatment, some babies can still get GBS disease.

Prevention and Outcomes

Methods to prevent GBS include screening pregnant women at thirty-five to thirty-seven weeks into the pregnancy and giving antibiotics during labor and delivery to women who are carriers of GBS bacteria, who have previously had an infant with invasive GBS disease, who have GBS bacterium in the present pregnancy, who go into labor or have a rupture of the membranes before the fetus has reached an estimated gestational age of thirty-seven weeks, who have a rupture of membranes for eighteen hours or more before delivery, who have a fever during labor, or who have a urinary tract infection with GBS. Another option is to give antibiotics (usually penicillin) to newborns who were exposed to the bacterium. No vaccine exists for the disease.

Bibliography

Centers for Disease Control and Prevention. “Provisional Recommendations for the Prevention of Perinatal Group B Streptococcal Disease.” Available at http://www.cdc.gov/groupbstrep/guidelines/provisional-recs.htm.

Cunningham, F. Gary, et al., eds. Williams Obstetrics. 23d ed. New York: McGraw-Hill, 2010.

Martin, Richard J., Avroy A. Fanaroff, and Michele C. Walsh, eds. Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 2 vols. 8th ed. Philadelphia: Mosby/Elsevier, 2006.

Phares, C. R., et al. “Epidemiology of Invasive Group B Streptococcal Disease in the United States, 1999-2005.” Journal of the American Medical Association 299, no. 17 (2008): 2056-2065.

Remington, Jack S., et al., eds. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia: Saunders/Elsevier, 2006.

Wilson, Michael, Brian Henderson, and Rod McNab. Bacterial Disease Mechanisms: An Introduction to Cellular Microbiology. New York: Cambridge University Press, 2002.

How can Macbeth be interpreted as a victim of his time who was misled and manipulated into committing murder?

In eleventh-century Scotland, most people would certainly have believed in witches as well as a witch's ability, in part, to prophesy the future. Therefore, when Macbeth is confronted by the Weird Sisters, it is not a leap to assume that he will believe in their legitimacy. This belief would make him much more likely interpret their words as truth rather than to be on his guard about their motives. The audience gets clues about their motives, though, because we see them planning his deception. In Act 1, Scene 1, they discuss their forthcoming meeting with Macbeth, saying that "Fair is foul, and foul is fair" (1.1.12-13). In other words, things that seem good are actually going to be bad, and things that seem bad will truly be good. Thus, when the sisters tell Macbeth that he will be king, it will seem great though it will actually be quite bad. Hecate's later plan to "draw him on to his confusion" by making Macbeth feel "secur[e]" so that he lets down his guard and is rendered more vulnerable is further evidence that the Weird Sisters seek to manipulate Macbeth with their statements, and these statements will appear to be prophecy but are really designed to prompt Macbeth to behave badly in order to make them come true (3.5.29, 32). In this way, it is not fate that Macbeth kills Duncan, but it is rather the result of his being manipulated into corrupt behavior by the Weird Sisters, who he perhaps only trusts because such things are thought to be possible in his era.

Macbeth is manipulated by his wife and her arguments regarding right behavior for men in this era as well. In Act 1, Scene 7, he lists the myriad reasons he has not to kill Duncan, and the only reason he has to go forward with the murder is his "Vaulting ambition" (1.7.27). Moments later, however, he tells Lady Macbeth that he "will proceed no further in this business" (1.7.34). In other words, he has decided that ambition is not enough reason to commit this terrible crime. Lady Macbeth then attacks his manhood, saying that if he does not go through with their plan, he will have to "live a coward in [his] own esteem" (1.7.47). She implies that he is not a man if he does not act as they've planned, and she swears that she would kill her own child if she had promised him to do so rather than go back on a promise she made to him. In this era, men were very much supposed to be the kings of their own castles and masters of their families. By insulting his masculinity, or lack thereof, she suggests that he is not a man to be respected by their era's standards: for them, men should be ruthless, powerful, determined. For Macbeth to make a decision and then renege on it makes him seem weak, she says, and she is embarrassed by his weakness. Were the gender roles of this era less rigid, less polarized, then Macbeth might not have been so easily manipulated by his wife. In the end, his ambition is not enough to prompt the murder, but his pride is.

Who wrote the gospel of Mark and why?

The authorship of the gospels is tricky, as they were all initially anonymous before later tradition ascribed authors to them. The Gospel of Mark is, originally, anonymous. We attach Mark to this particular gospel because the bishop Papias of Hierapolis did so around the year 100, himself referring an earlier tradition:

Mark, in his capacity as Peter’s interpreter, wrote down accurately as many things as he recalled from memory—though not in an ordered form—of the things either said or done by the Lord.

If this is to be believed, as the Church traditionally has, then the Gospel of Mark was written by the disciple Mark as an account of St. Peter’s recollections. The Gospel of Mark holds an interesting place in Christian scripture as the oldest canonical gospel and one of the direct sources for two of the other canonical gospels, the Gospels of Luke and Matthew. According to biblical scholarship, the Gospel of Mark was used as a basis for material for both Luke’s and Matthew’s gospels.

As for why, the Gospel of Mark seems to be written to reach Greek Christians who were mostly unfamiliar with Judaism and the Jewish context for a Messiah. The author of this gospel certainly wrote for a Greek-speaking Christian audience, as the language itself was Greek and the author explains Jewish customs and Aramaic terms to his readers. Interestingly, many scholars discredit Papias and his claim that the contents of the gospel were based on Peter's recollection; making that link would in turn make the Gospel of Mark a more authoritative and reliable document. 

If Christopher Columbus had never landed in North America, what would have happened to the culture, economy, religion, demographics and relations...

Of course, we will never be able to know for sure what would have happened if Christopher Columbus had not “discovered” the New World.  However, I am as certain as I can be that the course of history would not have changed significantly if Columbus’s three ships had been lost at sea or if he and his men had been massacred by natives when they landed.  Some European explorer would inevitably have come across the Americas and history would have played out roughly as it did in our world.

By the late 1400s, European countries had a strong incentive to explore and they had the best technology in the world with which to do dominate the people that they “discovered.”  European countries were hungry for spices and people who could bring those spices to their markets could make tremendous amounts of money.  For this reason, mariners were strongly motivated to explore and to see if they could find ways to get to places that had spices.  The Europeans were also motivated by the desire to find gold and other precious metals and to convert people to Christianity.  These things meant that Europeans would have kept exploring even if Columbus’s expedition had never returned.

If the Europeans kept exploring, they would inevitably have found the Americas.  If they found the Americas, they would surely have dominated its people.  They had technology that was vastly superior to the technology that the natives had.  They had guns, steel weapons, horses, writing, and other useful technologies that the natives lacked.  Moreover, they carried with them the germs of infectious diseases that would have decimated the native populations whenever they came in contact with Europeans.  In other words, there is no way that the natives of the Americas would have been able to effectively resist large numbers of Europeans for long.

With all this in mind, it is impossible for me to imagine any plausible scenario in which the Europeans did not come to dominate the Americas.  Because the Europeans would inevitably have come to dominate the New World, none of the things you mention would have turned out significantly differently if Columbus had never landed in the Americas.

How would you apply Piaget's stages of cognitive development to children with disabilities?

Piaget’s Stages of Cognitive Development essentially establishes the development of certain schemas over time to illustrate cognitive growth. A schema is an idea or thought process about what things are and how an individual deals with them. For each stage, Piaget lists specific schemas that are either first developed or have been expanded upon. For example, the sensorimotor stage begins with the schema of movement, meaning the child’s behaviors are entirely reflexive and in response to stimuli. Later, action schemas develop in which the child has learned to use some muscles and limbs for movement, with more conscious intention. Arguably, applying these stages to children with disabilities involves the same process as evaluating any child. The focus of this theory is on the development of an individual’s thought process over time. Evaluating a child, including one with a disability, involves identifying which schemas they currently utilize and if/how those ideas have evolved. While the tests themselves might be different depending on the ability of the child in question, all results could then be compared to the respective schemas for each stage to identify which stage best corresponds to the individual’s current thought processes. The importance is on which schemas an individual possess, not on when they have developed. The age ranges included with the stages are merely averages, and are objects of criticism in themselves. Piaget even notes that there will be individual differences in the rates of progress through the steps. While this theory posits that individuals cannot skip steps, not every individual will progress to the later steps.

What is the ebola virus?

Causes and Symptoms

The Ebola virus is named after the Ebola River in northern Zaire (now the Democratic Republic of the Congo), Africa. The virus was first detected in 1976, when hundreds of deaths were recorded in Zaire as well as in neighboring Sudan. Four species of the Ebolavirus genus cause human disease: Zaire ebolavirus (EBOV), Sudan ebolavirus (SUDV), Bundibugyo ebolavirus (BDBV), and Taï Forest ebolavirus (TAFV). A fatal disease among cynomolgus laboratory monkeys that were imported from the Philippines to Texas in 1996 was caused by the Reston ebolavirus (RESTV) subtype, which causes disease in nonhuman primates and in pigs but is not known to cause symptoms in humans. Another devastating outbreak among humans took place in early 1995 in Kikwit, Zaire, claiming the lives of 250 out of 315 reported patients, an 88 percent fatality rate. The epidemic ended within a few months, as suddenly as it began; this puzzled scientists, who are still not fully aware of the causes and nature of the virus. Despite the dreadful speed with which the disease killed its victims, scientists were able to contain it with a relatively small number of fatalities.

Outbreaks in Africa have continued to occur, some of them severe. A 2007 outbreak in the Democratic Republic of the Congo resulted in 264 cases and 187 deaths. Starting in February 2014, several West African countries were hit by the largest outbreak to date, with 3,069 reported cases (both confirmed and suspected) and 1,552 deaths as of August 26. Between September and October 2014, one man who had traveled to the United States from Liberia tested positive for Ebola and passed away days later; a handful of health care workers, including two who had been treating the Ebola patient at the hospital in Texas and two who had been missionary workers in Liberia, tested positive for the disease but recovered in the United States. By early March 2015, the Centers for Disease Control, in conjunction with the World Health Organization (WHO), reported 14,314 laboratory-confirmed cases and 9,714 deaths in Guinea, Liberia, and Sierra Leone.

The Ebola virus appears to have an incubation period of two to twenty-one days, after which time the impact is devastating. The patient exhibits appetite loss, increasing fever, headaches, and muscle aches. The next stage involves disseminated intravascular coagulation (DIC), a condition characterized by both blood clots and hemorrhaging. The clots usually form in vital internal organs such as the liver, spleen, and brain, with subsequent collapse of the neighboring capillaries. Other symptoms include vomiting, diarrhea with blood and mucus, and conjunctivitis. An unusual type of skin irritation known as maculopapular rash first appears in the trunk and quickly covers the rest of the body. The final stages of the disease involve a spontaneous hemorrhaging from all body outlets, coupled with shock and kidney failure, and typically death within eight to seventeen days.

Treatment and Therapy

The Ebola virus is classified as a ribonucleic acid (RNA) virus and is closely related to the Marburg virus, first discovered in 1967. Ebolavirus and Marburgvirus are two of only three identified genera in the Filoviridae family, which was first officially established in 1987; the third, Cuevavirus, was only added in 2013.

Electron microscope studies show the Ebola virus as long filaments, 650 to 14,000 nanometers in length, that are often either branched or intertwined. Its virus part, known as the virion, contains one single noninfectious minus-strand RNA molecule and an endogenous RNA polymerase. The lipoprotein envelope contains a single glycoprotein, which behaves as the type-specific antigen. Spikes are approximately seven nanometers in length, are spaced at approximately ten-nanometer intervals, and are visible on the virion surface. It is believed that once in the body, the virus produces proteins that suppress the organism’s immune system, thus allowing its uninhibited reproduction.

In 2002, researchers announced a new discovery about how Ebola enters and subverts human cells. Findings show that the virus targets “lipid rafts,” tiny fat platforms that float atop the membranes of human cells. These rafts act as gateways for the virus, the assembly platform for making new virus particles, and the exit point where new particles bud. This research is a significant step toward one day creating drugs that will stop viruses from replicating.

The Ebola virus can be transmitted through contact with body fluids, such as blood, semen, mucus, saliva, urine, and feces. It is thought that the first person in an outbreak acquires the virus through contact with an infected animal, including carcasses of dead animals. In early 2015, researchers for the National Institutes of Health conducting a study on macaque monkeys determined that the virus can remain infectious in a corpse for up to one week, and it can still be detected for close to ten weeks.

The level of infectivity of the Ebola virus is quite stable at room temperature. Its inactivation is accomplished via ultraviolet or gamma irradiation, 1 percent formalin, beta propiolactone, and an exposure to phenolic disinfectants and lipid solvents, such as deoxycholase and ether. The virus isolation is usually achieved from acute-phase serum of appropriate cell cultures, such as MA-104 cells from the kidney cell line of fetal rhesus monkeys. Satisfactory results have been accomplished using tissues obtained from the liver, spleen, lymph nodes, kidneys, and heart during autopsy. Virus isolation from brain and other nervous tissues, however, has been rather unsuccessful so far. Neutralization tests have been inconsistent for all filoviruses; Ebola strains show cross-reactions in tests of immunofluorescence assays.

There appears to be no known or standard treatment for Ebola fever. No chemotherapeutic or immunization strategies are available, and no antiviral drug has been shown to provide positive results, even under laboratory conditions. There is indirect evidence that convalescent blood transfusions may improve survival rates among patients, and certain monoclonal antibodies and RNA interference (RNAi) therapies have shown some effectiveness in nonhuman primates. During the 2014 outbreak, the monoclonal antibody ZMapp was given to several infected patients with mixed but potentially promising results. As of early 2015, two potential vaccines were under study.

Aside from experimental treatments, therapy for Ebola patients involves sustaining the desired fluid and electrolyte balance by the frequent administration of fluids. Bleeding may be fought off with blood and plasma transfusion. Sanitary conditions to avoid further contact with the disease are required. Proper decontamination of medical equipment, isolation of the patients from the rest of the community, and prompt disposal of infected tissues, blood, and even corpses limit the spread of the disease.

Perspective and Prospects

The puzzling characteristics of the Ebola virus are the location of its primary natural reservoir, its sudden eruption and quick end, and the unusual discovery of the virus in the organs of people who have survived it.

In the past, experimental work on the virus has been slow because of its high pathogenicity. The progress of recombinant deoxyribonucleic acid (DNA) technology has shed the first light on the molecular structure of this virus. It is hoped that further work using this technique as well as results from viruses of lower pathogenicity, such as the Reston virus, will provide the desired information on replication and virus-host interactions. Finally, the improvement of the various diagnostic tools will allow more accurate virus identification and assessment of transmission modes.

In 1995, investigators and epidemiologists from the WHO captured about three thousand birds, rodents, and other animals and insects that were suspected of spreading the disease in order to investigate the source of the virus. The results were obscure and inconclusive, and the main facts about the disease are still a mystery, with the exception of the established link between primates and Ebola virus infection in humans. This conclusion was reached after a researcher in Côte d'Ivoire contracted the Taï Forest virus in 1994 after performing an autopsy on an infected chimpanzee. This was the first—and, as of 2014, only—known human case of the Taï Forest subtype, which was subsequently named for the Taï National Park forest reserve in Côte d'Ivoire where the researcher had been working. The infection ultimately proved nonfatal.

Despite this evidence, however, the human outbreaks in the Democratic Republic of the Congo, Sudan, and West Africa have not been traced to primates. Certain species of fruit bat are suspected to be a natural source of the disease, but evidence of the virus has yet to be isolated in any specimen. As long as these puzzling questions linger, the disease should be contained as much as possible, with particular emphasis on the improvement of sanitary conditions and the control of body-fluid contact.

Bibliography

Balter, Michael. “On the Trail of Ebola and Marburg Viruses.” Science 290.5493 (2000): 923–25. Print.

Biddle, Wayne. A Field Guide to Germs. 3rd ed. New York: Anchor, 2010. Print.

Dyer, Nicole. “Killers without Cures.” Science World 2 Oct. 2000: 8–12. Print.

"Ebola." MedlinePlus. Natl. Lib. of Medicine, 27 Feb. 2015. Web. 3 Mar. 2015.

"Ebola Hemorrhagic Fever." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2 Mar. 2015. Web. 3 Mar. 2015.

"Ebola Virus Disease." World Health Organization. WHO, Sept. 2014. Web. 3 Mar. 2015.

Feldmann, Heinz. "Ebola: A Growing Threat?" New England Journal of Medicine. Massachusetts Medical Soc., 7 May 2014. Web. 28 Aug. 2014.

Gatherer, Derek. "The 2014 Ebola Virus Disease Outbreak in West Africa." Journal of General Virology 95.8 (2014): 1619–24. Print.

Jaax, Nancy, and Jerry Jaax. "Lethal Viruses, Ebola, and the Hot Zone: Worldwide Transmission of Fatal Viruses." E. N. Thompson Forum on World Issues. University of Nebraska–Lincoln. 22 Oct. 1996. Lecture.

Peters, C. J., and J. W. LeDuc. “An Introduction to Ebola: The Virus and the Disease.” Supp. to Journal of Infectious Diseases 179.1 (1999): ix–xvi. Print.

Rollin, Pierre E., et al. “Arenaviruses and Filoviruses.” Manual of Clinical Microbiology. Ed. James Versalovic et al. 10th ed. Vol. 2. Washington: ASM, 2011. 1514–29. Print.

Sifferlin, Alexandra. "Ebola Bodies Are Infectious a Week after Death, Study Shows." Time. Time, 13 Feb. 2015. Web. 3 Mar. 2015.

Strauss, James H., and Ellen G. Strauss. Viruses and Human Disease. 2nd ed. Burlington: Academic, 2008. Print.

"2014 Ebola Outbreak in West Africa." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2 Mar. 2015. Web. 3 Mar. 2015.

What things point out the tragic ending of "The Scarlet Ibis?"

It shouldn't be surprising that death lurks at the end of James Hurst's short story "The Scarlet Ibis." Hurst uses foreshadowing throughout the story to suggest a tragic ending. The narrator and brother of Doodle is telling the story from many years after the events took place so his narration is colored by references to death since he already knows that Doodle will not live.

In the very first paragraph he uses death imagery:

The last graveyard flowers were blooming, and their smell drifted across the cotton field and through every room of our house, speaking softy the names of our dead. 

Death is present in the first part of the story when it is revealed the family, except Aunt Nicey, thought Doodle would die as an infant. In one scene, the brother even shows Doodle the coffin which was originally meant for him. He forces Doodle to touch it and threatens to run away if his brother doesn't do so. The scene foreshadows later events when the brother runs away from Doodle in the rainstorm, prompting the boy's death.

In the fantasy story Doodle tells about Peter and the peacock, the narrator uses an almost deathlike reference to sleep:

When Peter was ready to go to sleep, the peacock spread his magnificent tail, enfolding the boy gently like a closing go-to-sleep flower, burying him in the glorious iridescent, rustling vortex.

The boy's mother also mentions the dead soldiers from World War I, praying over a neighbor's son who died in the war. The biggest reference to death involves the ibis which is a symbol for Doodle. After the bird dies, Doodle buries it and even sings a hymn over the bird's grave. After the death of the bird, the boy's aunt comments:

"Dead birds is bad luck," said Aunt Nicey, poking her head from the kitchen door. "Specially red dead birds!" 

The death of the bird foreshadows Doodle's death and the color red, which is present throughout the story (scarlet ibis, bleeding tree, mahogany coffin) is part of this focus on death.

How did trade between Nova Scotia and the West Indies improve the lives of the people?

Trade between Nova Scotia and the West Indies, which both produced diverse goods, played an important role in what was available to the people of both regions.  Nova Scotia shipped goods such as timber (spruce, pine, and balsam fir) and fish (haddock, mackerel, Atlantic salmon, and others) to the West Indies.  Merchants from the West Indies shipped goods such as rum and sugar cane to Nova Scotia.  People who lived in the West Indies benefitted from access to Nova Scotian goods, which they could not find at home.  The Nova Scotians enjoyed access to sugar and rum from the West Indies.

When Britain ruled the regions that made up the American Colonies, Nova Scotia, and the West Indies, trade was active and easy.  After the American Revolution when the United States became a separate country, trade relations between Nova Scotia and the West Indies strengthened.  Trade influence grew among merchants in Halifax.  Britain discouraged trade between the West Indies and the United States, but this did not stop it from continuing.  The United States produced a larger variety of goods because of more diversity in climate and landscape.  The options of goods available for trade were far greater in the United States than in Nova Scotia.

What is Epstein-Barr virus?

Causes and Symptoms

Present only in humans, Epstein-Barr virus was the first documented oncovirus. The virus, resembling other human herpesviruses, consists of sphere-shaped, barbed virions approximately 120 to 220 nanometers in diameter. Each Epstein-Barr virus genome contains two strands of deoxyribonucleic acid (DNA). A protein shell protects the genome, and an envelope surrounds the protein shell. Various Epstein-Barr virus strains have evolved that can infect an individual at the same time.

The Epstein-Barr virus typically infects
salivary gland
cells or B cells. Usually, Epstein-Barr viral infections are transmitted through saliva. Seeking host cells in order to replicate, the Epstein-Barr virus proliferates, creating approximately one hundred types of antigens, including nuclear antigen EBNA 1, which the Epstein-Barr virus uses to put its DNA into new cells created during cell division.

T cells fight Epstein-Barr virus antigens by destroying infected host cells. T cells and antibodies stay in the immune system to continue protecting against infection, regulating latency, and developing immunity. EBNA1 is necessary for the Epstein-Barr virus genomes to endure being latent. T cells cannot detect the antigen EBNA1 and attack those host cells, which results in the Epstein-Barr virus often being invisible to immune protection. Latent infections are not apparent, usually remaining passive, but they can become active, potentially resulting in tumors and diseases.

The Epstein-Barr virus usually infects throat, blood, or immune system cells. Infectious mononucleosis, also known as glandular fever, is the most widely known Epstein-Barr viral infection. Physicians determine if people have been infected by Epstein-Barr virus by performing laboratory tests analyzing blood samples to detect if any of the antibodies to combat Epstein-Barr virus antigens are present and, if so, how many are present. Such antibodies might have existed for years and are not proof of an active infection.

People can contract the virus as children, adolescents, or adults, depending on geographic location and socioeconomic factors. Some infants are born with the virus transmitted by their mothers. The Epstein-Barr virus usually infects people when they are children, without obvious signs. Often, these individuals never know that they are infected. Approximately half of the people who contract the Epstein-Barr virus as an adolescent or at an older age, however, develop infectious mononucleosis.

Activated Epstein-Barr virus can result in several serious diseases, and people with suppressed immune systems are vulnerable to developing such malignancies as cancerous tumors in smooth muscle tissue, stomach carcinomas, lymphomas, and sarcomas. Epstein-Barr virus often causes nasal and throat cancers known as nasopharyngeal
carcinoma. In some individuals with Acquired immunodeficiency syndrome (AIDS), Epstein-Barr virus replicates in tongue cells, resulting in oral hairy leukoplakia. Epstein-Barr virus has also been associated with leukemia.

Weak immune systems cause people to be vulnerable to Epstein-Barr virus infections, particularly after organ transplantation and the use of immunosuppressive drugs to lower the immune reaction and to encourage acceptance of the new organ. In those cases, Epstein-Barr virus sometimes causes post-transplant lymphoproliferative disease to occur.

When it infects the nodes, Epstein-Barr virus might be a factor in people affected by Hodgkin disease. Researchers have considered a possible role of Epstein-Barr virus in the development of multiple sclerosis and breast cancer. They have eliminated it as a factor in chronic fatigue
syndrome.

Treatment and Therapy

Approximately 90 to 95 percent of humans globally at any time have been infected with Epstein-Barr virus, which remains latent and endures in their bodies until death. There is currently no way to eliminate the virus once infection has occurred. Treatment focuses instead on the diseases that Epstein-Barr virus causes.

Researchers have attempted to develop antiviral vaccines to stop the replication of Epstein-Barr virus. In the early twenty-first century, scientists at Queensland Institute of Medical Research developed a vaccine prototype to strengthen T cells combatting Epstein-Barr virus antigens.

Perspective and Prospects

The Epstein-Barr virus was located as a result of researchers seeking viruses possibly associated with cancer in humans, In 1961, London researcher M. Anthony Epstein attended a lecture at which Denis P. Burkitt discussed his work with tumors, later called Burkitt lymphoma, in African children’s facial bones. Epstein, experienced with investigating viruses causing animal tumors, wanted to examine Burkitt lymphoma
tumor tissues to detect any viruses. The British Empire Cancer Campaign funded Epstein’s travel to Uganda to acquire a consistent supply of tumor samples for his Middlesex Hospital Medical School laboratory. Epstein tried unsuccessfully to locate a virus for a couple of years.

The U.S. National Cancer Institute presented Epstein $45,000 for his investigations, and he hired doctoral student Yvonne M. Barr and colleague Bert G. Achong to expand his laboratory work attempting to culture viruses. The trio successfully grew a Burkitt lymphoma cell line in culture. When cells from that sample were examined with an electron microscope, the London scientists saw viral particles with structural elements of herpesvirus. Scrutinizing the virions, the trio declared that they had isolated a previously unknown human herpesvirus. They published their results in a 1964 Lancet article. After Epstein-Barr virus was identified, additional investigators studied the virus to expand knowledge of its structure, replication, and the diseases associated with it, determining that it was an oncovirus.

Research into ways to fight Epstein-Barr virus is ongoing. Scientists at the European Molecular Biology Laboratory and Institut de Virologie Moléculaire et Structurale have focused on controlling a protein molecule known as ZEBRA that accompanies Epstein-Barr virus, helping activate it from the latent phase.

Bibliography

Cohen, Jeffrey I., et al. "The Need and Challenges for Development of an Epstein-Barr Virus Vaccine." Vaccine 31 (April, 2013): B194–B196.

Epstein, M. Anthony, and Bert G. Achong, eds. The Epstein-Barr Virus. New York: Springer, 1979.

Ford, Jodi L., and Raymond P. Stowe. "Racial-Ethnic Differences in Epstein-Barr Virus Antibody Titers Among U.S. Children and Adolescents." Annals of Epidemiology 23, no. 5 (May, 2013): 275–280.

Odumade, Oludare A., Kristin A. Hogquist, and Henry H. Balfour, Jr. "Progress and Problems in Understanding and Managing Primary Epstein-Barr Virus Infections." Clinical Microbiology Review 24, no. 1 (January, 2011): 193–209.

Jackson, Alan C. Viral Infections of the Human Nervous System. New York: Springer, 2013.

Robertson, Erle S., ed. Epstein-Barr Virus. Norfolk, England: Caister Academic Press, 2010.

Tselis, Alex C., and Hal B. Jenson, eds. Epstein-Barr Virus. New York: Taylor & Francis, 2006.

Umar, Constantine S., ed. New Developments in Epstein-Barr Virus Research. New York: Nova Science, 2006.

Wilson, Joanna B., and Gerhard H. W. May, eds. Epstein-Barr Virus Protocols. Totowa, N.J.: Humana Press, 2001.

If you ride your bicycle at an average speed of 15 km/h for 2 hours, how far will you go?

Distance traveled is a function of the speed of an object and the time during which it maintained the speed. Distance is calculated as the product of speed of the object and the time duration. That is,

Distance traveled = average speed x time

In this case, the average speed of the bicycle is given as 15 km/h and the time duration is given as 2 hours. Thus, the distance traveled can be calculated as:

distance traveled by the bicycle in 2 hours = speed of bicycle x time duration

= 15 km/h x 2 h = 30 km.

Thus, the bike will travel a distance of 30 km in 2 hours, if the average speed of the bicycle is 15 km/h.

Note that if the average speed was not given, we would need to multiply speed and time for all the duration when speed was different. In that case, distance traveled would have been:

distance = `sum_(n=1)^oo` `speed_n xx time_n`

Hope this helps.

Do George and Candy buy the farm after Lennie dies in Of Mice and Men?

According to what the reader knows from the novel, George and Candy never buy the farm. In Chapter Five, after Candy discovers Curley's wife dead in the barn, Candy immediately alerts George and shows him the body. While they are alone together Candy asks George,

“You an’ me can get that little place, can’t we, George? You an’ me can go there an’ live nice, can’t we, George? Can’t we?” 

Candy hopes that he and George can go to the farm which has been George's and Lennie's dream. It becomes possible because of the money Candy contributes. Unfortunately George doesn't want to continue with the dream without Lennie. Steinbeck writes,

Before George answered, Candy dropped his head and looked down at the hay. He knew. 

Candy knows George can't go along to the farm minus his best friend. George says, 

“—I think I knowed from the very first. I think I know’d we’d never do her. He usta like to hear about it so much I got to thinking maybe we would.”

Afterward George goes on with his old story about buying whiskey, sitting in a poolroom or going to a whorehouse. The assumption is that George will be like the rest of the lonely men who roam the country looking for work.

What is the significance of hands for Lennie in Of Mice and Men?

In "Of Mice and Men," hands take on a symbolic quality, and often reflect the characteristics of the those to whom they are attached. For example, Curley is described as keeping one of his hands in a vaseline-filled glove at all times, to keep it soft for his wife. His other hand is free for cruelty and beatings, as Lennie will soon find out. Thus, Curley's true nature is revealed both by his gloved hand, which is unnaturally, publicly, and deceptively softened, and his un-gloved hand, which is openly sadistic. He is the kind of man who believes that cheap, quick fixes, such as moisturizing one of his hands, will cause his wife to love him more, and trick her into thinking that he is actually a good man. He is superficial and silly, yet cunning and malevolent.

In contrast, Lennie's hands are quite paw-like, and he is described as being shapeless. Lennie's hands, and the rest of his body, reflect his child-like, innocent, and almost animalistic nature. They lack George's characteristic cleverness, or Curley's sadism. Unlike Curley, Lennie has neither the desire nor the ability to hide his true intentions. Ultimately, the brute strength of Lennie's hands, combined with his innocence, leads to his demise. He kills Curley's wife by accident, and, as a result, both his and George's dreams are irrevocably crushed.

Last, Curley's wife is described as having red nails. Her hands, and the rest of her, are soft, delicate, and alluring. In particular, her nails reflect her sense of beauty, pride, and flirtatiousness. She is, in many ways, the polar opposite of Lenny, who is huge, hulking, and oblivious. She is also a dangerous figure on the ranch, as Curley will attack any man who tries to connect with her. However, her nails also reveal a second, and perhaps more critical, aspect of her personality: she has dreams. Indeed, Curley's wife wants to be an actress, but because of her current situation (that is, her marriage to Curley, and her isolation), she cannot achieve it. Thus, her red nails and sausage-like curls represent her hope, and her unwillingness to let go of an impossible dream. Like Lennie and George, she yearns for a brighter future.

What role did the slave trade have in the establishment of centers of wealth in the West? Was that connected to the Industrial Revolution?

Slavery and the Industrial Revolution were highly connected in the Western world, particularly in what we now know as the United States. It has been suggested that profits from the slave trade fostered the Industrial Revolution, but it is more likely that the alternate is true.  The economy and industry of the European colonies (including those in North America) were primarily focused on the import, transformation, and export of goods which were not produced locally, but could be produced in large quantities elsewhere. For example, tea grown in India became a staple import and re-export in England. Similarly, tobacco and cotton grown in the North American colonies were exported to Europe for a profit. 

Imported goods were in high demand in the Western world, which called for increased production. Laborers or farmers could not always keep up with the demand for certain materials, so the use of slaves became a favored means of free or low-cost labor on a massive scale. The transformation of large quantities of raw materials (like cotton) was enabled by the innovations of the Industrial Revolution. Raw materials could be quickly, more efficiently, and more cheaply produced, transformed, and traded for greater economic gain. 

Some regions were able to take charge in the production of certain raw goods, or served as easily-accessible trade centers. Where the production and trade of goods really took off, centers of wealth were established and a reflexive relationship with the use of slave labor often followed. Any port which served as a point for the importation of slaves and export or trade of goods produced on the mainland really thrived in this economy. Many of the cities which experienced economic boom during this time remain quite affluent today.

I chose Jonas as my topic for The Giver. But I need a thesis statement about Jonas and his emotions, memories, and other stuff.

Because Jonas is the main character of the novel, he is a perfect topic for your essay. However, without knowing what your assignment asks for OR what your own argument is about Jonas, it is difficult to suggest a specific thesis.

You said you wanted to talk about his emotions, memories, and "other stuff." Since "other stuff" is vague and could mean anything, I'll talk about how you could tie together emotions and memories and give you a sample thesis. It is up to you to make sure that argument would work for your particular assignment.

Jonas has fairly superficial emotions through the first part of the book until he begins to receive memories from the Giver. At that point, he begins to experience emotions that are more complex and different that the emotions of those around him. For example, he understands what emotional pain is after remembering being at war and not being able to save someone. These are feelings that other people in the community have no concept of and that causes Jonas to begin to feel isolated. In turn, he begins to become resentful and even angry about the superficial feelings everyone in the community appears to have and we see this when his family is sharing their feelings about their days. His sister expresses anger, but Jonas realizes it is not really anger, but mere impatience. 

Perhaps you could tie the emotions and the memories together in your thesis. It might look something like this: Jonas experiences emotional growth as a result of the memories he receives from the Giver, but that same emotional growth also causes him to feel anxious and angry. 

In "The Diary of Anne Frank," what are Mr. Frank's views regarding the upbringing of children?

Mr. Frank is a gentle man who avoids conflict. He is never one to start an argument and he maintains his temper at all times. Anne loves her father because of his patient and loving nature. The way Mr. Frank lovingly and respectfully speaks with Margot and Anne shows that he believes that this is the best way to bring up children. However, when Anne discusses with him how she doesn't love her mother, this greatly concerns him. He does not take sides with Anne even though she says that she loves him the most in the whole world. Mr. Frank supports his wife by telling his daughter that it isn't right for her to make her mother cry. In fact, Mr. Frank's advice as she matures and grows is as follows:

"There is so little that we parents can do to help our children. We can only try to set a good example . . . point the way. The rest you must do yourself. You must build your own character."

As shown in the above passage, Mr. Frank believes that parents must set a good example and children must learn by watching and following as they see fit. This relieves him of some responsibility and places it upon Anne's shoulders. If Anne wants to be a good person, then she can watch her parents and decide what that means for herself. Only she can make the changes in her behavior if she so chooses.

What does Rudyard Kipling's If suggest about both life and choices?

Rudyard Kipling's If is a poem he wrote in 1895. It is said to be inspired by Leander Starr Jameson, the man who led the failed Jameson Raid, which took place about 15 years before the poem's publication. These days, If is often read at events such as graduations and/or farewell ceremonies. 
 
The poem reads as if the narrator is speaking directly to someone else, most likely a young man. The poem, in its entirety, is basically one big piece of advice on how to be a man. 
 
If, which is written in iambic pentameter, consists of only four stanzas; each one is comprised of a different potential "if" situation.
 
For example, in stanza one, the narrator says, "If you can keep your head when all about you/Are losing theirs and blaming it on you,/If you can trust yourself when all men doubt you,/But make allowance for their doubting too" (Kipling, 1 - 4). 
 
My Translation: If you, young man, can keep a level head in spite of everyone around you losing theirs and blaming you for it and you can still trust yourself, even after taking into consideration the doubts that others have of you, then... * 
 
* Note that the narrator does not yet reveal what will happen if the young man ends up in one of these situations but is still able to act in the manner described. 
 
That said, the following three stanzas are made up of similar hypothetical situations and there's no real change in pattern up until the last two lines of stanza four. There, the narrator offers his last potential "if" situation before revealing what will happen "if." 
 
He says, "If you can fill the unforgiving minute/With sixty seconds' worth of distance run,/Yours is the Earth and everything that's in it,/And - which is more - you'll be a Man, my son!" (Kipling, 29 - 32). 
 
And there, in those last two lines, lies the entire point of the poem: 
 
"Yours is the Earth and everything that's in it,/And - which is more - you'll be a Man, my son!" (Kipling, 31 - 32).
 
The narrator reveals that the secret to being a man, and the secret to living a good life, is being the exact person he was describing in all of those hypothetical situations. 
 
In order to find out what kind of person that is, you'll just have to refer back to the "what if" statements and make inferences about the characteristics that each one illustrates.
 
I would list them for you but they're all pretty workable, so you can use a number of different words to describe each trait.
 
I hope this helps!

What is depression?

Causes and Symptoms

The word “depression” is often used to describe many different things. For some, it defines a fleeting mood, for others an outward physical appearance of sadness, and for others a diagnosable clinical disorder. In any year, millions of adults suffer from a clinically diagnosed depression, a mood disorder that often affects personal, vocational, social, and health functioning. The fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5, 2013) of the American Psychiatric Association delineates a number of mood disorders that include clinical depression, known as major depressive disorder.

Major depressive disorder is characterized by a syndrome of symptoms, present
during a two-week period and representing a clinically significant change from
previous functioning. The symptoms include at least five of the following:
depressed or irritable mood for most of the day, diminished interest in previously
pleasurable activities, significant unintentional weight loss or weight gain,
insomnia or hypersomnia, physical agitation or slowness,
loss of energy or fatigue, feelings of worthlessness or excessive guilt,
indecisiveness or a diminished ability to concentrate, and recurrent thoughts of
death. The clinical depression cannot be initiated or maintained by another
illness or condition.

Major depressive disorder is often first recognized in the patient’s twenties,
while a major depressive episode can occur at any age. Women are twice as likely
to suffer from the disorder than are men.

There are several potential causes of major depressive disorder. Genetic factors may determine a person's susceptibility to developing depression following stressful life events. Genetic studies suggest a familial link with higher rates of clinical depression in first-degree relatives. There also appears to be a relationship between clinical depression and levels of the brain’s neurochemicals, specifically decreased monoamines—the neurotransmitters dopamine, norepinephrine, and serotonin. It is important to keep in mind, however, that anywhere from 15 to 20 percent of adults will experience major depression at some point in their lifetimes. Furthermore, not everyone has a biological cause for this depression. Common causes of clinical depression also include psychosocial stressors such as the death of a loved one, financial stress, loss of a job and unemployment, interpersonal problems, or traumatic world events such as natural disasters and war. It is unclear, however, why some people respond to a specific psychosocial stressor with a clinical depression and others do not. Finally, certain prescription medications have been noted to cause or be related to clinical depression. These drugs include muscle relaxants, heart medications, hypertensive medications, ulcer medications, oral contraceptives, painkillers, narcotics, and steroids. Thus there are many causes of clinical depression, and no single cause is sufficient to explain all clinical depressions.

Other likely risk factors for depression include past alcohol dependence, insecure attachment to parents in early adolescence, and the experience of childhood abuse or neglect. Possible risk factors for depression that have been explored include cannabis use, low birth weight, high levels of television viewing and media exposure in adolescence, and head injury.

In the DSM-5, the existence of at least three manic symptoms (which is
insufficient to satisfy the diagnostic criteria for a manic episode) within a
major depressive episode is acknowledged by the specifier "major depressive
disorder with mixed features." The presence of mixed features in an episode of
major depressive disorder increases the likelihood that the illness exists in the
bipolar spectrum, although separate criteria exist for the diagnosis of
bipolar
disorder, which can share some symptoms with major
depression.

Dysthymic disorder is another persistent depressive disorder characterized by
chronic low-level depression. In the United States, the twelve-month prevalence of
dysthymic disorder is estimated to be approximately 1.5 percent of the adult
population. Dysthymic disorder is characterized by at least a two-year history of
depressed mood and at least two of the following symptoms that cause clinically
significant impairment in social, work, or other important areas of functioning:
poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low
self-esteem, poor concentration or decision making, or
feelings of hopelessness. The individual cannot be without the symptoms for more
than two months at a time, the disorder cannot be superimposed on another
psychotic disorder, and it cannot be initiated or maintained by another illness or
condition. Dysthymic disorder is more common in adult women, equally common in
both sexes of children, and with a greater prevalence in families. The causes of
dysthymic disorder are believed to be similar to those listed for major depressive
disorder, but the disorder is less well understood than is depression.

In order to prevent the overdiagnosis of bipolar disorder in children, the DSM-5
added a new depressive disorder called disruptive mood dysregulation disorder
(DMDD). This diagnosis is given to children up to the age of eighteen years who
exhibit persistent irritability and frequent episodes of extreme emotional
outbursts and behavioral dyscontrol. DMDD is characterized by severe and recurrent
temper outbursts that are grossly out of proportion in intensity or duration to
the situation at hand, occurring on average three or more times per week for one
year or more. Diagnosis of DMDD requires the symptoms to be present in at least
two settings (at school, at home, and/or in social settings), and the child cannot
have gone three or more consecutive months without symptoms to be diagnosed with
DMDD. Onset of DMDD must occur before the age of ten years, and diagnosis cannot
be made for the first time before the age of six years or after eighteen
years.

Also in the category of depressive disorders, the DSM-5 includes premenstrual dysphoric disorder (PMDD), which was previously categorized under Appendix B "Criteria Sets and Axes Provided for Further Study" in the DSM-IV, due to a strong body of evidence supporting its existence and the validity of the diagnostic criteria. PMDD is an extreme version of premenstrual syndrome that affects approximately 2 to 5 percent of women of reproductive age. PMDD is characterized by the presence of symptoms for most of the time during the last week of the luteal phase of the menstrual cycle; these symptoms begin to remit within a few days of the onset of the follicular phase and are not present in weeks following menstruation. For the diagnosis of PMDD, a woman must have five or more of the following symptoms for most menstrual cycles during the past one year: markedly depressed mood or feelings of hopelessness, marked anxiety or tension, persistent anger or irritability or increased interpersonal conflicts, sense of difficulty in concentrating, lethargy or fatigue, marked changes in appetite, hypersomnia or insomnia, feelings of being overwhelmed or out of control, and/or physical symptoms such as headache, joint or muscle pain, and breast tenderness. These symptoms must also cause a clinically significant impact on functioning at work, school, and social settings or within personal relationships.

A final variant of clinical depression is known as seasonal affective
disorder (SAD). Patients with this illness demonstrate a
pattern of clinical depression during the winter, when there is a reduction in the
amount of daylight hours. For these patients, the reduction in available light is
thought to be the cause of the depression. In the DSM-5, SAD is categorized as a
mood disorder with a specifier called "with seasonal pattern."

Treatment and Therapy

Crucial to the choice of treatment for clinical depression is determining the variant of depression being experienced. Each of the diagnostic categories has associated treatment approaches that are more effective for a particular diagnosis. Multiple assessment techniques are available to the health care professional to determine the type of clinical depression. The most valid and reliable is the clinical interview. The health care provider may conduct either an informal interview or a structured, formal clinical interview assessing the symptoms that would confirm the diagnosis of clinical depression. If the patient meets the diagnostic criteria set forth in the DSM-5, then the patient is considered for depression treatments. Patients who meet many but not all diagnostic criteria are sometimes diagnosed with a “subclinical” depression. These patients might also be considered appropriate for the treatment of depression, at the discretion of their health care providers.

Another assessment technique is the “paper-and-pencil” measure, or depression
questionnaire. A variety of questionnaires have proven useful in confirming the
diagnosis of clinical depression. Questionnaires such as the Beck Depression
Inventory, Hamilton Depression Rating Scale, Zung Self-Rating
Depression Scale, and the Center for Epidemiologic Studies Depression Scale are
used to identify persons with clinical depression and to document changes with
treatment. This technique is often used as an adjunct to the clinical interview
and rarely stands alone as the definitive assessment approach to diagnosing
clinical depression.

Once a clinical depression (or a subclinical depression) is identified, several types of treatment options are available. These options are dependent on the subtype and severity of the depression. They include individual and group psychotherapy, light therapy, family therapy, psychopharmacology (drug therapy), electroconvulsive therapy (ECT), and other less traditional treatments. These treatment options can be provided to the patient as part of an outpatient program or, in certain severe cases of clinical depression in which the person is a danger to the self or others, as part of a hospitalization.

Clinical depression often affects the patient physically, emotionally, and socially. Therefore, prior to beginning any treatment with a clinically depressed individual, the health care provider will attempt to develop an open and communicative relationship with the patient. This relationship will allow the health care provider to provide patient education on the illness and to solicit the collaboration of the patient in treatment. Supportiveness, understanding, and collaboration are all necessary components of any treatment approach.

For the treatment of mild to moderate depression in adults, the American
Psychiatric Association (APA) recommends psychotherapy
as the initial treatment choice. The APA also recommends antidepressant
medications as an initial treatment choice, whereas the
National Institute for Clinical Excellence (NICE) recommends antidepressants only
if the patient is unresponsive to initial psychosocial interventions. For moderate
to severe depression in adults, the APA and the NICE recommend a combination of
psychotherapy and antidepressants. The APA also recommends electroconvulsive
therapy (ECT) for the treatment of severe unresponsive major depression in adults.

For the treatment of depression in children and adolescents, the recommended
initial treatment choices include education, supportive treatment, and case
management. If depression is complicated or chronic, psychotherapy may then be
recommended. Interpersonal therapy and cognitive-behavioral therapy have been
shown to be among the best psychotherapeutic options for the treatment of
depression. If the child or adolescent with depression is unresponsive to
psychotherapy, he or she may benefit from some types of antidepressant
medications; however, in most children with depression, antidepressants do not
appear to be an effective treatment.

Psychotherapy refers to a number of different treatment techniques used to deal
with the psychosocial contributors and consequences of clinical depression. In
psychotherapy, the patients develop knowledge and insight into the causes of and
treatment for their clinical depression. In cognitive psychotherapy, symptom
relief comes from assisting patients in modifying maladaptive, irrational, or
automatic beliefs that can lead to clinical depression. In behavioral
psychotherapy, patients modify their environment such that social or personal
rewards are more forthcoming. This process might involve being more assertive,
reducing isolation by becoming more socially active, increasing physical
activities or exercise, or learning relaxation techniques or other coping skills.
Research upholds the effectiveness of these and other psychotherapy techniques for
the treatment of depression and other mood disorders.

The primary types of medications used in the treatment of clinical depression in
adults include selective serotonin reuptake inhibitors (SSRIs), serotonin
norepinephrine reuptake inhibitors (SNRIs), mirtazapine (Remeron), and bupropion
(Wellbutrin). Monoamine oxidase inhibitors (MAOIs) should be restricted to
patients who do not respond to other treatments. The health care professional will
select an antidepressant based on side effects, dosing convenience (once
daily versus three times a day), and cost.

Cyclic antidepressants represent one class of antidepressant medications. As the name implies, the chemical makeup of the medication contains chemical rings, or “cycles.” There are unicyclic (buproprion and fluoxetine, or Prozac), bicyclic (sertraline and trazodone), tricyclic (amitriptyline, desipramine, and nortriptyline), and tetracyclic (maprotiline) antidepressants. These antidepressants function to either block the reuptake of neurotransmitters by the neurons, allowing more of the neurotransmitter to be available at a receptor site, or increase the amount of neurotransmitter produced. The side effects associated with the cyclic antidepressants—dry mouth, blurred vision, constipation, urinary difficulties, palpitations, and sleep disturbance—vary and can be quite problematic. Some of these antidepressants have deadly toxic effects at high levels, so they are not prescribed to patients who are at risk of suicide. Furthermore, in some patients, antidepressants such as SSRIs are associated with increased suicidal ideation, so patients should be carefully monitored as they begin an antidepressant treatment regimen.

Newer drugs are more specific in terms of the drug action. For instance,
fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and works
specifically on the neurotransmitter serotonin. Similarly, buproprion is a
norepinephrine and dopamine reuptake inhibitor (NDRI) and works specifically on
the neurotransmitters norepinephrine and dopamine. More specific drugs generally
create fewer side effects. Fewer side effects can be associated with greater
medication compliance, making these drugs a more effective treatment for many
individuals.

Monoamine oxidase inhibitors (isocarboxazid, phenelzine, and tranylcypromine) are
another class of antidepressants. They function by slowing the production of the
enzyme monoamine oxidase. This enzyme is responsible for breaking down the
neurotransmitters norepinephrine and serotonin, which are believed to be
responsible for depression. By slowing the decomposition of these transmitters,
more of them are available to the receptors for a longer period of time.
Restlessness, dizziness, weight gain, insomnia, and sexual dysfunction are common
side effects of the MAOIs. MAOIs are most notable because of the dangerous adverse
reaction (severely high blood pressure) that can occur if the patient consumes
large quantities of foods high in tyramine (such as aged cheeses, fermented
sausages, red wine, foods with a heavy yeast content, and pickled fish). Because
of this potentially dangerous reaction, MAOIs are not usually the first choice of
medication and are more commonly reserved for depressed patients who do not
respond to other treatment options.

Electroconvulsive or shock therapy is the single most effective treatment for severe and persistent depression that does not respond to other treatments. If the clinically depressed patient fails to respond to medications or psychotherapy and the depression is life-threatening, electroconvulsive therapy is considered. It is also considered if the patient cannot physically tolerate antidepressants, as with elderly patients who have other medical conditions. This therapy involves inducing a seizure in the patient by administering an electrical current to specific parts of the brain. The therapy has become quite sophisticated and much safer than when it was introduced in the mid-twentieth century, and it involves fewer risks to the patient. Patients undergo several treatments over a period of time. Some temporary memory impairment is a common side effect of this treatment.

A special treatment used for individuals with seasonal affective disorder is
light
therapy, or phototherapy. Light therapy involves exposing
patients to bright light for a period of time each day during seasons of the year
when there is decreased light. This may be done as a preventive measure and also
during depressive episodes. The manner in which this treatment approach modifies
the depression is unclear and awaits further research, but some believe it affects
the internal clock of the body, or circadian rhythm. Studies of the
effectiveness of light therapy have been mixed, but interest in this promising
treatment is strong, as it may prove useful for working with nonseasonal mood
disorders as well. It should be noted, however, that light therapy does have some
risks associated with it. Caution must be used to protect the eyes and to use the
light as directed. Additionally, the intensity of light must be correct so as to
achieve therapeutic effects and not cause other problems. Finally, some
individuals can experience manic episodes if they are exposed to too much light,
so caution must be exercised in terms of the length of time for light exposure
treatment sessions.

Surgery, the final treatment option for severe depression, is quite rare. Psychosurgery is used only after all treatment options have failed and the clinical depression is life-threatening. Vagus nerve stimulation (VNS) is a form of surgery that implants a stimulus generator on the vagus nerve; it is approved by the FDA for the treatment of severe unresponsive depression. Nonsurgical methods of creating similar stimuli have been explored as well.

Perspective and Prospects

Depression, or the more historical term “melancholy,” has had a history predating
modern medicine. Writings from the time of the ancient Greek physician Hippocrates
refer to patients with a symptom complex similar to the present-day definition of
clinical depression.

The rates of clinical depression have increased since the early twentieth century,
while the age of onset of clinical depression has decreased. Women appear to be at
least twice as likely as men to suffer from clinical depression.

While most psychiatric disorders are nonfatal, clinical depression can lead to
death. About 60 percent of individuals who commit suicide have a mood disorder
such as depression at the time. In a lifetime, however, only about 7 percent of
men and 1 percent of women with lifetime histories of depression will commit
suicide. Though these numbers are high, what this means is that not everyone who
is depressed will commit suicide. In fact, many receive help and recover from
depression. There are, however, other costs of clinical depression. Billions of
dollars are spent on clinical depression, divided among the following areas:
treatment, suicide, and absenteeism (the largest). Clinical depression obviously
has a significant economic impact on society, and major personal impacts on the
lives of individuals suffering from depression.

The future of clinical depression lies in early identification and treatment.
Identification will involve two areas. The first is improving the social awareness
of mental health issues to include clinical depression. By eliminating the
negative social stigma associated with mental health treatment, there will be an
increased level of the reporting of depression symptoms and thereby an improved
opportunity for early intervention, preventing the progression of the disorder.
The second approach to identification involves the development of reliable
assessment strategies for clinical depression. Data suggests that the majority of
those who commit suicide see a physician within thirty days of the suicide. The
field of psychology will continue to strive to identify biological markers and
other methods to predict and identify clinical depression more accurately.
Treatment advances will focus on the further development of nonpharmacological and
pharmacological strategies to increase effectiveness.

Bibliography

"About Mood Disorders."
DBSAlliance.org. Depression and Bipolar Support
Alliance, n.d. Web. 22 Aug. 2014.

American Psychiatric
Association. Diagnostic and Statistical Manual of Mental
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A beam of sunlight falling on a prism refracts and forms seven colored bands. What does this illustrate?

When the white light passes through a prism, it refracts into 7 bands of different colors. This shows that white light is composed of seven different colors. These seven colors are referred to as VIBGYOR, to represent violet (or V), indigo (or I), blue (or B), green (or G), yellow (or Y), orange (or O) and red (or R).  

Refraction is bending of a light ray as it goes from one medium to another. Speed of light is different in different media and hence it either refracts towards the normal or away from it. When that happens to white light, passing through a prism, its seven constituent colors move through the prism at different speeds and hence the white light gets split in seven different color bands.  

A similar splitting of white light into different colors is observed when it passes through water vapors in the atmosphere and we see a rainbow.

Hope this helps. 

What is ginseng as a dietary supplement?

Overview

Three different herbs are commonly called ginseng: Asian or Korean ginseng (Panax ginseng), American ginseng (P. quinquefolius), and Siberian ginseng (Eleutherococcus senticosus). The latter herb, however, is actually not ginseng.

Asian ginseng is a perennial herb with a taproot resembling the shape of the human body. It grows in northern China, Korea, and Russia; its close relative, P. quinquefolius, is cultivated in the United States. Because ginseng must be grown for five years before it is harvested, it commands a high price, with top-quality roots easily selling for more than ten thousand U.S. dollars. Dried, unprocessed ginseng root is called white ginseng, and steamed, heat-dried root is red ginseng. Chinese herbalists believe that each form has its own particular benefits.

Ginseng is commonly regarded as a stimulant. According to persons who use it
seriously, however, this description is inadequate. In traditional Chinese
herbology, P. ginseng was used to strengthen
the digestion and the lungs, to calm the spirit, and to increase overall energy.
Before World War II, a Russian scientist named Israel I. Brekhman became
interested in the herb and came up with a new way to describe it: as an
adaptogen.

An adaptogen is part of a hypothetical treatment that helps the body adapt to stresses of various kinds, whether heat, cold, exertion, trauma, sleep deprivation, toxic exposure, radiation, infection, or psychological stress. Furthermore, an adaptogen, by definition, should cause no side effects, should be effective in treating a wide variety of illnesses, and should help return an organism toward balance.

Perhaps the only indisputable example of an adaptogen is a healthful lifestyle. By eating right, exercising regularly, and generally living a life of balance and moderation, a person can increase physical fitness and the ability to resist illnesses of all types. Whether there are any substances that can do as much remains unclear. Brekhman believed that ginseng produced similarly universal benefits.

Traditional
Chinese medicine does not align with Brekhman’s idea. There
is no one-size-fits-all in Chinese medical theory. Like any other herb, ginseng is
said to be helpful for those people who need its particular effects and to be
neutral or harmful for others. In Europe, Brekhman’s concept took hold, and
ginseng is now widely believed to be a universal adaptogen.

Therapeutic Dosages

The typical recommended daily dosage of P. ginseng is 1 to 2 grams (g) of raw herb or 200 mg daily of an extract standardized to contain 4 to 7 percent ginsenosides. In one study of American ginseng for diabetes, the dose used was 3 g daily.

There are dozens of ginsenosides in ginseng. Because different ginsenosides have different effects, two different ginseng products with similar total ginsenoside content will not necessarily have similar efficacy. Scientific knowledge does not allow experts to make informed recommendations on which specific ginsenosides are useful for which conditions.

Ordinarily, a two- to three-week period of using ginseng is recommended, followed by a one- to two-week “rest” period. Russian tradition suggests that ginseng should not be used by those persons younger than age forty years. However, there is no scientific evidence to support these recommendations.

Therapeutic Uses

If Brekhman was right, ginseng should be the right treatment for the stresses of modern life. Ginseng is widely used for this purpose in Russia and Eastern Europe. However, the scientific basis for this use is largely limited to animal studies and human trials of unacceptably low quality.

There have been a few better-quality studies of various forms of ginseng for certain more specific purposes, such as strengthening immunity against colds and flu and other infections (including herpes), helping to control diabetes, stimulating the mind, increasing a general sense of well-being, and improving physical performance capacity. Some of these studies have found positive results with the use of ginseng.

The active ingredients in ginseng are believed to be substances called ginsenosides. Ginseng low in ginsenosides may not be effective. However, different ginsenosides appear to have differing actions, and the exact mixture of the ginsenosides in a given ginseng product may play a large role in its efficacy.

Two preliminary studies suggest that Korean red ginseng may have some benefits for impotence (erectile dysfunction). A poorly designed study using an untreated control group found indications that P. ginseng might improve sperm count and motility, thereby enhancing male fertility.

Highly preliminary evidence suggests that P. quinquefolius might improve the effectiveness of breast cancer chemotherapy drugs. P. ginseng also is said to help prevent cancer and to fight chemical dependency, but the scientific evidence for these uses is minimal at best. Another study failed to find ginseng helpful for menopausal symptoms.

Scientific Evidence

Adaptogenic effects. Numerous studies have evaluated the effects
of oral P. ginseng on animals under conditions of extreme stress.
The results suggest that ginseng increases physical endurance and causes
physiological changes that may help the body adapt to adverse conditions. In
addition, studies in mice found that consuming P. ginseng before
exposure to a virus significantly increased the survival rate and the number of
antibodies produced. However, most of these studies fall far
beneath modern scientific standards.

Colds and flu. A double-blind, placebo-controlled study of 323 people found meaningful evidence that an extract of American ginseng taken at 400 milligrams (mg) daily may help prevent the common cold. Participants who used the extract for four months had a reduced number of colds compared with those taking the placebo. Comparative benefits also were seen in the percentage of participants who developed two or more colds and in the severity and duration of cold symptoms that did develop. Similar benefits were seen in a study of forty-three people.

In addition, two double-blind, placebo-controlled studies indicate that P. quinquefolius may be able to prevent flulike illness in the elderly.

A double-blind, placebo-controlled study suggests that ginseng can also help
prevent flulike illnesses. This trial enrolled 227 participants at three medical
offices in Milan, Italy. One-half were given ginseng at a dosage of 100 mg daily,
the other one-half placebo. Four weeks into the study, all participants received
influenza
vaccine. The results showed a significant decline in the
frequency of colds and flu in the treated group compared with the placebo group
(fifteen versus forty-two cases, respectively). Also, antibody measurements in
response to the vaccination rose higher in the treated group than in the placebo
group.

On a much more theoretical level, two other studies found evidence that ginseng increases the number of immune cells in the blood, while a third study did not find this effect. (In any case, measuring changes in the number of immune cells is not a reliable method of demonstrating immune-system enhancement.) Also, a nonblinded pilot study provides weak evidence that ginseng might be helpful in chronic bronchitis.

Diabetes. In preliminary double-blind studies performed by a single research group, the use of American ginseng (P. quinquefolius) appeared to improve blood sugar control. In some studies, the same researchers reported potential benefit with Korean red ginseng.

A different research group tested ordinary ginseng and claimed to find it effective. However, this study was somewhat substandard in both its design and its reporting. In other studies, ordinary ginseng seemed to worsen blood sugar control rather than improve it, while yet another group found benefits. It appears possible that certain ginsenosides (found in high concentrations in some American ginseng products) may lower blood sugar, while others (found in high concentration in some P. ginseng products) may raise it. It has been suggested that because the actions of these various constituents are not well defined, ginseng should not be used to treat diabetes until more is known.

Mental function. Several studies have found indications that P. ginseng might enhance mental function. However, the specific benefits seen have varied considerably from trial to trial, tending to make the actual cognitive effects of ginseng (if there are any) difficult to discern. A double-blind, placebo-controlled study found that P. ginseng can improve some aspects of mental function. For two months, 112 healthy, middle-aged adults took either ginseng or placebo. The results showed that ginseng improved abstract thinking ability. However, there was no significant difference between the two groups in reaction time, memory, concentration, or overall subjective experience.

Another double-blind, placebo-controlled study of fifty men found that an eight-week treatment with a P. ginseng extract improved ability in completion of a detail-oriented editing task. Also, a double-blind trial of sixteen healthy males found favorable changes in ability to perform mental arithmetic in those given P. ginseng for twelve weeks.

A double-blind, placebo-controlled trial of sixty elderly people found that fifty or one hundred days of treatment with P. ginseng produced improvements in numerous measures of mental function, including memory, attention, concentration, and ability to cope. Benefits were still evident at the fifty-day follow-up. However, virtually no improvement was seen in the placebo group, a result that is highly unusual and raises doubts about the accuracy of the study. In addition, three double-blind, placebo-controlled studies evaluated combined treatment with P. ginseng and ginkgo and found some evidence of improved mental function.

Sports performance. The evidence for P. ginseng as a sports supplement is mixed at best. An eight-week, double-blind, placebo-controlled trial evaluated the effects of P. ginseng with and without exercise in forty-one persons. The participants were given either ginseng or placebo, and then they underwent exercise training or remained untrained throughout the study. The results showed that ginseng improved aerobic capacity in persons who did not exercise but offered no benefit in those who did exercise. In a nine-week, double-blind, placebo-controlled trial of thirty highly trained athletes, treatment with P. ginseng alone or in combination with vitamin E produced significant improvements in aerobic capacity. Another double-blind, placebo-controlled trial of thirty-seven persons also found some benefit.

A double-blind, placebo-controlled study of 120 people found that P. ginseng gradually improved reaction time and lung function in a twelve-week treatment period among those persons forty to sixty years old. No benefits were seen in younger persons.

However, numerous studies have failed to find P. ginseng effective. For example, an eight-week double-blind trial that followed sixty healthy men in their twenties found no evidence of ergogenic benefit. Many other small trials of P. ginseng also failed to find evidence of benefit.

General well-being. A double-blind study compared the effects of a nutritional supplement with and without P. ginseng extract on the feeling of well-being in 625 people whose average age was just under forty years. Quality of life was measured by a set of eleven questions. People taking the ginseng-containing supplement reported significant improvement compared with those taking the supplement without ginseng (the control group). Similar findings were reported in a double-blind, placebo-controlled study of thirty-six people newly diagnosed with diabetes. After eight weeks, participants who had been taking 200 mg of ginseng daily reported improvements in mood, well-being, vigor, and psychophysical performance that were significant compared with the reports of control participants.

A twelve-week, double-blind, placebo-controlled study of 120 people found improvement in general well-being among women aged thirty to sixty years and men aged forty to sixty years, but not among men aged thirty to thirty-nine years.

However, a double-blind, placebo-controlled trial of thirty young people found marginal benefits at four weeks and no significant benefits at eight weeks. Similarly, a sixty-day, double-blind, placebo-controlled trial of eighty-three adults in their mid-twenties found no effect on mood or psychological well-being.

A double-blind study of fifty-three people undergoing cancer treatment found equivocal evidence of benefit with a special form of ginseng modified to contain higher levels of certain constituents.

Impotence (erectile dysfunction). Two double-blind, placebo-controlled trials, involving a total of about 135 people, have found evidence that Korean red ginseng may improve erectile function. In the better of the two trials, 45 participants received either placebo or Korean red ginseng at a dose of 900 mg three times daily for eight weeks. The results indicate that while using Korean red ginseng, men experienced significantly better sexual function than while they were taking placebo.

In an analysis combining the results of six controlled trials, researchers found some evidence for the benefits of Korean red ginseng. However, the small size and generally low quality of the studies left some doubts about this conclusion.

Preventing cancer. An observational study on ginseng and cancer prevention has been widely publicized, but a close look at the data arouses serious suspicions. This study was performed in South Korea and followed a total of 4,587 men and women aged thirty-nine years and older from 1987 to 1991. People who regularly consumed P. ginseng were compared with otherwise similar people (matched in gender, age, alcohol use, smoking, education, and economic status) who did not.

The reported results were impressive. Those who used ginseng showed a 60 percent decrease in risk of death from cancer. Lung cancer and gastric cancer were particularly reduced. The more ginseng consumed, the greater the effect.

However, there is something not right about this study. The use of ginseng fewer than three times per year reportedly led to a 54 percent reduction in risk. It is difficult to believe that so occasional a use of ginseng could reduce cancer mortality by more than one-half.

Menopause. A double-blind, placebo-controlled study of 384 women experiencing menopausal symptoms found no significant benefit with P. ginseng and no evidence of hormonal effects.

Safety Issues

Ginseng appears to be nontoxic, both in the short term and the long term, according to the results of studies in mice, rats, chickens, and dwarf pigs.

Reported side effects in humans are rare. There are a few case reports of
breast tenderness, postmenopausal vaginal bleeding, and menstrual abnormalities
associated with P. ginseng use. Such side effects suggest that it
has estrogenic properties. However, a large double-blind trial of P.
ginseng found no estrogen-like effects. Another double-blind trial
found no effects on estrogen or testosterone,
and a carefully designed test-tube study showed that ginseng is not estrogenic.
Therefore, it is possible that these apparent side effects were coincidental;
another possibility is that adulterants in the ginseng product used caused the
problem. Ginseng and other Asian herbal products have often been found to contain
unlisted herbs and pharmaceuticals.

Estrogen itself stimulates the growth of breast cancer cells. In a test-tube study, P. ginseng was again found to be nonestrogenic, and yet, it nonetheless stimulated the growth of breast cancer cells. Although the mechanism of this effect is not known, the results suggest that women who have had breast cancer should avoid using ginseng.

Unconfirmed reports suggest that highly excessive doses of P. ginseng can cause insomnia, can raise blood pressure, can increase heart rate, and can cause other significant effects. Whether some of these cases were actually caused by caffeine mixed in with ginseng remains unclear. One double-blind study failed to find any effect on blood pressure.

One case report and one double-blind trial suggest that P.
ginseng can reduce the anticoagulant effects of Coumadin
(warfarin), but another trial failed to find such an
interaction. The reason for this discrepancy is not clear, so one should not
combine ginseng and warfarin.

Two reports indicate that combination treatment with P.
ginseng and antidepressant drugs may result in a
manic episode. There are also theoretical concerns regarding the use of ginseng by
people with diabetes. If it is true, as the foregoing preliminary studies suggest,
that ginseng can reduce blood sugar levels, people with diabetes who take ginseng
might need to reduce their dose of medication. On the other hand, if certain types
of ginseng have the opposite effect (as researchers hypothesize), this could
necessitate an increase in medication. People with diabetes should use ginseng
only under physician supervision.

In 1979, an article in the Journal of the American Medical Association claimed that people can become addicted to P. ginseng and can develop blood pressure elevations, nervousness, sleeplessness, diarrhea, and hypersexuality. However, this report has since been thoroughly discredited and should no longer be taken seriously.

Chinese tradition suggests that P. ginseng should not be used by pregnant or nursing women, and one animal study hints that ginseng use by a pregnant woman could cause birth defects. Safety in young children or in persons with severe liver or kidney disease has not been established.

Important Interactions

In persons taking antidepressants, P. ginseng might cause manic episodes. For persons using insulin or oral hypoglycemics, various forms of ginseng may unpredictably alter the dosage need. For persons taking Coumadin, P. ginseng might possibly decrease its effect. However, P. ginseng might increase the effectiveness of the influenza vaccine.

Bibliography

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Jang, D. J., et al. “Red Ginseng for Treating Erectile Dysfunction.” British Journal of Clinical Pharmacology 66 (2008): 444-450.

Kim, J. H., C. Y. Park, and S. J. Lee. “Effects of Sun Ginseng on Subjective Quality of Life in Cancer Patients.” Journal of Clinical Pharmacy and Therapeutics 31 (2006): 331-334.

Predy, G. N., et al. “Efficacy of an Extract of North American Ginseng Containing Poly-Furanosyl-Pyranosyl-Saccharides for Preventing Upper Respiratory Tract Infections.” CMAJ 173 (2005): 1043-1048.

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Vuksan, V., and J. L. Sievenpiper. “Herbal Remedies in the Management of Diabetes: Lessons Learned from the Study of Ginseng.” Nutrition, Metabolism, and Cardiovascular Diseases 15 (2005): 149-160.