What is the Controlled Substances Act (CSA)?

Background

Not until the 1960s did drug abuse
become a major federal-government issue in the United States. Before this time, drug abuse was considered mostly an unacceptable behavior. The 1960s, however, saw an escalation in drug-related crime, including the smuggling of drugs into the United States.

In response, in 1970, Congress passed the Comprehensive Drug Abuse Prevention and Control Act. The Controlled Substances Act (CSA) was part F of this law. To enforce this legislation US president Richard M. Nixon created the Drug Enforcement Administration
(DEA) in 1973. Before the establishment of the DEA, the United States had several federal agencies involved in drug regulation and control. The DEA was formed to group all drug-control activities under a single federal agency.

The DEA is responsible for achieving the mission of the CSA. Also involved in activities related to the CSA are the Department of Health and Human Services (including its National Institute on Drug Abuse, part of the National Institutes of Health) and the Food and Drug Administration
(FDA), both of which help determine what substances are to be covered by the CSA.

The CSA established five schedules to classify controlled substances. Controlled substances are narcotics, hallucinogens, anabolic steroids, stimulants, and tranquilizers. Controlled substances are assigned to a schedule based on three factors: their potential for abuse, whether they have a medical use, and whether the substance can be safely used.

Schedule I drugs have no medical use, have a high potential for abuse, and have no accepted safety levels. Prescriptions cannot be written for schedule I drugs. Some examples of Schedule I drugs are cannabis, heroin, 3,4-methylenedioxymethamphetamine, lysergic acid diethylamide, mescaline, and methaqualone.

Schedule II drugs have a high potential for abuse, have either no medical use or may have a medical use in certain conditions, and have a high potential for addiction. Some examples of schedule II drugs are cocaine, opium, morphine, methamphetamine, methylphenidate, and methadone. Schedule III drugs have less potential for abuse, are used for medical treatment, and have a moderate risk for addiction. Some examples of schedule III drugs are anabolic steroids, ketamine, and dihydrocodeine.

Schedule IV drugs are much less likely to be abused, have a medical use, and are less likely to lead to addiction. Some examples of schedule IV drugs are benzodiazepines, modafinil, zolpidem, and meprobamate. Schedule V drugs are even less likely to be abused, have a medical use, and are unlikely to lead to addiction. Some examples of schedule V drugs are diphenoxylate, pregabalin, and cough suppressants with codeine.

In addition to drug schedules, the CSA has other provisions related to drug use. The CSA requires that all persons involved with drug production, distribution, possession, use, importation, and exportation be registered with the DEA. The CSA includes the specifications for storage of controlled drugs and the security for this storage. It describes the records that must be kept for the use of controlled drugs. The CSA describes how controlled drugs are to be disposed of. In addition, the CSA discusses penalties for abuse of controlled drugs, procedures for importing and exporting controlled drugs, procedures for producing controlled drugs, and the provision for the taking of the violator’s assets.

The CSA has been amended several times since 1970, to include major changes in the law and to reflect amendments of CSA rules, such as to add new drugs or substances or to change the schedule of a drug or substance based on new information. Later changes have included permitting electronic and facsimile prescriptions for schedule II drugs and limiting the amount of pseudoephedrine that may be purchased at one time. This last change requires that the purchaser present a picture identification card at the point of sale. In the 2010s, there have been several attempts to convince federal courts, Congress, or the DEA to reclassify cannabis under schedule II or III, as there is increasing acceptance of its medicinal use, and its toxicity and potential for physical dependence are lower than those of other schedule I drugs. However, the DEA maintains that its medical usefulness has not yet been sufficiently proven and documented, and that any drug without an accepted medical use must remain in schedule I regardless of abuse potential.

"Controlled Substances Act (1970)." National Substance Abuse Index. National Substance Abuse Index, n.d. Web. 29 Oct. 2015.

Marion, Nancy E., and Willard M. Oliver. Drugs in American Society: An Encyclopedia of History, Politics, Culture, and the Law. Santa Barbara: ABC-CLIO, 2014. Print.

Steel, Brent S., ed. Science and Politics: An A-to-Z Guide to Issues and Controversies. Thousand Oaks: Sage, 2014. Print.

"Title 21 United States Code (USC) Controlled Substances Act." Office of Diversion Control. Drug Enforcement Administration, 2012. Web. 29 Oct. 2015.

United States. Drug Enforcement Administration. Pharmacist’s Manual: An Informational Outline of the Controlled Substances Act. Springfield: DEA, 2010. Print.

Van Dusen, Virgil, and Alan R. Spies. “An Overview and Update of the Controlled Substances Act of 1970.” 1 Feb. 2007. Web. 14 Apr. 2012.

Yeh, Brian T. Drug Offenses: Maximum Fines and Terms of Imprisonment for Violation of the Federal Controlled Substances Act and Related Laws. Rep. Washington, DC: Congressional Research Service, 2015. PDF file.

What is motor development?

Introduction

Motor development refers to the development of motor skills, or voluntary control over the body and its parts. Gross motor development refers to the development of skills or behaviors that involve the large muscle masses and large body movements (such as crawling, walking, running, and throwing), whereas fine motor development refers to the development of small muscle movements, usually in reference to the hands (as in grasping, writing, and fastening buttons). Motor skills develop rapidly during the early years of life and follow a predictable sequence of stages.

Motor development proceeds according to three developmental principles: from head to toe (cephalo-caudal development), from the center of the body to the body’s periphery (proximo-distal development), and from large to small muscle control, with actions becoming more refined and directed (mass-to-specific development). Cephalo-caudal development is illustrated by the fact that infants gain control over their heads and shoulders before their legs. Proximo-distal development is shown by young children gaining control over their arms before their hands and fingers, and mass-to-specific development is illustrated by the fact that infants reach for an object with both arms extended before they can reach out with one arm at a time.

The development of both gross and fine motor skills depends on the maturation (development attributable to one’s genetic timetable and not to experience) of the nervous system. Voluntary movements develop as the cortex, which is the outer layer of the brain, matures. Whereas the cortex is barely functioning at birth, the “lower” parts of the brain—such as the brain stem and the midbrain—that control basic, nonthinking functions such as breathing, heartbeat, digestion, and reflexes are mature at birth. This is part of the reason that newborns have only reflexive, involuntary movements during the first few months of life. Voluntary control over the body develops gradually as connections between the muscles and the higher brain centers such as the cortex become established. The parts of the brain concerned with posture and balance also develop gradually over the first year of life; they contribute to infants being able to sit up, stand, and then walk.

The gradual acquisition of fine and gross motor skills has a number of important implications for a child’s social, cognitive, and personality development. The development of fine motor skills allows infants to examine and experiment with objects, explore their environment, and even communicate with others by showing objects or by pointing. Gross motor milestones provide children with a new and progressively complex perspective of the world, more opportunities to explore and learn about the physical and social environment, and increasing degrees of independence—which have implications for children’s developing sense of mastery and competence. These motor milestones in turn affect parents’ interactions with, and treatment of, their increasingly independent children.

Sequences of Development

Gross motor and fine motor skills follow a specific sequence of development. Gross motor (or locomotor) development eventually results in a young child being able to walk and run. To reach this point, a child must first develop control of his or her head, sit up, and then develop enough balance and strength to stand. By approximately two months of age, most infants can lift their heads, and by three to four months of age they are usually able to roll over. At five or six months they can sit up, and by seven to nine months they usually begin crawling. Infants may be able to stand while holding on to an object at six months, pull themselves to standing between eight and ten months, and walk independently at around twelve to fourteen months. By eighteen months of age, toddlers are usually able to run, walk backward, throw a ball, and climb stairs; between twenty-four to thirty-six months, they may be able to ride a tricycle. From two to six years of age, children continue to refine their movements. For example, a two-year-old’s awkward gait and poor balance change by three years of age to a more stable and balanced gait, allowing the child to hop, jump, and run back and forth. By four years of age, children’s walking movements are similar to adults’, allowing them to move easily up and down stairs and even to hop on one foot. By age five, children are well coordinated, have good balance, and are able to move skillfully and gracefully while walking, running, climbing, and throwing.

Fine motor development eventually results in refined eye-hand coordination, which will enable a child to write. To achieve this, children must first be able to reach, grasp, and manipulate objects voluntarily and possess refined finger (especially thumb-to-index-finger) control. At birth, no voluntary control exists. By three months of age, babies begin to make poorly directed swiping movements with their entire arms (fists closed). At around four months, infants use an open-handed, scooping movement with a slightly better aim; by five months, infants can reach and grasp objects with both hands, holding the object in the center of the palm by all fingers. Between nine and ten months, infants can hold objects by the palm and middle fingers in a palmar grasp. The ability to use the thumb and index finger together (pincer grasp) typically develops between nine and fifteen months. Infants who have developed this skill usually enjoy practicing it and will pick up tiny objects such as lint or bugs from the floor. By eighteen months of age, toddlers are able to hold crayons and to open drawers and cupboards; by twenty-four months, the development of full thumb-to-index-finger control makes it easier for them to turn doorknobs, unscrew lids, scribble, and feed themselves. By age three, children may be able to put some puzzle pieces together. They also have better control when using forks and can begin to dress themselves. (The ability to lace shoes, fasten buttons, and pull zippers, however, generally does not appear until age six or seven.) By age four or five, eye-hand coordination and fine motor skills improve. Children may be able at this time to print large letters that look pieced together; they are typically placed anywhere on a piece of paper. Many can print their first names and a few numbers by age five. From age six on, hand movements become more fluid and refined; writing is characterized by more continuous strokes and is less choppy.

Although the sequence of stages of motor development is uniform in normal individuals, there is wide variation among individuals in the ages at which certain skills are acquired. This normal variation is attributable to both biological and environmental factors, including maturation, heredity, neurological maturity, health, activity level, experience, and nutrition.

Role of Biological Maturation

Learning to walk, achieving bowel and bladder control, and even learning to read and write are not physiologically possible until the child’s nervous and motor systems are sufficiently developed. Although normal experience (such as that offered by an average home environment) appears to be necessary for normal motor development, biological maturation places limits on what can be achieved through experience or practice. In fact, efforts by parents or other adults to teach or push young children to learn particular skills before they are maturationally ready may actually be harmful to their development.

Learning to walk, for example, requires central nervous system maturity, postural balance, muscular and skeletal strength, and well-developed sight and hearing. Studies have suggested that practicing the early walking reflex in infants to speed up their learning to walk may actually be harmful, because it may interfere with the development of the “higher” (cortical) areas of the brain that gradually take over the control of mature, independent walking. Early walking movements, which are evident between birth and three months of age, are actually a reflex that is controlled by the “lower” parts of the brain that control involuntary behavior. In addition, other studies have found that using walkers (seats on frames with wheels) too early or too often may damage infants’ hip sockets.

Toilet training is also dependent on nervous system maturation. The neurons (nerve cells) controlling bowel and bladder movements mature at about the same time that children generally achieve voluntary control, around eighteen to twenty-four months of age. Bowel control is achieved before bladder control, and girls typically achieve bowel and bladder control before boys do.

Being able to ride a tricycle (which usually occurs around age three) or a bicycle (which typically occurs by age six or seven) also requires that a certain level of muscle strength, posture, and balance be achieved before these skills are possible. Catching a ball is usually too difficult and complex for four-year-olds because it requires timing, distance perception, quick reactions, and coordinated movements of the arms, hands, eyes, and body. A successful way of playing “catch” with children of this age is to roll the ball on the ground.

Fine motor skills (such as pouring juice from a pitcher, writing with a pencil, assembling a puzzle with many small pieces, cutting food with a knife and fork, or fastening small buttons) develop more slowly than gross motor skills during infancy and early childhood and are therefore more difficult for young children to master. Children lack the motor control necessary to complete these tasks successfully because the central nervous system is not completely developed at this age—the parts of the brain governing fine motor coordination take years to mature fully.

Reading and writing also depend on maturational readiness. Reading requires focused attention, controlled coordination between the eye muscles and the brain, and a certain level of nervous system maturity. Children younger than six years of age usually are not physiologically capable of moving their eye muscles slowly and deliberately across lines of small letters. They also have a difficult time sustaining controlled and systematic focusing and are farsighted. Writing, on the other hand, depends on the eyes, brain, and small muscles of the fingers working together. As nervous system maturation progresses, greater fine motor control is achieved, and children’s hand strokes become more fluid and continuous during the school-age years.

Finally, hand preference (“handedness”) is also biologically based. Hand preference in reaching, grasping, and writing may be found even in infancy. Hand preference appears to be determined partly by heredity but also by the organization of the brain, with structural and functional differences between the left and right sides of the brain evident at birth. Most children develop hand preferences by age three or four, with the majority (85 to 90 percent) showing a right-hand preference. It may, however, take some children several years after this to solidify their hand preference. Forcing children to change their handedness may create a number of problems, including stuttering and other language problems, fine motor skill deficits, and emotional problems.

Evolution of Research

Early interest in motor development focused primarily on outlining the sequence of stages of motor development, identifying approximate ages at which these milestones occur, and speculating about the relative contributions of biology and the environment to motor development. These themes mirror two principal concerns of developmental psychology: the sequence of stages of development and the influence of biology versus experience on development.

Interest in, and observations of, early motor development date back at least to the eighteenth century. The earliest accounts of children’s development, known as “baby biographies,” were detailed descriptions of the developmental sequence of behavior during the early years of life. A more methodical approach to outlining behavioral milestones began around the early 1900s, when normative studies (studies investigating the typical performance of children at different ages) were undertaken. In 1911, for example, Arnold Gesell
founded the Yale Clinic of Child Development and constructed norms for such motor skills as grasping, crawling, swimming, standing, and walking. His norm charts were used throughout most of the twentieth century.

The general conclusion of Gesell and others during the 1930s and 1940s was that motor development is under biological control; however, studies have since shown that severe environmental deprivation can retard motor development and that environmental improvement by age two is necessary for infants to recover fully. Most researchers today believe that both maturation and experience play important roles in the course of motor development.

Although there was interest in motor development during the first half of the twentieth century, this interest declined somewhat from the 1950s until the 1980s. During this lull, however, motor development was still considered an integral part of Jean Piaget’s well-known theory of cognitive development in young children. Whereas motor development was originally viewed as the gradual acquisition of isolated skills, motor skill acquisitions are currently viewed as parts of a complex, interrelated motor system that parallels brain growth and development. It is likely that future research will continue to examine these issues as well as the relationship of motor development to cognition, language acquisition, and social development.

Bibliography

Bremmer, Gavin, and Theodore D. Wachs, eds. The Wiley-Blackwell Handbook of Infant Development. Vol. 1. Malden: Blackwell, 2010. Print.

Fitzgerald, Hiram E., et al. “The Organization of Lateralized Behavior During Infancy.” Theory and Research in Behavioral Pediatrics. Vol. 5. Ed. Hiram E. Fitzgerald, B. Lester, and M. Yogman. New York: Plenum, 1991. Print.

Gabbard, Carl P. Lifelong Motor Development. 5th ed. San Francisco: Pearson, 2008. Print.

Gallahue, D. L. Motor Development and Movement Experiences. New York: Wiley, 1976. Print.

Haywood, Kathleen. Life Span Motor Development. 5th ed. Champaign: Human Kinetics, 2009. Print.

Payne, V. G., and L. D. Isaacs. Human Motor Development: A Lifespan Approach. 7th ed. Boston: McGraw-Hill, 2008. Print.

Piper, Martha C., and Johanna Darrah. Motor Assessment of the Developing Infant. Philadelphia: Saunders, 1994. Print.

Rosenblith, Judy F., and Judith E. Sims-Knight. In the Beginning. 2nd ed. Newbury Park: Sage, 1992. Print.

Sugden, David, and Michael G. Wade. Typical and Atypical Motor Development. London: Mac Keith, 2013. Print.

Zelazo, Philip David. The Oxford Handbook of Developmental Psychology. Vol. 1. New York: Oxford UP, 2013. Print.

In "The Red-Headed League," why did Wilson believe he had a good chance at being chosen for the position?

Jabez Wilson was talked into going down to the office of the fictitious Red-Headed League because he had such brilliant red hair. He tells Sherlock Holmes and Dr. Watson:

“Now, it is a fact, gentlemen, as you may see for yourselves, that my hair is of a very full and rich tint, so that it seemed to me that if there was to be any competition in the matter I stood as good a chance as any man that I had ever met."

His assistant John Clay, who calls himself Vincent Spaulding, goes with him. This is vital to the plot because Clay's accomplice, who is masquerading as Duncan Ross, has never met Wilson and might not be able to identify him among all the red-headed men who are responding to the newspaper ad. Wilson describes the strange spectacle when they arrive.

“I never hope to see such a sight as that again, Mr. Holmes. From north, south, east, and west every man who had a shade of red in his hair had tramped into the city to answer the advertisement. Fleet Street was choked with red-headed folk, and Pope's Court looked like a coster's orange barrow. I should not have thought there were so many in the whole country as were brought together by that single advertisement. Every shade of colour they were—straw, lemon, orange, brick, Irish-setter, liver, clay; but, as Spaulding said, there were not many who had the real vivid flame-coloured tint. When I saw how many were waiting, I would have given it up in despair; but Spaulding would not hear of it. How he did it I could not imagine, but he pushed and pulled and butted until he got me through the crowd, and right up to the steps which led to the office. There was a double stream upon the stair, some going up in hope, and some coming back dejected; but we wedged in as well as we could and soon found ourselves in the office.”

Wilson loses his confidence when he sees how many red-headed men are waiting to be interviewed for the single opening in the Red-Headed League. He would have turned around and gone back to his shop if he hadn't been accompanied by the very aggressive John Clay, who gets him through the entire mob, up the stairs, and into the office, where Duncan Ross is waiting for him. Ross is clever enough not to make Wilson's acceptance look too easy. Poor Wilson suffers ups and downs of self-confidence. At first, he thinks he has a good chance of getting the position because of his exceptionally bright and flourishing red hair. However, he becomes disheartened when he sees how many other red-headed men he has to compete against. He is elated when Duncan Ross reacts so positively to his interview, actually going to the window and shouting that the vacancy has been filled. But Wilson becomes alarmed when Ross asks him if he has a family. This question has a triple purpose. It shows that the Red-Headed League might have a genuine mission in encouraging propagation of redheads. But at the same time it makes Wilson feel very fortunate to get a position despite being unmarried with no children. Its main objective is to ensure the two crooks that Wilson doesn't have any relatives who might drop in at his pawnshop unexpectedly.

Wilson is not completely confident in his unusual good fortune, despite shaking hands with Duncan Ross and agreeing to report to work the next morning. But he becomes reassured when he finally sits down and starts copying out of the Encyclopedia Britannica. The best part of his initiation into the League comes that Saturday.

...on Saturday the manager came in and planked down four golden sovereigns for my week's work. 

This is four times what the typical London clerk receives for the kind of copy work Wilson is doing. And Wilson is works about twenty-four hours a week, while the typical clerk would work around ten hours a day, six days a week. 

In To Kill a Mockingbird, what is the verdict in the Tom Robinson case?

Tom Robinson is a poor, crippled husband and father who gets caught in the clutches of a lonely white nineteen year-old's game and pays for it with his life. In a 1935 Alabama town, there's no justice for a black man, especially if his word is up against that of white folks. Atticus Finch works up the best defense any man could have asked for, but it isn't enough to change the minds of the twelve white men on the jury. There were just too many long-standing traditions at stake for them to acquit Tom for his alleged crime. Scout describes the announcement of the verdict as follows:

"A jury never looks at a defendant it has convicted, and when this jury came in, not one of them looked at Tom Robinson. The foreman handed a piece of paper to Mr. Tate who handed it to the clerk who handed it to the judge. . . 'Guilty. . . guilty. . . guilty.' I peeked at Jem: his hands were white from gripping the balcony rail, and his shoulders jerked as if each 'guilty' was a separate stab between them" (211).

Later, in chapter 23, Atticus and Jem are discussing the punishment for someone being found guilty of rape in the state of Alabama. Jem says that it isn't fair that he is considered guilty because Tom didn't take anyone's life. Atticus reminds Jem that the code of Alabama states that rape is a capital offense--punishable by death. Jem innocently says, "...the jury didn't have to give him death--if they wanted to they could've gave him twenty years" (219).

Clearly, Jem doesn't understand that it isn't the jury that sentences a convict, the judge declares it. Even so, Tom was convicted on rape charges and sentenced to death. Atticus wanted to push for an appeal, but Tom lost faith in his chances and tried to escape prison. As a result, he get shot while attempting to climb over a tall fence.

What is the relationship between schools and infectious disease?

Definition

Infectious diseases are rarely the top concern of school and public health
officials in the United States. Instead, of central concern are obesity, diabetes,
asthma, smoking, substance abuse, eating disorders, and bullying behaviors.
Now-routine immunization requirements for school entrance have reduced the occurrence of
infectious diseases in schools in industrialized nations. However, these diseases
have not been completely eradicated, and seasonal infections such as influenza
require ongoing school readiness.

Contagious Diseases of the Skin, Hair, and Eyes

Particularly in the preschool and elementary school years, infections that visibly affect the skin, hair, and eyes are fairly common. These diseases may be caused by viruses, bacteria, fungi, or lice; they may be mild and self-limited with no other symptoms outside the skin, or they may cause significant illness.

Chickenpox. Although it is seen less commonly since the varicella
vaccine was licensed in 1995, chickenpox still occurs in localized outbreaks in
children who are not immunized. Chickenpox is caused by the varicella
virus, which spreads easily by inhaling infected droplets released when a child
sneezes or coughs. The virus can also be spread though direct contact with
chickenpox skin blisters. Varicella vaccine is now required for school entrance in
nearly every state, and it is about 90 percent effective in preventing the
illness. For the small percentage of children who still develop chickenpox, even
after being vaccinated, the illness is usually mild and, generally, comes with
fewer than fifty skin lesions.

For nonimmunized children, chickenpox is more severe and may result in
pneumonia, infection of the brain (encephalitis), and other complications. For this reason, one
should never deliberately expose a child to chickenpox to “get the infection over
with.” An infected child may be contagious for one or two days before any skin
blisters appear, and the child will remain contagious (and should be kept home
from school) until all of the blisters have dried up and crusted over.

Impetigo. Impetigo is an infection of the skin
caused by Staphylococcus or Streptococcus
bacteria. Both types of this disease are highly contagious by direct contact, and
both spread easily among young children in preschool settings. Impetigo develops
as an area of redness and blistering of the skin that quickly weeps (oozes)
yellowish fluid and becomes covered with honey-colored crusts. This often occurs
on the face or arms and begins in an area of irritated skin, such as a patch of
eczema or a scratch. Treatment is with either oral antibiotics or an antibiotic
cream, and the child should be kept from school until twenty-four hours after
treatment is begun.

Erythema infectiosum. Also called fifth
disease, erythema infectiosum is a mild illness
often seen in school outbreaks in the late winter and spring months. Generally,
the only symptoms are reddened cheeks followed by a fine, lacy, red rash over the
trunk that may be slightly itchy. This infection is caused by parvovirus B19;
about one-half of adults are immune. However, adults and older children not
previously exposed may also have painful and swollen joints, and there can be some
risk of miscarriage for nonimmune pregnant women exposed to the virus. Children
with fifth disease are contagious only before they break out in the rash, and they
are no longer contagious by the time the rash appears. For this reason, most
school systems do not advise keeping an otherwise asymptomatic child with fifth
disease at home.

Head lice. Head lice (pediculosis capitis) has
long been associated with school-related infectious diseases, and it is most
common in preschool and elementary school children. Infestation of the hair with
these 2 millimeter parasitic insects generally causes more anxiety than actual
physical discomfort, as the lice do not carry disease and tend to cause only minor
itching. In many countries, cases of head lice appear in nearly all children.

Lice treatments involve the application of one of several approved treatments (available over the counter and by prescription), with repeat treatments either on day nine or in a three-dose regimen with repeat treatments on days seven and fourteen. In the past, undergoing treatment meant that children would be refused readmission to school until treatment was completed and there were no remaining visible “nits” (eggs and dead egg-casings) clinging to the hair shaft. However, the difficulty in removing all nits even after successful treatment, and the frequent misidentification of dandruff, skin particles, and scabs as nits, led to many uninfested children being excluded from school for an average of twenty days.

Many school policies are changing. Head lice are most commonly spread by direct head-to-head contact, which is not commonplace in the classroom beyond the preschool years. Lice are much less likely to be spread by the shared use of brushes, combs, and headgear. In the United States, most head lice are probably transmitted during close sleeping arrangements, such as the sharing of beds at sleepovers and summer camps, rather than at school. The American Academy of Pediatrics (AAP) recommends that school nurses be well trained in proper diagnosis of head lice, particularly in recognizing nits, mainly to avoid diagnostic confusion. At the same time, the AAP recommends that school districts abandon their “no-nit” policies for a child’s return to school, and that children should return to school the day after their first treatment, even if nits remain visible in the hair.

Conjunctivitis. The most common cause of conjunctivitis, or pinkeye, is a viral
infection of the clear membrane covering the white of the eye
and lining the eyelids. Viral conjunctivitis causes reddened, itchy eyes with a
clear watery discharge, and it is spread by contact with secretions (tears and
nasal discharge) that often are spread from the fingers. Children may remain
contagious for ten to twelve days. Bacterial conjunctivitis also causes reddened
eyes, but it is more likely to result in thick, puslike, yellow or green eye
secretions, and it responds quickly to antibiotic drops. Students with bacterial
conjunctivitis can usually return to school twenty-four hours after beginning
treatment, but students with viral conjunctivitis should remain home until they
are symptom free or until cleared by a physician.

Methicillin-resistant Staphylococcus aureus
(MRSA). MRSA has become a problem in schools, particularly in
physical education classes and high school athletic programs. This type of
bacteria mainly causes skin infections, usually of open
wounds, and is resistant to many common antibiotics that were previously able to
treat Staphyloccocus (staph) infections. MRSA causes redness,
swelling, pain, and pus, and it must be diagnosed by a bacterial culture. It
spreads by direct skin-to-skin contact or by contact with a used bandage, towel,
or surface in a locker room or other athletic facility. Athletes who have a break
in the skin should clean the area and cover it to prevent infection. Those who
already have an MRSA-infected wound should always keep the area completely covered
to prevent spreading the infection to another person. As long as the infected area
is not draining and can be completely covered, infected athletes, according to the
CDC, do not need to be excluded from athletic participation. It also is not
necessary to close or completely disinfect a school if a student has been
diagnosed with MRSA.

Respiratory Infections

Common cold. The most common respiratory illness in schools is
the viral infection known as the common cold. Caused by a variety of
viruses and spread by coughs, sneezes, and contaminated surfaces such as
doorknobs, colds affect otherwise healthy young children up to six times per year.
Chances are that each classroom will have a minimum of one child with a cold.
Although some preschools and day-care centers may exclude children from attending
if they exhibit cold symptoms, no medical reason exists for doing so, because
these illnesses are mild, self-limited, and ubiquitous.

Influenza. Another respiratory illness, influenza, is
of much greater concern in schools. Influenza, commonly referred to as the flu, is
characterized by respiratory symptoms more severe than those of the common cold.
Flu symptoms also include high fever, headache, and muscle aches, and the flu has
the potential for complications, including pneumonia and, rarely, death. The
illness is contagious and is transmitted through inhaling or contacting the
droplets of an infected person’s cough or sneeze.

Influenza occurs in predictable seasonal outbreaks during the winter months in both the Northern (peaking in January and February) and Southern (peaking in July and August) hemispheres. Several slightly different influenza viruses circulate each year, and these viruses tend to change year to year. Each year’s flu vaccine is tailored to prevent the viruses that are predicted for that year by virologists. These predictions are not always completely correct, meaning that in some years, even those persons who get that season’s vaccine will not be well protected.

Schools have three main strategies at their disposal for preventing large
outbreaks of influenza among students and staff. The primary tool is immunization.
The CDC recommends that all children older than age six months receive an annual
seasonal influenza vaccine, and schools often encourage this by means of letters
and other reminders to parents. Particularly in years in which a new strain of flu
is causing a pandemic, such as the 2009 H1N1 virus pandemic, schools may
provide in-school vaccinations with parental approval.

The second strategy available to schools for the prevention of influenza
outbreaks is attention to basic hygiene measures. Schools are teaching children to
cover their mouths and noses with a tissue when coughing or sneezing and to
discard the tissue in the trash immediately afterward. Alternatively, children are
being taught to sneeze into their arms near their elbows, instead of into their
bare hands, if no tissue is available. Handwashing is emphasized as a means to prevent transmission after coughing,
sneezing, blowing one’s nose, or touching an object that has been used by a sick
person. In preschools and elementary schools, children should be given frequent
opportunities for handwashing, and when no water is available, children should
have access to a gel-based hand sanitizer. These concepts can be reinforced as
part of morning announcements, in handouts, and through frequent review.

The third tool available to schools to manage influenza is attendance policy. Children and staff who display flulike symptoms should not attend school. However, because persons with influenza are contagious for about twenty-four hours before showing any symptoms, and will remain contagious until about the fifth day of illness, this type of attendance policy cannot completely protect students and staff. During the 2009 pandemic flu season, some schools closed when a significant number of students became ill. In general, however, this practice is not recommended for a variety of reasons, including that when schools are closed, parents often bring younger children to a babysitter, a neighbor, or even to the workplace. Older children, especially teenagers, often use this time away from school to congregate with their friends, often in public places. Overall, it appears that a school closure because of a flu scare aids in spreading the virus into the community, rather than keeping it contained. However, if absenteeism among teachers and staff is so high that the school cannot function appropriately, school closures may be inevitable.

Strep throat. Streptococcal pharyngitis, or strep throat,
is another common respiratory illness in school-age children. The majority of sore
throats are caused by some of the many viruses that cause the common cold, but up
to 30 percent may be caused by the bacterium Streptococcus
pyogenes. Children with a sore throat, fever, swollen lymph nodes
(glands) in the neck, headache, and, sometimes, abdominal pain and vomiting are
most likely to have strep throat, which is spread by infected droplets from
coughing and sneezing and from contaminated hands. Strep throat should be
diagnosed either by a rapid screening test or a throat culture, so that
antibiotics are not used unnecessarily for a viral infection. Antibiotics should
be given for a minimum of twenty-four hours before an infected child returns to
school, and they are critical for the prevention of later complications from
S. pyogenes. These complications include scarlet
fever, heart valve damage, and kidney damage.

Bacterial meningitis. Bacterial meningitis is a serious
illness that is life-threatening, may begin during the school day, and may
progress in severity in a matter of hours. Any child who develops a headache,
along with a stiff neck, fever, confusion, or rash or discoloration of the skin,
should be taken to a hospital for emergency treatment. If a certain type of
bacterial meningitis (meningococcal meningitis) is diagnosed,
health officials will contact the school and identify students and staff who were
in direct contact with the infected child so that prophylactic (preventive)
antibiotics can be administered to all who had contact.

Bacterial meningitis spreads by infected droplets from a cough or sneeze. A vaccine called meningococcal conjugate vaccine (MCV4) is routinely recommended at ages eleven and twelve years. Meningitis is also caused by a wide variety of viruses and is generally less severe. It is not prevented by or treated with antibiotics.

Gastrointestinal Infections

Gastroenteritis. Diarrhea and vomiting (gastroenteritis) is usually a more serious problem among
preschool and early elementary age students, who are more likely to have poor
restroom hygiene and more likely to put their hands, toys, and other items in or
near their mouths. Infections causing these symptoms can be classified as being
waterborne, food-borne, or acquired from another person or animal through contact
with their feces or body secretions.

A sudden, large outbreak of gastroenteritis in a school is often caused by a food-borne illness from cafeteria food. In this case, school officials should alert local or state health officials. Health officials will conduct an investigation of the outbreak to determine the cause. The investigation will include extensive questioning of students and staff, microbiological testing of food remnants and kitchen surfaces, and medical testing of cafeteria staff.

Other sudden, large outbreaks in a school may prove to be caused by
noroviruses, which can be food-borne but are more often
spread quickly and easily from person to person through either direct contact with
contaminated feces or vomit or from touching contaminated surfaces such as
restroom doors or another person’s towel. A norovirus infection tends to cause a
day or two of severe diarrhea in children, and then clears on its own.

Impact

Given that fifty-five million children age eighteen years and younger attend schools each day in the United States, an infectious disease affecting one child could potentially affect (and infect) many more. Many of the worst infectious diseases are rarely, if ever, seen in today’s schools because of stringent, compulsory school immunization laws. Today’s schools, however, face other potential infectious disease challenges.

Some students remain unimmunized because of their parent’s religion, or because
of other reasons, providing an opening for disease outbreaks. Antibiotic
resistance, such as that seen with MRSA infections, is likely
to become a more widespread problem. Immigrant populations in some areas increase
a student’s potential exposure to tuberculosis. As teens engage in oral
and genital sex at earlier ages, herpes infections, gonorrhea, human
immunodeficiency virus infection, and other sexually transmitted infections will
likely become more prevalent among teen social networks, which tend to revolve
around school activities. School nurses and administrators, and public health
officials, should continue to devote time and attention to infectious disease in
the schools.

Bibliography

Aronson, Susan S., and Timothy R. Shope. Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. 2d ed. Elk Grove Village, Ill.: American Academy of Pediatrics, 2009. A reference on infectious disease management and prevention in school and child-care settings.

Centers for Disease Control and Prevention. “Questions and Answers About Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools.” Available at http://www.cdc.gov/features/mrsainschools.

Fisher, Margaret C. Immunizations and Infectious Diseases: An Informed Parent’s Guide. American Academy of Pediatrics, 2006. A pediatrician explains childhood infection and its prevention.

Frankowski, Barbara L., and Joseph A. Bocchini, Jr. “Clinical Report: Head Lice.” Pediatrics 126 (August, 2010): 392-403. A report from the American Academy of Pediatrics’ Council on School Health and the Committee on Infectious Diseases includes a clinical overview of head lice diagnosis and treatment and expert opinion on school policies related to head lice.

Lee, Marilyn B., and Judy D. Greig. “A Review of Gastrointestinal Outbreaks in Schools: Effective Infection Control Interventions.” Journal of School Health 80 (2010): 588-598. A review of documented gastrointestinal illness outbreaks in schools since 2000.

What is the setting of the story and how does it affect the events in "The Monkey's Paw"?

In the story "The Monkey's Paw," the setting is an isolated, out-of-the-way place that floods with heavy rainfalls.

This deserted setting contributes to the Gothic atmosphere of the narrative as the guest's arrival is noted by the sound of the gate banging and heavy footsteps. Their visitor is listened to with eagerness since such visits by others are rare. Further, Sergeant Morris's tales of India are all the more fascinating to the Whites who have such isolated lives. For, had another family who were more cosmopolitan sat with the soldier, they may not have afforded him the captive audience that the Whites are. 

Then, too, if Mr. White were around more people and more involved with outside interests, he might not have recalled having heard his friend's tale of the monkey's paw and asked the sergeant about it. When the sergeant dismisses this tale by quickly replying, "Nothing....Leastways nothing worth hearing," Mrs. White's curiosity is aroused and she asks, "Monkey's paw?" also because her life is rather mundane.

 So, the sergeant produces the monkey's paw and describes its powers with the Whites as a rapt audience. Had they led a busier and more sophisticated life in another area, they may not have expressed such an interest in the occult tale and then, of course, the bizarre and tragic chain of events would not have happened.  Perhaps, too, the Whites would have wished for something else if their environment were different as they may have had more interests to captivate their desires, such as going on a voyage.

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

Coenzyme Q10 (CoQ10)

Effect: Supplementation Possibly Helpful

There is some evidence that clonidine might impair the body’s ability to
manufacture the substance CoQ10. However, it has not yet been shown
that CoQ10 supplements offer any particular benefit
to those taking this medication.

Yohimbe

Effect: Probable Dangerous Interaction

Persons taking clonidine should not take yohimbe.

Coleus forskohlii

Effect: Theoretical Interaction

The herb Coleus forskohlii relaxes blood vessels and might have unpredictable effects if combined with clonidine.

Bibliography

Brinker, F. Herb Contraindications and Drug Interactions. 2d ed. Sandy, Oreg.: Eclectic Medical, 1998.

Kishi, H., et al. “Bioenergetics in Clinical Medicine IIII: Inhibition of Coenzyme Q10-Enzymes by Clinically Used Anti-hypertensive Drugs.” Research Communications in Chemical Pathology and Pharmacology 12, no. 3 (1975): 533-540.