Find the angle of x in the shapes in the image below. A rectangle, obtuse triangle, and scalene triangle.

Hello!

1. The angles EAB and BEA are complementary, their sum is 90° (from the right triangle ABE). Therefore BEA=90°-36°=54°. Next, angles BEA, AED and DEC form a straight angle CEB. So 54°+x+62°=180°, x=180°-54°-62°=64°.

2. The angle XZY is the exterior angle for the triangle XZW, therefore XZY=x+32°. Because the triangle XYZ is equilateral, all its angles are the same x+32°. Now consider the triangle XYW and sum its angles:

X+Y+W = (x+32°+x) + (x+32°) + 32° = 3(x + 32°) = 180° = 3*60°,

so x=60°-32°=28°.

3. The angle PRQ is the same as the angle PQR, because PQ=PR. And also it is the exterior angle for the triangle PRS. Thus 71°=x+25° and x=71°-25°=46°.

What is cystitis?

Causes and Symptoms

The term “cystitis” is a combination of two Greek words: kistis, meaning hollow pouch, sac, or bladder, and itis, meaning inflammation. Cystitis is often used generically to refer to any nonspecific inflammation of the lower urinary tract. Specifically, however, it should be used to refer to inflammation and infection of the bladder. Three true symptoms denote cystitis: dysuria, frequent urination, and hematuria.

The symptoms of cystitis may appear abruptly and, often, painfully. One of the trademark symptoms signaling an onset is
dysuria (burning or stinging during urination). It may precede or coincide with an overwhelming urge to urinate, although the amount passed may be extremely small. In addition, some sufferers may experience
nocturia (sleep disturbance because of a need to urinate). In many cases there may be pus in the urine. Origination of
hematuria (blood in the urine), which often occurs with cystitis, may be within the bladder wall, in the urethra, or even in the upper urinary tract. These painful symptoms should be enough to spur one to seek medical attention; if left untreated, the bacteria may progress up the ureters to the kidneys, where a much more serious infection, pyelonephritis, may develop. Pyelonephritis can cause scarring of the kidney tissue and even life-threatening kidney failure. Usually kidney infections are accompanied by chills, high fever, nausea or vomiting, and back pain that may radiate downward.

Acute cystitis can be divided into two groups. One is when infection occurs with irregularity and with no recent history of antibiotic treatments. This type is commonly caused by the bacteria Escherichia coli. Types of bacteria other than E. coli
that can cause cystitis are Proteus, Klebsiella, Pseudomonas, Streptococcus, Enterobacter, and, rarely, Staphylococcus. The second group of sufferers have undergone antibiotic treatment; those bacteria not affected by the antibiotics can cause infection. Most urinary tract infections are precipitated by the patient’s own rectal flora. Once bacteria enter the bladder, whether they will cause infection depends on how many bacteria are present, how well the bacteria can adhere to the bladder wall, and how strongly the bladder can defend itself. The bladder’s inherent defense system is the most important of the factors.

One of the natural defense mechanisms employed by the bladder is the flushing provided by regular urination at frequent intervals. If fluid intake is sufficient—most urologists consider this amount to be sixty-four ounces daily—there will be regular and efficient emptying of the bladder, which can wash away the bacteria that have entered. This large volume of fluid also helps dilute the urine, thereby decreasing bacterial concentration. Another defense mechanism is the low pH of the bladder, which also helps control bacterial multiplication. It may be, too, that the bladder lining employs some means to repel bacteria and to inhibit their adherence to the wall. Some researchers theorize that genetic, hormonal, and immune factors may help determine the defensive capability of the bladder.

Cystitis occurs most frequently in women, in large part because of the length and positioning of the urethra. Many women experience their first episode of cystitis as they become sexually active. So-called honeymoon cystitis, that related to sexual activity, comes about when intercourse (penetrative or nonpenetrative) forces bacteria upward through the urethra. From the urethra, the bacteria travel to the bladder. Unless they are voided through urination upon conclusion of intercourse, they may multiply, causing inflammation and infection. Bathing after intercourse is too late to prevent the E. coli
from being pushed into the urethral opening. Some instances of cystitis may be reduced if there is adequate vaginal lubrication prior to intercourse and vaginal sprays and douches are avoided.

Women who use a
diaphragm as birth control are more likely to develop urinary tract infections than other sexually active women. The reason for this increased likelihood may be linked to the more alkaline vaginal environment in diaphragm users, or perhaps to the spring in the rim of the diaphragm that exerts pressure on the tissue around the urethra. Urine flow may be restricted, and the stagnant urine is a good harbor for bacterial growth.

When urine remains in the bladder for an extended period of time, its stagnation may allow for the rapid growth of bacteria, thereby leading to cystitis. Urine flow may be restricted by an enlarged prostate or pregnancy. Diabetes mellitus may also lead to cystitis, as the body’s resistance to infection is lowered. Infrequent urination for whatever reason is associated with a greater likelihood of cystitis.

Less frequently, cases have been linked to vaginitis as a result of Monilia or Trichomonas. Yeasts such as these change the pH of the vaginal fluid, which will allow and even encourage bacterial growth in the perineal region. Sometimes, it is an endless cycle: A patient takes antibiotics for cystitis, which kills her protective bacteria and allows the overgrowth of yeasts. The yeasts cause vaginitis, which may promote another case of cystitis, and the cycle continues. In fact, recurrent cystitis may be a result of an inappropriate course of antibiotic treatment; the antibiotic is not specific to the bacteria. More rarely, recurrent cases may be a result of constant seeding by the kidneys or a bowel fistula. The most common cause of recurrent cystitis, however, is new organisms from the rectal area that invade the perineal area. This new pool may be inadvertently changed by antibiotic treatment.

A less common but often more severe kind of cystitis is interstitial cystitis, an inflammation of the bladder caused by nonbacterial causes, such as an autoimmune or allergic response. With this type of cystitis, there may be inflammation or ulceration of the bladder, which may result in scarring. These problems usually cause frequent and painful urination and possible hematuria. What separates interstitial cystitis from acute cystitis is that it primarily strikes women in their early to mid-forties and that, while urine output is normal, soon after urination, the urge to void again is overwhelming. Delaying urination may cause a pink tinge to appear in the urine. This minimal bleeding is most often a result of an overly small bladder being stretched so that minute tears in the bladder wall bleed into the urine. This form is often hard to diagnose, as the symptoms may be mild or severe and may appear and disappear or be constant.

Treatment and Therapy

Medical students are typically underprepared to deal with the numerous cases of cystitis. The student is told to test urine for the presence of bacteria, prescribe a ten-day course of antibiotics, sometimes take a kidney x-ray or perform a cytoscopy, and then perhaps prescribe more antibiotics. If the patient continues to complain, perhaps a painful dilation of the urethra or cauterizing (burning away) of the inflamed skin is performed. None of these procedures guarantees a cure.

Diagnosis of cystitis should be relatively easy; however, in a number of cases it is misdiagnosed because the doctor has failed to identify the type of bacteria, the patient’s history of past cases, and possible links between cystitis and life factors (sexual activity, contraceptive method, and diet, for example). A more appropriate antibiotic given at this point might lower the risks of frequent recurrences. Diagnosis of urinary tract infection takes into account the medical history, a physical examination of the patient, and performance of special tests. The history begins with the immediate complaints of the patient and is completed with a look back at the same type of infections that the patient has had from childhood to the present. The physician should conduct urinalysis but be cognizant that if the urine is not examined at the right time, the bacteria may not have survived and thus a false-negative reading may occur.

One special test, a cytoscopy, is used to diagnose some of the special characteristics of cystitis. These include redness of the bladder cells, enlarged capillaries with numerous small hemorrhages, and in cases of severe cystitis, swelling of bladder tissues. Swelling may be so pronounced that it partially blocks the urethral opening, making incomplete emptying of the bladder likely to occur. Pus pockets may be visible.

In the case of women who first experience cystitis when they become sexually active, doctors usually instruct the patients to be alert to several details. They should wash or shower before intercourse and be warned that certain contraceptive methods and positions during intercourse may increase their chances of becoming infected. To decrease the chance of introducing the contamination of bowel flora to the urethra, wiping from front to back after urination and defecation is advised.

Children are not immune to attacks of cystitis; in fact, education at an early age may aid children in lowering their chances of developing cystitis. Some of the following may be culprits in causing cystitis and maintaining a hospitable environment for bacteria to grow: soap or detergent that is too strong, too much fruit juice, overuse of creams and ointments, any noncotton underwear, shampoo in the bath water, bubble bath, chlorine from swimming pools, and too little fluid intake. Once children reach the teenage years, many of the above remain causes. Added to them are failure to change underwear daily, irregular periods, use of tampons, and the use of toiletries and deodorants. Careful monitoring of these conditions can greatly reduce the risk of recurrent infections.

The symptoms of cystitis are often urgent and painful enough to alert a sufferer to visit a physician as quickly as possible. Such a visit not only makes the patient feel better but also decreases the chances that the bacteria will travel toward and even into the kidney, causing pyelonephritis. Antibiotic therapy is the typical mode of treating acute or bacterial cystitis. The antibiotics chosen should reach a high concentration in the urine, should not cause the proliferation of drug-resistant bacteria, and should not kill helpful bacteria. Some antibiotics used to treat first-time sufferers of cystitis with a high success rate (80 to 100 percent) are TMP-SMX, sulfisoxazole, amoxicillin, and ampicillin. Typically, a three-day course of therapy not only will see the patient through the few days of symptoms but also will not change bowel flora significantly. When E. coli
cause acute cystitis, there is a significant chance that one dose of an antibiotic such as penicillin will effectively end the bout, and again, the bowel flora will not be upset. Such antibiotics, when chosen carefully by the physician to match the bacteria, are useful in treating cystitis because they act very quickly to kill the bacteria. Sometimes, enough bacteria can be killed in one hour that the symptoms begin to abate immediately.

Yet antibiotics are not without their drawbacks: they may cause nausea, loss of appetite, dizziness, diarrhea, and fatigue and may increase the likelihood of yeast infections. The most common problem is the one posed by antibiotics that destroy all bacteria of the body. When the body’s normal bacteria are gone, yeasts may proliferate in the body’s warm, moist places. In one of the areas, the vagina, vaginitis causes a discharge that can seep into the urethra, causing the symptoms of cystitis to begin all over again.

For those suffering from recurrent cystitis, the treatment usually is a seven- to ten-day course of antibiotic treatment that will clear the urine of pus, indicating that the condition should be cured. If another bout recurs fairly soon, it is probably an indication that treatment was ended too quickly, as the infective bacteria were still present. To ensure that treatment has been effective, the urine must be checked and declared sterile.

Because cystitis is so common, and because many are frustrated by the inadequacies of treatment, self-treatment has become very popular. Self-treatment does not cure the infection but certainly makes the patient more comfortable while the doctor cultures a urine specimen, determines the type of bacteria causing the infection, and prescribes the appropriate antibiotic. Monitoring the first signs that a cystitis attack is imminent can save a victim from days of intense pain.

Those advocating home treatment do not all agree, however, on the means and methods that reduce suffering. All agree that once those first sensations are felt, the sufferer should start to drink water or water-based liquids; there is some disagreement on whether this intake should include fruit juice, especially cranberry juice. Some believe that the high acidic content of the juice may act to kill some of the bacteria, while others believe that the acid will only decrease the pH of the urine, causing a more intense burning sensation as the acidic urine passes through the inflamed urethra. An increased fluid intake produces more copious amounts of urine and, by diluting the urine, decreases its normal acidity. The excess urine acts to leach the bacteria from the bladder. More dilute urine will relieve much of the burning discomfort during voiding. If a small amount of sodium bicarbonate is added to the water, it will aid in alkalinizing the urine. The best self-treatment is to drink one cup of water every twenty minutes for three hours; after this period, the amount can be decreased. A teaspoonful of bicarbonate every hour for three or four hours is safe, unless the person suffers from blood pressure problems or a heart condition. Additionally, the patient may wish to take a painkiller such as acetaminophen. If lifestyle permits, resting will enhance the cure, especially if a heating pad is used to soothe the back or stomach. After the frequent visits to the toilet, cleaning the perineal area carefully can reduce continued contamination.

Diagnosis of interstitial cystitis can be made only using a cytoscope. Since the cause is not bacterial, antibiotics are not effective in treating this type of cystitis. To enhance the healing process of an inflamed or ulcerated bladder as a result of interstitial cystitis, the bladder may be distended and the ulcers cauterized; both procedures are done under anesthesia. Corticosteroids may be prescribed to help control the inflammation.

Perspective and Prospects

Infection in males is far less frequent than in females, although it does occur. Unfortunately, most urologists are better versed in male problems. Female specialists, gynecologists, treat the reproductive system but may not have studied female urinary dysfunction. If a man suffers from urinary dysfunction, he should seek the services of a urologist. A woman who has interstitial cystitis should also see a urologist, specifically one who knows about this form of cystitis. If a woman is experiencing recurrent cystitis, she is probably already seeing a gynecologist or an internist; however, if she is not getting relief, she should avail herself of a urologist, especially one specializing in female urology, if possible.

A strong social stigma is associated with bladder dysfunction, which may create an obstacle when treatment is necessary. From the time of infancy, some children are taught that anything to do with bladder or bowel function is shameful or dirty. Therefore, when dysfunction occurs, self-esteem may be decreased. As a result, the sufferer may fail to ask for help. Such a reaction must be overcome if there is to be significant progress in treating and conquering cystitis.

Bibliography

A.D.A.M. Medical Encyclopedia. "Cystitis—Acute." MedlinePlus, September 17, 2010.

A.D.A.M. Medical Encyclopedia. "Cystitis—Noninfectious." MedlinePlus, April 16 2012.

Chalker, Rebecca, and Kristene E. Whitmore. Overcoming Bladder Disorders. New York: HarperCollins, 1990.

Cohen, Barbara J. Memmler’s The Human Body in Health and Disease. 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009.

Gillespie, Larrian, with Sandra Blakeslee. You Don’t Have to Live with Cystitis. Rev. ed. New York: Quill, 2002.

Parker, James N., and Philip M. Parker, eds. The Official Patient’s Sourcebook on Urinary Tract Infection. San Diego, Calif.: Icon Health, 2002.

Riley, Julie. "Acute Cystitis." HealthLibrary, April 12, 2013.

Schrier, Robert W., ed. Diseases of the Kidney and Urinary Tract. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007.

What do we learn about the Holden's brother D.B. in The Catcher in the Rye?

At the beginning of the story, Holden is in California retelling the story that landed him in a mental hospital. His older brother D.B. also lives in California working as a successful screenwriter. Like a good big brother, he visits Holden every weekend and says he will drive him home to New York in his Jaguar when the time comes. Before D.B. could afford Jags, he wrote a short story called The Secret Goldfish which Holden really likes (1). He's so upset that D.B. went to Hollywood to write for movies because Holden hates movies; so, he calls his brother a prostitute for selling himself short rather than becoming a real author. 

Holden isn't the only one to think that D.B. is selling his talent out to the wrong industry. One of Holden's former English teachers from Elkton Hills also disagrees with D.B.'s choice to move to California and called him up to tell him so before he left. Holden says, "Mr. Antolini said that anybody that could write like D.B. had no business going out to Hollywood. That's exactly what I said, practically" (181).

At one point, Holden dreams of living in a cabin and inviting his family over for visits. He would have the following rules, though:

"I'd let old Phoebe come out to visit me in the summertime and on Christmas vacation and Easter vacation. And I'd let D.B. come out and visit me for a while if he wanted a nice, quiet place for his writing, but he couldn't write any movies in my cabin, only stories and books. I'd have this rule that nobody could do anything phone when they visited me. If anybody tried to do anything phony, they couldn't stay" (205).

Here again we see Holden mention D.B. being in his life, but not if he's doing anything with movies. It's a bit funny, actually. Holden isn't as close with D.B. obviously, as he was with his little brother Allie who died of Leukemia, but he doesn't completely forget about him, either. 

What is perinatology?

Science and Profession

Practitioners of perinatal medicine include physicians and advanced practice nurses with a specialty in perinatology (neonatal and pediatric nurse practitioners). They then complete additional training specifically related to the perinatal period (defined variously as beginning from twenty to twenty-eight weeks of gestation and ending one to four weeks after birth). The emphasis of perinatology is on a time period rather than on a specific organ system. The principal event of the perinatal period is birth. Prior to delivery, the perinatologist is concerned with the physiological status and well-being of both mother and fetus. Immediately after delivery, the perinatologist strives to maximize the newborn’s chances for survival.

Diagnostic and Treatment Techniques

Prior to the birth, several diagnostic procedures are commonly employed by the perinatologist: ultrasonography, the measurement of fetal activity, and the evaluation of fetal lung maturity. Ultrasonography uses sound waves to create images. Sound waves are transmitted from a transducer that has been placed on the skin. Waves that are sent into the body reflect off internal tissues and structures, and the reflections are received by a microphone. Sound travels through tissues with different densities at different rates, which are characteristic for each tissue. Computers interpret the reflected sounds and convert them into an image that can be viewed. The images must be interpreted or read by someone with specialized training, usually a radiologist. Ultrasound does not involve radiation; thus it is not harmful to the fetus. Because sound waves are longer than radiation, the image generated is not as clear as that obtained with electromagnetic waves such as those from a computed tomography (CT) scan or a conventional x-ray.

The measurement of fetal activity is important in evaluating fetal health. Fetal movement is normal; the earliest movement felt by the mother is called quickening. The diminution or cessation of fetal movement is indicative of fetal distress
. Accordingly, movement is monitored by reports from the mother, palpation by the clinician, and ultrasound: Mothers report movements, individuals examining pregnant women can apply their hands to the abdomen and feel fetal movements, and ultrasonography can show breathing and other movements in real time using continuous video records of fetal movements.

Fetal lung maturity is assessed by measuring the relative amounts of lecithin and sphingomyelin in amniotic fluid. The concentration of lecithin increases late in fetal development, while sphingomyelin decreases. A lecithin-sphingomyelin ratio that is greater than two indicates sufficient fetal lung maturity to ensure survival after birth.

Labor and delivery are the primary events of the perinatal period. Factors that can lead to difficulties include abnormalities of the
placenta and prematurity. The placenta can be abnormally located (placenta previa) or can separate prematurely (placenta abruptio). Normally, the placenta is located on the lateral wall of the uterus. Placenta previa is defined as a placenta located in the lower portion of the uterus. The placenta is compressed by the
fetus during passage through the birth canal. This compression compromises the blood supply to the fetus, which causes ischemia and can lead to brain or other tissue damage or to death. This condition is usually managed by a cesarean section. Placenta abruptio refers to a normal placenta that separates prior
to fetal delivery. This condition is potentially life-threatening to both mother and fetus; immediate hospitalization is indicated.

Prematurity is defined as delivery before the fetus is able to survive without unusual support. Premature infants are placed in incubators. A lack of body fat in the infant leads to difficulty in maintaining a normal body temperature; special heating is provided to offset this problem. Lung immaturity may require mechanical assistance from a respirator. An immature immune system makes premature infants especially susceptible to infections; strict isolation precautions and prophylactic antibiotic therapy address this problem.

Many factors contribute to increasing the risks normally associated with pregnancy and delivery: maternal size and age; drug, tobacco, or alcohol use; infection; medical conditions such as diabetes mellitus and hypertension; and multiple gestations. A woman with a small pelvic opening may be unable to deliver her child normally; the solution in this case is a cesarean section. The risk of genetic abnormalities increases with advancing maternal (and, to a lesser degree, paternal) age. Counseling prior to conception is indicated. Once an older woman becomes pregnant, amniotic fluid should be obtained to test for genetic abnormalities. The degree of surveillance is dependent on maternal age: The recommended frequency of medical checks increases for older women.

Alcohol intake during pregnancy can result in an infant who is developmentally disabled; smoking during pregnancy frequently leads to an infant with a low birth weight. Drug usage during pregnancy can lead to anatomic or mental impairment. Avoiding the use of all substances is the easiest way to eliminate problems completely; any drug should be used only under the guidance of a physician. Some viral infections such as German measles (rubella) early in pregnancy can cause birth defects. Immunization prior to conception will avoid these problems.

Diabetes mellitus can cause abnormally large intrauterine growth and babies (frequently more than 10 pounds and referred to as macrosomic) who are too large for normal delivery. Diabetes that commonly develops during pregnancy is called gestational diabetes. Medical monitoring to detect diabetes early is prudent. Appropriate medical management of preexisting diabetes minimizes problems associated with pregnancy. A macrosomic infant must be delivered with a cesarean section. Hypertension can also develop during pregnancy. Like diabetes, it can compromise both mother and fetus. Appropriate and aggressive medical management, sometimes including complete bed rest, is needed to control high blood pressure during pregnancy. Multiple gestations (such as twins or triplets)
strain the supply of maternal nutrients to the developing fetuses. Because space is limited, multiple fetuses are usually smaller than normal at birth.

Rhesus disease, also known as Rh incompatibility, can complicate pregnancy. It can occur only in the child of a father whose blood type is Rh-positive and a mother whose blood type is Rh-negative, and it affects the blood supply of a fetus. The treatment includes the identification of both maternal and paternal blood types and the administration of Rho(D) immune globulin to the mother at twenty-six weeks of gestation and again immediately after birth. An affected infant may require blood transfusions; in a severe case, transfusions may be needed during pregnancy.

Perspective and Prospects

Management of a pregnancy requires specialized skills. As the number of risk factors related to either mother or fetus increases, the problems associated with pregnancy also increase. The care of a pregnant woman and her fetus requires input from many individuals with specialized training. Consequently, perinatology is very much a team effort. Together, the team members can ensure a safe journey through the perinatal period for a pregnant woman and a healthy transition to life outside the womb for a newborn infant.

Bibliography

Bradford, Nikki. Your Premature Baby: The First Five Years. Toronto, Ont.: Firefly Books, 2003.

Creasy, Robert K., and Robert Resnik, eds. Maternal-Fetal Medicine: Principles and Practice. 5th ed. Philadelphia: W. B. Saunders, 2004.

Cunningham, F. Gary, et al., eds. Williams Obstetrics. 23d ed. New York: McGraw-Hill, 2010.

Martin, Richard J., Avroy A. Fanaroff, and Michele C. Walsh, eds. Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 2 vols. 9th ed. Philadelphia: Mosby/Elsevier, 2011.

Moore, Keith L., and T. V. N. Persaud. The Developing Human. 9th ed. Philadelphia: Saunders/Elsevier, 2013.

"Pregnancy and Perinatology Branch (PPB)." National Institute of Child Health and Human Development, November 30, 2012.

Ruhlman, Michael. Walk on Water: Inside an Elite Pediatric Surgery Unit. New York: Viking-Penguin, 2003.

Sadler, T. W. Langman’s Medical Embryology. 12th ed. Philadelphia: Lippincott Williams & Wilkins, 2012.

What would happen if gray wolves became extinct?

As with the extinction of any other species, loss of the gray wolf could have a significant effect on the food chain(s) and ecosystems of which it is a member. Think of how a drop of water creates ripples on the surface of a lake—the loss of the gray wolf would at first have immediate impacts on its natural predators and prey, and eventually disrupt the food chains these other organisms are a part of.

Canis lupus, the gray (also spelled "grey") wolf, is found naturally throughout North America. Gray wolves' diets typically consist of large animals like deer, elk, or bison, but if these large animals aren't available, these wolves will eat rabbits or other small mammals. If the gray wolf were to go extinct, the populations of their prey—the deer, rabbits, and so on—may increase due to a lack of at least one natural predator. Especially in food chains where there is an exclusive predator-prey relationship, the population of the prey can essentially grow out of control with the loss of a predator. This can have secondary effects which deplete the food of the prey or cause a boom in the populations of other predators. 

Gray wolves are sometimes prey to larger mammals like bears or mountain lions. The loss of the gray wolf in an area where bears or lions rely on the wolf population for a source of food would significantly disrupt the food chain. 

What is an example of hyperbole in "All Summer in a Day"?

Hyperbole is used for descriptions of the rain stopping and the jungle growing.

Hyperbole is extreme exaggeration. Authors use it to describe situations that are intense, as a way to help the reader fully gauge the extremity of them. Bradbury uses hyperbole and other literary devices throughout this story to help the reader fully appreciate the situation on Venus, where it never stops raining.

This story is about a group of children who do not remember seeing the sun. They live on Venus, where it rains almost constantly. The sun came out once when they were two years old, but they do not remember it. Now the sun is supposed to come out again, and the children are very excited.

One child, Margot, has been to Earth more recently than the others. She remembers the sun, and suffers more from the constant rain on Venus than most. To help us appreciate the situation, Bradbury uses hyperbole to describe the way everyone feels when the constant rain stops.

The silence was so immense and unbelievable that you felt your ears had been stuffed or you had lost your hearing altogether.

In other words, the lack of rain is deafening, because the people of Venus are so used to hearing rain that the lack of rain comes as a shock to their ears.

The description of the jungle is also an example of hyperbole. 

They stopped running and stood in the great jungle that covered Venus, that grew and never stopped growing, tumultuously, even as you watched it.

You can’t literally see the jungle growing, but it rains so much and the jungle grows so fast that it seems this way. This adds to the helplessness that the children, especially Margot, are feeling. It seems as if the rain will never end and it will just swallow them up.

How is the Prince of Morocco depicted in The Merchant of Venice?

The first thing we learn about the prince of Morocco on his arrival is that he is quite aware of his appearance and asks Portia not to dislike him because of his dark complexion:

Mislike me not for my complexion,
The shadow'd livery of the burnish'd sun,
To whom I am a neighbour and near bred.
Bring me the fairest creature northward born,
Where Phoebus' fire scarce thaws the icicles,
And let us make incision for your love,
To prove whose blood is reddest, his or mine.
I tell thee, lady, this aspect of mine
Hath fear'd the valiant: by my love I swear
The best-regarded virgins of our clime
Have loved it too: I would not change this hue,
Except to steal your thoughts, my gentle queen.

He explains that his color is the result of a hot climate where the sun has tanned him. He is, however, proud of his heritage, for he asks Portia to bring around the most handsome men to test who has the reddest blood. He obviously believes his would be the best, since otherwise he would not have made such a claim. He proudly states his skin has driven fear into the bravest men. Furthermore, the most valued and unblemished women of his region also loved his complexion. He states that he would not change his color except to have Portia think only of him.

The prince obviously carries his sword with him, for he tells Portia:

...By this scimitar
That slew the Sophy and a Persian prince
That won three fields of Sultan Solyman,
I would outstare the sternest eyes that look,
Outbrave the heart most daring on the earth,
Pluck the young sucking cubs from the she-bear,...

The scimitar is a curved sword common in the Middle East at the time and the prince is clearly proud of his prowess as a swordsman since he brags about his victories on the battlefield. Added to that, he is also quite smug about the fact that he can outstare and outbrave the most daring opponents and would even snatch a she-bear's suckling cubs from her grasp.

The prince comes across as vain. He so easily boasts about his abilities that one can easily believe he is arrogant and pompous. A close reading indicates that he uses these glorious comparisons and images to assure Portia that he would undertake any trial or tribulation to win her affection. He is clearly desperate to impress her. He is fearful, though, that since he cannot predict the future and is not entirely in control of his own destiny, one lower in stature than he might win her hand.

The prince is clearly not afraid to take risks, since he asks Portia to allow him to take his chance immediately. She, however, informs him that he must first make a vow in the temple. He can choose a casket after they have had dinner. His vanity finds further support in the fact that he chooses the gold casket because he believes he has the right to what all men desire, which is what the inscription on the casket indicates. Silver has too low a value and lead is too gross to even contemplate.

The prince shows great honor in his response to choosing the incorrect chest:

...your suit is cold.
Cold, indeed; and labour lost:
Then, farewell, heat, and welcome, frost!
Portia, adieu. I have too grieved a heart
To take a tedious leave: thus losers part.

On realizing that his attempt was a flop, he takes his leave like a gentleman and wishes Portia farewell, stating he is too aggrieved to stay around now that he and Portia have both lost. 

What is the relationship between post-traumatic stress disorder and addiction?

Post-Traumatic Stress Disorder

The lifetime prevalence rate for exposure to a potentially traumatic event is approximately 70 percent, while the lifetime prevalence rate for post-traumatic stress disorder (PTSD) is approximately 8 to 12 percent. These statistics mean that not all people exposed to potentially traumatic events will develop subsequent PTSD.

A number of factors may mediate the relationship between the occurrence of a traumatic stressor and the development of PTSD symptoms, including the nature of the traumatic event, demographic characteristics of the person (for example, his or her age and gender), and the person’s coping resources. For example, research indicates that women are twice as likely as men to develop PTSD. This statistic likely means that women are more likely than men to experience personally violent traumatic events (such as sexual assault). Research indicates that when men experience trauma such as sexual assault, their rates of PTSD can be as high as among women.

Events qualifying as potentially traumatic include surviving a natural disaster, being involved in or witnessing a motor vehicle accident, being the victim of a physical or sexual assault, childhood emotional or physical abuse, being kidnapped or abducted, and being exposed to combat or a war zone. While this list is not exhaustive, it captures the overall quality of extreme traumatic stressors. Additional qualifications include the criteria that the traumatic event was personal or direct and that the person’s response to the event included intense fear, helplessness, or horror.

There are four diagnostic behavioral symptoms used by clinicians to diagnose PTSD in individuals. "Re-experiencing" involves nightmares or disturbing day-time spontaneous memories of the traumatic event, flashbacks, or prolonged psychological distress. "Avoidance" is used to describe disturbing memories the individual may experience or any upsetting, intrusive, or debilitating thoughts, feelings, reminders of the event. "Negative cognition and mood" relates to any of the multitude of emotions that may accompanying the after-effects of the event, such as a persistent sense of blame of oneself or others for the trauma, detachment or estrangement from others or a noticeable disinterest in previously enjoyable activities, and an inability to remember specific details of the event. "Arousal" is used to explain noticeable aggression or reckless or self-destructive behavior or sleep disturbances, which professional refer to as the "fight" portion of the "fight or flight" theory.

Dual Diagnosis

An estimated 30 to 50 percent of people seeking treatment for substance-related problems also suffer from PTSD; the rate is much higher among women. One way a person might cope with the symptoms of PTSD is by abusing substances to self-medicate (that is, to decrease the presence or effect of unpleasant symptoms) or to punish oneself because of feelings of guilt, self-blame, and shame associated with the traumatic event.

A person might self-medicate to escape from and attempt to forget the pain of post-traumatic symptoms and to enter into a state of oblivion. These coping responses, however, are generally unhelpful and counterproductive from the perspective of therapeutic recovery.

Alternatively, another mechanism of action between PTSD and substance abuse is the possibility that underlying substance-related problems may place a person at greater risk for developing PTSD. According to this model, recurrent substance abuse may increase the likelihood that a person is exposed to potentially traumatic situations and, therefore, to PTSD, as substance abuse reduces judgment and decision-making capabilities and increases risky behavior. It is likely that both of these models (that is, PTSD as a precursor to substance-related problems and substance-related problems as a precursor to PTSD) help to explain the relationship between PTSD and addiction.

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-5. Washington: APA, 2013. Print.

Jacobsen, Leslie K., Steven M. Southwick, and Thomas R. Kosten. “Substance Use Disorders in Patients with Posttraumatic Stress Disorder.” American Journal of Psychiatry 158.8 (2001): 1184–90. Print.

Khantzian, Edward J. "Addiction as a Self‐regulation Disorder and the Role of Self‐medication." Addiction 108.4 (2013): 668–69. Print.

Messman-Moore, Terri L., Rose Marie Ward, and Amy L. Brown. “Substance Use and PTSD Symptoms Impact the Likelihood of Rape and Revictimization in College Women.” Journal of Interpersonal Violence 24.3 (2009): 499–521. Print.

Najavits, Lisa M. “Helping ‘Difficult’ Patients.” Psychotherapy Research 11.2 (2001): 131–52. Print.

"Post Traumatic Stress Disorder and Addiction." Dual Diagnosis. Dual Diagnosis, 2015. Web. 4 Nov. 2015.

Tipps, Megan E., Jonathan D. Raybuck, and K. Matthew Lattal. "Substance Abuse, Memory, and Post-traumatic Stress Disorder." Neurobiology of Learning and Memory 112 (2014): 87–100. Print.

How does Fitzgerald use the heat of the summer to create the mood in Chapter 7?

In Chapter 7, on the hottest day of the summer, Nick, Gatsby, Daisy, Jordan, and Tom all go to New York City and rent the parlor of a suite at the Plaza. The oppressive heat of the day helps enhance the mood of tension that exists among the characters. Even opening the window "admitted only a gust of hot shrubbery from the park" (page 126). In this stifling environment, Tom attacks Gatsby, accusing him of lying about having attended Oxford. Gatsby retorts with a plausible explanation that he went to Oxford on a short program for former servicemen, but then Tom accuses Gatsby of being a bootlegger. Daisy's love towards Gatsby starts to cool just as the heat of the afternoon is oppressively high. When the party breaks up and they drive home (with Gatsby and Daisy in the same car), they hear that Myrtle has been killed. The heat of the afternoon is symbolic of the anger that exists among the characters in this chapter.

A Rocket fired vertically burns its fuel for 25 seconds, which provides a thrust producing a constant upward acceleration of 8 m/s2. Determine (i)...

Denote the first 25 seconds as `t_1` and the acceleration during this time as `a.` Then the height is  `H_1(t) = (a t^2)/2` and the speed is  `V_1(t) = at.` So the final speed after fuel is burnt is  `v_1=a t_1`  and the final height is `h_1 = (a t_1^2)/2.`

The height after `t_1` is the usual free fall height:

`H_2(t) = h_1+v_1 (t-t_1) - (g (t-t_1)^2)/2.`

The maximum altitude is reached at  `t_2=t_1+v_1/g`  and it is  `h_2 = h_1+(v_1^2)/(2g) = a/2 t_1^2(1+a/g).`

Rocket falls when `H_2(t)=0,` `tgtt_1.` This is a quadratic equation and the solution is 

`t_3 = t_1+(v_1+sqrt(v_1^2+4*g/2*h_1))/(2*(g/2)) = t_1+(v_1+sqrt(v_1^2+2g h_1))/(g) =`

`= t_1+a/(g) t_1 (1+sqrt((a/g)^2+a/g)).`

The answers are: (i) `h_1,` (ii) `h_2,` (iii) `t_3.` In numbers they are (i) 2500 m, (ii) about 4541 m and (iii) about 70 s.

What is the impact of the monster's vow to return on Victor's wedding night?

Victor destroys the female creature he had promised to create in order to satisfy his first creature (who is miserable because he has no companion), prompting the creature to vow that Victor "'shall repent of the injuries [he] inflict[s]'" and that he will "'be with [Victor] on [his] wedding night.'"  Most readers can immediately identify this statement as a danger to Victor's spouse rather than Victor himself: so far, the monster has only sought to deprive Victor of his loved ones, rather than his own life.  Death would be too swift, and the creature wants Victor to feel the intense loneliness that he, himself, feels.  Victor, with his typical arrogance, interprets these lines as a threat to himself and thus he takes no steps to protect his fiancee, Elizabeth.  Had Victor been less self-centered, he might have realized that the creature would take away his chance at happiness with a partner, just as Victor has taken away the creature's chance.  

Elizabeth, however, feels "a presentiment of evil" pervade her on their wedding day.  Victor, instead of focusing on her feelings, focuses on his own, telling her,

"'Ah! if you knew what I have suffered, and what I may yet endure, you would endeavour to let me taste the quiet, and freedom from despair, that this one day at least permits me to enjoy.'"  

Victor is so focused on his own feelings, his own concerns, that he fails to take Elizabeth's seriously or to consider her safety in regard to the pattern his creature has established.  Thus, Shelley employs dramatic irony (when readers know more than the characters) to build tension until the moment the creature takes her life.

Trace the flow of blood through your heart to your left hand.

Blood that has been used by the body returns to the heart via either the inferior or superior vena cava. This blood is deoxygenated. Before being pumped to your left hand, the blood will pass through the heart.  The path of the blood through the heart is as follows:

• Oxygen-poor blood that has been used by the cells is delivered back to right atrium via the inferior or superior vena cava.


• The right atrium pumps this oxygen-depleted blood to the right ventricle.


• The right ventricle then pumps the blood to lungs, where oxygen is received.


• The oxygenated blood is brought back to the heart via the pulmonary veins.


• The pulmonary veins enter the left atrium.


• The left atrium receives this oxygen-rich blood from the pulmonary veins and pumps it to the left ventricle.


• The left ventricle then pumps the oxygenated blood to the body, such as your left hand.

What is the relationship between prison and substance abuse?

Demographics

The US criminal justice system is overburdened by an epidemic of drug addiction and alcoholism. The United States consumes two-thirds of the world’s illegal drugs and incarcerates more than one-quarter of the world’s prisoners. According to a December 2014 report by the US Department of Justice, Bureau of Justice Statistics (BJS), 6.899 million people were identified within the criminal justice system as incarcerated, on parole, or on probation in 2013.

In the second of a two-part landmark report, Behind Bars II: Substance Abuse and America’s Prison Population
(2010), published by the National Center on Addiction and Substance Abuse at Columbia University, substance use disorders among inmates were found to be at epidemic proportions. Prison inmates are seven times more likely to have a substance use disorder (SUD) than are persons in the general population.

The BJS noted in “Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002,” a survey of federal and state prisons, that 68 percent of inmates, in the year before their imprisonment, met the criteria of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders
(DSM) for substance dependence or abuse. An additional 16 percent acknowledged that their convictions were directly related to obtaining money for drugs, and more than one-half acknowledged the use of drugs or alcohol in the commission of a property crime or other violent crime. Of inmates who did not meet the full DSM criteria for SUD, an additional 20 percent acknowledged that substance use was a factor in their crimes, that is, the inmate had been under the influence at the time of the offense or had directly violated alcohol or drug laws.

The survey further showed that diagnoses of alcohol abuse and dependence (47 percent) and drug abuse and dependence (53 percent) were fairly evenly distributed within the prison population. Female prisoners (52 percent) were found to have higher rates of substance dependence than males (44 percent), although males had higher rates of substance abuse. Race also varied among inmates. More white inmates (78 percent) were diagnosed with SUD than were black inmates (64 percent) or Hispanic inmates (59 percent). White women, although they represented 43 percent of all incarcerated women, had the highest rates of SUD.

Age is also significantly related to SUD in the prison population. The survey showed that younger prisoners age twenty-five to forty-four years had higher rates of SUD than prisoners age fifty-five years or older, who had the lowest rates of SUD. Younger inmates tended to abuse drugs, whereas older inmates tended to abuse alcohol. Ten percent of juvenile offenders were found to have been involved with drugs.

The family backgrounds of prisoners with SUD are different from those inmates not diagnosed with addiction. Of those inmates who met criteria for SUD, most had a previous criminal record and had a previous history of homelessness. Their family backgrounds showed that they were twice as likely to be the child of a parent or guardian with a history of SUD as an inmate who has no history of SUD. Almost twice as many prisoners with SUD (21 percent) reported being victims of physical or sexual abuse. More prisoners with a diagnosis of SUD had a parent who also had been incarcerated.

A study published in Current Psychiatry Reports in 2013 reported that more than 80 percent of inmates in state prison and local jails had used an illegal drug, and that 53.4 percent of inmates met the DSM-4 criteria for drug abuse or dependence. The same study found that 69 percent of offenders on probation reported using an illegal drug and 32 percent had used an illegal drug in the month before their arrest.

Benefits of Treatment

Since about 2000, substance abuse treatment has been offered to some people in the criminal justice system. Special attention has been focused on diversion programs and the use of drug courts to provide alternative paths to incarceration.

The National Institute on Drug Abuse issued several principles advocating treatment for the criminal offender. The principles acknowledge that drug abuse is a disease that requires proper assessment and treatment. Co-occurring mental and physical health issues, such as human immunodeficiency virus, acquired immunodeficiency syndrome, and hepatitis, should be addressed and treated. Drug treatment should be tailored to the criminal justice population. Special attention to treatment for the criminal offender must have strong drug-monitoring procedures and familiarity with correctional facility requirements. Treatment must target criminal behavior and thinking patterns and must help the inmate anticipate the consequences of his or her drug and alcohol use. Ideally, treatment should begin in prison and have aftercare programs in place within the community upon release.

In 2005, the US government spent $74 billion on incarceration, court proceedings, probation, and parole for offenders of substance-related crimes. However, the government committed less than 1 percent of that amount—$632 million—to prevention and treatment programs. In contrast, the National Drug Intelligence Center places the cost of effective prevention and treatment at $113 billion, which includes the cost of the criminal justice system itself and the cost of crime to its victims. An overwhelming body of evidence supports the inclusion of substance abuse treatment in the criminal justice system as a cost-effective and humanitarian way to reduce crime.

Recidivism

Substance-involved offenders are more likely to recidivate (repeat crimes) than those who are not involved with substance use. More than one-half (52.2 percent) of substance-involved inmates have been previously incarcerated, compared with 31.2 percent of inmates who are not involved with substances.

SUD is preventable and treatable. Without treatment, however, the statistics suggest that substance-involved offenders will return to prison. Also, in spite of the recommendations for drug treatment, few inmates actually receive drug treatment that is adequate or tailored to their specific needs. Without treatment the rates of relapse will continue, driving up the rate of recidivism.

Bibliography

Balenko, Steven, Matthew Hiller, and Leah Hamilton. “Treating Substance Use Disorders in the Criminal Justice System.” Current Psychiatry Reports 15.11 (2013): n. pag. NCBI PMC. Web. 30 Oct. 2015.

Chandler, R. K., B. W. Fletcher, and N. D. Volkow. “Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety.” Journal of the American Medical Association 301 (2009): 183–90. Print.

Glaze, Lauren E., and Danielle Kaeble. “Correctional Populations in the United States, 2013.” Bureau of Justice Statistics. BJS, 19 Dec. 2014. Web. 30 Oct. 2015.

Karberg, Jennifer C., and Doris J. James. “Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002.” July 2005. Web. 3 Apr. 2012. http://bjs.ojp.usdoj.gov/content/pub/pdf/sdatji02.pdf.

National Center on Addiction and Substance Abuse. Behind Bars II: Substance Abuse and America’s Prison Population. Feb. 2010. Web. 3 Apr. 2012. http://www.casacolumbia.org/articlefiles/575-report2010behindbars2.pdf.

What is gastrointestinal health?

Overview

The gastrointestinal (GI) system includes the esophagus,
stomach, intestines, colon, rectum, and anus. Many other organs assist in the
digestive process of the GI system; they include the gallbladder, pancreas, and
liver.

GI conditions are often chronic, can cause various degrees of discomfort, and can affect a person’s quality of life. Millions of people look to complementary and alternative medicine (CAM) as an adjunct to or a substitute for traditional medical therapy. While many CAM therapies do relieve symptoms, one should use them with caution because some therapies and dietary supplements can affect other modes of care and can lead to adverse reactions.

A National Health Interview Survey showed that 3.7 percent of Americans use CAM for GI care. Many persons with GI problems do not disclose their use of CAM to their doctor, which may also impact optimal care.

GI disorders may be functional (the system appears normal but does not “work” properly) or structural (the system includes swelling, obstruction, or other visual symptom). Constipation and irritable bowel are common functional disorders, and hemorrhoids and cancer are examples of structural disorders.

Common CAM Therapies

The National
Center for Complementary and Alternative Medicine (NCCAM),
part of the National Institutes of Health, categorizes CAM into four
major categories: biologically based (supplementing the diet with nutrients,
herbs, particular foods, or extracts), manipulative and body-based (using
touch and manipulation such as chiropractic or massage), mind/body
(connecting the mind to the body and spirit with practices such as yoga and
meditation), and energy therapies (aiming to restore balance to the body’s
energy with therapies such as qigong and Reiki). Other whole, ancient medical
systems include traditional Chinese medicine, Ayurveda,
homeopathic
medicine, and naturopathic medicine.

Common Gastrointestinal Conditions

The most common GI health issues addressed by CAM include nausea and vomiting, dyspepsia, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), diarrhea and constipation, liver disease (hepatitis B and C and alcohol-related disease), and cancer.

Nausea and vomiting. Nausea and vomiting can be quite unsettling.
They often arise in pregnancy, with an infection, or during medical treatment.
Certain CAM therapies have been used for the relief of symptoms, including
relaxation for chemotherapy-induced nausea and vomiting and the herb
ginger, the most commonly employed supplement to relieve
nausea and vomiting. Some studies have demonstrated that ginger improves GI
motility and acts as an antiemetic (blocks serotonin receptors in the GI tract and
in the central nervous system). Ginger also has been used with some success for
morning sickness, motion sickness, chemotherapy, and postoperative nausea.

Acupuncture and acupressure have been shown to reduce
symptoms of nausea and vomiting, and their use has been supported by much research
on their effectiveness. Many hospitals have acupuncturists on staff.

Dyspepsia. Mild dyspepsia is often self-managed with CAM therapeutic agents, including bananas, red pepper, peppermint, caraway, and turmeric. Most have shown efficacy over placebo in randomized-control trials and are common in the average home. Other lesser-known herbs also have shown promise. These include celandine, liu-jun-zi-tang, shenxiahewining, and STW 5.

Irritable bowel syndrome. Irritable bowel syndrome
(IBS) affects about 5 to 10 percent of Americans, mostly
women. Many CAM therapies have been investigated to relieve the discomfort.
Bulking agents such as psyllium have been most studied and prescribed. Psyllium, a
first-line of treatment for many, has been shown to speed up bowel movements.
Allergic reactions to psyllium are possible, but rare.

Many other CAM therapies have been used for IBS, including acupuncture, Ayurvedic medicine, Chinese herbal medicine, homeopathy, hypnotherapy, peppermint oil, probiotic therapy, and STW 5. Randomized-control trials have shown positive results for many of these therapies.

Diarrhea and constipation. Several herbal supplements are commonly used to improve colonic health. These supplements include aloe, apple pectin, cascara sagrada, chamomile, clove, echinacea, fennel, fenugreek, ginger, hibiscus, magnesium citrate, marshmallow, oat bran, Oregon grape, papaya, psyllium, raspberry, rhubarb, senna, spirulina, valerian, and yellow dock. Nearly all of these herbs stimulate action and have a laxative effect. Few adverse reactions have been reported. Some of these herbs, however, may interfere with other blood-thinning medications and should be discussed with a doctor before use.

Probiotics, good bacteria found in a healthy gut, are also
used to prevent diarrhea and constipation. They are essential to overall gut
health. Infection, the use of antibiotics, and even modern-day stress can lower
healthy amounts of good bacteria in the gut. Antibiotics
can disturb the balance of the gut’s ecosystem by killing friendly bacteria. It
appears that the regular use of probiotics can generally improve the health of the
GI system by stocking the gut with healthy bacteria and making less room for
harmful bacteria and yeasts. Certain strains of Lactobacillus
were shown to help restore colonic health after a course of antibiotics.
L. casei Shirota and L. rhamnosus  are
helpful bacteria for treating chronic constipation. Also, a mixture of 
Bifidobacteria  and Lactobacilli was shown to improve
symptoms. In another study, a combination of B.
lactis and B. longus showed promise for improving
bowel regularity in persons in nursing homes. In a six-week double-blind,
placebo-controlled trial of 274 people with constipation-predominant IBS, the use
of a probiotic formula containing B. animalis significantly
improved stool frequency.

Cultured dairy products such as yogurt and kefir are good sources of acidophilus and other probiotic bacteria. Supplements are widely available in powder, liquid, capsule, or tablet form. Grocery stores and natural-food stores both carry milk that contains live acidophilus.

In addition to probiotics, related substances known as prebiotics may enhance the colonization of healthy bacteria in the intestinal tract. It is important to note that many products sold on the market may not contain viable cultures at the time of purchase. A study reported in 1990 found that most acidophilus capsules on the market contained no living acidophilus. The situation has improved in subsequent evaluations, but some products still have no living organisms and therefore will provide no benefit. Some container labels guarantee the units of living organisms at the time of purchase, not just at the time of manufacture.

Other CAM therapies that have been used to treat IBS include biofeedback,
abdominal massage, homeopathy, and colonic irrigation.

Mind/Body Therapies

The power of the mind to heal and bring about well-being has been demonstrated
in self-reported quality-of-life measures. Strong evidence in the form of
randomized-control trials is lacking, in part because of the difficulty in
devising placebo/sham therapies and because of funding obstacles. Many practices,
such as yoga, meditation, and Tai Chi, are
said to help reduce abdominal symptoms and bring about a sense of relaxation.

Deep breathing and yoga are often used by persons with IBS. Stress can exacerbate symptoms, so any sort of practice that reduces stress and helps one cope with stress can reduce symptoms. Yoga focuses on a healthy spine for a healthy body and incorporates deep-breathing exercises. Different poses and movements involving twist and balance are said to stimulate the nerves along the spine and promote circulation and the flow of energy.

Many professional athletes practice some form of yoga for increased flexibility. It is often incorporated into cross-training exercise routines. Some adolescents are embracing mind/body forms of CAM. One study showed that adolescents between the ages of twelve and nineteen with IBS were likely to engage in or consider meditation or prayer, or both, for symptom management.

Energy Therapies

Acupuncture is commonly employed to reduce GI symptoms. While acupuncture may be helpful for some people and for certain conditions, the evidence for its effectiveness is unclear. Studies have shown no difference in acupuncture versus sham acupuncture. Several well-designed studies have shown both sham and treatment groups improving at the same rate. Modern science is still not clear how or if acupuncture works.

Chinese medicine has outlined hundreds of meridians, or channels, along the body that are thought to stimulate certain organs or systems. According to Chinese medicine, these channels conduct the flow of energy, or qi, a vital force that flows through the body. It is thought that blockages along the vital channels can result in pain or illness. Acupuncture is thought to remove blockages from the system and restore the normal circulation of qi. There is no scientific evidence, however, for the existence of the meridians or of qi. These channels have never been seen under a microscope or mapped, and they do not correspond to major nerve pathways.

Bibliography

Feldman, Mark, Lawrence S. Friedman, and Lawrence J. Brandt, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 8th ed. 2 vols. Philadelphia: Saunders/Elsevier, 2006. A comprehensive textbook of gastrointestinal diseases and physiology. Contains excellent chapters and endoscopic photographs.

Micozzi, Marc S., ed. Fundamentals of Complementary and Integrative Medicine. 3d ed. St. Louis, Mo.: Saunders/Elsevier, 2006. A good overview of complementary, alternative, and integrative medicine basics.

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

What is eye movement desensitization and reprocessing (EMDR)?

Introduction

Eye movement desensitization and reprocessing (EMDR) is a widely implemented and controversial psychological treatment for anxiety disorders and other conditions. EMDR was originally developed for post-traumatic stress disorder (PTSD). In PTSD, a patient who has been exposed to a traumatic event experiences a set of symptoms such as intrusive memories of the event, avoidance of situations reminiscent of the event, and excessive physiological arousal. Some therapists have extended EMDR to a host of other conditions, including phobias (intense, irrational fears), obsessive-compulsive disorder, clinical depression, eating disorders, schizophrenia, sexual dysfunction, discomfort concerning sexual orientation, and psychological distress resulting from cancer.

Description of the Procedure and Rationale

Although EMDR is a complex treatment that contains multiple components, its most distinctive feature is the induction of lateral eye movements. EMDR requires clients to track the back-and-forth movements of the therapist’s fingers with their eyes as they recall disturbing memories, such as those of a traumatic event. As Harvard University psychologist Richard McNally observed, this element of EMDR is reminiscent of the classic portrayal of hypnosis, in which the subject follows the lateral movements of the hypnotist’s dangling pocket watch. EMDR also includes cognitive restructuring, a technique that encourages clients to learn to think about life problems in new and more constructive ways and to make positive self-statements (such as “I can get over my fears”).

EMDR advocates have proposed a number of explanations for the technique’s apparent success, none of which has been universally accepted. Some have maintained that the eye movements of EMDR simulate those of rapid eye movement (REM) sleep, the stage of sleep often associated with vivid dreaming. Because some research suggests that REM sleep plays a role in the processing of memories, including painful ones, these advocates have conjectured that EMDR may similarly facilitate such processing. Others have speculated that EMDR may accelerate memory processing by synchronizing the brain’s two hemispheres. Still others have suggested that the lateral eye movements of EMDR may serve as a distraction while people visualize unpleasant memories and that this distraction may reduce the anxiety associated with these memories. All these explanations assume that eye movements contribute to EMDR’s clinical effects.

History of the Procedure

EMDR was developed in 1989 by California psychologist Francine Shapiro. According to Shapiro, while walking in a forest, she found that her anxieties dissipated after visually scanning her surroundings. This informal observation led her to attempt a similar eye scanning procedure with her anxiety-disordered clients, which she claimed to be successful. Following an initial publication by Shapiro in 1989 suggesting that EMDR may be effective for individuals with traumatic memories, research on the technique expanded at a remarkably rapid rate, with more than two hundred publications on the technique appearing in the following decade.

EMDR has been widely disseminated in workshops aimed at psychotherapists. The Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the US Department of Health and Human Services, estimated in 2014 that since its introduction in 1989, approximately 100,000 therapists have participated in EMDA training, and that EMDR had been implemented in over seventy countries worldwide. The EMDR International Association (EMDRIA) began certifying practitioners in EMDA in 1999, and over the next fifteen years, approximately 2,500 clinicians were certified, with certified clinicians and approved consultants located in over forty countries worldwide. Many practitioners routinely administer the technique as part of their daily practice. EMDR has been administered to clients in the aftermath of several traumatic events, including witnesses of the September 11, 2001, terrorist attacks in New York City as well as victims of Hurricane Katrina in New Orleans and Mississippi in 2005.

Controversy and Scientific Status

EMDR has been embroiled in scientific controversy virtually since its inception. Many of its proponents claim that it is a major innovation and others call it a breakthrough in the treatment of PTSD and other anxiety disorders. They hold that EMDR is more effective and efficient than extant treatments and operates by means of distinctly different mechanisms than these treatments. Lending credibility to these assertions was the 1998 decision by a committee within the American Psychological Association’s Society for Clinical Psychology to list EMDR as a “probably efficacious” treatment for civilian PTSD (such as PTSD induced by rape). EMDR is also endorsed under the Veterans Administration and the US Department of Defense practice guidelines for the management of PTSD and is described by these groups as a treatment of significant benefit.

Some skeptics, including University of Arkansas psychologist Jeffrey Lohr and Drexel University psychologist James Herbert, have argued that EMDR is no more effective than a host of longstanding treatments that rely on exposure to anxiety-provoking imagery. Psychotherapy researchers have known for decades that prolonged exposure to stimuli that trigger anxiety, a technique called flooding, is an effective treatment for anxiety disorders. For example, in a flooding session for a client with severe acrophobia, or fear of heights, a therapist might accompany this client to the top floor of a skyscraper and instruct the person to look at the ground below until the fear dissipates.

Buttressing the assertions of these critics are meta-analyses indicating that although EMDR is more effective for PTSD than no treatment, it is no more effective than other exposure-based treatments. These analyses have led some scholars to conclude that EMDR is merely a variant of standard exposure therapies and that EMDR is effective only because it asks clients to focus repeatedly on their anxiety-provoking memories.

Further fueling the criticisms of skeptics are controlled studies demonstrating that the eye movements of EMDR do not contribute to its clinical effectiveness. For example, investigations comparing EMDR with a fixed eye movement condition—which is identical to standard EMDR except that clients keep their eyes stationary—typically reveal that both procedures yield identical effects on anxiety and other psychological symptoms. These studies raise questions concerning theoretical explanations of EMDR that involve a special role for eye movements.

To resolve these controversies, researchers will need to better understand EMDR’s underlying mechanisms of action. The question of whether EMDR is a novel treatment or merely a repackaging of standard exposure-based treatments remains unresolved. Moreover, although EMDR is more effective than no treatment for individuals with PTSD, it remains to be seen whether it contributes to clinical improvement over and above extant treatments. Finally, because controlled studies of EMDR for conditions other than PTSD are lacking, further work will be needed to ascertain the boundaries of its effectiveness.

Bibliography

Arabia, E., et al. "EMDR for Survivors of Life-Threatening Cardiac Events: Results of a Pilot Study. Journal of EMDR Practice and Research 5 (2011): 213. Print.–

Davidson, Paul R., and Kevin C. H. Parker. “Eye Movement Desensitization and Reprocessing (EMDR): A Meta-analysis.” Journal of Consulting and Clinical Psychology 69 (2001): 305–16. Print.

De Roos, Carlijn, et al. "A Randomised Comparison of Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) in Disaster-Exposed Children." European Journal of Psychotraumatology 2 (2011): n. pag. Web. 12 May 2014.

"Eye Movement Desensitization and Reprocessing." NREPP. US Department of Health and Human Services, 28 Jan. 2014. Web. 12 May 2014.

Herbert, James D., et al. “Science and Pseudoscience in the Development of Eye Movement Desensitization and Reprocessing: Implications for Clinical Psychology.” Clinical Psychology Review 20 (2000): 945–71. Print.

Lee, C. W., and P. Cuijpers. "A Meta-Analysis of the Contribution of Eye Movements in Processing Emotional Memories. Journal of Behavior Therapy and Experimental Psychiatry 44 (2013): 231–39. Print.

McNally, Richard J. “EMDR and Mesmerism: A Comparative Historical Analysis.” Journal of Anxiety Disorders 13 (1999): 225–36. Print.

Shapiro, Francine. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. New York: Guilford, 1995. Print.

Shapiro, Francine. Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy. New York: Rodale, 2012. Print.

Stickgold, Robert. “EMDR: A Putative Neurobiological Mechanism of Action.” Journal of Clinical Psychology 58 (2002): 61–75. Print.

Please explain all the stanzas of "Phenomenal Woman" by Maya Angelou.

The stanzas are homogenous in structure. Each has four or five rhyming lines, then the line "I say," then a few lines of rhyming imagery describing the speaker physically, then a refrain:

I’m a woman

Phenomenally.

Phenomenal woman,

That’s me.

This overall structure of rhythm, rhyme, and refrain makes the poem resemble an upbeat song. Along with the imagery of the speaker's body and physical attributes, this song-like structure creates a sense of a woman singing or dancing, which adds to the poem's sex appeal and sense of sensual beauty.

The first stanza says that "pretty women" question what it is that makes the speaker attractive, since she is not "cute" or "a fashion model's size." This shows that the speaker is confident and strong, which adds to her attractiveness.

Her confidence and strength is added to in the first stanza with the words Angelou chose to physically describe the speaker: the word "reach" in "reach of my arms" indicates that this is a strong woman who strives towards her goals. We imagine her with her arms outstretched confidently. The word "stride" in "stride of my step" makes readers picture a woman with a purposeful walk.

The second stanza describes what happens when the speaker enters a room full of men. She compares them to "a hive of honeybees." This metaphor creates an image of a single woman, a queen bee, surrounded by a large group of noisy men all wanting to be close to her and please her. Like a phenomenal woman, a honey bee produces something sweet but can also sting. The second stanza also has some physical description that adds to the development of this strong woman: "fire" in "fire in my eyes" paints the speaker as a woman who can burn you with a look. "Flash" in "flash of my teeth" shows that she is not afraid to open her mouth, to speak her mind or to share her emotions through laughter.

In the third stanza, the speaker is again answering questions, echoing the first stanza. In the first stanza, the questions were from pretty women who didn't understand why the speaker is considered phenomenal. In the third stanza, in contrast, the questions are from men, questioning themselves and why they find her so attractive. Also in contrast, the third stanza presents the quiet mystery of the speaker. Words like "arch," "smile," and "grace" create an image of a woman with silent poise. She attracts others to her because she is proud and enigmatic.

In the fourth and final stanza, the speaker compares herself to women who have to make a spectacle of themselves to be considered attractive. The image of an obnoxious woman jumping around and talking loudly is a contrast to the picture of a quiet, mysterious woman who stands erect and proud in the previous stanza. In this description, the onomatopoeic "click of my heels" reminds the reader of every formidable woman in their lives, when the only sound is the click of her heels as she approaches down a silent hall: the teacher, the school principal, the boss. However, Angelou also finally reveals that what makes this proud, confident, enigmatic, strong woman so attractive is that she cares for others: "the palm of my hand" creates an image of the phenomenal woman reaching out to the reader, and "The need for my care" shows that men and women alike are not just struck by her physical beauty or confidence, but also by her loving, caring nature. The most phenomenal woman in your life is someone who cares for you deeply, your mother.

Each stanza closes with the refrain, and the four stanzas build up the explanation of what a phenomenal woman actually is: a strong, confident woman. A mysterious woman. Not a loud, boisterous, self-absorbed woman, but a calm, caring woman. These qualities make her desirable and phenomenal.

What were the important themes of George Washington's Inaugural Address of 1789?

George Washington's Inaugural Address  of 1789 demonstrated his modesty and reverence towards a government for the people and by the people. While Washington was most likely the most popular president to ever assume office of president, he made it clear that he did not wish to abuse his mandate. The president did not use the first inaugural address to make demands on the new Congress.  His only directive towards Congress was the hope that amendments would be passed to provide comfort for the anti-federalist who were not comfortable with the new federal system of government.

James Madison helped George Washington with his inaugural speech. They decided that the speech should be short and to the point. Washington was reluctant to take the office of president and they agreed that this would be included in the speech. Washington stated in his speech that he overcame his own hesitation out of a sense of civic duty and because he loved his country. Another important theme that Washington spoke about was the divine guidance that this country was blessed with. The importance of the speech's theme was that George Washington was going to respect the limitations that the Constitution placed on the executive branch and place trust in the elected officials in the legislative branch. At the same time, he communicated the need to put regional differences aside for the greater good of national unity.

What is prostatitis?

Definition

Prostatitis is inflammation of the prostate gland. The prostate is a walnut-sized gland in
males that surrounds the urethra. The prostate produces a fluid that is part of semen.

There are four types of prostatitis: categories 1 through 4. Category 1, or acute bacterial, is the least common of the four types but is the most common in men age thirty-five years and younger. Category 2, or chronic bacterial, is not common but affects mostly men between the ages of forty and seventy years. Category 3, or chronic nonbacterial/prostadynia, is the most common type and causes chronic pelvic pain, or prostadynia. (Prostadynia is also known as chronic pelvic pain syndrome, or CPPS, a condition that has similar symptoms to those of chronic nonbacterial prostatitis. However, CPPS has no evidence of prostatic inflammation.) The final type of prostatitis is category 4, or asymptomatic inflammatory prostatitis.

Causes

Acute and some chronic bacterial prostatitis are caused by bacteria that infect
the prostate gland. The bacteria usually come from the urinary tract or rectum.
The causes of nonbacterial prostatitis can be difficult to identify, but some
believe it may be caused by pathogens such as
Mycoplasma, Chlamydia, a virus, or a
fungus.

The causes of prostadynia can be even more difficult to identify. However, the
condition can be associated with stress or disorders (or both) of pelvic floor
muscle tension or conditions such as interstitial cystitis. Asymptomatic
inflammatory prostatitis is found during a prostate biopsy. The
cause is not clearly understood.

Risk Factors

Risk factors include medical procedures that involve inserting a catheter or other tubing into the urethra or rectum; anal
intercourse; a recent bladder infection; abnormalities in the anatomy of the
urinary tract; diabetes; a suppressed immune system; and obstruction of the
bladder, such as by a tumor, a kidney stone, or an enlarged prostate
gland.

Symptoms

Symptoms of prostatitis can appear slowly or suddenly, and they can be mild or
quite severe. In nonbacterial prostatitis, symptoms often come and go. Symptoms
may include needing to urinate frequently or urgently, or both, especially at
night; pain or burning while urinating; difficulty urinating; blood in the urine;
psychological stress; lower abdominal pain or pressure; rectal or perineal
discomfort; lower back pain; fever or chills; painful ejaculation; and
impotence, because of inflammation around the gland.

Screening and Diagnosis

A doctor will ask about symptoms and medical history and will perform a physical exam. Diagnosis of prostatitis is usually based on the symptoms and on massaging the prostate gland. In this test, the doctor places a lubricated, gloved finger into the rectum to feel the back wall of the prostate. In prostatitis, the prostate is usually tender and soft. Other tests include bladder function tests and an analysis of urine and prostate fluid expressed after massaging the prostate gland.

Treatment and Therapy

Treatment depends on the type of prostatitis. Acute bacterial prostatitis is
treated with oral antibiotics for one to two weeks. The commonly used drugs
include quinolones (norfloxacin, ciprofloxacin, and levofloxacin) or trimethoprim,
and in severe cases, treatment with intravenous antibiotics may be necessary.
Chronic bacterial prostatitis is also treated with oral antibiotics, but for four
to twelve weeks. Other medications include stool softeners, anti-inflammatory
medications, other analgesics or pain medications, alpha-blockers such as Flomax,
and 5-alpha reductase inhibitors such as Proscar or Avodart.

For noninfectious prostatitis, patients are often initially given a course of
antibiotics in case an infectious cause was missed during
diagnosis. Other treatments include alpha-blockers such as Flomax, 5-alpha
reductase inhibitors such as Proscar or Avodart, anti-inflammatory medications
such as ibuprofen, pain killers, warm sitz baths, and repeated prostate massages.

Prevention and Outcomes

There are no guidelines for preventing prostatitis.

Bibliography

Komaroff, Anthony, ed. “Prostate Gland.” In Harvard Medical School Family Health Guide. New York: Free Press, 2005.

Propert, K. J., et al. “A Prospective Study of Symptoms and Quality of Life in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome: The National Institutes of Health Chronic Prostatitis Cohort Study.” Journal of Urology 175 (2006): 619-623.

“Prostate Disorders.” In The Merck Manual Home Health Handbook, edited by Robert S. Porter et al. Whitehouse Station, N.J.: Merck Research Laboratories, 2009.

Walsh, Patrick C., et al., eds. Campbell-Walsh Urology. 4 vols. 9th ed. Philadelphia: Saunders/Elsevier, 2007.

Explain Napoleon's paranoia as it is depicted in Animal Farm.

Once Napoleon had seized power on the farm by getting rid of Snowball, he becomes obsessed with protecting himself from what he believed would be a challenge to his position. Immediately after Snowball had been expelled from the farm, he proceeds to exercise his dominance by firstly, changing whatever good memory the animals might have had about Snowball. He goes about demonizing him by spreading lies about Snowball's involvement in the Battle of the Cowshed and suggesting that he had been in cahoots with Mr Jones from the outset.

The reason for Napoleon doing this is that he wants to win the animals' trust so that they can believe that Snowball's expulsion had been in their best interest. It does not take long for the gullible animals to believe whatever they are told by the manipulative Squealer. It reaches a point where every mishap on the farm is blamed on Snowball. Snowball becomes the scapegoat for the pigs' inability to provide for the other animals since they look only after themselves and their kind, living lives of privilege. 

It becomes easy for Napoleon to create fear, born from his paranoia, and thoroughly dominate the animals. He claims that Snowball had been secretly visiting the farm to perform mischief. He had, it is claimed, been responsible for the destruction of the windmill, when, in fact, it had been destroyed in a violent storm. Napoleon has now fabricated a reason to claim that there is an ongoing threat to the farm and to himself, and he seeks to find those who have secretly been helping Snowball.

This results in a terrible purge in which Napoleon calls all the animals together and starts off by executing four pigs who confessed that they had been secretly assisting Snowball. Soon other animals come forward to confess and they are all executed on the spot by Napoleon's fierce dogs. The animals are terrified. So begins Napoleon's tyranny.

To further ensure his security, Napoleon starts walking around the farm always accompanied by the nine dogs he had raised. Furthermore, after the purge, he also uses the dogs to suppress and literally wipe out any criticism anyone might have of his control.

Napoleon assumes the role of supreme leader and is now referred to as 'Our Leader, Comrade Napoleon.' He is praised for every good thing that happens on the farm, no matter how simple or unimportant. To further confuse the animals and keep them guessing, stories are spread about the threat from the farmers, first its Frederick then Pilkington, then vice versa. Finally a death sentence is declared against Frederick for he had cheated the farm out of timber by paying for it with fake money.

In the end, though, Napoleon's so-called paranoia is a cleverly created scheme to manipulate the animals and keep them guessing. Whenever he identifies a threat and erases it, he ensures the animals' loyalty. This guarantees their belief in him. Also, since the animals are unintelligent and forget easily, they lack the ability to question anything about their history and, therefore, accept what they are told. To further ensure the retention of power and privilege for himself and the other pigs, Napoleon also threatens violence and extreme punishment, even execution, through his dogs.

How can feminism be applied to the poem "To His Coy Mistress" by Andrew Marvell?

In "To His Coy Mistress," the poem's narrator is trying to persuade his girlfriend to have sex with him. He does this by using the carpe diem or "seize the day" theme, saying to her that they don't have all the time in the world, for at any time they could die. If he had world enough and time, the narrator says, he would spend 200 years praising each of his beloved's breasts and 30,000 years lavishing praise on the rest of her body. He would take her to India, at that time an immensely long journey from England, and once there, would lounge with her by the Ganges River and find her rubies. However, he says, there just isn't time for all this.

A feminist lens would focus on what is at stake for an unmarried woman in that time and place. She would have no access to reliable birth control, because there was none, and, in that culture, would be shamed and dishonored were she to become pregnant without being married. Having a baby without being married could also leave the woman unable to marry someone else, as she would be considered damaged goods. A feminist reading would question why the narrator is so blind to the possible consequences of sex on his beloved. Is it selfish of him to put his own desire for sex above the problems it could create for her? Why doesn't he see or acknowledge this reality? What might the beloved say back to him, were she to be given a voice? Why isn't she given a voice in the poem to respond?

In Act One of The Tempest, who stole Prospero's position?

Prospero’s brother Antonio conspired with Alonso to steal his position from him. 

Prospero is a wizard or magic-user who is stranded on a deserted island with his daughter, Miranda.  He used to be a duke, but his brother Antonio conspired against him with the king, Alonso, and shut him out.  He pretty much then forced Prospero and Miranda onto a tiny boat and pushed them out to sea.  Prospero’s friend Gonzalo took pity on him, helping him by bringing him food and his magic books so he would survive the journey.  He did.

When Prospero creates a storm and Miranda begs him to stop, Prospero reminds her of all of this.  It is not something he has ever forgotten. 

PROSPERO

My brother and thy uncle, call'd Antonio--
I pray thee, mark me--that a brother should
Be so perfidious!--he whom next thyself
Of all the world I loved and to him put
The manage of my state … (Act 1, Scene 2) 

Indeed, Prospero has his opportunity for revenge.  Alonso, Antonio, and Alonso’s son Ferdinand are shipwrecked in Prospero’s storm.  He uses his magical servant Ariel to mess with them.  She reminds them of what they did to him. 

ARIEL

You are three men of sin, whom Destiny,
That hath to instrument this lower world
And what is in't, the never-surfeited sea
Hath caused to belch up you; and on this island
Where man doth not inhabit; you 'mongst men
Being most unfit to live. … (Act 3, Scene 3)

Miranda and Ferdinand hit it off.  Prospero treats Ferdinand poorly, so that his prize will not seem too light, but Prospero is actually secretly delighted at the match.  He also changes his mind about getting brutal revenge against Ferdinand's father and his brother.  He decides they have suffered enough, and he forgives them. He does take back his kingdom though.  His forgiveness has its limits, after all!