Why didn't the South like Lincoln?

The South did not like Lincoln or the Republican Party in general in 1860--in fact, in many cases Lincoln was not even on presidential ballots south of the Mason-Dixon line.  Lincoln was a moderate Republican who viewed the abolitionists as warmongers.  He was in favor of allowing slavery to exist where it was already established, but he did not approve of its expansion into Western territories.  Many Southerners claimed that all Republicans were alike and did not see this difference between Lincoln and the rest of the party.  Also, Southern congressmen believed that eventually free states would outnumber slave states and this would allow them to vote to end slavery.  

During the war, Southerners also did not approve of Lincoln not allowing the Confederacy to leave the nation peacefully.  Southerners in the border state of Maryland did not approve of him instituting martial law and calling in troops in order to keep that state in the Union.  Southern sympathizers in the North did not approve of Lincoln suspending the writ of habeas corpus which allowed him to imprison people for hindering the Northern war effort.  

Why is knowing about cells important if you are not going to be a scientist in the future?

The cell is the basic building block of life. All living things are composed of cells, including you! Throughout your life, your body will change in a variety of ways. Some of these changes are normal (caused by aging) and others are not normal (caused by ill health or disease). It is important for you to care for your body and your health. This requires recognizing which changes are normal and which are perhaps a cause for concern. Knowing how your body functions will aide you in understanding your state of health. A deep understanding of your own biology starts with an understanding that you are made of cells.

In summary, it is important for everyone, including non-scientists, to have a basic understanding of cells and human biology because this understanding will help them to lead healthier lives.

What are co-occurring disorders?

Overview

Persons who have been diagnosed with a substance abuse disorder are twice as likely to also have a serious mental illness, compared with the general population. Moreover, the reverse holds true—people diagnosed with a serious mental illness are twice as likely to also have a substance abuse disorder. When two (or more) separate disorders occur simultaneously or concomitantly in the same person, they are said to be comorbid or co-occurring, although one illness does not directly cause the other.

Despite this, the two disorders do interact, and each can affect the course and outcome of the other. Substance abuse disorders and serious mental illnesses are caused by overlapping factors, such as underlying deficits in the brain and genetic vulnerabilities, and both affect similar neurotransmitters and signaling pathways. Substance abuse can acerbate or trigger psychosis and mood and affective disorders; worsening or untreated mental illness can intensify the drug or alcohol problem.

Experience has shown that mental health issues tend to surface before the onset of substance abuse, which then becomes a conscious or subconscious form of self-medication to alleviate symptoms of mental anguish. People with COD have a poorer prognosis and higher rates of drug relapse, and they are more prone to treatment noncompliance and violent behaviors. Risk factors for having CODs include family history of substance use; multidrug use; antisocial personality disorder; being a young, single, adult male; having a lower level of education; homelessness; incarceration; and limited access to treatment.

Evolving Evidence

The association between substance abuse disorder and serious mental illness has been well established, supported by several major studies first conducted during the late 1990s. These studies include the landmark Epidemiologic Catchment Area Study and the National Comorbidity Survey, both sponsored by the National Institute of Mental Health. Also, the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the US Department of Health and Human Services, issues its annual National Survey on Drug Use and Health (NSDUH), which provides data on health and the use of tobacco, alcohol, and illicit drugs in the United States.

According to the NSDUH, 2.5 million adults aged eighteen years or older had a COD in 2008. In general, adults with a past-year serious mental illness had higher rates of past-year illicit drug use (30.3 versus 12.9 percent), higher rates of past-year cigarette use (50.5 versus 28.5 percent), higher rates of heavy alcohol use (11.6 versus 7.3 percent), and higher rates of binge drinking (29.4 versus 4.6 percent), compared with those without a serious mental illness.

Among adults with past-year major depressive episode (MDE), 20.3 percent abused or were dependent on alcohol or illicit drugs, compared with 7.8 percent without MDE. More specifically, adults with MDE had higher rates of past-year illicit drug use (27.2 versus 13.0 percent), past-thirty-day heavy alcohol use (9.6 versus 7.1 percent), and past-thirty-day cigarette use (29.1 versus 15.2 percent), compared with those without MDE. Adults with past-year serious psychological distress (SPD) had higher rates of past-thirty-day illicit drug use (19.6 versus 7.3 percent, and, excluding marijuana, 12.3 versus 2.9 percent), heavy alcohol use (12.1 versus 7.3 percent), binge drinking (30.9 versus 24.6 percent), and cigarette use (47.6 versus 24.5 percent), compared with adults without SPD.

Furthermore, the NSDUH reports that two million youths aged twelve to seventeen years had MDE in 2008, and of that figure, 21.3 percent had illicit drug or alcohol dependence or abuse, indicating that there were 426,000 youths with CODs in 2008. For those who did not have MDE, the rate of dependence or abuse was only 6.4 percent. Youths with MDE also had higher rates of illicit drug use (37.4 versus 17.2 percent), past-thirty-day cigarette use (3.6 versus 1.8 percent), and past-thirty-day heavy alcohol use (3.4 versus 1.8 percent), compared with those without MDE.

Treatment Approaches

Researchers now have a better understanding of the prevalence of CODs, of the specific issues related to CODs, and of how CODs affect treatment and treatment outcome. Of the 2.5 million adults with COD in 2008, 60.5 percent received treatment at a specialty facility, but only 11.4 percent received treatment at a facility equipped to treat both substance abuse disorders and serious mental illnesses. However, efforts to provide targeted treatment for both disorders concurrently is gaining favor, as mental health professionals realize the need to address the interrelationships among the two disorders and begin to focus more attention on their shared neurobiological aspects.

Integrated treatment
involves combining COD treatment with a primary treatment relationship or service setting. The intention is to treat the whole person. SAMSHA states that integrated COD treatment “is an evidence-based approach to care, which recognizes that individuals go through different stages on their way to recovery.” These stages include engagement (establishing a working alliance), persuasion (forming a trusting relationship), active treatment (seeing the problem and making positive changes), and relapse prevention (creating a relapse prevention plan and building on positive behaviors). Such practices as integrated screening and assessment techniques, treatment planning strategies, motivational interviewing, cognitive-behavioral therapy, and peer support are part of the treatment program. Integrated stage-wise treatment is proving to be a viable path to recovery and is helping individuals with COD improve the quality of their lives.

Bibliography

Atkins, Charles. Co-Occurring Disorders: Integrated Assessment and Treatment of Substance Use and Mental Disorders. Eau Claire: PESI, 2014. Print.

Choi, Sam, Susie M. Adams, Siobhan A. Morse, and Sam MacMaster. "Gender Differences in Treatment Retention among Individuals with Co-Occurring Substance Abuse and Mental Health Disorders." Substance Use and Misuse 50.5 (2015): 653–63. Print.

Galanter, Marc, and Herbert D. Kleber, eds. Psychotherapy for the Treatment of Substance Abuse. Arlington: American Psychiatric, 2011. Print.

Hendrickson, Edward L. Designing, Implementing, and Managing Co-Occurring Treatment Services for Individuals with Mental Health and Substance Use Disorders. Binghamton: Haworth, 2006. Print.

Mignon, Sylvia I. "Treatment of Co-Occurring Disorders (Dual Diagnosis)." Substance Abuse Treatment: Options, Challenges, and Effectiveness. New York: Springer, 2015. 139–56. Print.

Smith, John. Co-Occurring Substance Abuse and Mental Disorders: A Practitioner’s Guide. Lanham: Aronson, 2007. Print.

What did the Mormons hope to find in the West in 1830?

Joseph Smith founded the Mormon Church, often called the Church of Jesus Christ of Latter-day Saints, in 1830 in Fayette, New York. The Mormons were looking for converts and a place to worship in peace after they formed. The Mormons had some different religious practices, including polygamy, which often created tensions with other people and with other religious groups. Thus, the Mormons looked to move westward in the 1830s.

The Mormons did move westward during this time. The settled in Ohio, Missouri, and Illinois. However, they weren’t able to find long-term freedom from religious persecution. People continued to be concerned about their religious practices. There was some concern about the voting patterns of the Mormons. They tended to vote in a united bloc. There also was some economic competition between the Mormons and other groups. After Joseph Smith was killed in Illinois in 1844, the Mormons, in 1846, moved even further west, and they eventually settled in Utah under the leadership of Brigham Young.

In The Witch of Blackbird Pond, how many meetings did Kit Tyler miss?

Kit Tyler does not miss any formal prayer meetings under the strict surveillance of her pious Uncle Matthew; however, she does miss a Thursday Lecture, which is the day that people are publicly punished in Wethersfield. Kit is terrified of seeing what will happen to Nat, who is being punished for illuminating jack-o-lanterns in the house of William Ashby.

An hour before the meeting is due to start, Kit sneaks out alone and goes to see Nat, who is locked up in the stocks with some of his fellow sailors. Kit attempts to comfort Nat and offers to bring him food, but Nat is too proud for that and says, 'You can stop trying to be a lady of mercy. 'Twas well worth it. I'd gladly sit here another five hours for a sight of Sir William's face that evening." Unimpressed by this childish display of bravado, Kit leaves the square with "[h]ead held high," trying "to keep a ladylike pace." Embarrassed that her very public "foolish concern" might be the subject of the town gossip, Kit wanders to the meeting house, where she sees the formal notice of Nat's punishment: he must pay a fine of forty shillings, remain in the stocks "from one hour before the Lecture till one hour after," and must never return to Wethersfield "on certainty of thirty lashes at the whipping post." 

Kit decides right then and there that she will not go into the Meeting House to hear Nat's sentence read to the entire town since "[s]he could not bear to sit there and hear that sentence read aloud," or "face the family, or the whispering and staring that would turn her own family pew into a pillory." This is, as the book says, "the first time since she had come to Wethersfield in the spring that she had dared to miss a Thursday Lecture."

What distraction jars Mitty out of his first daydream in James Thurber's "The Secret Life of Walter Mitty"?

Insofar as one need only read the first two paragraphs of James Thurber's short story The Secret Life of Walter Mitty to discover the source of the interruption in the protagonist's daydream, the answer is pretty simple to find. As Thurber's classic tale of a man routinely escaping his dreary daily existence through the use of his very active imagination begins, the reader is immediately placed inside of a military aircraft, a Navy hydroplane, during a dangerous maneuver. The plane's crew, including "the Commander" and "Lieutenant Berg," is battling hostile conditions, their lives clearly in danger from the brutal, winter weather that is causing ice to form on the pilot's window. The scene is frightening, and exciting. It is interrupted, however, by the following comment:

"Not so fast. You're driving too fast. . .What are you driving so fast for?"

This admonition comes from the wife of the man driving their car, during which time his mind has wandered and he has escaped reality once again only to be abruptly brought back to the present. Walter Mitty lives every man's nightmare. He is married to a domineering, demanding wife who insists on micromanaging his life, and one can assume that he is stuck in menial dead-end job suitable an individual of limited capabilities. This first dream in Thurber's story ends, as will another, with Mitty's wife destroying yet another fantasy.

What is avian influenza?

Causes and symptoms

A group of RNA viruses causes influenza in birds. Most such viruses do not attack humans, although human influenza viruses were probably derived from bird influenza viruses. On the rare occasion that a bird flu strain achieves the ability to enter and reproduce in human cells, the human is unlikely to have effective defenses and the viral attack is likely to be severe. If the virus strain combines its ability to reproduce in humans and its highly pathogenic nature with the ability to transfer from human host to human host efficiently, then it is particularly dangerous. The most deadly human influenza pandemics
in history probably began this way. Public health officials have been concerned that the avian influenza A virus strain H5N1 might undergo such a transformation and initiate such a pandemic.

Influenza virus subtypes are named for two types of their surface proteins, hemagglutinin (sixteen subtypes) and neuraminidase (nine subtypes), and all have been identified in avian influenza viruses. Each different protein is assigned a number, so that H5 in H5N1 refers to the hemagglutinin that is assigned the number five. Similarly, N1 refers to the neuraminidase assigned the number one. Hemagglutinins are responsible for attachment of the virus to host cells and entry into those cells. After the production of new viruses in the cell, neuraminidases are used by the new viruses to break out of the cell.

Influenza viruses are notorious for their ability to change their surface antigens and thereby escape host defenses, which are dependent on recognition of those antigens. The H5 and N1 surface proteins characterize the subtype causing severe human disease (since 1997) and are also antigens targeted by host defenses. Both are displayed on the surface of the membranelike coat that surrounds the virus. The hemagglutinin (H5) is the primary target for cell defenses. If an organism has been exposed to a given hemagglutinin, then it will quickly produce antibodies that attach to that hemagglutinin, blocking the site that is normally used to attach to the organism’s cells. The virus is rendered harmless if it cannot attach to and enter a cell. If this is the organism’s first exposure to the specific hemagglutinin, however, then the response will not be as rapid. The host’s immune system will begin making antibodies against the new antigen, but they are made too slowly during this first exposure, and illness results. Most humans have had no exposure to H5 antigens and so
are unprotected against H5N1.

Symptoms of avian influenza in humans include the familiar set generally caused by flu viruses. Those symptoms—fever, loss of appetite, clogged sinuses, runny nose, muscle aches, and so forth—pass in three to five days with most influenza strains, and the victim recovers. With H5N1, however, other host systems—such as the circulatory, nervous, reproductive, and gastrointestinal systems—often become involved. In approximately 60 percent of human cases reported, death occurs, sometimes within a day of the onset of symptoms.

Treatment and Therapy

The major medical solutions to avian flu infection are medications and vaccination. Antiviral medications have been difficult to develop, and few effective drugs are available. Many of the drugs prescribed for viral infections are actually used to combat secondary infections by bacteria attempting to take advantage of the host’s weakened condition. Vaccine development against influenza viruses is also problematic. The vaccines target antigens on the surface of the viruses, and the viruses mutate and change their surface antigens so frequently that new vaccines must be developed almost every year to defend against the new strains of influenza. Given these difficulties and the fact that most influenza victims recover in three to five days without treatment, drugs and vaccines against influenza have often not been a high priority compared to those against more deadly diseases such as smallpox. Periodically, however, a particularly pathogenic influenza strain has developed, and effective treatment would have saved many lives. Because the H5N1 strain is feared for its potential to be one of those strains, scientists have sought to develop both drugs and vaccines against this virus.

Four medications that act against flu viruses are available, but the virus has quickly developed resistance to the older pair, amantadine and rimantadine. The H5N1 virus populations in Vietnam and other Southeast Asian countries are already resistant to these drugs. In those countries, the virus has been present in poultry, and occasionally in humans, a bit longer than elsewhere. Two newer drugs, oseltamivir and zanamivir, have shown effectiveness against H5N1, although the virus has sometimes been resistant to oseltamivir. The antiviral resistance of avian flu is being continuously monitored.

Progress in vaccine development has been encouraging, but no 100-percent proven vaccine is available. Even when a vaccine becomes ready for use, production of enough to meet the needs of a pandemic would be challenging. Stockpiling a vaccine in anticipation of a pandemic is possible, but the exact antigen against which it must be directed cannot be known until the virus is in the process of initiating the pandemic. Each year, experts predict the most likely antigens for an approaching flu season, and vaccines are produced in advance against those antigens. Should an influenza virus employ an antigen not anticipated by the experts, then the stockpiled vaccines would be worthless.

Vaccine production technology is also improving, but the improvements have not been fully implemented. In the standard technique, the antigenic virus to be used in the vaccine is grown in fertilized eggs—an expensive, slow, and inefficient method. Tissue culture techniques, in which the antigenic virus is grown in cells in artificial media, promise dramatic improvement in vaccine preparation once they are fully integrated into the production system.

Perspective and Prospects

The history of influenza can be traced much further back in time than the understanding of its cause. Reports describing epidemics and pandemics in which the victims showed symptoms of influenza go back to the early sixteenth century at least, but the first isolation of an influenza virus did not occur until 1933. The worst flu pandemic occurred in 1918 to 1919 (the Spanish flu), when twenty million to one hundred million people died of influenza. It was one of the deadliest diseases in history. Two more recent flu pandemics, the Asian flu (1957) and the Hong Kong flu (1968), were seriously disruptive, but not as deadly. All these pandemics were caused by influenza type A viruses, the type to which strain H5N1 and the other avian influenza viruses belong.

The concern over avian influenza type A H5N1 began in 1997 in Hong Kong, where poultry and humans came under attack. Three events associated with these infections captured the attention of epidemiologists, because together they suggested H5N1’s potential as the agent of an influenza pandemic. First, transmission occurred from poultry to humans. Second, H5N1 proved to be highly pathogenic, as six of the eighteen infected humans died. Third, there was some indication of human-to-human transfer of the virus. If the virus maintained its pathogenic nature and its ability to move from poultry to humans, and if it added the ability to transfer efficiently from one human to another, it would almost certainly initiate another deadly pandemic.

Between 1997 and 2006, a number of human cases of avian influenza type A were documented in a number of countries. Not all were the result of the feared H5N1 strain, but the other strains bear watching as well. Between 2004 and 2006, there were two hundred confirmed cases of human infection with H5N1, most in Southeast Asia (Vietnam, Cambodia, Indonesia, Thailand) but also in Egypt, Iraq, Azerbaijan, and Turkey. Since November 2003, more than six hundred people across fifteen countries in Asia, the Pacific, Europe, Africa, and the Middle East have been infected with H5N1; and more than half of those infected have died. No H5N1 infections have been documented in North America, but avian influenza virus type A H7N2 caused illness in New York, and H7N3 attacked poultry workers in Canada. No North American infection resulted in a human fatality. A new serious strain of avian influenza type A, H7N9, was discovered in China in March 2013. By early May 2013, more than 130 people had been infected, and just over 20 percent of those infected had died. There is concern over H7N9's ability to spread more easily to mammals than other strains of bird flu; health officials have been working on a vaccine against this strain. None of these infections have involved extensive or sustained human-to-human transmission, though a few restricted transfers between humans may have occurred. Most of the human infections were transferred from infected domestic poultry. Some may have been contracted from wild waterfowl (ducks and geese).

Human health is not the only concern regarding the H5N1 strain; there are agricultural and economic concerns as well. Poultry flocks can be destroyed by the virus. There were several poultry outbreaks around the world before 2006, in which an estimated 150 million barnyard birds either died as victims of the virus or were culled to remove the infection focus and prevent further spread of the virus. Although the governments involved often compensated individuals for their culled animals, the compensation was usually well below market value. This practice encourages farmers to hide infections that occur in their flocks, which slows the discovery of potential outbreaks and gives the virus a head start that it does not need. In addition, several governments were suspected of hiding avian flu outbreaks until they were impossible to conceal, in an attempt to protect their countries’ economic interests.

The role played by wild birds is an important piece of this puzzle as well. Wild birds, especially waterfowl, act as the reservoir for H5N1. The birds maintain the virus between epidemics. Waterfowl are known to carry the virus, release virus in their feces and oral secretions, and are usually not sickened by the virus infection. These characteristics of the reservoir indicate how easily a pandemic could start from a mutant virus in the reservoir. In Hong Kong in 2002 to 2003 and again in China in 2005, large numbers of wild birds were killed by the virus, emphasizing the virus’s tendency to mutate. Experts believe that it may take only a few mutations for the virus to gain the ability to successfully transfer between humans. If they are right, then the waterfowl reservoir is always just a step away from creating a pandemic virus strain.

Given their mobility, especially during migration, wild birds also appear to be good candidates for spreading the virus among countries and continents. However, investigations suggest that, while wild bird migration might play a role in viral geographic expansion, it is probably secondary to the role played by commercial poultry exchanges.

Avian influenza virus type A H5N1 has demonstrated its ability to transfer from wild birds to domestic poultry (and perhaps to humans), to decimate domestic poultry flocks, to be transferred from poultry to humans, and to be highly pathogenic for humans. It has not definitively demonstrated the ability to pass freely from one human to another, although the Centers for Disease Control and Prevention indicates that a limited amount of human-to-human cases may have occured. While for the most part, H5N1 cannot transmit effectively from person to person, if it were to add this last ability successfully to its arsenal, it would be a candidate to initiate a pandemic as deadly as the influenza pandemics of the past. The change required to introduce this ability to the H5N1 virus is not thought to be elaborate. A few simple mutations in the viral RNA might suffice.

Epidemiologists have one special concern, the potential for the H5N1 virus to use pigs for reassortment of its genes. In developing countries, pigs often share living space with chickens and other poultry. Humans often live adjacent to the animals or even share their living space. These associations are troubling because pigs host both human and bird flu viruses—for example, the H1N1 strain that caused a global pandemic between 2009 and 2010 was of swine origin, although the H1N1 virus is endemic to both birds and pigs—and the intimate association of the three species presents the two viral strains with the opportunity to invade the same pig. Together in the same host, they would be expected to exchange RNA strands. Some reassortments might produce a virus with the capability to transfer from human to human. There is no evidence that such a transformation has occurred. However, the possibility is real and the defenses (antiviral drugs and vaccination) are not in place and fully functional, so the concern is understandable.

Some investigators suggest, however, that the concern has been overblown. They point out that no H5 influenza strain has ever caused a pandemic and that successful pandemic-causing influenza strains attach to receptors in the upper parts of the human respiratory tract, while the receptors to which H5N1 viruses attach are in the lower reaches. Some skeptics also argue that if H5N1 went through the changes necessary to achieve efficient transfer among humans, it would invariably lose pathogenic potency in the process, thus minimizing its pandemic potential.

Governments and public health officials are between the proverbial rock and hard place. They would be criticized if they prepared for a threat that did not materialize, but more tragic results would occur if they failed to prepare and a pandemic broke out. Criticism for a perceived lack of preparation is already widespread. While another pandemic is probably inevitable, no one can know when it will materialize or what specific disease organism will be the cause, so there is no easy answer to their conundrum. For the long-term struggle against avian influenza, however, disease patterns in animal populations might be very helpful in predicting which threats have the potential to cause human pandemics and in otherwise understanding the viruses. This possibility calls for close coordination among students of wildlife, veterinary, and human disease. That coordination will not solve all the mysteries of influenza outbreaks but should aid in understanding them, and the influenza viruses will not be controlled until they are more thoroughly understood.

Bibliography:

"Avian Influenza A (H7N9) Virus." Centers for Disease Control and Prevention, Apr. 23, 2013.

"Avian Influenza A (H7N9) Virus." World Health Organization, May 10, 2013.

"Avian Influenza A Virus Infections in Humans." Centers for Disease Control and Prevention, June 21, 2012.

Beigel, John, and Mike Bray. “Current and Future Antiviral Therapy of Severe Seasonal and Avian Influenza.” Antiviral Research 78 (2008): 91–102.

"Bird Flu." MedlinePlus, May 2, 2013.

Carson-DeWitt, Rosalyn. "Avian Influenza." Health Library, Dec. 30, 2011.

Clark, Larry, and Jeffrey Hall. “Avian Influenza in Wild Birds: Status as Reservoirs, and Risks to Humans and Agriculture.” In Current Topics in Avian Disease Research: Understanding Endemic and Invasive Diseases, edited by Rosemary K. Barraclough. Washington, D.C.: American Ornithologists’ Union, 2006.

Davis, Mike. The Monster at Our Door: The Global Threat of Avian Flu. New York: New Press, 2005.

Green, Jeffrey. The Bird Flu Pandemic. New York: Thomas Dunne Books, 2006.

"Highly Pathogenic Avian Infleunza A (H5N1) Virus." Centers for Disease Control and Prevention, June 21, 2012.

"Information on Avian Influenza." Centers for Disease Control and Prevention, Apr. 12, 2013.

Sfakianos, Jeffrey N. Avian Flu. New York: Chelsea House, 2006.

Siegel, Marc. Bird Flu: Everything You Need to Know About the Next Pandemic. Hoboken, N.J.: John Wiley & Sons, 2006.

Wehrwein, Peter, ed. “Bird Flu: Don’t Fly into a Panic.” Harvard Health Letter 31, 8 (June, 2006): 1–3.

What are some examples of dogs and question marks for St. Jude's Children Hospital?

Using the Boston Consulting Group Model, dogs create low growth and low market share.  Dogs are expensive for the organization and create slow turn-around. Dogs may create some revenue or cash flow.  However, if they do not, dogs should be liquidated. A dog program at St. Jude's may be a holistic clinic for children with Attention Deficit Disorder. The clinic serves a much needed purpose. However, the clinic is costly and generates little to no revenue. The revenue that is created takes months to realize since revenue is generated between monthly visits. The clinic also demands high skill level and high salary time for a smaller percentage of patients.

A question mark at St. Jude's could be the treatment of severe accident victims in the surgery department. Because of the nature of accidents and treatments, this would be a low market share limited to their immediate geographical area. The service, however, provides much needed services and could generate more revenues. Because of the demand for services, St. Jude's should invest heavily in this area. 

What government group did President Thomas Jefferson consult before buying the Louisiana Purchase?

Thomas Jefferson had trouble deciding whether to make the Louisiana Purchase. President Jefferson hoped to buy West Florida and New Orleans from France for $10 million. He wanted to secure the Port of New Orleans so we would be able to use it to trade. When Napoleon offered to sell the entire Louisiana Territory for $15 million, President Jefferson wasn’t sure he had the authority to do this.

Thomas Jefferson believed in a strict interpretation of the Constitution. A person who believes in a strict view of the Constitution believes the government can only do what the Constitution specifically says it can do. Since the Constitution didn’t say the President could buy so much land, President Jefferson was hesitant to make this deal.

President Jefferson consulted with his Cabinet. The Cabinet is a group of people who provides advice to the President. His Cabinet recommended that he make this purchase. As a result, the Louisiana Purchase was made by President Jefferson and approved by the Senate.

At the end of Kurt Vonnegut's story "Harrison Bergeron," Harrison screams, "I am the Emperor!" Do you think Harrison is a hero or a danger to his...

The end of "Harrison Bergeron," when Harrison shouts on TV that "I am the Emperor! Everybody must do what I say at once!" he shows that he is a danger to American society in the year 2081. While we look at him as the story's hero because he's challenging a social order we may find offensive, it's important to recognize him as a threat.

In "Harrison Bergeron," Harrison is taken away from his family because of his extraordinary abilities. The government places him in elaborate handicaps to ensure that he was "equal every which way" to everyone else. At the end of the story, when he rips off his handicaps "like wet tissue paper," he challenges the laws of the land created and supported by the American people and the "211th, 212th, and 213th Amendments to the Constitution." This makes him a danger to his society.

However, it's important to understand that any individual who challenges the social order can be considered dangerous. For example, in the 1960s, the FBI tracked Martin Luther King, Jr. because they saw him as a threat to society. If we treat the New Testament as literature, the execution of Jesus occurs precisely because he challenges the social order. 

In dystopian literature, the heroes, or antiheroes, in this case, often end up dead because they are threats. In the movie V for Vendetta, V is a dangerous person, but he's the hero of the film because he plots an overthrow of this government, much in the way Harrison does in the Kurt Vonnegut story.

What are Fusarium?

Definition

Fusarium are widely distributed plant pathogens
that can cause skin, wound, lung, and invasive infections in humans.
Fusarium also produce many allergens and mycotoxins.

Natural Habitat and Features

Fusarium are widely distributed fungi (molds) that grow on a variety of substrates, including plants (and
their roots), food, soil, and wet, indoor environments. Fusarium
tend to produce fast-growing, woolly to cottony, flat-spreading cultures and come
in many colors, including white, gray, red, cinnamon, pink, yellow, and
purple.

Fusarium are present mainly in the anamorphic or asexual phase. Some Fusarium species also have a telemorphic phase and produce ascospores. Some of the more common Fusarium ascospore forms are Gibberella avenacea, intricans, zea, subglutinans, and moniformis; these are the telomorphic forms of F. avenaceum, equiseti, graminearum, subglutinans, and verticilloides, respectively. Haematonectria spp.are teleomorphic forms of F. solani.

Fusarium often produce two types of asexual spores, including macroconidia, borne on long sickle or banana-shaped structures, and microconidia, borne on chains. Many species of Fusarium also produce chlamydospores, which are thick-walled resting spores that can survive long periods in unfavorable conditions, such as drought.

Like most fungi, Fusarium are usually identified by macroscopic and microscopic features, although molecular methods such as 28S rRNA (ribosomal ribonucleic acid) gene-sequencing may also be used.

Pathogenicity and Clinical Significance

Fusarium exposure can adversely affect human health by three
mechanisms: infection (fusariosis), exposure to allergens, and exposure to toxics produced by
Fusarium. Fusarium frequently invade the skin, especially if the skin is damaged by trauma, burns, or diabetic
ulcers. Fusarium also can invade the eyes (endophtalmitis), nasal
sinuses, and lungs. Localized Fusarium infections may disseminate
through the bloodstream to become life-threatening infections.

Invasive disseminated Fusarium infections commonly occur in
immunocompromised persons, such as those with leukemia, lymphoma, or HIV
infection; those who are malnourished or neutropenic;
persons suffering from burns or other skin trauma; and persons taking
immunosuppressive drugs following bone or organ transplantation. Invasive
Fusarium infections can spread through blood vessels and cause
tissue infarction (tissue death).

The rate of Fusarium invasive infection is on the rise and now
makes up 1 to 3 percent of all invasive fungal infections. Disseminated
invasive Fusarium infections have high mortality rates that range
from about 30 to 90 percent.

F. solani is the most common cause of skin and disseminated invasive Fusarium infections (about 50 percent), followed by oxysporum (about 20 percent) and verticillioidis and monilforme (about 10 percent each).

Fusarium also produce a variety of toxins (mycotoxins), including fumonisins, trichothecenes, and zearalenones. Domestic animals and humans have become acutely ill after eating foods contaminated with Fusarium mycotoxins.

Fumonisins can increase the risk of some cancers, can damage the immune system, and can cause respiratory problems. Trichothecenes damage the immune and nervous systems, block cell protein synthesis, and cause vomiting. Zearalenones are estrogen-mimicking chemicals that can cause early female puberty, infertility, and spontaneous abortion in humans and other mammals. Human studies have linked consumption of Fusarium-contaminated corn (maize) with higher rates of early female puberty. Exposure to airborne Fusarium spores can also worsen asthma and sinus problems.

Drug Susceptibility

Fusarium infections are sometimes difficult to diagnose in their
early and less serious stages. Infections can often be diagnosed by culturing
Fusarium from the blood and from skin lesions. High resolution
computed
tomography (CT) scans of the chest are often useful in
diagnosing fusariosis. Polymerase chain reaction (PCR) blood tests also are used
to diagnose Fusarium infections.

Localized Fusarium
skin
infections can often be treated with topic antifungal drugs
such as natamycin and voriconazole. Disseminated Fusarium
infections are often difficult to treat because few antifungals are consistently
effective against many Fusarium species. Amphotericin B is often
used as a first-line drug against Fusarium; however, roughly 50
percent of Fusarium isolates, including many
solani and verticilloides, are resistant to
amphotericin B. Some Fusarium strains are susceptible to
voriconazole and posaconazole, while few Fusarium isolates are
susceptible to itraconazole. Most Fusarium strains are resistant
to the new echinocandin drugs (anidulafungin, caspofungin, and micafungin). These
chinocandin drugs are generally effective in treating disseminated
Aspergillus and Candida infections.

Other treatments that may be helpful in some cases of fusariosis include surgical debulking of Fusarium-infected tissue, removal of contaminated catheters, and using granulocyte-colony-stimulating factors.

The best method for controlling Fusarium infections is
avoidance of the mold. Medical experts recommended that immunocompromised persons
who are hospitalized be placed in rooms with positive air pressure, air
filtration, sterile water, and adequately cleaned surfaces, sinks, and showers to
reduce the risk of Fusarium infection. Any water damage or
visible mold growth in hospital rooms should be cleaned immediately. To
significantly reduce exposure to Fusariumand their mycotoxins in
the home, persons should keep dry, clean, and refrigerated all stored food, such
as grains, fruits, vegetables, and animal feeds.

Bibliography

Marom, Edith M., et al. “Imaging of Pulmonary Fusariosis in Patients with Hematologic Malignancies.” American Journal of Roentgenology 190 (2008): 1605-1609.

Nucci, Marcio, and Elias Anaissie. “Fusarium Infections in Immunocompromised Patients.” Clinical Microbiology Reviews 20 (2007): 695-704.

Patridge-Hinckley, Kimberly, et al. “Infection Control Measures to Prevent Invasive Mould Diseases in Hematopoietic Stem Cell Transplant Recipients.” Mycopathologica 168 (2009): 329-337.

Samson, Robert, Ellen Hoesktra, and Jens Frisvad. Introduction to Food and Airborne Fungi. 7th ed. Utrecht, the Netherlands: Central Bureau for Fungal Cultures, 2004.

Stanzani, Marta, et al. “Update on the Treatment of Disseminated Fusariosis: Focus on Voriconazole.” Therapeutics and Clinical Risk Management 3 (2007): 1165-1173.

Webster, John, and Weber, Roland. Introduction to Fungi. New York: Cambridge University Press, 2007.

Why did so many people come to the United States in the late 19th and in the early 20th centuries?

There were several reasons why so many people came to the United States in the late 1800s and in the early 1900s. One reason was to find work. There were more jobs available in the United States. Many people had heard that they could become wealthy in the United States. They had heard the streets were paved with gold. A big reason for many people coming to the United States was for the economic opportunity that they perceived existed in the United States.

Some people came for political considerations. There wasn’t a lot of political freedom in many countries. People with different views were often punished or harassed. In some countries, people were also required to serve in the military. Some people came to escape this required military service. Others came to have more political freedom.

Some people came to have religious freedom. In some countries, there was an official religion. People who practiced different faiths often were persecuted. Thus, they came to the United States to have religious freedom.

A lack of food encouraged people to come to the United States. There were shortages of food in some countries. People left their countries to come to the United States because more food was available. In some cases, leaving their homeland was a matter of survival for these people.

There were many reasons why people came to the United States in the late 1800s and in the early 1900s.

Why was there a WWII?

World War II occurred for several reasons. One reason was the anger the resulted as a result of the harsh terms of the Versailles Treaty. This treaty really punished Germany. Germany had to pay $33 billion in reparations. They had to accept the responsibility for World War I. They also had their military capability greatly weakened. Germany also lost some land. Germans were angry at these harsh terms, and Adolf Hitler tapped into this anger to get revenge. Plus, the huge reparations cost helped create a severe depression in Germany. This contributed to the failure of the democratically elected government. Italy also felt it didn’t get enough land from then Versailles Treaty. Benito Mussolini promised to restore Italian pride and return Italy to the glory days of the Roman Empire.

In the 1930s, Great Britain, France, and the United States ignored the aggressive actions of Germany, Japan, and Italy. They also ignored the violations of the Versailles Treaty that occurred. When Germany began to violate the Versailles Treaty, the Allies did nothing about these events. When Germany, Japan, and Italy became aggressive and began to invade other countries, the Allies remained silent. When the Allies eventually took action, it was too late. The Munich Pact, negotiated by the British and French, failed to stop Germany’s aggressive actions. When Great Britain and France said that any more aggressive actions would lead to war, the stage was set for World War II to begin. When Germany invaded Poland in September 1939, the Great Britain and France declared war on Germany.

Just twenty-one years after World War I had ended, World War II began.

In the poem "Don't Quit," what do these lines mean? "Life is queer with its twists and turns, As every one of us sometimes learns."

“Don’t Quit,” by Edgar A. Guest, is a motivational poem. Its four stanzas encourage the reader to keep on going and to make progress toward a goal, even if a situation seems impossible or insurmountable. The motivating narrator implies that everyone has experienced such times, and many have come through them successfully. It’s a good poem to read when you’re feeling down, depressed, or overwhelmed by some problem. You are not alone in feeling this way. For many centuries, others have been in these situations and have survived.

The second stanza begins: “Life is queer with its twists and turns, / As everyone of us sometimes learns …” The key words here are “queer” and “sometimes.” Since Edgar Guest lived at the turn of the last century, he uses the word “queer” to mean “odd” or “strange.” Life doesn’t proceed as if it were a flat, straight road. It has twists and turns in it. (Guest is quietly using the road image as a metaphor for life, without using the word “road.”) Then comes that follow-up line, “As everyone of us sometimes learns.” Does every person learn that life can be complicated, all the time, in every instance? No. According to Guest, “everyone of us sometimes learns.” In other words: sometimes we learn that life has challenges, and sometimes we don’t remember this fact. The implication is that the successful folks are the ones who learn from past events and mistakes and who proceed anyway, knowing that success surely must lie ahead.

Mary's behavior changes drastically throughout the story. Please explain how and why that happened.

Love can turn to hate, and it often does so in marriages. The surprising thing in "Lamb to the Slaughter" is that Mary's love for Patrick turns to hate so suddenly. Her action in killing her husband with the frozen leg of lamb is probably a surprise even to her. She seems to be acting on a blind impulse. If she hadn't been holding the leg of lamb, she probably wouldn't have committed the murder. Her impulse is probably caused by her sudden and complete disillusionment. She loved her husband. She was expecting a baby in a few months. She thought she had a happy home. She must have believed that Patrick loved her as much as she loved him. Then in just a few minutes he destroyed all her illusions, and at the same time he must have destroyed her love.

"This is going to be a big shock to you, I'm afraid," he said. "But I've thought about it a good deal and I've decided that the only thing to do is to tell you immediately." And he told her. It didn't take long, four or five minutes at most, and she sat still through it all, watching him with puzzled horror.

Characters don't really change. They evolve. Mary's violent reaction to Patrick's shocking betrayal must have been like uncorking a bottle and releasing a whole cloud of pent-up emotions and previously unsuspected character traits. Mary seems to become a different woman, but actually she is the same woman with multiple depths or dimensions exposed. We readers accept this new "liberated woman." Significantly, the author Roald Dahl doesn't try to explain her motivation. We don't question the possibility that she could have changed so radically. We find ourselves thinking along with her. How is she going to get out of this situation? What would become of her unborn baby?

It certainly shouldn't be surprising that someone kills someone else in a fit of rage. It must happen all the time. It has often been called "the urge to kill." And it shouldn't be surprising that the perpetrator doesn't want to get punished for it. Since we are the only witnesses to Mary's crime we are like accessories after the fact, so to speak. We don't like Patrick. We don't blame Mary for clobbering him. We want to see her get away with her crime. Maybe she shouldn't have done it, but what's done is done. 

What are some things that Atticus Finch loves and cannot imagine his life without?

First and foremost, Atticus Finch loves his children. Scout and Jem are his world and they are his primary focus throughout the novel. He is painfully aware of how he acts in front of his children and encourages them to act morally every chance he gets. Atticus also loves to read. In particular, Atticus loves to read The Mobile Register and The Maycomb Tribune. There are numerous scenes throughout the novel that depict Atticus reading on the porch or in the living room, relaxing after his stressful days.

Miss Maudie makes the comment that Atticus is the individual Maycomb relies upon to represent true Christian values when others simply will not accept the challenge. Also, we know from Chapter 12 that Atticus routinely takes his children to church. Judging by his morally upright character and religious disposition, I believe it would be safe to say that Christianity is something that Atticus dearly admires.

The last thing I would include that Atticus absolutely loves and cannot live without is "a challenge." Atticus is a hard-working, driven individual. He accepts the difficult task of defending Tom Robinson, and does not back down when faced with adversity. When Alabama's legislature meets to deal with the recent economic crisis, Atticus works diligently to fulfill his duties. He does not back down to the Old Sarum bunch, and accepts the challenge of shooting Tim Johnson when Sheriff Tate gives him the rifle. Atticus cannot simply live a mundane, uneventful life. He is a competitor who thrives off of adversity.

Where does Ichabod Crane live?

Ichabod Crane lives in a "sequestered glen... known by the name of Sleepy Hollow."  Sleepy Hollow is located just north of Tarrytown in New York.  It is located in the Hudson River Valley, along the banks of the Hudson River.  Some consider the place to be bewitched.  Legend says that the area is haunted by a Headless Horseman.

It is customary for a schoolmaster in the 1700s to "[board] and [lodge] at the houses of the farmers whose children he instruct[s]."  Typically, a schoolmaster spends a short period of time staying at the house of one student before moving on to board with another.  This is often part of the contribution that parents make toward their children's education in this time period.  As an unmarried schoolmaster, Ichabod does not have a real home.  He does always have a place to sleep at night, even though the location of the bed changes based on which family he is staying with that week.  He stays in various parts of the village with the different families.  He spends a lot of time visiting with the locals in his spare time.

In Hinton's That Was Then, This Is Now, what does Bryon learn from Mark, and how does it help him change?

Bryon learned from Mark that one's actions can negatively affect other people and that consequences are essential in teaching individuals the difference between right and wrong. At the beginning of the novel, Bryon willingly broke the law with Mark and did not feel bad about how his actions hurt others. As the novel progresses, Bryon matures and begins to feel empathy for those around him. He realizes that Mark has no conscience and does not understand the concept of right and wrong. Mark's willingness to harm others and not think twice about taking advantage of people concerns Byron. After hearing Mike's story, witnessing Charlie die, and finding M&M high off of LSD, Byron's perspective on life changes and he understands that Mark is a dangerous person. Mark's actions and disregard for others teaches Bryon that in order to make the world a better place, he must take responsibility and do everything that he can to stop those who are willing to hurt people. Although Bryon loses his best friend, he does the right thing by calling the police to lock up a criminal.

Do you think the speaker in ''The Road Not Taken'' made a wise choice?

In “The Road Not Taken,” the narrator remembers a time when he was faced with a decision. It may have been the choice between two physical roads that led in two different directions. Or, if the road image is seen here as a metaphor, it may have been the choice between two major life decisions – like whether or not to go to college, whether or not to get married, whether or not to move to another city or state to get a better job, etc. We have to make these decisions without knowing if they will turn out to be the “right” ones for us in the long run. Sometimes we look back with regret and wonder if our lives would have been better if we had made other choices and gone the other way. Only we can judge this outcome for ourselves.

The last stanza of the poem holds the key to your answer:

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.

Now, his choice that day “made all the difference” in his life. But he anticipates that in the future, he’ll be telling this story “with a sigh.” Does this mean he already regrets the decision? Or will he sigh to his audience for another reason? He could sigh in frustration that he has to explain himself to others. What do you think? I have always read this poem thinking that the narrator was pleased with his decision not to follow the road that everyone else did.

Then again, the title of the poem is “The Road Not Taken.” Does it refer to the road that everyone else avoided? Or to that popular road that the narrator did not take in the end? Is the narrator now wistfully considering what would have happened if he had made the other choice? I tend to champion people who do things differently, so I think the narrator made the wise choice in taking the road less traveled. But I think you could argue this case either way.

What are the qualities of the emperor of Blefuscu in Gulliver's Travels by Jonathan Swift?

The emperor of Blefuscu is kind, as he grants Gulliver supplies to outfit the ship that Gulliver has found. In addition, the emperor refuses to send Gulliver back to Lilliput, though the Lilliputians demand that the emperor do so, so that he can properly thank Gulliver for making peace between Lilliput and Blefuscu. The emperor of Blefuscu promises Gulliver protection, and he is sincere about granting it. However, when Gulliver decides that he would rather leave Blefuscu, the emperor agrees to Gulliver's wishes, showing that the emperor is gracious and beneficent. In fact, the emperor gives Gulliver fifty purses filled with money. While the emperor is giving towards Gulliver, the emperor nonetheless insists on ceremony and the trappings of a traditional monarch. Gulliver has to lie down to kiss the emperor's face, and the emperor gives Gulliver a full-length picture of himself when Gulliver leaves Blefuscu. 

What does "glittered when he walks" suggest in Edwin Arlington Robinson's poem "Richard Cory"?

The line "...he glittered when he walked" suggests the perspective that the common people think of Richard Cory as an almost celestial being—certainly, one much above them in social position.

Just as people nowadays speak of great athletes, famous actors and actresses, and others who are above the norm as "stars," the people who suffer during the Panic of 1893, a serious economic depression, perceive Richard Cory as a being who is untouched by the vicissitudes of their lives.

Of course, the irony in this poem is that although Richard Cory is wealthy and does not have to go "without the meat," the "people on the pavement" (the ordinary people) feel intimidated by his high station and, therefore no one engages with him or even considers why he comes to town and speaks to people. In reality, Richard Cory, "who is always human when he talked," would probably like to have some interaction with people. So, in his terrible loneliness, Richard Cory despairs and puts a bullet into his head.

What happened during apartheid in South Africa, and how?

From 1948 to 1994, the South African government enforced the social and legal segregation of people of color from white people. Though the roots of racism are much older, Apartheid really began with the election of the (white) National Party gained greater support in the 1940s. The justification for Apartheid was based on a racist system of classification established during the Imperial-Colonialist era and continually benefited the white, colonist, upper classes of society while oppressing and exploiting the native, lower class, people of color. Because the National Party was primarily made up of people descended from the Dutch and English colonists of South Africa, when they came into power, the system of benefit-exploitation became institutionalized and bound up in every part of the law. 

Under Apartheid, physical space was separated according to the amount of access people of differing races could have to it. All Black South Africans were required to carry identification passes with their fingerprints on it when visiting "white" spaces. Whites and people of color were not allowed to marry. Education was segregated not just by race or color but also by the quality of education, with people of color essentially being trained for lives as laborers. Most people of color were also denied their right to vote, and so did not have a say in making changes to this system which continually oppressed them.

In the 1950's, there were attempts to pacify the disquiet of people of color in South Africa by establishing a number of self-governed "homelands." However, the white-run system of South Africa was dependent upon the labor of people of color, and the self-governed homelands were still entirely dependent upon South African economy and administration. What's more, the people of color, now considered citizens of the homelands, had their South African citizenship revoked and now had no rights. Where previously people of different races were able to live in the same geographic space-- say, the same city-- but with differential access, the self-governed homelands approach made it so that people of different races were totally separated from one another. 

With increasing outside pressures from the Western World to establish racial equality, combined with shifting attitudes among the white population of South Africa, some of the heavy restrictions were relaxed into something known as "petty apartheid." Riots persisted among people of color, because while some things were improving, most were trapped and still suffering in this institutionalized racism. In the early 1990's the government began to do away with some of the legislation which had justified Apartheid, but it had become endemic in society and continued on an informal, social level. In 1994, with the election of Nelson Mandela and a black-majority government, Apartheid had officially been ended. The scars of Apartheid remain in South Africa as many people were raised and enculturated into the system of racial oppression.

Why does Malvolio want to marry Olivia in Twelfth Night?

Malvolio himself actually answers this question quite well in Act II, Scene 5, when Sir Toby, Sir Andrew, and Maria are eavesdropping on his little private moment.  In a few words, he wants respect--he feels like Sir Toby and Sir Andrew don't ever listen to him (and to be completely fair, he's right), and he fantasizes about having such far-reaching authority that he can boss them around and they have to listen to him.

To hear him tell it in that scene:

"...she uses me with a more exalted respect..."  By which he means Olivia, at least, has the decency to respect him and his position.

"Calling my officers about me, in my branched velvet gown..." and a bit later, "Seven of my people, with an obedient start, make out for him: I frown the while; and perchance wind up watch, or play with my--some rich jewel..."  Both of these quotes reflect Malvolio's longing for the outward signifiers of power as well as power itself.  Velvet and jewels (ignoring what's almost certainly a lewd joke on Shakespeare's part with regard to the jewel) are obvious markers of wealth and power, but Malvolio also regards other people as markers of wealth and power.  He refers to "my officers" and "my people," indicating a degree of possession.  More generally, having people around to do his business for him, instead of having to do it himself, would indicate more power and influence than he currently has.

"Toby approaches; courtesies there to me..."  Quite the image, isn't this--Sir Toby having to grovel in front of a former servant.  Yet it seems to be Malvolio's most fervent desire.

Now, let's back it up a bit.  "There is example for't; the lady of the Strachy married the yeoman of the wardrobe."  This quote is particularly telling.  Twelfth Night as a play is concerned with a lot of overarching themes, perhaps most notably gender roles, but class and its cousin propriety are two other hugely important themes.  The play's name itself is a reference to a traditional festival from medieval/Tudor times, in which the Lord of Misrule turns all society upside down.  Class roles are reversed temporarily.  So the play itself is full of role reversals, of class boundaries being transcended or disregarded.  Malvolio, meanwhile, is the character perhaps most emotionally invested in maintaining order and propriety, particularly where Sir Toby and Sir Andrew's antics are concerned.  That makes this quote doubly interesting, because he expresses a wish to rise above his station, to defy class strata, but he also defends himself by citing precedent.  Inter-class marriage has been done before, he reasons, so in a way he thinks that gives him the right to do it himself.

So, in short: Malvolio wants to marry Olivia because he thinks it'll give him the power and respect he needs in order to maintain propriety in the household.

What is a ileostomy, and what is a colostomy?

Indications and Procedures

Despite great advances in drugs and nonsurgical procedures, doctors can cure some disabling or life-threatening diseases of the
intestines only on the operating table. Common procedures of this type are the colostomy and ileostomy, both of which replace the
anus with a stoma on the abdominal wall.

Colostomy and ileostomy are medical terms compounding stoma (from the Greek word for “mouth”) and a prefix identifying the section of gut that ends in the newly created “mouth.” If a portion of the colon is retained and ends in a stoma, the operation constructing it is called a colostomy. If the entire colon is removed and the lower section of the small bowel, or ileum, ends in a stoma, the operation constructing it is called an ileostomy. Nonmedical support groups for patients commonly use the back-formation “ostomy” to refer to any operation that creates a stoma (including a urostomy, in which a stoma is created for the excretion of urine) and to such patients as “ostomates,” although neither term belongs to medical technical vocabulary.

Physicians determine that an ileostomy or a colostomy is necessary after inspecting the damaged intestinal segments by endoscopy, by imaging, or during surgery. In consultation with a surgeon, the patient agrees to undergo the procedure. The patient fasts before the surgery and receives laxatives and enemas (except in the case of obstructions or severe ulcerative colitis) to clean as much feces from the intestines as possible and thus reduce the chance of infection during surgery. The surgeon, often with the advice of an enterostomal therapist (ET), examines the patient’s abdomen carefully, checking where the skin naturally folds and stretches when the patient assumes various common body positions, and a spot for the stoma is selected that is convenient for the patient and free of stress from muscles and skin tension. That place is marked. An area to the right and below the navel is the usual location for an ileostomy. The left side is commonly chosen for a colostomy.

In ileostomy, the surgeon makes the opening incision, starting a few centimeters above the navel and continuing to the pelvic area. After the abdominal cavity is exposed, the tissues connecting the colon to surrounding structures are severed, starting at the cecum; the blood supply is cut and tied off; and clamps are placed over the
ileum and
rectum. Then the colon is cut free of the small intestine
and rectum and is removed. If the operation is a subtotal procedure, the rectum is sutured shut and left in place or the open end is pulled through the abdominal wall as a mucous stoma. (Such a second stoma is sometimes fashioned because the surgeon plans to connect the ileum and rectum in a later operation.) If the surgeon performs a proctocolectomy, the rectum is removed after the stoma is made and the anus is sutured shut.

The stoma is built by cutting a small round opening first in the skin and then in the abdominal wall and pulling the end of the ileum through the hole. The end sticks above the skin, is folded back over itself, and is sutured to the edges of the hole, leaving the stoma protruding two to three centimeters. This basic ileostomy is called a Brooke ileostomy, after the English surgeon Bryan Brooke.

Variations on this basic procedure are employed depending on the wishes and health of the patient. A Kock pouch, named after its inventor, Nils Kock of Sweden, can be fashioned just behind the stoma in the abdominal cavity to act as an artificial rectum, collecting liquid waste until the ostomate wishes to void it; because this arrangement gives the patient control over defecation, it is called a continent ileostomy. The surgeon uses about forty-five centimeters of ileum to form the pouch and adjusts the stoma so that it acts as a valve until a tube is inserted for drainage. In some cases, when the underlying condition necessitating removal of the bowel segment is ultimately determined to be cured, and if there is sufficient remaining bowel, the ostomy can be reversed by closing the stoma and then reconnecting the bowel either to the rectum or to the anus.

If the ileum and rectum are joined, the procedure is called an ileorectal anastomosis. The rectum resumes its old job as a feces reservoir, and the patient defecates normally through the anus. This arrangement is seldom employed for ulcerative colitis patients, however, since the disease usually persists in the rectum. If the ileum is sutured directly to the anus, the procedure is called an ileoanal anastomosis. Because there is no rectum to collect feces, the surgeon must construct one. The pouch is made from loops of ileum that are slit along their length and stitched together. If not enough ileum remains from which to make a pouch, the surgeon pulls the end through the rectum and ties it directly to the anus, a procedure called an endorectal ileal pull-through. The anastomosis procedures require two operations—one for the temporary stoma and construction of the pouch, one to connect the pouch and the rectum, or anus—to give the artificial rectum a chance to heal properly and so prevent leaking.

Colostomies feature somewhat more variety of stoma placement than ileostomies, but since removal of the rectum, sigmoid colon, or both are the most common reasons for the creation of the stoma, it is usually placed on the lower left of the abdomen, near the hipbone. If more of the colon is removed, the stoma may be higher up toward the rib cage. The operation begins much as for an ileostomy, except that only the portion of the colon from the damaged or diseased area to the anus is removed and the initial incision begins near that damaged section. The remaining, healthy colon is pulled through holes in the abdomen and skin, and its end is rolled back and fastened. The stoma protrudes out about two to three centimeters, so that an appliance for storing waste, if needed, can be attached.

There are three varieties of colostomy. The first, a single-barreled end colostomy, is the classical configuration. The rectum and anus are removed, and a single circular stoma, about twenty-five millimeters (one inch) in diameter, is the permanent exit for stool. If, however, the surgeon believes that the colon and rectum can be rejoined, the rectum is left intact and closed. Either of two procedures can be used to give the colon a rest period between the removal of the diseased section and reconnection to the rectum. A double-barreled colostomy involves slicing through the colon and making side-by-side stomas from the ends. In a loop colostomy, the colon is not cut through; instead, a slit is made in one side, which is pulled through the skin and made into an oval stoma, usually larger than other stomas. In both cases, the upper colon discharges stool, and the lower length passes mucus.

Uses and Complications

Both colostomy and ileostomy are last-resort or emergency treatments. When a wound, such as one caused by a knife or gunshot, punctures the intestines, waste matter, full of bacteria, spills into the abdominal cavity. The severe infection that is sure to follow can kill a patient in days; thus, an emergency operation is required. The surgeon pulls healthy bowel through the abdominal wall and forms a temporary stoma (so that no more waste can leak out of the intestines), cleans out the spillage, and repairs the damaged bowel. In many cases, it is possible to reconnect the healthy bowel to the damaged portion after the wound has healed; at the same time, the stoma is closed, and the patient resumes defecation through the anus.

Emergency operations, however, account for only a small percentage of colostomies and ileostomies. About two-thirds of surgeries to form stomas are colostomies, most of which follow operations removing

cancer (usually in the lower colon or rectum) or an obstruction.
Diverticulitis, the inflammation of little pouches in the colon wall, may also require a colostomy; the diversion of wastes allows the inflammation to subside and the colon wall to heal, after which the stoma may be removed and the colon reconnected. Additionally, repair of some rare birth defects may entail a colostomy.

Ileostomies account for about one-quarter of stoma-creating procedures. Most are performed to eradicate ulcerative colitis, a chronic inflammation of the colon that begins in the rectum and may spread upward until the whole colon is involved. No drug or dietary treatment cures ulcerative colitis; when the condition becomes too unbearable for a patient to endure, the colon is removed and an ileostomy is performed. Long-standing ulcerative colitis is particularly likely to become cancerous, and the colon may be removed for that reason alone. Likewise, familial polyposis, a hereditary disease that dots the colon with toadstool-shaped lumps that are likely to become cancerous, may require removal of the colon and ileostomy.

Wounds, diverticulitis, familial polyposis, and birth defects, while not particularly rare, are the reasons for relatively few stomas. Stoma surgery is more commonly performed to treat colorectal cancer (particularly in the elderly) and ulcerative colitis (commonly disabling patients in their twenties). As the average age of the population increases, so does the incidence of
colon cancer and the need for ostomies.

Recovery from stoma surgery is prolonged. Surgery shocks the intestines, and several days pass before the gut resumes the wavelike contractions (called
peristalsis) that enable digestion and push wastes toward the stoma. In the meantime, patients live on intravenous fluid nourishment. When bowel motion restarts and wastes begin coming through the stoma, the ileostomate must develop new habits to cope with the flow of wastes (which are always fluid because the ileum does not remove sufficient water to solidify the waste matter) by learning to attach and empty appliances and to keep the stoma clean. Colostomates, especially those who have lost only their sigmoid colon, can look forward to passing firm stools and may eventually be able to live without an appliance, but months of diarrhea occur before the bowel regains full operation.

Many complications can plague the new anatomy, some of which require surgical correction. The most serious include intestinal obstruction, scar adhesions that distort the shape of the bowel, retraction of the stoma, abscesses, prolapse (more of the bowel pushing out of the body), and kidney stones (which form because persistent diarrhea can dehydrate ostomates). Less threatening, but demanding attention, are offensive odors, diarrhea, skin irritation, and bowel inflammation. Steady advances in surgical technique have lowered the complication rates, and few patients die because of the surgery.

Ostomates often must live with the stoma for the rest of their lives. Feces exit through the stoma, rather than the anus, forcing patients to “toilet train” themselves all over again. Some stomas, known as continent stomas, hold back wastes until the patient is ready to defecate by draining them with a tube. Many, however, are not, and stool and gas steadily seep through the opening, where the waste matter is collected in an appliance, usually a plastic bag that seals over the stoma.

Having a plastic bag of stool on the abdomen and needing to empty it periodically to prevent it from leaking, instead of defecating by sitting down on a toilet, proves a difficult adjustment for some patients, both physically and psychologically. Several aid resources help new ostomates adjust. Specially trained registered nurses called enterostomal therapists teach patients how to manage their new stomas and how to attach appliances or insert catheters to drain continent stomas; they also help care for the stomas after the operation and periodically review their patients’ progress. Gastroenterologists, physicians who specialize in the intestinal tract, can provide medical guidance and directly inspect the bowel wall behind the stoma through an endoscope, a flexible fiber-optic tube, should trouble develop. Support groups offer various resources to those ostomates who feel isolated and depressed because of the stoma.

Out of the hospital, ostomates face a new and different life. As well as learning to handle appliances or irrigate artificial rectums, they must face the fact that a major organ of their bodies is changed. The need for the stoma may anger or depress them, and this fixation on the change, if unalleviated, can evolve into loss of self-esteem and attendant social withdrawal. Many ostomates experience guilt in the belief that the disease and stoma, as well as the effects of the stoma on their families, are somehow their own fault.

These reactions require social and psychological therapy, extending care well beyond that afforded by the surgeon and the hospital. Support groups and the enterostomal therapist supply the majority of this care, but occasionally professional psychological help is required. The repulsion that patients feel for stomas and the consequent chance of morbid psychological reactions have encouraged surgeons to prefer anastomoses to stomas when possible, even though anastomoses are more difficult, have higher failure rates, and require a longer recovery period.

Fortunately, the great majority of ostomates do adjust to their new lives; they seldom have any other alternative. Providing that the original need for surgery has been eliminated—the cancer has been removed, for example—they can look forward to an undiminished life span and few if any restrictions upon appetite, sexual function, or exercise. The majority of ostomates recover completely and are able to return to their previous occupations after recovery. Without the operations, all of them would have led drastically impaired lives, and many would have died. The high success rate places the ileostomy and colostomy procedures among the ranks of surgical interventions that rescue the seriously ill from otherwise incurable organic diseases.

Perspective and Prospects

Although drastic techniques requiring much skill from surgeons and stamina from patients, ostomies did not originate with modern medicine and its sophisticated technology for sustaining patients during operations. Some colostomies date from the last quarter of the eighteenth century. In the nineteenth century, the number of operations creating a stoma—then called “artificial” or “preternatural” anus—increased, although without antiseptic conditions or anesthesia a patient’s chances for survival were not good. Surgeons sometimes placed the stomas on the back instead of the abdomen. In 1908, William Ernest Miles conducted the first operation to remove a cancerous rectum; since the patient’s intestines were still moving waste matter, which needed an exit, Miles created a stoma, thereby establishing one of the most common surgeries of the twentieth century.

Still, colostomies and ileostomies did not proliferate until after World War II. Since then, refinements in surgical techniques and postoperative care have steadily reduced the chance of complications and the length of the recovery period. At the same time, several variations of permanent and temporary stomas have been developed.

Like many other extreme surgical interventions, the ileostomy and colostomy testify to the limits of biomedical knowledge: most of these surgeries are performed because other remedies fail. Until researchers discover the mechanisms causing cancer, ulcerative colitis, and other deadly lower bowel diseases and develop nonsurgical cures, ileostomies and colostomies will remain common, especially among the elderly.

Bibliography

A.D.A.M. Medical Encyclopedia. "Colostomy." MedlinePlus, May 6, 2011.

A.D.A.M. Medical Encyclopedia. "Ileostomy." MedlinePlus, December 10, 2012.

Adrouny, Richard. Understanding Colon Cancer. Jackson: University Press of Mississippi, 2002.

Brandt, Lawrence J., and Penny Steiner-Grossman, eds. Treating IBD: A Patient’s Guide to the Medical and Surgical Management of Inflammatory Bowel Disease. Reprint. New York: Raven Press, 1996.

Bub, David S., et al. One Hundred Questions and Answers About Colorectal Cancer. Sudbury, Mass.: Jones and Bartlett, 2003.

Doherty, Gerard M., and Lawrence W. Way, eds. Current Surgical Diagnosis and Treatment. 12th ed. New York: Lange Medical Books/McGraw-Hill, 2006.

Fries, Colleen Farley. “Managing an Ostomy.” Nursing 29, no. 8 (August, 1999): 26.

Kalibjian, Cliff. Straight from the Gut: Living with Crohn’s Disease and Ulcerative Colitis. Cambridge, Mass.: O’Reilly, 2003.

Mullen, Barbara Dorr, and Kerry Anne McGinn. The Ostomy Book: Living Comfortably with Colostomies, Ileostomies, and Urostomies. Rev. ed. Palo Alto, Calif.: Bull, 1992.

National Digestive Diseases Information Clearinghouse. "Bowel Diversion Surgeries: Ileostromy, Colostomy, Ileoanal Reservoir, and Continent Ileostomy." National Institutes of Health, April 23, 2012.

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

United Ostomy Associations of America. http://www .uoaa.org.

How did people during the Renaissance view the ideas of ancient classical civilizations, like Greece and Rome?

During the Renaissance, there was a resurgence of interest in Greek and Roman civilizations. Throughout the Middle Ages most of the teaching and learning was church-centered. At the time of the Renaissance, the church had started to lose its hold on people’s thoughts and actions.

The invention of the printing press made books more widely available. In addition, the population was becoming wealthier and could afford these books. These readers from the upper classes and nobility wanted to learn about history, math, finance, business, science, and philosophy outside the church’s teachings. They turned to the knowledge of the ancient Greeks and Romans to help them prepare to live and work in a much more secular world.

The Renaissance standard for what constituted an educated person was based on the Greek concept of a well-rounded man who could think, speak, and write about a variety of topics. Cicero and Demosthenes were favorite authors for these lessons. The study of politics drew on the workings of the Greek and Roman political systems. Renaissance architects recreated Greek and Roman style buildings. Depending on Greek and Roman texts for scientific knowledge also established another divide with the church.

As people began to question the authority of the church, they cast back to the days of ancient Greece and Rome to cull the knowledge gathered by those civilizations and bring it back into their own.

What are soilborne illness and disease?

Definition

Soilborne illnesses and diseases are caused by numerous microorganisms and parasites that live in soils. Soil serves as an ecosystem for diverse microbes that perform various roles and that range from useful organisms in biological and geological processes to dangerous transmitters of diseases. In May, 2001, a resolution of the World Health Assembly of the United Nations emphasized the need for increased medical intervention to minimize the occurrence of soil-transmitted diseases. The next year, the United Nations reiterated the goal of preventing soilborne worm infestations.

Causes

Soilborne, or soil-transmitted, diseases are common, especially in tropical
regions, and affect more than two billion people globally in the early
twenty-first century, according to the World Health Organization (WHO). In
2010, more than one-half million children internationally suffered sicknesses,
particularly helminthiasis infections, contracted from soil. Although most people
survive these illnesses, sources indicate approximately 12,000 to 135,000 people
die yearly from soilborne helminth infections. Scientists estimate that the life
spans of people infected with the most prevalent soilborne diseases and parasites
are reduced by 43.5 million life years, more than the lifespan reductions of
measles and malaria and exceeded only by tuberculosis.

Most soilborne illnesses are transmitted from soil to humans through the
pathogens (such as bacteria, fungi, protozoa, and worms)
that are shed in fecal material, which contaminate soil. These pathogens infect
people who eat the plants grown in the contaminated soil or who drink water polluted by that soil. Human and nonhuman animals infected with
soil-transmitted illnesses perpetuate the cycle when their feces contact soil.
Bacteria and viruses associated with enteric diseases, specifically infections in
the gastrointestinal tract, often are transmitted to humans in soils that have
been used to bury sewage. Landfills that do not have procedures to control
leaching enable bacteria and viruses to contaminate soil.

Helminthiasis is a frequently diagnosed disease reported worldwide that is
transmitted by contact with soil. Eggs from worms, or helminths, are dormant in
soil until they enter human or animal bodies, move through those bodies as larvae,
and mature within three months into worms that infest the intestines. Worm
infestation is often chronic, as parasites can live several years in their
hosts. Soils host numerous types of worms (also referred to
as nematodes), including roundworms, hookworms,
and whipworms, which transmit diseases to humans.

The roundworm Ascaris lumbricoides infects humans with
ascariasis. According to WHO, more than one billion humans
are infected with this worm. Soils host these parasites’ eggs. Roundworms are
prolific, producing approximately 200,000 eggs daily. Humans are exposed to these
immature worms by touching contaminated soil or by swallowing dirt or food that
has not been adequately cleaned. Inside human bodies, roundworm eggs hatch into
larvae that then invade essential body parts, including nerves and organs.

Other worms transmitted through soil include the hookworms Necator americanus and Ancylostoma duodenale. Those larvae enter skin from soil, infecting people with ancylostomiasis. WHO states approximately 740 million people have hookworms. The disease trichuriasis results from eggs from the whipworm, Trichuris trichiura, contaminating soil. About 795 million people have this infection, according to WHO.

Humans also are infested with the threadworm Strongyloides
stercorali, which causes the disease strongyloidiasis as it moves from soil into the feet.
Through worm eggs shed in fecal material, infested domestic pets expose humans to
parasites and diseases associated with them, including visceral larva migrans and
toxoplasmosis infections caused by Toxoplasma
gondii.

As a cause of anthrax infections, dormant Bacillus anthracis
bacteria spores often exist in soil for long durations, ranging from several years
to decades. Growing grass blades transport anthrax spores from soil when
grass-grazing animals ingest them. Associated with listeriosis,
the bacterium Listeria monocytogenes is frequently found in soils
and manure, contaminating livestock and plants used as food sources. The
Brucellosis bacterium, often associated with livestock, can
enter bodies through exposure to touching or breathing dust. The
Leptospira interrogans bacterium, which causes
leptospirosis, is present in soil and muddy areas where
rodent urine containing that pathogen soaks into the ground. The
Acinetobacter baumannii bacterium, which lives in soil, causes
acinetobacter.

Most soil-transmitted disease deaths involve the pathogen Clostridium
tetani, responsible for the deaths of approximately 450,000 infants
and 50,000 adults each year. Scientists state that this bacterium’s spores can be
dormant in soil for almost one-half century and can still infect humans.
C. botulinum bacteria spores also remain dormant in soils for
extended times, causing botulism infections that are spread
through foods. Soils in tropical areas often host the bacteria
Burkholderia pseudomallei and B. mallei,
which infect people with melioidosis and glanders when
they touch or inhale soil or eat foods cultivated in contaminated fields.
Nocardiosis infections occur when people breathe
Nocardia bacteria found in dust or when contaminated soil
contacts a person’s skin injury.

Rarer, and often more deadly, soil-transmitted diseases occur when
Chromobacterium violaceum bacteria infect humans by spreading
from skin openings through the circulatory system and attacking organs
simultaneously, preventing their function. Although Legionnaires’
disease is usually transmitted through air or water, the
Centers for
Disease Control and Prevention (CDC) in 2000 reported cases
in which the bacterium Legionella longbeachae infected people who
had touched potting soil. Scientists have linked poliovirus 1 to soil, noting that
the virus can survive more than three months underground and contaminate
crops.

Fungi in soils, including the fungi Mucorales,
Aspergillus, Fusarium, and
Blastomyces dermatitidis, also transmit diseases.
Cryptococcus neoformans can infect people who inhale dust
containing it, leading to cryptococcal meningitis. Histoplasmosis is another soilborne illness, this time
caused by Histoplasma fungus, which exists in soils as mold and
affects the lung. Fungal Coccidioides immitis spores in soil
cause coccidioidomycosis infections.

Risk Factors

Socioeconomic factors increase the risk of a person being infected with soilborne diseases. Poor sanitation exposes humans to soils contaminated with microorganisms and parasites. Areas without hygienic toilets or other devices to contain human wastes contribute to soil-transmitted infestations. Inadequate sewage systems result in fecal material being present near houses, schools, and other buildings. Rain washes these soils into water supplies, often rivers and ponds, which people use as a source for drinking water and use for bathing, swimming, fishing, and cleaning of cooking and eating implements.

Impoverished populations often lack access to sufficient preventive medical care. Illiteracy and restricted educational opportunities result in people not having information on preventing soilborne diseases or on treating those conditions if infected. Many people who suffer soil-transmitted diseases do not consume diets with nutritional foods that provide vitamins and minerals. They often eat foods that have not been thoroughly cooked or cleaned, and they do not have access to pasteurized products and boiled water. Pregnant women and people with weak immune systems or other health problems are extra-susceptible to soilborne illnesses and suffer miscarriages and mortality caused by infections.

Populations living in areas where crops are fertilized with feces or irrigated with polluted water risk being infected by diseases transmitted by soil, either by consuming foods, especially vegetables and fruits, grown in those soils or by working in contaminated fields. Runoff from pastures can contaminate communities with pathogens associated with livestock manure. Risks associated with contacting contaminated soils increase with people’s proximity to landfills or other sites where sewage is stored in soil and where pathogens seep into the ground.

Dangers associated with exposure to soil depend on how accessible a person’s skin is to contacting soils directly. People who work outdoors
, performing landscaping, agricultural, forestry, sewage, or other jobs that involve contact with soil are at high risk of acquiring soil-transmitted illnesses. Hikers and others participating in outdoor recreation come into contact with soils and the pathogens they host. Children’s risk is increased because they often play in dirt that can be contaminated. People with the disorder called pica (in which they consume, among other non-nutritive substances, soil) are especially vulnerable to soilborne illnesses.

Weather can intensify the occurrence of soilborne diseases. Floods, for
example, can force to the surface underground soil layers and the pathogens they
host. Violent storms such as hurricanes and typhoons can move soil and pathogens
great distances. Soilborne diseases identified as potential biological
weapons also present public safety concerns. Terrorists have
threatened to use anthrax spores secured from soil sources. The CDC designated
B. pseudomallei and B. mallei to be
bioterrorism agents because of their universal availability
in soils.

Symptoms

Various symptoms are exhibited by people infected with soil-transmitted diseases. Probably the most obvious symptom associated with soilborne illness is the shedding of parasites while vomiting or during a bowel movement. People infected with soil-transmitted helminths often suffer gastrointestinal pain and swollen stomachs. Other organs occasionally swell. Infected people frequently experience diarrhea, nausea, bloody bowels, and vomiting, and they can become anemic.

Soil-transmitted infections usually cause people to become weak and listless. Fevers, rashes, headaches, and stiffness are common symptoms too. Infected persons often are not strong enough to attend school or perform labor. Some people with soilborne illnesses exhibit impaired cognition, experiencing problems with memory and language functions. Long-term symptoms include decreased mental and physical development in children. Lung damage from soilborne illness is often exhibited through pneumonia, coughing, or asthma. Although most adults do not exhibit the symptoms of toxoplasmosis infection, children who were infected in utero develop symptoms as they mature. Health problems associated with toxoplasmosis include blindness, deafness, and retardation.

Illnesses associated with soil often weaken immune systems, causing people to develop infections and conditions unrelated to soil. Soil-transmitted diseases are sometimes described as food-borne illnesses, even though pathogens such as Escherichia coli O157:H7 and Salmonella, which are associated with food poisoning, are present in soil that contaminates foods. Poor agricultural yields, damaged plants, and ill livestock may indicate the presence of pathogens and parasites in soil.

Screening and Diagnosis

Medical professionals evaluate those with soil-transmitted illnesses according to conditions and physical ailments unique to each person. Examinations usually begin with recording an infected person’s medical history and asking where the person lives and if they have traveled to other areas. This geographical information helps clinicians determine the most likely soil-transmitted disease infected the patient.

Health care workers assess various tissue samples to diagnose soilborne
diseases associated with microorganisms. Specimens acquired for analysis
frequently include blood, sputum, urine, feces, skin, bone marrow, and
cerebrospinal
fluids. Blood tests reveal the presence of antibodies to
bacteria. X rays and biopsies are often used to detect fungal soil-transmitted
diseases such as cryptococcosis. Some physicians utilize magnetic resonance
imaging or computed tomography scans to assess damage by mucormycosis
and other microbe infections.

For diagnosis of helminth infections, patients provide fecal samples for
laboratory analysis to detect evidence of parasites and to examine worms.
Technicians utilize several methods to evaluate specimens, including formalinethyl
acetate sedimentation and Kato-Katz fecal-thick smear to count worm eggs. Medical
personnel use imaging procedures and tools, such as endoscopy and
ultrasonography, to determine any internal damage to organs
and intestines.

Treatment and Therapy

Persons diagnosed with soil-transmitted diseases undergo various methods to treat their infection. Many treatments focus on removing worms and include tablets composed of benzimidazole anthelmintics. The drugs most frequently dispensed include albendazole and mebendazole in doses of 400 to 500 milligrams (mg) for children two years of age and older and for adults, including women who have reached their second trimester of pregnancy. Toddlers younger than two years of age receive 200 mg. Amounts of the drug praziquantel are determined by measurements of the patients’ height with a dose pole. Helminth-infected persons often receive iron and vitamin A supplements. People at risk of being reinfected receive additional drug doses at later times.

Researchers are developing new pharmaceuticals and methods to control
soil-transmitted parasites that have become resistant to standard treatments.
Other drugs sometimes used include levamisole, pyrantel pamoate, nitazoxanide, and
tribendimidine. Many soilborne infections caused by microbes are treated with
antibiotics. These drugs, however, often cannot defeat
pathogens that become resistant to antibiotics. Medical researchers have tested
the use of recombinant larval antigen ASP2 to create a hookworm vaccination.
Scientists have investigated incorporating outer membrane proteins in a
leptospirosis vaccine, reporting successes in 2010 in strengthening immunities in
test animals.

Prevention and Outcomes

Most people contact soil daily. Interaction with soil varies depending on a person’s activities, exposure to the outdoors, and dietary habits. People can minimize the possibility of being infected by avoiding areas most likely to host parasites and pathogens. One should wash his or her hands, feet, or any bare skin that has been in contact with soil. Wearing gloves while gardening lessens hazards associated with handling soils. Wounds, cuts, abrasions, cracks, and other skin damage should be covered with bandages. Shoes prevent soilborne illnesses from being transmitted through the soles of the feet. People should avoid inhaling dust. Masks help block spores in areas where fungi thrive in soil.

Soil contaminant hazards can be minimized through purifying water supplies, cleaning unsanitary sites, and providing sanitary toilet facilities. Other preventive measures include washing soil from raw foods harvested from gardens or bought at markets. Cooking meats thoroughly to destroy parasites helps reduce risks associated with consuming livestock products that might have been infected while animals grazed on forage that grew on contaminated soil.

The transmission of diseases associated with soil can be prevented by not eating soil. Crops fertilized with raw waste or irrigated with wastewater should not be consumed. Agricultural laborers should avoid handling those contaminated soils. People should regularly deworm domesticated pets and not touch any fecal material.

Some schools, particularly in tropical regions or developing countries, sponsor programs to deworm students. Health care personnel provide children medical treatments to purge and prevent further helminth infections. Educational presentations teach children and adults hygienic behavior and discourage contact with hazardous soils. Several charities and shoe manufacturers distribute free shoes in impoverished communities where residents are at risk of contracting soilborne diseases.

Bibliography

Albonico, Marco, Dirk Engels, and Lorenzo Savioli. “Monitoring Drug Efficacy and Early Detection of Drug Resistance in Human Soil-Transmitted Nematodes: A Pressing Public Health Agenda for Helminth Control.” International Journal of Parasitology 34, no. 11 (2004): 1205-1210. Reviews pharmaceuticals and techniques to assess which helminths resist chemotherapy, emphasizing the necessity for continued research and development.

Albonico, Marco, et al. Preventative Chemotherapy in Human Helminthiasis. Geneva: World Health Organization, 2006. Outlines treatment procedures and drug doses for people representing various age and risk factors. Glossary, charts, appendices.

Ambrosioni, Juan, Daniel Lew, and Jorge Garbino. “Nocardiosis: Updated Clinical Review and Experience at a Tertiary Center.” Infection 38, no. 2 (2010): 89-97. Presents authors’ experiences with this soilborne disease during a twenty-year period, noting how patients were infected and noting their symptoms, diagnoses, and treatments.

Bethony, Jeffrey, et al. “Soil-Transmitted Helminth Infections: Ascariasis, Trichuriasis, and Hookworm.” The Lancet 367 (May 6, 2006): 1521-1532. Summarizes information regarding the most prevalent soil-transmitted worm infections, including statistics and prevention and treatment methods.

Brooker, Simon, et al. “Global Epidemiology, Ecology, and Control of Soil-Transmitted Helminth Infections.” In Global Mapping of Infectious Diseases, edited by Simon I. Hay, Alastair Graham, and David J. Rogers. Amsterdam: Elsevier, 2006. Considers environmental factors that affect the geographical distribution of nematodes and the occurrence of soilborne diseases.

De Siqueira, Isadora Cristina, et al. “ Chromobacterium violaceum in Siblings, Brazil.” Emerging Infectious Diseases 11, no. 9 (2005): 1443-1445. Case study of an incident in which three brothers were exposed to soil contaminated with bacteria. Images show microscopic view of bacteria and a scan of organ damage.

“Legionnaires’ Disease Associated with Potting Soil—California, Oregon, and Washington, May-June, 2000.” Journal of the American Medical Association 284, no. 12 (September 27, 2000): 1510. Reports rare incidences in which persons acquired this usually waterborne disease by handling gardening materials.

Santamaría, Johanna, and Gary A. Toranzos. “Enteric Pathogens and Soil: A Short Review.” International Microbiology 6, no. 1 (2003): 5-9. Examines how disposing solid wastes contaminates soil with microorganisms, noting several soilborne disease outbreaks.

World Health Organization. “Soil-Transmitted Helminthiasis: Number of Children Treated 2007-2008: Update on the 2010 Global Target.” Weekly Epidemiological Record 85 (April 16, 2010): 141-148. Discusses efforts to prevent worm infections, providing statistics and a map showing locations of the most urgent cases.