How is Dorian from "The Picture of Dorian Gray" similar to Victor Frankenstein from "Frankenstein" in bringing about his own destruction?

Dorian and Victor are similar in one key aspect —  they are brought to their demise by their respective choices. Dorian, on the one hand, is granted eternal youth in exchange for the aging of his likeness (in a portrait). As Dorian's hedonistic tendencies deepen, the portrait begins to show signs of aging that he himself, of course, does not show. The portrait ages in Dorian's place, growing more and more grotesque. His wish for youth prevents him, in a way, from feeling the effects of his self-destructive behavior, until the novel ends with him and the portrait switching places (that is, the portrait returns to its original state and he ages all at once, becoming unrecognizable).

Victor Frankenstein, on the other hand, is driven to reanimate a dead body. After successfully doing so, Victor realizes his mistake. The monster is an outcast, and Victor cannot deal with him. Victor shirks his responsibility to the monster, which leads the monster to resent him and take revenge. As with Dorian, Victor's irresponsible choices end up killing him. 

Do the Igbo women willingly accept polygamy?

Chinua Achebe's novel Things Fall Apart illustrates many aspects of Igbo culture that strike American readers as strange or even immoral; this includes the Igbo practice of polygamy. 

Polygamy is the marriage of one person to multiple other persons. Traditionally, across many cultures, it involves one man marrying many women. American culture, and in fact law, prohibits the practice of polygamy, and it is considered unethical and sexist. 

This American perspective aligns with a feminist perspective, albeit a Westernized one. From a gendered lens, polygamy as a practice reduces women to an inherently unequal role in marriage, in which one man is considered the equal of one, two, or more women. 

It is important to note, however, that this feminist lens is the result of a specific cultural paradigm. Women who develop within Igbo culture might embrace this practice, perhaps finding religious or moral justifications for its preservation or finding a sense of community and support within their fellow wives. 

It is vital to remember that every perspective is influenced by multiple elements, including culture, context, and gender in this case. 

What is folk medicine?

Overview

At the beginning of the twentieth century in the United States, different forms
of medical care were widely patronized. In 1910, Abraham
Flexner published an influential report that advocated for
the use of medical practices based on scientific evidence; he anticipated that
folk medicine, which was presumably not evidence-based, would die out in time. A
century later, however, alternative medicine is very much alive and thriving. With
the advent of the Internet and the Web, and with the growing scope of immigration
and travel, alternative medical practices from a wide range of cultures have been
introduced in the United States. Furthermore, the number of rigorous clinical
studies comparing the efficacy of alternative medical practices with conventional
medicine continues to increase.

Besides treating a specific disease, many types of folk medicine aim to treat and promote well-being in the whole person, including a person’s physical, emotional, mental, and spiritual aspects. Some practices evoke the occult and witchcraft and aim to remove or neutralize evil spirits to cure physical ailments. Other practices take into account a person’s character traits and predispositions before making a diagnosis or creating a treatment plan.

There are many types of folk medicine, but all can be roughly classified into several categories. The first category involves natural products, which are ingested, inhaled, or applied to parts of the body. Over centuries and even millennia of empirical testing, many cultures have derived combinations of natural substances such as plant and animal materials for treating disease. Plant material includes leaves, fruits, seeds, bark, stems, and roots.

Another category of folk medicine is mind/body medicine, which involves
using the power of the mind to heal the body. Yoga,
meditation, and acupuncture can be classified under
this category. A popular example of mind/body medicine is acupuncture, in which
thin metal needles are inserted through the skin at specific pressure points along
“meridians,” or pathways, on the body to clear blockages in the flow of qi
(energy). Acupressure stimulates these pressure points manually, using
the hands instead of needles.

A third category of folk medicine, manipulative and body-based practices,
encompasses therapies that address the bones and joints, soft tissues, and the
circulatory and lymphatic systems. One example is spinal manipulation, which
involves applying force to a part of the spine, causing it to move beyond its
passive range of motion. Another example is massage,
which involves rubbing and pressing muscles to stimulate blood and oxygen flow
through the muscles.

Finally, other practices, such as movement therapies and energy therapies, can
also be considered folk medicines. Energy therapies include those that exploit
electromagnetic fields for healing purposes and practices, such as
Reiki, which involve the transmission of “universal” energy
(believed to be present in every person) from the practitioner to the patient by
placing of hands on or near the patient or by transmission from a distance.

Mechanism of Action

Natural products that are used as medicines have many different modes of action. For example, fish, seeds, and oils rich in omega-3 fatty acids act by reducing the level of cholesterol in the blood, reducing inflammation, and reducing cardiac arrhythmias (irregular heartbeat). The biological effects of Asian herbal medicines range from promoting circulation and dilating blood vessels to stimulating digestion and increasing skin elasticity. Natural products, such as herbs, are used in both Asian and Hispanic traditional medical practices to restore balance between “hot” and “cold” humors or conditions. In Hispanic folk medicine, for example, hot states are associated with vasodilation and a high metabolic rate, while cold states are associated with vasoconstriction and a low metabolic rate. A hot condition would be treated with herbal therapies that are considered cold treatments; conversely, cold conditions would be treated with hot therapies. Similar principles are used in Asian folk medicine.

Mind/body medicine such as meditation, yoga, and acupuncture uses the power of
the mind to improve physical and mental health. The idea is that the mind and body
are inextricably connected and influence health as an inseparable whole.
Meditation and yoga improve health by reducing stress and increasing calmness and
relaxation, which in turn boosts the immune system and promotes physical health.
According to Chinese medical concepts, acupuncture releases qi
blockages in the body, allowing qi to flow freely, and corrects
imbalance between the yin (“cold”) and yang (“hot”) forces. Although the positive
effects of acupuncture are becoming accepted among a growing number of laypersons
and clinicians, the mechanism of action cannot be readily explained in
conventional or Western medical terms. Faith healing can also be thought of as
mind/body medicine and is thought to work through the actions of a spiritual
power.

Manipulative and body-based practices work by applying force on parts of the
body such as muscles and bone. Massage therapy soothes muscle tension
and stimulates blood and oxygen circulation in the muscles. Spinal manipulation
increases flexibility and range of motion of the spinal vertebrae. The mechanisms
of action of energy therapies such as Reiki therapy are challenging to
characterize in scientific terms.

Uses and Applications

The uses of natural products are wide-ranging. They can be used to improve blood circulation throughout the body, treat headaches, and promote weight loss; they are also used to treat arthritis, diabetes, cancer, and heart disease. Mind/body techniques such as yoga and meditation are often used to treat illnesses related to anxiety, stress, and depression. Yoga, meditation, and acupuncture can be helpful in alleviating chronic pain. Acupuncture is also used to treat a wide range of disorders, from headaches to cancer. Manipulative and body-based practices treat back, neck, and shoulder pain, as well as spinal problems. Spinal manipulation is especially useful for treating lower back pain, a common ailment.

Scientific Evidence

Many scientific studies support the use of different types of oils in treating and preventing disease. This includes the use of fish oil in reducing cardiac arrhythmias, sunflower seed oil and olive oil in reducing cholesterol in the blood, and red palm oil in protecting against ischemia-reperfusion injury, which refers to damage to the heart when blood flow is restored (reperfusion) following a period without blood flow (ischemia).

Among mind/body traditional practices, acupuncture is one of the most widely
studied. A National Institutes of Health (NIH) consensus panel reviewed
the scientific literature about acupuncture to assess its clinical efficacy and
biological effects. According to the NIH panel, scientific evidence shows that
only dental pain and nausea (related to surgery, chemotherapy, or pregnancy) have
been effectively treated by acupuncture. More scientific studies are needed to
determine if acupuncture is effective for other conditions. Several studies
sponsored by the National Center of Complementary and Alternative Medicine are
underway to explore the use of acupuncture therapy in treating high blood pressure
and advanced colorectal cancer. However, the National Cancer Institute Web site
provides a summary of studies that show the efficacy of acupuncture in boosting
immune function and in reducing some of the side effects of chemotherapy,
including nausea, weight loss, and depression. Acupuncture also appears to reduce
cancer-related fatigue.

Choosing a Practitioner

One should choose a practitioner only after carefully researching his or her training, qualifications, and experience. In some types of alternative medicine, certification by an accreditation board can help in selecting a practitioner. For example, forty-one states in the United States require acupuncturists to be certified by the National Certification Commission for Acupuncture and Oriental Medicine before they are issued a license to practice. Certification requires passing of exams in oriental medicine, acupuncture, and Western biomedicine, usually after completion of master’s-level educational programs that involve three to four years of course work and clinical experience. If candidates pass these exams, they are awarded a diplomate in acupuncture.

As with conventional health-care practitioners, certified acupuncturists must
earn sufficient continuing education credits to renew this certification every
four years. Some physicians and dentists are certified and licensed to practice
acupuncture. There are also advanced degree programs in naturopathy
and complementary medicine in the United States, focusing on holistic healing
using alternative and conventional medical practices. Several schools offer the
doctor of naturopathy (N.D.) degree, which takes four to six years to complete,
and fourteen states license N.D.’s; licensing requires successful completion of
the naturopathic licensing examination.

Safety Issues

The safety of alternative medicine depends on the practitioner and on the
nature of the therapy and the context in which the therapy is applied. In addition
to choosing a qualified, well-established practitioner, one should take care when
initiating new alternative therapies. For example, when starting a new diet
regimen or adding dietary supplements, one should be alert to possible
interactions with medications or other supplements. Also, because many supplements
are not regulated by the U.S. Food and Drug Administration and
can be purchased without a prescription, one should research possible side effects
and interactions thoroughly before adding these substances to one’s diet.

For therapies that involve body manipulation, such as massage and spinal manipulation, possible side effects from poor treatment include sore muscles and muscle and ligament injury. Acupuncture has several side effects; these are mainly associated with the needle puncture site and include the puncture of organs, nerves, or blood vessels; infection (avoidable by using safe-needle techniques); puncture site pain; bleeding; hematoma; and the so-called needle shock reaction, which manifests as excessive sweating and a feeling of faintness after needle puncture.

Bibliography

Bester, D., et al. “Cardiovascular Effects of Edible Oils: A Comparison Between Four Popular Oils.” Nutrition Research Reviews (2010): 1-15. Review article of the efficacy of fish, sunflower seed, olive, and red palm oils in treating and preventing heart disease.

Brady, E., ed. Healing Logics: Culture and Medicine in Modern Health Belief Systems. Logan: Utah State University, 2001. Overview of the traditional medical practices of various cultures.

Hadady, L. Asian Health Secrets: The Complete Guide to Asian Herbal Medicine. New York: Three Rivers Press, 1996. Comprehensive and user-friendly guide to the use of Asian herbal medicine in the diagnosis and treatment of a range of diseases.

Kirkland, H. F., et al., eds. Herbal and Magical Medicine: Traditional Healing Today. Durham, N.C.: Duke University Press, 1992. Discusses the use of traditional herbal medicines in disease treatment.

National Cancer Institute. “Acupuncture.” Available at http://www.cancer.gov/cancertopics/pdq/cam/acupuncture/healthprofessional. A summary of clinical studies examining the efficacy of acupuncture for cancer symptoms and chemotherapy-related side effects.

National Center for Complementary and Alternative Medicine. http://nccam.nih.gov. A comprehensive U.S. government resource for news articles, scientific studies, and general consumer information about complementary and alternative medicine.

What is glutamine as a therapeutic supplement?

Overview

Glutamine, or L-glutamine, is an amino acid derived from
another amino acid, glutamic acid. Glutamine plays a role in the health of the
immune system, digestive tract, and muscle cells, as well as of other bodily
functions. It appears to serve as a fuel for the cells that line the intestines.
Heavy exercise, infection, surgery, and trauma can deplete the body’s glutamine
reserves, particularly in muscle cells.

The fact that glutamine does so many good things in the body has led people to
try glutamine supplements as a treatment for various conditions, including
preventing the infections that often follow endurance exercise, reducing symptoms
of overtraining
syndrome, improving nutrition in critical illness,
alleviating allergies, and treating digestive problems.

Requirements and Sources

There is no daily requirement for glutamine because the body can make its own supply. As mentioned earlier, various severe stresses may result in a temporary glutamine deficiency. High-protein foods such as meat, fish, beans, and dairy products are excellent sources of glutamine. Typical daily intake from food ranges from approximately 1 to 6 grams (g).

Therapeutic Dosages

Typical therapeutic dosages of glutamine used in studies ranged from 3 to 30 g daily, divided into several separate doses.

Therapeutic Uses

Endurance athletes frequently catch cold after completing a marathon or similar forms of exercise. Preliminary evidence, including one small double-blind, placebo-controlled trial, suggests that glutamine supplements might help prevent such infections.

Another small double-blind, placebo-controlled trial suggests that glutamine
might support standard therapy for angina. Angina is too dangerous a
disease for self-treatment. A person who has angina should not take glutamine (or
any other supplement) except on the advice of a physician.

Because, as noted above, cells of the intestine use glutamine for fuel, the supplement has been tried as a supportive treatment for various digestive conditions, with mixed results. Tested uses include reducing diarrhea caused by the drug nelfinavir (used for treatment of human immunodeficiency virus, or HIV), digestive distress caused by cancer chemotherapy, and symptoms of inflammatory bowel disease.

Glutamine appears to help reduce leakage through the intestinal wall. On this basis, glutamine has also been suggested as a treatment for food allergies, according to the idea that in some people, whole proteins leak through the wall of the digestive tract and enter the blood, causing allergic reactions (so-called leaky gut syndrome). However, there is no reliable evidence that glutamine actually provides any benefits for food allergies.

Preliminary evidence suggests that glutamine combined with antioxidants
or other nutrients may help people with HIV to gain weight. Glutamine (often
combined with other nutrients) also appears to be useful as a nutritional
supplement for people undergoing recovery from major surgery or critical
illness.

Glutamine has been tried as an ergogenic aid for bodybuilders, but two small trials failed to find any evidence of benefit. Based on glutamine’s role in muscle, it has been suggested that glutamine might be useful for athletes experiencing overtraining syndrome. As the name suggests, this syndrome is the cumulative effect of a training regimen that allows too little rest and recovery between workouts. Symptoms include depression, fatigue, reduced performance, and physiological signs of stress. Glutamine supplements have additionally been proposed as treatment for attention deficit disorder and ulcers, and as a “ brain booster.” However, there is little to no scientific evidence for any of these uses.

Scientific Evidence

Infections in athletes. Endurance exercise temporarily reduces immunity to infection. This effect may be due in part to reduction of glutamine in the body, although not all studies agree.

A double-blind, placebo-controlled study evaluated the benefits of supplemental glutamine (5 g) taken at the end of exercise in 151 endurance athletes. The results showed a significant decrease in infections among treated athletes. Only 19 percent of the athletes taking glutamine got sick, compared with 51 percent of those on a placebo.

Recovery from critical illness. One small double-blind study found that glutamine supplements might have significant nutritional benefits for seriously ill people. In this study, eighty-four critically ill hospital patients were divided into two groups. All the patients were being fed through a feeding tube. One group received a normal feeding-tube diet, whereas the other group received this diet plus supplemental glutamine. After six months, fourteen of the forty-two patients receiving glutamine had died, compared with twenty-four of the control group. The glutamine group also left both the intensive care ward and the hospital significantly sooner than the patients who did not receive glutamine. Benefits have been seen in other controlled trials as well.

HIV support. One double-blind, placebo-controlled study of
twenty-five people found that use of glutamine at 30 g daily for seven days
reduced diarrhea caused by the protease inhibitor nelfinavir. In addition,
combination supplements containing glutamine may help reverse HIV-related weight
loss. For example, a double-blind, placebo-controlled study found that a
combination of glutamine and antioxidants (vitamins C and E, beta-carotene,
selenium, and N-acetyl cysteine) led to significant weight gain in people with HIV
who had lost weight. Another small double-blind trial found that combination
treatment with glutamine, arginine, and beta-hydroxy
beta-methylbutyrate (HMB) could increase muscle mass and possibly improve immune
status.

Cancer chemotherapy. There is mixed evidence regarding whether
glutamine can reduce the side effects of cancer chemotherapy.
A double-blind, placebo-controlled trial of seventy people undergoing chemotherapy
with the drug 5-FU for colorectal cancer found that glutamine at a dose of 18 g
daily improved intestinal function and structure and reduced the need for
antidiarrheal drugs. However, a double-blind trial of sixty-five women undergoing
various forms of chemotherapy for advanced breast cancer failed to find glutamine
at 30 g per day helpful for reducing diarrhea. Based on a review of several
studies, there is some preliminary evidence that glutamine may help relieve the
pain associated with nerve damage (peripheral neuropathy) caused by some
chemotherapy drugs.

Angina. Researchers conducted investigations in rats and found that glutamine could protect the heart from damage caused by loss of oxygen. Based on these findings, they went on to evaluate the effects of glutamine in ten people with chronic angina who were also taking standard medication. In this double-blind, placebo-controlled trial, each participant received a single oral dose of glutamine (80 mg per kg of body weight) or placebo forty minutes before a treadmill test. A week later, each participant received the opposite treatment. The results showed that use of glutamine significantly enhanced the ability of participants to exercise without showing signs of heart stress. Based on the results in rats, researchers suggest that a higher dose of glutamine would be worth trying.

Crohn’s disease. Because glutamine is the major fuel source for
cells of the small intestine, glutamine has been proposed as a treatment for
Crohn’s
disease, a disease of the small intestine. However, two
double-blind trials enrolling a total of thirty people found no benefit.

Sports performance. A double-blind, placebo-controlled trial of thirty-one people ranging from eighteen to twenty-four years of age evaluated the potential benefits of glutamine as a sports supplement for improving response to resistance training (weight lifting). Participants received either a placebo or glutamine at a dose of 0.9 g per kg of lean tissue mass. After six weeks of resistance training, participants taking glutamine showed no relative improvement in performance, composition, or muscle protein degradation. Similarly, negative results were seen in a small double-blind, placebo-controlled trial of weightlifters using a dose of 0.3 g per kg of total body weight.

Safety Issues

As a naturally occurring amino acid, glutamine is thought to be
a safe supplement when taken at recommended dosages. There is strong evidence that
glutamine is safe at levels up to 14 g per day, although higher dosages have been
tested without apparent adverse effects.

Nevertheless, those who are hypersensitive to monosodium glutamate
(MSG) should use glutamine with caution, as the body
metabolizes glutamine into glutamate. In addition, because many antiepilepsy drugs
work by blocking glutamate stimulation in the brain, high dosages of glutamine
might conceivably overwhelm these drugs and pose a risk to people with epilepsy.
In one case report, high doses of the supplement L-glutamine (more than 2 g per
day) may have triggered episodes of mania in two people not previously known to
have bipolar disorder. In a small randomized trial including thirty older people,
L-glutamine did not cause any clinically significant changes in lab tests. The
researchers did urge caution, though, since there were some statistically
significant changes for certain kidney levels. Maximum safe dosages for young
children, pregnant or nursing women, and those with severe liver or kidney disease
have not been determined.

Important Interactions

Persons taking antiseizure medications, including carbamazepine, phenobarbital,
phenytoin (Dilantin), primidone (Mysoline), and valproic acid (Depakene), should
use glutamine only under medical supervision. Persons taking nelfinavir or other
protease
inhibitors for HIV, or cancer chemotherapy drugs should note
that concurrent glutamine may reduce intestinal side effects.

Bibliography

Amara, S. “Oral Glutamine for the Prevention of Chemotherapy-Induced Peripheral Neuropathy.” Annals of Pharmacotherapy 42, no. 10 (2008): 1481-1485.

Antonio, J., et al. “The Effects of High-Dose Glutamine Ingestion on Weightlifting Performance.” Journal of Strength and Conditioning Research 16 (2002): 157-160.

Candow, D. G., et al. “Effect of Glutamine Supplementation Combined with Resistance Training in Young Adults.” European Journal of Applied Physiology 86 (2001): 142-149.

Clark, R. H., et al. “Nutritional Treatment for Acquired Immunodeficiency Virus-Associated Wasting Using Beta-Hydroxy Beta-Methylbutyrate, Glutamine, and Arginine.” JPEN: Journal of Parenteral and Enteral Nutrition 24 (2000): 133-139.

Daniele, B., et al. “Oral Glutamine in the Prevention of Fluorouracil-Induced Intestinal Toxicity.” Gut 48 (2001): 28-33.

Galera, S. C., et al. “The Safety of Oral Use of L-Glutamine in Middle-Aged and Elderly Individuals.” Nutrition 26, no. 4 (2010): 375-381.

Khogali, S. E., et al. “Is Glutamine Beneficial in Ischemic Heart Disease?” Nutrition 18 (2002): 123-126.

Quan, Z. F., et al. “Effect of Glutamine on Change in Early Postoperative Intestinal Permeability and Its Relation to Systemic Inflammatory Response.” World Journal of Gastroenterology 10 (2004): 1992-1994.

Shao, A., and J. N. Hathcock. “Risk Assessment for the Amino Acids Taurine, L-Glutamine, and L-Arginine.” Regulatory Toxicology and Pharmacology 50, no. 3 (2008): 376-399.

What is ductal carcinoma in situ (DCIS)?

Related conditions:
Breast cancer, Paget disease of the nipple

Definition:



Ductal carcinoma in situ (DCIS) is a noninvasive form of breast cancer occurring in the ducts that are responsible for secreting milk. It is the most common type of noninvasive breast cancer, and because it is nonmetastatic, most patients survive their disease.

Risk factors: Reproductive risk factors include women who never had a full-term pregnancy, had their first pregnancy after age thirty, started menstruation early, or had a late menopause. The use of oral contraceptives and postmenopausal estrogen-progestin replacement therapy (more than five years) has been shown to increase the risk of breast cancer. Having a family history of early-onset or bilateral disease and carrying the breast cancer susceptibility gene
BRCA1
or BRCA2 increase the risks as well. Breast cancer risk increases with age, with most cases occurring in women over the age of sixty. The following are factors that reduce the risk of breast cancer: physical activity (exercise), multiple pregnancies, breast-feeding, and early removal of both ovaries.

Etiology and the disease process: Not all DCIS lesions become invasive breast cancer, but most invasive lesions are preceded by DCIS. Most of the genetic changes present in invasive breast cancer are already present in DCIS, suggesting that if left untreated, these tumors would indeed become invasive.

Incidence: The National Cancer Institute estimated in 2012 that one out of every eight women born would be diagnosed with breast cancer at some time in their lives. The American Cancer Society claimed that in 2012, DCIS was the most common type of breast cancer, representing 25–30 percent of all newly diagnosed cases. According to Siegel in the journal CA, more than 90 percent of all DCIS cases in 2011 were diagnosed by mammography. In 2013, the American Cancer Society estimated that approximately 60,000 new US cases of DCIS were diagnosed annually, which accounted for approximately 1 out of every 5 new breast cancer cases. The use of digital mammography and MRIs (magnetic resonance imaging) has greatly increased the detection and diagnosis of DCIS and therefore the number of new cases reported. New technology has also lead to an increased rate of survival for those women whose lesions are detected early.

Symptoms: Most breast cancers do not cause any pain, making them hard to detect. However, any change in the size or shape of the breast, change in the look or feel of the breast or nipple, or any lump or thickening in or near the breast or underarm area may be a symptom of breast cancer. Other more obvious changes include nipple discharge, tenderness, an inverted nipple, and ridges in or pitting of the breast (when the skin looks like that of an orange).

Screening and diagnosis: Because this disease can remain symptomless, monthly self-examination of the breasts after the age of twenty, yearly checkups, and regular mammographies after the age of forty are crucial to early detection. Most of the new cases of DCIS detected by mammography are not detectable by examination alone.

Once DCIS is detected, tissue is sampled using fine needle aspiration (FNA) biopsy or core needle biopsy. According to the standard staging system, DCIS is a Stage 0 breast cancer. Pathologic analysis will determine the classification of the tumor, its size and margins, and if the tumor is hormone dependent. These criteria are then further classified as follows:

• Grade I (low grade): Non-high grade without necrosis (the tumor cells look similar to normal cells, and the tumor may be solid, cribriform, or papillary)





• Grade II (medium grade): Non-high grade with necrosis





• Grade III (high grade): Very quickly growing tumor with the cells in the center of the duct becoming starved from the blood supply; described as “comedo”

Treatment and therapy: Treatment will vary from case to case depending on the size and grade of the tumor and whether there is a family history of breast cancer. Typically, once diagnosis is confirmed, a lumpectomy is performed to remove the entire area of the DCIS and a marginal area of normal breast tissue around it. This is followed by radiation to the whole breast to kill cancer cells outside the surgical margin and to reduce the risk of the cancer coming back. In some cases a mastectomy, in which the entire breast is removed, may be recommended if the DCIS covers a very large area or multiple areas of the breast or if the patient has a family history of breast cancer or a known gene abnormality (BRCA1 or BRCA2). Because this type of cancer has not invaded into the normal tissue, chemotherapy is not needed for DCIS. If the tumor tests positive for hormone receptors, hormonal therapy (tamoxifen and aromatase inhibitors) can be used to lower the risk of recurrence.

Prognosis, prevention, and outcomes: Because DCIS is a precancerous or preinvasive lesion, the prognosis is very good. Less than 1 percent will die from this disease. It is possible that an invasive focus not found at the time of diagnosis will later develop into metastatic disease, but the likelihood is small. About 40 to 50 percent of local recurrences are invasive and 10 to 20 percent of patients will develop metastases and die from their disease. The more aggressive the therapy, the lower the rate of mortality. Additional treatment, including surgery, radiation therapy, antiestrogen therapy, or a combination of these, will reduce the chances of recurrence of the disease.

Bibliography

"Breast Cancer." American Cancer Society. Amer. Cancer Soc., 2014. Web. 27 Aug. 2014.

Hunt, Kelly K., Geoffrey L. Robb, Eric A. Strom, and Naoto T. Ueno. Breast Cancer. M. D. Anderson Cancer Care Series. New York: Springer, 2001. Print.

Link, John. Breast Cancer Survival Manual: A Step-by-Step Guide for the Woman with Newly Diagnosed Breast Cancer. 5th ed. New York: Holt, 2012. Print.

Mulcahy, Nick. "In US, Even More DCIS is Coming: What Should Be Done?" Medscape. WebMD, 12 Mar. 2013. Web. 19 Sept. 2014.

Newman, Lisa A., and Jessica M. Bensenhaver, eds. Ductal Carcinoma In Situ and Microinvasive/Borderline Breast Cancer. New York: Springer, 2014. Print.

“The Picture Problem: Mammography, Air Power, and the Limits of Looking.” The New Yorker, December 13, 2004. http://www.gladwell.com/2004/2004_12_13_a_ picture.html.

Roses, Daniel F. Breast Cancer. Philadelphia: Elsevier, 2005. Print.

Shockney, Lille D. Navigating Breast Cancer: A Guide for the Newly Diagnosed. Sudbury: Jones & Bartlett, 2006. Print.

Siegel, R., et al. "Cancer Statistics, 2011: The Impact of Eliminating Socioeconomic and Racial Disparities on Premature Cancer Deaths." CA: A Cancer Jour. for Clinicians 61.4 (2011): 212–36. Print.

Virnig, B. A., et al. "Ductal Carcinoma In Situ of the Breast: A Systematic Review of Incidence, Treatment, and Outcomes." Jour. Natl. Cancer Inst. 102 (2010): 170. Print.

Is fear the emotion most likely to influence one’s behavior?

If we consider behavior from an evolutionary perspective, fear could be said to be at the root of all actions. Anthropologists and many psychologists feel that human behavior has developed as an adaptation to survive in our world. Humans are highly social creatures, so the ways we behave, even when on our own, play a big part in helping us attain our best possible chance at survival. All sentient living things have the base instinct to improve our chances at survival. In some animals, this may be a fairly straightforward process of eat, sleep, hydrate, and breed. For humans, the satisfaction of our needs and improving our chance of survival is a little more complex.

A lot of the behaviors we learn as humans have developed for the purpose of improving or maintaining our social networks. Without social networks, humans could not survive. As infants, we require the care of others, and as adults we must socialize to perform most of our daily functions. While it may not seem so obvious, when we look at the motivations behind behaviors, we may see that they stem from our drive to survive and thrive. We could alternately call this the fear of death.

Let's consider a behavior that seems to have little to do with fear or survival- waving to a friend. What are we doing when we wave to greet our friends or family? The act of waving is a sign of recognition and typically conveys some joy at seeing our friend. Though this is a rather low-contact form of social interaction, waving to each other reaffirms the relationship at work. Having a social network of many relationships not only offers us happiness, but creates a support network for ourselves and any offspring we might have. 

Human behavior is so complex that sometimes it is difficult to say what is really the motivation behind one's actions. There's only so much that is determined by biology. For humans, socialization is one of our biological necessities, along with food, water, shelter, and rest. Culture comes in where biology falls short and serves to shape the ways in which we fulfill these needs.

In sum, I would say that survival is the biggest influence on people's behavior, and what is survival but the fear of death?

What difficulties did the animals in Animal Farm have in gathering the harvest, and how did they overcome these difficulties?

The animals are faced with bringing in the harvest with farm tools designed for humans. The animals also have to find a way to work with farm machinery designed for two legs. The pigs, being "clever," become managers, devising ways around the obstacles. The horses, we learn, actually know how to rake and mow better than the humans ever did. A spirit of solidarity also helps the animals gather the harvest. Every animal willingly pitches in now they are free of Farmer Jones. The ducks and hays gathered up tiny bits of hay in their beaks. They also gather up stray grain, garnering five extra bushels. Nobody steals. There is no waste.

Later, when harvesting the corn, the animals have to thresh it out the old-fashioned way because the farm has no threshing machine. This is difficult, but Boxer, with his "tremendous muscles," pulls them through. Boxer also begins to get up a half hour early to help the cause. 

Overall, in these early days after the revolt, the animals are united in their enthusiasm for running the farm without their human masters, and this gives them the energy and motivation to overcome their problems. 

What was Casca's motive for killing Caesar in the play Julius Caesar? When in the play does he show this?

Casca is worried that the senate will name Caesar king and enslave all of Rome.

Cassius describes Casca as “sour.”  He is definitely more hardened than the rest of the group of senators who are involved in the conspiracy to kill Julius Caesar.  He provides a cynical description of Mark Antony’s offering Caesar a crown and the people’s reaction to it.

Casca also describes the punishment of Marullus and Flavius, the two we saw in the first scene who complained to the crowd about celebrating for Caesar when they used to love Pompey. 

I could tell you more
news too: Marullus and Flavius, for pulling scarfs
off Caesar's images, are put to silence. Fare you
well. There was more foolery yet, if I could
remember it. (Act 1, Scene 2) 

From Casca's perspective, the "silence" of Marullus and Flavius is unfair, and a warning to them all to be careful about speaking against Caesar.

Casca also complains about bad omens that he sees on the way to Brutus’s house.  He believes they are “they are portentous things” (Act 1, Scene 3).  Casca is worried that the senate will offer Caesar a real crown, and he and every other Roman will become a “bondman.” 

Indeed, they say the senators tomorrow
Mean to establish Caesar as a king;
And he shall wear his crown by sea and land,
In every place, save here in Italy. (Act 1, Scene 3)

It seems that Casca was the tough guy of the group.  He is appointed to stab Caesar first, and in fact his wound was the fatal one.  Everyone else was stabbing Caesar as he was bleeding out, just trying to get a jab in.  Casca did not necessarily have a personal cause against Caesar, but he did not want him to become king.  He took part in killing Caesar for political reasons.

Why was the NAALC a good thing?

The North American Agreement on Labor Cooperation was developed and adopted to support the North American Free Trade Agreement (NAFTA). NAFTA was instituted to increase opportunities for trade among the member countries. However, there was a need to address the issue of living standards among the partners. This led to the signing of the NAALC, which sought to ensure that benefits for all partners were above board. The agreement provides a framework aimed at ensuring that working conditions and living standards were improved among the member countries in line with growing economic ties and trade opportunities.

The agreement works through mutual cooperation by the different partners. Additionally, it provides the basis for labor standards and a framework for enforcing these standards by the different parties. This works to ensure that working conditions are standardized preventing businesses from benefiting at the expense of the workers/people.

Some of the protections established by the NAALC according to the U.S. Department of Labor include;

• 
  

  freedom of association and protection of the right to organize;

  
  


• 
  

  the right to bargain collectively;

  
  


• 
  

  the right to strike;

  
  


• 
  

  prohibition of forced labor;

  
  


• 
  

  labor protections for children and young persons;

  
  


• 
  

  minimum employment standards, such as minimum wages and overtime pay, covering wage earners, including those not covered by collective agreements;

  
  


• 
  

  elimination of employment discrimination on the basis of race, religion, age, sex, or other grounds as determined by each country's domestic laws;

  
  


• 
  

  equal pay for men and women;

  
  


• 
  

  prevention of occupational injuries and illnesses;

  
  


• 
  

  compensation in cases of occupational injuries and illnesses; and

  
  


• 
  

  protection of migrant workers.

  
  

`sum_(i = 1)^6 (6i - 8i^3)` Find the sum using formulas for the sums of powers of integers.

Given: `sum_(i=1)^6 (6i-8i^3)`

`=sum_(i=1)^6 6i -sum_(i=1)^6 8i^3`

`=6sum_(i=1)^6 i- 8sum_(i=1)^6 i^3`

Use the Sums of Powers of Integers to find the sums.

`1+2+3+4+...+n=[n(n+1)]/2`

`1^3+2^3+3^3+4^3+...+n^3=[n^2(n+1)^2]/4`

`=6[6(6+1)]/2-8[6^2(6+1)^2]/4`

`=6(21)-8(441)`

`=-3402`

The sum is -3402.

How long have the Tucks lived in their home?

It is not possible to give a definitive answer to the question.  The text does not indicate specifically how long the Tuck family lived in their home.  

The reader does know that eighty-seven years earlier the Tuck family drank from the spring in Treegap.  That is when they became immortal. Treegap was not their final stop, so they moved on through the woods until they came to a nearby valley.  

They had come out of the forest at last, many miles to the west, had found a thinly populated valley, had started their farm. "We put up a house for Ma and Pa," said Miles, "and a little shack for Jesse and me.

The text says that the Tuck family stayed there for 20 years.  Then they were forced to wander like gypsies to avoid suspicion.  The family split up and gets together at their house during the first week of August every ten years.  

But they come home whenever the spirit moves, and every ten years, first week of August, they meet at the spring and come home together so's we can be a family again for a little while.

I suppose that you could estimate how many times the Tuck family has been back to the house during their 87 years of life, but that would be pointless, because they haven't gone back to that first house.  Mae tells Winnie in chapter 10 that they never live in a house more than 20 years at a time now.

But they can't stay on in any one place for long, you know. None of us can. People get to wondering." She sighed. "We been in this house about as long as we dare, going on twenty years. It's a right nice place. Tuck's got so's he's real attached to it. Then, too, it's off by itself, plenty of fish in the pond, not too far from the towns around. When we need things, we go sometimes to one, sometimes the next, so people don't come to notice us much. And we sell where we can. But I guess we'll be moving on, one of these days. It's just about time."

The best answer that I can possibly give to your question is that the Tuck family has owned their current home for "going on twenty years."  

Your teacher weighs a bottle of perfume and then passes it around the whole class so you can smell the perfume. Then your teacher weighs the bottle...

The primary reason is that the amount of mass lost by a room of people sniffing the perfume is basically negligible. Yes, particles are traveling from the perfume bottle into people's noses, which could take some mass away, but that potential loss of mass is so small that you would need extremely sensitive equipment to detect it.

There is another reason, as well; if the perfume is not pressurized above atmospheric pressure, then when opened in the air the amount of perfume that flows out will be the same as the amount of air that flows in. If the perfume had approximately the same density as air, then the bottle could go from completely full to completely empty without getting substantially lighter.

If it had been a pressurized container, then it would actually get lighter when opened, because more gas would flow out than flows in. Try lifting full and empty propane tanks sometime. Because the propane in a full tank is pressurized, the tank contains more mass when full than it will once the pressure has equalized and the tank is empty.

Prepare brief remarks that the narrator might deliver to the inquisitors after he is rescued. Try to capture Poe’s style in the narrator’s...

To write a creative response like this, imagine yourself in the shoes of the narrator, remembering everything he endured at the hands of the inquisitors. Choose a tone that you will be writing from. You could be angry, wanting to express how wrong the inquisitors were to treat you that way. You could be vengeful, pouring out threats against them about how they will be punished for what they have done. You could be triumphant, gleeful, or taunting, declaring how you won at last and how they were not able to fulfill their sick desires in destroying your mind, life, or body. You could be curious, taking advantage of a chance to clarify things about your torture that remained obscure. Whatever tone you choose, stay in that state of mind as you compose your remarks.

As you write your remarks, be sure to work in details from the story to connect what you are saying to what the man endured. Some of the points you would probably mention would be the pitch blackness, the pit in the middle of the room, being drugged, the savory meat given with no water, the frightening pictures on the wall of the torture chamber, the gradual descent of the pendulum, and the rats. 

To make your response sound like the way the character in the story thinks, use long sentences and sophisticated words, and be wordy. Don't write in short, quick sentences. Look back into the story to find good vocabulary words that you can incorporate into your response, but rearrange the wording so that you are not copying anything directly from the story.

What is the net ionic equation of sodium fluoride solution added to sulfuric acid solution?

Step 1: Write the balanced equation for the reaction:

`~2NaF + ~H_2SO_4 -gt ~Na_2SO_4 + ~2HF`

Step 2: Determine the states of all of the substances.

We know, from the question, that NaF and `~H_2SO_4` are aqueous solutions.

The product hydrofluoric acid (HF) is also an aqueous solution.

To determine the status of the product `~Na_2SO_4` , check a list of solubility rules. You can find a list of solubility rules by googling "solubility rules" or looking in your textbook.

According to the solubility rules, compounds that contain sulfates are soluble (unless they also contain Pb, Ca, Sr, or Ba).

So, `~Na_2SO_4` is soluble (i.e. forms an aqueous solution).

Therefore, all of the substances in the reaction are aqueous solutions:

`~2NaF_(aq)` + `~H_2SO_4_(aq)` -> `~Na_2SO_4_(aq)` + `~2HF_(aq)`

Step 3: Write the net ionic equation if a reaction has occurred.

In this case, since all of the substances are soluble, there is no real change from the reactant side of the equation to the product side of the equation. In both cases, the solution contains the following dissolved ions: `~Na^+` ,` ~F^-` , `~H^+` ,  `~SO_4^2^-` .

Therefore, there is no net ionic equation.

Please explain this quote from Macbeth: "The service and the loyalty I owe, / In doing it, pays itself. Your highness' part / Is to receive our...

King Duncan has bestowed upon Macbeth the title Thane of Cawdor, in addition to the title he already has, as a reward for his bravery and loyal service to the crown during the battles against the rebel Macdonwald and the Norwegian king.  Macbeth was already the Thane of Glamis, and now he is Thane of Cawdor as well. 

When Macbeth arrives and sees Duncan, he greets Duncan as his friend, kinsman, and king.  Duncan expresses his gratitude to Macbeth for everything that he has done to protect Scotland, and Duncan says that he feels as though he cannot actually reward Macbeth enough for all his service.  Macbeth responds with the lines you cite, saying, 

"The service and the loyalty I owe,

In doing it, pays itself. Your highness' part

Is to receive our duties: and our duties

Are to your throne and state, children and servants."

What he means is that it is his duty to serve the crown, and this service is its own reward.  It is the king's job simply to receive the services his subjects provide because it is their duty.  Finally, he says that these duties performed by his subjects are owed to Duncan the way children owe their parents and servants owe their masters.

How would I make an argument of free will vs. the conformity of roles presented in an idyllic society based on A Clockwork Orange and 1984? I need...

Both Anthony Burgess’ A Clockwork Orange and George Orwell’s 1984 address dystopian societies in which individual thought is less valuable than conformity to the status quo. While these novels address these issues in disparate ways, both authors provide valuable insight into the struggle between individuality and conforming to dystopian values.

First, Orwell’s 1984 has proven hugely influential through its depiction of a totalitarian state’s influence on individual free will. The government conscripts its citizens to conform to and follow the values they have set forth. Indeed, at the end of the novel, after Winston Smith has been captured and tortured, Winston Smith prescribes to the norms and values of the government, and foregoes his ability to think independently.  

Similarly, Burgess’ A Clockwork Orange explores how society can influence and stifle individual will. Young, violent Alex is “reformed” from his depraved thoughts through questionable methods. Here, Burgess challenges a society which enforces acceptable behavior, and champions individual thought, even if it is what many would consider evil. Alex is not good by choice; certainly, he is still the same bloodthirsty teenager for much of the novel. So is it valuable that he has been essentially brainwashed into not committing acts of violence? The prison chaplain questions this distinction:

“They have turned you into something other than a human being. You have no power of choice any longer. You are committed to socially acceptable acts, a little machine capable only of good” (174).

Both Burgess and Orwell potently use images of individuals coerced into following the status quo of a given dystopian society in order to illustrate their point: individual will is more valuable than groupthink, even if societal pressure is difficult—or impossible—to resist.

What is fiber?

Structure and Functions

Dietary fiber helps regulate the passage of food material through the gastrointestinal tract and influences the absorption of various nutrients. It represents the content of substances that cannot be broken down by human digestive enzymes or absorbed by the gastrointestinal tract. Nearly all dietary fiber content is contributed by the insoluble structural matter of plants. Cellulose is an insoluble unbranched glucose polymer that can absorb relatively large volumes of water. Hemicellulose is the name for a wide variety of polymers of five carbon sugars. Pectin is a water-soluble polymer that forms gels and binds water, cations, and bile acids. Gums and mucilages are highly branched polysaccharides that form gels and bind water and other organic material. Increased fiber intake may promote health by promoting the normal elimination of waste products of digestion, by promoting satiety, by helping control serum cholesterol, and by other mechanisms. Greatly increased fiber intake, however, may reduce the absorption of some nutrients.

Disorders and Diseases

The ingestion of too much fiber can result in the formation of an obstructing bolus in a narrowed intestinal or esophageal lumen. The purpose of a low-fiber or fiber-restricted diet is to help prevent this occurrence and to rest the gastrointestinal tract. In acute phases of ulcerative colitis, a fiber-restricted diet lessens the pain and stress of defecation by decreasing the weight and bulk of the stool and delaying intestinal transit time.

A low-fiber diet contains approximately two grams of crude fiber. Foods included are refined bread and cereal products, cooked fruits and vegetables that are low in fiber, and juices. Nuts, legumes, and whole-grain bread and cereal products are restricted. Minimal-fiber diets consist of strained fruit and vegetable juices and white potatoes without skins. Milk is limited to two cups per day, as it indirectly contributes to fecal residue even though it contains no fiber. Continued use of a low-fiber diet in refined carbohydrates, however, is believed to cause diverticular disease of the colon. Reduced bulk causes the colonic lumen to narrow.

A high-fiber diet contains increased amounts of foods containing cellulose, hemicelluloses, lignin, and pectin, and reduced amounts of refined carbohydrates. Insoluble fibers increase the volume and weight of the residue to maintain the normal size of the colonic lumen and to increase gastrointestinal mobility. Soluble fibers, such as gums and pectins, reduce the rate of intestinal absorption, altering the metabolic effects. High-fiber intake necessitates increased fluids.

Certain individuals should not be encouraged to increase the amount of fiber in their diet. Those who have had gastric
surgery, vagotomy, pyloroplasty or Roux-en-Y, and some diabetics with gastroparesis diabeticorum have less acid secretion or decreased gastrointestinal motility and may encounter bezoar formation, a compacted mass that does not pass into the intestine. The high-fiber diet has been recommended, however, in the treatment or prevention of dumping syndrome, hyperlipidemia, gallstones, diabetes, and many other diseases and disorders.

Bibliography

"Dietary Fiber." MedlinePlus, May 8, 2013.

"Digestive System." MedlinePlus, January 14, 2013.

Dudek, Susan G. Nutrition Essentials for Nursing Practice. 6th ed. Philadelphia: Lippincott, Williams and Wilkins, 2010.

Kirschmann, John D. Nutrition Almanac. 6th ed. New York: McGraw-Hill, 2007.

Nix, Staci. Williams’ Basic Nutrition and Diet Therapy. 14th ed. New York: Elsevier Health Sciences, 2013.

Sizer, Frances, and Ellie Whitney. Nutrition: Concepts and Controversies. 13th ed. New York: Cengage Learning, 2013.

Whitney, Eleanor Noss, and Sharon Rady Rolfes. Understanding Nutrition. Updated 12th ed. New York: Cengage Learning, 2011.

In Act III of Romeo and Juliet, what does Mercutio think is the reason for Romeo refusing to fight?

Mercutio thinks Romeo refuses to fight with Tybalt when challenged because he is afraid of him. Neither Mercutio nor Tybalt knows Romeo secretly married Tybalt's cousin Juliet and now feels well disposed to all members of the Capulet family because of his new relationship with them. Mercutio believes Romeo's refusal to fight the insulting and belligerent Tybalt is disgraceful and challenges Tybalt to fight him instead.

Romeo tries to prevent Mercutio and Tybalt from fighting by getting between them. He reminds them the Prince forbids sword-fighting in the streets. Tybalt gives Mercutio a fatal sword-wound. According to the stage directions:

Tybalt under Romeo's arm thrusts Mercutio in, and flies with his Followers.

Because Mercutio is his best friend and a member of the house of Montague, Romeo feels compelled to challenge Tybalt in revenge, especially since his attempted intervention was responsible for Mercutio's fatal wound. When Tybalt returns to the scene, the two young men have a brief duel in which Romeo kills Tybalt in the heat of anger.

This marks the turning point in the play. It leads to the deaths of Juliet and Romeo in the tomb after the young bride is in a state resembling death. 

Is Atticus from To Kill a Mockingbird proactive? Why?

Being proactive means that a person prepares to intervene in an expected negative situation. Atticus does this by preparing a fair defense for his client Tom Robinson, who has rape charges against him by Mayella Ewell. About six months before the trial, Atticus is talking with his brother Jack about the case and says the following:

"Before I'm through, I intend to jar the jury a bit--I think we'll have a reasonable chance on appeal, though. . . But do you think I could face my children otherwise? . . . I hope and pray I can get Jem and Scout through it without bitterness, and most of all, without catching Maycomb's usual disease" (88).

The above passage shows Atticus consciously thinking about and preparing for what he will do when he presents Tom's defense. Not only that, but Atticus takes great care to make sure that Tom makes it to his trial without any interference. When Atticus hears that the Old Sarum bunch might be out to lynch Tom before the trial in chapter 15, he goes to the jail with a light, a chair, and a book to wait and see if anyone tries to take Tom away. The mob does show up for Tom, so Atticus was right to do his best to stop them. This is a proactive stance, too, because by not going, he would have been passive and not an intervening element. Fortunately for Tom, he had a very proactive person and lawyer on his side to defend him.  

What is galactosemia?

Causes and Symptoms

In classic I galactosemia, a congenital deficiency of the enzyme galactose-1-phosphate uridyl transferase (GALT) causes galactose to accumulate instead of being converted to glucose for energy production. As galactose accumulates in the child’s tissues and organs, it will have a toxic effect and cause various signs and symptoms. Galactosemia means “galactose in the blood.” Galactose is a sugar that may be found alone in foods but is usually associated with lactose, a milk sugar.

A gene mutation on the short arm of chromosome 9 has been identified in babies with galactosemia. About one in forty thousand newborns is affected with this autosomal recessive disorder. Both parents serve as carriers; they are not themselves affected, but each conception carries a one in four chance that the child will be born with galactosemia. Prenatal diagnosis is possible in cultured fibroblasts from amniotic fluid. Mandatory screening programs in many states test all newborns for galactosemia during the first week of life.

Galactosemia is an example of a multiple-allele system. In addition to the normal allele (G) and the recessive allele (g), a third allele, known as GD, has been found. The D allele is named after Duarte, California, where it was discovered. The existence of three alleles produces six possible genotypic combinations in the deoxyribonucleic acid (DNA). These enzymatic activities may range from 0 to 100 percent. Consequently, it is very important to monitor each patient with biochemical studies.

Homozygous recessive infants (gg) are unaffected at birth but develop symptoms a few days later, including jaundice, vomiting, an enlarged liver from extensive fatty deposits, cataracts, and failure to thrive. Mental retardation and death may also occur if dietary treatment has not been started.

Treatment and Therapy

Galactosemia is treated by removing foods that contain galactose from the diet. Since milk and milk products are the most common source of galactose, infants with galactosemia should not be given these foods. Serious problems can be prevented through this early exclusion of galactose.

While it is not possible for a child with galactosemia to have an entirely galactose-free diet, all persons with galactosemia should limit galactose intake from foods to a very low level. The galactose-1-phosphate levels determine the degree of dietary restriction for each individual. Advice from a dietician is needed.

Bibliography

Badash, Michelle. "Galactosemia." Health Library, November 26, 2012.

Berry, Gerard T. "Galactosemia: When is it a Newborn Screening Emergency?" Molecular Genetics & Metabolism 106, no. 1: 7–11.

Cummings, Michael R. Human Heredity: Principles and Issues. 8th ed. Pacific Grove, Calif.: Brooks/Cole, 2009.

"Galactosemia." MedlinePlus, May 1, 2011.

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

Kasper, Dennis L., et al., eds. Harrison’s Principles of Internal Medicine. 16th ed. New York: McGraw-Hill, 2005.

Rudolph, Colin D., et al., eds. Rudolph’s Pediatrics. 21st ed. New York: McGraw-Hill, 2003.

If there were no demarcation of time, in terms of BC and AD, how would it have affected the study of history?

The use of BC (or BCE) and AD (or CE) creates a fixed point of reference for events which have occurred throughout history. It is difficult to say when humans began using calendars, or even began to care about the passage of time. The Ishango Bone, a baboon's fibula etched with a series of lines, dates to about 22,000 years ago and may represent the earliest means of tracking time. It is thought to have been either a counter for the lunar cycle or a woman's menstrual cycle. Even if this is the earliest evidence of keeping track of time, it doesn't tell us much about what humans thought about the solar year.

Perhaps the biggest trouble in establishing continuity for historical reference is that it requires a fixed point to relate to. Since we don't know exactly when humans started keeping track of years, and for the fact that keeping track of the solar year may have come into fashion at different times in different places, it is difficult to determine a "year zero" for humans keeping track of time. 

Numerous calendar systems have been developed throughout history. Some marked cyclical time, like the Mayan Calendar, and others track time in a progression from a fixed beginning point. Some means of tracking time use the lifespans of rulers, as in the traditional Japanese calendar. The Gregorian or Western Calendar, which much of the world uses formally, is based on the demarcation of BCE/CE (or BC/AD) and progresses ever onward with the revolution of the Earth around the Sun.

Using BCE/CE (or BC/AD) gives us a sense of what happened before and after a fixed point in time, namely the presumed birth of Jesus of Nazareth. This way of organizing time is clearly religious in origin but is used in even secular studies, today. The greatest benefit for historians is that using the BCE/CE transition as a fixed point in time allows us to assign fixed dates to other events, people, or objects. If we were to use relative time, where one might say something occurred so many years ago, the dates for events would constantly be changing. Textbooks would have to be republished every year to keep up with the shift from x years ago to x+1 years ago. The study of history would be far more tedious if we had to speak and write in relative time, and one might never really be sure how "up to date" a piece of writing was.

I need to write a response to Wilson's "Declaration of War" from the perspective of the German government.

On April 2, 1917, President Woodrow Wilson presented a "Declaration of War" against Germany to Congress. Though he had run for re-election in 1916 with the platform "he kept us out of war," Wilson was frustrated by unrestricted submarine warfare carried out by the Germans. Part of the beginning of his speech read:

"Vessels of every kind, whatever their flag, their character, their cargo, their destination, their errand, have been ruthlessly sent to the bottom without warning and without thought of help or mercy for those on board, the vessels of friendly neutrals along with those of belligerents.…"

In other words, Wilson was condemning the German policy, announced by their government, of sinking boats, even those of neutral countries, without warning. 

The German government would have opposed this declaration for several reasons. First, the navy of Great Britain had imposed a blockade of German ports since the beginning of the war. This blockade made it very hard for Germans to get food and supplies, and it was virtually causing starvation in Germany. As a result, the Germans felt that they had the right to retaliate against British ships. Second, the German government felt that submarines needed the element of surprise to successfully sink ships, so they could not provide any warning to enemy ships. Submarines were very exposed when they surfaced, so they needed to attack without providing any warning. Finally, the German government may have responded that Wilson's real reasons to go to war also resulted from the Zimmermann telegram, in which a German government official asked the Mexican government to help it fight against the United States. That may have also motivated Wilson to declare war, and he may have been using German submarine warfare as a pretext to some degree. 

How are Jane Eyre, Mrs. Reed and Mr. Rochester characterized in the novel Jane Eyre?

From childhood, Jane is a passionate person who learns as she grows up to hide her turbulent emotions under a placid and controlled facade. But beneath that facade lies a seething cauldron of feelings. The child Jane attacks the cold Mrs. Reed quite vehemently, hurling emotions at her with "ungovernable" passion:

"You think I have no feelings, and that I can do without one bit of love or kindness; but I cannot live so: and you have no pity. I shall remember how you thrust me back—roughly and violently thrust me back—into the red-room, and locked me up there, to my dying day; though I was in agony, though I cried out, while suffering with distress, ‘Have mercy! Have mercy, Aunt Reed!’"

Although the adult Jane will refer to herself as a "Quakerish governess," quiet and plain, she will understand herself as a person of extremes:

I know no medium [middle ground]: I never in my life have known any medium in my dealings with positive hard characters, antagonistic to my own, between absolute submission and determined revolt. I have always faithfully observed the one up to the very moment of bursting, sometimes with volcanic vehemence into the other...

We see some of her tendency to extremes when she thinks she would agree to have her arm broken at Lowood School if it meant people would like her, and when she runs wildly away across the moor after she finds out that Bertha Poole is Rochester's wife. Jane feels deeply.

Mrs. Reed is characterized, in contrast, as a cold woman lacking in empathy to the point that it makes her cruel:

Mrs. Reed's hands still lay on her work inactive: her eye of ice continued to dwell freezingly on mine.

“What more have you to say?” she asked rather in the tone in which a person might address an opponent of adult age than such as is ordinarily used to a child.

We note the "icy eye" and that Mrs. Reed has no idea how to talk to a child with any warmth or caring. She does the letter of her duty in caring for Jane, but without any real connection to the child, and ships her off to boarding school as soon as she gets difficult.

Mr. Rochester, however, shares with Jane a passionate, feeling heart. He is also a commanding, intimidating person used to being in charge and used to having his way. He falls in love with and idealizes Jane. We see his passion as he curses his fate in being married to the mad Bertha, and his idealization of Jane in the following:

"Such is the sole conjugal embrace I am ever to know [speaking of the mad Bertha]—such are the endearments which are to solace my leisure hours! And this is what I wished to have" (laying his hand on my shoulder): "this young girl, who stands so grave and quiet at the mouth of hell, looking collectedly at the gambols of a demon...

His attempt at a bigamous marriage with Jane shows his strong will and his desire to have his own way, even if it means hurting someone he loves.

What is carbamazepine, and how does it interact with other drugs?

Ginkgo

Effect: Possible Harmful Interaction

The herb ginkgo (Ginkgo biloba) has been used to treat
Alzheimer’s
disease and ordinary age-related memory loss, among many
other conditions. This interaction involves potential contaminants in ginkgo, not
ginkgo itself.

A recent study found that a natural nerve toxin present in the seeds of Ginkgo biloba made its way into standardized ginkgo extracts prepared from the leaves. This toxin has been associated with convulsions and death in laboratory animals.

The detected amounts of this toxic substance are considered harmless. However, given the lack of satisfactory standardization of herbal formulations in the United States, it is possible that some batches of product might contain greater amounts of the toxin depending on the season of harvest. In light of these findings, taking a ginkgo product that happened to contain significant levels of the nerve toxin might theoretically prevent an anticonvulsant from working as well as expected.

Glutamine

Effect: Possible Harmful Interaction

The amino acid glutamine is converted to glutamate in the body. Glutamate
is thought to act as a neurotransmitter (chemical that enables
nerve transmission). Because anticonvulsants work (at least in part) by blocking
glutamate pathways in the brain, high dosages of the amino acid glutamine might
theoretically diminish an anticonvulsant’s effect and increase the risk of
seizures.

Grapefruit Juice

Effect: Possible Harmful Interaction

Grapefruit juice slows the body’s normal breakdown of several drugs, including
the anticonvulsant carbamazepine, allowing it to build up to potentially dangerous
levels in the blood. A recent study indicates this effect can last for three days
or more following the last glass of juice. Because of this risk, if one uses
carbamazepine, the safest approach is to avoid grapefruit juice altogether.

Ipriflavone

Effect: Possible Harmful Interaction

Ipriflavone, a synthetic isoflavone that slows bone breakdown,
is used to treat osteoporosis. Test-tube studies indicate that ipriflavone
might increase blood levels of the anticonvulsants carbamazepine and
phenytoin when they are taken therapeutically. Ipriflavone
was found to inhibit a liver enzyme involved in the body’s normal breakdown of
these drugs, thus allowing them to build up in the blood. Higher drug levels
increase the risk of adverse effects.

Because anticonvulsants are known to contribute to the development of osteoporosis, a concern is that the use of ipriflavone for this drug-induced osteoporosis could result in higher blood levels of the drugs with potentially serious consequences. Persons taking either of these drugs should use ipriflavone only under medical supervision.

Hops, Kava, Passionflower, Valerian

Effect: Possible Harmful Interaction

The herb kava (Piper methysticum) has a sedative effect and is
used for anxiety and insomnia. Combining kava with
anticonvulsants, which possess similar depressant effects, could result in
“add-on” or excessive physical depression, sedation, and impairment. In one case
report, a fifty-four-year-old man was hospitalized for lethargy and
disorientation, side effects attributed to his having taken the combination of
kava and the anti-anxiety agent alprazolam (Xanax) for three days.

Other herbs having a sedative effect that might cause problems when combined with anticonvulsants include ashwagandha (Withania somnifera), calendula (Calendula officinalis), catnip (Nepeta cataria), hops (Humulus lupulus), lady’s slipper (Cypripedium species), lemon balm (Melissa officinalis), passionflower (Passiflora incarnata), sassafras (Sassafras officinale), skullcap (Scutellaria lateriflora), valerian (Valeriana officinalis), and yerba mansa (Anemopsis californica). Because of the potentially serious consequences, one should avoid combining these herbs with anticonvulsants or other drugs that also have sedative or depressant effects, unless advised by a physician.

Nicotinamide

Effect: Possible Harmful Interaction

Nicotinamide (also called niacinamide) is a compound produced by the body’s
breakdown of niacin (vitamin B3). It is a supplemental form
that does not possess the flushing side effect or the cholesterol-lowering ability
of niacin. Nicotinamide appears to increase blood levels of carbamazepine and
primidone, possibly requiring a reduction in drug dosage to
prevent toxic effects.

Carbamazepine blood levels increased in two children with epilepsy
after they were given nicotinamide, but the fact that the children were on several
anticonvulsant drugs clouds the issue somewhat. Similarly, nicotinamide given to
three children on primidone therapy increased blood levels of primidone. It is
thought that nicotinamide may interfere with the body’s normal breakdown of these
anticonvulsant agents, allowing them to build up in the blood.

Dong Quai, St. John’s Wort

Effect: Possible Harmful Interaction

St. John’s wort (Hypericum perforatum) is primarily used to
treat mild to moderate depression. The herb dong quai
(Angelica sinensis) is often recommended for menstrual
disorders such as dysmenorrhea, premenstrual syndrome (PMS), and
irregular menstruation.

The anticonvulsant agents carbamazepine, phenobarbital, and valproic acid have been reported to cause increased sensitivity to the sun, amplifying the risk of sunburn or skin rash. Because St. John’s wort and dong quai may also cause this problem, taking them during treatment with these drugs might add to this risk.

It may be a good idea to use sunscreen or wear protective clothing during sun exposure if one takes one of these herbs while using these anticonvulsants.

Biotin

Effect: Supplementation Possibly Helpful, but Take at a Different Time of Day

Anticonvulsants may deplete biotin, an essential water-soluble B
vitamin, possibly by competing with it for absorption in the intestine. It is not
clear, however, whether this effect is great enough to be harmful.

Blood levels of biotin were found to be substantially lower in 404 people with
epilepsy on long-term treatment with anticonvulsants compared with 112 untreated
people with epilepsy. The effect occurred with phenytoin, carbamazepine,
phenobarbital, and primidone. Valproic acid appears to affect biotin
to a lesser extent than other anticonvulsants. A test-tube study suggested that
anticonvulsants might lower biotin levels by interfering with the way biotin is
transported in the intestine.

Biotin supplementation may be beneficial if one is on long-term anticonvulsant therapy. To avoid a potential interaction, one should take the supplement two to three hours apart from the drug. It has been suggested that the action of anticonvulsant drugs may be at least partly related to their effect of reducing biotin levels. For this reason, it may be desirable to take enough biotin to prevent a deficiency, but not an excessive amount.

Folate

Effect: Supplementation Possibly Helpful

Folate (also known as folic acid) is a B vitamin that plays
an important role in many vital aspects of health. Carbamazepine appears to lower
blood levels of folate by speeding up its normal breakdown by the body and also by
decreasing its absorption. Other antiseizure drugs can also reduce levels of
folate in the body.

Low folate can lead to anemia and reduced white blood cell
count, and folate supplements have been shown to help prevent these complications
of carbamazepine treatment.

Adequate folate intake is also necessary to prevent neural tube birth defects,
such as spina
bifida and anencephaly. Because anticonvulsant drugs deplete
folate, babies born to women taking anticonvulsants are at increased risk for such
birth defects. Anticonvulsants may also play a more direct role in the development
of birth defects.

The low serum folate caused by anticonvulsants can raise homocysteine levels, a condition hypothesized to increase the risk of heart disease. However, the case for taking extra folate during anticonvulsant therapy is not as simple as it might seem. It is possible that folate supplementation itself might impair the effectiveness of anticonvulsant drugs, and physician supervision is necessary.

Calcium

Effect: Supplementation Probably Helpful, but Take at a Different Time of Day

Anticonvulsant drugs may impair calcium absorption and, in this way, increase the risk of osteoporosis and other bone disorders. Calcium absorption was compared in twelve people on anticonvulsant therapy (all taking phenytoin and some also taking carbamazepine, phenobarbital, and/or primidone) and twelve people who received no treatment. Calcium absorption was found to be 27 percent lower in the treated participants.

An observational study found low calcium blood levels in 48 percent of 109 people taking anticonvulsants. Other findings in this study suggested that anticonvulsants might also reduce calcium levels by directly interfering with parathyroid hormone, a substance that helps keep calcium levels in proper balance. A low blood level of calcium can itself trigger seizures, and this might reduce the effectiveness of anticonvulsants.

Calcium supplementation may be beneficial for people taking anticonvulsant drugs. However, some studies indicate that antacids containing calcium carbonate may interfere with the absorption of phenytoin and perhaps other anticonvulsants. For this reason, one should take calcium supplements and anticonvulsant drugs several hours apart if possible.

Carnitine

Effect: Supplementation Possibly Helpful

Carnitine is an amino acid that has been used for heart conditions, Alzheimer’s
disease, and intermittent claudication. Intermittent claudication is a possible
complication of atherosclerosis, in which impaired blood circulation causes
severe pain in calf muscles during walking or exercising.

Long-term therapy with anticonvulsant agents, particularly valproic acid, is associated with low levels of carnitine. However, it is not clear whether the anticonvulsants cause the carnitine deficiency or whether it occurs for other reasons. It has been hypothesized that low carnitine levels may contribute to valproic acid’s damaging effects on the liver. The risk of this liver damage increases in children younger than twenty-four months, and carnitine supplementation may be protective. However, in one double-blind crossover study, carnitine supplementation produced no real improvement in well-being as assessed by parents of children receiving either valproic acid or carbamazepine.

L-carnitine supplementation may be advisable in certain cases, such as in infants and young children (especially those younger than two years) who have neurologic disorders and are receiving valproic acid and multiple anticonvulsants.

Vitamin D

Effect: Supplementation Possibly Helpful

Anticonvulsant drugs may interfere with the activity of vitamin D. As
proper handling of calcium by the body depends on vitamin D, this may be another
way that these drugs increase the risk of osteoporosis and related bone
disorders.

Anticonvulsants appear to speed up the body’s normal breakdown of vitamin D, decreasing the amount of the vitamin in the blood. A survey of forty-eight people taking both phenytoin and phenobarbital found significantly lower levels of calcium and vitamin D in many of them compared with thirty-eight untreated persons. Similar but lesser changes were seen in thirteen people taking phenytoin or phenobarbital alone. This effect may be apparent only after several weeks of treatment.

Another study found decreased blood levels of one form of vitamin D but normal levels of another. Because there are multiple forms of vitamin D circulating in the blood, the body might be able to adjust in some cases to keep vitamin D in balance, at least for a time, despite the influence of anticonvulsants.

Adequate sunlight exposure may help overcome the effects of anticonvulsants on vitamin D by stimulating the skin to manufacture the vitamin. Of 450 people on anticonvulsants residing in a Florida facility, none was found to have low blood levels of vitamin D or evidence of bone disease. This suggests that environments providing regular sun exposure may be protective. Persons regularly taking anticonvulsants, especially those taking combination therapy and those with limited exposure to sunlight, may benefit from vitamin D supplementation.

Vitamin K

Effect: Supplementation Possibly Helpful for Pregnant Women

Phenytoin, carbamazepine, phenobarbital, and primidone speed up the normal
breakdown of vitamin K into inactive byproducts, thus depriving the body
of active vitamin K. This can lead to bone problems, such as osteoporosis. In
addition, use of these anticonvulsants can lead to a vitamin K deficiency in
babies born to mothers taking the drugs, resulting in bleeding disorders or facial
bone abnormalities in the newborns. Mothers who take these anticonvulsants may
need vitamin K supplementation during pregnancy to prevent these conditions in
their newborns.

Bibliography

Asadi-Pooya, A. A., and E. Ghetmiri. “Folic Acid Supplementation Reduces the Development Abnormalities in Children Receiving Carbamazepine.” Epilepsy and Behavior 8 (2006): 228-231.

De Vivo, D. C., et al. “L-carnitine Supplementation in Childhood Epilepsy.” Epilepsia 39 (1998): 1216-1225.

Kishi, T., et al. “Mechanism for Reduction of Serum Folate by Antiepileptic Drugs During Prolonged Therapy.” Journal of the Neurological Sciences 145 (1997): 109-112.

Lewis, D. P., et al. “Drug and Environmental Factors Associated with Adverse Pregnancy Outcomes: Part 1–Antiepileptic Drugs, Contraceptives, Smoking, and Folate.” Annals of Pharmacotherapy 32 (1998): 802-817.

Ono, H., et al. “Plasma Total Homocysteine Concentrations in Epileptic Patients Taking Anticonvulsants.” Metabolism 46 (1997): 959-962.

Takanaga, H., et al. “Relationship Between Time After Intake of Grapefruit Juice and the Effect on Pharmacokinetics and Pharmacodynamics of Nisoldipine in Healthy Subjects.” Clinical Pharmacology and Therapeutics 67 (2000): 201-214.

Where did the books in Gatsby's library come from?

Gatsby's library is first mentioned in chapter three of F. Scott Fitzgerald's novel The Great Gatsby. Nick and Jordan are at one of Gatsby's lavish parties at his palatial mansion in West Egg. While they are searching for the host they meet a "stout middle-aged, owl-eyed man" in the library. He carries on about the books. He can't believe they are actually real. He had originally thought they were simply cardboard. The scene fits the theme of the chapter as wild speculation about Gatsby pervades the party. Some believe he killed a man and some say he was a German spy. He is a complete mystery to most of the party goers and the "owl-eyed" man is quite impressed by the "thoroughness" and "realism" of the library.

The mansion, the parties, and the library are all part of Gatsby's plan to lure Daisy Buchanan to his mansion. He believes that an ostentatious display of wealth will win her. In chapter five Gatsby's dream partially comes true as he gives Daisy a tour of his house. It is here that the reader learns the books are supposedly from "the Merton College library," which is on the Oxford, England campus. Throughout the novel, Gatsby claims to be an "Oxford man." This title is presumably just another way he hopes to impress Daisy. 

Interpret yourself as Macbeth, and then write your thoughts about your first encounter with the witches.

If I were Macbeth and met the Weird Sisters upon "a blasted heath" (as the stage directions of Act 1, Scene 3 describe it), I would no doubt feel many emotions. First of all, based on Banquo's description of Macbeth's reaction - Good sir, why do you start, and seem to fear/ Things that do sound so fair?" (51-2) - I would be frightened of the the three sisters, and probably more than a little repulsed by their wild and wicked appearance. Second, based on Macbeth's response in lines 70-78, I would feel confusion and doubt about the prophecy and would ask for more explanation. However, judging by the way Macbeth gradually warms to the notion of becoming king ("They did say I was destined to be king, after all," he probably reasons to himself), I would begin to lust and hunger after power, especially after being unexpectedly named Thane of Cawdor later in the scene (105). As such, it's clear that, in Macbeth's first encounter with the Weird Sisters, he already begins to experience the conflicting thirst for power and fear of the fulfilled prophecy that he experiences throughout the play.