How did the Great Depression challenge political establishments after World War I? What values and assumptions did the Great Depression challenge?

The Great Depression that occurred after World War I had far-reaching political implications in the United States and abroad. The war had disrupted agriculture and manufacturing to an extent that countries were hard pressed to recover. Many nations were steeped in debt from the conflict. The loss of millions of potential laborers on the battlefield also wreaked havoc on industrial potential. In the United States, citizens were unhappy but chose to work within their democracies to fix the economic issues at hand. In other countries around the world, fledgling democracies fell under the weight of unemployment and inflation. While the United States stayed with their system of democracy, major reforms to the system were made to deal with the misery that was the Great Depression.

In many respects, the Depression marked a significant political change in the United States. It marked a shift to an interventionist federal government. The laissez-faire government approach towards the economy was now viewed as ineffective. The American people spoke loud and clear in the election of 1932 as a new political coalition overwhelmingly chose the democrat Franklin D. Roosevelt to the presidency. This coalition, which would endure to the present day, included urban ethnic groups, organized labor, and African-Americans. Roosevelt would transform the federal government to make it more responsive to the economic needs of a struggling nation.

Roosevelt challenged many political norms in instituting his New Deal. For most of America's history, the government felt that the economy should manage itself, with minimal oversight. By allowing big business to prosper unabated, jobs would be created for the masses. The unprecedented growth in the stock market in the 1920's seemed to confirm this on the surface. When the market crashed in 1929, the need for government intervention was made clearer. Roosevelt's first act as president was to fix the banks. He closed all of the banks and set up commissions to review the health of the banks. The ones that could fail were not permitted to re-open. The actions of Franklin D. Roosevelt during this bank holiday indicated a clear shift away from a laissez-faire approach toward American financial institutions.

The federal government during this period took an aggressive approach to fixing unemployment. This was accomplished by creating agencies to hire Americans for massive public works projects. Direct aid was granted through the Social Security Act and unemployment compensation. Many of the safety net programs that exist today to help Americans were instituted during the Great Depression. These concepts included aid for dependent children, minimum wage, and public housing. The political change would inspire further reforms for the poor in the years to follow World War II. The age-old American convention of pulling yourself up "by the bootstraps" seemed quite dated during the Great Depression.

Around the world, the economic depression that followed World War I had a dramatic effect. After the Great War, many countries felt that democracy was a system of government that could ensure peace and prosperity. Because of their inexperience with representative government, these attempts at democracy failed. There were too many political parties in countries like Italy and Germany to solve the issues of inflation and unemployment. Citizens felt that authoritarian rule was more efficient and they turned to radical leaders. In Japan, democracy failed to solve the issue of unemployment and the people turned to an aggressive military structure to govern them. The economy had dictated a change to the far left in these countries, which would eventually plunge the world into another war.

Which family of rocks is most likely to contain fossils?

There are three main categories of rocks: igneous, metamorphic, and sedimentary. These categories correspond to how the rocks form. Igneous rocks are formed when magma cools and hardens. Granite is a common example of igneous rock. Metamorphic rocks form from other rock that is subjected to a new extreme environment. Commonly, they form when rocks get buried deep within Earth's crust and are exposed to extreme heat and pressure. The rock never melts, but the heat and pressure cause the minerals to change in such a way as the resulting rock is considerably different from the original. Marble is a common example of a metamorphic rock. Sedimentary rocks are formed from layers of sediment that are compacted and cemented together. These sediments can come from other rocks, dissolved minerals that are left behind after evaporation, or from organic material from living organisms. Sandstone and limestone are common examples of sedimentary rocks.

Because sedimentary rocks are subjected to the least extreme environments and form where living organisms are, they are the type of rock that is most likely to contain fossils. This doesn't mean that other rock types don't have any fossils, just that sedimentary rocks most commonly have fossils. For example, imagine a mudslide occurs underwater in a lake or ocean. Many plants and animals get buried in this mudslide. Over time, the sediments compact and cement and become sedimentary rock. Traces of those living organisms that had been trapped in the mudslide will very likely be found in that sedimentary rock. By organisms becoming buried in sediment they are able to be preserved as fossils. 

Let's take a journey with this rock through an example of the rock cycle. Imagine after millions of years that sedimentary rock is eventually buried very deep, subjected to extreme heat and temperature, and becomes a metamorphic rock. The extreme heat and temperature may result in the loss of some of the fossils because of the drastic changes the rock went through. Fast forward millions of years more, and this metamorphic rock gets subducted underneath another tectonic plate and melts into magma. The fossils are now lost forever, and when that magma eventually hardens and becomes igneous rock, there won't be any traces of the fossils to be found. So, the reason that sedimentary rocks are most likely to contain fossils is because the environment in which they form is most conducive to preserving evidence of life.

What contrast does Lord Henry make between Basil and Dorian in The Picture of Dorian Gray?

In the first chapter of The Picture of Dorian Gray, Lord Henry makes the following contrast between Basil and Dorian:

Basil...with your rugged, strong face and your coal-black hair, and this young Adonis, who looks as if he were made out of ivory and rose-leaves.

To put this into context, this contrast appears after Basil has shown the painting of Dorian to Lord Henry and has told him that he will not exhibit it. Basil explains this by saying, "I have put too much of myself into it," and this prompts the above contrast from Lord Henry. 

Lord Henry interprets Basil's comment as an admission of his perceived beauty. He thinks that Basil believes himself to be as beautiful as Dorian but he is, in fact, making an admission of his love. This reference to homosexual love is one of the reasons why the publication of Dorian Gray sparked such outrage among the Victorian public. Whether Lord Henry really appreciates the extent of Basil's feelings towards Dorian is not made clear in the chapter. It goes a long way, however, in explaining why Basil is so hesitant in allowing Lord Henry and Dorian to meet: he is possessive and protective because he is in love. 

We also learn something important about Dorian in this contrast. Not only is he extremely beautiful, his youth and vitality also strike Lord Henry, hence his comparison to Adonis. These characteristics are what enable Lord Henry to become such a strong influence on Dorian later in the novel and which ultimately bring about Dorian's demise.   

What role did George have in Of Mice and Men?

The characters in Of Mice and Men can be seen as narrative archetypes, or characters that represent broader symbolic "types" of people. When viewed through this lens, George would symbolize the "everyman." He represents a surrogate character for the reader to insert themselves into the story. As such, he is neither especially terrible or especially great as a person, but just average. As the "everyman," George also demonstrates the obstacles and hardships faced by the average working American, making his inability to access his American Dream more poignant and relevant. Through George, Steinbeck is saying that there is something wrong with a country where a decent man can work hard and struggle and try to be a good guy, but still end up poor and miserable. 

What mood does the cluster of images in the first stanza create?

Overall, the images in the first stanza of Thomas Gray's "Elegy Written in a Country Churchyard" create a mood of melancholy, tiredness, and finality.

There are four main images here, one in each of the first four lines. In the first line, Gray describes a "curfew" tolling, and we can assume this image refers to a tolling bell in a church yard. In the second line, Gray paints a picture of an ambling herd of cows, and in the third line he discusses a tired plowman heading home after what we can assume was a tiring day. He ends the stanza by describing the falling darkness and the isolation of the narrator, and so we know that the poem takes place during the evening and in solitude.  

There is a certain peaceful element to these images, as Gray is certainly illustrating a classic pastoral scene, one that most of us will probably associate with natural beauty and good, clean farm work. However, there is a persistent melancholy streak at work here; whether Gray is describing the "weary way" (3) of the plowman, or the tolling of the bell (1), a faintly ominous image, we get the sense that this is an exhausted world and that something is coming to an end. By beginning his poem with a mood of sadness and tiredness, Gray prepares us for a discussion on the toil of common folk and the melancholy, bittersweet beauty of a peasant's life.  

Why does a balloon get larger when it is heated?

This mostly has to do with the energy of the molecules inside the balloon.

Anything that has mass has some energy just by existing. Usually, if you add some energy to that mass, you can get it to move; if we compared two objects of identical mass, but one of them is moving, we can safely say that the moving one has more energy. This is the basic explanation for the various states of matter; solids have less energy and aren't moving as much as gases, which are moving rapidly and have so much energy that they just bounce off of each other when they collide.

This "bouncing" is identical to the air pressure we feel at all times. This is also why you have to exert some force to blow up the balloon in the first place; you have to resist the force of all those air molecules ramming into the balloon at high speeds. However, once you've filled the balloon, it should stay the same size; this is because the average energy of the molecules inside the balloon "pushing" on it from the inside, is equal to the energy from the outside.

When you heat up the balloon, you add energy to the molecules inside. Since they can't really get any heavier, that energy goes into their motion instead, so they move faster. This means each collision is even more powerful than it was a a moment ago, when the molecules were cooler. You also haven't changed the energy of the molecules on the outside; they're still pushing with the same energy as a moment ago. So, the hot balloon molecules start to "win" - they get to push outwards until they reach a new equilibrium point; the point at which their extra energy is balanced by the other forces, such as the distance they have to travel or the greater number of molecules pushing on them from the outside. 

How did the frontier compare to the mythology of the Wild West?

Although it is rooted in certain aspects of history, the construction of the Wild West was more of a literary and, in some cases, political device.

Despite the newly acquired territory in the west, many 19th century Americans continued to live in over-crowded urban centers where there was little work and rapidly increasing poverty. In order to encourage people to move out west, the government introduced programs like the Homestead Acts, which gave men a certain amount of land in the west for little or no money. Going west was framed and promoted as an exciting patriotic action, helping to settle the wild landscape and improve the nation's agricultural production, while also taking control of their individual futures and destiny.

Unfortunately, once they arrived, Homesteaders and other settlers learned quickly that the reality of the West was quite different than it had been described. In addition to the unfamiliar terrain and climate, the West was still occupied by a number of Native tribes that were actively and aggressively trying to protect their land and communities. Not only was the environment dangerous, but the fortunes that many had expected to build never quite materialized. Homesteading probably sounded great in theory, but most of the people in urban centers knew nothing about farming and couldn't afford the equipment and assistance that was required to set up and operate an independent farm. As a result, a large percentage of people either went back east or found work in the mines or with the railroad.

The mythology of the Wild West, then, is a re-framing of reality in which settlers and Homesteaders weren't failures; rather, they were heroic patriots working to tame the savage frontier. This mythology survived in large part because people found the stories exciting and romantic. It's also important to remember that this mythology served a greater purpose. Had the public known the truth about westward settlement, its very likely they wouldn't have volunteered to relocate and Manifest Destiny would have been an abject failure. 

What steps did the Western allies (Great Britain, France, and the United States) take to promote economic growth during the early Cold War era?

After World War II, the Western allies consciously chose to rebuild Europe rather than to punish the countries that they had fought against, such as Germany. They realized that punishing Germany after World War I had helped pave the way for Hitler's rise to power, and they were eager to make sure European countries, devastated by the destruction of the war, did not become communist. To this end, the United States instituted the Marshall Plan, which gave $13 billion in aid to rebuild Europe's economy after the war. Great Britain, France, and West Germany received a great deal of the aid. The U.S. offered the Soviet Union aid, but they declined.

In Japan, the United States, led by General Douglas MacArthur, rebuilt the Japanese economy. They redistributed land and broke up large corporations called zaibatsu. The intent was to rebuild Japan along the lines of a Western-style capitalist country, and the U.S. also wrote a new constitution for Japan that included more rights for women and that made the military only serve as defensive if Japan were attacked. The Americans were concerned that if Japan had a weak economy, it would become communist. During the Korean War of 1950-1953, Japan became the staging ground for the American operations in the war (led under the United Nations), which further strengthened the Japanese economy and made the country the recipient of American goods. 

What does Gram ask Max to do with regard to the hoodlum boy?

Tony D. is an older boy who likes to pick on Max. Tony's nickname is "Blade" because he carries a knife and has a couple of friends who assist him in carrying out his criminal mischief. Max explains in chapter 6 that Tony has been in and out of juvenile detention three or four times. Rumor has it that he actually cut another boy with a razor and the boy almost died. Max says, ". . . everybody says the best way to handle Tony D. and his gang is, you avoid them. Cross the street, hide, whatever it takes" (29-30). Max tells Freak that you can't just be brave and face off one-on-one with Tony—you have to fight his whole gang if you do that.

On the night of the Fourth of July, Freak and Max run into the pond near their neighborhood to avoid Tony D. and the gang. The cops come to help them and they are safe because Freak used his brains to tell Max where to run. When Max gets back home safe to Grim and Gram, they give him ice cream and coffee. In chapter 8, Gram says the following:

"I want you to promise me something, Maxwell dear. Promise me you'll keep away from the hoodlum boy and his awful friends. Nobody got hurt this time, but I shudder to think what might have happened" (43).

Grim, on the other hand, thinks that Max could take the boys because he's so big and strong, but rather than contradict his wife, he tells Max that "evasive action" is different than running away. Max is lucky that he has such good and supportive grandparents looking after him.

In the poem "The old woman's message" by Kumalau Tawali, do you think the speaker is happy with her sons' behavior? Why, or why not? Quote from the...

The old woman is not happy with her sons' behavior, because they are neglecting her. She writes the poem as a message, telling them to come visit. The first line makes this clear:

Stick these words in your hair 
And take them to Polin and Manuai 
my sons ... 

She goes on to say:

 my sons, forgetful of me... 

Her sons are so forgetful of her that the old woman needs other people to bring them the message that she wants to see them. She seems to have no other way to contact them to make them understand how close she is to dying.

The woman says that other sons come back to their mothers. She explains that she doesn't have much time before she dies and that she wants her sons to visit her soon:

I have little breath left 
to wait for them. 

In the last part of the poem, she describes how she is suffering: she is old and withered and dried up and she cannot see:

I sway like a dry falling leaf 
I see with my hands – 

She says they must hurry to arrive in time for her "death feast." These are not the words of a woman happy with her sons' behavior but of a woman wishing they would behave differently and pay attention to her. 

In The Adventures of Huckleberry Finn, Huck frequently examines and re-examines his own moral values. In what ways has society shaped his moral...

In Mark Twain's The Adventures of Huckleberry Finn, Huck frequently worries about the fact that he's helping Jim, a runaway slave. Through Huck's musings and fretting, we ascertain that the society in which he was raised taught him to agree with the classic racist assumption that African Americans are inferior to whites, and so he believes it's shameful for a white boy to befriend a black man. 

One of the most obvious places we see this idea at work in Huck's psyche is in his agonized debate about whether or not to free Jim after the duke and the king sell Jim back into slavery. Huck wrestles with his friendship with Jim and the stigma that society places upon associating with African Americans. In the end, Huck decides to save Jim, although he assumes he'll be sent "to hell" (210) as a result. Huck's assumption that he'll go to hell for helping a black man shows just how racist his society is.

I can't answer how the society you've been raised in has taught you different lessons than Huck's society, but I can provide an example by reflecting on my own experience. While my society is not as focused on equality as many people would like to believe (the tensions around race in the last few years have proved many racist attitudes are alive and well), there is at least one key difference between the way my society shaped me and the way Huck's society shaped him. In my familial community, I was always taught that everyone is equal, regardless of race, gender, religion, or any other characteristic. This idea was not present in Huck's society, as racist attitudes were clearly the norm. As such, while my society at large still struggles to embrace differences between its citizens, the personal community that I grew up with always encouraged me to regard everyone as equal. Hopefully, this reflection will give you an idea of how to reflect on how your own experience with modern society can compare to Huck's experience with his society. Good luck!  

What is stevens-johnson syndrome?

Causes and Symptoms

Stevens-Johnson syndrome begins with a nonspecific upper respiratory tract infection or after the consumption of a particular drug. The early symptoms last for one to fourteen days and consist of fever, sore throat, headache, cough, body aches, and sometimes vomiting and diarrhea. Subsequently, a flat, red rash (erythema multiforme) breaks out over the face and trunk that later spreads to the rest of the body. Painful blisters form in the center of the rash, and the skin around the blisters is quite loose and rubs off easily. Patients have a headache, fever, weakness (malaise), and a cough that produces thick, pus-filled material.

Blisters can form on the mucous membranes that line the mouth (preventing the patient from eating or drinking), throat, genitals, eyes, and anus. If the urinary tract is involved, then the patient will not be able to urinate. Eye involvement causes the eyes to swell and fill with pus so that they seal shut. Blisters on the surface of the eyes (corneas) can scar them. Lesions in the respiratory tract restrict breathing, and tissue sloughing can cause respiratory collapse. Sores in the digestive tract can cause diarrhea and narrowing of the esophagus. The open, skinless sores are also susceptible to infections.

Stevens-Johnson syndrome is classified according to the percentage of the skin affected. If 10 percent or less of the body surface area detaches, then the patient has Stevens-Johnson syndrome. If 10 to 30 percent of the skin detaches, then the patient has overlapping Stevens-Johnson syndrome/toxic epidermal necrolysis (TEN). If more than 30 percent of the skin is detached, then the patient has TEN.

Drug reactions cause most cases of Stevens-Johnson syndrome. The drugs that may trigger it include antibiotics, such as penicillin, ciprofloxacin, and sulfa drugs; anticonvulsant drugs, such as phenytoin, carbamazepine, and barbiturates; nonsteroidal anti-inflammatory drugs (NSAIDs); the antigout drug allopurinol; the narcolepsy treatment modafinil (Provigil); anti-Human immunodeficiency virus (HIV) drugs; diuretics; and topical ocular medications. Viral, bacterial, fungal, and protozoan infections can also cause the disease, as can various types of cancers. Between one-quarter and one-half of all cases of Stevens-Johnson syndrome are idiopathic, which means that there is no discernable cause. There is also a genetic basis for this disorder.

Diagnosis requires a skin biopsy, which shows extensive cell death, detachment of the upper layer of the skin (epidermis) from the middle layer of the skin (dermis), and infiltration of the skin with particular white blood cells called lymphocytes.

The large amount of skin loss in TEN is similar to a severe burn and is life threatening. Water and salts leak through the denuded areas and can produce organ failure. Infection at the damaged areas is also a major cause of death in TEN patients.

Treatment and Therapy

The most important therapeutic step is to discontinue all drugs suspected of triggering the disease. Management of symptoms is also essential. Mouthwashes can treat oral lesions and allow fluid intake, which, when coupled with the intravenous replacement of fluid and salts, can prevent dehydration and electrolyte imbalance. Skin lesions are treated as burns. Topical anesthetics can reduce pain, and denuded skin areas are covered with saline compresses. Any secondary infection that develops must be rapidly identified and treated.

There is no universally accepted drug treatment for Stevens-Johnson syndrome. Oral corticosteroids appear to help during the first few days, but not after that. In advanced cases of TEN, corticosteroids increase the incidence of complications. Intravenous delivery of antibodies (immunoglobulins) against the Fas ligand that mediates cell death has helped small groups of TEN patients, but this treatment has not been systematically evaluated. Also, drugs that down-regulate the immune system have been used, but too little data exists to evaluate their efficacy properly.

Perspective and Prospects

Stevens-Johnson syndrome was first described in 1922 by Albert Mason Stevens and Frank Chambliss Johnson. They encountered two young boys who showed inflammation of the mucous lining of the cheeks, pus-filled eyes, and the generalized skin blisters that are now commonly associated with the disease. Stevens and Johnson originally thought that the boys suffered from a type of unknown infectious disease. Bernard Thomas named the condition in 1950. The condition gained public attention in 2010 when it contributed to the death of former professional basketball player Manute Bol.

No treatment for Stevens-Johnson syndrome provides consistent benefits to patients in systematic studies. Nevertheless, several treatments have shown promise in small studies. For example, intravenous immunoglobulin treatments, skin grafts, the antitransplant rejection drug cyclosporine, and a blood filtration procedure called plasmapheresis have successfully treated small groups of patients with few complications and little mortality. However, until larger, double-blind, placebo-based studies establish the efficacy of these treatments, they will remain experimental.

Bibliography

Berman, Kevin, et al. "Erythema Multiforme." MedlinePlus, Nov. 20, 2012.

Boyer, Woodrow Allen. Understanding Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Raleigh, N.C.: Lulu Press, 2008.

Kellicker, Patricia, and Peter Lucas. "Erythema Multiforme." Health Library, Sept. 30, 2012.

Koh, Mark-Jean-Aan, and Kwang-Yong Tay. “An Update on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children.” Current Opinion in Pediatrics 21, no. 4 (August, 2009): 505–510.

Parrillo, Steven J. “Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.” Current Allergy and Asthma Reports 7, no. 4 (July, 2007): 243–247.

"Stevens-Johnson Syndrome." Mayo Clinic, Apr. 9, 2011.

Warn, Dana, and Nancy Matharu. Stevens-Johnson Syndrome: A Booklet for Children and Their Families. Vancouver, B.C.: Provincial Health Services Authority, 2006.

The codon UUA was changed to AUA. How would that base change impact the protein being translated?

DNA directs protein synthesis by the processes of transcription followed by translation. When messenger RNA copies the DNA code in a process called transcription, each triplet or codon signifies which amino acid will be added into a growing polypeptide. 

The mRNA attaches to a ribosome which is the site of translation. Transfer RNA molecules bring the correct amino acids to the growing polypeptide chain based on each triplet or codon in the mRNA. They transfer these amino acids from the cytoplasmic pool which contains all 20 amino acids. On one end of tRNA is the amino acid it carries and on the other end is a triplet called an anticodon which base pairs to the codon on mRNA while it delivers its amino acid. Ribosomes facilitate the joining of the tRNA anticodons with the mRNA codons during protein synthesis.

There is a start codon AUG and the tRNA brings into the first position the amino acid methionine. At the end of the mRNA transcript is a stop codon or termination sequence, which is one of the following triplets: UAA, UAG or UGA. This causes translation to stop and the polypeptide to detach from the ribosome. The translation assembly will break down. The polypeptide will then fold into a protein.

The codon UAA is a stop codon. If a mutation changed it to AUA, this would result in the addition of the amino acid isoleucine to be added to the polypeptide chain.  The stop codon would no longer be present in the correct position. This type of mutation will result in a protein that is longer than normal. Translation won't cease until another termination codon is found. The new protein will be longer than normal and may not function properly or at all.

The rise of the Mongol Empire contributed to all of the following except (a) the spread of Christianity (b) an empire that extended into parts of...

The correct answer to this question is Option A.  The Mongol Empire contributed to all of the things mentioned here except for the spread of Christianity.

The Mongol Empire certainly contributed to the creation of an empire that covered parts of both Asia and Europe.  The Mongols originated, of course, in Asia since Mongolia is part of that continent.  By the time they were finished conquering, they had taken much of Eastern Europe into their empire.  Therefore, Option B is wrong.

The Mongol Empire also contributed to an unsuccessful invasion of Japan.  To be technically precise, the Mongols actually tried to invade Japan twice.  One attempt was in 1274 while the other was in 1281.  Both attempts failed.  Therefore, Option C is wrong.

Because the Mongol Empire led to an increase in trade across Central Asia, it also helped to spread the plague (Black Death).  The Mongol Empire helped increase trade because it maintained peace and order across a huge area of land.  This meant that traders could safely travel with their goods.  Because trade increased, places that had previously been remote from one another became connected.  This helped cause the plague to spread from formerly isolated regions to population centers in Europe.  For these reasons, Options D and E are wrong.

That leaves Option A as the correct answer.  Since the Mongols were not Christian, they did not help to spread that religion.

What is resuscitation?

Physiology of Respiration and Circulation

Every cell in the human body needs a constant and steady supply of oxygen. The delivery of oxygen is possible only through a continuous movement of oxygen-rich blood, with the heart and lungs working efficiently together. To survive, the body must have a functioning heart and lungs, or an outside force that makes both organs function artificially. Two major life-threatening conditions include respiratory arrest (cessation of breathing) and cardiac arrest (cessation of heartbeat). Death is certain unless something is done to put oxygen into the blood and circulate it throughout the body. Cardiopulmonary resuscitation (CPR) is the artificial action of putting oxygen into the lungs and making the heart pump blood throughout the body. By understanding the anatomy and physiology of the heart and lungs, and their entire systems, it is easier to see how CPR can help a person who is not breathing and whose heart is not pumping blood.

The respiratory system.
This system has many parts, from the nose down to the smallest sacs of the lungs. After air is taken in through the nose or mouth, it moves farther down into the throat (pharynx), past the larynx (voice box) and the trachea (windpipe). Next, the inhaled air goes through specialized tubes called bronchi, one connected to each lung. From this larger tube, the air passage narrows into smaller tubes called bronchioles. The bronchioles become smaller and end at the air sacs, called alveoli. Alveoli are actually millions of tiny air sacs that allow oxygen to move into the bloodstream and carbon dioxide to be removed from the blood and exhaled. The
alveoli are hollow and surrounded by a very thin, specialized membrane that is only one
or two cells thick. This transfer of needed oxygen, along with the removal of the carbon dioxide waste products, happens through the small capillaries surrounding the alveoli. In the blood, oxygen attaches to the hemoglobin found in red blood cells, and, in return, carbon dioxide crosses back into the lungs in order to be exhaled.

It is this carbon dioxide buildup in the blood that stimulates how deep and how often one breathes. An area of the brain called the medulla is considered the body’s respiratory center because it is responsible for sending electrical signals to the chest
muscles that control breathing. A check-and-balance system monitors the amount of carbon dioxide in the bloodstream. When the level increases, the rate and depth of respirations also increase so that the excess amount can be exhaled.

The brain sends messages via the nerves to the muscles of the ribs. In addition to smaller muscles between each rib, the neck and shoulder muscles must also help during breathing. The diaphragm, a large, sheetlike muscle that separates the chest from the abdominal organs, also plays a major role in inspiration and expiration. The diaphragm extends from front to back by attaching to the lower part of the ribs. During inhalation, the muscles raise the ribs up and forward while the diaphragm moves downward toward the abdominal cavity, thus making room for the lungs to expand. As a result, the pressure inside the lungs becomes less than that of the surrounding air. It is this difference in air pressure, not an actual sucking in of air, that causes air to move into the lungs. The act of exhaling occurs when these muscles relax, causing the ribs to move back down and the diaphragm to rise. The size of the chest cavity decreases, the elastic nature of the lungs causes them to become smaller, and air moves out of the lungs.

The circulatory system. Life cannot be sustained simply by air moving in and out of the lungs. Once the oxygen moves from the tiny air sacs in the lungs and across into the bloodstream, it must be moved to every cell in the body. This transportation is possible because of the
circulation of blood within the many vessels. At the center of this circulatory system, the heart acts as the pump, pushing blood out through the large arteries and the smaller arterioles and capillaries. After reaching the capillaries, the oxygen is delivered to the cells, and waste products such as carbon dioxide are picked up. The capillaries branch into larger venules and then into even larger veins. The major veins, from all areas of the body, return blood to the heart that is no longer rich in oxygen. Instead, it contains carbon dioxide that needs to be removed. It is this lack of oxygen that makes the blood in veins appear bluish, whereas the oxygen-rich blood found in arteries is more red in color.

The heart is responsible for sending out oxygen-carrying blood to all body tissues and moving carbon dioxide-rich blood to the lungs so that it can be exhaled. The right side of the heart is responsible for receiving blood that no longer has enough oxygen, called deoxygenated blood. The blood is next pumped through the bottom half of the heart (right ventricle) into a specialized artery called the pulmonary artery and then into each lung. Although the term “arteries” is usually reserved for vessels carrying blood with high levels of oxygen, there is one exception: The pulmonary artery does not carry oxygen-rich blood. The blood then flows into smaller capillaries surrounding the alveoli in the lungs, where it exchanges carbon dioxide for oxygen. On the return trip to the left side of the heart, after leaving the lungs, the oxygenated blood moves through the pulmonary veins. Blood then travels from the left upper portion of the heart (left atrium) to the left ventricle, which is the major muscle of the heart responsible for pumping blood to all the cells of the body.

In summary, the right side of the heart carries deoxygenated blood from the body to the lungs. The left side of the heart receives the oxygenated blood from the lungs and pumps it throughout the body. The huge network of connections in the circulatory system, from the heart all the way out to the tips of the toes and returning to the heart, makes up a closed system that must not have any large leaks, which occur during bleeding.

Indications and Procedures

It might seem that whether the heart is functioning is not a matter of yes or no, black or white. However, there are many gray areas that represent a heart that is beating but not working in a manner that will support life. These gray areas include many types of abnormal beats, known as
arrhythmias, or abnormal rhythms. If the heart is beating too fast (tachycardia) or extremely slowly (bradycardia), then it cannot supply body tissues with needed oxygenated blood. A constant and even pressure of blood flow must also be maintained.

The amount of pressure inside the circulatory system varies.
Blood pressure is measured as systolic pressure over diastolic pressure. In a blood pressure reading of 120/70, the top number, 120, indicates the amount of pressure on the walls of the vessels when the heart is beating (contracting). The bottom number, 70, reflects the amount of pressure on the vessel walls between beats when the heart is at rest. In cases when both numbers are extremely low or high, the system is not working properly and urgent measures must be taken to identify and fix the problem.

When either the circulatory or the respiratory system is not able to perform properly, the entire body suffers quickly. Without oxygenated blood, brain damage begins within four to six minutes. While sitting, the human heart pumps sixty to one hundred times each minute, moving about 5.5 liters of blood throughout the body every minute. The average 150-pound man has a total of about 6.75 liters of blood that must be kept constantly moving. The heart acts like a pump because it is a special muscle with its own electrical system. Much the same way as a light switch turns on a light bulb, the heart pumps because an electrical message at the top of the heart, in the sinoatrial (S-A) node, makes the entire heart muscle contract. This natural pacemaker keeps the heart beating when all things are in proper working order. If the heart stops beating correctly or the lungs do not work, however, the person will die unless resuscitation is started.

Resuscitation means making the heart pump blood and getting oxygen into and out of the lungs. In an example of the most severe case, a person is found not breathing and without a pulse. Cardiopulmonary resuscitation (CPR) courses teach that the first step is to open the airway and be sure that nothing is blocking the flow of air in and out of the lungs. If a blockage is found, it must be removed immediately. If the person is not breathing, the rescuer must breathe for him or her. Artificial respiration, or mouth-to-mouth ventilation, in which one individual breathes air into another’s mouth, will force oxygen-containing air into the lungs so that it can be picked up in the bloodstream and transported to body cells. Pinching the patient’s nose and blowing into the mouth forces air into the lungs in much the same way as taking a deep breath. Yet this artificial breathing alone is not enough. The oxygen put into the lungs must be moved around the body, which can only be done through circulating blood.

To move the blood through the circulatory system, something must be done to make the heart pump. This can be accomplished through chest compressions. Since the heart lies between the breastbone (sternum) and the spine, it is surrounded by hard, bony structures. By pressing in the correct position, with sufficient pressure and depth, the heart muscle can be squeezed. This squeezing action will result in blood being forced out of the heart and onto its path around the body. The oxygen blown into the lungs will be picked up by the passing blood and moved out to necessary areas of the body.

Even with the use of proper techniques, however, cardiopulmonary resuscitation should only be a temporary measure for a person who has no pulse and who is not breathing. CPR is only a momentary first-aid measure. Yet this procedure is a vital one: Until further medical assistance can be given, it is extremely important that oxygen circulate in the patient’s body.

CPR is usually done by the first responder who finds the victim. This form of resuscitation is known as basic life support (BLS). The administration of BLS is the step just before advanced cardiac life support (ACLS), which offers additional treatment measures given by medically trained personnel. ACLS is given by emergency medical technicians (EMTs), paramedics responding in ambulances, or other health care professionals. While continuing CPR, the medical team will start advanced care before or during the drive to a hospital emergency department.

To provide the proper treatment, paramedics must determine the electrical activity of the heart. The heart’s rhythm is recorded on an electrocardiograph (ECG or EKG) machine, which helps the medical team find the cause of the problem. The portable ECG machine, which is commonly called a cardiac monitor, displays the electrical activity in the heart. When the electrical impulses are not producing a rhythmic beating pattern, various treatment procedures may follow, depending on how the heart is pumping or if it is working at all. It is possible to correct a heart that has an irregular beat caused by abnormal electrical activity. A total lack of electrical activity in the heart is called asystole and is recorded on the monitor as a flat line. The ACLS team can attempt to adjust the abnormal electrical signal but usually cannot mechanically restart a heart that has no electrical impulses. Other heart problems produce other types of tracings on the monitor. In one type of arrhythmia called ventricular fibrillation, the heart has a rapid, chaotic electrical activity that does not allow the heart to beat;
the patient will stop breathing and will have no pulse. In this case, CPR is needed to reduce brain damage caused by decreased oxygen to cells, while paramedics and other health care professionals begin advanced life support in an attempt to reverse the dying process.

Many different protocols exist on how ACLS treatment should progress, and the following is merely one example. In 2005, the American Heart Association made changes in CPR, BLS, and ACLS protocols. The medics may use an electrical machine known as a defibrillator to deliver electrical shocks through the chest and toward the heart in the hope of correcting the rhythm. A single electric shock is given, followed by CPR. A needle and special catheter are placed in a vein to start intravenous (IV) fluids, in which medications can be given to travel to the heart through the veins. A high concentration of oxygen is delivered through a tube inserted through the mouth or nose and passed into the upper part of the lung so that artificial ventilation can aid in the movement of concentrated oxygen. Adrenaline (also known as epinephrine) is given through the IV; this drug will increase the blood flow to the heart and brain by narrowing other vessels and will also increase the heart rate and blood pressure. CPR is continued for two minutes, then a brief pause occurs for another single electric shock. CPR resumes immediately.

Studies of actual resuscitation processes have demonstrated that CPR was often stopped while personnel prepared medications or prepared to defibrillate. These pauses caused the absence of blood flow and oxygen for prolonged periods of time. This observation led to the new guidelines. Single shocks are given, rather than the previous three shocks of increasing voltage. CPR is given continuously except during the actual shock.

The next drug given may be amiodarone, which helps to calm a heart that is beating too fast or erratically. If the irregular rhythm has still not been corrected, then sodium bicarbonate may given to reduce the acids produced in the body because of the lack of oxygen. This entire scenario is repeated until the heart is beating in a manner that will sustain life or it is determined by a physician that the person cannot be resuscitated.

Other drugs that are used for specific heart problems include atropine, lidocaine, vasopressin, procainamide, verapamil, dopamine, and adenosine. All these drugs target specific problems during a cardiac episode. For individuals who are successfully resuscitated and are stable but unresponsive on arrival at the hospital, induced hypothermia is recommended for the first twenty-four hours to improve brain functioning.

When the heart slows or weakens to the point that it is barely beating, life can be artificially maintained in a few cases by using a cardiac pacing unit to create an artificial heartbeat electrically, a procedure called cardiac pacing. This artificial heartbeat may be sufficient until a permanent pacemaker can be implanted.

Perspective and Prospects

Over the years, huge advances have been made in resuscitation measures. More lives have been saved by the training of medical personnel to administer advanced life support before a patient reaches the hospital. Lifesaving drugs and defibrillation have greatly decreased the death rate for
heart attack victims and cardiac patients. With the continued training of emergency medical technicians, the survival rate can improve as a result of earlier and more aggressive medical treatment.

Medical treatment could be avoided entirely, however, if more preventive health measures were implemented. With continued research identifying risk factors, the public can be educated about how to prevent conditions that lead to heart attacks. Among the known risk factors are cigarette smoking, hypertension (high blood pressure), high cholesterol and triglycerides, lack of exercise, excess weight and improper nutrition, stress, and diabetes mellitus. Three risk factors cannot be changed: predisposing heredity, gender (men are more likely to have heart attacks), and increasing age.

With further research, the first group of risk factors may be addressed in society through extensive education, but heart attack rates cannot be curbed unless people change their lifestyles. An understanding of heredity, gender, and age risk factors can bring changes in these rates only through further research into their relationship to heart attacks.

Until people are willing to change their lifestyles, early recognition of the warning signs of a heart attack may be the easiest method of increasing survival rates. A heart attack occurs when the heart muscle itself does not receive enough oxygen. The heart muscle has its own blood supply through the coronary arteries. The blood supply to the heart may be reduced by a clot or by a narrowing in the coronary arteries. The warning signals of a heart attack include a squeezing tightness or pressure in the chest; pain in either arm, neck, jaw, or between the shoulder blades; sweating; nausea; weakness; and shortness of breath. People with diabetes and women may have milder or different symptoms. Too often, people deny that they could be suffering a heart attack, with many believing that the pain is heartburn or indigestion. If medical attention is sought immediately, however, severe damage can often be reduced or stopped. Special drugs such as streptokinase or tissue plasminogen activator (TPA) can dissolve clots that interfere with blood flow, while surgical techniques such as coronary artery bypass surgery (CABG) or angioplasty can open clogged arteries. Heart transplants offer a solution for patients with extensive heart damage. Research continues to decrease the rejection rates for heart transplants. Medications are being developed to decrease the buildup of plaque in arteries. The fields of genetics and gene therapy hold many keys to the prevention and treatment of heart disease.

It is important to note that all medically trained personnel, from the EMT to the emergency medicine physician, must be able to perform life-support measures. Unless patients have given appropriate do-not-resuscitate (DNR) orders, they will receive some form of the previously mentioned procedures. A living will
is a legal document that directs medical personnel in the level of care an individual wishes to have. For example, a person with advanced cancer may want to not be placed on a breathing machine. Those wishes are to be communicated through a living will. Without this document, health care providers are mandated by law to provide lifesaving measures. Future resuscitation measures will be influenced by ethical questions regarding when to sustain life.

Bystander CPR (initiation of CPR by the first person to find a cardiac arrest victim) is a vital component in the chain of survival between BLS and ACLS. It has been recognized, however, that very few people are willing to perform mouth-to-mouth rescue breathing, a vital component of success for CPR. Therefore, it has been acknowledged that it is better to at least open the victim’s airway by extending the neck and doing chest compressions alone versus doing nothing at all. The layperson will no longer be taught to check for a pulse before initiating CPR. Checking for a pulse was removed from the recommendations because it was demonstrated that laypersons could not be taught to reliably check for a pulse. Instead, they will be taught to look and examine for “signs of circulation,” which include breathing, coughing, or chest movements, before starting CPR. Another recommendation for BLS was to train nonmedical professionals such as police, firefighters, security officers, and others exposed to large populations in the use of the automated external defibrillator
(AED). The AED has two pads that, when applied to the chest of the cardiac
victim, analyze the electrical heart activity. The AED then administers the electrical shock (defibrillation) necessary to restart a heart if the cause of cardiac arrest was ventricular fibrillation, the most common arrhythmia of cardiac arrest. Bystander CPR and early defibrillation by the AED have been shown to do more to reduce morbidity and mortality from cardiac arrest than all current therapies for cardiac arrest combined.

Bibliography

"Cardiopulmonary Resuscitation (CPR): First Aid." Mayo Clinic, February 7, 2012.

Cayley, William E., Jr. “2005 AHA Guidelines for CPR and Emergency Cardiac Care.” American Family Physician 73, no. 9 (May 1, 2006): 1645.

"CPR." American Heart Association, 2013.

Hamilton, Glenn C., et al. Emergency Medicine: An Approach to Clinical Problem-Solving. 2d ed. New York: W. B. Saunders, 2003.

Henry, Mark C., and Edward R. Stapleton. EMT: Prehospital Care. Rev. 4th ed. St. Louis, Mo.: Mosby/Elsevier, 2012.

Tintinalli, Judith E., ed. Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011.

Torpy, Janet M., Cassio Lynm, and Richard M. Glass. "Cardiopulmonary Resuscitation." JAMA 304, no. 13 (October 6, 2010): 1514.

White, Roger D. “2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation: Physiologic and Educational Rationale for Changes.” Mayo Clinic Proceedings 81, no. 6 (2006): 736–740.

What five events happen in Ray Bradbury's story "All Summer in a Day"?

In "All Summer in a Day," some of the story is in flashback, describing events that happened before the day of the events of the story. On the day that the story recounts, the one day in seven years that the sun comes out on Venus, the following events occur:

1. The children of the "rocket men and women" who live on Venus and go to school there are all gathered at the window, awaiting the predicted appearance of the sun.

2. The children are verbally and physically abusive to Margot. William begins to bully Margot, taunting her and shoving her. The other children join in with William in teasing Margot, telling her that the sun will not really come out today, that it has all been a joke.

3. The children descend upon Margot and as a crowd bear her down the hall to a closet, where they lock her in. 

4. Without Margot, all the children go outside with their teacher, who does not realize Margot is missing. The children run around in the sunshine for over an hour until it begins to rain again.

5. The children return indoors, and remembering Margot, they release her from the closet. 

Although more information is revealed in the story via flashback about things that happened to Margot prior to this day, these are the five events that take place on the day the sun comes out.

What effect did United States v. Nixon have on students today?

The Supreme Court's unanimous decision in August of 1974 had an immense impact of how students today, as well as citizens in general, view presidential power, how skeptical they are of politicians, and how little they trust those men and women who hold the highest offices of the land. The ruling by the Supreme Court in United States vs. Nixon demonstrated to the country that nobody, not even the President, was above the law, or beyond reach of its power. By forcing Nixon and his administration to release the now infamous secret recordings that he and his aides had made in the White House, the Judicial Branch reasserted its power and laid bare to the nation the criminal misconduct and mendacity of a sitting president. The fact that the court publicly checked presidential power was shocking at the time. 

Many students today take it for granted that corrupt politicians who flagrantly abuse their power for self-advancement will be removed from office and likely prosecuted. That was not the case prior to United States vs. Nixon. At the time, the power of the president, as well as the power of senators and other high office holders like governors, was considered almost absolute, at least while they were in office.

Part of the reason for this sentiment was that generally speaking, before Watergate, most Americans just assumed that their leaders acted in good faith, and that they exercised their powers judiciously. Before Watergate, journalists gave presidents and other men in power tremendous leeway: no major publications published stories about JFK's extra-marital affairs while he was in office, just as no major news outlets reported on the fact that FDR was wheel chair bound when he was in office. Before Watergate, a sort of "gentlemen's agreement" existed between journalists and politicians: people in power were shown great deference. If the president claimed that something was true, it reported as true, unless and until some very compelling evidence to the contrary could be found, and that rarely happened. 

The United States vs. Nixon set both a legal and journalistic precedent that made the Pentagon Papers, and other whistle-blower accounts, like those of Edward Snowden, possible. When the public found out that Nixon and his aides had been lying to the American public and perverting the course of justice, their faith in government disappeared. Consequently, investigative journalists went from being portrayed as mud-slinging nerds to the true heroes of democracy, whose mission it was to expose the power-hungry crooks in government who would otherwise run roughshod over the people they were supposed to protect. Most students today learn that they must question authority, think for themselves and do their own research, particularly when it comes to deciding on how to vote. That way of thinking is diametrically opposed to the old teachings that preceded Watergate and Nixon's resignation, which stressed unquestioning loyalty to the government, as well as a pledge of allegiance. 

What comparison can be made about Boo Radley and Scout Finch?

The biggest comparison between Boo Radley and Scout Finch has got to be that both of them are misunderstood and not accepted for who they are. For some reason, people believe the worst about each one of them. For example, Boo Radley is first depicted as an out-of-control youngster who must be locked away so he doesn't embarrass his father in chapter one. In much of the same way, Aunt Alexandra seems to think that Scout is out of control and needs to change so she won't embarrass the family name. 

"Aunt Alexandra was fanatical on the subject of my attire. I could not possibly hope to be a lady if I wore breeches. . . furthermore, I should be a ray of sunshine in my father's lonely life. . . but Aunty said that one had to behave like a sunbeam, that I was born good but had grown progressively worse every year" (81).

Another example is how Boo Radley reaches out to make friends with the kids by leaving gifts in the knothole of his tree; but Mr. Nathan Radley fills up the hole with cement and stops the practice. Likewise, Scout wants to invite a schoolmate, Walter Cunningham, to her house sometime and Aunt Alexandra says no "because he is trash" (225).

Boo Radley and Scout Finch are also prematurely judged on a specific incident that seems horrible at the time, but given an opportunity to explain, it would show a nobler reason for their behavior. For instance, Boo Radley stabbed his father in the leg with scissors and he is demonized for it around the community. If he had gotten an opportunity to explain himself, maybe he would have said it was in self-defense or in the name of something noble. The same thing happened to Scout at Christmas time when Francis called her father mean names. Scout punches him in the name of honor and her father, but Uncle Jack spanks and disciplines her without allowing her to defend her case first.

All of these instances show that Boo and Scout seem to have a lot in common. They are misjudged, mistreated at times, and misunderstood. They are probably the most genuine characters in the whole book, too, because they are never hypocritical. They might be misfits of sorts, but they are kindred spirits as well.

The density of 1 kilogram of iron is less than the density of 1 gram of iron. True or false?

There are two types of physical properties of matter:

• 
  Intensive Properties: Properties that don't change when the amount of the substance changes. For example, the color of one gram of iron is the same as the color of ten grams of iron. The color of iron is an intensive property because it is the same regardless of how much iron is present.

• 
  Extensive Properties: Properties that do change when the amount of the substance changes. For example, the volume of one gram of iron is different than the volume of ten grams of iron.

Density is the amount of mass in a particular volume of a substance. It is calculated using the ratio of the substance's mass to its volume.

   Density = mass/volume

The mass/volume ratio of a substance is always the same regardless of how much substance is present. Therefore, density is an intensive property. The density of iron is always the same, although it CAN be expressed differently by using different units. The answer is false.

Why are biodegradable polymers used less often than polymers that are non-biodegradable?

"Polymer" is a generic term that means repeating units of the same type. Biomolecules, for example, include proteins (polymers of amino acids),  DNA (polymers of nucleic acids) and starches (polymers of sugars). Although you do not specify I am guessing you refer to polymers that are types of synthetic molecules derived mostly from petroleum products. These include synthetic rubber, polyester, nylon, and various types of plastics. It is possible to create types of synthetic polymers that are biodegradable, but manufacturers of goods made from these substances generally want their products to last for a long time. For example, polychloroethene is used to make electrical insulation and water pipes. These have to be stable for long periods of time. The ability to biodegrade would be a plus for some of the plastics currently overflowing landfills, such as plastic bags. Many plastic bags are now marketed as being biodegradable, but conditions deep in landfills may not actually allow that to happen.

How did Queen Victoria influence the concept of 'the family' in 1840 -1860?

Queen Victoria's reign saw immense growth of the Middle Class and an increase of consumerism. Along with leisure, clothing, and household goods, the family also became commodified, with the Royal Family upheld as the ideal.

Though many children were employed in factory work, it is often said that the Victorians invented childhood. Prior to the growth of the Middle Class in Britian, the only young people with leisure time were the Upper Class. Even so, many of these young nobles and "old money" types were expected to be in training for their life as future rulers of estates. When the Middle Class expanded, there was an entire portion of society who could afford leisure time and goods, and their children had no demands on their time (or manners) beyond schooling. 

Queen Victoria was not very fond of children or motherhood, herself- perhaps because her own childhood was very isolating. Nonetheless, the public image of Queen Victoria, her husband Albert, and their nine children, was the model of the ideal British family. The privacy of the family home was a rather new phenomena, whereas previously most working people lived and labored in rather close quarters. With the idea of the family home as a distinct entity, so came the ideal for mothers to "run the home." While fathers worked out of the home (somewhat reminiscent of Prince Consort Albert's involvement overseas,) mothers were expected to be in charge of all that went on within the home. This included designating childcare to a nanny or nurse, ensuring that domestic servants were on task, and coordinating the family's schedules. The mother was also champion of the moral and social education of her children, ensuring they had good religious values and could tell their Michaelangelos from their Da Vinci's. Queen Victoria represented the kind of stern and exacting administrator a family needed.

The Victorian family was not only a social or economic unit, it also came to represent a particular moral aesthetic. The Victorians were highly concerned with moral purity, and fulfillment of one's god-given roles in the family was considered the highest achievement. At least, for women, to become a wife and mother was the absolute ideal. The Victorian family could almost be likened to one of the machines that produced their new textiles and luxury goods- if all members of the family fulfilled their duties properly, the family as a whole functioned smoothly.

Even though Queen Victoria occupied the highest position in her country and empire, she was a firm believer in a natural difference of the biological sexes and was in favor of the tradition of patriarchy which preceded her. Amidst women's public desire for suffrage, Victoria was the authority on what men and women's natural roles and rights were.

How is Jem described in chapter 15 of To Kill A Mockingbird? Include references to both physical and personality traits. Support your descriptions...

Much is revealed about Jem's character in this chapter. We, for example, learn that he has outgrown Dill and Scout, for he does not hang out in the treehouse with them anymore. This is meant not only in a physical sense, but also alludes to his intellectual growth. He has reached a point where he deems it inappropriate to be around them:

Jem had outgrown the treehouse, but helped Dill and me construct a new rope ladder for it . . .

He also, on a Sunday afternoon, did not play with them as he used to, as Scout somewhat wryly observes: 

Jem in his old age had taken to his room with a stack of football magazines.

He is clearly also more stubborn than ever, for when his Aunt Alexandra asks him to turn on the lights in the living room during a visit by Heck Tate and a number of other men, he pretends not to hear her because he wants to observe events on the outside from the darkness of the room so that he is not seen.

Jem also displays an astute awareness of what is happening around him. He is able to derive information from events which he would otherwise have ignored. After Atticus' visitors have left, he asks him:

“They were after you, weren’t they?” Jem went to him. “They wanted to get you, didn’t they?” Atticus lowered the paper and gazed at Jem. “What have you been reading?” he asked. Then he said gently, “No son, those were our friends.” “It wasn’t a—a gang?” Jem was looking from the corners of his eyes.

Since his father was involved in a controversial case which had drawn much attention and more than a bit of acrimony, Jem thought that the men had come to threaten him. He believed that they were ganging up against his father. He could also read from his aunt and his father's argument, as well as from the men's arrival, that there was some danger, and he told Scout that he was scared.

This also displays a more concerned attitude from Jem, for he ventures outside to see where Atticus was heading when he takes the car. He allows Scout to accompany him and when they see Atticus at the jailhouse, Scout wants to run to him, but he stops her.

I made to run, but Jem caught me. “Don’t go to him,” he said, “he might not like it. He’s all right, let’s go home. I just wanted to see where he was.”

Later, when there is a clear threat against his father, Jem displays courage and a stubborn refusal to leave Atticus' side. Atticus asks him to leave, but he does not.

“Go home, I said.” Jem shook his head. As Atticus’s fists went to his hips, so did Jem’s, and as they faced each other I could see little resemblance between them . . .

In this scene, we are also given a physical description of Jem:

Jem’s soft brown hair and eyes, his oval face and snug-fitting ears were our mother’s, contrasting oddly with Atticus’s graying black hair and square-cut features, but they were somehow alike. Mutual defiance made them alike.

Jem obviously has inherited a trait from his father—they are both defiant in the face of danger, which speaks to an inherent courage possessed by both. Atticus expresses pride in his son after things have calmed down and the mob who had come to face him have left. Scout observes the following at the end of the chapter:

Atticus and Jem were well ahead of us, and I assumed that Atticus was giving him hell for not going home, but I was wrong. As they passed under a streetlight, Atticus reached out and massaged Jem’s hair, his one gesture of affection.

What is the date of Shakespeare's death?

William Shakespeare was born on an undetermined date in April of 1564 and lived until April 23, 1616 (which several scholars believe was also the day of his birth). The only primary source records of his life are his plays, poems, and sonnets, as well as various official records, such as court and church documents. Because of this, much has to be inferred about Shakespeare's life. Over time, he became prominent as an actor, playwright, and manager for the London acting company the Lord Chamberlain's Men, and bought the second-largest house in Stratford-upon-Avon. His investments in real estate brought him extra income and gave him time to focus on his writing.

The cause of Shakespeare's death is unknown. His brother-in-law had died a week earlier, so there may have been a disease spreading. However, that is only a possibility.

One of the things that interests people about Shakespeare's death is his will. In it, he leaves most of his estate to his eldest daughter, Susanna. Many note that he left his wife, Anne, the "second-best bed." Some see this as a slight; Shakespeare married her when he was 18 and she was 26 and pregnant, and so he may have resented her. Still, others argue that the second-best bed would be the marital bed (the best bed being reserved for guests) and so the request was sentimental, not spiteful. Like much of Shakespeare's life and thoughts, we can only guess about the truth.

What is end-stage renal disease?

Causes and Symptoms

End-stage renal disease (ESRD) is stage 5 of chronic kidney
disease, defined as kidney function at less than 10 percent of normal and a glomerular filtration rate of less than 15 milliliters per minute. Both diseases are characterized by the inability to remove wastes and concentrate urine, have poor outcomes, and are usually the result of long-standing diabetes and/or uncontrolled hypertension.

ESRD is a serious, life-threatening systematic disease characterized by renal failure,
decreased production of red blood cells and active vitamin D3, and excess excretion of acid, potassium, salt, and water. Many metabolic abnormalities and imbalances occur, causing complications, such as anemia, acidemia or acidosis, hyperkalemia, hyperphosphatemia, hyperparathyroidism, and hypocalcemia. Symptoms include swollen feet and ankles, fatigue, lethargy or weakness, itching, skin color changes, loss of mental alertness, shortness of breath, and recurrent or chronic heart failure.

Tests that measure the level of creatinine and urea in blood and urine are conducted to determine the extent of kidney damage and the filtration capacity of the kidneys. High levels of these waste products found in the blood but not in the urine are signs of kidney damage. ESRD may be suspected when very high levels of protein are detected in the urine (proteinuria). The results of a creatinine clearance are used to determine the glomerular filtration rate, the standard measurement used to assess kidney function.

Diabetes mellitus
is the most common cause of ESRD, due to its underlying kidney disease—diabetic nephropathy. Approximately 20 to 40 percent of patients with diabetes develop the disease, and nearly half of them progress to ESRD within five to ten years. Diabetic nephropathy develops with changes in the microvasculature (tiny blood vessels) of the glomerulus and is characterized by a progressive and aggressive disease course: wastes increase, building up in the blood; kidneys leak larger amounts of albumin, causing proteinuria; and nodular glomerulosclerosis lesions proliferate and destroy the glomeruli.

Hypertension (high blood pressure) is a major cause of ESRD, estimated at approximately 30 percent of all cases. Although arteries are elastic, they can become overstretched from hypertension and narrow, weaken, or harden. This is especially deadly in the kidneys, which are highly vascular and carry large volumes of blood. Damaged blood vessels and filters prevent the kidneys from functioning adequately, including reducing the hormone that they normally produce to help the body regulate its own blood pressure. Thus, hypertension is both a cause and a symptom of ESRD.

Uremia
is a syndrome that develops with ESRD when metabolic, fluid, electrolyte, and hormone imbalances emerge concurrently. Clinical symptoms include nausea or vomiting, fatigue, weight loss, muscle cramps, pruritus (itching), mental status changes, visual disturbances, and increased thirst.

Renal osteodystrophy
is a degenerative bone disease that develops with metabolic imbalances in the minerals phosphorus and calcium. High levels of phosphorus in the blood draw calcium out of the bones, causing them to become brittle and break. The excess of phosphorus and calcium salts in the blood deposit and harden, forming metastatic calcifications in the skin, blood vessels, and other soft tissues.

Treatment and Therapy

Dialysis and kidney transplantation are the only treatments for ESRD and provide a means of prolonging a patient’s life span and maintaining quality of life.

Dialysis is a means of cleansing the blood when the kidneys do not function and is done by the process of diffusion, in which blood is passed through a filter in contact with a dialysate (salt solution), separating the smaller molecules (solute particles) from the larger molecules (colloid particles). There are two types of dialysis—hemodialysis and peritoneal dialysis—each of which has several variants.

In hemodialysis, blood is filtered by diverting it outside the body through a fistula and flows across a semipermeable membrane in the dialysis unit in a direction countercurrent to the dialysate. Hemodialysis takes three to four hours to complete and must be done three to five times a week, usually in a dialysis clinic. In peritoneal dialysis, blood is filtered internally through the peritoneum, a thin membrane inside the abdomen and peritoneal dialysis
fluid is infused into the cavity via a catheter. Exchanges are repeated four to six times a day by the patient, and the process must be done every day.

Kidney transplants
are another option for most ESRD patients. The United Network for Organ Sharing recommends that patients be put on the cadaveric renal transplant list when their glomerular filtration rate is less than 18 milliliters per minute. Improvements in their policies provide for a more equitable allocation system, broaden the classification of expanded donor criteria, and are expected to increase the donor pool. Unfortunately, thousands of patients die each year waiting for an available kidney.

Perspective and Prospects

Chronic kidney disease and ESRD represent a growing public health problem and reflect the disturbing health profile of present-day society—rising numbers of people with obesity, diabetes, hypertension, cardiovascular disease, and metabolic syndrome. The prevalence of chronic kidney disease has risen steadily since the 1980s. Changes in lifestyle and increased awareness of disease risk—including the monitoring of one's blood sugar levels and blood pressure—are key to preventing chronic kidney disease and reducing the number of patients who progress to ESRD.

Bibliography:

"Chronic Kidney Disease." MedlinePlus, Apr. 23, 2013.

"Kidney Failure." MedlinePlus, Apr. 23, 2013.

Offer, Daniel, Marjorie Kaiz Offer, and Susan Offer Szafir. Dialysis Without Fear: A Guide to Living Well on Dialysis for Patients and Their Families. New York: Oxford University Press, 2007.

Savitsky, Diane, and Adrienne Carmack. "Kidney Failure." Health Library, Oct. 31, 2012.

Townsend, Raymond R., and Debbie Cohen. One Hundred Q&A About Kidney Disease and Hypertension. Sudbury, Mass.: Jones & Bartlett, 2008.

Walser, Mackenzie, and Betsy Thorpe. Coping with Kidney Disease: A Twelve-Step Treatment Program to Help You Avoid Dialysis. Hoboken, N.J.: John Wiley & Sons, 2004.

Wein, Alan, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia: Saunders/Elsevier, 2012.

How does the author describe Mrs. Drover's house at the beginning of the "The Demon Lover"?

At the beginning of the story, the author describes Mrs. Drover's house as deserted and dilapidated. Because of the bombing, there are a few cracks in the structure and the door is warped. The protagonist, Kathleen, notes that the tell-tale marks of the family's past occupancy still stands in familiar places. The old smoke stain is still apparent on the marble mantelpiece, the escritoire still bears the mark of the bottom of a vase, the wallpaper still displays a bruise mark from the door handle, and the claw marks left by the piano on the parquet floor are still visible.

The author describes the air in the house as stale and the atmosphere, eerie. Whether this is due to a supernatural presence in the house or to Kathleen's state of mind, the author does not say. However, when Kathleen discovers a letter on the hall table that is addressed to her, she becomes visibly anxious and frightened. The letter is not stamped but bears the current day's date. As the story continues to its resolution, the reader senses that the state of the house may possibly bear a direct correlation to the state of Kathleen's psyche.

Describe the relationship between Bessie and Nora in The Plough and the Stars by Sean O'Casey.

The relationship between Nora Clitheroe and Bessie Burgess in Sean O'Casey's The Plough and the Stars is complicated. They are neighbors and clearly have known each other for a long period of time, but do not appear to be on close terms. The women are never depicted as true friends, in fact there is much friction early on in the play, however they have a deep and lasting impact on each others' lives. 

Nora desires to be seen as an upright woman with a proper, respectable family and Bessie is the opposite - a brash woman prone to drinking. Early in the play, Bessie drunkenly chastises Nora about how she treats her neighbors in her attempts to be "proper" and is sent away from the house by Nora's husband. Later in the story however, when Nora's husband dies and her child is stillborn leaving her nearly insane with grief, Bessie takes care of her despite the fact that it results in many sleepless nights for Bessie. The relationship is further complicated by the fact that Nora is ultimately responsible for Bessie's death, albeit unintentionally.

What is heart failure?

Causes and Symptoms

The circulation of the blood has many functions. It is essential for the delivery of oxygen, nutrients, and elements of the immune system to tissues. It also contributes to regulation and communication between different parts of the body by moving chemical messengers from where they are produced to where they have a biological effect. The delivery of warm blood to the surface of the skin is one essential element in temperature control. The blood pressure determines how much water can move across the exchange surfaces in the kidneys, thus affecting water balance in the body. The movement of blood through the kidneys, the lungs, and all tissues is important for waste removal.

All these functions depend on the ability of the heart to contract and eject blood. Blood is pumped, in two serial circuits, from the right heart through the lungs into the left heart and from the left heart around the body back to the right heart. In each circuit, the blood travels through large arteries, then to smaller arterioles, to capillaries (where exchange takes place), and back via small venules and veins to the heart. Heart failure describes the situation in which heart function is reduced. While still able to beat, the heart is unable to meet the circulatory needs of the body. That is, the heart muscle is unable to contract enough to pump the blood adequately.

The severity of the heart failure can be gauged by the ejection fraction, a measure of the pumping capacity of the heart. It is the percentage calculated from the stroke volume (the volume of blood leaving a heart chamber with each beat) divided by the residual volume (the volume left in the heart chamber at the end of a heartbeat). Thus, the ejection fraction measures how much blood in the heart chamber can actually leave when the heartbeat occurs. In normal, healthy hearts, this value is 100 percent: the amount that stays in the heart is approximately equal to the amount that leaves it. In mild or moderate heart failure, it ranges approximately between 15 and 40 percent: Less blood leaves the heart with each beat, and more blood remains behind.

The pressure inside the heart at the end of a heartbeat is another index of heart performance. If the heart is failing and more blood is left behind in the heart at the end of a beat, the pressure inside the heart at the end of the beat will be increased. In cases of severe failure, the pressure in the arteries outside the heart will fall.

In failure, the heart cannot supply enough blood for all the functions of the circulation. This fact accounts for the variety of symptoms that accompany heart failure: labored breathing; light-headedness; generalized weakness; cold, pale, or even bluish skin tone; and accumulation of fluid in the extremities and/or lungs. Other possible symptoms include distended neck veins, accumulation of fluid in the abdomen, abnormal heart rate and rhythm, and chest pain.

The specific symptoms of the condition depend on the type of failure, its severity, its underlying causes, and the ways in which the body attempts to compensate. There are several ways to categorize types of heart failure: acute or chronic, forward or backward, and right-sided or left-sided.

Acute heart failure refers to a sudden decrease in heart function. It can be caused by toxic quantities of drugs, anesthetics, or metals or by certain disease states, such as infections. Most often, however, it is caused by a sudden blockage of the coronary arteries supplying the heart muscle. A sudden blockage caused by a blood clot can induce a heart attack and subsequent heart failure, causing chest pain and often abnormal heart rate or rhythm. These effects are sometimes so rapid that there is little time for the body to attempt compensation.

Chronic heart failure is a progressive reduction in heart function that develops over time. It can be caused by inherited or acquired diseases, allergic reactions, connective tissue or metabolic abnormalities, high blood pressure, and anatomical defects. The most common cause, however, is coronary artery disease. This disease narrows blood vessels and leads to a reduction in the amount of blood reaching the heart muscle. It causes reduced oxygen availability and, eventually, a reduction in the ability of the heart muscle to contract.

In the early stages of chronic failure, the hormone and nervous systems promote compensation in the heart, blood vessels, and kidneys to help the heart continue to pump enough blood. These systems stimulate the heart muscle directly to make it beat harder. They also take advantage of the fact that modest stretching of the heart muscle increases its ability to contract. By stimulating the blood vessels to contract, more blood moves back toward the heart, causing a cold, pale, or even bluish skin tone. Stimulation of the kidney to retain water and sodium results in an increase in blood volume, which also moves more blood back to the heart. In each case, the heart muscle is stretched by these increases and, therefore, can contract harder.

Yet these reactions do not constitute a long-term solution. The heart muscle can become fatigued from overwork and can become overstretched. A resulting accumulation of fluid in the heart reduces its ability to contract. Compensation fails, and the additional fluid in the blood starts to back up in the circulation. This condition is called backward heart failure. At the same time, the heart is unable to pump hard enough to move the blood forward against the higher resistance caused by the contraction of the blood vessels. This condition is termed forward heart failure. Congestive heart failure is the stage that occurs when the backup of pressure is worsened by fluid retention and blood vessel contraction. The congestion, or accumulation of fluid, occurs in the veins and tissues.

Left-sided or right-sided heart failure can occur alone or together. The right side of the heart pumps blood to the lungs to be oxygenated, and the left side of the heart pumps oxygenated blood to the organs of the body. Normally, these two sides are well matched so that the same volume moves through each side. When the right heart cannot contract properly, however, blood accumulates upstream in the veins and somewhat less blood reaches the lungs to pick up oxygen, resulting in distended veins and shortness of breath. It is primarily a backward heart failure. Fluid can back up in the veins and increase pressure in the capillaries so that it starts to leak out of the circulation into the surrounding tissues. This leads to an accumulation of fluid (called
edema), especially in the liver and lower extremities. In isolated right-sided heart failure, this pressure rarely backs up to such an extent that it causes problems through the rest of the circulation to the left side of the heart.

In contrast, when the left side of the heart cannot contract properly, it can back up pressure so badly that it creates a pressure overload against which the right side of the heart must pump. This increase in the workload on the right side of the heart frequently leads to two-sided heart failure. This outcome is especially common since the disease conditions that exist in the left side are likely to exist on the right as well. In left-sided heart failure, blood accumulates upstream in the lungs, increasing pressure enough to cause a leakage of fluid into the lungs (pulmonary edema). This leakage interferes with oxygen uptake and therefore causes shortness of breath. It also results in inadequate blood flow to the body’s tissues, including the muscles and brain, resulting in generalized weakness and light-headedness. Left-sided heart failure is thus both a backward and a forward failure.

Treatment and Therapy

Treatments for cardiac failure, like its symptoms, depend on a variety of factors. The first goal of treatment is to avoid any obvious precipitating causes of the failure, such as alcohol, drugs, the cessation of nonessential medications, acute stress, a salt-loaded diet, overexercise, infection, illness, or surgery. The next approach is to take the simplest measures to reduce distension of the heart by controlling salt and water retention and to decrease the workload of the heart by altering the circulatory needs of the tissues. The former can be achieved by dietary salt restriction, restriction of fluid consumption, or mechanical removal of fluid accumulating around the lungs or abdomen. The latter can be accomplished with bed rest and weight loss.

Typically, drug therapy is also required in order to treat heart failure. No single agent meets all the requirements for optimal treatment, which includes rapid relief of labored breathing and edema, enhanced heart performance, reduced mortality, reduced progression of the underlying disease, safety, and minimal side effects. Therefore, drugs are used in combination to achieve control over sodium and water retention, improve heart contraction, reduce heart work, and protect against blood clots.

The purpose of therapy with diuretic drugs (drugs that increase salt and water loss through the kidneys) is threefold: to reduce the pooling of fluid that can take place in the lungs, abdomen, and lower extremities; to minimize the buildup of back pressure from the accumulation of blood in the veins; and to reduce the circulating blood volume. All these things will lessen the overstretch of the heart muscle and bring it to a level of stretch that is closer to its optimum. Care must be taken, however, not to reduce severely the water content of the blood, which could reduce the stretch on the heart muscle to below the optimum and consequently impair heart contraction. One way to monitor how much water is lost or retained is for patients to empty their bladders and then weigh themselves each day before breakfast. If weight changes steadily or suddenly, then sodium and water loss may be too great or too little. In either case, an adjustment is in order. Some generic diuretic drugs used to treat heart failure include furosemide, ethacrynic acid, the thiazides, and spironolactone.

The purpose of therapy with inotropic drugs (drugs that increase the contractile ability of heart muscle) is to improve the pumping action of the heart. This effect causes an increase in stroke volume (more blood moves out of the heart per beat) and helps compensate for forward failure. The increased output also reduces the backup of blood returning to the heart and thus also compensates for backward failure.

Digitalis, a derivative of the foxglove plant which originated as a Welsh folk remedy, is still the most frequently used inotropic drug for the treatment of chronic heart failure. Because it improves heart muscle contraction, it reverses to some extent all the symptoms of heart failure. Digitalis exerts its effects by increasing the accumulation of calcium inside the heart muscle cells. Calcium interacts with the structure of the shortening apparatus inside the cell to make more contractile interactions within the cell possible. Its disadvantages are that it becomes toxic in high doses and that it can severely damage performance of an already healthy heart.

Other inotropic agents also act to improve contraction by increasing calcium levels within the heart muscle cells. Some of them mimic the naturally produced hormones and neurotransmitters that are released and depleted in early stages of heart failure. These are called the sympathomimetic drugs. They include drugs such as dopamine, terbutaline, and levodopa. While these drugs improve heart performance, they can have serious side effects: increased heart rate, palpitations, and nervousness. One group of inotropic agents improves cardiac contraction while relaxing blood vessels. These drugs, called phosphodiesterase inhibitors, stop the breakdown of an essential cellular messenger molecule which helps to manage calcium levels and other events inside both heart cells and blood vessel cells. Examples of these drugs include amrinone and milrinone. Their use is not common because they can cause stomach upset and fatigue and because they are not clearly superior to other treatments.

The purpose of therapy with
vasodilator drugs (drugs that relax the blood vessels) is to decrease the work of the heart. The resulting expansion of the blood vessels makes it easier for blood to be pumped through them. It also leaves room for pooling some of the blood in the veins, decreasing the amount of blood returning to the heart and so reducing overstretching as well. Some of the vasodilators, such as hydralazine, pinacidil, dipyridamole, and the nitrates, act directly on the blood vessels. Other vasodilators, such as angiotensin-converting enzyme (ACE) inhibitors and adrenergic inhibitors, inhibit the release of naturally produced substances that would make the blood vessels contract. Sometimes it is hard to predict the effects of vasodilators because they may act differently in different blood vessels and the body may attempt to offset the effects of the drug by releasing substances that contract blood vessels. Vasodilator drug therapy is usually added to other treatments when the symptoms of heart failure persist after digitalis and diuretic therapy are used.

The purpose of therapy with antithrombotics (blood clot inhibitors) is to prevent any further obstruction of the circulation with blood clots. Because heart failure changes the mechanics of blood flow and is the result of damaged heart muscle, it can increase the formation of blood clots. When blood clots form an obstruction in the large blood vessels of the lungs, it is often fatal. Clots can also lodge in the heart, causing further damage to heart muscle, or in the brain, where they could cause a stroke. Both the short-acting clot inhibitor heparin and oral agents such as aspirin are used to prevent these effects.

The combination of all these drug therapies, while unable to reverse the permanent damage of heart failure, makes it possible to treat the condition. Individuals treated for heart failure can lead comfortable, productive lives.

If the heart failure progresses to acutely life-threatening proportions and the patient is in all other ways healthy, the next alternative is surgical
replacement of the heart. Artificial hearts are sometimes used as a transition to heart transplant while a donor is sought. Yet transplantation is not a perfect solution. Transplanted hearts do not have the nervous system input of a normal heart and so their control from moment to moment is different. They are also subject to rejection. Nevertheless, they provide an enormous improvement in quality of life for severe heart failure patients.

Perspective and Prospects

The vital significance of the pulse and heartbeat have been part of human knowledge since long before recorded history. Pulse taking and herbal treatments for poor heartbeat have been recorded in ancient Chinese, Egyptian, and Greek histories. Digitalis has been used in treatment for at least two hundred years. It was first formally introduced to the medical community in 1785 by the English botanist and physician William Withering. He learned of it from a female folk healer named Hutton, who used it with other extracts to treat more than one kind of swelling. Withering identified the foxglove plant as the source of its active ingredient and characterized it as having effects on the pulse as well as on fluid retention. The plant is indigenous to both the United Kingdom and Europe and may well have been employed as a folk remedy for far longer.

The developments in physiology and medicine during the nineteenth century set the stage for greater understanding and further treatments of heart failure. It was then that the stethoscope and blood pressure cuff were created for diagnostic purposes. In basic science, cell theory, hormone theory, and kidney physiology led to a better understanding of how heart muscle contraction and fluid balance might be coordinated in the body. The concepts and techniques required to keep organs and tissues alive outside the body with an artificial circulation system were conceived and introduced. Anesthesia and sterile techniques essential for cardiac surgery were developed.

These ideas and accomplishments contributed to important discoveries in the early twentieth century that greatly enhanced the understanding of the early compensatory responses to heart failure. For example, it was found that when heart muscle is stretched, it will contract with greater force on the next beat and that heart muscle usually operates at a muscle length that is less than optimal. Thus, when the amount of blood returning to the heart increases and stretches the muscle in the walls of the heart, the heart will contract with greater force, ejecting a greater volume of blood. This phenomenon, called the Frank-Starling mechanism, was first demonstrated in isolated heart muscle by the German physiologist Otto Frank and in functional hearts by the British physiologist Ernest Henry Starling in 1914.

Subsequent developments in the second half of the twentieth century, such as more specific vasodilator and diuretic drugs as well as the heart-lung machine, have led to the options of more complete drug therapy, artificial hearts (first introduced to replace a human heart by William DeVries in 1982), and heart transplant (first performed by Christiaan Barnard in 1967) as options for the treatment of heart failure. Researchers have begun clinical trials to assess the viability of using gene therapy for increasing blood flow in patients with advanced heart failure. Though treating heart failure is an ongoing challenge for the medical profession, diagnosing the ailment is becoming easier than before through preventative methods such as annual blood tests and breath tests, findings for the latter of which were published in the Journal of the American College of Cardiology in 2013. Furthermore, ongoing stem-cell research may lead to greater advances in the treatment of heart failure.

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