Can the GOP legally block Obama's appointment to the Supreme Court?

The short answer to this question is "Yes." This is not exclusive to the Republican party, though. The Senate can block a Supreme Court candidate no matter which party is in the majority. The Constitution provides in Article II that the President appoints with the "advice and consent" of the Senate. This does not require that the Senate approve an appointment, merely that the Senate must consent to the candidate in order for that person to actually become a Supreme Court Justice. Additionally, there is no mandate for the Senate to even hold hearings on a candidate, much less to approve one. Historically, the Senate has declined to approve twelve candidates, most recently in 1987, when it refused to approve President Reagan's candidate, Robert Bork. In fact, this led to a new verb in the English language: to "Bork" someone was to orchestrate an unfair campaign to prevent a justice from being approved by the Senate. Whether that campaign was actually fair or unfair is a judgement that rests in the eye of the beholder.

Whether or not the Senate maintains its present position on this issue, declining to even hold hearings, is going to be a very carefully calculated political position. As it stands now, there are four conservative justices and four liberal justices.  This means that many issues are likely to result in a tie vote. When this happens, whatever the court below has decided stands as the law in that circuit. Only when there is a tie-breaking vote does a decision of the Supreme Court become the law of the land and have precedential value.  Those of a conservative bent in the Senate will be concerned about more liberal decisions at the circuit level standing as good law, so that is one part of the political calculus.  Another aspect Senators must consider is the public's perception of its unwillingness to act, something that has plagued the Senate in recent years and has contributed to the unfavorable ratings it gets from the public, historically, I believe, the lowest of all time. Still another political consideration is the voters back home for each senator.  What will their responses be to a failure to consider or appoint a replacement? All of these are what the Senate will consider. I would like to think that they might also consider what their ethical obligations are to the people who elected them as representatives meant to do the work of the United States government. Sadly, that seems to be a rapidly disappearing consideration.

One interesting thing to consider is what would happen if this issue, the legality of the Senate's refusal to act, were to end up in court. The first problem would be the question of standing. Standing is the concept that one must be able to show harm in order to sue in court, so the first question would be who has standing to sue the Senate for this. It might be that the only person who would have standing would be the candidate not acted upon by the Senate. Then we need to ask whether that person would need to sue the Senate as a body or individual senators. Certainly, not all Senators have refused to consider a nominee. It would be difficult to make a case that all American citizens can sue the Senate. These taxpayer suits are usually thrown out for lack of standing, the harm alleged being far too amorphous.  Supposing that a nominee were to have standing, this case would go to a federal district court, be appealed to a circuit court, and then end up at the Supreme Court, with its equally divided justices. It is difficult to contemplate how all of this would turn out, particularly because there has been no constitutional violation that could be alleged, and I'm not certain if there is any other legal theory on which a case like this could proceed. Nevertheless, it's an interesting thought experiment!

How did Adam Smith and Karl Marx view human nature and define the purpose of the state?

Adam Smith and Karl Marx were both initially trained as philosophers, and then both went on to focus more on economics than philosophy. They were both certainly political philosophers, or if they wouldn’t describe themselves that way, at the very least they focused on theories of politics and economics. Smith’s magnum opus, An Inquiry into the Nature and Causes of the Wealth of Nations, or just The Wealth of Nations, indicates that there is a propensity in human nature toward a desire to barter or exchange goods and services for other goods or services as we need them. He casually asserts (without defending this statement, since it is not part of his main point) that this propensity has most likely been acquired with the advent of reason and written and spoken language. (Reason, by the way, is the apex of human achievement and our crowning glory, according to 18th and 19th century German Idealism philosophy. Human rationality continues to be seen as our defining characteristic to this day.) The desire to exchange one thing for something else that is more useful to us is, in Smith’s estimation, a part of our nature as humans. This desire also ends up serving us all pretty well, since it means that the baker can keep some bread for himself, and trade some bread for a coat, which means he doesn’t have to learn how to make his own coat or buy the materials to do so. That is to say, when we decide to barter what we have or can make for things that we don’t have, or can’t make, we have a natural division of labor.

Smith held that the role of the state was primarily to enforce contracts. Bartering entails a usually tacit contract, but much of society is based on more formal contracts as well. The role of the state is also to grant patents and copyrights and encourage new ideas and entrepreneurship.

Karl Marx certainly held a different idea of human nature and the purpose and role of the state than Adam Smith did, and wrote about some of his ideas in Das Kapital. He agreed with Smith’s basic ideas about the division of labor in capitalist society, but he also believed that at base, the source of capitalist profit was the exploitation of the working class. He held a somewhat complex “labor theory of value,” claiming that only human labor was variable capital whereas all other sources of profit were constant capital. This theory that surplus profit can only come from human labor doesn’t work out in reality, but one point that remains relevant is his criticism of the exploitation of the lower working classes.

Marx believed that capitalism is not based on any particular nature or propensity of humans, and that since it rested on the weary back of the working class, it would eventually fail. He also believed that the fall of capitalism would instigate the rise of communism, or a classless society, but what that would look like in reality when it came about was not something he felt anyone could predict, since it would be a product of our future history.

`n! > 2^n n>= 4` Use mathematical induction to prove the inequality for the indicated values of n.

You need to use mathematical induction to prove the formula for every positive integer n, hence, you need to perform the two steps of the method, such that:

Step 1: Basis: Show that the statement P(n) hold for n = 4, such that:

`(4!) => 2^4=> 1*2*3*4 > 16 => 24>16`

Step 2: Inductive step: Show that if P(k) holds, then also P(k + 1) holds:

`P(k): k! > 2^k ` holds

`P(k+1):  (k+1)! > 2^(k+1) => k!(k+1) > 2^(k+1)`

You need to use induction hypothesis that P(k) holds, hence, you need to re-write the left side, such that:

`(2^k)(k+1) > 2^(k+1)`

`(2^k)(k+1) > 2*2^k`

`(k+1) > 2*2^k`

Notice that P(k+1) holds.

Hence, since both the basis and the inductive step have been verified, by mathematical induction, the statement `P(n):  n! > 2^n `  holds for all positive integers n.

When copper and oxygen react, forming copper oxide, do the reactants form a product with different or the same properties?

When copper and oxygen react to form copper oxide, the product has properties that are different from those of the reactants. There are two types of copper oxide, copper(I)oxide and copper(II)oxide:

`4Cu + O_2-> 2 Cu_2O` (copper(I)oxide)

`2 Cu + O_2-> 2 CuO` (copper(II)oxide)

Copper metal is a red-brown color, as seen on the outer layer of a penny. Like other metals it's ductile, malleable and is a good conductor of electricity and heat.

Oxygen is a reactive non-metal that exists as a colorless gas under normal conditions. Oxygen is an oxidizer and a reactant in combustion.

The two copper oxides that can form are ionic compounds. Copper(I)oxide, also known as cuprous oxide, is red-colored solid that doesn't dissolve in water. Copper(II)oxide, also known as cupric oxide, is a black solid that is also insoluble in water. Both oxides are poor thermal and electrical conductors.

Whenever a chemical reaction takes place new substances form with different chemical formulas and different properties from the reactants.

What is an example of an idiom in Chapter 7?

An idiom is a phrase whose meaning cannot be guessed from the individual meanings of its component parts. For example, kick the bucket is an English idiom for dying—if you did not know what the phrase as a whole meant, you would never be able to guess by the denotations of each of the words involved, because literally kicking a bucket has nothing in common with passing away. In Chapter 7 of The Magician’s Nephew, while Digory is waiting for a sign of the return of the witch after she has left the house to (potentially) run amok in London, “he went into the dining-room and ‘glued his face,’ as they say, to the window.”  Here, glued his face to the window is an idiom—he of course did not literally glue his face to the glass, but rather he watched for anything out the window with unyielding vigor. So, the meaning of the phrase is not equal to the meaning of its individual parts.

What is the point in the Boo Radley game in Chapter 4?

In Chapter 4, Jem pushes Scout in the tire directly into the Radley yard where she crashes into the porch. Scout is stunned when she exits the tire and Jem is forced to run into the yard to retrieve the tire. Although Jem was afraid when he entered the yard to grab the tire, he tries to act like it was not a big deal. Shortly after the incident, the children are drinking lemonade when Jem announces that he has a new game that they can play. Jem then suggests that the children play a game where they reenact Boo Radley's life story. Scout mentions that Jem's head was transparent and he obviously created the game as a way to prove that he was not scared of Boo. She also says that Jem wanted to contrast "his own fearless heroism" with her cowardice. Other than Jem's motivation to prove that he is not afraid of Boo Radley, the game also serves as a new form of entertainment. The children were sick of playing other games and found the Boo Radley game entertaining. Dill and Jem are especially entertained, while Scout experiences feelings of trepidation while playing.

What quote best describes Liesel's reaction to Werner's death in The Book Thief?

Liesel responds with disbelief and intense grief when Werner dies.

When Liesel’s little brother dies, her first reaction is shock.  She wakes up and sees that he is dead.

For Liesel Meminger, there was the imprisoned stiffness of movement and the staggered onslaught of thoughts. Es stimmt nicht. This isn’t happening. This isn’t happening.  (Ch. 1)

Liesel shakes her brother, which puzzles Death.  He doesn’t understand why the “leftover humans" always shake the people who have just died, as if this will bring them back to life.  Liesel is numb with grief and doesn’t know what to do.  She just follows her mother.  

When Liesel’s brother is buried, she stares in disbelief.  Then she reacts out of grief and perhaps impulse.  She steals a book from the gravediggers, even though she doesn’t really know how to read. 

When the dragging was done, the mother and the girl stood and breathed. There was something black and rectangular lodged in the snow. Only the girl saw it. She bent down and picked it up and held it firmly in her fingers. The book had silver writing on it. (Ch. 1) 

After her brother is buried, Liesel is screaming.  As she is being dragged away, she notices something.  It is a book.  Actually, it is The Grave Digger’s Handbook.  It doesn’t matter to Liesel.  She takes it because it is a souvenir of her brother, however morbid.  She is grieving and in shock, and takes it without thinking. 

Of course, this is the first book that Liesel takes.  Death is impressed.  As Liesel continues on her journey without her brother, she steals other books.  She learns how to read by using The Grave Digger’s Handbook with the help of her new foster father Hans Hubermann.  It gives her an escape from life and a connection to the brother she just lost.

What quote in Chapter 8 explains why Daisy married Tom instead of waiting for Gatsby?

In Chapter 8, Gatsby explains to Nick (who relays to the reader) the story of how he met and then lost Daisy.

According to Gatsby, he was penniless when he and Daisy fell for one another, but he acted as if he was rich like her and would be able to take care of her:

"...he had deliberately given Daisy a sense of security; he let her believe that he was a person from much the same stratum as herself—that he was fully able to take care of her."

So we assume that Daisy didn't stop waiting for him because of money, since she was led to believe he was rich.

While he was away at war, Gatsby stayed in touch with Daisy, but in her letters she seemed to be getting impatient waiting for him to come back: "—there was a quality of nervous despair in Daisy’s letters. She didn’t see why he couldn’t come." This shows that Daisy loved Gatsby, but she was too impatient to wait an uncertain length of time for him to return and marry her. Gatsby was away at war and nobody knew when the war would end, or who would survive.

Daisy was immature and materialistic, living in a world of money, fashion, and flowers, which throughout the novel symbolize the short-lived beauty of love:

"Through this twilight universe Daisy began to move again with the season; suddenly she was again keeping half a dozen dates a day with half a dozen men and drowsing asleep at dawn with the beads and chiffon of an evening dress tangled among dying orchids on the floor beside her bed."

The beads and chiffon symbolize wealth and parties, and the dying orchid symbolizes Daisy's dying love for Gatsby. Daisy was also impatient and decided not to wait any longer for Gatsby to return:

”She wanted her life shaped now, immediately—and the decision must be made by some force—of love, of money, of unquestionable practicality—that was close at hand."

This means that Daisy made a conscious decision not to wait anymore for Gatsby, because she wanted her life to continue immediately. It might have been love or it might have been money that forced her to make the decision. That was when Tom Buchanan came along, and she married him. 

What is the plot of War Horse?

Michael Morpurgo's novel War Horse was originally published in 1982 and was made into a motion picture in 2011. It is a unique story told from the perspective of a horse named Joey and set against the backdrop of World War I. Morpurgo's choice to have the horse narrate the story offers readers a unique insight into the kindness and brutality of men's hearts, and the best and worst of people. Through Joey's eyes, we see how people can choose peace in the middle of chaos and hate, and how war affects every facet of life when it rages. 

Joey is just a colt when he is sold at auction to Albert's father. Albert is a thirteen-year-old boy who forms a bond with Joey that lasts even through the separation of war. Albert's father is an alcoholic and sells Joey to help pay the mortgage on his farm. Joey is purchased by a military man named Captain Nicholls. Captain Nicholls has a friend named Captain Stewart. His horse is named Topthorn, and he and Joey become friends. They go through many experiences together during the war. In Joey's first battle as a cavalry horse, Captain Nicholls is killed. Joey is cared for by a kind young man named Trooper Warren, and the horses are used primarily for transporting equipment now. 

Topthorn and Joey show great courage when they are sent back to the war front and cross enemy lines during a battle. They are captured by German soldiers and separated from their human companions, Captain Stewart and Trooper Warren. Joey and Topthorn are used for the dangerous mission of transporting wounded soldiers from the battle front to hospitals. During this mission, Joey meets Emilie, a young girl who has lost her mother, father, and brother to the war. She is kind and forms a close bond with Joey. One day, the soldiers come through and proclaim that they are taking the horses to transport artillery. Emilie and her grandfather have no choice in the matter, but Emilie tells the soldiers she is just loaning the horses to them and expects them to return. 

Topthorn and Joey are worked hard on this assignment, and Topthorn falls ill. One day, Topthorn stumbles and doesn't get back up. A battle rages around Joey, Topthorn, and their handler Friedrich, but Joey refuses to leave his friend. He finally flees because of his fear of the shelling and ends up in "No Man's Land," which is a space between the German trenches and the British soldier's trenches. A German soldier waves a white flag to go out to help the horse. In the midst of war, these two enemy soldiers forge peace out of their common interest in helping the horse. They flip a coin to decide who will get the horse, and amiably accept the results. The British soldier wins, and Joey is taken to have his wounds tended to, which include a nasty cut from the barbed wire. 

Albert, who was Joey's first human friend, has joined the British forces in a veterinary capacity, in the hopes that he might find Joey again. Joey recognizes Albert right away, but Albert isn't sure if it's him or not. He tests him by calling him with the whistle he taught him long ago. Joey responds and Albert is jubilant. 

Joey learns that Albert is going to marry a girl named Maisie and that she is the only one who understood his desire to find Joey again. When the fighting finally ends, the horses are sold at auction. Albert's fellow soldiers take up a collection to try to buy Joey for Albert. Albert is outbid by an older gentleman who is buying the horse in memory of his beloved granddaughter, Emilie, who has passed away. He promised Emilie that he would find Topthorn and Joey for her. When he hears Albert's story and sees his love for Joey, he makes a deal with him to give Joey to him for one English penny, and his promise that he will care for Joey for the rest of his life. It is a beautiful story of healing in the midst of unimaginable pain and suffering. There is a chapter by chapter summary available by using the link below. 

In "The Cask of Amontillado," how does Montresor chain Fortunato up?

Montresor describes his chaining of Fortunato in fairly precise detail. There is a very narrow niche in the granite wall of the catacombs. 

Within the wall thus exposed by the displacing of the bones, we perceived a still interior crypt or recess, in depth about four feet, in width three, in height six or seven. . . . In its surface were two iron staples, distant from each other about two feet, horizontally. From one of these depended a short chain, from the other a padlock. Throwing the links about his waist, it was but the work of a few seconds to secure it.

Montresor did not install these chains. They had been there for centuries and used by feudal lords to dispose of disobedient vassals, who would simply disappear and never be heard from again. Montresor must have gotten the idea of killing Fortunato this way while exploring the catacombs. Concealing the crypt or recess with a stone wall was his own innovation. Since it is only three feet wide and six or seven feet high, it will be easy to build the wall.

One chain is only two feet long. The other is only a stub of a chain with a padlock. Montresor only has to draw the longer chain across Fortunato's body and secure it with the padlock. The recess is four feet deep, so the victim will be unable to interfere with the construction of the wall or knock it down after it is finished but still damp. His arms would only be about three feet long, so the wall would be a full foot beyond his reach.

He is pinned tightly to the wall. He has no chance of slipping out from under the chains or of climbing over them. Montresor has specified that Fortunato is wearing a tight-fitting jester's costume. He has no flexibility in such an outfit, and he probably doesn't even have any pockets. He has no weapon and nothing he could use as a tool to try to file a chain or pick the padlock. The padlock is old-fashioned. It is locked with a key rather than snapping shut like our modern padlocks.

Withdrawing the key I stepped back from the recess.

Fortunato would find it impossible to pick such a padlock even if he had some sort of tool. His death will be agonizing because he will have to stand in one upright position until he dies of starvation. Montresor repeatedly specifies that there is a lot of dripping water, so Fortunato will be able to lick drops off his hands and off the rock wall. It takes much longer for a man to die of starvation than of thirst.

Montresor has an easy time chaining Fortunato because of the simplicity. He also has an easy time building the stone wall because it only needs to be three feet wide. He is not using bricks but stones. The stones are heavy and may be almost a full foot long, so three or four stones would make up a whole tier. He has already prepared the mortar (because Poe wants this part of the story to end quickly); and the mortar stays damp because of all the dripping water. Montresor keeps the trowel on his person because he doesn't want it to rust. At the same time, he doesn't want to have to go someplace to fetch it when he brings Fortunato home. He uses the remaining mortar he has mixed in the trough to "plaster over" the entire stone wall and make it look like part of the catacomb wall itself. Then he covers the fake wall with what he calls a "rampart" of human bones. He is writing or telling this story fifty years after the event, and in all that time no one has discovered what is left of Fortunato.

Does the actuality of Camp Green Lake live up to its name?

No, Camp Green Lake does not live up to its name in the present day. The name is ironic, the opposite of what actually faces the boys, like Zero, when they arrive at this remote locale. The name Camp Green Lake suggests a summer camp, full of swimming, fun, and frolics, but what the boys find is actually a prison environment full of hard labor in which they dig five-by-five holes every day in a desert. Rather than the abundance of water suggested by the words "green lake," the boys are constantly thirsty and pouring the water out of their water bottles in front of them becomes a form of punishment meant to keep them in line. 

However, a hundred years in the past, the name accurately reflected the setting, as there was a lake on the spot that has now become a desert. 

Who is the protagonist in "The Black Cat"?

Although most people think of a protagonist as the "good guy" or the hero of the story, a protagonist is simply the main character. I have provided a couple of links explaining what a protagonist is; the first is a literary site that explains the concept in terms of literature only, and the second is just a dictionary definition of the word. 

In The Black Cat, the protagonist is the narrator, and he is certainly not a good guy or a hero. In fact, he is quite the opposite, as he ends up being abusive both to his wife and his pets when he is drunk (which is often), and he ends up killing both his favorite cat and his wife in rather gruesome ways. This narrator is a perfect example of how protagonists are not necessarily always good. 

In A Separate Peace by John Knowles, how and where does Phineas show that he's innocuous?

The word innocuous means harmless or non-irritating. Since A Separate Peace is written from Gene's perspective, there are many times when he feels that Phineas is irritating or out to get him. However, Gene's opinion can be skewed because of his own jealousy and paranoia when it comes to his best friend. One minute, Gene thinks Phineas is being competitive or jealous with a hidden agenda, and the next minute, he thinks Finny is his best friend. From an objective standpoint, however, Phineas would rather have fun and engage in friendly sporting competitions than seek the downfall or failure of a friend. Gene is simply paranoid.

Phineas shows that he is innocuous during the first time the boys jump from the tree into the river in chapter two. Gene almost falls out of the tree because he turns back for a moment to say something. He loses his balance and almost falls uncontrollably to the ground, but Phineas reaches out, grabs his arm, and saves him. Gene later realizes the following:

"If Finny hadn't come up right behind me . . . if he hadn't been there . . . I could have fallen on the bank and broken my back! If I had fallen awkwardly enough I could have been killed. Finny had practically saved my life" (32).

This isn't enough to convince Gene that Phineas isn't out to destroy him or his life. In chapter three, Phineas creates a game called "Blitzball" and Gene is jealous of this. Gene feels that Finny creates the game to show off his own athletic ability and talent. This is a misconception because Phineas is innocuous! He just loves being social and playing sports. Put the two together and Phineas is a leader in fun, not treachery.

One last example of Phineas being harmless is when he breaks the school swimming record in chapter three. Gene is the only witness to the event and expects that Phineas would want to show off and tell the whole school what he had accomplished. This doesn't happen, because Phineas tells Gene to be quiet about it. His response is as follows:

"By the way . . . we aren't going to talk about this. It's just between you and me. Don't say anything about it, to . . . anyone" (44).

Phineas isn't out to seek praise and glory like Gene thinks he is. He's humble and not as bad as he's made out to be in Gene's mind. This proves that Phineas is not harmful, too competitive, or bent on seeing the downfall of others.

What is the background of Oedipus the king?

Oedipus, the king of Thebes at the beginning of the play, believes that he hails from Corinth and is the son of King Polybus and Queen Merope.  However, he is really the son of King Laius and Queen Jocasta from Thebes.  His birth parents heard a prophecy that their son would kill his father and marry his mother, and so they sent the baby Oedipus away with a servant to be killed in the woods.  This servant instead gave him to another servant from house of Polybus.  Thus, Polybus and Merope raised Oedipus as their own. 

One day, when he's grown up, a drunken man tells him that he's been adopted, and so he goes to the oracle of Delphi to learn the truth.  Instead of answering his questions, the oracle tells him the same prophecy Laius had heard: that he would kill his father and marry his mother.  Oedipus decides, then, not to return home to Corinth so that he cannot fulfill the prophecy.  On the road, he gets into an altercation and kills all but one man in the party, and it turns out that one of the men he killed was Laius, his birth father.  Then, after he frees Thebes from the dreadful sphinx by answering her riddle, the Thebans make him the king and he marries the old king's wife, Jocasta, who is actually his mother.  In this way, he has fulfilled the prophecy before the play has even begun.

What is Jared Diamond arguing in Guns, Germs, and Steel?

In Guns, Germs, and Steel, Jared Diamond is arguing that Europe (and, by extension, places where Europeans settled like the United States and Australia) became rich and powerful simply because of geographic luck.  He is arguing that there was nothing about European people or European culture that made them better than other people.

In this book, Diamond sets out to answer “Yali’s Question.”  This question asks why “white people” came to have so much more material wealth and power than other people.  Diamond says that many people have answered this question by saying that Europeans are in some way superior.  Some have argued that Europeans are genetically superior to other people.  Others have argued that the Europeans are not genetically superior but that they do have cultures that are superior in that their cultures make them work harder and make them more likely to accept and embrace progress.  In Guns, Germs, and Steel, Diamond refutes this idea.

In his book, Diamond argues, instead, that the Europeans came to power because they were lucky.  Diamond says that Europeans became powerful because they lived on a landmass where agriculture arose early.  Agriculture, to Diamond, is very important.  It allows people to live together in large groups that do not move around.  Because these groups do not move around, and because they have more than enough to eat, they can have specialists who create technology.  The sooner a group gets agriculture, the longer it has to create the “guns” and “steel” that helped the Europeans become powerful.  Farming communities also create the conditions in which infectious diseases (the “germs” of the title) can arise.

What this means is that whoever got farming first was likely to become powerful.  Diamond then asks why people in Eurasia got farming first.  He concludes that this happened because that landmass was home to more plants and animals that could be easily domesticated.  This was not something that we should give the Europeans credit for.  They did not develop agriculture and civilization because they were better than other people.  Instead, they developed agriculture earlier because they were lucky.  This luck allowed them to get a head start and to, by modern times, dominate the world.  This is the gist of Jared Diamond’s argument in Guns, Germs, and Steel.

What is first aid?

Introduction

In 2005, the American Red Cross and the American Heart Association created the National First Aid Science Advisory Board (NFASAB) to review scientific literature on first aid. The board’s review found few published studies on first-aid practices and concluded that most of them are based on professional experience and expert opinion. The board then published evidence-based first-aid guidelines that can be used to update training programs.

First aid administered at the scene of an accident can be lifesaving. As a general rule, a victim should not be moved if spinal injury is suspected. Advanced first-aid training should include the proper use of immobilization devices for suspected spinal injuries.

Common first-aid breathing emergencies include asthma attacks, allergic anaphylaxis, seizures, and choking. A first-aid responder to an asthma
attack can assist a victim in administering his or her prescribed medication, usually an inhaler, while waiting for professional aid. For anaphylaxis due to allergies to insect stings or food, first-aid responders should be trained to administer epinephrine in an emergency, if state law permits, or to assist a victim in self-administering. Seizure treatment should focus on preventing injury and keeping the airway open. Restraining a victim during a seizure is not recommended, as it can cause bruising or injury. Placing an object in the mouth can damage teeth or obstruct airways and is also not recommended. Choking can occur in adults and children when an object gets stuck in the throat and cuts off air. First-aid techniques for choking include using the heel of the hand to administer five firm blows between a person’s shoulder blades and, if that fails to dislodge the object, administering the Heimlich maneuver. Both techniques can injure a person if not done correctly. Standard first-aid training should include common breathing emergency techniques.

Common injury-related first aid includes bleeding control and wound management. Excessive bleeding should be controlled by applying pressure over the area until the bleeding stops. Gauze or other clean, soft material can be placed over the wound while applying pressure and should not be removed prematurely. The use of pressure points and the elevation of a limb to help control excessive bleeding are not well studied and should not be used instead of the proven method of applying pressure to the wound. The safety and effective use of tourniquets is also under review.

Cuts, scrapes, and puncture wounds
should all be cleaned with cool water. Soap and a soft cloth should be used to clean around the wound, and sterile tweezers should be used to remove any dirt that remains in the wound after rinsing with water. Bleeding can help clean out a shallow wound and usually stops in a few minutes. Deeper cuts may require gentle, firm pressure with gauze or other sterile material. If the wound is on the leg or arm, after bleeding has been controlled, raising it above the patient's head may help, but this should not be used if it interferes with the application of pressure. The wound should be covered if it will get dirty or rub against something; otherwise a shallow wound can remain uncovered to help it dry and heal faster. Large-area scrapes need to be kept moist and covered to avoid scarring. Bandages should be changed at least every day. Antibiotic cream can help prevent infections; triple antibiotic cream is recommended as the most effective.

First-aid training for burns includes how to identify first-, second-, and third-degree burns. Serious burns can result from exposure to fire, heat sources, the sun, electricity, chemicals, or radiation. A serious burn can be any burn more than several inches in diameter or one that turns the skin white or looks charred. Stabilizing treatment includes soaking the burned area in cool water (five minutes for a first-degree burn, fifteen minutes for a second-degree burn), then treating with a skin ointment such as aloe or antibacterial cream and covering the burn area with loose gauze to keep air off and keep the area clean. Over-the-counter pain or anti-inflammatory medicine may help reduce pain and swelling. Direct application of ice cubes to skin is not recommended. Burn blisters should not be popped or removed.

First aid for muscle injuries includes applying a cold pack for no more than twenty minutes to the injury to reduce hemorrhage, edema, pain, and disability. Use of a compression bandage to reduce edema has not been well studied. If an injured extremity is blue or extremely pale, then immediate medical care is needed.

There are many toxic or poisonous substances in the home and workplace. First-aid training includes instruction in emergency procedures for different classes of poisons. Government-sponsored poison-control centers are a good resource. Poisoning can occur by swallowing a poisonous substance, breathing in poisonous air, or contacting a poisonous substance with bare skin. Poison-control centers can provide advice. First-aid training for poison response includes strategies for stabilizing the victim, identifying the poison, and minimizing the responder’s exposure to poisonous substances. For ingested poisons, some commonsense approaches or older methods are no longer recommended. Inducing vomiting with syrup of ipecac is not recommended, nor is administering charcoal. If poisons have been inhaled, then removing the person to a place with fresh air as fast as possible is essential.

Standard first aid includes recognition and treatment of insect, snake, and animal bites. Some insect bites or stings, such as from bees, wasps, yellow jackets, and fire ants, can cause localized pain and swelling; if a person is allergic, they can cause more serious reactions, including life-threatening swelling of airway passages (anaphylaxis). Only a small number of spiders cause serious reactions in nonallergic people; chief among these are the black widow and the brown recluse. First-aid training should cover treatment for insect bites or stings, including tick bites, as well as animal bites. The latter should also feature assessment of the possibility of rabies
infection. Poisonous snakebites are a medical emergency. First-aid recommendations focus on limiting the spread of venom in the bloodstream by not moving the affected area. It is not advised to try to suck out the venom or cut out the bitten area.

Wilderness first aid requires some additional skills and supplies. Stabilizing an injured person and assisting them in evacuating a remote area are critical skills. Components of wilderness first-aid training can include how to treat hyperthermia, hypothermia, frostbite, and altitude sickness; specific knowledge of marine hazards, such as stinging jellyfish; emergency treatment for diarrhea and dehydration; and how to make splints and other supports from available materials. Hikers and explorers should learn specifics about first aid for the area where they will be traveling.

Discussion

First-aid training is often available through local Red Cross chapters or local community or health centers. Key components of first-aid training should include knowing how to get help, knowing how to position a victim, and knowing how to handle medical emergencies. Key medical emergencies include breathing difficulties, anaphylaxis, and seizures. Key injury emergencies include bleeding; wounds and abrasions; burns; spine injuries; musculoskeletal injuries such as sprains, strains, and fractures; and dental injuries. Key environmental emergencies include hypothermia, drowning, poisoning, and snakebites. More complex first-aid training may include safe handling of blood-borne pathogens and administration of oxygen and cardiopulmonary resuscitation (CPR). Specific first-aid training, such as wilderness first aid and travel first aid, are offered by a number of organizations.

The most common first-aid courses offer home first-aid training for parents and other caregivers. Basic first-aid training for the home includes how to respond to common illnesses and conditions such as croup, stroke, angina, asthma, diabetes, epilepsy, meningitis, anaphylaxis, heart attack, and febrile convulsions. It can also include how to identify and respond to common household poisonings, eye injury, head injury, crush injury, spinal injury, and the effects of temperature extremes. Other topics include how to respond to minor injuries and illness such as fever, cramps, blisters, fainting, earache, vomiting, headache, diarrhea, toothache, sore throat, abdominal pain, crushed fingers, burns and scalds, allergic reactions, stings, splinters, and small wounds and grazes.

First-aid kits are a key component of any first-aid effort. First-aid kits should be available in every home, school, work site, and vehicle. A standard kit should include a first-aid manual; bandages, including elastic bandages and sterile gauze; adhesive tape; disinfectants, such as antiseptic wipes or solutions; antibiotic ointment; over-the-counter pain and anti-inflammatory medicine, such as acetaminophen and ibuprofen; various tools, such as tweezers, sharp scissors, and safety pins; a thermometer; and plastic gloves.

Perspective and Prospects

First aid has been a part of organized Western medicine since the mid-nineteenth century, when it was expanded from efforts to tend to wounded soldiers. It began as basic training for soldiers to tend war casualties. The term “first aid” was coined from the terms “first response” and “National Aid” (the precursor to the British Red Cross) in 1878 by British Army officer and doctor Peter Shepherd, who, together with fellow officer Francis Duncan, introduced the concept of training civilians in first aid. Participants in these training courses received a certificate and volunteered to help care for wounded soldiers.

First aid became an established form of emergency care in the late nineteenth century. In Great Britain, the St. John Ambulance Brigade was established in 1873 to provide first aid to the public, and the St. John Ambulance Association was established in 1877 to train civilians in first-aid care. The primary focus was on providing aid to industrial workers. As part of the St. John Ambulance Association program, first-aid volunteers also helped in public disaster response. Both these groups have their roots in the Order of St. John, a religious order that provided medical services to soldiers as early as the twelfth century. St. John Ambulance remains one of the largest providers of first aid worldwide, operating in thirty-nine countries.

At about the same time that the Order of St. John was establishing first-aid classes, the International Red Cross committee was working to provide humanitarian aid to soldiers worldwide. In 1863, Henry Dunant founded the International Committee of the Red Cross as a reaction to the mass war casualties that he witnessed during a business trip to Italy and the lack of medical and humanitarian care available to wounded soldiers. This was the beginning of international efforts to establish Red Cross societies around the world. In the United States, Clara Barton, a nurse and teacher, became president of the American Red Cross in 1881. She expanded basic first-aid training for soldiers to include training for industrial accidents and disaster relief. Today, national Red Cross societies exist in most countries.

Bibliography

American Red Cross and Kathleen A. Handal. The American Red Cross First Aid and Safety Handbook. Boston: Little, Brown, 1992.

“First Aid.” MedlinePlus, May 28, 2013.

Krohmer, Jon R., ed. American College of Emergency Physicians First Aid Manual. 2d ed. New York: DK, 2004.

Subbarao, Italo, Jim Lyznicki, and James J. James, eds. The American Medical Association Handbook of First Aid and Emergency Care. Rev. ed. New York: Random House Reference, 2009.

Weiss, Eric A. Wilderness and Travel Medicine: A Comprehensive Guide. 4th ed. Seattle: Mountaineers, 2012.

In Maya Angelou’s speech for Coretta Scott King’s funeral, what are the literary and poetic devices used?

In the speech, Maya Angelou uses metaphors to characterize Coretta Scott King. She describes Coretta as a woman who was 'born a cornflower and destined to become a steel magnolia.' Cornflowers are beautiful summer plants; they are hardy and flower abundantly throughout the entire summer season, often bathing whole fields in blue. The magnolia itself is a most impressive and stately flower; it is associated with the vibrant resilience of the South. The term, 'steel magnolia,' popularly symbolizes the inner strength and irrepressible courage inherent in southern womanhood. Maya Angelou uses the metaphor of the cornflower and steel magnolia to characterize the progressive vibrancy, resilience, and courage exhibited by Coretta Scott King throughout her lifetime.

In the speech, Maya Angelou also uses the metaphor of sleeping children to characterize the calm innocence of Coretta Scott King's hands.

In the midst of national tumult, in the medium of international violent uproar, Coretta Scott King’s face remained a study in serenity. In times of interior violent storms she sat, her hands resting in her lap calmly, like good children sleeping.

To reiterate the image of Coretta Scott King's purity of conduct (hands that are as innocent as 'good children sleeping' will never support violence), Maya Angelou uses the literary device of anaphora.

She believed religiously in non-violent protest.

She believed it could heal a nation mired in a history of slavery and all its excesses.

She believed non-violent protest religiously could lift up a nation rife with racial prejudices and racial bias.

Maya Angelou continues to use anaphora (the repetition of the first word/words in succeeding sentences) to emphasize Coretta Scott King's personal belief in the equality of all people.

She loved her church fervently. She loved and adored her husband and her children. She cherished her race. She cherished women. She cared for the conditions of human beings, of native Americans and Latin — Latinos and Asian Americans. She cared for gay and straight people. She was concerned for the struggles in Ireland, and she prayed nightly for Palestine and equally for Israel.

I mean to say I want to see a better world.

I mean to say I want to see some peace somewhere.

I mean to say I want to see some honesty, some fair play.

Maya Angelou also uses parallelism to lend a rhythm and flow to her rhetoric that is indispensable in emphasizing her plea for consensus.

And those of us who gather here, principalities, presidents, senators, those of us who run great companies, who know something about being parents, who know something about being preachers and teachers — those of us, we owe something from this minute on; so that this gathering is not just another footnote on the pages of history. We owe something.

Maya Angelou's use of end rhyme and internal rhyme at the end of her speech lends a unique, musical rhythm to her final words. End rhymes occur when the last syllables/words in two or more end lines rhyme with one another; internal rhyme occurs on the same line.

[Sings: “I open my mouth to the Lord and I won’t turn back, no. I will go, I shall go. I’ll see what the end is gonna be.”]

Hope this helps!

How does Elizabeth come to Darcy's defense in Pride and Prejudice?

Although Elizabeth develops a strong prejudice against Darcy when she overhears him say she is "tolerable" but not worth the effort to dance with, after he proposes to her and she turns him down, she comes to realize that he might not be as bad as she had been led to believe. Wickham, who charmed her with his good looks and good manners, told Elizabeth that Darcy cheated him, but Darcy then sent Elizabeth a letter offering his side of the story. Upon her return home, Elizabeth defended him to Jane, which meant exposing Wickham: 

What a stroke this was for poor Jane, who would willing have gone through the world without believing that so much wickedness existed in the whole race of mankind, as was here collected in one individual. 

But when Jane tries to "clear" both Darcy and Wickham, Elizabeth defends Darcy: 

There is but such quantity of merit between them to make one good sort of man ... For my part I am inclined to believe it is all Darcy's .... 

Later, after the second marriage proposal in which Elizabeth accepts Darcy, her father is astonished, still believing in Elizabeth's assessment of Darcy as a proud, insufferable person. Here she has to persuade father otherwise, for he says: 

Lizzy ... are you out of your senses to be accepting this man? Have not you always hated him?

Lizzy regrets her former harsh words but responds

I love him. He has no improper pride. He is perfectly amiable. You do not know what he really is ...

Not only does Elizabeth have to get over her prejudice, she, like Darcy, must swallow her pride in admitting she had judged wrongly.

What is fatigue?

Causes and Symptoms

Almost all people suffer from fatigue at some point in their lives. It is a nonspecific complaint including tiredness, lack of energy, listlessness, or malaise. Patients often confuse fatigue with weakness, breathlessness, or dizziness, which indicate the existence of other physical disorders. Rest or a change in the daily routine ordinarily alleviates fatigue in healthy individuals. Though normally short in duration, fatigue occasionally lasts for weeks, months, or even years in some individuals. In such cases, it limits the amount of physical and mental activity in which the person can participate.

Long-term fatigue can have serious consequences. Often, patients begin to withdraw from their normal activities. They may withdraw from society in general and may gradually become more apathetic and depressed. As a result of this progression, a patient’s physical and mental capabilities may begin to deteriorate. Fatigue may be aggravated further by a reduced appetite and inadequate nutritional intake. Ultimately, these symptoms lead to
malnutrition and multiple vitamin deficiencies, which intensify the fatigue state and trigger a vicious circle.

This fatigue cycle ends with a person who lacks interest and energy. Such patients may lose interest in daily events and social contacts. In later stages of fatigue, they may neglect themselves and lose track of their goals in life. The will to live and fight decreases, making them prime targets for accidents and repeated infections. They may also become potential candidates for suicide.

Physical and/or mental overactivity commonly cause recent-onset fatigue. Management of such fatigue is simple: Adequate physical and mental relaxation typically relieve it. Fortunately, many persistent fatigue states can be easily diagnosed and successfully treated. In some cases, however, fatigue does not respond to simple measures.

Fatigue can stem from depression. Depressed individuals often reflect boredom and a lack of interest, and frequently express uncertainty and anxiety about the future. These people usually appear “down.” They may walk slowly with their head down, slump their shoulders, and sigh frequently. They often take unusually long to respond to questions or requests. They also show little motivation. Depressed individuals typically relate feelings of dejection, sadness, worthlessness, or helplessness. Often, they complain of feeling tired when they wake up in the morning, and no amount of sleep or rest improves their condition. In fact, they feel weary all day and frequently complain of feeling weak. They often have poor appetites and sometimes lose weight. Once these patients are questioned by a physician, however, it may become apparent that their state of fatigue actually fluctuates. At times they feel exhausted, while at other times (sometimes only minutes later) they feel refreshed and full of energy.

Other manifestations of depression include sleep disorders (particularly early morning waking), reduced appetite, altered bowel habits, and difficulty concentrating. Depressed individuals sometimes fail to recognize their condition. They may channel their depression into physical complaints such as abdominal pain, headaches, joint pain, or vaguely defined aches and pains. In older people, depression sometimes manifests itself as impaired memory.

Anxiety, another major cause of fatigue, interferes with the patient’s ability to achieve adequate mental and physical rest. Anxious individuals often appear scared, worried, or fearful. They frequently report multiple physical complaints, including neck muscle tension, headaches, palpitations, difficulty in breathing, chest tightness, intestinal cramping, and trouble falling asleep. In some cases, both depression and anxiety may be present simultaneously.

Medications also constitute a major cause of fatigue. Most drugs—prescription, over-the-counter, or recreational—can cause fatigue. Medications for sleep, antidepressants, antianxiety medications, muscle relaxants, allergy medications, cold medications, and certain blood pressure medications can lead to problems with fatigue.

An excessive intake of stimulants, paradoxically, sometimes leads to easy fatigability. Stimulants can interfere with proper sleeping habits and relaxation. Common culprits include caffeine and medications (such as some diet pills and nasal decongestants) that can be purchased without a prescription. Recreational drugs can also contribute to chronic fatigue. Depending on their tendencies, they function to cause fatigue in much the same way as the prescription and over-the-counter drugs already discussed. Cocaine and amphetamines, for example, act as stimulants. Narcotics such as heroin and barbiturates (downers) possess strong sedative qualities. Alcohol consumption in an attempt to escape loneliness, depression, or boredom may further exacerbate a sense of fatigue. Alcohol produces fatigue in two ways. It has sedative qualities, and it also intensifies the sedative effects of other medications, if taken with them.

Other drugs that may induce fatigue include diuretics and those that lower blood pressure. These medications increase the excretions of many substances through the kidneys. If inappropriately given or regulated, these drugs may alter the blood concentration of other medications taken concurrently.

Painkillers can lead to fatigue in a different way. In some individuals, they irritate the lining of the stomach and cause it to bleed. Such bleeding usually occurs in small amounts and goes unnoticed by the patient. This slight blood loss can gradually lead to anemia and fatigue.

Medications are particularly likely to cause fatigue in elderly individuals. With many drugs, their elimination from the body through metabolism or excretion may decrease with age. This often leads to higher drug concentrations in the blood than intended, resulting in a state of constant sedation and lethargy. Also, elderly individuals’ brains may be more sensitive to sedation than those of younger individuals. Finally, the elderly tend to take more medication for more illnesses than younger adults. The additive side effects of multiple medicines can contribute to fatigue problems.

Sleep deprivation or frequent sleep interruptions lead to fatigue. A change in environment can induce sleep disorders, especially if accompanied by unfamiliar noises, excessive lighting, uncomfortable temperatures, or an excessive degree of humidity or dryness. Total sleep time may be adequate under such conditions, but quality of sleep is usually poor. Nightmares can also interrupt sleep, and if numerous and recurring, they also cause fatigue.

Some sleep interruptions are not so readily apparent. In sleep apnea, a specific and increasingly diagnosed sleep disorder, the patient temporarily stops breathing while sleeping. This results in reduced oxygen levels and increased carbon dioxide levels in the blood. When a critical level is reached, the patient awakens briefly, takes a few deep breaths, and then falls asleep again. Many episodes of sleep apnea may occur during the night, making the sleep interrupted and less refreshing than it should be. The next day, the patient often feels tired and fatigued but may not recognize the source of the problem. Obstructive sleep apnea normally develops in grossly overweight patients or in those with large tonsils or adenoids. Patients with obstructive sleep apnea usually snore while sleeping, and typically they are unaware of their snoring and sleep disturbance.

A number of diseases can lead to easy fatigability. In most illnesses, rest relieves fatigue and individuals awake refreshed after a nap or a good night’s sleep. Unfortunately, they also tire quickly. Unlike psychogenic fatigue or fatigue induced by drugs, disease-related fatigue is not usually the patient’s main symptom. Other symptoms and signs frequently reveal the underlying diagnosis. Individuals who suffer from severe malnutrition, anemia, endocrine system malfunction, chronic infections, tuberculosis, Lyme disease, bacterial endocarditis (a bacterial infection of the valves of the heart), chronic sinusitis, mononucleosis, hepatitis, parasitic infections, and fungal infections may all experience chronic fatigue.

In early stages of acquired immunodeficiency syndrome (AIDS), fatigue may be the only symptom. Persons at high risk for contracting the human immunodeficiency virus (HIV)—those with multiple sexual partners, those who have unprotected sex, those with a history of blood transfusion, or intravenous drug users—who complain of persistent fatigue should be tested for HIV infection.

Abnormalities of mineral or electrolyte concentrations—potassium, sodium, chloride, and calcium are the most important of these—may also cause fatigue. Such abnormalities may result from medications (diuretics are frequently responsible), diarrhea, vomiting, dietary fads, and endocrine or bone disorders.

Some less common medical causes of chronic fatigue include dysfunction of specific organs such as kidney failure or liver failure. Allergies can also produce chronic fatigue. Cancer can cause fatigue, but other symptoms usually surface and lead to a diagnosis before the patient begins to notice chronic weariness.

Treatment and Therapy

When an individual’s fatigue persists in spite of adequate rest, medical help becomes necessary in order to determine the cause. Common diseases known to be associated with fatigue should be considered. Initially, the physician makes detailed inquiries about the severity of the fatigue and how long ago it started. Other important questions include whether it is progressive, whether there are any factors that make it worse or relieve it, or whether it is worse during specific times of the day. An examination of the patient’s psychological state may also be necessary.

The physician should ask about the presence of any symptoms that occur along with the general sense of fatigue. For example, breathlessness may indicate a cardiovascular or respiratory disease. Abdominal pain might arouse the suspicion of a gastrointestinal disease. Weakness may point to a neuromuscular collagen disease. Excessive thirst and increased urine output may suggest diabetes mellitus, and weight loss may accompany metabolic or endocrinal abnormalities, chronic infections, or cancer.

Whether they have been prescribed by a physician or purchased over the counter, the medications taken regularly by a patient should be reviewed. The doctor should also inquire about alcohol and tobacco use and dietary fads. A thorough physical examination may be required. During an examination, the doctor sometimes uncovers physical signs of fatigue-inducing diseases. Blood tests and other laboratory investigations may also be needed, especially because a physical examination does not always reveal the cause.

Often, however, despite an extensive workup, no specific cause for the persistent fatigue appears. At this stage, the diagnosis of chronic fatigue syndrome should be considered. To fit this diagnosis, patients must have several of the symptoms associated with this syndrome. They must have complained of fatigue for at least six months, and the fatigue should be of such an extent that it interferes with normal daily activities. Since many of the symptoms associated with chronic fatigue syndrome overlap with other disorders, these other fatigue-inducing conditions must be considered and ruled out.

To fit the diagnosis of chronic fatigue syndrome, patients must have at least six of the classic symptoms. These include a mild fever and sore throat, painful lymph nodes in the neck or axilla, unexplained generalized weakness, and muscle pain or discomfort. Patients may describe marked fatigue lasting for more than twenty-four hours that is induced by levels of exercise that would have been easily tolerated before the onset of fatigue. They may suffer from generalized headaches of a type, severity, or pattern that is different from headaches experienced before the onset of chronic fatigue. Patients may also have joint pain without swelling or redness and neuropsychologic complaints such as a bad memory and excessive irritability. Confusion, difficulty in thinking, inability to concentrate, depression, and sleep disturbances are also on the list of associated symptoms.

No one knows the exact cause of chronic fatigue syndrome. Researchers continue to study the disease and come up with hypotheses, though none have proven entirely satisfactory. One theory argues that since patients with chronic fatigue syndrome appear to have a reduced aerobic work capacity, defects in the muscles may cause the condition. This, however, constitutes only one of many theories concerning the syndrome and its origin.

Many patients with chronic fatigue syndrome relate that they suffered from an infectious illness immediately preceding the onset of fatigue. This pattern causes some scientists to suspect a viral origin. Typically, the illness that precedes the patient’s problems with fatigue is not severe, and resembles other upper respiratory tract infections experienced previously. The implicated viruses include the Epstein-Barr virus, Coxsackie B virus, herpes simplex virus, cytomegalovirus, human herpesvirus 6, and the measles virus. It should be mentioned, however, that some patients with long-term fatigue do not have a history of a triggering infectious disease before the onset of fatigue.

Patients with chronic fatigue syndrome sometimes have a number of immune system abnormalities. Laboratory evidence exists of immune dysfunction in many patients with this syndrome, and there have been reports of improvement when immunoglobulin (antibody) therapy was given. The significance of immunological abnormalities in chronic fatigue syndrome, however, remains uncertain. Most of these abnormalities do not occur in all patients with this syndrome. Furthermore, the degree of immunologic abnormality does not always correspond with the severity of the symptoms.

Some researchers believe that the acute infectious disease that often precedes the onset of chronic fatigue syndrome forces the patient to become physically inactive. This inactivity leads to physical deconditioning, and the progression ends in chronic fatigue syndrome. Experiments in which patients with chronic fatigue syndrome were given exercise testing, however, do not support this theory completely. In the case of physical deconditioning, the heart rates of patients with chronic fatigue syndrome should have risen more rapidly with exercise than those without the syndrome. The exact opposite was found. The data were not determined consistent with the suggestion that physical deconditioning causes chronic fatigue syndrome.

A high prevalence of unrecognized psychiatric disorders exists in patients with chronic fatigue, especially depression. According to a 2012 article in American Family Physician, depression affects approximately 39 to 47 percent of chronic fatigue syndrome patients. Yet a critical question remains unanswered concerning chronic fatigue syndrome: Are patients with this syndrome fatigued because they have a primary mood disorder, or has the mood disorder developed as a secondary component of the chronic fatigue syndrome?

No completely satisfactory treatment exists for chronic fatigue syndrome. A group of researchers using intravenous immunoglobulin therapy met with varying degrees of success, but other investigators could not reproduce these results. Other therapeutic trials used high doses of medications such as acyclovir, liver extract, folic acid, and cyanocobalamine. A mixture of evening primrose oil and fish oil was also administered with some degree of success. Claims have also been made that patients administered magnesium sulfate improved to a larger extent than those receiving a placebo. Other therapeutic options include cognitive behavioral therapy, programs of gradually increasing physical activity, analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and antidepressants. Finally, a number of self-help groups exist for chronic fatigue sufferers.

The prognosis and natural history of chronic fatigue syndrome are still poorly defined. Chronic fatigue syndrome does not kill patients, but it does significantly decrease the quality of life for sufferers. For the physician, management of this syndrome remains challenging. In addition to correcting any physical abnormalities present, the physician should attempt to find an activity that interests the patient and encourage him or her to become involved in it.

Perspective and Prospects

Fatigue is generally considered a normal bodily response, protecting the individual from excessive physical and mental activity. After all, the normal levels of performance for individuals who do not rest usually decline. In the case of overactivity, fatigue should be viewed as a positive warning sign. Using relaxation and rest (both mental and physical), the individual can often alleviate weariness and optimize performance.

In some cases, however, fatigue does not derive from physical or mental overactivity, nor does it respond adequately to relaxation and rest. In these instances, it interferes with an individual’s ability to cope with everyday life and enjoy usual activities. The patient begins referring to fatigue as the reason for not participating in normal physical, mental, and social activities.

Unfortunately, physicians, health care professionals, society, and even the patients themselves dismiss fatigue as a trivial complaint. As a result, sufferers seek medical help only after the condition becomes advanced. This dangerous, negative attitude can delay the correct diagnosis of the underlying pathology and threaten the patient’s chances for a quick recovery.

The diagnosis and management of chronic fatigue syndrome prove challenging for both physician and patient. It is important to note that chronic fatigue syndrome often stems from nonmedical causes. While the possibility of a serious medical illness should be addressed, illness-related fatigue usually occurs along with other, more prominent symptoms. The causes of chronic fatigue syndrome are numerous and can take time to define. Patients need to answer all questions related to their complaints as thoroughly and accurately as possible, so that their physicians can reach accurate diagnoses using the minimum number of tests. Extensive testing for rare medical causes of fatigue can become extraordinarily expensive and uncomfortable, so doctors select the tests that they are ordering cautiously. They must balance the benefit, the cost, and the risk of each test to the patient. Such decisions should be based on their own experience and on the available data.

Open communication between the patient and doctor is of paramount importance. It ensures a correct diagnosis, followed by the most effective treatment. Follow-up visits and reassurance may be the best therapy in many cases. Professional counselors can offer assistance with fatigue-inducing psychological disorders. Examination of sleep and relaxation habits can reveal potential problems, and steps can be taken to ensure adequate rest.

Persistent fatigue should not be regarded lightly, and serious attempts should be made to determine its underlying causes. In this respect, it may be appropriate to recall one of Hippocrates’ aphorisms, “Unprovoked fatigue means disease.”

Bibliography

Archer, James, Jr. Managing Anxiety and Stress. 2d ed. New York: Routledge, 1991. Print.

Clever, Linda Hawes, and Dean Omish. The Fatigue Prescription: Four Steps to Renewing Your Energy, Health, and Life. Berkeley: Cleis, 2010. Print.

DePaulo, J. Raymond, Jr., and Leslie Ann Horvitz. Understanding Depression: What We Know and What You Can Do About It. New York: Wiley, 2003. Print.

Feiden, Karyn. Hope and Help for Chronic Fatigue Syndrome: The Official Guide of the CFS-CFIDS Network. New York: Prentice, 1990. Print.

Goroll, Allan H., and Albert G. Mulley, eds. Primary Care Medicine. 5th ed. Philadelphia: Wilkins, 2006. Print.

Patarca-Montero, Roberto. Chronic Fatigue Syndrome and the Body’s Immune Defense System. New York: Haworth, 2002. Print.

Poppe, Carine, et al. "Cognitive Behavior Therapy in Patients with Chronic Fatigue Syndrome: The Role of Illness Acceptance and Neuroticism." Journal of Psychosomatic Research 74.5 (2013): 367–72. Print.

Smith, Howard S. Handbook of Fatigue in Health and Disease. New York: Nova, 2011. Print.

Talley, Joseph. Family Practitioner’s Guide to Treating Depressive Illness. Chicago: Precept, 1987. Print.

Wilson, James L. Adrenal Fatigue: The Twenty-first Century Stress Syndrome. Petaluma, Calif.: Smart, 2004. Print.

Yancey, Joseph R., and Sarah M. Thomas. "Chronic Fatigue Syndrome: Diagnosis and Treatment." American Family Physician 86, no. 8 (October 15, 2012): 741–746.

Zgourides, George D., and Christie Zgourides. Stop Feeling Tired! Ten Mind-Body Steps to Fight Fatigue and Feel Your Best. Oakland: Harbinger, 2003. Print.

What is the movie Doctor Zhivago about?

Based on Russian author Boris Pasternak's 1957 novel of the same title, Doctor Zhivago is about a young, idealistic medical student and poet, the titular character, whose marriage to one woman and love for another takes place against the backdrop of the Russian Revolution and ensuing civil war. As is usually the case, the film is a truncated version of the novel, but it succeeds in capturing the tone of Pasternak's prose and providing a genuine feel for life in revolutionary Russia.

Told in flashback by his half-brother, a general in the Soviet Army who has been searching for the long-lost daughter of his now-deceased brother, Yuri, the filmed adaptation of Doctor Zhivago covers the protagonist, Yuri Zhivago's life very briefly, establishing that this orphaned boy is adopted by the Gromykos, a wealthy, aristocratic family whose demise following the overthrow of the czarist regime, serves to illustrate the decline of the old upper-classes of Russia after the Bolsheviks took power. As Yuri grows and prospers as a promising medical student, his marriage to the daughter of the family that raised him, Tonya, is assured. Yuri, however, meets and falls in love with Lara, the beautiful wife of a major figure in the Bolshevik movement known for his ferocity and for the devastation left in his wake wherever he travels.

As Doctor Zhivago progresses, the love triangle involving Yuri, Tonya and Lara becomes increasingly complicated, with the Gromyko family's post-revolution difficulties forcing them into a life of economic destitution. The Gromykos are forced from their once-palatial home to a small home near the Ural Mountains. When Yuri learns that Lara lives in a nearby town, he renews their affair. On one trip to town to see Lara, however, he is essentially kidnapped (or forcibly conscripted) by Bolshevik (or, Red) guerrillas fighting reactionary "White" forces. Kept in a form of enforced servitude, providing medical care to wounded combatants, Yuri eventually escapes only find that his family and Lara have all moved on.

Throughout the course of the film, Yuri loses and reconnects with Lara, their destinies seemingly entwined. In the meantime, the story's narrator, Yuri's half-brother, General Yevgraf, describes his own service in the Russian and then Soviet Army and his encounters with his brother. General Yevgraf takes it upon himself to help Yuri and his family escape the fighting in Moscow, securing for them a place on the train that takes them to the Urals, the aforementioned location of the cabin in which the family takes refuge. Another element of the story involves the character Komarovsky, a clever, intelligent and thoroughly Machiavellian figure whose illicit affair with Lara and subsequent attempts at "helping" Yuri and Lara survive this turbulent period in Russian history serves to contrast the benign, innocent nature of Yuri with the ruthless character of the man who would be his protector.

As the film draws to a close, Yuri has not seen Lara for several years, they having been separated when Komarovsky convinces Yuri and Lara to escape to the Russian Far East with him to avoid the spreading fighting. Yuri and Lara agree to go with Komarovsky despite their shared loathing of him, but Yuri backs out at the last minute, leaving Lara and Komarovsky to leave without him. As they depart, Lara reveals to Komarovsky, with whom she had maintained, in earlier times, a torrid and degrading affair that included Komarovsky's rape of her, that she is pregnant with Yuri's child. The child that will be born of this romance, we are led to believe, is the now-grown child for whom General Yevgraf has been searching. The film ends with Yuri's death following a heart attack he suffers after frantically trying to get to a woman he views from a trolley window and believes to be his long-lost love, Lara. The film then returns to the "current" period, where it began, with General Yevgraf, speaking with this grown woman at the enormous dam where she is employed. The general is convinced that this girl is his niece, but she is extremely reticent, as a general in the Soviet Union is an enormously powerful figure and she is but a laborer. She leaves the meeting with Yevgraf in the arm of her boyfriend, an operator of the dam, a symbol of the industrialization of a once weak and backward country.

What is healing?

The Healing Process

The human body is not able to reproduce injured parts during the healing process. Most injured tissue in the body is replaced with collagen, a white protein known as scar tissue. Body areas capable of reproducing, or regenerating, include the outer layer of skin and the inner layers of the intestines.

The human body is involved in a continuous process of self-healing. The outer layer of the skin is constantly rubbed off, yet the body is able to replace (regenerate) new skin to take its place. Another body area capable of regeneration is the innermost layer of the intestine. All other types of tissue, however, such as muscle, fat, blood vessels, or even bones, must rely on other ways to heal when injured. How quickly the body heals depends on many factors, but the process is a predictable one. The healing process includes three phases: the acute inflammatory phase, the repair or regeneration phase, and the remodeling phase.

The first phase of healing, the immediate inflammatory phase, includes the first three or four days after the injury. This process, carried out by vascular, chemical, and cellular events, leads to the repair of tissue, to regeneration, or to scar tissue formation. If the hand is sliced open by a piece of broken glass, the first healing response would be a temporary decrease in blood flow, known as vasoconstriction, or narrowing of the blood vessels at the injury site to prevent the person from bleeding to death. With extensive vessel damage, however, the body is unable to close off enough vessels, and life-threatening hemorrhaging may occur.

The blood begins to seal the broken vessels by coagulation, also known as blood clot formation. The next step is activation of the chemicals needed in the healing process, which is possible only after the blood vessel diameter increases in a process called vasodilation. During vasodilation, the blood flow is slowed and the blood becomes thicker, resulting in swelling. At this point, a buildup or accumulation of fluid results from the seeping of plasma, the fluid portion of the blood, through the vessel walls. This seeping or leakage results from the difference in pressure within the vessel and outside its walls, as well as in the increased permeability of blood vessel walls during the inflammatory process. The amount of swelling at the injury site depends on the amount of seeping, which in turn depends on how much tissue damage has occurred.

Because the blood flow is slower, the concentration of red blood cells and white blood cells is increased. The white blood cells line up and adhere to the inside walls of small blood vessels, known as venules. These white blood cells then pass through the venule walls and are chemically attracted to the injury site over the next several hours. A specialized connective tissue cell, known as a mast cell, is also sent to the injury site. Mast cells contain heparin and histamine. Heparin prolongs the clotting time of blood by temporarily preventing coagulation, while histamine causes dilation of the capillaries. During this earliest phase, both heparin and histamine are important factors, since their actions allow other specialized cells to move into the injured area. The amount of bleeding and fluid buildup at the injury site depends on the extent of damage and how easily materials can cross the walls of intact vessels.
Both of these conditions influence the healing process.

The second phase of healing can be called the repair or regeneration phase. For tissue capable of regeneration, this phase involves the restoration of destroyed or missing tissue. For other types of tissue, this second phase would entail the repair process. The healing of a deep cut in the hand would not be considered regeneration, since the body is not able to remake all the different layers of skin and muscle injured. This healing phase would extend forward from the previously described inflammatory phase. During this phase, the cut is naturally cleaned through the body’s ability to remove cellular waste, the help of the red blood cells, and the formation of a blood clot.

Two types of healing can occur. Primary healing, or healing by primary intention, could take place in the hand laceration example, since the edges are even and close together. If this injury resulted in a large piece of tissue being removed, then the body would fill the gap with scar tissue. The replacement of tissue with scar tissue is an example of secondary healing, or healing by secondary intention. A torn muscle would be an example of secondary healing if it is allowed to heal on its own by the formation of scar tissue within the muscle.

No matter which type of healing occurs, several factors regulate how quickly and how completely this process takes place. Because blood vessels and cells are deprived of oxygen and die from the injury, this new cellular waste or debris must be cleaned from the area before repair or regeneration can take place. This tissue death promotes the formation of new capillary buds on the walls of the intact vessels. As these mature, the injury site is newly supplied with oxygenated blood and the healing process continues into the third phase.

The third phase of healing, known as the remodeling phase, includes the laying down of young scar tissue that increases in strength over the next year. Although the healing process has no distinct time frame, it is believed that three to six weeks are needed for the production of scar tissue. There must be a balance between the toughness and the elasticity of the scar. The amount of stress placed on a newly formed scar will determine the tensile strength of the collagen content. If stress or strain is placed on this forming scar tissue too early, the healing process will take longer. A desirable outcome would be a scar of adequate collagen content through the development of sufficient mature collagen fibers of proper tensile strength. Adequate tensile strength is also affected by how long inflammation is present.

If an injury site has inflammation that lasts up to one month, it is considered a subacute inflammation. When it lasts for months or years, it is then called chronic inflammation. Chronic inflammation is a condition in which small traumas happen repeatedly; it is often seen in overuse injuries. Because this type of injury lasts longer, different types of chemicals try to initiate complete healing. The role of some of these special chemicals is not completely understood.

The healing of a broken bone, similar in many ways to the healing of the skin, is somewhat easier to understand. The first phase shows the same acute inflammation that lasts about four days, involving clotting blood, dead bone

cells, and soft tissue damage around the injury site. The second phase, the repair and regeneration phase, differs slightly when a bone is broken, since the blood clot (hematoma) becomes granulated and builds between the two bone ends. The bone produces a specialized cell that turns into a soft or hard fibrous callus, matures into cartilage, and finally becomes bone with a firmly woven network of cells.

The beginning soft callus is a network of unorganized bone that forms at the two broken edges and is later absorbed and replaced by a hard callus. With appropriate care, a broken bone will develop a new network in the center and eventually become primary bone. The amount of oxygen available in the area determines this development. It is important to keep in mind that when the injury is severe enough to break a bone, then the blood supply is interrupted, lowering the amount of oxygen that is available. Low oxygen could result in the formation of only fibrous tissue or cartilage. Strong, healthy bone results when oxygen and the correct amount of compression are available. The third phase, the remodeling phase, describes the time when the callus has been reabsorbed and special intersecting bone fibers cover the broken area. It may take many years for this entire process to be completed, until the bone has regained its normal shape and ability to withstand stresses.

Disorders and Treatment

Any of the three stages of healing can be delayed or prevented. The three main causes for failed healing are poor blood supply, poor immobilization, or infection.

The healing process within the body can be seriously hampered if the blood supply is poor, since the delivery of nutrients, chemicals, hormones, and specialized building materials to the injury site is hampered. It is extremely important that oxygen levels are adequate for proper healing. If the blood supply is not sufficient, then the tissue may die, especially in broken bone fragments. Fortunately, most tissues of the body have a good blood supply, as demonstrated by the amount of bleeding that takes place when the skin and underlying tissues are injured.

The second condition that interferes with healing is excessive movement because the body part was not immobilized. For the scar tissue or even new bone to become well organized, the two edges of the injured tissue must be kept close together.

The third reason for poor healing is infection. Although the body has many defenses against infection, foreign material can slow healing. If this infectious material invades the space between the two bone ends of a fracture, the necessary building materials may not reach the site. Infection invading the hand tissue cut by the glass could prevent the edges from healing together because of pus, scab formation, or the interference of germs.

There are many different types of injuries, and several steps must be taken in caring for each type. Soft tissues, the first line of defense against injuries, can be used to describe all tissues other than bone. Soft tissue injuries are classified as either closed or open. In a closed wound, the damage lies below the surface of the skin and the skin remains intact. A sprained ankle or a bruised knee are classified as closed wounds. In an open wound, the skin or mucous membranes, such as the lining of the mouth, are broken or torn.

There are four types of open soft tissue injuries; each has specific characteristics and heals differently. The first type is an abrasion, in which part of the outer layer of the skin and some underlying tissue is rubbed or scraped off. A common injury of this type is a scraped knee resulting from a fall on the sidewalk. The second type, a laceration, results from a sharp object cutting the skin, such as the previous example of a piece of glass cutting the skin either superficially or very deeply. The third type, an avulsion, results when a piece of skin or even an entire fingertip is torn off or left loosely hanging by a small flap of skin. It is important that this flap not be removed since a physician can sometimes reattach the part. The last type of soft tissue injury is the puncture wound, which results when a sharp object penetrates the skin and into a body part. Such an injury could be a stab from a knife or an ice pick, a splinter stuck in the foot, or even a bullet shot into the leg. The initial management is the same for all four types of injury.

Management of open wounds must include the control of bleeding, infection prevention, and immobilization. Two of the above injuries, an avulsion and a puncture wound, require additional special care. In the case of an avulsed body part, the amputated part should be saved; wrapped in a dry, sterile piece of gauze; and placed in a plastic bag. If this bag is kept in something cool, such as a bucket of ice, the possibility of reattachment is increased. An impaled object remaining in a puncture wound should never be removed but held in place, all movement restricted until medical care can be given.

Several medical treatments can aid in promoting the healing process, as can commonsense first aid measures taken immediately after an injury occurs. For example, with a glass cut to the hand one should immediately stop the bleeding by placing a sterile piece of gauze, or a very clean cloth, directly over the laceration. By adding direct pressure over the gauze, the circulation is reduced. If the cut is deep, if the bleeding cannot be controlled, or if a piece of glass remains in the wound, then it is advisable to seek medical attention. A physician would then thoroughly clean the injury site and stitch the two edges together. Immobilizing the two flaps of skin together by sewing them will allow the first two phases of healing to progress. By having the wound inspected and cleaned by medical personnel, the risk of infection is reduced. A small injury can be cared for at home, but infection must be prevented through proper cleansing. Even soap and water, along with a bandage or dressing, will help ward off infections.

Perspective and Prospects

Many strategies to improve the healing of human tissue have evolved over time—from ancient times, when healers packed mud on the top of sores to draw out the infection, to modern alternative medicines. Every person, at one time or another, receives a cut, scrape, bump, or bruise. Therefore, there is much interest in speeding up the healing process.

Renewed interests in nontraditional approaches to medicine explore the healing powers locked within the human body. The use of homeopathy, acupuncture, and acupressure are examples of alternatives to antibiotics and standard first aid measures to help an injury heal. Holistic health care, hypnosis, and osteopathic medicine offer other areas of exploration. The practice of Chinese medicine includes the use of herbs, crystals, massage, and meditation to allow healing to proceed quickly but through natural means. Even the use of aromatherapy—treatment through the inhalation of specific smells—has gained a foothold in the medical world. The manipulations done by chiropractic doctors offer other possibilities. Some seek cures in nature, from sources below the sea or deep in the forest. Yet, many untapped resources remain. The continuing research in genetics offers vast possibilities, and the link between mental attitude and the immune system presents a rich area for further exploration. Even innovations as simple as a special glue, used to replace sutures or staples for closing wounds, would have an important influence on the future of the healing process.

Bibliography

American Academy of Orthopaedic Surgeons. Emergency Care and Transportation of the Sick and Injured. Edited by Benjamin Gulli, Les Chatelain, and Chris Stratford. 10th ed. Sudbury, Mass.: Jones and Bartlett, 2011.

"Bruises." MedlinePlus, June 10, 2013.

DiPietro, Luisa A., and Aime L. Burns, eds. Wound Healing: Methods and Protocols. Totowa, N.J.: Humana Press, 2003.

Eisenberg, David. Encounters with Qi. New York: W. W. Norton, 1995.

"Fractures." MedlinePlus, May 15, 2013.

Gach, Michael R. Acupressure’s Potent Points: A Guide to Self-Care for Common Ailments. New York: Bantam Books, 1990.

Goldberg, Linn, and Diane L. Elliot. The Healing Power of Exercise: Your Guide to Preventing and Treating Diabetes, Depression, Heart Disease, High Blood Pressure, Arthritis, and More. New York: Wiley, 2002.

Handal, Kathleen A. The American Red Cross First Aid and Safety Handbook. Boston: Little, Brown, 1992.

"Handout on Health: Sports Injuries." National Institute of Arthritis and Musculoskeletal and Skin Diseases, April 2009.

Heller, Jacob L, et al. "Cuts and Puncture Wounds." MedlinePlus, January 1, 2013.

Kemper, Kathi J. The Holistic Pediatrician: A Pediatrician’s Comprehensive Guide to Safe and Effective Therapies for the Twenty-five Most Common Ailments of Infants, Children, and Adolescents. 2d ed. New York: HarperCollins, 2007.

Kopec, Tom. "Wound Healing and Care." TeensHealth. Nemours Foundation, November 2011.

"Nutrition Guidelines to Improve Wound Healing." Cleveland Clinic, November 1, 2007.

Subbarao, Italo, et al., eds. American Medical Association Handbook of First Aid and Emergency Care. Rev. ed. New York: Random House Reference, 2009.

Woodham, Anne, and David Peters. The DK Natural Health Encyclopedia of Natural Healing. 2d ed. New York: DK, 2000.

What type of allusion would the mechanical hound be referring to? Scientific? Literary? Historical? Artistic? Political?

The Mechanical Hound is stored at the firehouse and is a lethal weapon. It's a robotic soldier of sorts that can be programmed to hunt down a specific target. At one point, Montag thinks that the hound doesn't like him, which would mean that someone may have been giving it his biological information. Montag asks his boss, Captain Beatty, about it. Beatty replies "It's a lesson in ballistics. . . It targets itself, homes itself, cuts off. It's only copper wire, storage batteries, and electricity" (26). Montag understands that part of it, but he also knows that the hound can be given a target if provided with the following elements:

"It's calculators can be set to any combination, so many amino acids, so much sulphur, so much butterfat and alkaline. Right?" (26).

From this conversation, a more descriptive image of the hound can be imagined. Since the Mechanical Hound will seek out a specific target based on biological makeup, then one could argue that this alludes to Nazis who also targeted Jews during the Holocaust. It could also refer to any government, military, or soldier who seeks out to destroy someone based on genetics or race. Therefore, the allusion is based in science-fiction because the hound is a robot that identifies its targets by scientific evidence; but, the allusion can also be historical, political, and literary when applying it to any genocidal situation in history or literature. And any time there's a genocide, there's definitely something political behind it as well.

How does the Raven reveal the dark aspects of humanity?

The Raven, by Edgar Allan Poe, reveals the dark aspects of humanity in the following ways:

It reveals that love lost is a fact of life sometimes

In this poem, Edgar Allan Poe reveals that the narrator has lost his true love, Lenore. She was the love of his life and his inspiration and soul mate. He states:

“For the rare and radiant maiden whom the angels name Lenore—

            Nameless here for evermore.” (Stanza number 2, lines 5 and 6)

The dark side of humanity is that Death is an enemy. We often do not like to think of death. We want to dwell on living and the wonderful and beautiful aspects of life. But to be steeped in reality and live constructive proper lives we must acknowledge death as a part of life. It is, to most people, a darker aspect of humanity.

It reveals that life can be toilsome

The poet indicates that human beings can be wearied by daily striving. The fight to earn a living and make ends meet, health issues, personal relationship troubles, and more can take their toll on us. In the very first line of The Raven it is apparent that the narrator is tired and drained:

“Once upon a midnight dreary, while I pondered, weak and weary,”

Therefore, a second aspect of the dark side of humanity is revealed here.

It reveals that our own negative thoughts are a dark aspect of being human

The narrator’s outlook on life is revealed in this poem. At the very least the poem reveals how the narrator sometimes thinks, not that he is always morose. Our unconstructive and even destructive thoughts, and not having a proper outlook on life, can lead to down days, negativity, and even depression. Consider that the narrator has a negative view of December and winter. In addition, he is sorrowful over the loss of Lenore:

“Ah, distinctly I remember it was in the bleak December;” (Stanza number 2, line 1)

“From my books surcease of sorrow—sorrow for the lost Lenore—” (Stanza number 2, line 4)

It reveals that people can be influenced that there is no future hope

This poem reveals that the raven is influencing the narrator to believe that nevermore shall he see Lenore. The narrator asks the raven:

“Tell this soul with sorrow laden if, within the distant Aidenn,

    It shall clasp a sainted maiden whom the angels name Lenore—”

The raven answers “Nevermore”.

This makes the narrator angry. The narrator does reveal that he believes in God. If he does, he should have the hope of an afterlife where he will see Lenore again, should he qualify for life in God’s Kingdom. Nonetheless, the darker side of humanity is revealed here – a person being influenced by external forces, and this influence harming a person.