What is the theme of "Identity" by Julio Noboa Polanco?

"Identity" by Julio Noboa Polanco is a poem about a singular identity awash in a constrained group culture. The poem starts by comparing unnamed individuals to flowers.

Let them be as flowers, always watered, fed, guarded, admired, but harnessed to a pot of dirt.

These flowers have what they want. They have no fear of going without. The sun will not stop shining on them, and they will always have admirers. However, they will never be free. They must stay where they are, at the mercy of those who tend to them. These handlers give, but they may also take, plucking the flowers from their happy home. The narrator does not want to be a flower. He would rather be free. This, he feels, would make him feel the "madness of the world." He's willing to make some sacrifices for that. He's willing to be unseen and shunned. The poem ends with these lines.

If I could stand alone, strong and free, I'd rather be a tall, ugly weed.

The narrator is struggling with his identity through the course of the poem. The things he wants are different from what others want, and he goes through the ramifications in this poem, but it's a trade he's willing to make. Being strong and free is more important than being beautiful but weak and trapped.

What leads up to Mr. Rochester sleeping with Amelie? What implications of racial identity and ambiguity are there?

Jean Rhys’ Wide Sargasso Sea is a postcolonial novel that considers the relationship between race, sexuality, and identity through imperialistic and patriarchal oppression.  In Part Two of the text, these perceived binaries (white/black; civilized/savage; colonizer/colonized; male/female; Self/Other) reach the foreground when Rochester betrays his wife Antoinette and sleeps with Amelie, the black housemaid.

On the day that Rochester sleeps with Amelie, he wakes up next to his wife and becomes violently sick. He states, “I woke in the dark after dreaming that I was buried alive, and when I was awake the feeling of suffocation persisted” (Rhys 137). When Rochester wakes up, he feels as if he is trapped and smothered, indicating a loss of power that directly challenges his patriarchal control over his wife and surroundings. He believes he has been poisoned, stating, “I thought, I have been poisoned. But it was a dull thought, like a child spelling out the letters of a word which he cannot read, and which if he could would have no meaning or context” (Rhys 137). In this simile, Rochester compares his awareness to a child performing a task with no understanding of the meaning, further conveying a sense of impotence and incompetence. As an English man in the patriarchal society of the nineteenth century, Rochester is obsessed with dominance and control, making his current state a driving factor for sleeping with Amelie later that day.  On a more subtle note, Rochester is agitated by his inability to categorize the racial identity of his Creole wife. This is portrayed through the color imagery that he associates with her sleeping body. He states, “I was too giddy to stand and fell backwards on the bed, looking at the blanket which was a peculiar shade of yellow. After looking at it for some time, I was able to go over to the window and vomit” (Rhys 138). The image of “peculiar shade of yellow” symbolizes the skin tone of his wife—she is neither black nor white, often referred to as the juxtaposed epithet of “white nigger” throughout the novel. Her racial ambiguity disturbs Rochester, causing him to become physically sick. This pivotal morning scene presents Rochester as a “colonizer” unable to understand the world around him, and his fear of losing his power causes him to later sleep with Amelie.

Rochester leaves Antoinette sleeping in their bed, covering her body with a sheet as if she was “a dead girl” (Rhys 138). Again, this simile conveys Rochester’s desired dominance over his wife—she is merely a body. Rochester wanders to an abandoned house in the nearby woods, falls asleep, and this time, awakens to Amelie offering him food and drink. Amelie comforts Rochester, and he states, “Her arm behind my head was warm but the outside when I touched it was cool, almost cold. I looked into her lovely meaningless face, sat up and pushed the plate away” (Rhys 139). This quote is a strong parallel to how Rochester viewed his wife earlier that morning, using nearly the same language to describe their physical features. He perceives his white wife and the black housemaid as the same person, accentuating the racial ambiguity of both women. Further, this ambiguity makes him ill, again aligning his inability to categorize with a loss of control.

This is perhaps why Rochester chooses to commit adultery with Amelie, but he does so in a way that blatantly demonstrates his power to both his wife and the servant: he sleeps with Amelie and knows Antoinette can hear them. He states, “I had not one moment of remorse. Nor was I anxious to know what was happening behind the thin partition which divided us from my wife’s bedroom” (Rhys 140). In true patriarchal fashion, Rochester does not feel guilty for committing adultery, and he uses the act as a demonstration of his authority. Yet, when he wakes up the next morning, he looks at Amelie and again becomes disgusted with her appearance. He states, “Another complication. Impossible. And her skin was darker, her lips thicker than I had thought” (Rhys 140). The imagery emphasizes Amelie’s “black” features, but simultaneously shows how Rochester perceives the woman—as a racialized body. This becomes apparent when he gives Amelie money in exchange for her time. He states, “I told her that I was leaving the island soon but that before I left I wanted to give her a present. It was a large present but she took it with no thanks and no expression on her face” (Rhys 140). By paying Amelie, Rochester treats her as an object or commodity, relying on the rhetoric of master-slave to describe their relation. This is reinforced by the lack of expression on Amelie’s face—she is merely a body. Thus, this act is imbued with implications of racial identity and ambiguity because it explores Rochester’s frustration over his inability to categorize the identities of both women, and it simultaneously serves to undermine his wife’s white identity, thereby casting her as an ambiguous racialized body. Rochester emerges from the scene with his power restored and his wife destroyed.

What is an example of a person vs. supernatural conflict from Julius Caesar?

The play contains many examples of superstitions and warnings of doom. 

A person vs. supernatural conflict is a conflict between a character and something that is not normal in some way.  Supernatural elements include ghosts, omens, and superstitions.  Romans were very superstitious, and there are many examples of superstitions in the play.

First of all, the soothsayer’s warning to Caesar is an example of a character vs. supernatural conflict because the soothsayer warns Caesar that he is doomed.  Caesar does not pay attention, even though someone is telling him a specific day when he should beware. 

CAESAR

What say'st thou to me now? speak once again.

Soothsayer

Beware the ides of March.

CAESAR

He is a dreamer; let us leave him: pass. (Act 1, Scene 2) 

This is not the only bad omen mentioned in the play.  The conspirators mention all kinds of spooky signs that they say they saw, such as tempests, flaming slaves, and owls during the day.  Calpurnia has a dream where she imagines Caesar’s blood running like a fountain, and she does not want him to go to the capital on the Ides of March.  Caesar almost listens to her, until Decius Brutus convinces him to reinterpret the dream as a positive sign.  Of course, it wasn't.  Caesar was assassinated on the Ides of March.

Another example of a character vs. supernatural conflict is Cassius’s birthday omens.  Cassius gets very superstitious on his birthday, deciding that the bad omens he is seeing mean that his battle is doomed and he is about to die.  Although Cassius says he does not normally pay attention to omens, the combination of the fact that it’s his birthday and he is about to go into a battle he does not think will go well makes him morbid.

Coming from Sardis, on our former ensign
Two mighty eagles fell, and there they perch'd,
Gorging and feeding from our soldiers' hands;
Who to Philippi here consorted us:
This morning are they fled away and gone;
And in their steads do ravens, crows and kites,
Fly o'er our heads and downward look on us,
As we were sickly prey … (Act 5, Scene 1)

Cassius was right to be worried.  Brutus and Cassius were apparently outmatched at Philippi.  Cassius’s interpretation of the omens led him to misread what happened in the battle and commit suicide prematurely.  Brutus’s suicide came not much later.

What is gamete intrafallopian transfer (GIFT)?

Indications and Procedures

Couples who have sexual intercourse for a year without contraception and do not achieve pregnancy are defined as infertile. So too are couples who conceive but, because of repeated miscarriages, have not had a child. There are many possible causes of infertility. In women, they include abnormal or irregular ovulation, blocked or constricted fallopian tubes, and growths, scarring, or abnormalities of the uterus. In men, infertility may result from failure to ejaculate, low sperm count, abnormalities in sperm cells, or a blocked sperm tube. In many cases, no cause of infertility can be determined.

To have a child, some infertile couples turn to clinics offering assisted reproductive technology
(ART) services. The most common form of ART is in vitro fertilization
(IVF). Gamete intrafallopian transfer (GIFT) is similar to IVF, but it does not involve fertilization outside the body. Gametes (sperm and egg) are collected and then surgically introduced into a fallopian tube, where fertilization is expected to occur naturally.

Women who have at least one fallopian tube open are considered candidates for any of the ARTs, if sufficient numbers of healthy sperm can be collected from the male partner. GIFT may be the ART of choice for young women who have never undergone laparoscopy and for men with weak or few sperm. GIFT is sometimes employed in cases of unexplained infertility.

Prior to the procedure, egg maturation in the ovaries is stimulated with fertility drugs. With ultrasound guiding the probe, the physician retrieves eggs using a laparoscope. Sperm are collected several hours before the procedure. A laparoscope is also used to inject eggs and sperm into a fallopian tube. The patient may be awake or under general anesthesia for GIFT, which is typically done as a same-day, outpatient procedure. The American Society for Reproductive Medicine recommends that GIFT be performed only in a facility capable of performing IVF, in case GIFT fails or excess eggs are recovered.

Uses and Complications

All ART procedures involve risks, including general surgical risks and pregnancy complications such as multiple fetuses, low birth weight, and possibly certain birth defects. The rate of ectopic pregnancy (implantation outside the uterus) is also slightly higher. Multiple fetuses, which are present in nearly one-third of ART pregnancies, are associated with increased risk of prematurity, low birth weight, and neonatal death in the infant and of cesarean section and hemorrhage in the mother. Although ARTs are emotionally taxing, physically demanding, and expensive, thousands of infertile couples seek them annually.

The possible side effects of the hormonal drugs used to induce ovulation include hot flashes, changes in vision, ovarian cysts (sacs of fluid forming in the ovary), ovarian enlargement, and leakage of fluid into the abdominal cavity, which can trigger kidney failure, strokes, and heart attacks if not treated. IVF entails a slightly increased risk of chromosomal birth defects; whether GIFT carries a similar risk is unknown. ARTs do not appear to increase the overall risk of birth defects, although specific defects, such as vision problems, have been uncovered in some studies.

Some couples choose GIFT because they consider it more natural than IVF. However, GIFT is a riskier procedure than IVF, because laparoscopic surgery is required. Also, because fertilization is not confirmed before the injection of gametes, there is no way of knowing whether it occurred unless pregnancy is achieved. The mother’s age is an important factor: the younger the mother, the better the chance of success.

Perspective and Prospects

Before the 1970s, infertility treatment was limited mostly to the surgical repair of blocked Fallopian tubes and the insertion of sperm into the uterus (artificial insemination). In the early 1960s, Min Chang, a scientist at the Worcester Foundation in Shrewsbury, Massachusetts, performed the first IVF. He used sperm and eggs from black rabbits to grow embryos in vitro (meaning literally “in glass,” or in a laboratory dish). He then placed the embryos in the uterus of a white rabbit. A litter of black pups was born.

In 1969, English physician Robert G. Edwards successfully fertilized human eggs in vitro. Cell division was achieved a year later. He next collaborated with English physician Patrick Steptoe, who specialized in laparoscopic surgery. Together, they developed reliable techniques for retrieving eggs and maintaining embryos. The result was Louise Brown, the first “test tube baby.” She was born in England in 1978. In 1981, the breakthrough was replicated in the United States. During the following twenty years, more than one million IVF babies were born.

After that, the field of reproductive endocrinology flourished, as did the development of ART techniques. Ricardo H. Asch of the University of Texas at San Antonio performed the first successful GIFT in 1984. Another, similar development was zygote intrafallopian transfer (ZIFT), first successfully performed in 1986. ZIFT involves mixing sperm and eggs together outside the body and then confirming fertilization before the zygote is surgically placed in a fallopian tube. Another ART, intracytoplasmic sperm injection (ICSI), was introduced in 1992. It involves injecting a single sperm directly into an egg. It is often used in conjunction with IVF to fertilize eggs before embryo
transplantation.

Research and development activities continue to improve ART methods and techniques. Certain conditions within the fallopian tube that interfere with ART can now be treated, and better culture media have been developed for growing and maintaining embryos. The selection of smaller numbers of higher-quality embryos may cut the rate of multiple pregnancies, and improved methods for identifying those couples most likely to benefit from ART are being perfected. Researchers hope that implanting smaller numbers of more mature embryos will reduce the number of multiple births and diminish the risks that they entail.

ARTs raise ethical and social issues. Some churches and religious leaders oppose ARTs because they believe them to be unnatural or because some of the embryos produced in vitro are subsequently destroyed. Other controversies include pregnancies achieved in women past their natural reproductive age and legal issues surrounding the ownership of reproductive cells and frozen embryos.

Bibliography

A.D.A.M. Health Encyclopedia. "Infertility." MedlinePlus, February 26, 2012.

American Society for Reproductive Medicine. "Assisted Reproductive Technologies." American Society for Reproductive Medicine, 2013.

Johns Hopkins Medicine Fertility Center. "Gamete Intrafallopian Transfer (GIFT)." Johns Hopkins Medicine, 2013.

Meniru, Godwin I. Cambridge Guide to Infertility Management and Assisted Reproduction. New York: Cambridge University Press, 2001.

Peoples, Debby, and Harriette Rovner Ferguson. Experiencing Infertility: An Essential Resource. New York: W. W. Norton, 2000.

US Department of Health and Human Services. 2002 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports. Atlanta: Author, 2004.

What is aseptic technique?

Definition

Aseptic technique involves applying preventive measures to minimize the chance of introducing into clinical settings the microorganisms, such as viruses and harmful bacteria (known as pathogens), that cause disease. In other words, its purpose is to maintain asepsis, or the absence of pathogens, in clinical settings. Aseptic technique is intended to protect the patient and the health care worker from pathogens and to prevent their spread.

Pathogens may introduce infection to a patient through contact with the environment, with personnel, or with medical equipment. The environment contains potential hazards that may disseminate pathogens through movement, touch, or proximity.

Aseptic technique involves a set of procedures designed to remove or kill microorganisms on hands and objects, reducing a patient’s risk of exposure. It includes the use of sterile instruments and of barriers such as personal protective equipment, adequate handwashing, patient preparation, and maintenance of sterile fields and a safe environment in surgical and other areas for medical procedures.

Minimizing Contamination During Surgery

Interventions such as minimizing surgical-room traffic, isolating a patient to
reduce airborne contamination, and using low-particle-generating surgical attire
contribute to reducing environmental hazards. Equipment or supplies can be
sterilized through chemical treatment, radiation, gas, or
heat.

The most prominent example of aseptic technique occurs in the operating room, in which clinicians work to prevent postoperative infection. Aseptic technique protocols during surgical procedures include patient skin preparation, handwashing and surgical scrub, barrier protection for the patient (draping) and the surgical team (surgical attire), and maintenance of the sterile field.

Hand hygiene among medical personnel is the most important aspect of reducing contamination. Adequate handwashing involves removing jewelry, avoiding contact with the sink, and performing vigorous hand scrubbing. Thorough drying is critical because moist surfaces encourage pathogen growth. Bare hands are potential sources of infection, and glove use is important.

Sterile surgical clothing and protective devices such as gloves, face masks, goggles, and transparent eye and face shields serve as barriers against microorganisms. Surgical attire must be worn with deliberate care to prevent contact of sterile surfaces with nonsterile objects, including skin. Procedures for putting on surgical attire include covering facial hair, tucking hair out of sight, and removing jewelry or other dangling objects that may contain microorganisms. Personnel assist the surgeon in putting on gloves and the surgical gown and in arranging equipment to minimize the risk of contamination. Creating surgical fields with drapes, which are sterilized linens placed on the patient or around the field to define sterile areas, helps maintain asepsis in the operating room during surgery or other invasive procedures.

Other principles applied to maintain asepsis include ensuring that all items in a sterile field are actually sterile. Also sterile packages should be opened as close as possible to time of use.

Moist areas are not considered sterile. Contaminated items must be removed
immediately, and nonsterile items should not cross a sterile field. Edges of
sterile fields are not considered sterile, and a margin of safety is maintained
between sterile and nonsterile objects. Drapes or wrapped kits of equipment are
opened in a manner to prevent contents from touching nonsterile surfaces. Others
who work close to the sterile field, such as anesthesia personnel, also must
follow aseptic technique. During a procedure, staff members are positioned so that
those who have undergone surgical scrub and are wearing sterile attire are closest
to the patient while unscrubbed staff members remain on the perimeter to obtain
supplies, acquire assistance, and communicate with outside personnel.

Nonsurgical Clinical Settings

Aseptic technique is also used in a variety of settings outside the operating room. A primary difference between the operating room and other clinical environments is that areas outside the operating room generally do not allow for the same rigorous level of asepsis. Avoiding potential infection is still the goal, however. For example, changing a surgical dressing at the patient’s bedside should still include thorough handwashing, use of gloves and other protective garb, creation of a sterile field, and avoidance of contact with nonsterile items.

Typical situations that require aseptic measures include insertion of intravenous lines, urinary or other catheters, and drains; changing of wound dressings; vaginal exams during labor; and respiratory suction. General habits such as prompt disposal of contaminated needles or blood-soaked bandages and dressings and the prevention of accumulation of drained bodily fluids through regular emptying of receptacles help preserve and maintain a clean medical environment and keep it as free of microorganisms as possible.

Impact

Practices that clean (remove dirt and other impurities), sanitize (reduce the number of microorganisms), or disinfect (remove most microorganisms) are not always adequate to prevent infection. The Centers for Disease Control and Prevention estimated in 2015 that more than 50 million surgical procedures are performed in the United States each year. Surgical site infections are among the most common nosocomial, or hospital-acquired, type of infection and result in longer hospital stays and greater patient costs. Aseptic technique is vital in reducing the morbidity and mortality associated with surgical infections. Aseptic technique is especially important in cases involving patients who have compromised (weak) immune systems.

Bibliography

Caprette, David R. "Methods Manual—Applied Microbiology: Aseptic Technique." Laboratory Studies in Applied Microbiology. Rice University, 13 Oct 2015. Web. 30 Dec. 2015.

Clancy, Carolyn. “Simple Steps Can Reduce Health Care-Associated Infections: Navigating the Health Care System.” Rockville, Md.: Agency for Healthcare Research and Quality, 2008. Available at http://www.ahrq.gov/consumer/cc/cc070108.htm.

Farb, Daniel, and Gordon Bruch. Infection Control in Healthcare Facilities Guidebook: A Concise Compliance Guide for Healthcare Staff and Management. Los Angeles: UniversityOfHealthCare, 2006. Print.

Kennamer, Mike. Basic Infection Control for Health Care Providers. 2d ed. Clifton, N.Y.: Thomas Delmar Learning, 2007. Print.

Ochoa, Pamella S., and Jose A. Vega. Concepts in Sterile Preparations and Aseptic Technique. Burlington: Jones & Bartlett Learning, 2015. Print.

Peleg, Anton Y., and David C. Hooper. “Hospital-Acquired Infections Due to Gram-Negative Bacteria.” New England Journal of Medicine 362, no. 19 (2010): 1804–1813. Print.

Perry, Christine. Infection Prevention and Control. Malden, Mass.: Blackwell, 2007. Print.

Westin, Debbie. Infection Prevention and Control: Theory and Practice for Healthcare Professionals. Hoboken, N.J.: John Wiley & Sons, 2008. Print.

Workman, Barbara A., and Clare L. Bennett. Key Nursing Skills. London: Whurr, 2003. Print.

What do you need to do to get into architecture as a career?

In most US states and most other First World countries, working as an architect requires some form of license. Obtaining such a license usually involves paying a fee and passing some sort of certification, but may also require a specific college degree.

In general, it is probably wise to get a college degree in architecture anyway, as there are a number of complex skills involved in being an architect and a formal education will not only ensure that you have those skills, but also that you can successfully signal that knowledge to potential employers. A bachelor's degree in architecture is usually sufficient, though a master's degree is desirable (many universities offer joint bachelor/master's programs as well). PhDs in architecture are fairly rare and usually unnecessary.

Once you have the credentials, you have two options: You can set up your own practice and provide consulting services (about 20% of architects do this), or you can find a job at an architectural firm. Working for yourself has potentially higher rewards, but also much higher risk; working for a firm pays less on average but is much more stable. Median pay for architects employed at firms is about $75,000 per year.

Architecture is a field that demands a strong balance between creative and analytical skills; you are essentially doing art and engineering at the same time. This makes architecture a challenging career, but also potentially a very fulfilling one.

Ag2SO4 has a solubility of 4,496 g/L. What's its Ksp (product of solubility)?

Silver sulfate has the formula `Ag_2SO_4` . The number you gave for solubility is not within the range of solubility of silver sulfate, so I'm assuming that the comma should be a decimal point and you're trying to calculate Ksp based on a solubility of 4.496 grams per liter.

First, we need to change the grams to moles to get the molar solubility of `Ag_2SO_4` :

(4.496 grams Ag2SO4)/1 Liter x (1 mole/311.8 grams) = 0.01442 moles/L

Here's the equation for the dissociation of `Ag_2SO_4` :

`Ag_2SO_4 -> 2 Ag^+ + SO_4^(2-)`

The expression for the solubility product constant is:

`K_(sp) = [Ag^+]^2[SO_4^(2-)]`

For each mole that dissolves, two moles of `Ag^+` and 1 mole of `SO_4^(2-)` are produced. We can substitute the molarity previously calculated, giving us:

`K_(sp) = [2(0.01442]^2[0.01442] = 1.199 X 10^(-5)`

This is the accepted value of Ksp for silver sulfate at 25ºC as per the attached link, so this verifies that the solubility in the problem is 4.496 g/L and not 4,496 g/L.

What happens to the pressure and temperature in an evaporator?

An evaporator is a scientific piece of equipment that converts a liquid into a gaseous phase. The temperature and pressure both increase in an evaporator.

In order for a substance to evaporate, it must gain kinetic energy.  Kinetic energy is the energy of movement or motion. Temperature is simply the average kinetic energy of all the particles of a substance. Thus, kinetic energy and temperature are directly related.  

As the particles of a liquid that is placed in an evaporator increase in temperature and gains kinetic energy, the particles begin to move faster and spread apart. Eventually, the particles move so far away from one another that the intermolecular forces between the particles are broken. The shape of the substance becomes less definite and its volume increases. The increased movement of the particles allows to particles to flow past one another. It is at this point that the liquid has evaporated into a gas.

Gas pressure is caused by the collision of the gas particles with the sides of the evaporator. As the particles in the evaporator gain temperature and kinetic energy, they collide with the sides of the evaporator more often. Thus, the pressure inside an evaporator also increases when a liquid evaporates into a gas.

In A Christmas Memory, as friends, what do Buddy and his cousin give to each other, and what do they get in return? In your opinion, why does this...

Buddy and his cousin provide invaluable things to each other during their friendship. Buddy provides a mirror to his cousin’s past. She lost her childhood friend named Buddy, therefore she calls her cousin Buddy. Due to her disabilities she cannot function as a mature adult. Buddy does not judge her; instead he is her truest friend and confidant. They function on a similar level even though, in this memoir, he is only seven years old. He is able to accept her quirks, superstitions, and slightly adventurous spirit.

For his part, Buddy receives unconditional love from his cousin, which he does not receive from the other adults in his life. She showers him with attention and teaches him the value of the little things in life such as homemade kites on sunny, windy days and time spent together making Christmas ornaments.

Other people inhabit the house, relatives; and though they have power over us, and frequently make us cry, we are not, on the whole, too much aware of them.

The second part of this question asks for an opinion. In my opinion, the friendship has a lasting impression on Buddy due to its unconditional nature. He does not receive attention or approval from the other adults in his life; therefore he bonds with his cousin as she does with him. When he is sent away to military school, she provides the link to the only home he knew by writing to him. Although the news she provides is mundane, it is what he needs to stay connected. Their bond is so close that Buddy instinctively knows when his friend dies. They fulfill a void in each other other’s lives.

What is erythema nodosum?

Definition

Erythema nodosum (EN) is an
inflammation of subcutaneous fat tissue characterized by nodules beneath the skin. EN is considered a nonspecific immune-related skin reaction with an incidence of 1 to 5 per 100,000 persons each year. EN is more common in women than in men. The predominant age of those infected is between fifteen and forty years.

Causes

Although the cause of about 50 percent of EN cases is unknown, the most common
cause is streptococcal pharyngitis (up to 44 percent in adults
and 48 percent in children). The most common bacterial agent for streptococcal
pharyngitis in children and adolescents is
Streptococcus pyogenes (group A Streptococcus,
or GAS). Other causes of EN include gastrointestinal disorders (Crohn’s
disease, ulcerative colitis, bacterial gastroenteritis);
diseases with large lymph nodes (hilar adenopathy) in the middle part of the chest
(sarcoidosis, tuberculosis); diseases caused by
various infectious agents (other bacteria, syphilis, cat
scratch fever, leprosy); fungi (histoplasmosis, coccidiomycosis,
blastomycosis); viruses (human immunodeficiency
virus, hepatitis B, cytomegalovirus); protozoa
(giardiasis, toxoplasmosis, amebiasis);
medications (sulfonamides, amoxicillin, oral contraceptives); rheumatologic,
inflammatory, and autoimmune disorders (systemic lupus erythematosus,
rheumatoid
arthritis, scleroderma); cancers (leukemia,
lymphoma, colon cancer); and pregnancy.

Risk Factors

Persons with conditions noted in the foregoing section are at risk for developing EN.

Symptoms

EN starts as a red, hot, flat, firm, palpable, and painful nodule or lump, most
commonly in the shins, but it may affect other parts of the body (such as the
forearms, arms, trunk, thighs, and ankles). The nodule is usually one inch in
diameter but can be up to four inches in diameter. The nodules change color from
purplish (in days) to brownish patches (in weeks). Other symptoms may occur one to
three weeks before the appearance of the nodule, These symptoms include fever,
malaise, and joint aches, and inflammation or swelling of the affected areas.

Screening and Diagnosis

A physician will perform a thorough medical history evaluation and a physical examination, considering the wide spectrum of conditions that can cause EN. Diagnosis is based on the clinical features of EN. To establish the most probable cause, studies may include blood tests (complete blood count with differential, erythrocyte sedimentation rate, C-reactive protein, liver enzymes and products, and basic metabolic panel), determining streptococcal infection (antistreptolysin-O level, throat culture, and polymerase chain reaction), chest radiograph to evaluate hilar adenopathy, tuberculin skin test for tuberculosis, and stool cultures to evaluate gastrointestinal causes. Excisional biopsy of the skin lesion may be needed, if EN diagnosis is uncertain.

Treatment and Therapy

EN usually resolves, and treatment focuses on managing the underlying cause.
Pain relief can be provided with nonsteroidal anti-inflammatory drugs
(such as naproxen or ibuprofen). A solution of potassium iodide taken for one
month is another treatment and is most effective when taken during the early
manifestation of EN. Thyroid function should be monitored if potassium iodide will
be used long-term because it can cause hyperthyroidism. If infection and
malignancy have been ruled out, oral steroid is another therapeutic option.

Prevention and Outcomes

There is no vaccination or medication that can prevent EN. One should practice basic hygiene measures that help prevent infections. Recommended cancer screenings should be followed, such as colonoscopy for colon cancer screening, based on clinical guidelines. Finally, one should adhere to medication regimens for the causative diseases.

Bibliography

Ferri, Fred F. “Erythema Nodosum.” In Ferri’s Clinical Advisor 2011: Instant Diagnosis and Treatment, edited by Fred F. Ferri. Philadelphia: Mosby/Elsevier, 2011.

Requena, Luis, and Evaristo Sanchez Yus. “Erythema Nodosum.” Dermatologic Clinics 26 (2008): 425-438.

Schwartz, Robert A., and Stephen J. Nervi. “Erythema Nodosum: A Sign of Systemic Disease.” American Family Physician 75 (2007): 695-700.

What causes Marian to abruptly leave the women's room in " A Visit of Charity"?

In Eudora Welty's story "A Visit of Charity," readers get a glimpse of a young girl witnessing what might be her own fate when she is older. When Marian goes to visit the Old Ladies' Home as an act of charity for her Campfire Girl requirement, she expects that it will be a quick and painless visit. During her visit, Marian sees women who remind her of sheep and who bicker constantly. As she watches the two old women, they become increasingly mean to each other, and Marian becomes increasingly disoriented. At one point, Marian can't even remember her own name.

When the old woman makes Addie cry, saying the reason she’s upset is because it’s her birthday, the spell over Marian is broken. Once Addie cries, Marian recognizes the cruelty of the women and is able to break free. Therefore Addie's crying is what causes her to abruptly leave the women’s room, but more importantly, the recognition of the ugliness and cruelty in that place and between women is what ultimately impels her to escape.

What is the history of efforts to censor or ban Huckleberry Finn?

Huckleberry Finn, almost from its publication in 1885, has been the subject of banning and censorship. Just one month after its publication, the public library in Concord, Massachusetts banned the novel, saying it was "trash and only suitable for the slums." Throughout the 20th century, the book has been banned from school libraries and kept out of classrooms because of its depiction of blacks, Huck's penchant for lying, and Twain's use of the vernacular. In the 1950s, the NAACP challenged the book for its use of the word "nigger"; in 1998 a parent in Arizona sued the local school board over the book, saying that it exacerbated racial tensions. Huckleberry Finn was no. 14 on the American Library Association's list of "most banned or challenged" books for the years 2000-2009.

For all the attempts to ban the book, it was nevertheless considered a masterpiece fifty years after its publication, lauded by T.S. Eliot, Ernest Hemingway (who said "all American writing" comes from it), and Ralph Ellison, among others. Critical consensus is that the novel, far from stereotyping blacks, provides a powerful critique of racism.

Who is Saint Augustine? What are some important things about him, and what are some important things about his biography on Confessions of Saint...

Saint Augustine of Hippo lived from 354 CE to 430 CE in modern-day Algeria. He developed the concept of the City of God- a Catholic city which exists in spirit but not necessarily on Earth. Though he is a patron saint, he did not become a Catholic until the age of 31. It is his writings on his life before Catholicism, and how he came to understand sin, that make up the Confessions. He was very interested in philosophy and the workings of the world, even before his conversion. He studied and taught rhetoric, which certainly played a large part in his success as an ordained preacher.

Saint Augustine is primarily remembered for his work in theology. He is an inspiration to many Catholics with regard to conversion, and during his life he strove to free himself of sinful thoughts and behaviors. He believed that slavery was caused by sin and encouraged his fellow clergy at Hippo to free any slaves they owned. Just as he believed in wrote of the distinction between the spiritual and earthly City of God, he believed in the distinction between (and marriage of) the spirit and the human body. He wrote that the spirit is an eternal substance which may persist after death, and that the spirit is only truly "married" or united with the body when we act according to what is morally and spiritually good. His belief that the passages on creation in Genesis are not mean to be taken literally was quite revolutionary at the time. He also disapproved of astrology and war.

The Confessions is an important text for theologians, Christians, and in the study of autobiography. As I mentioned above, Augustine wrote about his early, sinful life and how he came to understand the necessity of acting with good morals. His writings laid the foundation for the belief that the earthly body is tainted by Original Sin. He believed that a child, left to their own devices, will be sinful because they have not been taught spiritual discipline. For the very same reason, he believed that humans are easily swain into committing sinful acts, and that it takes learning a sense of personal, moral responsibility to act in accordance with God. He relates a story when he was pressured to act sinfully, and stole some pears with friends. He felt that if he had been on his own, he would not have done so.

Though the Confessions are largely autobiographical, Augustine dwells heavily on the nature of creation, sin, and how humans can come to act morally. He believed that through veneration of God and through morally good (Godly) action, one would return to divinity after their time on Earth.

A cake recipe calls for 472 ml of milk. You don't have a metric measuring cup at home, so you need to convert milliliters to cups.You know that 1 l...

Unit conversion is needed in this question. Let us gather the given information. Since 1 l is equal to 1.06 quart,

1 l = 1.06 quart

and 1 quart contains 4 cups.

Thus, 1 l = 1.06 quart = 1.06 quart x 4 cups/quart = 4 x 1.06 cups = 4.24 cups.

Thus, 1 l is equal to 4.24 cups. Since 1 l consists of 1000 ml,

1000 ml = 4.24 cups.

or, 1 cup = 1000 ml / 4.24 = 235.85 ml

Thus, 1 cup contains 235.85 ml of a liquid. 

In this case, for making the cake, we need 472 ml of milk. Since we have to use a cup, 

number of cups = volume needed / volume of a cup

= 472 ml / 235.85 ml/cup = 2 cups (approximately).

Thus, we can use 2 cups full of milk for the given cake recipe.

Hope this helps.

What would be in a dialogue between Roger and Mrs. Jones when they encounter each other ten years later.

Langston Hughes' short story "Thank You, M'am" is about a young man who gets the lesson of a lifetime. Roger is a teenager who tries to steal a lady's purse on the street of a large city, probably New York. When the lady, Mrs. Luella Bates Washington Jones, grabs Roger she doesn't haul him off to jail. Surprisingly, she brings him into her apartment and cooks a meal for him. She sees that he is young and has probably never been taught the difference between right and wrong. The story echoes the old Christian parable of the Prodigal Son.

If they were to meet ten years later we may hope that Roger would be able to express his gratitude and appreciation a little more formally. At the end of the story he is barely able to say "thank you." Hopefully he would tell Mrs. Jones that he has become a success. He finished school and has a good job. Maybe Roger brings Mrs. Jones a present, such as a new handbag or a stove to cook her meals. Maybe Roger is even working to improve civil rights and the lives of hard-working black people like Mrs. Jones. He might explain to Mrs. Jones that he took the ten dollars she gave him, and instead of buying "blue suedes shoes," he helped a friend or did something constructive with the money. Roger might also ask Mrs. Jones questions about her life, like why she has such a long name.

As for Mrs. Jones, we would guess that her life hasn't changed much. She is still working as a hair dresser late into the evening. She definitely remembers Roger and is interested in how the young man's life has progressed. She would ask him if he was married or had children. She might express pride that he turned out so well and that she contributed to his success. 

When you write the dialogue you should use similar dialect as found in the story. Mrs. Jones would definitely still speak in dialect ("You a lie!" "Ain't you got nobody..."). Maybe Roger speaks more conventional English since he has been educated or maybe he reverts back to a colloquial way of speaking ("Yes'm," "No'm"). 

What were the short-term and the long-term consequences of the Lewis and Clark Expedition?

Lewis and Clark explored the northern portion of the Louisiana Purchase and the Oregon Territory. Their exploration, along with explorations of Zebulon Pike and of Stephen Long, had both short-term and long-term effects.

There were short-term effects of the exploration of Lewis and Clark. One short-term effect was that they were able to provide important geographic information. This information led to the creation of maps of the region. They were also able to gather scientific information about the area they explored. We learned about the wildlife, the soil, and the climate of the region. We also learned about some of the people who lived in the areas they explored.

There were long-term effects of their exploration. Based on the information they gathered, we believed the Great Plains region was a worthless desert. Thus, when policies were developed to deal with the Native Americans, it was decided to relocate the Native Americans to the Great Plains. This led to the forced removal of the Native Americans to the lands west of the Mississippi River beginning around 1830. Their exploration also encouraged other people to head west. People began to move to the Oregon Territory following what became known as the Oregon Trail. The discovery of the South Pass made it possible to travel through the Rocky Mountains to reach the lands bordering the Pacific Ocean. This helped the Oregon Territory grow as Americans moved to that area.

The exploration of Lewis and Clark had many effects, both in the short-term and in the long-term.

In Dorothy Livesay's poem "Bartok and the Geranium", where are the themes of feminism?

This poem by Canadian poet Dorothy Livesay can be read as a commentary on the dynamics between the male and the female. Without context, the reader only has the unnamed "he" and "she" of the poem. Where He "whirls / explodes in space" and is "never content with this small room," She is accepting, the "essence of serenity." In the poem they "together breathe and be" for a short time before He disappears. In the beginning and end of the poem, the reader experiences Her as an entity confined to and content with her own space, accepting of whatever happens. At first glance this might appear to be advancing the view that women just let things happen and don't try to make any changes or reach higher. A feminist lens, however, might help us read this instead as the idea that females tend to find happiness in their surroundings, to reach for satisfaction and enjoyment in their environment, while men are something like a destructive, whirling tornado, which, failing to get what it wants, then leaves.

What factors are responsible for the tragedy of Oedipus the King ?

By definition, a tragedy is a play in which a hero experiences a tragic fall from a high position, typically as the result of a flaw within himself. The hero starts out as basically a good character and usually holds a position of power (like King, as in Oedipus the King). As a result of his tragic flaw, this hero falls from power and often, though not always, dies at the end of the play. Oedipus does not die, but he ends up blind and banished. There are two major factors in Oedipus's downfall. 

First, Oedipus sometimes exhibits qualities of pride or arrogance. This prevents him from learning the truth about his background and parentage earlier in the play. It is important to remember, though, that at the start of the play, Oedipus is seen as basically a good king. He cares about his people's concerns and takes steps to resolve the plague that is wreaking such havoc on his city. Later, though, when Tiresias suggests that Oedipus may be to blame for the plague, Oedipus lashes out and the reader/audience can see his arrogance. Oedipus also demonstrates excessive pride in his conversations with his brother-in-law Creon, whom he accuses of plotting against him with Tiresias. Oedipus's stubborn arrogance creates much of the dramatic irony of the play, as well, because he insists that he could not have been involved in the murder of Laius (which has caused the plague) without knowing that he did, in fact, murder the former king who was also his biological father. 

A second factor in Oedipus's downfall, and thus in the tragedy, is fate. In the play, various characters visit the Oracle at Delphi for guidance. The first instance occurs before the play starts. Oedipus's parents (Jocasta and Laius) learned that they would have a son who would murder his father and marry his mother. In an attempt to cheat fate, Jocasta orders a servant to tie the baby's feet together and leave  him on a mountain. What she doesn't know, though, is that the servant cannot bring himself to do this and instead gives the baby to another man, who brings him to the King and Queen of Corinth, where it is presumed he will be safe. Oedipus is raised as the Corinthian royalty's son, but as he grows up, he starts to hear rumors about his background. He visits the oracle and learns he is destined to kill his father and marry his mother. Thinking the King and Queen of Corinth are his parents, he flees. Along the way, he meets a caravan that includes the King of Thebes, Laius (his biological father) and slays the travelers because he feels they have run him off the road. Oedipus proceeds on to Thebes, where he solves the riddle of the Sphinx and becomes King of Thebes. There, he marries the recently-widowed queen, Jocasta (his biological mother). All of these events show that Oedipus's fate could not be avoided. This furthers the tragedy of the play because Oedipus's fall seems to be out of his own control. 

What does a Rehabilitation Center worker do in the book The Giver?

In Lois Lowry's The Giver, there are many different assignments that Jonas and his friends could receive as they turn twelve years old. In order to see what jobs they enjoy, children volunteer for service hours as early as eight years old. Fiona, for example, enjoys working in the Home of the Old where she takes care of the elderly. In chapter 4, one boy named Benjamin is mentioned to have worked at the Rehabilitation Center for most of his time between ages 8 and 12. This center focuses on helping people who have been physically injured. If someone falls off of a bike and breaks a leg, then after it is healed, he or she can go to the Rehabilitation Center for physical therapy. Benjamin, while volunteering at this center, "had even developed some machines and methods to hasten rehabilitation" (27). So it was no surprise when he was assigned to work there for his life's job. He became so skilled at this job during his service hours that he probably skipped some of the formal training once he was formally assigned to work there.

What is digoxin? How does it interact with other drugs?

Magnesium

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

Magnesium deficiency can increase the risk of toxicity from digoxin. However,
taking magnesium supplements at the same time as digoxin might
impair the absorption of the drug. One should not take the magnesium supplement
during the two hours before or after using digoxin.

Calcium

Effect: Supplementation Possibly Helpful

Although the evidence is quite weak, digoxin might cause a tendency toward
calcium deficiency. Taking calcium supplements can be helpful.

Hawthorn

Effect: Possible Interaction

The herb hawthorn is used to treat congestive heart failure. Whether
it is safe to combine hawthorn with digoxin remains unclear. One small study
failed to find any harmful interaction, but more research must be done before
reliable conclusions can be drawn.

Licorice

Effect: Possible Dangerous Interaction

Licorice root can lower potassium levels in the body, which can be dangerous for a person taking digoxin. The special form of licorice known as DGL (deglycyrrhizinated licorice) is a deliberately altered form of the herb that should not affect potassium levels.

Eleutherococcus senticosus

Effect: Possible Interaction

There has been one report of an apparent elevation in digoxin level caused by the herb Eleutherococcus senticosus (also known as Siberian ginseng). However, the details of the case suggest that the Eleutherococcus product might actually have interfered with a test for digoxin, rather than the digoxin levels themselves.

Horsetail

Effect: Possible Dangerous Interaction

Because horsetail can deplete the body of potassium, it may not be
safe to combine this herb with digitalis drugs.

St. John’s Wort

Effect: Possible Reduction of Effectiveness of Drug

Evidence suggests that St. John’s wort may interact with
digoxin, possibly requiring an increased dosage to maintain the proper effect.
Conversely, persons taking St. John’s wort and whose digoxin dose is adjusted by
their physician should note that suddenly stopping the herb could cause blood
levels of the drug to rise dangerously high.

Uzara

Effect: Possible Harmful Effect

Uzara root (Xysmalobium undulatum) is used to treat diarrhea. It contains substances similar to digoxin and may cause false readings on tests designed to measure digoxin levels. These substances also might alter (either increase or decrease) the effectiveness of digoxin.

Ginkgo biloba

Effect: No Interaction

One study found that simultaneous use of the herb Ginkgo biloba (80 milligrams three times daily of the typical standardized extract) does not change digoxin levels.

Bibliography

Gurley, B. J., et al. “Gauging the Clinical Significance of P-Glycoprotein-Mediated Herb-Drug Interactions: Comparative Effects of St. John’s Wort, Echinacea, Clarithromycin, and Rifampin on Digoxin Pharmacokinetics.” Molecular Nutrition and Food Research 52, no. 7 (2008): 772-779.

Mauro, V. F., et al. “Impact of Ginkgo biloba on the Pharmacokinetics of Digoxin.” American Journal of Therapeutics 10 (2003): 247-251.

Mueller, S. C., et al. “Effect of St John’s Wort Dose and Preparations on the Pharmacokinetics of Digoxin.” Clinical Pharmacology and Therapeutics 75 (2004): 546-557.

Pronsky, Z. M., and J. P. Crowe. Food Medication Interactions. 16th ed. Birchrunville, Pa.: Food-Medication Interactions, 2010.

Tankanow, R., et al. “Interaction Study Between Digoxin and a Preparation of Hawthorn (Crataegus oxyacantha).” Journal of Clinical Pharmacology 43 (2003): 637-642.

Thurmann, P. A., et al. “Interference of Uzara Glycosides in Assays of Digitalis Glycosides.” International Journal of Clinical Pharmacology and Therapeutics 42 (2004): 281-284.

How would one summarize the life of a horse based on Anna Sewell's Black Beauty?

In her children's novel Black Beauty, Anna Sewell paints the life of a horse as being full of hardships; she even likens a horse's life to that of a slave. However, she also offers a ray of hope by showing that horses' lives are made much easier, even happy, when masters are educated and sensible enough that they can refrain from foolish behavior and cruelty.

In Sewell's story, Black Beauty's happiest early days are spent at Farmer Grey's, where he was born as a colt and raised, and at Squire Gordon's Birtwick Park, his first master's home. It is at these two homes that he receives nurturing care. Sewell uses the description of these two homes to paint horses as loyal hard workers who do their best when treated with the most compassion, understanding, and gentleness.

As the story progresses, Sewell paints horses as being enslaved as laborers to cruel masters. When Squire Gordon must sell his home and horses to tend to his wife's illness, Black Beauty begins to find himself in harder work environments under crueler masters, masters who treat him as nothing more than a slave laborer. Sewell uses the descriptions of these homes to show how much suffering the foolishness and cruelty of mankind can inflict on not just human slaves but on innocent enslaved animals as well.

However, unlike human slaves, Black Beauty ends his days fully recovered from the past cruelties inflicted upon him and happy in his final home owned by kindly ladies. He is also under the good care of Joe Green, a stable boy from Squire Gordon's who grew up to be an excellent groom:

My ladies have promised that I shall never be sold, and so I have nothing to fear; and here my story ends. My troubles are all over, and I am at home; and often before I am quite awake, I fancy I am still in the orchard at Birtwick, standing with my old friends under the apple-trees. (Ch. 49, Pt. 4)

Sewell uses this happy ending to show that horses require little to make them their happiest; all they require is love and care.

Who got punished by God in Holes by Louis Sachar?

In the novel Holes, by Louis Sachar, God is called on to mete out punishment to Katherine and Sam, two characters in the back story. Sam is an African American man and Katherine is a white American woman of European descent. They fall in love with each other and share a kiss. A villager who witnesses the kiss and the village sheriff both tell Katherine and Sam that God will punish them.

Sam is punished -- killed -- by the townsfolk when he and Katherine are trying to escape in a boat. Perhaps Katherine is punished by God, because she becomes an outlaw, Kissin' Kate Barlow, and spends the next twenty years robbing and killing, and then dies, taking the secret location of her stolen loot with her.

Perhaps God punished the entire village of Green Lake, because on the day that Sam dies, rain stops falling on Green Lake. The lake dries up and all the townsfolk move away.

God may also punish the Walker family. Trout Walker wants to marry Katherine, and he leads the attack on Sam when he realizes he won't get what he wants. The Walker family tries in vain to find Katherine's buried stolen treasure. The Warden, descendent of the Walker family, even eventually opens Camp Green Lake and forces juvenile delinquents to dig holes in search for the treasure, considered 'punishment' for their misdeeds.  

It's possible that Stanley and the Yelnats family feel as if they are also being punished, but not by God. Stanley's great-great-grandfather, Elya Yelnats, was cursed with bad luck when he neglected to fulfil a promise to an old woman, Madame Zeroni, in the old country. However, all Stanley's bad luck eventually leads him to the buried treasure, the original property of his great-grandfather, also named Stanley Yelnats, and to fulfil Elya Yelnats's promise to Madame Zeroni when Stanley carries Zero (Hector Zeroni) up the mountain. Stanley's lawyer gets involved and the police come and arrest the Warden. So the universe rights itself and punishment rains down on those who deserve it. It is up to the reader to determine how much of the punishment is meted out by God.

Why is Zora Neale Hurston famous?

Zora Neale Hurston is an important part of the canon of twentieth-century American literature for several reasons. While one could claim that the most important reason is the quality of her writing, that is a somewhat subjective matter, as people can reasonably disagree over whether they consider books well- or badly written.

The first reason students are asked to read her work is that she represents a women's voice in the Harlem Renaissance, a movement of predominantly male African-American writers. Her perspective is therefore unusual. She is a forerunner of the more recent black female writers such as Maya Angelou, Toni Morrison, and Alice Walker and important to understanding them. She is also distinctive in being a conservative voice, unlike many of her more liberal peers.

Next, she writes about the early free black cities of Florida, which gives many of her characters roots in an African-American tradition that is not dominated by racism and slavery, but in black success.

Finally, as well as being a creative writer, she studied anthropology and collected, studied, and preserved African-American folklore. Her distinctive use of African-American dialect in part reflects this desire to preserve and make public the unique artifacts of her cultural tradition.

What is the stigma of addiction?

Theories of Stigma and Addiction

No single theoretical model of stigma guides empirical work on the phenomenon, even though there exists a substantial body of theoretical and empirical work on stigma in general and the stigma of addiction in particular. Canadian sociologist Erving Goffman’s 1963 analysis emphasized the effect of the stigmata (the devalued marker) on one’s sense of social identity and the negative effect of stigma on social interaction with others. The stigmatized person may not feel fully human, and the responses of avoidance and disdain by others serve to confirm this compromised humanity.

In their 1984 work, psychologist Edward Jones and colleagues considered the social-cognitive response of others to a person marked by stigmata. The researchers’ basic claim was that the stigma engenders consensual social attributions about the person’s dispositions. An addicted person, for example, may be consensually judged as weak, out of control, and possibly immoral. Research in 1982 proposed that social stigma legitimizes the social exclusion of a person and that social norms governing everyday social interaction do not apply to the stigmatized person. In the workplace, for example, a person with hypertension may be encouraged by coworkers and supervisors to use stress-reduction strategies, exercise, and avoid salt. An addicted person may not be afforded such normative support, and plans may be laid to exclude the employee from the workplace.

Social psychologist Jennifer Crocker and colleagues (1998) took a social-psychological perspective on stigma and focused on group membership that may be a basis of stigma. From the perspective of non-addicted people, those with an addiction are devalued, likely to be judged negatively, and likely to be seen as interchangeable entities. That is, the addicted person will be judged as inferior and will be undifferentiated; people will use the “they’re all the same” bias when evaluating addicts.

Another theoretical approach to stigma, explored by researchers Robert Kurzban and Mark R. Leary in 2001, conceptualizes this phenomenon from the perspective of evolutionary theory. Their theory assumes an evolved brain mechanism that functions to avoid exposure to those who may carry pathogens that can compromise one’s adaptive potential. This mechanism may have a propensity for false positives such that those who are different on a broad array of dimensions (for example, addicted people, the mentally ill, the obese, gay and lesbian individuals, persons with cancer, and persons from different racial and ethnic backgrounds) are evaluated negatively and avoided. For example, this avoidance might occur when one discovers that a potentially attractive romantic partner is in the process of addiction recovery, leading the discoverer to change his or her mind about pursuing the relationship further. While distinct, all theories of stigma acknowledge the negative effects on the self-assessment of the person with the stigmata and the social avoidance it promotes in others.

Adverse Consequences

Stigma can adversely affect entry into treatment for substance abuse. Research published by Katherine M. Keyes and colleagues in 2010 found that persons with an alcohol disorder who believe that alcoholism is a stigmatizing condition are less likely to seek clinical treatment. In a large national sample of 34,653 people with an alcohol use disorder, those who judged their disorder as stigmatizing were 37 percent less likely to seek treatment. Social interventions are needed to reduce the stigma associated with addiction because of the barriers posed for those who need clinical intervention to recover from a substance use disorder.

Bibliography

Crocker, Jennifer, Brenda Major, and Claude Steele. “Social Stigma.” The Handbook of Social Psychology. Ed. Daniel. T. Gilbert, Susan T. Fiske, and Gardner Lindzey. Vol. 2. 4th ed. Boston: McGraw, 1998. 504–53. Print.

Goffman, Erving. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs: Prentice, 1963. Print.

Jones, Edward E., et al. Social Stigma: The Psychology of Marked Relationships. New York: Freeman, 1984. Print.

Keyes, Katherine M., et al. “Stigma and Treatment for Alcohol Disorders in the United States.” American Journal of Epidemiology 172.12 (2010): 1364–72. Academic Search Complete. Web. 9 Nov. 2015.

Kurzban, Robert, and Mark R. Leary. “Evolutionary Origins of Stigmatization: The Functions of Social Exclusion.” Psychological Bulletin 127.2 (2001): 187–208. Academic Search Complete. Web. 9 Nov. 2015.

Room, Robin. “Stigma, Social Inequality and Alcohol and Drug Use.” Drug and Alcohol Review 24.2 (2005): 143–55. Academic Search Complete. Web. 9 Nov. 2015.

Smith, Sharon M., et al. “Examining Perceived Alcoholism Stigma Effect on Racial-Ethnic Disparities in Treatment and Quality of Life among Alcoholics.” Journal of Studies on Alcohol and Drugs 71.2 (2010): 231–36. Print.

From the beginning of Act I, Torvald calls Nora several pet names. What do these names suggest about Torvald's perception of his wife and his...

From the beginning of Act One, Torvald's habit of addressing his wife, Nora, by her pet names is indicative of his personal convictions about gender roles in the domestic sphere. Torvald takes a protective stance towards his wife; he views Nora as someone who needs his masculine help and direction.

In Act One, Torvald invariably addresses Nora using terms that highlight her diminutive size and helpless condition. She is his 'little skylark,' 'little featherhead,' and 'little squirrel.' Torvald scolds Nora indulgently about her spendthrift ways, and he admonishes her to be careful about wasting money. Torvald views his wife as an innocent and child-like woman who is charmingly oblivious to the intricacies of money management.

It is Torvald who sets the tone for all the couple's interactions; when Nora pouts after his pronouncement of 'no debt, no borrowing,' Torvald proceeds to humor her with a generous cash gift for their housekeeping needs. Basically, Torvald's use of pet names for his wife cements his dominant position in the marriage. Because he views her as an innocent, Torvald does not castigate his wife for her seemingly spendthrift ways; he rationalizes that his wife is merely an 'odd little soul' who has inherited her spendthrift tendencies from her father.

Because he views himself as the preeminent intellectual and moral authority in the marriage, Torvald also insists on monitoring his wife's eating habits. He addresses her as 'Miss Sweet Tooth' when he interrogates her about committing a nutritional faux pas. In short, Torvald's use of pet names for Nora indicates his perception of his wife as the weaker partner in their marriage; as the husband, Torvald holds himself responsible for guiding and protecting his wife, whether she likes it or not.

What will probably happen to Rikki-tikki in the future in "Rikki-tikki-tavi"?

Rikki will probably remain in the bungalow and keep snakes from going into the garden.

Rikki-tikki is glad when he washes up in the garden of the British family. They have a house and a garden full of adventure for him. Rikki knows that being a house-mongoose is a big responsibility, but “every well-brought-up mongoose always hopes to be a house-mongoose some day.” Rikki protects the people from snakes, and they make sure he is comfortable and well-fed.

Rikki has a big task ahead of him, because the garden is inhabited by a pair of cobras and a tiny snake. He has to kill all of the snakes in order for the people to be safe in their house. The snakes know that Rikki is a danger to them, and they put up quite a fight.

Nag was thinking to himself, and watching the least little movement in the grass behind Rikki-tikki. He knew that mongooses in the garden meant death sooner or later for him and his family, but he wanted to get Rikki-tikki off his guard.

Rikki battles Nag and Nagaina, killing the male cobra first and then the female one. He dispatches with little Karait too. Soon the garden is safe from snakes, because he has also killed all of the baby cobras. Rikki knows that his responsibility is not ended, however.

Rikki-tikki had a right to be proud of himself; but he did not grow too proud, and he kept that garden as a mongoose should keep it, with tooth and jump and spring and bit, till never a cobra dared show its head inside the walls.

Even though there are no snakes now, that does not mean there will not be snakes in the future. Rikki has to be constantly alert. With him there on patrol, the snakes will stay away and the family will be safe.

What is bullying? How does it affect development?

Introduction

Research professor of psychology Dan Olweus defined bullying as an intentional act of aggression that is designed to harm another person, is often repeated, and reflects a power imbalance between the individuals involved. Bullying can be either direct (as in hitting, kicking, pushing, teasing, verbal harassment, and obscene gestures) or indirect (as in spreading rumors, excluding others, and cyberbullying). Although most people equate bullying with physical attacks, in fact the most common type of bullying involves verbal taunts or threats.

Olweus began the systematic study of bullying in the 1970s in Norway and Sweden. In a survey of more than 150,000 children and youth, Olweus found that 15 percent of the respondents had experienced bullying—9 percent as victims, 7 percent as bullies, and 2 percent as both bully and victim. He later developed the Olweus Bullying Prevention Program in response the 1983 suicide of three bullying victims in Norway.

The first national study of bullying in the United States was conducted by researcher Tonja R. Nansel and colleagues in 1998, and the results were published in 2001. In a survey of more than 15,000 students in sixth though twelfth grades, the researchers found that 17 percent reported being victims of bullying, 19 percent reported perpetrating bullying, and 6 percent reported being both bully and victim.

With the advent of electronic communication, bullying has taken on a new form known as cyberbullying, or online social cruelty. Cyberbullying is defined as bullying that occurs via the Internet (e-mails, instant messages, chat rooms, online games, and so on) or text messages. Unlike traditional bullying, which is most likely to occur at school, cyberbullying can occur anywhere that children and youth have access to technology, leaving targets accessible to perpetrators at any time of the day or night.

Consequences of Bullying

Children and youth who are bullied experience a number of adverse physical and psychological effects. Children who are bullied are more likely to be anxious and depressed and to have lower self-esteem than their peers who do not experience bullying. They are also more likely to have lower academic performance, as assessed by school grades and number of school absences. A survey of Dutch children by researcher Minne Fekkes, Frans I. M. Pijpers, and S. Pauline Verloove-Vanhorick found that, relative to children who are not bullied, children who are bullied have more frequent headaches and stomachaches. These consequences of bullying are most problematic for children and youth who are both bully and victim.

The Bully and the Victim

The typical bullying victim does not fit any specific profile. However, children who are bullied are more likely to be in elementary school than in middle or high school. Some research reports that boys are more likely than girls to be victimized. Other research suggests that boys and girls are equally likely to be victimized, albeit in different ways: boys are more likely than girls to be physically bullied, while girls are more likely to be bullied through indirect methods such as social exclusion and rumor spreading. Unlike boys, who tend to be bullied most often by other boys, girls are bullied by both girls and boys.

Children who are bullied are often quiet, sensitive children who may have low self-esteem. They tend to be social isolates who are more comfortable spending time with adults than with their peers. They also frequently experience anxiety and depression. It is often difficult to know whether these characteristics predispose an individual to be bullied or whether they are a consequence of the bullying that subsequently sets the child up for further victimization.

Just as there is no prototype for a victim of bullying, so too is there no single profile of an individual who bullies. However, children who bully are more often boys than girls and more likely to be in middle or high school. Children and youth who bully are often assertive and impulsive. They fail to follow rules and show little empathy toward others. Although children and youth who bully are often thought to have low self-esteem, in fact they tend to have higher self-esteem and to be less anxious and less depressed than their nonbullied peers. Indeed, psychology professor Jaana Juvonen and her colleagues found in 2003 that children who bully are often the most popular children in the class.

Prevention

The US Health Resources and Services Administration (HRSA) created a list of recommended practices regarding bullying prevention and intervention. Included among these is that bullying prevention efforts must involve changing the school climate and norms. The prevalence of bullying needs to be assessed, and parents, educators, and administrators must unite in their efforts to combat bullying. Staff should be trained to recognize and intervene in bullying situations, and school policies should be clear regarding the consequences for bullying. Bullying prevention needs to be an ongoing effort with repeated training sessions for staff and educational sessions for students and parents.

Bibliography

Bazelon, Emily. Sticks and Stones: Defeating the Culture of Bullying and Rediscovering the Power of Character and Empathy. New York: Random, 2013. Print.

Englander, Elizabeth Kandel. Bullying and Cyberbullying: What Every Educator Needs to Know. Cambridge: Harvard UP, 2013. Print.

Fekkes, Minne, Frans I. M. Pijpers, and S. Pauline Verloove-Vanhorick. “Bullying Behavior and Associations with Psychosomatic Complaints and Depression in Victims.” Journal of Pediatrics 144.1 (2004): 17–22. Print.

Hirsch, Lee, and Cynthia Lowen, eds. Bully: An Action Plan for Teachers, Parents, and Communities to Combat the Bullying Crisis. With Dina Santorelli. New York: Weinstein, 2012. Print.

Kowalski, Robin M., Susan P. Limber, and Patricia W. Agatston. Cyber Bullying: Bullying in the Digital Age. Malden: Blackwell, 2008. Print.

Nansel, Tonja R., et al. “Bullying Behavior among US Youth: Prevalence and Association with Psychosocial Adjustment.” Journal of the American Medical Association 285.16 (2001): 2094–100. Print.

Olweus, Dan. Bullying at School: What We Know and What We Can Do. New York: Blackwell, 1993. Print.

Patchin, Justin W., and Sameer Hinduja, eds. Cyberbullying Prevention and Response: Expert Perspectives. New York: Routledge, 2012. Print.

United States. Dept. of Health and Human Services. Stop Bullying.gov. US Dept. of Health and Human Services, n.d. Web. 27 Feb. 2014.

What is George Orwell's tone in the first two paragraphs of "Shooting an Elephant"?

George Orwell’s short story "Shooting an Elephant" opens with the narrator discussing his setting and station in life at the time. The tone of the first two paragraphs is serious and conveys an individual’s conflict between long-held beliefs about the world and real-life experiences in that world. “I had already made up my mind that imperialism was an evil thing,” states the narrator at the beginning of paragraph two. He opens the story by declaring that he was hated by most people in Burma, speaking in the tone of one ostracized from the rest of the world. He also claims to hate his job, but at the same time is impressing upon the reader that his treatment by the Burmese people is awful. Later in that second paragraph, the narrator shares that “I could get nothing into perspective. I was young and ill-educated . . .” The overall tone expresses a highly stressful situation. The narrator clearly illustrates that he had solidly formed opinions concerning the British Empire, but that he was too uninformed to fully understand his own beliefs and role in the Burmese society.

“Shooting an Elephant.” The Literature Network. Jalic Inc., 2000-2016. Web. 30 March 2016.

Who are three stakeholders in the controversy over the ban on large sugary drinks in New York City?

Here are three groups that would have stakes in the proposed ban on large, sugary drinks in New York City:

1. Bottlers of soda and/or vendors of the syrup used to make the soda in restaurants and other establishments.  These groups clearly have an economic stake in this issue.  If Bloomberg’s ban were to become law, they would surely lose money.  Therefore, their likely position will be that the ban should not become/remain law.


2. Public health advocates.  These people do not really have a financial stake in the issue.  However, they do have a stake in it because they want to improve the health of people in New York City.  They would certainly argue that the ban should remain in place because it is clear that sugary drinks are bad for people’s health.


3.  Firms that sell drinks that compete with the drinks that are banned.  For example, Bloomberg’s ban did not apply to sweet coffee drinks such as those sold at Starbucks.  The firms that sell these drinks would have an interest in the ban because it would harm their competitors.  Therefore, they would most likely support the ban unless they worried that it would eventually be changed to apply to them as well.

Frank, who is 18 years old, applies for a job as a clerk in a sporting goods store in Ontario. The store manager is impressed with Frank and says...

In my answer to this question, I will discuss both sides of the issue where that seems useful.

One the one hand, you can say that the store manager has violated Frank’s human rights because he has refused to hire Frank on the basis of a traffic violation.  You can argue that a traffic violation is not relevant to the position Frank applied for.  People should have a right to be hired (or rejected) based on their actual qualifications for the job, not based on any other characteristic. 

On the other hand, you can argue that the store manager did not violate Frank’s rights.  There are two possible arguments here.  First, we can say that the careless driving conviction is relevant.  You can say that a person who would drive “without reasonable consideration for other persons” is a person who does not have a good moral character.  You want people with good characters working for you so this is relevant.  Second, you can say that society does not need to protect people from discrimination on the basis of criminal background.  We should not discriminate against women, minorities, the disabled, and other such groups, but people who commit crimes is not a group of this nature.

You can argue that we would be more lenient with a 17 year-old.  A 17 year-old has less capacity to control themselves.  We should expect that they would make bad choices at times.  On the other hand, you can also argue that a 17 year-old who would drive carelessly would be just as bad for your business as an 18 year-old who would do so.

Finally, I would argue that there is no way you can say that the manager violated Frank’s rights if Frank were applying for a job that involves driving.  The careless driving conviction would be directly and indubitably related to that job.  There would be no reason to say that the manager should not consider the conviction in that situation.

Please provide a character sketch of Edward Everett Hale.

Dr. Edward Everett Hale was a longtime dear friend of Helen Keller.  He was a distant relation of hers through her maternal grandmother, who was an Everett.

Helen met Dr. Hale when she was eight-years-old.  Helen described him as having "wise, tender sympathy" for her as his "strong hand... helped [her] over many rough places."  Helen recognized that Dr. Hale was loyal to his country and kind to others.  It is clear through Helens writings that she greatly admired and respected Dr. Hale.  She even praised him as "a prophet and an inspirer of men, and a mighty doer of the Word, the friend of all his race."  He was a man who had a fresh way of thinking, according to Helen.  His approach was like "new wine."  

Dr. Hale was both understanding and accommodating to Helen.  He sought to connect with her in spite of her deafness and blindness.  When Dr. Hale wrote Helen letters, he would sign them by "pricking his signature in braille" on the paper.  Helen was able to read his signature because of this.

The House of Representatives is capped at 435, or several hundred thousand people per representative. If the Framers had used the same guidelines...

The Framers believed that in order for a government to be truly answerable to its constituents, it needed to make its representatives easily accessible to the people who voted them in and out of office. One of the main reasons that Jefferson, Adams, Washington and the other Framers objected to being ruled by England was that the parliament was thousands of miles away, and therefore hard to reach, and detached from the day to day lives of American colonists.

Jefferson said (and wrote) many times that for a government official to serve effectively, that official needed to fear the wrath of those he governed. In other words, if the people being governed got angry at the policies enacted by their representatives, then those people should be able to physically accost their representatives, and if necessary, forcibly remove them from office.

The only way to guard against corruption and tyranny, according to the more radical Framers like Jefferson, was to ensure that the government was responsive to the people, and to achieve that responsiveness, the people needed to be able to overthrow the government by any means necessary, including violence. If the representatives could seclude themselves far away from the people that they were supposed to govern, then those representatives would not be able to know what it was that the citizens wanted and needed. Constituents were supposed to be able to air their grievances and seek redress from their representatives whenever there was a problem. That is why Jefferson and the anti-Federalists were horrified by the proposal to create a strong central government, far away from the prying eyes of most of its citizens.

Jefferson, Burr, Samuel Adams and other anti-Federalist Framers believed that only local governments could be responsive to their citizenry. The creation of a bicameral legislature, with the more frequently elected house, and less frequently, indirectly-elected senate, was supposed to balance the need for stability with the need for responsiveness.

By making our representatives speak for hundreds of thousands of citizens, we have effectively diluted each individual citizen's power and influence over government policy. Even the Federalists acknowledged the need for a more directly line of communication between citizens and their elected officials. Yet none of the Framers could have imagined that the small, relatively homogenous, loosely federated state they founded in the late 1800s would grow to become the gargantuan polyglot nation it is today. 

Who is the Scarlet Pimpernel in the novel The Scarlet Pimpernel?

The main character of the swashbuckling adventure novel written by Baroness Emmuska Orczy, the Scarlet Pimpernel is a flamboyant heroic character who is sympathetic to the French aristocracy during the French Revolution.

With his ingenious escapades, he is able to smuggle these aristocrats past the revolutionary guards in France. Then, after completing his capers, the Pimpernel leaves a note, boldly describing how it was effected. This note is signed with a red, star-shaped flower from England that is called a scarlet pimpernel.

The Pimpernel's real name is Sir Percy Blackeney, and he is married to Marguerite St. Just, who is called Lady Blakeney. A rich and fashionable man, Sir Percy, however, is perceived in his own country as a rather dull and somewhat foolish man because he has appeared inept before the Comtesse de Tournay's son, who has challenged him to a duel. As Sir Percy fumbles, Lady Blakeney intervenes and cleverly saves the situation. Of course, this perceived ineptness on the part of Sir Percy is but a ploy to keep his identity secret. 

What is Sinclair Lewis's topic in the third and fourth paragraphs of The Jungle? What is the message of the two paragraphs?

In the third and fourth paragraphs of The Jungle, Lewis focuses on the bride Ona Lukoszaite, an innocent young Lithuanian woman who has just turned 16. Lewis describes her joy at being married, calling it the "supreme hour of ecstasy in the life of one of God's gentlest creatures." He takes some time to describe Ona in her white muslin wedding dress and "stiff little veil." She wears new white cotton gloves and has exactly five pink paper roses "twisted" into her veil and eleven green rose leaves. She twists her hands together from nervousness. Lewis paints a detailed picture of her to humanize her for the reader so that she is not simply a faceless immigrant. 

The purity of little Ona and her white wedding clothes contrast with the locale of her wedding reception, the back room of a saloon behind the stockyards where livestock is slaughtered in filthy conditions. While immigrants like Ona and her new husband and their families are brutally exploited in a number of ways by American society, Lewis wants us to know from the very start of the novel that they are people like us full of hopes, joys and a desire for a better life, no matter how poor and foreign they might be. 

How does Shelley present time in "Ozymandias"?

In "Ozymandias," time is shown to be constant, sharply contrasting with the way human beings live their lives.

Shelley shows human beings to be finite. They are transitory, entering and leaving. This impermanence is seen in the poem's opening about meeting "a traveller from an antique land." The traveller passes and is far from permanent. Ozymandias is seen in the same way. He believes himself to be meaningful and powerful, someone who can tell others to "Look on my works, ye Mighty, and despair!" However, his statue has eroded and there is nothing left of his reign. In these examples, human beings are temporal creatures.

In the poem, the only constant is time. It is as consistent as the stretching sand that concludes the poem. Time keeps going as it permanently encompasses the life of human beings. While human beings are impermanent and not lasting, time continues its march. Time was there when Ozymandias ruled and when the statue was built. It continues even after Ozymandias dies and the statue crumbles. Time is there when the speaker meets the traveller, and will be there when both of them die as well. Shelley portrays time as infinite and inescapable. We can see that the permanent nature of time contrasts with the way human beings live their lives.

Compare and contrast Dexter's desire for material success with his desire for Judy.

 In F. Scott Fitzgerald’s “Winter Dreams” financial success was Dexter’s ambition but Judy Jones was his obsession. From a young age, Dexter dreamed of joining the ranks of the wealthy men he caddied for at the country club. He wanted to be more than the other young men and proved that by choosing a prestigious college where he was uncomfortable with his lack of spending money. By the time he was in his early twenties, he was well on his way to financial success with his business acumen. His small laundry business quickly grew as did his wealth.

He was invited back to play golf at the country club where he caddied as a boy. It was during this golf game that he was reintroduced to Judy Jones. The obstinate little girl had grown into a feisty, beautiful young woman who broke men’s hearts on a regular basis.

Dexter became a successful, self-made man with the airs that he acquired during his years at university. 

He made money. It was rather amazing. After college he went to the city from which Black Bear Lake draws its wealthy patrons. When he was only twenty-three and had been there not quite two years, there were already people who liked to say: "Now there's a boy--"

Despite his rise, Judy could always bring him to his knees. She was a fickle lover to the many men she dated. For a number of years, he lived for time spent with this illusion of a lover.

Already he was playing with the idea of going East to New York. He wanted to take Judy Jones with him. No disillusion as to the world in which she had grown up could cure his illusion as to her desirability.

Eventually, Dexter became engaged to another young lady who would further his dreams of a stable home life in which his children grew up with the easy attitudes of the rich. On the night before his engagement, Judy comes back into his life. Once again he is drawn to her. He leaves his fiancée and wedding plans to spend one month with Judy Jones.

When their relationship ends on her terms, he sells his businesses and moves to New York City where he easily furthers his financial success. A gentleman from Detroit visits his New York office, and shares news of Judy’s sad marriage to a philandering man. Dexter realizes, although he became a financial success, he failed to reach his dreams.

Even the grief he could have borne was left behind in the country of illusion, of youth, of the richness of life, where his winter dreams had flourished.

What attitude does James take toward Annie in The Miracle Worker?

James is Helen’s half-brother, and with his negative attitude, he emphasizes the ‘half,’ desiring to distance his association with her.  He wants Helen sent away to an asylum, out of sight and out of mind.

James feels no sympathy for Helen and shows little respect to his parents or Annie. When he meets Annie at the train station, he decides she is too young and inexperienced to deal with the uncontrollable Helen. He calls Annie “half a governess” to emphasize his point.

He also scorns Annie’s attempts to teach Helen. One afternoon when he sees Annie trying to teach Helen finger spelling, he remarks, “You think she knows what she's doing? She's a monkey. She imitates everything.”

Later he tells Annie, “You'd be quite a handsome girl if it weren't for your eyes.” This isn’t exactly a terrific compliment!

But as James sees Annie’s amazing progress with Helen, his sour attitude toward Annie and even Helen begins to change. He supports Annie’s methods, even standing up to his father on her behalf:

“She's right, Kate's right, I'm right and you're wrong. If you drive her away from here it will be over my dead— chair, has it never occurred to you at on one occasion you might be consummately wrong?” 

Despite his complete negativity throughout much of the play, at the end James respects and even likes Annie.

What is von Gierke disease?

Risk Factors

Von Gierke disease is an autosomal recessive trait that requires that both
parents pass on the mutations. In September 2013, Deeksha Bali reported eighty
percent of cases are type Ia, and 20 percent are type Ib. The incidence is about
one case per 100,000 births. Type Ia is more common in Ashkenazi Jewish populations, where the incidence is 1 case per 20,000 births.

Etiology and Genetics

Normally, the body stores excess sugar as glycogen in the liver and kidneys. As the glucose is needed for energy and to
support body functions, it is freed from the glycogen by a process that requires
the enzyme G6P. A
similar process converts proteins and fats to glucose. Without G6P, blood glucose
levels are unstable, and the body develops large stores of glycogen. The drop in
blood glucose levels several hours after meals or at night causes severe
hypoglycemia, which can be fatal. Chronic hypoglycemia
causes other problems of metabolism. Levels of lactic acid, triglycerides, and
uric acid are elevated.

Von Gierke type Ia is caused by mutations on chromosome 17 at 17q21. As
reported by Roseline Froissart et al, more than eighty-five mutations had been
identified as of May 2011. Mutations tend to vary according to country of origin.
The more common mutations are R83C, Q347X,
459insTA, and R83H. These mutations stop
production of G6P. According to Deeksha Bali et al, there have been no strong
genotype-phenotype correlations identified for Von Gierke disease.

Von Gierke type Ib is caused by the absence of translocator1 gene
(G6PT1) located on chromosome 11 at 11q23. Some of the
mutations are due to splicing bases from one exon to another. Froissart reports
more than eighty mutations have been identified. The more common mutations are
1211delCT, G339C, and
W188Rv.

Symptoms

Symptoms of von Gierke disease develop right after birth and can be fatal if not treated. The infant can demonstrate symptoms of irritability, tremors, cyanosis, seizures, apnea, and coma. Usually, the disease is diagnosed at this time. If not, the child exhibits lethargy, difficult arousal from overnight sleep, overwhelming hunger, poor growth, increase in abdominal girth, easy bruising, and puffy cheeks as a result of fat deposits.

Older patients have poor tolerance of fasting, severe hepatomegaly, growth retardation, osteoporosis, gout, and enlarged kidneys. With type Ib, there are frequent infections.

Screening and Diagnosis

Due to its rarity, von Gierke disease is not screened for unless there is a family history. The diagnosis includes the presenting symptoms. Blood tests of glucose, lactic acid, triglycerides, and uric acid are performed four hours after eating. Typically, the blood glucose is quite low, while lactic acid, triglycerides, and uric acid are elevated. For type Ib, a complete blood count with white cell differential is performed to evaluate for decreased neutrophils. Ultrasounds of the liver and kidneys demonstrate organ enlargement.

The liver is biopsied and examined for G6P activity and deposits of glycogen.
Growth and development is behind schedule. Genetic
testing is performed for the chromosomal changes that occur
with von Gierke disease.

Treatment and Therapy

Von Gierke disease is treated by a diet that is high in starches and glucose.
According to guidelines from the European Study on Glycogen Storage
Disease, as reported by Rake et al, this diet should be 60 to 70
percent carbohydrate, 10 to 15 percent protein, and the remainder from fat.
Galactose, fructose, sucrose, and lactose should be avoided, since these sugars
require G6P to be converted to glucose. Carbohydrates, such as glucose or corn
starch, are provided during the night. This is done using a gastric tube with
continuous infusion of glucose or starch, or by night feedings with uncooked corn
starch.

Elevated uric acid levels are treated with the drug allopurinal, which
interferes with its production. During childhood, episodes of metabolic acidosis
can occur during minor illnesses or vomiting. They are treated with intravenous
fluids in order to restore glucose levels. If all else fails, a liver transplant
can be performed to treat von Gierke disease.

Prevention and Outcomes

There is no way to prevent von Gierke disease unless there is a family history
of the condition. In this case, genetic testing is performed.

There is no cure for the disease. Patients should be taught to observe for
hypoglycemia and how to treat it. Long-term complications of von Gierke disease
include seizures, kidney failure, hepatic tumors, kidney stones, and brain damage.
Type Ib can also lead to inflammatory bowel disease, frequent lung and skin
infections, secondary diabetes mellitus, and acute myelogenous leukemia.

Bibliography

Bali, Deeksha S., Yuan-Tsong Chen and
Jennifer L Goldstein. "Glycogen Storage Disease Type I."
GeneReviews. Ed. Roberta A. Pagon et al. Seattle: U of
Washington, Seattle, 1993–2014. NCBI Bookshelf. Natl.
Center for Biotechnology Information, 19 Sept. 2013. Web. 11 Aug.
2014.

Froissart, Roseline, et al.
"Glucose-6-Phosphatase Deficiency." Orphanet Journal of Rare
Diseases 6.27 (2011): n. pag. Web 18 Aug. 2014.

Haldeman-Englert, Chad. "Von Gierke Disease."
MedlinePlus. US Natl. Lib. of Medicine, 7 May 2013. Web.
11 Aug. 2014.

Nussbaum, Robert,
Roderick R. McInnes, and Huntington F. Willard. Thompson and
Thompson Genetics in Medicine. 7th ed. Philadelphia: Saunders,
2007. Print.

Pritchard, Dorian J.,
and Bruce R. Korf. Medical Genetics at a Glance. 3rd ed.
Hoboken: Wiley-Blackwell, 2013. Print.

Rake, JP, et al. "Guidelines for Management
of Glycogen Storage Disease Type I - European Study on Glycogen Storage
Disease Type I (ESGSD I)." European Journal of Pediatrics.
161 (2011): S112-S119. PDF File.

"Type I Glycogen Storage Disease."
Association for Glycogen Storage Disease. Assoc. for
Glycogen Storage Disease, 10 Aug. 2014. Web. 11 Aug. 2014.