Is it important to the story that we should know what Margot's thoughts and feelings are?

Since the emotional impact of the story depends on how strongly we identity with her, it is important that we know what Margot's thoughts and feelings are. What Bradbury tries to do is drive a wedge between how the other children view Margot and how we as readers do. The children view her as an Other, an outsider, as one who won't join in their games, and they envy her for her memories of sunshine. The reader, however, is encouraged to feel sympathy for her as a lonely and sensitive child who wants nothing more than to feel the sun again, so much so that her parents may leave Venus early to take her home. The more acutely we feel Margot's intense longing for the upcoming time in the sun, which occurs only once in seven years, the greater the impact when the children lock her in the closet so that she misses it. If we don't care about Margot, it won't matter to us that she loses her chance at the sun, and the whole story will fizzle out. Most readers, however, feel Margot's pain, which is why we are still reading the story decades after it was published.

Sally Monilla has started serving lunch at her new business called Salmonilla’s Diner. During lunch hours, they serve an average of 10 customers...

This is a question of queuing theory and the Poisson process would be applicable in this question. Sally typically serves 10 customers per hour.

The number of customers served in a given 15 minute window

= 10 customer/hour x 15 minutes x 1/60 hour/minute = 2.5 customers

This can also be termed as mean serving rate (number of customers served per unit time) or `lambda`. Thus,

`lambda` = 2.5 customers

The probability of serving less than 3 customer per block of 15 minutes can be determined as

P (x < 3) = P (x = 0) + P (x = 1) + P (x = 2)

where, x is the number of customers served in the 15 minute time period.

Thus, P (x < 3) = `(2.5^0 xx e^(-2.5))/(0!) + (2.5^1 xx e^(-2.5))/(1!) + (2.5^2 xx e^(-2.5))/(2!) `

= 0.544.

 Thus, the probability that less than 3 customers are served in a given 15 minute time period is 0.544.

Hope this helps. 

What are the concentric and eccentric contractions involved in returning a tennis serve?

This is a very complex question.  The answer depends on if you are looking to focus on a specific area of the body, or conduct a full body mechanical analysis. A very basic answer is that muscles will both concentrically and eccentrically contract during this movement based on the phase of the movement (i.e. Wind-up, strike, follow-through), which side of the body is producing the most movement, which type of stroke return (forehand versus backhand versus volley), one-handed versus two-handed return, and possibly singles versus doubles.  Below are some examples of what I have just described:

Upper Body (Forehand Return -- Strike)

1. 
   Concentric: Anterior Deltoid, Coracobrachialis, Pectoralis Major and Minor, Subclavius, Biceps Brachii, Flexor Digitorum Profundus and Superficialis, Flexor Pollicis Longus and Brevis, Opponen Pollicis


2. 
   Eccentric: Triceps Brachii, Posterior Deltoid, Levator Scapulae, Lateral Aspect of Upper Trapezius, Proximal Aspect of Latissimus Dorsi

I hope this answer provides you a basic foundation on analyzing a service return.  Please feel free to contact me if you need additional help.

What is the Hippocratic oath?

Medical Codes of Ethics

Western civilization has long held the writings of the fifth century BCE. Greek physician Hippocrates, and in particular the Hippocratic oath, as a model of ethical values to be followed in the medical profession. As the nature of Western civilization itself has changed over the centuries, interpretations of the ethical values behind the Hippocratic oath have also changed. The circumstances of modern medical practice and ethical values, however, have ironically made certain elements of the classical Hippocratic tradition even more relevant than they may have appeared in previous eras.

In fact, the Hippocratic oath is only the introductory section of the Corpus Hippocraticum (Hippocratic Collection) traditionally attributed to Hippocrates. (There is debate about whether he is the author of all the books or only some.) The actual medical observations of Hippocrates were studied and applied for many centuries, until scientific research rendered many of them recognizably obsolete. A number of sections of the corpus, however, reflect the Greek physician’s recurring concern for rules to guide the medical profession. Hippocrates’s chapters on “The Art,” “Decorum,” and “The Law” complement the more famous ethical precepts contained in the oath.

The first part of the oath itself covers the physician’s lifelong commitment to his or her teachers. This commitment extends not only to the symbolic bonds of respect but also to obligation to share one’s medical practice and even to provide financial assistance to one’s teachers, if requested. Additionally, the physician is committed to train, free of charge, the families of his or her teachers in the art of medicine.

The second part of the Hippocratic oath contains the more general pledges that would contribute to its value as an ethical guide for the medical profession. The physician is bound, in a very general way, to help the sick according to his or her ability and judgment in a manner that can never be interpreted as involving injury or wrongdoing. The physician is bound both to confidentiality concerning direct experiences in the patient-doctor relationship and to extreme discretion to avoid the circulation of professional knowledge that is not appropriate for publication abroad.

In addition to these general precepts, all of which have an ethical timelessness that would survive the centuries, there were two points in the oath that refer to specific issues that cannot be separated from the modern debate over medical ethics. Addressing the questions of euthanasia (“mercy killing”) and abortion, Hippocrates stated: “I will give no deadly drug to any, though it be asked of me, nor will I counsel such, and especially I will not aid a woman to procure abortion.”

Anyone searching for wider guidelines can glean many items of timeless wisdom from other sections of Hippocrates’s writings. In the pieces titled “The Physician” and “Decorum,” for example, the personal behavior of doctors is discussed. In all cases, Hippocrates exhorted physicians to maintain even levels of dignity and patience, to practice exemplary personal hygiene, and to avoid excesses in living habits that could introduce an element of distance between themselves and the patients who depend on them. Many centuries later, as in the eighteenth century English essay by Samuel Bard titled “A Discourse upon the Duties of a Physician,” one can see similar concerns for behavioral propriety toward the defenseless: for example, “Never affect to despise a man for the want of a regular education, and treat even harmless ignorance with delicacy and compassion” and protect against the effects of “foolhardiness and presumption.” These admonitions are indicative of the defining boundaries of the views of Hippocrates and those of the later, Christian era on the practice of medicine. The main attention of commentators on the Hippocratic corpus in recent generations has been directed to two broad divisions in the main ethical issues that he formulated: the physician’s role in abortion and in the decision to end life by either withholding or administering certain treatments. It took many centuries, however, for degrees of emphasis in analyzing the Hippocratic oath to take form. In the interim, and after a delay that separated the classical world from the late medieval world, different interpretations of the Hippocratic oath would appear, each reflecting the cultural environment to which it was meant to apply.

Several factors may explain why centuries passed before systematic attention was given to the rules of medicine first broached in the classical Greek and Roman worlds. The first of these was the general decline of political and economic conditions after the fall of Rome (fifth century CE), which had repercussions in a variety of cultural areas. Medical practices tended to revert to quite crude levels until the rediscovery of early medical texts, including those of Hippocrates, sparked interest in improving conditions of medical treatment in the late Middle Ages.

One can say that, in addition to editing elements of Hippocratic teachings to Christianize the pagan references that they contained, a second important redirection occurred in setting down medieval rules for the practice of medicine. It was Holy Roman Emperor Frederick II, around 1241, who specified for the first time that the higher authority of the state alone should define institutional procedures for certifying physicians. This was to be done through formal training and examinations in the universities of Naples or Salerno, and later in universities throughout the Western world.

In addition to rules leading to physicians’ certification, Frederick II stipulated that doctors must take an oath binding them to obligations that, in comparison to the Hippocratic oath or modern codes of medical ethics, covered very specific issues. One of these was an obligation to report any irregularities in an apothecary’s preparation of drugs that were to be dispensed to patients. Another enjoined doctors to provide free medical services to the poor.

If one looks at more modern standards for the regulation of relations between physician and patient, it is possible to suggest that—until some very major changes took place in society’s views on delicate questions previously reserved for ecclesiastical law—similar operatives continued to govern the guidelines for medical ethics. In the “Code of Medical Ethics” (1846–47) by the American Medical Association
(AMA), for example, primary focus is still visibly on the physician’s obligation to place the patient’s interest before his or her own, particularly in terms of prospects for material or other forms of personal gain. Defense of the public’s interest against quackery or the distribution of drugs that are either dangerous or illegally prepared follows, as well as avoidance of “crude hypotheses” or “magnification of the importance of services” sought, merely for the purpose of “temporary effect and popularity.” Although there are enormous time spans between the classical Hippocratic model, the medieval variant offered by Frederick II, and the mid-nineteenth century AMA code, all are comparable in their focus on what, in the terminology of the 1847 code, would be called “Duties for Support of Professional Character” (part 1, article 1) or “Duties of the Profession to the Public” (part 2, article 1).

One hundred years later, however, different societal attitudes toward medical ethics would establish themselves in most Western nations, including the United States. Generally stated, the basic changes reflected in ethical debates emphasized (or questioned the rising emphasis on) the protection of individual rights and privacy in matters relating to human life and the intervention of physicians. On one hand, changing directions in the expression of ethical orientations stemmed from advances made in key areas of medical science in the twentieth century, such as technologies for combating terminal disease, saving the lives of severely preterm infants, and prolonging life in old age. On the other hand, and in an even broader context, extraordinary scientific discoveries concerning the genetic keys behind life itself introduced an entirely different dimension to medical ethics, that of responsibility for monitoring or “engineering” life that has not yet been conceived.

Modern Applications

Although neither the original nor edited versions of the Hippocratic oath are applied today as a condition for becoming a doctor, the medical profession in the United States has definitely formalized publication of what it considers to be a necessary code of medical ethics. Evolving versions of this “Code of Medical Ethics” date from the original (1847) text of the AMA as revised by specific decisions in 1903, 1912, and 1947.

When the AMA adopted a statement under the title “Guide to Responsible Professional Behavior” in 1980, it assigned to a formal body within its organization, the Council on Ethical and Judicial Affairs, the task of publishing, on a yearly basis, updated paragraphs that reflect ethical guidelines for the profession as a whole. These evolving guidelines are organized under such subheadings as “Social Policy Issues,” “Interprofessional Relations,” “Hospital Relations,” “Confidentiality,” and “Fees and Charges.”

At the turn of the twenty-first century, the public’s growing uncertainty about a doctor’s role in a market-oriented health care delivery system and increasing mistrust in the face of malpractice suits prompted physicians to question their professional responsibilities and roles within modern medicine. In 2002, a joint effort between the American Board of Internal Medicine (ABIM), the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), and the European Federation of Internal Medicine (EFIM) introduced a new professional code of conduct designed to address these issues and help physicians meet the needs of patients in the twenty-first century. The charter incorporated traditional understanding of professional norms into the unique circumstances of modern medicine by addressing issues such as patient autonomy and choice, working in physician teams and respecting other professionals, managing conflicts of interest, social justice and equality in health care access, and market forces—issues not relevant during the time of Hippocrates. The American-British team noted that they hoped their efforts reaffirmed to a wary public the profession’s commitment to putting the needs of the patient first and offered guidelines to physicians for coping with the ethical problems in the modern world.

Along with such modern-day charters, physicians are bound to respect the ethical guidelines provided to them by their professional association. Failure to respect these guidelines is tantamount to breaking one’s binding ethical obligations and can lead to expulsion from the medical profession.

Several major changes, both in levels of medical technology and in social attitudes toward issues relating to medical practice, have played key roles in several spheres of an ongoing debate concerning medical ethics. In two cases, those of abortion and euthanasia, debate has focused on the ethics of deciding to end life; in the third, referred to generally as genetic engineering, the central question involves both the living and those yet to be born. In all these spheres, the legal and ethical debates have revolved around potential conflicts between physicians and patients but also in the context of wider social values.

Movement from the historical domain of idealized codes or oaths to the more practical and contemporary realm of changing societal reactions to what constitutes injury or breach of professional ethics in several areas of modern medicine is facilitated by reference to landmark legal decisions that have given a modern and quite different meaning to Hippocratic concepts.

Probably the most widely recognized issue reflecting such ethical conflicts, and one that received specific attention in the Hippocratic oath itself, involves abortion. In the United States, the climate of public opinion toward doctor-assisted pregnancy terminations was altered considerably by the landmark 1973 Supreme Court decision
Roe v. Wade
. In this decision, the Court judged that state laws defining abortion as a criminal offense were unconstitutional. The main thrust of the argument in Roe v. Wade was that, although the Constitution does not provide a specific guarantee of a civil right of privacy that could be applied to questions of life and death in medical care, parallels exist in Supreme Court decisions on other matters of individual rights with respect to procreation. These rights tend to fall under the Fourteenth Amendment’s concept of personal liberty and restrictions on state action. These rights, in the Court’s words, are “broad enough to encompass a woman’s decision whether or not to terminate her pregnancy.”

Reference to the fundamental right of “personal privacy” in Roe v. Wade granted individual women and their physicians recourse against specific state laws criminalizing abortion. It did not, however, consider the right to have an abortion to be unqualified; nor did it extend beyond the domain of pregnancy termination to cover a general assumption that constitutional protection of the right of privacy included the individual’s right to “do with one’s body as one pleases.” In fact, there was an explicit suggestion that the legal definition of protection of an individual’s right to privacy where critical medical decisions affecting vital life processes are concerned is “not unqualified and must be considered against important state interests in regulation.”

As time passed in the evolving debate over abortion, definitions of what this could mean became colored by the inevitable introduction of religious conceptions of defense of the unborn individual—the fetus—as a possessor of life separate from that of the pregnant woman. This was a precursor to the “right to life” versus “right to choice” debate that would place physicians between two poles of opinion as to where their final obligations should lie.

What seemed most important in the beginnings of the abortion debate (and then, a few years later, the euthanasia debate) was the Supreme Court’s inclusion of commentary on Hippocratic ethical precepts as part of its argument justifying recognition of individual rights to final responsibility for the disposition of someone else’s “future” life or the disposition of one’s own life. The Roe v. Wade brief actually argued that the strict Hippocratic injunction against abortion must be recognized as a reflection of only one segment of opinion and values (specifically Pythagorean) at a particular time in history. By underlining the fact that other views and practices were known to be current throughout antiquity, and that later Christian ethics chose to ignore diversity of interpretations of medical ethics in such matters, Roe v. Wade implied that diversity of ethical opinion within a social environment must be recognized in order to avoid too narrow a definition of what standards should be followed by physicians in dealing with their patients.

The implications of these two directions in interpreting the ethical bonds between patient and physician—the right to privacy in reaching individual decisions and recognition of a degree of social relativity in defining guidelines for medical ethics—are equally visible in the debate concerning the ultimate source of authority for deciding when to terminate life and the presumed authority of the Hippocratic oath in this process.

Two issues, one involving the ethics of sustaining life by means of advanced medical technology and the other involving the “engineering” of lives according to genetic predictions, fall under the provisions of the Hippocratic oath. As one approaches more contemporary statements of professional obligations of medical doctors, such as the “Principles of Medical Ethics” (1957) of the American Medical Association, one finds that, as certain areas of specificity in classical Hippocratic or Christian medical ethics (the illegality of abortions or the administration of deadly potions) tend to decline in visibility, another area begins to come to the forefront—namely, striving continually to improve medical knowledge and skills to be made available to patients and colleagues.

This more modern concern for the application of advancements in medical knowledge, especially in the technology of medical lifesaving therapy, has introduced a new focus for ethical debate: not “lifesaving” but “life-sustaining” techniques, particularly in cases judged to be otherwise terminal or hopeless. As with the issue of abortion, the question of a doctor’s responsibility to use every means within his or her reach to sustain life, even when there is no hope of a meaningful future for the patient, reflects a dilemma regarding Hippocratic injunctions. This debate is more important now than in any earlier era because advanced medical technology has made it possible either to extend the lives of aged patients who would die without life-sustaining machines or—in the case of younger persons afflicted by brain damage, for example—to sustain life although the patient remains in a comatose state.

A prototype in the latter case was a 1976 Supreme Court decision that allowed the parents of New Jersey car accident victim Karen Quinlan to instruct her physician to remove life support systems so that their comatose daughter would die. At issue in this complicated case, which also rested on legal discussions of the constitutional right of privacy, was the question of who should decide that inevitable natural death is preferable to prolongation of life by externally administered means. When the Court took this decision away from an appointed court guardian and gave it to those closest to the patient, the question became whose privacy was being protected. This dilemma is not unlike that inherent in the abortion debate, where the privacy of the pregnant woman is weighed against that of the as-yet-unconscious, unborn child. To whom does the physician’s oath to avoid doing injury actually apply?

Legal solutions to subareas of the euthanasia debate were attained in stages, especially in cases of the very aged or patients afflicted with known terminal diseases. A living will
, for example, allows individuals to instruct their physicians not to sustain their lives by artificial means if, beyond a certain point, they are unable to express their own will to die. In some cases, this discretion is assigned to the next of kin. In both cases, the objective is to remove ultimate responsibility for inevitable natural death from the physician’s shoulders and to place it as closely as possible to within the private sphere of the patient.

Another area in which the oath's injunction against administering "deadly drugs" causes conflict is in the case of inmates who have been sentenced to death via lethal injection. While the AMA's Code of Medical Ethics also prohibits the involvement of doctors in executions, it is nevertheless not uncommon, and many states afford legal protections to physicians who assist in capital punishment. In 1991, a group of doctors sued the Georgia State Medical Board for not disciplining a doctor who had inserted an IV into an inmate so that lethal injection could take place, arguing that the doctor had violated his Hippocratic oath. However, as the oath is not legally binding, there are no legal grounds to actually discipline such doctors in most states.

A final area of contemporary debate over medical ethics illustrates how far conceptions of ultimate responsibility for the protection of life have gone beyond frames of reference that might have been familiar not only in Hippocrates’s time but also as recently as the generation of doctors trained before the 1980s. Impressive advances in the research field of human genetics by the mid-1980s began to make it possible to predict, through analysis of deoxyribonucleic acid (DNA) structures, the likelihood that certain genetic traits (specifically debilitating chronic diseases) might be transmitted to the offspring of couples under study. Inherent in the rising debate over the ethics of such studies, which range from the prediction of reproductive combinations (genetic counseling) through actual attempts to detach and splice DNA chains (genetic engineering), was the delicate question of who, if anyone, should hold the responsibility of determining if individuals have ultimate control over their genes. In the most extreme hypothetical argument, a notion of scientific exclusion of certain gene combinations, or planning of desirable gene pools in future generations, began to appear in the 1980s and 1990s. These notions represent potential problems for medical ethics that, because of exponential changes in technological possibilities, surpass the entire realm of Hippocratic principles.

Perspective and Prospects

Despite the introduction of certain legal precedents that tried to protect both physicians and their patients against dilemmas stemming from the assumed immutable ethical principles of the Hippocratic oath, society continues to witness practical shortcomings in modern understanding of who needs to be protected and how such protection should be institutionalized.

Malpractice insurance offers legal protection to physicians against personal damage claims levied by aggrieved patients or those surviving deceased patients; by the late twentieth century in the United States, these rates had soared. The larger debate regarding whether what physicians have done in individual cases was right or wrong rests on the assumption that his or her judgment can be put to the test by private parties defending their rights against professional incompetence. Therefore, the issue, as well as the institutional and/or legal devices pursued to resolve it, lies beyond the strict realm of a patient’s privacy vis-à-vis a physician’s responsibilities.

More characteristic examples of the contemporary social-ethical dilemma of whether doctors are fulfilling their appropriate professional responsibilities in recognizing patients’ rights to certain types of treatment continue to fall into legally unresolved categories. The most obvious appears to be the ongoing debate concerning the legality of physician-assisted abortions. The considerations that have been introduced clearly go beyond the black-or-white principles that simple comparison with the content of the Hippocratic oath might involve. Courts and legislators involved in the ethics of abortion have had to devote extensive attention to the considerations of how pregnancies were induced (with attention to the anomalies of incest or rape, for example) or to questions of whether tax-appropriated funds gathered from an ethically divided public body can be dispensed to pay for medically approved abortions.

Still other dimensions of contemporary physician-patient relationships reveal that new forms of legislation will be needed before debates over the applicability of Hippocratic principles to modern society will recede from front-page prominence. With living wills having more or less resolved the question of individuals’ right to instruct physicians or families to make decisions for them when personal capacities decline to incoherence, signs of new legal dilemmas began to emerge in the 1990s concerning fully coherent, terminally ill patients. Despairing of future suffering that can come well before any question of life support devices arises, some patients contracted their physicians—initially one physician in particular, Jack Kevorkian of Detroit, Michigan—to perform “mercy killing” by the administration of lethal poisons. Thus, one of the specific negative injunctions of the original Hippocratic oath returned the question of individual physicians’ ethical and legal obligations to the forefront of public attention and court proceedings more than two millennia after its initial statement.

Bibliography

Antoniou, Stavros A. "Reflections of the Hippocratic Oath in Modern Medicine." World Journal of Surgery 34.12 (Dec. 2010): 3075–079. Print.

Campbell, Alistair V., Grant Gillett, and Gareth Jones. Medical Ethics. 4th ed. New York: Oxford UP, 2005. Print.

Casarett, David J., Frona Daskal, and John Lantos. “Experts in Ethics? The Authority of the Clinical Ethicist.” Hastings Center Report 28.6 (1998): 6–11. Print.

Devine, Richard J. Good Care, Painful Choices: Medical Ethics of Ordinary People. 3rd ed. New York: Paulist, 2004. Print.

Fletcher, John C., et al., eds. Introduction to Clinical Ethics. 3rd ed. Hagerstown: University, 2005. Print.

Harron, Frank. Biomedical-Ethical Issues: A Digest of Law and Policy Development. Binghamton: Vail-Ballou, 1983. Print.

Hulkower, Raphael. "The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant." Einstein Journal of Biology & Medicine 25 (2010): 41–44. Print.

Jonsen, Albert R., Mark Siegler, and William J. Winslade. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. 6th ed. New York: McGraw, 2006. Print.

Klisiaris, C. F., C. Sfakianakis, and I. V. Papathanasiou. "Health Care Practices in Ancient Greece: The Hippocratic Ideal." Journal of Medical Ethics and History of Medicine 7 (2014): 6. Print.

Martin, William. "Beyond the Hippocratic Oath: Developing Codes of Conduct in Healthcare Organizations." OD Practitioner 45.2 (2013): 26–30. Print.

Mountokalakis, Theodore D. "Modern Medical Ethics and the Legacy of Hippocrates." Hospital Chronicles 10.4 (2014): 1–3. Print.

Pence, Gregory. Classic Cases in Medical Ethics: Accounts of Cases That Have Shaped Medical Ethics, with Philosophical, Legal, and Historical Backgrounds. 4th ed. Boston: McGraw, 2004. Print.

Zamichow, Nora, and Ken Murray. "Is the Hippocratic Oath Really Fair to Patients?" Chicago Tribune. Chicago Tribune, 2 Jan. 2015. Web. 13 Feb. 2015.

What is masturbation?

Physical and Psychological Factors

Masturbation is the first sexual experience for a great majority of people. Some young people inadvertently stumble on sexual arousal and orgasm in the course of engaging in some other physical activity. Others purposely stimulate themselves, aroused by curiosity after reading erotic literature, watching sexually explicit films, or listening to the imaginary or real sexual adventures of their peers.

Most men and women practice masturbation to relieve sexual tension, achieve sexual pleasure, enjoy sexual stimulation in the absence of an available partner, and experience relaxation. When masturbating, men tend to focus on the stimulation of the penis. Stimulation of the clitoral shaft and clitoral area, and/or the vagina, with a hand or an object is the method that women most commonly employ. Some women masturbate by using a vibrator. Mutual masturbation provides a satisfying and pleasurable form of sexual intimacy and release for many couples. It is also one of the most common techniques that gay and lesbian couples use during sexual intimacy.

Disorders and Effects

Under certain circumstances, masturbation may result in some undesirable consequences. If a child masturbates constantly, it may be an indication of excessive anxiety and tension. Compulsive and frenzied masturbation may reflect abuse or maltreatment in a child’s home life. Frequent masturbation may be a child’s way of relieving tension or unconsciously reenacting past or present traumatic sexual episodes. Among adults, excessive masturbation may point toward a lack of self-esteem and the resultant fear and inability to develop healthy intimate relationships with others. Psychiatry, psychotherapy, and sex therapy have proven helpful in successfully alleviating these problems.

Perspective and Prospects

Throughout history, attitudes toward the practice of masturbation have been riddled with misconceptions, guilt, and fear. Fear of masturbation and its supposed harmful effects, such as loss of memory and intelligence, was widespread through the nineteenth century. Semen was considered a vital fluid important for bodily functioning, and wasting it through masturbation was thought to contribute to a weakening of the body and production of illness. Medical authorities today do not find any evidence of physical damage from masturbation. In fact, many modern sex therapists encourage self-stimulation as part of healthy sexuality. In modern sex therapy, masturbation has become part of the therapeutics used in treating certain sexual dysfunctions. Patients with difficulties or inability to have orgasm are encouraged by their therapists to engage in masturbation. It is widely believed that orgasm once achieved through masturbation will eventually generalize and transfer to satisfactory sexual intercourse.

Bibliography

Bockting, Walter, and Eli Coleman, eds. Masturbation as a Means of Achieving Sexual Health. New York: Haworth Press, 2003.

Dodson, Betty. Sex for One: The Joy of Selfloving. New York: Harmony Books, 1996.

Laqueur, Thomas Walter. Solitary Sex: A Cultural History of Masturbation. New York: Zone Books, 2003.

Marcus, Irwin M., and John J. Francis, eds. Masturbation: From Infancy to Senescence. New York: International Universities Press, 1975.

"Masturbation." HealthyChildren.org, May 11, 2013.

"Masturbation." InteliHealth, June 10, 2008.

Rowan, Edward L. The Joy of Self-Pleasuring: Why Feel Guilty About Feeling Good? Amherst, Mass.: Prometheus Books, 2000.

Sarnoff, Suzanne, and Irving Sarnoff. Masturbation and Adult Sexuality. Bridgewater, N.J.: Replica Books, 2001.

What is seasonal influenza?

Definition

Seasonal influenza (the flu) is a viral infection that affects the
respiratory system. It can cause mild to severe illness and sometimes death. To
avoid getting the flu, one should get vaccinated every year.

Causes

The flu is caused by the influenza virus. Each winter, the virus
spreads around the world. The strains usually differ from one year to the next.
The two main kinds of influenza virus are type A and type B.

A person who is infected with the virus may sneeze or cough, releasing droplets into the air. If another person breathes in infected droplets, he or she can become infected. A person can also become infected by touching a contaminated surface, which risks the transfer of the virus from one’s hand to one’s mouth or nose.

Risk Factors

Factors that increase the chance of getting the flu include living or working
in crowded group conditions, such as in nursing homes, schools, day-care centers,
and the military. Factors that increase the risk of developing complications from
flu include being pregnant; having recently given birth; having diabetes or
chronic lung, heart, kidney, liver, nerve, or blood conditions; and being in a
chronic care facility. Other persons at risk are those who have a weakened immune
system, such as people infected with the human immunodeficiency
virus and people taking immunosuppressive drugs.

Also at higher risk are children younger than five years of age, adults ages sixty-five years and older, and people younger than the age of nineteen years (and who are on a long-term aspirin regimen).

Symptoms

A person with the flu is infectious beginning one day before his or her own symptoms start and up to five days (sometimes more) after becoming sick. This means that a person who has the flu could infect others before knowing that he or she is sick.

Symptoms usually start abruptly and include a high fever and chills; severe muscle aches; severe fatigue; a headache; decreased appetite or other gastrointestinal symptoms, such as nausea, vomiting, and diarrhea (more common in children than in adults); a runny nose and nasal congestion; sneezing; watery eyes or conjunctivitis; a sore throat; a cough (that lasts for two or more weeks); and swollen lymph nodes in the neck. The ill person might start to feel better in seven to ten days but may still have a cough and feel tired.

Screening and Diagnosis

A doctor will ask about symptoms and medical history to determine a person’s diagnosis of the flu. In some cases, the doctor may take samples from the person’s nose or throat to confirm the diagnosis.

Treatment and Therapy

Treatment for the flu includes antiviral prescription medicines. Most people
with the flu do not need antiviral medicine, but persons who do are those who are
in a high-risk group or who have a severe illness (such as breathing problems).
Antiviral medicines, which generally help relieve symptoms and shorten the time a
person is sick, should be taken within forty-eight hours of the first symptoms.
These medicines include zanamivir (Relenza), which may worsen a patient’s asthma
or chronic
obstructive pulmonary disease (COPD), and oseltamivir
(Tamiflu), amantadine (Symmetrel), and rimantadine (Flumadine), all three of which
are ineffective against some kinds of seasonal influenza viruses. Furthermore,
oseltamivir (and perhaps zanamivir) may increase the risk of self-injury and
confusion shortly after being ingested, especially by children. One should monitor
children closely for signs of unusual behavior.

Other forms of treatment include rest, which will help the body fight the flu;
fluids, including water, juice, and caffeine-free tea; over-the-counter pain
relievers, which are used to control fever and to treat aches and pains (adults
can use acetaminophen or ibuprofen); and decongestants, which are available as pills or as nasal sprays.
One should not use a nasal spray for more than three to five days. When stopping,
the patient may experience an increase in congestion called a rebound.

Prescription cough medicines and cough drops also are available, as are
over-the-counter cough and cold medicines. These include decongestants,
expectorants, antihistamines, and cough suppressants. However, these
should not be used to treat infants or children less than two years of age. Rare
but serious side effects have been reported, including death, convulsions, rapid
heart rates, and decreased levels of consciousness. Serious side effects have also
been reported in children between the ages of two and eleven years.

Herbal treatments, such as elderberry extract, may reduce flu symptoms. Researchers have found that products such as Sambucol and ViraBLOC, which contain elderberry, decrease symptoms in some studies. Herbal remedies, however, are not regulated by the government, so care should be taken in using them. The herbal supplements may not have the same ingredients as those studied and may contain impurities.

Prevention and Outcomes

To prevent getting the flu, one should get vaccinated and do so each year because the virus changes every season. The best time to get vaccinated is between the months of September and January (or later, because the flu season can last longer). Two forms of the vaccine are available: a flu shot (injection) and a nasal spray (FluMist). The nasal spray is approved for healthy (and nonpregnant) people between the ages of two and forty-nine years.

People who care for others with severely weakened immune systems should not get
the nasal spray; instead they should get the flu shot. The flu shot is not
effective against H1N1 flu, however, which has its own vaccine.

Persons who want to reduce their risk of the flu should consider the vaccine. It takes about two weeks for the vaccination to protect against the flu. Those who should get a yearly flu vaccine include children ages six months to eighteen years; parents, babysitters, and caretakers of children less than six months of age (because these children are too young to be vaccinated); adults older than fifty years of age (because vaccination in this age group likely reduces hospitalizations and deaths); those living or working in nursing homes and long-term care facilities; those with chronic medical conditions such as asthma; those with diabetes, kidney problems, hemoglobin abnormalities, or immune system problems; women who are pregnant; health care workers; and those living with someone who is at high risk for complications from the flu.

People who should not be vaccinated are those who are severely allergic to chicken eggs, those who had a severe reaction to vaccination in the past, and children less than six months of age. Persons who are sick and have a fever should discuss vaccination with a medical provider.

There are general measures one can take to reduce the risk of getting the flu. These measures include washing one’s hands often, especially after contacting someone who is sick (rubbing alcohol-based cleaners on one’s hands is also helpful), and avoiding close contact with people who have respiratory infections. The flu can spread starting one day before and ending seven days after symptoms appear.

Other preventive measures are to cover one’s mouth and nose with a tissue when coughing or sneezing, and then throwing away the tissue after use; avoid spitting; avoid sharing drinks or personal items; avoid biting one’s nails; and avoid putting one’s hands near one’s eyes, mouth, or nose. Another measure is to keep surfaces clean by wiping them with a household disinfectant.

One should consult a doctor about lowering the risk of getting the flu (also
about lowering the risk for children who are one year of age or older) with
antiviral medications (such as zanamivir). Antiviral medications are helpful for
persons at high risk for the flu and for those who were only recently vaccinated
(within the past two weeks), especially if the flu is spreading in one’s
community; for persons at high risk for the flu and who cannot have the vaccine;
and for persons not vaccinated and who have repeated close contact with persons
(such as family members) who are at high risk for the flu. Persons (such as the
elderly, infants, and persons with cancer) who are at risk for complications of
the flu and who live with someone who has the flu should get antiviral
medications.

Persons who have the flu should take the following steps to avoid spreading the virus to others: Before returning to school or work, one’s fever should be gone for at least twenty-four hours without the help of fever-reducing medicine. This could take up to seven days after symptoms first appear. A sick person who cannot avoid close contact should cover his or her mouth and nose with a face mask.

Bibliography

Belshe, R. B., et al. “Live Attenuated Versus Inactivated Influenza Vaccine in Infants and Young Children.” New England Journal of Medicine 356 (2007): 685-696. Available through DynaMed Systematic Literature Surveillance at http://www.ebscohost.com/ dynamed.

Centers for Disease Control and Prevention. “Home Care Guidance: Physician Directions to Patient/Parent.” Available at http://www.cdc.gov/h1n1flu/ guidance_homecare_directions.htm.

_______. “Key Facts About Seasonal Influenza (Flu) and Flu Vaccine.” Available at http://www.cdc.gov/flu/keyfacts.htm.

Cowling, B. J., et al. “Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Cluster Randomized Trial.” Annals of Internal Medicine 151, no. 7 (2009): 437-446. Available through DynaMed Systematic Literature Surveillance at http://www.ebscohost.com/dynamed.

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

_______. Health Library: Flu. Available through http://www.ebscohost.com.

Mandell, Gerald L., John E. Bennett, and Raphael Dolin, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. New York: Churchill Livingstone/Elsevier, 2010.

Nichol, K. L., et al. “Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly.” New England Journal of Medicine 357 (2007): 1373-1381. Available through DynaMed Systematic Literature Surveillance at http://www.ebscohost.com/dynamed.

Smith, N. M., et al. “Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices.” Morbidity and Mortality Weekly Report 55 (2006): 1-42.

U.S. Food and Drug Administration. “Public Health Advisory: FDA Recommends that Over-the-Counter (OTC) Cough and Cold Products Not Be Used for Infants and Children Under Two Years of Age.” Available at http://www.fda.gov/safety/medwatch.

_______. “2008 Safety Alerts for Drugs, Biologics, Medical Devices, and Dietary Supplements: Tamiflu (Oseltamivir Phosphate).” Available at http://www.fda.gov/safety/medwatch.

World Health Organization. “Influenza Vaccines.” Weekly Epidemiological Record 28, no. 77 (2002): 229-240.

Zakay-Rones, Z., et al. “Inhibition of Several Strains of Influenza Virus In Vitro and Reduction of Symptoms by an Elderberry Extract (Sambucus nigra l.) During an Outbreak of Influenza B Panama.” Journal of Alternative and Complementary Medicine 1 (1995): 361-369.

_______. “Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections.” Journal of International Medical Research 32, no. 2 (2004): 132-140.

Why do you think Winnie is reminded of her grandfather’s funeral when she is talking to the stranger in Tuck Everlasting?

The stranger seems formal and acts suspicious.

Winnie is suspicious of the man in the yellow suit because he is dressed formally and acts formally.  You would not expect either of these things from the average passer-by on the street.  She is reminded of a funeral when she sees him because of how is dressed and how he behaves.

His tall body moved continuously; a foot tapped, a shoulder twitched.  And it moved in angles, rather jerkily. But at the same time he had a kind of grace, like a well-handled marionette. Indeed, he seemed almost to hang suspended there in the twilight. (Ch. 4) 

At first, the man has Winnie almost entranced.  Then the man’s unusual behavior makes Winnie think of “the stiff black ribbons they had hung on the door” during her grandfather's funeral.  She looks at the man more carefully.  She asks if he wants to see her father, and when her grandmother sees her talking to the man she is suspicious of him too. 

The man on the other side of the fence bowed slightly. "Good evening, madam," he said. "How delightful to see you looking so fit."

"And why shouldn't I be fit?" she retorted, peering at him through the fading light. His yellow suit seemed to surprise her, and she squinted suspiciously. (Ch. 4) 

Winnie’s grandmother is ready to run the man off until they hear music coming from the woods.  She gets so excited that she forgets her suspicion, and the man in the yellow suit is interested to know that she has heard the music before.  She says it is elves, but Winnie thinks that it is a music box. 

The music box is important because it is Mae Tuck’s box, and it is a connection to her past.  It is also, ironically, how the man in the yellow hat finds her.  He wants desperately to find the Tucks so that he can make money off of the immortal spring.

"Love and reason keep little company together:" comment in reference to A Midsummer Night's Dream.

The whole madcap story of mixed-up love in this play illustrates the truth of the quote, spoken by Bottom after Titania falls in love with him under the influence of a magic potion. We see throughout the play that love causes people to behave irrationally. Titania, a queen, falls in love with Bottom, a comical, lower class man who, under the influence of magic, has been given the head of an ass. Helena follows Demetrius into the forest, even though he has told her he is in love with Hermia. Helena also invites him to abuse her as long as he will make her his, another form of madness. Throughout the play, love potions cause forms of zany madness that have everyone falling in love with the wrong person and behaving in ways that defy reason.

We've all witnessed what the heady feeling of first falling in love can do to a person and Shakespeare makes the most of it in this play. Right after he delivers his line about love and reason not keeping company, Bottom says:

The more the pity that some honest neighbors will not make them [love and reason] friends.

Then, in one the more complexly ironic lines in the play, Titania responds:

Thou art as wise as thou art beautiful.

She is blinded by love at this moment: Bottom with his ass's head is not conventionally beautiful, so saying he is as wise as he is handsome is, on the surface, saying he is a fool. It's a gag line. But what complicates the irony is that Bottom's words are wise: so perhaps, the irony is, that love--or the imagination behind love--actually might make him beautiful.

This play, with its focus on the madness of love, demonstrates both what can be most charming and most dangerous about love's unreason. 

What percentage of the earth is covered in land?

According to the U.S. Geological Services, approximately 71% of the earth is covered in water, leaving 29% covered in land. Interestingly, of this 71% of water, 96.5% is found in the earth’s oceans, meaning only a small percentage of the earth's water is fresh water. An even smaller percentage is available for human consumption, as just over 30% is trapped as groundwater. In fact, over 68% of all fresh water on earth is found in glaciers or ice, making it currently unavailable for human consumption. This makes issues such as melting ice paramount because it decreases the amount of overall freshwater, as well as potentially leading to the loss of some landmass currently above water. While it is hard to predict exactly how the ratio of landmass to water will shift with the melting of glaciers and ice, it is an important metric to keep track of moving forward.

Hope this helps!

In the book The 21 Balloons, how many people did Krakatoa feed each night?

The short answer is "eighty." Here are the details:

In The Twenty-One Balloons by William Pène du Bois, twenty families live on the island of Krakatoa, and each family has "one boy and one girl," in addition to a mother and father. Each family is renamed after a letter of the alphabet, so that the members of the first family, for example, are called Mrs. A. and Mr. A, with the kids called A-1 (the son) and A-2 (the daughter).

This means that four people make up each of the twenty families, so in total, eighty people live on the island. They all dine every night in a restaurant (with each family running an individual restaurant), so that means that all eighty of them are eating each night on the island.

In the story, Mr. F. elaborates on how the restaurants are set up: "'There are twenty restaurants around the village square hen. We lettered them, A, B, C, D, E, and F, all around the square up to T, the twentieth house.'" 

When George gets angry with all the trouble Lennie causes, what does Lennie say he will do in Of Mice and Men?

In chapter one of Steinbeck's novella Of Mice and Men George and Lennie camp in a spot between the Gabilan Mountains and Salinas River. They are on their way from northern California to work on a ranch near the small town of Soldedad.

George first becomes angry with Lennie over the dead mouse which Lennie has been keeping in his pocket. When George takes it away, Lennie goes after it again and this, along with Lennie's request for ketchup to put on his beans, sets George off. His anger boils over and he describes all the problems Lennie causes and his wish to be away from his friend and be able to do what he wants:

"God a’mighty, if I was alone I could live so easy. I could go get a job an’ work, an’ no trouble. No mess at all, and when the end of the month come I could take my fifty bucks and go into town and get whatever I want. Why, I could stay in a cat house all night. I could eat any place I want, hotel or any place, and order any damn thing I could think of. An’ I could do all that every damn month."

George's anger makes Lennie cry and the big man threatens to run away and live in a cave:

“Well, I could. I could go off in the hills there. Some place I’d find a cave.”...“I’d find things, George. I don’t need no nice food with ketchup. I’d lay out in the sun and nobody’d hurt me. An’ if I foun’ a mouse, I could keep it. Nobody’d take it away from me.”

Ultimately, George apologizes and once again tells Lennie about the dream of the "little piece of land" he one day hopes to acquire. Although George often becomes frustrated with his mentally challenged friend, he seems to have genuine affection for Lennie, and he commits a very unselfish act of love in the end by killing Lennie after the accidental death of Curley's wife. 

Why were factories found in the North? Who worked in them?

In the United States in the 1800s, there was an economic division between the North and the South. The South was mainly a farming region while the North mainly had industries. There were reasons for this.

The North had many industries for several reasons. One reason was the climate and soil were not as well suited for farming in the North as they were in the South. The North had rocky soil and cold winters. This made farming more difficult. The South had a mild climate and fertile soil, which was good for farming. The North also had more resources available. These resources were needed for the manufacturing that was being done. The North had excellent ports. This made it easier to ship products and to trade. Thus, the North was more suited for manufacturing. It made more sense for the North to have industries and for the South to farm.

The people who worked in these factories were mainly the people who lived in the North. This included those people already living in the North. There were also many people who moved from other countries to get jobs in our factories. These immigrants settled in the North and worked in the factories.

The North and the South were very different. One way was in terms of the jobs the people did.

What is anhedonia?

Causes

Anhedonia is associated with substance abuse, depression, schizophrenia, and some neuroses. It is thought that anhedonia reflects a problem in the dopamine pathways of the brain. Research has used functional magnetic resonance imaging to examine the brains of persons with depression and anhedonia. This research showed less activity in the ventromedial prefrontal cortex, ventral striatum, and amygdala of the brain. These areas of the brain are involved in reactions to pleasant and unpleasant occurrences.

Clinical depression is often associated with anhedonia. However, not all persons with depression have anhedonia, although it is common. Persons with anhedonia often have a flat affect; have a loss of interest in eating, sexual activity, and other normal daily activities; avoid eye contact; and withdraw or isolate themselves. With schizophrenia, it is thought that the chemical imbalance that causes this condition also causes anhedonia.

Anhedonia is fairly common in drug addicts after withdrawal
, particularly from cocaine and amphetamines. Withdrawal appears to deplete dopamine, serotonin, and other neurotransmitters involved with feeling pleasure. Also, chronic substance abuse causes changes in the functioning of the brain. These changes affect emotions and are more likely to occur in persons whose substance withdrawal, called protracted withdrawal, has taken longer than usual. A person with long-term addictions appears to have permanent damage to the pleasure pathways in his or her brain, damage that is characterized by apathy.

Serious losses that cause depression also can trigger anhedonia. These losses include the loss of a loved one; physical trauma; serious illness; extreme stress, such as living through a disaster; and other life-altering happenings. In these instances, the anhedonia will pass eventually, as will the depression.

Treatment

The most common treatments of anhedonia are antidepressant medications, cognitive-behavioral psychotherapy, and group milieu therapy. Other treatments for anhedonia include regularly scheduled exercise, setting goals, spending time with other people, yoga, art and music therapy, and sunlight and fresh air. The antidepressants most commonly used are the selective serotonin reuptake inhibitors and the selective serotonin and norepinephrine reuptake inhibitors.

The therapist working with a withdrawing substance abuser should inform the patient that he or she may continue to have withdrawal symptoms after the acute withdrawal period or detoxification. If necessary, the patient’s doctor should prescribe medications to counter these symptoms.

Ideally, the therapist should encourage his or her patient to be active both physically and mentally, and should suggest that the patient join an appropriate support group. Many recovering addicts need to relearn good sleep habits. The therapist should assist them with this as well.

Bibliography

Brynie, Faith. “Depression and Anhedonia.” Psychology Today, 21 Dec. 2009.

Hatzigiakoumis, D. S., et al. “Anhedonia and Substance Dependence: Clinical Correlates and Treatment Options.” Frontiers in Psychiatry 2 (2011). Web. http://www.frontiersin.org/addictive_disorders/10.3389/fpsyt.2011.00010/full

Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. “Substance Abuse Treatment Advisory: Protracted Withdrawal.” Web. http://hap.samhsa.gov/products/manuals/advisory/pdfs/SATA_Protracted_Withdrawal.pdf.

Website of Interest

Substance Abuse and Mental Health Services Administration

http://www.samhsa.gov

What is the narrator from "The Pit and the Pendulum" dreading when the story begins?

At the very beginning of the story, the narrator is dreading his own execution.  He has been put on trial for unknown crimes during the Spanish Inquisition, and in the first few lines of the story we hear the pronouncement of his sentence – “the dread sentence of death.”  He has been condemned, and upon hearing the result of his trial, his senses leave him – he can see the judge, see the judge’s lips pronouncing our narrator’s fate, but sees them morphed into grotesque caricatures.  He can at first hear the words spoken at the trial in a murmur, as “the burr of a mill wheel,” but soon he ceases to process all sound.  And it seems that the “decree…[was] still issuing from those lips” long after the simple decision of death need have been pronounced.  We can assume that the judge is giving the details for the long bouts of torture the narrator would soon have to endure.

At this realization the narrator has a new dread – the prolongation of his fate – and begins to imagine “what sweet rest there must be in the grave.”  Soon after this thought sneaks into his mind he loses consciousness, only to awake to a nightmarish ordeal.

In the Ernest Hemingway short story "A Day's Wait," why does Hemingway give so much attention to the details of his activities outside after giving...

Ernest Hemingway's “A Day's Wait” is about a boy who thinks he is dying. He has really just misunderstood the meaning of his 102 degree fever, but for a full day he lives with the premise that he will soon die.

Your question is a good one. Hemingway was never one to over-explain things, so when we hear the narrator describing his hunting excursion of a few hours while his son is at home with a mild case of the flu, but thinking he is dying (unbeknownst to the father), we can't help but wonder what Hemingway is up to.

One possibility is that Hemingway wants to juxtapose the father's relatively trivial activity and pleasure with the turmoil that the boy must be going through. Does the boy know his father has gone hunting while he is in the process of dying (at least in his own mind)? Hemingway doesn't tell us if the boy knows or not.

Another possibility is that Hemingway wants to make a point of how we go through our days doing things that don't really amount to much, when we all have such a momentous event in our future—our own death, still ahead of us.

Perhaps Hemingway just wanting to give his story a buffer between the two key moments in the story: the boy's misunderstanding, followed by his father's explanation. This gives the reader some time to subconsciously reflect on what must be going on in the boy's mind. Then, when the father tells him what's really happening, we feel a sense of compassion for the boy, who had to struggle through all that time thinking he was dying.

What is computed tomography (CT) scanning?

Indications and Procedures

Computed tomography (CT) scanning collects X-ray data and uses a computer to produce three-dimensional images, called tomograms, of body cross sections, or slices. The noninvasiveness of CT scanning yields easy and safe body part analysis based on varying tissue opacity to X-rays. Bone absorbs X-rays well and appears white. Air absorbs them poorly, so the lungs are dark. Fat, blood, and muscle absorb X-rays to varying extents, yielding different shades of gray. Tumors and blood clots, for example, appear as areas of abnormal shades in normal tissue.

CT scanning is used to analyze disorders of the brain (brain CT) and most body parts (body CT), yielding tomograms that are hundreds of times more definitive than conventional X-rays. For example, conventional abdominal X-rays show bones and faintly outline the liver, kidneys, and stomach. Tomograms clearly depict all abdominal organs and large blood vessels.

Physicians call CT scanning the most valuable diagnostic method because, without it, the symptoms that patients describe may not be identified clearly as minor, serious, or life-threatening. For example, a subjective description of repeated headache does not reveal whether the cause is tension, stroke, or brain cancer. Before CT scanning, an accurate diagnosis often required complex or dangerous identification methods.

A CT patient changes into a hospital gown, removes any metal possessions, and lays on a table that can be raised, lowered, or tilted. During a scan, the patient enters a doughnut-shaped scanner that holds an X-ray source, detectors, and computer hookups. In brain CT, the patient’s head is in the scanner. Some CT patients have experienced claustrophobia, which can be prevented with faster scanner speeds and less-enclosed scanners. A patient who must stay still for an extended time may be given a sedative. If small anomalies are foreseen, then contrast materials are given before or during the procedure. These materials include barium salts and iodine, X-ray blockers that allow better visualization of specific tissues. Subjects may take the materials orally, by enema, or intravenously.

The CT scanner generates a continuous, narrow X-ray beam while moving in a circle around the patient’s head or body. The beam is monitored by X-ray detectors sited around the aperture through which the patient passes. Slices are produced as the scanner circles the head or body. Between slices, the table moves through the scanner. Slices become tomograms seen on a cathode-ray tube (CRT) and are stored in a computer. The procedure used to take twenty to forty minutes in a standard scanner. However, in the newer spiral CT, which is now standard in most hospitals, a patient is scanned rapidly as the X-ray tube rotates in a spiral. There are no gaps, as with slices, and tissue-volume tomograms are produced. A simple spiral scan is completed while the patient holds his or her breath, aiding the detection of small lesions and decreasing scan artifacts. Spiral CT, twenty times faster than standard CT, is useful in all patients, from restless children to the critically ill.

Uses and Complications

CT scanning detects organ abnormalities, and a major use is in diagnosing and treating brain disease. Even the earliest scanners could distinguish tumors from clots, aiding in the diagnosis of cancer, stroke, and certain birth defects. Furthermore, brain CT saves lives as physicians avoid risky methods requiring opening of the brain for pretreatment diagnosis. In addition, postsurgical scans can find recurrences or metastases.

Body CT allows for better damage appraisal of broken bones than does conventional X-ray analysis. Another use of body spiral CT is in the diagnosis of pulmonary
embolism; it is safer than using pulmonary angiography, which maneuvers a catheter from the heart to the pulmonary artery. CT scans can also guide surgery, biopsy, and abscess drainage and can help fine-tune radiation therapy. Speed and excellent soft tissue elucidation make CT scanning invaluable for trauma detection in emergency rooms.

There are few side effects to CT scanning. Preparation for a scan may be mildly uncomfortable, but it is rarely dangerous. Before body CT, subjects often fast, take enemas to clear the bowels, and receive contrast materials through enemas or IVs. If contrast materials are used, then physicians must be told of allergies, especially to iodine. Contrast materials—enhancers of specific tissue CT—may cause hot flashes. Barium enemas for lower gastrointestinal tract scans cause full feelings and urges to defecate.

Perspective and Prospects

British engineer Godfrey Hounsfield and American physicist Allan Cormack won the 1979 Nobel Prize in Physiology or Medicine for the theory and development of computed tomography. CT scanning was first used in 1972, after Hounsfeld made a brain scanner holding an X-ray generator, a scanner rotated around a circular chamber, a computer, and a CRT. The patient laid on a gurney, head in the scanner, and emitter detectors rotated 1 degree at a time for 180 degrees. At each position, 160 readings entered the computer, so 28,800 readings were processed.

CT scanning is essential to radiology, which began in 1885 after Wilhelm Conrad Röntgen discovered X-rays. The rays soon became medical aids, and for years broad X-ray beams were sent through body parts to exit onto film, yielding conventional X-ray images. Bones absorb X-rays well, appearing white, and conventional images can show bone fractures and give some soft tissue data. However, soft tissue evaluation is poor, the tissues superimpose, and estimating their condition is difficult. CT scans allow convenient, noninvasive analysis.

CT scans and stereotaxic neurosurgery, later joined, have improved diagnosis and treatment. For example, the implantation of electrodes in a brain can be monitored using CT, enhancing accuracy. Similar techniques are used in breast biopsy. Current progress in CT scans includes thinner slices, spiral scans, and fast-operating standard scanners. Because complex scans expose patients to more radiation than do conventional X-rays, fast scans are preferred to minimize patient risk.

Bibliography

"CT Scans." MedlinePlus, June 12, 2013.

Durham, Deborah L. Rad Tech’s Guide to CT: Imaging Procedures, Patient Care, and Safety. Malden, Mass.: Blackwell Scientific, 2002.

Hsieh, Jiang. Computed Tomography: Principles, Design, Artifacts, and Recent Advances. 2d ed. Bellingham, Wash.: SPIE Press, 2009.

Kalender, Willi A. Computed Tomography: Fundamentals, System Technology, Image Quality, Applications. 3rd ed. Weinheim, Germany: Wiley VCH, 2009.

McCoy, Krisha, and Brian Randall. "CT Scan (General)." Health Library, Nov. 26, 2012.

"Radiation-Emitting Products: Full-Body CT Scans – What You Need to Know." US Food and Drug Administration, Apr. 6, 2010.

Slone, Richard M., et al., eds. Body CT: A Practical Approach. New York: McGraw-Hill, 2000.

What is some personification in Robert Frost's poem "Mending Wall"?

The erosion of the fence and the apple trees are personified.

Personification is the description of something innate or not human as if it were a person.  For example, there is some phantom force personified in this poem that doesn’t like walls and tears this one down every year.

Something there is that doesn’t love a wall,

That sends the frozen-ground-swell under it,

And spills the upper boulders in the sun;

And makes gaps even two can pass abreast.

There is not actually anything there that doesn’t like walls.  Time erodes the wall and causes parts of it to come down.  The speaker just personifies this force of normal erosion, saying that it “doesn’t love a wall.”  The one who really does not love the wall is the speaker.  He gets annoyed by the process of repeatedly rebuilding the wall, which he considers to be unnecessary in the first place.

Another example of personification is the apple, trees, which may actually be compared to animals.

My apple trees will never get across

And eat the cones under his pines, I tell him.

He only says, ‘Good fences make good neighbors.'

The apple trees are not actually able to move, and of course that is the speaker’s point.  Apple trees getting up and walking over to eat pinecones is very silly.  This is the reason why the speaker doesn’t want a fence. It makes sense to have a fence if you have animals that you have to keep in.

The moral of the story with this poem is that you are going to be able to more easily get along with your neighbor if there is a fence between the two of you.  The speaker prefers closer contact with the neighbor, but the neighbor wants to maintain the fence between them.  The less you see of your neighbor, the better, according to him.

What is deep vein thrombosis?

Causes and Symptoms

Deep vein or venous thrombosis (DVT) is a blood clot (thrombus) in a deep vein. In vessels that transport blood toward the heart, various disorders including skin infections or phlebitis
(inflammation of the vein) can occur; however, specific tests are required to diagnose the existence of DVT. While phlebitis afflicts superficial veins, DVT occurs in deep veins, usually in the legs.

Because of the possibility of its breaking loose, lodging in the lungs, and creating a potentially fatal pulmonary
embolism

(blockage of blood to the lungs), a clot in the leg is highly dangerous. Clots in veins in the legs generally form following long periods of inactivity or lengthy bed rest, pregnancy, obesity, smoking, estrogen therapy, oral contraceptive medication, or surgery.

With DVT, the afflicted leg begins to swell, turn red, become warm, and throb. Occasionally, the area is tender to touch or movement. However, about one-half of the instances of DVT produce no symptoms, and it is frequently referred to as a silent killer.

Treatment and Therapy

Treatment for deep vein thrombosis begins with anticoagulants (blood thinners), specifically heparin, administered intravenously in the hospital, or through self-injections given at home. The anticoagulant warfarin (Coumadin), given as pills, are then prescribed daily to prevent clots from becoming larger. Frequent check-ups with a physician are mandatory to maintain a certain level of medication effectiveness; depending upon the risk of further clotting, Coumadin can be required anywhere from three months to the remainder of the patient’s life. Patients may also be advised to elevate the afflicted leg or apply a heating pad to the area. Walking is sometimes recommended, as is wearing tight-fitting stockings or compression stockings to reduce pain and swelling. In the event that Coumadin is unable to prevent blood clots, a filter may be surgically placed into the vena cava, the large vein carrying blood from the lower body to the heart, to prevent clots from entering the lungs. Also, a large clot may be removed through surgery or may be treated with powerful clot-destroying drugs.

Perspective and Prospects

Inquiries into the mysteries of blood coagulation have existed since 400 BCE, when Hippocrates observed that blood appeared to congeal as it cooled. By the nineteenth century, Pierre Andral, the founder of hematology (the branch of biology that deals with the blood and the blood-forming organs) and one of the first physicians to study the chemistry of the blood, formulated the classical hypothesis of blood coagulation. He found that the process of blood coagulation follows two pathways: the intrinsic, wherein, within seconds, platelets form a hemostatic plug at the site of the injury (primary hemostasis, or stoppage of bleeding); and the extrinsic, wherein fibrin molecules react in a complex cascade or network (secondary hemostasis) that ultimately moves into a third stage, wherein protein factors combine with the enzyme thrombin and contribute to the clotting of blood. Twentieth-century research determined, however, that the tissue pathway (formerly known as the extrinsic) is a series of enzymes generated to participate with thrombin and catalyze fibrinogen into fibrin, which is essential to blood clotting. These factors are responsible for any abnormalities in the clotting of blood.

While the most commonly known blood clotting disorder is hemophilia, or uncontrolled bleeding, its opposite condition, hypercoagulation, specifically the formation of abnormal clots in veins, can also be life-threatening. In 1994, the clotting disorder factor V Leiden (named for the Dutch city in which it was discovered) was identified as a hereditary resistance to activated protein C. An estimated 30 percent of those individuals who suffer from hypercoagulation are afflicted by this enzyme mutation that encourages the overproduction of thrombin and, consequently, causes excessive clotting. Most of these persons are unaware of their condition or its dangers. Treatment and control of this disorder depends largely on antiplatelet medication, such as aspirin or clopidogrel (Plavix), that is designed to prevent platelets from sticking together. Maintaining a heart-healthy lifestyle by getting regular caradiovascular exercise, maintaining a healthy weight, avoiding smoking, and controlling blood pressure and cholesterol levels can significantly reduce an individual's risk of developing lethal blood clots.

Continued research into the complexities of coagulation account for new developments in medications, including thrombin inhibitors or molecular products that target enzymes controlling specific coagulation factors.

Bibliography:

American Medical Association. Family Medical Guide. 4th ed. New York: John Wiley, 2004.

"Are You at Risk for Deep Vein Thrombosis?" Centers for Disease Control and Prevention, March 7, 2011.

"Fact Sheet: Deep Vein Thrombosis and Pulmonary Embolism." SurgeonGeneral.gov, n.d.

Johnston, Bernard, ed. Collier’s Encyclopedia. 24 vols. New York: Collier’s, 1997.

Owen, Charles A. History of Blood Coagulation. Edited by William L. Nichols and E. J. Walter Bowie. Rochester, Minn.: Mayo Foundation for Medical Education and Research, 2001.

"What Is Deep Vein Thrombosis?" National Heart, Lung, and Blood Institute, October 28, 2011.

Wood, Debra. "Deep Vein Thrombosis." Health Library, May 7, 2013.

What is the theme of "Hearts and Hands" by O. Henry?

"Hearts and Hands" is a wonderfully ironic story by O. Henry. In the story, a passenger on a train in Denver named Miss Fairchild is seated across from an old acquaintance named Mr. Easton. She notes that Mr. Easton is handcuffed to an older, less attractive man, and the less attractive man asks her to intervene with the marshal, indicating Mr. Easton. Miss Fairchild believes that Mr. Easton is a marshal, a man of the law, and they have a conversation about old times. In the end, strangers on the train note that a marshal would never handcuff a man to his right hand. In other words, Mr. Easton is the prisoner, and the other man, older and heavier, is the marshal.

The theme of the story is that appearances can be deceiving. Miss Fairchild believes that her old friend must be a marshal because she knows him and because he is young and attractive. However, the reality is quite different, as he is a prisoner. O. Henry suggests that people often jump to conclusions that aren't true. 

What is crystal healing?

Overview

Crystals fall into seven structural types, but individual examples range in the
thousands, each with its own alleged traditional uses in healing. For example,
agate is used for gastritis and skin diseases, chrysoprase is used in the
treatment of depression and alcoholism, and jade is used for improving kidney
function and emotional balance. These forms are subdivided into more descriptive
varieties. In some crystal directories, for instance, agate is divided into blue
lace, dendritic, fire, and moss, which may be used, respectively, for throat
infections, neuralgia, vision problems, and fungal infections.

The use of crystals to promote healing and well-being is attested in many ancient cultures, including Egyptian, Indian, and Native American. Traditional and mythological lore about crystals has continued from the Middle Ages to the present day.

One modern discovery added a scientific veneer to the notion that crystals emit
forces. In 1880, brothers Jacques and Pierre Curie found that crystals
subjected to mechanical pressure yielded a measurable electrical discharge. This
process is called the piezoelectric effect.

Mechanism of Action

The mechanism of action in crystals varies according to culture. In
Ayurvedic
medicine, crystals are said to interact with the energy
system of the body, the aura and seven chakras, which are the energy vortices
located at different points in the body.

Uses and Applications

Crystal healing is said to help alleviate physical, mental, emotional, and spiritual problems.

Scientific Evidence

Unsubstantiated scientific explanations often cite the piezoelectric effect as
evidence of the positive effects of crystal healing and construct models such as
lasers or capacitors (as in the use of quartz to amplify and focus a healer’s
bioenergy). The absence of a standard transcultural crystal directory that would
be recognized by theoreticians and practitioners of crystal healing renders
biomedical testing difficult. Remedies vary from directory to directory and depend
on cultural context, tradition, and mythology; remedies also depend on the
practitioner’s own usage or even the intuition of the person seeking help. The
notion that agate, because of its layered appearance, is useful in
treating organs with different layers of tissue is a type of magical thinking of
which the ancient Egyptian physicians would have approved. Also, biomedical
explanations would include a placebo effect. Crystal healing may be
better accepted by basing itself not on a Western biomechanical paradigm but on an
Eastern paradigm of vitalism or energetics.

Safety Issues

With some exceptions, there exists no obvious risk in wearing or carrying crystals, in temporarily applying a crystal to a person seeking care, in placing crystals around a person in a circular pattern, or in simply placing crystals in view for contemplation. Certain imported gemstones (such as blue topaz, which is sometimes used to treat digestive problems or to stimulate the metabolism) are irradiated to enhance or intensify color. In this case, the blue topaz’s radioactivity could be harmful if exposure were repeated or prolonged.

Bibliography

Gerber, Richard. Vibrational Medicine: The Number One Handbook of Subtle-Energy Therapies. 3d ed. Rochester, Vt.: Bear, 2001.

Gienger, Michael. Crystal Power, Crystal Healing: The Complete Handbook. Translated by Astrid Mick. London: Cassell, 2009.

Jerome, Lawrence E. Crystal Power: The Ultimate Placebo Effect. Buffalo, N.Y.: Prometheus Books, 1989.

What kind of poem is "The Secret Heart"?

"The Secret Heart" by Robert Peter Tristam Coffin is a lyric verse. A lyric poem is one in which the speaker in the poem expresses strong feelings about an experience or idea. Although we might think of the word "lyric" as referring to the words of a song, in poetry it refers to a poem that uses rhythm, rhyme, meter, and sound devices to create a lyrical effect. The term "verse" means that the poem rhymes and has a regular rhythm and meter. 

This poem expresses the speaker's feelings about a boy and his father, especially the boy's memory of his father checking on him after he has gone to bed. The father's actions and the boy's memories are described in warm, loving, and appreciative terms. The poem uses the visual of the heart shape the father formed with his hands to portray the father's love for his son. Such symbolism and/or metaphor is a common device in lyric poetry. The poem is written in one stanza composed of eleven couplets, or pairs of rhyming lines. Most of the lines are iambic tetrameter, although there is some variation. The poem uses soft alliterative sounds like repeated /s/ and /h/ sounds to create a pleasant and quiet sound. 

When you find a poem that makes use of traditional rhythm, meter, rhyme, and other poetic devices and that does not fit into any other category of poetry (see link below), you may categorize it as lyric verse. 

What is homocystinuria?

Risk Factors

A child is only at risk for this disorder if both parents are carriers of the faulty gene that causes it. Carriers appear to have an increased risk of thromboembolic events and coronary artery disease.

Etiology and Genetics

Mutations in five separate genes have been shown to cause homocystinuria. In the majority of cases, a mutation is found in the CBS gene, which is located on the long arm of chromosome 21 at position 21q22.3. This gene encodes the enzyme cystathionine beta-synthase, which catalyzes one step in the pathway that processes the amino acid methionine (MET). When the enzyme is missing or nonfunctional, there is a block in the pathway, resulting in the accumulation of homocysteine, one of the intermediate compounds. High levels of homocysteine can be toxic. They are detected by urinalysis, since some of the excess homocysteine is excreted in the urine.

The enzymes specified by the four other genes are all involved in converting homocysteine back to MET, so mutations in these genes can also lead to a cellular accumulation of homocysteine. The responsible genes are MTHFR (found on chromosome 1 at position 1p36.3), MTR (also found on chromosome 1 at position 1q43), MTRR (found on the short arm of chromosome 5 at position 5p15.31), and MMADHC (found on chromosome 2 at position 2q23.2).

Regardless of which gene is responsible, homocystinuria is inherited in an autosomal recessive pattern, which means that both copies of the gene must be deficient in order for the individual to be afflicted. Typically, an affected child is born to two unaffected parents, both of whom are carriers of the recessive mutant allele. The probable outcomes for children whose parents are both carriers are 75 percent unaffected and 25 percent affected. If one parent has homocystinuria and the other is a carrier, there is a 50 percent probability that each child will be affected. While carrier individuals do not have homocystinuria, they are more likely than members of the general population to have deficiencies in folic acid and vitamin B12
.

Symptoms

The number and severity of symptoms vary among individuals. Symptoms include nearsightedness and other visual problems, flush across the cheeks, fair complexion, high-arched palate, scoliosis, seizures, a tall and thin build, long limbs, high-arched feet (pes cavus), knock-knees (genu valgum), abnormal formation of the rib cage (pectus excavatum), protrusion of the chest over the sternum (pectus carinatum), intellectual disabilities, and psychiatric disease. Osteoporosis may be noted on an x-ray.

Newborn infants appear normal, and early symptoms, if present at all, are vague and may occur as mildly delayed development or failure to thrive. Increasing visual problems may lead to diagnosis of this condition when the child, on examination, is discovered to have dislocated lenses and myopia.

Some degree of intellectual disability is usually seen, but some affected people have normal intelligence quotients (IQs). When such disabilities are present, they are generally progressive if left untreated. Psychiatric disease can also result.

Homocystinuria has several features in common with Marfan syndrome, including dislocation of the lens; a tall, thin build with long limbs; spidery fingers (arachnodactyly); and a pectus deformity of the chest. The most serious complications of homocystinuria may be the development of blood clotting, which could result in a stroke, heart attack, or severe hypertension.

Screening and Diagnosis

Many states require that newborns be tested for homocystinuria before they leave the hospital. The test usually looks for high levels of MET. If the test is positive, blood or urine tests can be done to confirm the diagnosis. These tests can detect high levels of MET, homocysteine, and other sulfur-containing amino acids. Tests to detect an enzyme deficiency, such as a test of the enzyme cystathionine synthetase, can also be done.

If a child is not tested at birth, a doctor may later discover the disorder based on symptoms. At this point, tests may be conducted, including blood tests to confirm the diagnosis, x-rays to look for bone problems, and an eye exam to look for eye problems.

Treatment and Therapy

There is no specific cure for homocystinuria. However, treatment should begin as early as possible. Treatment may include medication and a special diet.

Many people respond to high doses of vitamin B6
, also known as pyridoxine. Slightly less than 50 percent respond to this treatment; those that do respond need supplemental vitamin B6 for the rest of their lives. A normal dose of folic acid supplement is also helpful. Individuals who do not respond require a low-methionine diet with supplements of cysteine (an amino acid) and, occasionally, treatment with trimethylglycine

There is some evidence that vitamin C in relatively high dosage can improve blood vessel functioning in persons with homocystinuria. While data remains incomplete, this treatment might prove effective in reducing the risks of blood clotting and heart attacks.

A special diet may help people who do not respond fully or at all to vitamin B6 treatment. Starting the diet early in life can help prevent intellectual disabilities and other complications. In general, the diet should restrict foods with MET; should consist mainly of fruits and vegetables; and should allow very little, if any, meats, eggs, dairy products, breads, and pasta. This diet is supplemented with cysteine and folic acid.

Prevention and Outcomes

Genetic counseling is recommended for prospective parents with a family history of homocystinuria. Prenatal diagnosis of homocystinuria is available and is made by culturing amniotic cells or chorionic villi to test for the presence or absence of cystathionine synthase (the enzyme that is missing in homocystinuria).

If the diagnosis is made while a patient is young, a low-methionine diet started promptly and strictly adhered to can spare some intellectual disabilities and other complications of the disease. For this reason, some states screen for homocystinuria in all newborns. Individuals should check to see if their states screen for this condition.

Bibliography

Alan, Rick, and Kari Kassir. "Homocystinuria." Health Library. EBSCO, 30 May 2014. Web. 4 Aug. 2014.

Andria, Generoso, Brian Fowler, and Gianfranco Sebastio. "Disorders of Sulfur Amino Acid Metabolism." Inborn Metabolic Diseases: Diagnosis and Treatment. Ed. Jean Marie Saudubray, Georges van den Berghe, and John H. Walter. 5th ed. Heidelberg: Springer, 2012. 311–22. Print.

Houser, Christine M. Pediatric Genetics and Inborn Errors of Metabolism: A Practically Painless Review. New York: Springer, 2014. Print.

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

Porter, Robert S., et al., eds. The Merck Manual of Diagnosis and Therapy. 19th ed. Whitehouse Station: Merck, 2011. Print.

Schiff, Manuel, and Henk J. Blom. "Treatment of Inherited Homocystinurias." Neuropediatrics 43.6 (2012): 295–304. Print.

Singh, Rani. “Homocystinuria.” Pediatric Nutrition in Chronic Diseases and Developmental Disorders: Prevention, Assessment, and Treatment. Ed. Shirley W. Ekvall and Valli K. Ekvall. 2nd ed. New York: Oxford UP, 2005. 263–66. Print