How is Clarisse different from Mildred?

Mildred is obsessed with the parlour shows. In other words, she is a television addict. She has no interest in literature, books, or anything that requires critical thinking. She is comfortable with her life and sees no reason to change. In her society, she is a model citizen. She is happy (in ignorance) and does not question or challenge authority. 

Clarisse is Mildred's opposite. Clarisse is curious about everything. Note how engaged she is in her conversations with Montag. She asks him question after question and even inquires about something basic, yet meaningful: she asks Montag if he's happy. Afterward, this affects Montag profoundly. He remarks that Clarisse has made him think deeply about himself. He does not get this kind of thought-provoking conversation with Mildred: 

How rarely did other people's faces take of you and throw back to you your own expression, your own innermost trembling thought? 

Clarisse is introspective, socially engaging, and full of life. While Clarisse intellectually and emotionally engages other people, Mildred channels her intimacies with her "family" on the television shows. She takes sleeping pills and places radio pieces ("seashells") in her ears while she sleeps. She is consumed with television, radio, and sleeping drugs. Therefore, she is removed from any real social interaction. Since Mildred is comfortable in this brainwashed state, she is never introspective. Clarisse is the opposite. 

Some dreadful calamity will happen, it is not to be doubted this third time, after what has gone before. But surely this is a cruel haunting of me....

The speaker of these lines is the signalman and he is speaking to the narrator. The signalman feels certain that a "dreadful calamity" is about to happen because two accidents have recently occurred on the railway line and each of these was preceded by a ghostly apparition which warned him of the events to come.

The signalman suspects that this third ghostly sighting is designed to warn him of another impending accident but he is unable to decipher the ghost's message, prompting him to call it a "cruel haunting." He desperately wants to understand the meaning, to try and prevent an accident but is unable to do so.

The signalman is understandably grieved by these recent events and the prospect of another accident on his watch. This is supported by the narrator's observation of the man:

His pain of mind was most pitiable to see. It was the mental torture of a conscientious man, oppressed beyond endurance by an unintelligible responsibility involving life.

The narrator's response is to try and help the signalman. His initial scepticism now gone, the narrator wants to prove that he has indeed been visited by a ghost. His solution is to accompany the signalman to see the "wisest medical practitioner" in the area and take his opinion.

The narrator and the signalman thus agree to meet the next evening but the meeting never takes place. In a tragic twist of events, the signalman is killed the next morning and the narrator realises that the ghost had come to warn the signalman of his own death on the line.

What does Duncan call Macbeth when he hears Macbeth has defeated Macdonwald?

Duncan calls Macbeth valiant and worthy when he hears about his defeat of Macdonwald. 

Although we know that Macbeth becomes a murderer and a tyrant, at the beginning of the play he is a loyal and brave soldier.  The bloody sergeant tells Duncan about how Macbeth defeated the traitor Macdonwald in battle.  He calls Macbeth brave. 

For brave Macbeth--well he deserves that name--
Disdaining fortune, with his brandish'd steel,
Which smoked with bloody execution,
Like valour's minion carved out his passage
Till he faced the slave … (Act 1, Scene 2) 

Duncan, the king, hears that Macbeth mowed through a bunch of soldiers to get to the traitor and then killed him, cutting him in half.  The king is very impressed by these actions, which are indeed the act of a brave soldier. 

DUNCAN

O valiant cousin! worthy gentleman! (Act 1, Scene 2)

It is because of these actions that Duncan awards Macbeth the promotion to Thane of Cawdor.  Under normal circumstances, I would think that that would be enough.  However, Macbeth has been told by three witches that he will be king.  He is unhappy to learn that he is still a thane.  His ambition has been aroused.

Duncan clearly has no idea who he is dealing with here.  He thinks of Macbeth as his kinsman and friend.  He goes to stay at his house!  He feels that Macbeth will be thrilled with this promotion, and thinks that no one would question his naming Malcolm his successor.  Malcolm is his son.  It makes much more sense, to everyone but Macbeth.

In what state of mind are the friends in Three Men in a Boat by Jerome?

This question seems to refer to the opening chapter of Three Men in a Boat. Friends J. (the narrator), George, and Harris are chatting and exchanging information about their various medical maladies. None of them are suffering from any serious illnesses, you see. They’re all just feeling slightly “seedy.” They’re in somewhat restless or listless states of mind. They agree that they have all been recently overworked and that they need to go on vacation. After discussing a few possibilities, they land on the idea to take a boating trip along the River Thames. But it takes a while – and the recounting of several past stories – to even get the friends to this point of agreement. Thus, this chapter sets the stage for the rest of the “action” in the book. It seems as though nothing these men do is easy or cut-and-dried.

What was the impact of war on Modernism?

Arguably, the Modernist era began after the First World War. Every aspect of society changed. First, industry developed, particularly with the introduction of the assembly line in the United States. This allowed women to work, which expanded their economic power and brought in a new era of consumerism and -- for better or worse -- advertising. Women also gained the right to vote in the United States in 1920 and, in Britain, full suffrage was granted in 1928. 

Social mores changed. Strict propriety was demanded, particularly of the upper- and middle-classes in the Victorian and Edwardian eras. It did not matter, really, if one engaged in "immoral" acts privately, as long as they were not found out. This hypocrisy did not survive well into the twentieth century without being questioned or criticized. 

There was something about the First World War that was especially cataclysmic to the human spirit. It raised existential questions: Was there any certifiable meaning to life? Is there any such thing as the "truth" of existence? The answers from artists and writers of the period was "no" to both questions. Morality became an individual thing. In his novels and short stories, Hemingway promotes the idea of every man (in some ways, he was rather chauvinist) having his own moral code. Suicide is no longer regarded as an unspeakable sin but a real consideration in the face of existential crises. This is something that Virginia Woolf explores in Mrs. Dalloway. Finally, sexuality is no longer unspeakable, it is celebrated in Ulysses; and aspects of female autonomy, such as the right to an abortion, are addressed in Dubliners. 

In visual art, Cubism is probably the most important movement. Though Georges Braque and Francis Picabia should not be neglected from any discussion, Picasso is clearly the most important. Picasso presents figures that are distorted and dismembered. They are flat shapes in the canvas, illuminated only by color. Depending on the period in which we regard Picasso's work, that color could have been either red or blue.

His paintings appear to be a comment on what it meant to be human at this time. The notion of being "modern," as wonderful as it sounds in some respects, is also disorienting. There is no longer a clear sense of right and wrong, no longer any rules on what is to be done and what is not to be done to survive in the world. Much of this is due to what people learned in the aftermath of the First World War: that death was far closer than any of us had realized. It was, therefore, important to live an honest and meaningful life.

What role does happiness play in ethics? Explain with reference to Kant and Aristotle.

Before I answer this question, I should clarify that "happiness" was not the same thing for Aristotle and for Kant, and it's yet another thing for us; this has something to do with the different languages  and the different time periods. The Greek word which is translated as "happiness" is "eudaimonia." This means, more accurately, "well-being" or "flourishing." It has nothing to do with subjective contentment. You might be "happy" watching TV, but Aristotle would not call this "eudaimonia." Kant, on the other hand, describes happiness (Glück) as continuous well-being, enjoyment of life, and complete satisfaction with one's condition. So Kantian happiness is much more subjective that Aristotelian happiness (and closer to what we often mean by "happiness"). Now that the terminological issue has been addressed, let's turn to the main question: what role does happiness play in Aristotle's and Kant's ethics?

For Aristotle, happiness was the highest end and the goal of human life. The Nicomachean Ethics begins by asserting that all arts and all crafts have one end, and we later learn that this end is happiness. Aristotle's ethics are often described as "eudaimonistic." Of course, happiness in this context entailed the cultivation of moral and intellectual virtues and required that even one's descendants be virtuous, since a person cannot be deemed "happy" until well after he or she is dead.

Kant, on the other hand, did not have much room for happiness in his ethics. Kant's ethics are often described as "deontological" or duty-based. For Kant, the right action was that which we ought to do irrespective of how it makes us feel. Our happiness is entirely secondary and has nothing to do with morality.

Here, I should also clarify that Aristotle's ethics deal with the question of how one should be whereas Kant's ethics deal with the question of how one should act. Aristotle's conclusion is that one should lead a life of happiness (eudaimonia) and Kant concludes that one should act according to duty irrespective of how happy it makes us.

What is a major similarity between "Sweat" by Zora Neale Hurston and "Saboteur" by Ha Jin?

While on the surface these two stories seem vastly different, there are three major similarities between them.

First, each of the main characters are prisoners, just in different ways. In "Sweat," Delia is a prisoner of her marriage. Her husband, Sykes, is emotionally and physically abusive to her and she struggles to escape him. In "Saboteur," Chiu is literally a prisoner in a Chinese jail. It is important to note that Delia and Chiu both start out as powerless victims and prisoners who are innocent of any wrongdoing. Delia does not deserve to be abused and Chiu has done nothing to be imprisoned. Because each of them are prisoners, their free will is limited and their abuser/accusers hold all of the power.

A second similarity is that both Delia and Chiu find freedom. Neither one dies a prisoner, as each are freed from their respective prisons. Sykes dies, so Delia is no longer married to him, and Chiu is released from prison after having to sign a false confession. It is important to realize, however, that they arrive at their freedom differently. Where Delia has become stronger and more independent in her marriage, Chiu has become sick and signs the false confession because he is so ill he will die in prison if he doesn't.

Finally, each character has been changed significantly by their imprisonment. Delia was once a submissive wife who was forced to live with what she saw as routine abuse. During the course of the book she becomes more independent, she fights back against Sykes, and she eventually takes pleasure in watching him die. We see that she has gone from completely controlled to being in control. For Chiu, he began the story as a happily married newlywed. Over the course of his imprisonment he realized the world is not as happy as he had hoped, that many things were out of his control, and he becomes quite angry at the powers that be (mostly the Chinese officials who he sees as imprisoning and torturing innocent people). At the end of the story he also takes his power back, but in a more negative way than Delia. Chiu has hepatitis, a very contagious disease, and he walks around the city drinking out of one straw after another, causing a hepatitis epidemic. His anger becomes directed at society rather than at just one individual, like Delia's anger was.

How can the behavior of two magnets show the presence of a magnetic force?

A magnet is a metal that has a positively charged magnetic field on one of its ends, and a negatively charged magnetic field on the other end due to negatively charged electrons allocating on one of its ends.

What we know is that like charges repel each other and opposite charges attract each other. Hence, when an area of high electron density (negative charge) is brought close to another area of high electron density, there is a repulsion force repelling each other away. When an area of high electron density is brought near an area of low electron density (more protons in the area than electrons, resulting in a positive charge), there is a force of attraction from the opposite charges. And finally, when two areas of low electron density (positive charge) are brought close, they repel each other, as protons are electrostatically attracted to negatively charged electrons instead.

Hence, when two magnets are brought close to each other with one magnet's positively charged end facing the other's negatively charged end (opposite poles), an attractive magnetic force pushes the magnets closer to each other. In contrast, when both positively charged or both negatively charged ends of the magnets (like poles) are brought close to each other, there is a repulsive magnetic force, pulling the magnets away from each other.

How does Atticus Finch go through misery or "hell" after taking the Tom Robinson case?

While the Finches initially have a good reputation in Maycomb County, Atticus' reputation certainly weathers significant hardships after he agrees to take the Tom Robinson case. In particular, various neighbors begin to accost Scout and Jem, ridiculing their father for his decision to defend a black man. This verbal assault takes on a physical manifestation as the book goes on. Indeed, at one point Atticus stands up to a hostile mob of men trying to kill Tom Robinson in the local jail, while at the end he nearly loses Scout and Jem to the deadly anger of Bob Ewell. All in all, it's clear that Atticus' neighbors want to bully him into submission, making his life as miserable and "hellish" as possible in order to maintain the racist status quo. This conflict becomes one of the most important points of the novel, as it illustrates how social pressure from the masses can uphold racial oppression. More optimistically, it also illustrates Atticus' admirable moral courage, as he refuses to modify his honorable values in the face of hardships.

What are the effects of Robert Walton's epistolary frame story?

By having Captain Walton provide the narrative frame for Victor Frankenstein's story, the reader has the opportunity to see the shattered Victor through someone else's eyes.  We can truly see the tragic effects of his incredible pride when we see Victor from Walton's sympathetic perspective.  It might be tempting for us to villainize Victor utterly, but Walton's characterization of him as an almost divine being of sorts helps to soften our judgment. 

Further, we are able to see the way in which Victor reflects on the story's events at their conclusion. The fact that he is unable to learn from his mistakes is key. He claims to have been reflecting on his past conduct and he does not find it "blameable," as he tells Walton. His pride, even now, renders him a tragic figure because he never really realizes the full extent of his responsibility. 

However, readers do get to see how Walton responds to having heard Victor's story. When his crew approaches him with a request to return home, their mission unaccomplished, he feels that he cannot take their lives into his hands if they are unwilling. In this way, then, he has learned from Victor not to jeopardize others in order to fulfill his own ambitions. His ability to take this lesson away throws into greater relief the fact that Victor never does.

Is there a genetic component to bipolar disorder?

Some mental illnesses, like bipolar disorder, are caused by both genetics and the environment. Although certain life circumstances can exacerbate chemical disruptions in the brain, scientists who study bipolar disorder believe there is a genetic component to the resulting mood and behavior disturbances.

No single gene has been pinpointed as the cause of bipolar disorder, and the complexity of the disorder makes it difficult to track down which genes might be turning on or off what chemical processes in the brain. A paper published in 2014 by the National Institute of Health states there are some single-nucleotide polymorphisms which seem to be associated with bipolar disorder and the heritability of this disorder. This means that there may be some chain(s) of "code" in a person's genes which are at the root of the development of this disorder.

It is important to understand bipolar disorder is a complex mental illness and may vary greatly from one person to the next. Where genetics is involved, it is not so simple as one gene causing the disorder. Rather, many chromosomes may play a role in creating the kind of brain structure and chemistry that results in symptomatic behavior.

In "Funeral Blues" by W.H. Auden, what does 'he' (the person being talked about) mean to the narrator?

In this poem, “he” has passed away, and the narrator says of him:

He was my North, my South, my East and West,
My working week and my Sunday rest,
My noon, my midnight, my talk, my song;
I thought that love would last forever: I was wrong.

This person obviously meant the world to the speaker; every direction the speaker looked, every day, every hour, was consumed by 'him,' was given to him by the speaker.  And now the speaker is despairing, quite understandably.  In the final verse, he or she bids the stars be snuffed out, bids the sun and the moon to stop shining, because these bodies invite life and happiness, two things that the speaker believes cannot exist without this person.  The speaker desires that the entire world go into mourning for this person, down to traffic officers and “the public doves.”  He was obviously of tremendous importance to the narrator.

It should be noted that the first version of this poem, published in 1936, was written as a satirical response to the death of a political leader in the play The Ascent of F6.  The first two verses of the second, widely published version are drawn from this first draft.  And these first two stanzas certainly do have a thin air of sarcasm about them; the last two verses, however, are far more sentimental and seem to have been written in earnest.  Thus we can assume that the speakers feelings of loss and depression are very real, even though his or her responses to this death are at some points a bit dramatic.

How does absorption take place in the small intestines?

Food that was in the stomach was mechanically churned, mixed with the protein enzyme pepsin as well as hydrochloric acid. At this point in the digestive process, it is a liquid called chyme and is passed into the small intestine.

The small intestine is the site for most of the chemical digestion or hydrolysis of food as well as the absorption of nutrients into the circulatory and lymphatic systems.

The small intestine has villi, which increase surface area for the process of absorption. These are tiny finger-like projections which allow absorption through the intestinal lining. They can do this because they are thin-walled and diffusion can occur through these tiny structures.

Within each villus is a lymphatic vessel called a lacteal, which absorbs fatty acids and allows them to circulate through the lymph and eventually return to the bloodstream.  There are also blood capillaries inside the villus to absorb amino acids and glucose and other nutrients.

The combination of approximately 23 feet of small intestine lined with villi makes the process of chemical digestion and absorption very efficient and greatly increases the surface area for the important work of getting necessary nutrients to the cells of the body.

What is 5-hydroxytryptophan (5-HTP) as a dietary supplement?

Overview

Many antidepressant drugs work by raising serotonin levels. The supplement
5-hydroxytryptophan (5-HTP) has been tried in cases of depression for a similar
reason: The body uses 5-HTP to make serotonin, so providing the body with 5-HTP
might, therefore, raise serotonin levels.

As a supplement, 5-HTP has also been proposed for the same uses as other
antidepressants, including aiding weight loss, preventing
migraine
headaches, decreasing the pain and discomfort of
fibromyalgia, improving sleep quality, and reducing
anxiety.

Sources

The supplement 5-HTP is not found in foods to any appreciable extent. For use as a supplement, it is manufactured from the seeds of an African plant called Griffonia simplicifolia.

Therapeutic Dosages

A typical dosage of 5-HTP is 100 to 300 milligrams (mg) three times daily. Once 5-HTP starts to work, it may be possible to reduce the dosage significantly and still maintain good results.

Therapeutic Uses

The primary use of 5-HTP is for depression. Several small, short-term
studies have found that it may be as effective as standard antidepressant drugs.
Because standard antidepressants are also used for insomnia and
anxiety, 5-HTP has also been suggested as a treatment for
those conditions, but there is only preliminary evidence that it works.

Similarly, antidepressant drugs are often used for migraine headaches. Some studies suggest that the regular use of 5-HTP may help reduce the frequency and severity of migraines and may help other types of headaches. Additionally, preliminary evidence suggests that 5-HTP can reduce symptoms of fibromyalgia and perhaps help a person lose weight.

Scientific Evidence

Depression. Several small studies have compared 5-HTP to standard antidepressants. The best trial was a six-week study of sixty-three people given either 5-HTP (100 mg three times daily) or an antidepressant in the Prozac family (fluvoxamine, 50 mg three times daily). Researchers found equal benefit with the supplement and with the drug. However, 5-HTP caused fewer and less severe side effects.

Migraine and other headaches. There is some evidence that 5-HTP may help prevent migraines when taken at a dosage of 400 to 600 mg daily. Lower doses may not be effective.

In a six-month trial of 124 people, 5-HTP (600 mg daily) proved just as effective as the standard drug methysergide. The most dramatic benefits observed were reductions in the intensity and duration of migraines. Because methysergide has been proven better than placebo for migraine headaches in earlier studies, the study results provide meaningful, although not airtight, evidence that 5-HTP is also effective.

Similarly good results were seen in another comparative study, using a different medication and 5-HTP (at a dose of 400 mg daily). However, in another study, 5-HTP (up to 300 mg daily) was less effective than the drug propranolol. Also, in a study involving children, 5-HTP failed to demonstrate benefit. Other studies that are sometimes quoted as evidence that 5-HTP is effective for migraines actually enrolled adults or children with many different types of headaches (including migraines).

Putting all this evidence together, it appears likely that 5-HTP can help people with frequent migraine headaches if taken in sufficient doses, but further research needs to be done. In particular, what is needed is a large double-blind study that compares 5-HTP with placebo over a period of several months.

Finally, an eight-week, double-blind, placebo-controlled trial of sixty-five people (mostly women) with tension headaches found that 5-HTP at a dose of 100 mg three times daily did not significantly reduce the number of headaches experienced; however, it did reduce participants’ need to use other pain-relieving medications.

Obesity (weight loss). The drug fenfluramine (with phentermine) made up the infamous Fen-Phen for weight loss. Although successful for weight loss, fenfluramine was later associated with damage to the valves of the heart and was removed from the market. Because fenfluramine raises serotonin levels, it seems reasonable to believe that other substances that affect serotonin might also be useful for weight reduction.

Four small, double-blind, placebo-controlled clinical trials examined
whether 5-HTP can aid weight loss. The first, a double-blind crossover study,
found that the use of 5-HTP (at a daily dose of 8 mg per kilogram of body weight)
reduced caloric intake even though the nineteen participants made no conscious
effort to eat less. Participants given placebo consumed about 2,300 calories per
day, while those taking 5-HTP ate only 1,800 calories daily. The use of 5-HTP
appeared to lead to a significantly enhanced sense of satiety after eating. In
five weeks, women taking 5-HTP effortlessly lost more than three pounds of body
weight.

A follow-up study by the same research group enrolled twenty overweight women who were trying to lose weight. Participants received either 5-HTP (900 mg per day) or placebo for two consecutive six-week periods. During the first period, there was no dietary restriction, while during the second period, participants were encouraged to follow a defined diet expected to lead to weight loss.

Participants receiving placebo did not lose weight during either period. However, those receiving 5-HTP lost about 2 percent of their initial body weight during the no-diet period and an additional 3 percent while on the diet. Thus, a woman with an initial weight of 170 pounds lost about 3.5 pounds after six weeks of using 5-HTP without dieting and another 5 pounds while dieting. Once again, participants taking 5-HTP experienced quicker satiety.

Similar benefits were seen in a double-blind study of fourteen overweight women given 900 mg of 5-HTP daily. Finally, a double-blind, placebo-controlled study of twenty overweight people with type 2 diabetes found that the use of 5-HTP (750 mg per day) without intentional dieting resulted in about a 4.5-pound weight loss in two weeks. The use of 5-HTP reduced carbohydrate intake by 75 percent and fat intake to a lesser extent.

Fibromyalgia. Antidepressants are the primary conventional treatment for fibromyalgia, a little-understood disease characterized by painful and tender muscles, fatigue, and disturbed sleep. One study suggests that 5-HTP also may be helpful for fibromyalgia. In this double-blind trial, fifty persons with fibromyalgia were given either 100 mg of 5-HTP or placebo three times daily for one month. Those receiving 5-HTP experienced significant improvements in all symptom categories, including pain, stiffness, sleep patterns, anxiety, and fatigue.

Anxiety. An eight-week, double-blind, placebo-controlled study compared 5-HTP and the drug clomipramine in forty-five people suffering from anxiety disorders. The results showed that 5-HTP was effective, but clomipramine was more effective.

Safety Issues

No significant adverse effects have been reported in clinical trials of 5-HTP. Side effects appear to be generally limited to short-term, mild digestive distress and possible allergic reactions.

One potential safety issue with 5-HTP involves an interaction with a medication
used for Parkinson’s disease: carbidopa. Several reports suggest that the
combination can create skin changes similar to those that occur in the disease
scleroderma.

According to several reports, dogs that have consumed excessive amounts of
5-HTP have developed signs of excess serotonin. In humans, this so-called
serotonin syndrome includes such symptoms as confusion, agitation, rapid heart
rate, high blood pressure, muscle jerks, loss of coordination, sweating,
shivering, and fever; rapid breathing, coma, and death are possible. Serotonin
syndrome might also occur if 5-HTP is combined with drugs that raise serotonin
levels, such as selective serotonin reuptake inhibitors (including Prozac),
other antidepressants, or the pain medication tramadol.

There are some reasons for concern that 5-HTP could increase the risk of “infantile spasms” (technically, massive myoclonic seizure disorder) in developmentally disabled children. Although safety in children in general has not been proven, children have been given 5-HTP in studies without any apparent harmful effects. Safety in pregnant or nursing women and those with liver or kidney disease has not been established.

Peak X. One report in 1998 raised a potential safety concern with 5-HTP. Researchers discovered evidence of an unidentified substance called peak X in a limited number of 5-HTP products.

Peak X has a frightening history involving a supplement related to 5-HTP: tryptophan. The body turns tryptophan into 5-HTP, and the two supplements have similar effects in the body. Until the late 1980s, tryptophan was widely used as a sleep aid. However, it was taken off the market when thousands of people using tryptophan developed a disabling and sometimes fatal blood disorder called eosinophilia myalgia. Peak X, introduced through a manufacturer’s mistake, is thought to have been the cause, although not all experts agree.

Despite this one report, it seems unlikely that 5-HTP could present the same risk as tryptophan. It is manufactured completely differently; peak X has not been seen again in 5-HTP samples, and no epidemic of eosinophilia myalgia has occurred with 5-HTP use.

Important Interactions

Persons should not take 5-HTP, except on a physician’s advice, if also taking
prescription antidepressants (including selective serotonin reuptake inhibitors,
monoamine
oxidase inhibitors, or tricyclics), the pain drug tramadol,
or migraine drugs in the triptan family (such as sumatriptan). One also should
avoid taking the Parkinson’s disease medication carbidopa at the same time as
5-HTP; the two together could cause skin changes similar to those that develop in
the disease scleroderma.

Bibliography

Cangiano, C., et al. “Effects of Oral 5-Hydroxy-Tryptophan on Energy Intake and Macronutrient Selection in Non-insulin-Dependent Diabetic Patients.” International Journal of Obesity and Related Metabolic Disorders 22 (1998): 648-654.

Das, Y. T., et al. “Safety of 5-Hydroxy-L-Tryptophan.” Toxicology Letters 150 (2004): 111-122.

Ribeiro, C. A. F. “L-5-Hydroxytryptophan in the Prophylaxis of Chronic Tension-Type Headache.” Headache 40 (2000): 451-456.

How can the conflict of individual vs society be expressed as a theme in Lois Lowry's The Giver?

In The Giver, the community in which Jonas lives does not value individualism. In fact, it is seen as dangerous and punishable. The community values uniformity instead, so everyone and everything is as similar as possible. Therefore, we can see the conflict of individual vs society expressed in several areas, including:

• The rules set up by the community to control its citizens (the curfew, for example). In our own society, we generally have the freedom to come and go as we please.


• The fact that no one has an individual age, even the children. Although the children are categorized by years, in our own society we often look at very young children in terms of months. In this community a "one" could be a day old or 12 months old. After age 12, age is not even considered or labeled. Individual birthdays are not celebrated in this society, while in our society it is very much a mark of our individuality.


• One hallmark of the community Jonas lives in is that no one is supposed to question anything, especially the decisions made by the Elders. In our society we are encouraged to question authority; it is built into our constitution as a cornerstone of our Democracy. 


• In their community, sexuality is repressed so that individuals do not engage in sexual acts, even married couples. In our society, we generally consider sex and sexuality to be a normal part of a healthy lifestyle.

These are just a few of the ways in which the theme of individual vs society can be seen in The Giver. 

I have homework about World War II, and I need help with a couple questions. 1) What marked the turning point in the war and the beginning of...

The Battle of Stalingrad from the summer of 1942 to February of 1943 marked the turning point of World War II. After successful attempts to capture parts of Eastern Europe, Germany launched an offensive on the Russian city of Stalingrad. The Russians defended their city and stopped the German incursion into the Soviet Union. During the long and bloody battle, the Axis forces suffered approximately 800,000 casualties, including soldiers lost, wounded, or killed. The Germans alone had 400,000 casualties and lost 900 aircraft, 500 tanks, and 6,000 pieces of artillery, affecting their ability to wage war in the future. 

World War II ended in Europe on V-E Day, or Victory in Europe Day, which was May 8, 1945, when the Nazis officially surrendered unconditionally. Adolph Hitler had killed himself on April 30, 1945, as Berlin was falling to the Allies. The U.S. had gotten involved in the war after the Japanese attack on the U.S. naval base at Pearl Harbor on December 7, 1941, in which 2,403 American military personnel were killed. On December 8, 1941, President Franklin Roosevelt gave a speech before Congress in which he called the attack "a date which will live in infamy" and declared war on Japan, marking the entry of the U.S. into World War II. 

What are home health services? How do they help cancer patients?

History: At one time, the poor were sent to the hospital while the wealthy received health care services in the comfort of their homes. Physicians made house calls and nurses made home visits. Both provided health care services and education. These nurses became known as public health or visiting nurses. In the twenty-first century, home health services are still provided in the patient’s residence, but the technology, costs, and scope of services have changed.

Coming home: Cancer patients are often discharged from hospitals while still recovering from illness or surgery. Supportive skilled services and treatments by the home health care team make it possible for cancer patients to heal in the comfort of their homes. Home health care agencies provide intermittent skilled and nonskilled home care services as indicated by the patient’s diagnosis, medical orders, and insurance reimbursement.

The home care team usually includes a multidisciplinary group of professionals such as registered nurses, nursing assistants/home health aides, physical therapists, respiratory therapists, occupational therapists, speech therapists, and medical social workers. Sometimes agencies also include chaplains and volunteers. Staff members work together to provide holistic health services in the home, with the physician providing oversight through the medical care plan.

Most home care agencies provide home health services for Medicare patients as well as private insurance and self-pay patients. To qualify for home health care services under Medicare, the patient must meet the following criteria:

• Require a skilled service by a registered nurse, physical therapist, or occupational therapist.





• Meet guidelines as a homebound patient due to illness or injury. The patient does not have to be bed-bound but must require considerable assistance or use a supportive device, such as a wheelchair or walker, to get around. The patient is able to leave the home only on a limited basis, usually for doctor office visits.





• Be under the care of a qualified physician who provides written medical orders to the home care agency for skilled care services and treatments.





• Receive home health services from a certified home care agency, subject to state and federal requirements and inspection.

Types of home health services: The interdisciplinary team of professionals coordinates the skills and knowledge needed to provide a comprehensive approach to home health services. Services may vary based on the needs of the cancer patient and the reimbursement. Services are provided on an intermittent basis (usually several times a week) so the caregiver remains the person responsible for daily continuous care. Home health services are not meant to be custodial or long term.

Skilled nursing services are provided by a registered nurse (R.N.). The nurse usually coordinates care and develops the patient’s plan of care. Nurses provide infusion therapy in the home for intravenous antibiotics, chemotherapy, or home parenteral nutrition (HPN). They support the patient and caregiver with teaching. They provide pain management and medication information. The R.N. supervises the home health aide who gives personal care to the patient in the home. Also, the nurse assesses ongoing problems and addresses these promptly. Home safety is important for effective home health services.

Physical therapists provide physical therapy to homebound patients with the goal of restoring function, encouraging independence, and minimizing decline. Physical therapists teach patients and caregivers how to maintain gains in function and prevent further injury.

Occupational therapists are key to enabling homebound patients to perform activities of daily living, such as bathing, dressing, feeding, or toileting. They may help redesign the placement of kitchen dishes and utensils to allow the patient with decreased functional ability to carry on daily chores. These professionals teach the patient how to use adaptive equipment such as a prosthesis. The goal is for the patient to attain the highest level of functioning possible.

Speech therapists work with patients who have suffered strokes, are neurologically compromised, or are having trouble swallowing or communicating, as is common among patients with cancers of the lips, mouth, or throat. Again, the goal is optimal function of the patient in normal routines.

Home health aides can make all the difference in the success of home health services. These caregivers are supervised and directed by the R.N. while providing personal hygiene care such as bathing, dressing, feeding, washing hair, or helping the patient walk. Sometimes they provide light housekeeping or a simple meal if these tasks are covered by the insurance provider. Many patients and caregivers report that the home health aide is the most helpful of all home health service providers.

Medical social workers assist cancer patients and caregivers to assess resources available in the community. Their skills are valuable as they facilitate referrals to other services, provide counseling and support, and act as patient advocates.

Registered dietitians and nutritionists may provide education for the patient and caregiver. These professionals are especially important if the patient is receiving an infusion of home parenteral nutrition (nutrition introduced nonintestinally, such as intravenously). They also can teach patients and caregivers critical aspects of diet and nutrition related to their cancer.

An infusion therapy company may provide infusion therapy products and equipment, becoming an important part of the home health care team. Once infusion therapy was provided only in a hospital setting, but now it is a part of home care services. Intravenous antibiotics, chemotherapy, or home parenteral nutrition is delivered through an infusion pump within the residence.

Specimens for tests ordered by the physician can be collected in the home. Samples can be taken by a registered nurse or phlebotomist. Lab tests can vary from routine blood counts to monitoring of medication/drug levels needed for the treatment plan.

Home medical equipment providers play a critical role in home health services. Specialized equipment provided in the home can make care of the patient more efficient and ease the physical stress on the caregiver. Typical equipment needs in the home include special beds designed for home use, walkers, wheelchairs, wound and ostomy supplies, catheters, bed pads for incontinence, and oxygen therapy and supplies.

Volunteers may be a part of the home health care service. They can provide a range of services such as cooking, cleaning, emotional support, providing transportation, making phone calls, or providing respite care while the caregiver rests or runs errands. These services are needed in the home but rarely are covered under the reimbursement insurance.

Chaplains are sometimes a part of the home care team, especially in a specialized home health service called hospice for terminally ill patients. These professionals provide spiritual support to the patient, caregiver, and home care staff.

Skilled vs. custodial health care services: Some cancer patients may not need a skilled service provided by professionals but may require support services to continue to stay in their homes. These services are considered custodial services and are usually not covered by Medicare or private insurance. Community or private agencies may provide support services such as private duty nurses or sitters to stay with the patient for shifts of eight to twelve hours, live-in companions, or home-delivered meals. Some pharmacies provide delivery services for medications. Groceries can be delivered to the home. These types of services are generally considered out-of-pocket expenses and are paid for by the patient, caregiver, or both. These services, however, can help the patient stay in the home environment. Medical social workers from a home health care agency are available to assess patient needs and make necessary referrals to community agencies.

Nontraditional therapy at home: Cancer patients may choose to pay for nontraditional care services delivered in their homes. Therapies and services that may be available to homebound patients include massage therapy, podiatrist services, and acupuncture services. Engaging in relaxation therapies such as yoga, meditation, tai chi, or guided imagery may be useful to reduce stress. Patients may choose to investigate or use herbal or vitamin supplements, but they should discuss any supplement with their health care provider before adding these to the mediations already prescribed; certain medication interactions can occur when supplements are taken with prescribed drugs. For their safety and optimal health outcome, patients are advised to discuss alternative therapies with their health care provider.

Balinsky, Warren L. Home Care: Current Problems and Future Solutions. San Francisco: Jossey-Bass, 1994.

Cannon, Geneva. Caring for Your Loved One Who Is Ill at Home: A Comprehensive Guide and Planner for Family Caregivers and Personal Home Care Assistants. Salisbury, Md.: Avenegg, 2006.

Gingerich, Barbara Stover, and Deborah Anne Ondeck, eds. Clinical Pathways for the Multidisciplinary Home Care Team. Gaithersburg, Md.: Aspen, 1997.

Meyer, Marie M., and Paula Derr. The Comfort of Home: A Complete Guide for Caregivers. Portland, Oreg.: CareTrust Publications, 2007.

What are examples of good decisions and bad decisions Scout makes in Harper Lee's To Kill a Mockingbird?

Most of Scout's poor decisions in Harper Lee's To Kill a Mockingbird reflect her hotheaded temper and tomboyish nature. However, by the end of the novel, she has come to associate being a girl with bravery, and her acceptance reflects in her good decisions.

Early in the novel, Scout's hotheaded temper is first reflected when she attacks Walter Cunningham Jr., blaming him for her having gotten herself into trouble on the first day of school. After she gets into trouble for explaining to her first-grade teacher, Miss Caroline, why Walter doesn't have any lunch and is unable to pay back borrowed lunch money, Scout accosts Walter in the playground and rubs "his nose in the dirt" but is stopped by Jem, who, after hearing what happened, invites Walter home for lunch. Scout's attack on innocent Walter, as well as her treatment of him during lunch, certainly count as poor decisions.

Scout takes to heart Atticus's warning that she must start fighting with her head, not with her fists. Plus, upon the influence of role model ladies in her life, like Calpurnia, Miss Maudie, and Aunt Alexandra, Scout begins to accept her role as a girl. She particularly accepts her role when she observes her aunt and Miss Maudie put on brave smiles and continue entertaining their guests in the face of the news of Tom Robinson's unjust and untimely death; she decides that if they can be brave by acting like ladies, so can she:

I carefully picked up the tray and watched myself walk to Mrs. Merriweather. With my best company manners, I asked her if she would have some. After all, if Aunty could be a lady at a time like this, so could I. (Ch. 24)

Scout's observations of Miss Maudie's and Aunt Alexandra's ladylike behavior at a time when they must be brave shows us that Scout has come to associate being a lady with being brave, since it takes a great deal of bravery to be able to put others first at a time when you only want to think of your own distressed emotions. Scout makes a good decision in deciding she can be a lady if the role is associated with bravery.

What are jail diversion programs?

Overview

According to several sources, the United States has one of the highest incarceration rates in the world. The country contains 5 percent of the world's population, yet over 25 percent of the world's prisoners. Of those US prisoners, over 20 percent had significant mental health issues and over 60 percent had substance use disorder, with the majority having been incarcerated on nonviolent drug offences. In 2005, the Bureau of Justice Statistics issued a report stating that more than one-half of all inmates in prisons and jails across the United States had a mental illness.

In large correctional facilities such as the Los Angeles County Jail and the Rikers Island complex in New York City, the population of inmates with mental illness is greater than the number of persons being treated for mental illness in any hospital in the United States. As a result of the modern trend of deinstitutionalization, correctional facilities have become the nation’s largest providers of mental health treatment.

In response to this growing problem, many communities have turned to jail diversion programs to better meet the rehabilitation needs of offenders with mental illness and to alleviate some of the strain that housing such inmates places on the criminal justice system. Jail diversion programs are designed to identify and redirect offenders with serious mental health problems and substance abuse problems from jail or prison and toward various community-based treatment and recovery centers. In doing so, these programs allow mentally ill offenders to receive the type of rehabilitative support they need to cope with their illness and to begin to recover instead of being incarcerated, which often only exacerbates their condition.

Along with improved access to quality health care, jail diversion programs are beneficial to offenders with mental illnesses in many other ways. Such programs frequently allow offenders to maintain their employment, which, in turn, provides them with a means of supporting their families and continuing to be productive members of society. In many cases, upon completion of treatment, offenders in jail diversion programs also become eligible to have the charges against them expunged from their records.

Jail diversion programs also are advantageous for the communities in which they operate. In many correctional facilities, the cost of housing a single inmate is often around $100 per day. In communities with active jail diversion programs, which can effectively reduce or eliminate jail time for thousands of offenders, the economic savings for taxpayers is considerable.

Types of Jail Diversion Programs

Three common types of jail diversion programs are in practice.

Prebooking diversion takes place before a person is booked into jail and before any charges are filed. The strategies employed within these diversion programs usually focus on the initial contact between an offender and law enforcement officers. As such, prebooking diversion programs require police officers to be specially trained to recognize the indicators of a potential mental illness or substance abuse problem and to make the appropriate judgment as to how an offender should be handled on-scene.

Many of these programs involve collaboration between police and local mental health and substance abuse facilities. This collaboration may come in the form of a team of specifically trained mental health professionals who respond with police to calls that are likely to involve mental illness or substance abuse. In other cases, police officers may simply choose to transport a mentally ill offender directly to a mental health facility instead of to the police station or jail.

The second and more widely utilized type of jail diversion program is postbooking diversion. Postbooking diversion occurs after a person is arrested and formally charged with a crime. Once charged, the offender is screened for mental health and substance abuse problems. If the offender is deemed to be qualified for diversion, those in charge of the diversion program work with prosecutors and court officials to negotiate a reduction in or elimination of jail time for the offender in favor of mental health treatment.

The third type of jail diversion program that is becoming increasingly popular is geared specifically toward nonviolent drug offenders. Drug court was first implemented in 1989 in Miami-Dade County, Florida, by a group of law professionals who determined another solution to the problems of repeat offenders was needed. They combined drug treatment with judicial supervision to effect changes in convicted individuals' lifestyle and behavior. Within ten years of the first drug court, almost 500 additional drug courts had been in operation throughout the United States. As of June 2014, over 3,400 drug courts were operating in the country.

Some criminal justice systems also have separate mental health courts where offenders diagnosed with mental illnesses and charged with nonviolent crimes are tried. In these courts, convicted offenders receive sentences that are specifically designed to allow them to avoid jail or prison time by participating in a voluntary treatment program.

Effectiveness

Studies have shown that jail diversion programs for offenders with mental illnesses or substance abuse problems have been successful in terms of their ability to rehabilitate offenders and reduce or prevent instances of recidivism following release. According to the National Institute of Justice, one study conducted in the Kansas City, Missouri, drug courts indicated that the felony rearrest rate decreased from 40 percent prior to individuals attending drug court to 12 percent after being enrolled in drug court. In Pensacola, Florida, the felony rearrest rate decreased from 50 percent to 35 percent.

Similarly, other studies have shown that offenders who participated in a jail diversion program experienced fewer arrests and fewer days incarcerated or hospitalized after they completed the program than they did in the year prior to their initial arrest. These results show that jail diversion programs do achieve their intended goals of reducing crime among persons with mental illnesses while keeping them out of correctional facilities.

One can, therefore, conclude that jail diversion programs are effective in dealing with mental illness, substance abuse, and crime for all parties involved. Offenders themselves receive the rehabilitation and support they need while avoiding the difficulties associated with serving jail or prison time. Criminal justice systems benefit from the reduction in the number of offenders entering already overcrowded correctional facilities. Communities are, in turn, relieved of some of the economic burdens of paying to support additional inmates. From every perspective, jail diversion programs are effective and worthwhile alternatives to the traditional methods of criminal justice in the United States.

Bibliography

DeLisi, Matt, and Peter John Conis. American Corrections: Theory, Research, Policy, and Practice. Sudbury: Jones, 2010. Print.

"Jail Diversion Program." Jail Diversion Program. Jail Diversion Program, 2013. Web. 6 Nov. 2015.

Landsberg, Gerald. Serving Mentally Ill Offenders: Challenges and Opportunities for Mental Health Professionals. New York: Springer, 2002. Print.

Mays, G. Larry, and Rick Ruddell. Making Sense of Criminal Justice: Policies and Practices. 2nd ed. New York: Oxford UP, 2015. Print.

Osher, Fred C., et al. Adults with Behavioral Health Needs Under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promotion Recovery. New York: W. S. Hein, 20121. Print.

Public Citizens Health Research Group. Criminalizing the Seriously Mentally Ill: The Abuse of Jails as Mental Hospitals. Darby: Diane, 1998. Print.

Why are John Locke's ideas important?

John Locke’s ideas are historically important largely because they helped to inspire the American Revolution.  Many of the Patriot leaders read and accepted Locke’s ideas about government.  We can see proof of this in the fact that the Declaration of Independence uses Locke’s ideas.

John Locke was an Enlightenment thinker who did not believe that monarchy was rational.  Locke believed that it was irrational to think that God had appointed certain families of people to rule over others.  Instead, he tried to come up with a more logical way to think about how government came to be and what made government legitimate.

Locke argued that governments arose because people wanted something to protect them from other people in the state of nature.  In the state of nature, there was no government and no limits on what people could do, but there was also no way for people to protect their rights.  Therefore, Locke argued, people created governments.  The governments were legitimate because the people agreed to be ruled by them.  The governments were also legitimate because they protected the people’s fundamental rights.  These were the rights to life, liberty, and property.

These ideas are very clearly reflected in the Declaration of Independence.  Jefferson uses Locke’s arguments almost word for word in that document.  He did this because he and many of the other American leaders believed that Locke’s democratic vision was correct.  Locke’s vision helped inspire them to want to rebel against the British monarchy.  Therefore, Jefferson said, in the Declaration, that government got its power from the consent of the governed and that the purpose of government was to protect the people’s rights to “life, liberty, and the pursuit of happiness.”

Historically speaking, then, Locke’s ideas are important mainly because they helped to inspire one of the most important political revolutions in the history of the world. 

What were FDR's New Deal programs and what problems did they attack?

President Franklin D. Roosevelt launched his New Deal programs to try to deal with the effects of the Great Depression. There were many programs that were part of the New Deal. These programs tried to bring relief to the American people, recovery to the economy, and reform the economic system.

There were several relief and recovery programs. Many of these programs created jobs for the American people. The Civilian Conservation Corps created jobs for young, unemployed people who went to the West to work on conservation programs. The Public Works Administration and the Civil Works Administration were also programs that created jobs. These programs provided jobs for people to work on various construction projects including airports, roads, bridges, and schools. The Agricultural Adjustment Act was designed to help farmers. Farmers were paid not to grow crops. There were too many crops in the market, which helped keep prices of crops very low. The Home Owners Loan Corporation helped some people refinance their mortgages at lower interest rates.

There were programs designed to reform the economy to try to prevent another depression from occurring. The Glass-Steagall Act prevented commercial banks from investing in the stock market. The Federal Deposit Insurance Corporation was created to provide insurance for savings accounts. This was done to try to restore confidence in the banking system. People could put money into their saving accounts knowing their money was safe. The Securities Act was designed to deal with the stock market. Companies were required to provide complete and truthful information to investors. The Securities and Exchange Commission was established to regulate the stock market and to prevent fraud.

President Roosevelt hoped these New Deal programs would reinvigorate the economy and place the United States on the road to recovery.

Why did Tom stay home while his wife went out to the movies?

In Jack Finney’s short story “Contents of the Dead Man’s Pockets” Tom Benecke has high professional aspirations. While his wife goes out to enjoy a movie, he stays home to work on a project he wants to present to his boss. Tom worked for months collecting information, which he feels will be revolutionary in the grocery business. Is he required to do this? No, he chooses to complete the extra work in an effort to increase his earnings and professional standing. He tells his wife to go without him so he can complete the project.

She nodded, accepting this. Then, glancing at the desk across the living room, she said, "You work too much, though, Tom--and too hard."

 He smiled. "You won't mind though, will you, when the money comes rolling in and I'm known as the Boy Wizard of Wholesale Groceries?"

Unfortunately, he obsession with upward mobility leaves his life unbalanced. It takes a life or death incident to influence his decision making. After his ordeal, he realizes how skewed his thinking is and rushes out to join his wife at the movies.

What is an inspirational quote?

An inspirational quote is one that inspires you (or your reader) to do better, to be happier, to improve in some important way. They are important to many people, who keep them handy to remind themselves that they want to do better.  There are many such quotations out there, suitable for all sorts of occasions.  For example, for people who are very ill, such quotes inspire to enjoy what there is to enjoy or to think healing thoughts.  For people who have experienced some sort of loss, for instance, a job or a breakup of a relationship, one quote that is commonly shared is "When one door closes, another door opens."  For people who have lost a loved one, there are inspirational quotes, too, and I would guess that all religions have their own special inspirational quotes.  A personal favorite of mine is from John Fowles' The Magus, "Which are you drinking, the water or the wave?" I apologize for not having a page number, but I seem to have lent my copy to someone.  The inspirational aspect of this quote for me is that we should never be experiencing things in life simply for their sustenance, but also for the adventure and joy they bring. Try to find an inspirational quote or two for yourself! 

Is it true that God is real?

As pohnpei noted, there is no definitive answer to this question. He notes correctly that direct, impartial evidence of God's existence cannot be observed; therefore God's existence cannot be proven scientifically. He also notes, however, that God's nonexistence cannot be proven scientifically either; so the question is indeterminate on such grounds.

Many modern philosophers, often arguing from Occam's razor ("do not multiply hypotheses needlessly"), assert that the burden of proof for the claim "God exists" rests with the claimants. Since it cannot be conclusively proven, we must proceed without it. This amounts to acting, in the absence of positive proof, as if God does not exist. This is the position of naturalist philosopher Daniel Dennett, and has been championed in the public sphere by the so-called "New Atheists": Richard Dawkins, Christopher Hitchens, Sam Harris, et al.

Many religious people claim that God's existence is proven by revelation: that a particular text is Divinely inspired or even Divinely written, and by its very nature constitutes proof of God's existence. Other believers claim that their chosen prophet, teacher, etc. is Divinely inspired (or even Divine him/herself). Obviously, these answers are almost entirely subjective; the only standard by which any particular text or person can be judged to be Divine or Divinely inspired is personal experience, which can differ enormously.

Still others will say that God is a matter of faith rather than proof -- that they have faith that God exists, and such faith sustains them through the good and bad of their lives. They are making a consequentialist argument: that one ought to believe in God because it leads to desirable consequences. Another consequentialist argument is the infamous "Pascal's wager": that the penalties for false belief in a nonexistent God are finite, but the penalties for disbelief in a real God are infinite; therefore it is prudent to act as if God exists whether He does or not. Both of these arguments attempt to evade the question rather than answering it.

However, many philosophers and theologians have tackled the question of God's existence over the centuries, with various results. Such arguments usually fall into the tradition of natural theology: the derivation of religious principles from reason and observation alone, without recourse to Divine revelation. Thomas Aquinas famously listed five arguments for the existence of God, most or all of which can be considered special cases of the cosmological (or causal) argument: i.e., that God's existence can be inferred from observation of certain properties of the natural world as a whole -- the cosmos.

Such arguments remain a subject of active study today. A leading contemporary proponent of the kalam cosmological argument (a variation which originated in the Muslim theological school called "kalam", or "discourse") is William Lane Craig. An excellent book which both summarizes and synthesizes the current state of the art in natural theology is A Case for the Existence of God, by Dean Overman. Less technical arguments may be found in the works of C. S. Lewis, particularly the first chapters of Mere Christianity and The Problem of Pain.

What is Atticus' defense strategy in the novel To Kill a Mockingbird?

Atticus' strategy to defend Tom Robinson is to essentially illustrate the Ewells' despicable character, draw attention to the Ewells' conflicting testimonies, highlight the location of Mayella's injuries, reveal that Bob Ewell is left-handed, and to point out Tom Robinson's handicap. Atticus also plans to encourage each jury member to view the case void of prejudice by judging solely on the evidence and testimonies presented.

Atticus begins to by questioning Sheriff Tate to describe the specific location of Mayella's injuries. Tate says that Mayella was beaten predominately on the right side of her face and that her right eye was swollen. When Bob Ewell takes the stand, Atticus asks him to confirm Sheriff Tate's testimony regarding the location of Mayella's bruises, and he does. Atticus then proceeds to ask Bob to sign his signature on the back of an envelope. When Bob signs the paper, it is revealed that he is left-handed. The significance of Bob's "strong hand" comes into play later on in the trial.

When Atticus cross-examines Mayella, he asks her numerous questions regarding her home life. It is revealed that the Ewell family is dirt poor, Bob is a hopeless alcoholic who has violent tendencies when he is drunk, and Mayella is solely responsible for raising her siblings. Atticus asks Mayella to describe the assault, and she is unable to give an accurate description of what happened. When Atticus asks her if she remembers being beaten in the face, she says, "No, I don't recollect if he hit me. I mean yes I do, he hit me" (Lee 248). Atticus understands that Mayella's fabricated story will crumble under pressure, which is why he continues to question her about the events of the evening when she was allegedly raped.

When Atticus asks Mayella to identify her perpetrator, she points to Tom Robinson. Atticus has Tom stand up to reveal to the jury and audience that his left arm is severely crippled. This is a significant moment in the trial because the audience is aware that an individual leading predominately with their left arm could inflict injuries to the right side of a person's face. Tom cannot use his left arm, and Bob Ewell is, in fact, left-handed which suggests his guilt.

When Mayella claims that Tom was the man who raped her, Atticus simply asks, "How?" (Lee 249). Mayella knows that it is obvious that Tom could not have raped her and begins to alter her testimony. Atticus applies more pressure by asking her consecutive questions that she refuses to answer. Atticus asks, "Why don't you tell the truth, child, didn't Bob Ewell beat you up?" (Lee 251). Mayella's silence signifies her guilt.

When Tom takes the witness stand, Atticus begins by bringing up the fact that Tom was once convicted of disorderly conduct. Jem tells Dill that Atticus was showing the jury that Tom had nothing to hide. Atticus allows Tom to tell his version of what happened the evening of November 21st which is drastically different from Mayella's story. Atticus had mentioned before that he wanted the entire truth to be told during the trial which is why he allows Tom to tell it in explicit detail.

During Atticus' closing remarks he elaborates on the fact that no medical evidence was presented and draws attention to the Ewells' conflicting testimonies. Atticus reveals Mayella's motivation for accusing Tom Robinson by claiming that she felt guilty about getting caught seducing a Negro. He then urges the jury not to let their prejudice affect their decision because every man is considered equal in a court of law. By appealing to the jury's conscience, he hopes that Tom will be acquitted.

In the poem "To Everything There Is a Season," are all activities the poet mentions permanent? Or do they come or go? How do you know?

The poem begins with the statement that everything has its season. This implies a seasonal rhythm like the seasons in nature. However, the first example given is "a time to be born and a time to die." One might immediately think of the birth and death of a person, or the birth and death of oneself, which only happens once in the given person's lifetime. That death is permanent.

All the other events in the poem speak to things that are cyclical or recurring. Planting and reaping happen each year in spring and fall. People know that laughing and weeping are cyclical: Although when one is extremely sad, it feels like one will never laugh again, even devastating sorrow recedes in its intensity, allowing the grief-stricken person to eventually laugh again. Breaking down and building up, keeping and throwing away, and ripping out seams and sewing them up again are all things that happen repeatedly in one's life. Loving and hating, keeping quiet and speaking, and winning and losing all happen over and over again for any given person.

Therefore, the only thing in the poem that seems of a permanent nature is death. From the context of the poem, one could infer that the poet wants to make the point that death, despite its seeming permanence, is in reality a part of a cycle that will lead to rebirth. This poem is rooted in the passage from the Old Testament book of Ecclesiastes, part of the Hebrew scriptures that is one of the Wisdom books. Keeping that religious worldview in mind, one might interpret the poem as presenting the concept of resurrection and an afterlife, seeking to prove it by showing that everything that is known is cyclical. Based on inductive reasoning where one makes a conclusion about what is not known based on what is known, death is not permanent but will come around to birth again. 

What are meningiomas?

Related conditions:
Intracranial and spinal tumors, extra-axial brain tumors, neurofibromatosis

Definition:
Meningiomas are tumors of the meninges, the thin layers of tissue that surround the brain and spinal cord. This type of neoplasm most likely originates from cells of the arachnoid matter, the middle element of the three meningeal coverings, and occur mainly at the base of the brain and around the cerebral convexities. Meningiomas are visibly demarcated from the brain tissue and thus are classified as extra-axial tumors. They can extend from the surface of the dura matter, the outer meningeal layer, and erode the cranial bones, causing exostosis, or growth of the bone. In general, these are solitary lesions, and, as reported by the American Society of Clinical Oncology in 2014, about 80 percent of them are benign. However, multiple lesions are common in patients with neurofibromatosis type 2 (NF2), a genetic disorder that affects the nervous system. Several different histological types have been described, with the meningothelial, fibrous, and transitional forms as the most frequently found.

Risk factors: Although the risk factors for meningiomas are largely unknown, evidence suggests an association of risk with a family or personal history of neurofibromatosis type 2, exposure to ionizing radiation (during full-mouth dental radiographs), and use of sex hormones (oral contraceptives or hormone replacement therapy). Other risks factors that have been explored without conclusive results are head trauma, cell phone use, breast cancer, and allergic diseases.

Etiology and the disease process: The precise origin of the majority of the meningiomas is uncertain. However, several forms of this disease are clearly associated with the loss of a tumor-suppressor gene on chromosome 22, known as merlin and encoded by the NF2 gene. Merlin belongs to the 4.1 family of proteins, a group of molecules with roles in maintaining cell structure. Genetic defects in merlin account for many sporadic meningioma cases. In addition to merlin, other members of the 4.1 protein family with tumor-suppression activity have been involved in meningioma initiation (for example, 4.1B and 4.1R). However, meningioma progression seems to involve genetic changes in chromosomes other than chromosome 22.

The presence of a high density of progesterone receptors in the vast majority of meningiomas suggests a functional role of progesterone-signaling pathways in the pathogenesis and might explain the twofold and tenfold higher incidence respectively of cranial and spinal meningiomas in women. Other proteins that might participate in the disease process of meningioma include telomerase, transforming growth factor-beta, and somatostatin.

Incidence: Meningiomas are the most common nonglial and most common extra-axial tumors of the brain, with an incidence rate of approximately 7 per 100,000 individuals, according to the American Society of Clinical Oncology in 2014. The relatively frequent autopsy finding of small asymptomatic undiagnosed meningiomas suggests that the actual incidence rate is significantly higher. According to the American Brain Tumor Association's 2012 statistics, meningiomas are about twice as common in women, and the highest incidence is observed beginning in the sixth decade of life. Childhood cases of meningioma are rare.

Symptoms: Symptoms of meningiomas depend on the location and size of the lesion and result from increased intracranial pressure and edema of the brain structures adjacent to the tumor. The most common symptoms are headache, unilateral sensory disturbances (for example, hearing or visual loss), vertigo, imbalance, focal seizures, spastic weakness, numbness of the limbs, and painless proptosis or “bulging” eyes, among others.

Screening and diagnosis: No screening tests are available. The tendency of meningiomas to calcify and their abundant blood supply allow their diagnosis by contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and arteriography. On both CT and MRI scans, meningiomas appear as homogeneous, smoothly outlined masses, with attachments to the dura matter. Their extra-axial location differentiates them from common intra-axial tumors of the central nervous system, and their unique image density characteristics differentiate them from Schwannoma, another extra-axial tumor.

The World Health Organization (WHO) classifies meningiomas into three grades based on their histological features and the likelihood of recurrence.

• Grade I: benign meningiomas, with low risk of recurrence and aggressive growth





• Grade II: Atypical meningiomas, with greater risk of recurrence and aggressive growth





• Grade III: anaplastic or malignant meningiomas, with the greatest risk of recurrence and aggressive growth

Some 80 percent of all meningiomas are of WHO Grade I on diagnosis, according to the American Cancer Society in 2014.

Treatment and therapy: The primary treatment is complete surgical excision of the tumor. Focused radiation by Gamma Knife or proton beam is used when the lesion is located around vital structures or when it is a high-grade or recurrent tumor. Although effective chemotherapy has not yet been developed, studies on the use of hormonal antagonists and other molecules are ongoing.

Prognosis, prevention, and outcomes: Complete removal of the tumor is achieved in many cases, and in most patients, hearing and other functions of the nervous system are preserved. Recurrence depends on the grade of the tumor, ranging from 7 to 25 percent for noncancerous tumors to between 29 and 52 percent for atypical meningiomas, according to the American Society of Clinical Oncology as of 2014. Prevention of meningiomas is difficult since the etiology is poorly understood.

Backer-Grøndahl, Bjørnar H. Moen, and Sverre H. Torp. "The Histopathological Spectrum of Human Meningiomas." International Journal of Clinical & Experimental Pathology 5.3 (2012): 231–42. Web. 29 Oct. 2014.

Claus, Elizabeth B., et al. “Epidemiology of Intracranial Meningioma.” Neurosurgery 57.6 (2005): 1088–95. Print.

DeMonte, Franco, Michael W. McDermott, and Ossama Al-Mefty, ed. Al-Mefty's Meningiomas. New York: Thieme, 2011. Print.

Hyat, M. A., ed. Meningiomas and Schwannomas. New York: Springer, 2012. Print. Tumors of the Central Nervous System 7.

Lusis, Eriks, and David H. Gutmann. “Meningioma: An Update.” Current Opinion in Neurology 17.6 (2004): 687–92. Print.

Riemenschneider, Markus J., Arie Perry, and Guido Reifenberger. “Histological Classification and Molecular Genetics of Meningiomas.” Lancet Neurology 5 (2006): 1045–54. Print.

What is spectrum emission?

Spectrum emission is when an excited body releases radiation in a variety of wavelengths.

In this case, the body can be anything: a table, a star, a hot piece of metal, or a cloud of gas. Any matter can be considered a body in this definition. As an easy example, I prefer a hot bar of metal as it is easy to visualize.

When you heat up a bar of metal, it begins the color of the metal; for iron this is grey, for gold the color is yellow. As it heats, however, the colors change. Iron will progress from a deep red to a yellow, and eventually a bright white. These colors are important, as these emitted photons are in decreasing wavelengths.

The color you see is the peak wavelength of the light in your visual range. When the bar is cool, the grey light you see is only being reflected by the bar. There is light you do not see, however, in much longer wavelengths being emitted by the bar as radiation. When the bar is white, there are photons being emitted in shorter wavelengths than you can see.

This means that the bar is emitting light in a range of frequencies, or a spectrum.

All elements release photons in specific wavelengths more than others, on what are called emission lines. For example, the first spectrum line for hydrogen is called h-alpha, and is at 656.2 nm, and is used in astronomy frequently. 

Is there any potent political resource that money can't buy?

There is absolutely a “potent political resource that money can’t buy.”  That political resource is charisma.  Many candidates who have seemed to be very attractive on paper, and who have had plenty of financial support, have been unable to win elections because they have lacked charisma.

In order to succeed, political candidates need to come across well to the public.  They have to be able to make the public like them or want to be led by them.  This does not come easily to everyone.  Perhaps the best example of this in the current election cycle is Jeb Bush.  Bush seemed to be a strong contender for the Republican nomination.  He had experience, many high officials who endorsed him, and tons of money. With all of this, he still did terribly in the actual primaries and caucuses and had to end his campaign very early.  His father, George H. W. Bush also lacked charisma.  This played a large role in his defeat by Bill Clinton, who was a very charismatic and talented politician.

Money cannot buy elections.  It can buy ad time.  It can buy people who will create good strategies for your campaign.  It will buy many other things, but it cannot buy charisma and political talent.  This shows that there is at least one “potent political resource that money can’t buy.”

What evidence was presented against Giles Corey?

Giles Corey was accused of being a warlock during the Salem Witch Trials. He was accused by the girls and Ann Putnam of practicing witchcraft. This was confirmed by Mercy Lewis’s deposition records available from the Supreme Court archives. The deposition documents and a confession from Abigail were used as evidence against Giles.

In her deposition, Mercy Lewis alleged that Giles’ ghost appeared to her and urged her to write in the devil’s book. Mrs. Putnam also made similar allegations against Giles. The girls also claimed that his ghost would appear to them and violently torment them. Evidence against Giles was solely based on the testimony from the witnesses.

Giles refused to take his plea and was subsequently subjected to pressing in attempts by the courts to force him to take the plea. He was adamant about his position, forcing the officials to press him to death. He pleaded for more weight before he died.

In the novel To Kill a Mockingbird, which female characters influence Scout and how?

There are several female characters who influence Scout throughout the novel. Scout's neighbor, Miss Maudie, is a positive role model to Scout and continually offers her support, encouragement, and insight. Miss Maudie influences Scout's perception of the Radley family, Atticus, and the community of Maycomb. Scout first learns about Arthur Radley's background from Miss Maudie, and also finds out that Atticus was the deadliest shot in Maycomb after Maudie calls him "Ol' One-Shot." Maudie elaborates on why it is a sin to kill a mockingbird and explains to Scout why Atticus' defense of Tom Robinson is valiant. Scout is influenced by Maudie's easy-going, morally upright character and views her as a close friend.

Scout is also influenced by Calpurnia. Calpurnia not only teaches Scout how to write but also introduces her to the African American community by taking her to First Purchase African M.E. for Sunday service. Scout learns about Calpurnia's "double life" which is a significant moment that enhances Scout's perception.

Aunt Alexandra also influences Scout throughout the novel. Aunt Alexandra encourages Scout to become a proper Southern belle. Alexandra views Scout with contempt for her "tomboy" personality and wishes that Scout would wear a dress instead of overalls. Scout is exposed to Alexandra's prejudiced views toward lower-class citizens, as well as her obsession with heredity. When Scout attends Aunt Alexandra's missionary circle, she begins to become intrigued with the idea of one day becoming a lady. Scout also witnesses Alexandra's sensitive side after several tragic events. Scout gains perspective regarding the duality of human nature from her experiences with Alexandra.

Scout is also influenced by her female teachers and neighbors throughout the novel. Scout learns the importance of viewing situations from other people's point of view after her interactions with Miss Caroline, and questions Miss Gates' hypocrisy after hearing her say that America was void of prejudice. Scout also witnesses what real courage looks like from Mrs. Dubose and realizes the negative effects of gossip from Miss Stephanie Crawford.

In "Harrison Bergeron," how does George feel about his handicaps?

In Kurt Vonnegut’s short story, “Harrison Bergeron,” George is Harrison’s father. Vonnegut mentions that George has two handicaps, a radio that dulls George’s intelligence by emitting a loud noise every twenty seconds, and a “forty-seven pound of birdshot in a canvas bag, which was padlocked around George’s neck,” to dull his strength.

To George, his handicaps are not something to endure, but a proud symbol of the society in which he lives. “If I tried to get away with it,” George says to his wife about the possibility of removing the weights, “then other people’d get away with it-and pretty soon we’d be right back to the dark ages again.” Despite the pain and discomfort, George views the handicaps as a necessary pillar of America’s egalitarian society.

Whether Vonnegut intended it or not, it is difficult to understand why George would have such deep convictions when his mental handicap doesn’t allow for deep thought. One can argue that George’s comments reflect an opinion held by many Americans when Vonnegut wrote the story: social order is more important than justice.

What are the various parts of a volcano?

A volcano is an opening in the Earth's outermost layer (crust) through which hot gases and molten material, from Earth's interior, emerges out. A volcano consists of a number of parts and a brief description of these components is presented here:

• Magma chamber: Magma is molten rock, present underneath the surface of Earth. A magma chamber is an underground reservoir of pressurized magma waiting to get released above the surface of the planet. 


• Conduit: The passage through which the hot magma and gases reach the planet's surface.


• Throat: The opening of the volcano from which the magma comes out. It is the upper part of a volcano.


• Vent: Crack or rupture in Earth's surface from which hot magma and gases escape to the surface.


• Crater: The mouth of the volcano. It is formed around the main vent.


• Flank: The side of a volcano is known as the flank.

Hope this helps. 

In The Great Gatsby by F. Scott Fitzgerald, what does the reader learn about the differences between East Egg and West Egg?

In the first chapter, Nick Carraway, the narrator, says that West Egg is the "less fashionable" of the two, while East Egg is populated with "white palaces [that] glittered" on the water.  Nick describes Gatsby's mansion, a "colossal affair" that attempts to imitate a fancy French hotel with its tower, ivy, marble swimming pool, and massive lawn.  It sounds a bit gauche compared to the home of the Buchanans.  Tom and Daisy's home is "a cheerful red-and-white Georgian Colonial mansion, overlooking the bay."  Gatsby's home is constructed to look like something it is not, just as the man himself has been.  Tom and Daisy's home doesn't have to prove anything to anyone because its owners don't have to either.  Further, descriptions of Tom's family as "enormously wealthy" and his "string of polo ponies" that he brought with him help to make it clear that East Egg is populated by families which possess old money, the kind of money that one inherits and for which one does not work.  Gatsby has new money, money that has had to be earned and which is, therefore, less valuable in terms of status.

What quotes show Friar Lawrence has kept Romeo and Juliet's marriage a secret?

In Act II, Scene 3 Friar Lawrence agrees to marry Romeo and Juliet despite the fact that they are the son and daughter of families who are involved in a bitter and violent feud. He hopes that such a union will cause the families to make peace ("rancor to pure love"). He marries them in secret the same day and tells no one. In fact, the only individuals privy to the information are the friar and Juliet's nurse. One quote from Friar Lawrence which suggests that he has kept the marriage a secret appears in Act III, Scene 3 when he is attempting to convince Romeo to heed the Prince's declaration that he be banished to Mantua. He claims that once tempers have quieted he will announce the marriage and beg forgiveness from the Prince:

But look thou stay not till the watch be set,
For then thou canst not pass to Mantua,
Where thou shalt live till we can find a time
To blaze your marriage, reconcile your friends,
Beg pardon of the Prince, and call thee back
With twenty hundred thousand times more joy
Than thou went’st forth in lamentation.

Another quote implying his secrecy comes at the beginning of Act IV as he is speaking to Count Paris. Paris has come to ask the friar to marry him to Juliet. Of course, Juliet is already married, by Friar Lawrence. When Paris asks if the friar believes the marriage should be delayed, Lawrence, in an aside (not spoken directly to Paris but for the audience), "I would I knew not why it should be slowed." He is basically saying he wishes he didn't know why the marriage between Paris and Juliet cannot occur.

What are some feminine descriptions of Mr Hyde in Jekyll and Hyde?

Perhaps the most striking description of Hyde, besides his indescribably ugly face, is that he's considerably smaller than Jekyll.  While Stevenson describes Jekyll as "a large, well-made, smooth-faced man," and just a bit later emphasizes Jekyll's "large handsome face," Hyde, in contrast, is "small and very plainly dressed," even "dwarfish."  Jekyll himself explains that away by claiming that since he suppressed his evil nature for so long, its personification is by necessity smaller, but it could also be seen as yet another manifestation of the dichotomy of humankind.  Good versus evil manifests itself in large versus small, and many other binaries can be incorporated into this--light versus dark, open versus hidden, and indeed male versus female.  (I'm verging a bit into Derridean philosophy here, but it's a subject worth looking into in this context, particularly with regard to binary oppositions.)

Additionally, the first time Utterson meets Hyde, he notes that Hyde's footstep is "light," and he reiterates much later that Hyde's steps differ from Jekyll's "heavy creaking tread."  Hyde speaks, as well, with "a husky, whispering and somewhat broken voice"--a voice well paired with such an unimpressive figure as Hyde's, and not one you'd expect from such a large man as Jekyll.  Jekyll's butler Poole is the only character to go so far as to explicitly describe Hyde in feminine terms, though; he tells Utterson that he hears the person in Jekyll's study "weeping like a woman or a lost soul."

I hope this helps!

What are complementary and alternative treatments for heart disease?

Overview

With the advent of lifesaving antibiotics in the early to mid-twentieth century, conventional or allopathic medicine became the preeminent form of health care in the United States. Although most of the other health care systems continued to function, they were deemed unscientific. Moreover, as a result of public health interventions, such as better sanitation, the populace enjoyed greater longevity. As the gradual aging of the population began to significantly increase the prevalence of chronic illnesses such as arthritis, diabetes, high blood pressure, and heart disease, mainstream medicine began to address these conditions.

Cardiovascular disease (CVD) is the leading cause of death in the United States. Of note, CVD includes all conditions affecting the heart and the blood vessels. While many risk factors for CVD may be addressed by lifestyle changes such as smoking cessation and by adherence to diets low in saturated fats and trans fatty acids, the aging process and hereditary factors predispose for risk factors that cannot be altered. Until the age of fifty years, men are at greater risk than women of developing CVD, although once a woman enters menopause, her risk increases threefold.

Many people with CVD have low levels of high-density lipoproteins (HDL) or good cholesterol or high levels of low-density lipoproteins (LDL) or bad cholesterol (or both), and the levels of both are more specifically linked to CVD than is total cholesterol. Atherosclerosis (hardening of the arteries) is the most frequent cause of heart attacks, and it usually occurs in persons with high cholesterol. Overweight persons are more likely to have additional risk factors related to heart disease, specifically hypertension, high blood-sugar levels, high cholesterol, high triglycerides, and diabetes. Most often, recommended treatments for cardiovascular diseases by conventional physicians are invasive and include stents and bypass graft surgery. There are, however, instances when complementary and alternative medicine (CAM) or integrative therapies can augment or even preclude invasive measures.

CAM and Heart Health

The National Center for Complementary and Integrative Health (NCCIH), formerly known as the National Center for Complementary and Alternative Medicine (NCCAM), is a branch of the National Institutes of Health (NIH). NCCIH was established in 1998 to ensure that high-quality scientific research is conducted in CAM practices. Complementary medicine is used together with conventional medicine, an example being aromatherapy, and alternative medicine is used in place of conventional medicine, an example being the Zone diet to lower LDL and raise HDL levels. Integrative medicine is a combination of conventional medicine with therapies for which there is evidence of both safety and efficacy, such as relaxation and therapeutic touch in addition to the administration of analgesics for postoperative pain. CAM may be classified into five types of therapy (some systems or therapies may fit into two or more categories) as they pertain to CVD: alternative medicine systems, mind/body medicine, manipulative and body-based systems, energy therapies, and biologically based therapies.

Alternative medicine systems are based upon complete systems of theory and practice, such as homeopathic and naturopathic medicine in Western culture; non-Western systems include traditional Chinese medicine such as acupuncture and ancient Indian medicine such as Ayurveda, which originated in India more than eight thousand years ago. Ayurveda uses an integrated approach combining meditation, exercise, lifestyle changes, diet, and herbs such as guggulipid (guggul) and its extracts, which have been used to lower lipids in persons with ischemic heart disease, hypercholesterolemia, and obesity. Clinical studies conducted in India have shown that guggul is effective in lowering triglycerides and total cholesterol. In the first clinical randomized trial of guggul in 103 healthy adults, no effect was observed on their lipids. Gastrointestinal upset, rash, headache, and nausea were noted. Guggul has been shown to interfere with the prescription heart medications propranolol and diltiazem. The herbal/mineral abana formulation may lessen angina symptoms, reduce high blood pressure, and improve cardiac function.

Mind/body
medicine uses meditation, prayer, music therapy, and yoga to
provide a positive influence upon the mind to improve a person’s health; mind/body
medicine’s clinical correlates to CVD unite both social and biological aspects of
CVD. An increasing body of evidence suggests that persons with depression are
predisposed to cardiovascular events; persons with depression after a myocardial
infarction were shown to have greater mortality rates than their cohorts who were
not depressed. Stress is another psychosocial determinant of cardiovascular
pathology and disease, such as high blood pressure; in the Framingham study, high
blood pressure was linked to more than 80 percent of all cardiovascular deaths and
was at least twice as strong a predictor of death as high cholesterol levels or
smoking.

Mind/body techniques have been used as adjuncts to traditional therapies in treating heart diseases. For coronary heart disease, these CAM techniques include stress reduction, meditation (yoga), and group support. CAM includes biofeedback, stress reduction, and group support for arrhythmia; guided imagery for presurgery therapy; stress reduction and meditation for elevated cholesterol levels; group support and biofeedback for congestive heart failure; and group support, biofeedback, meditation (yoga), and pet companionship for high blood pressure.

A 2009 study was undertaken to determine whether breathing exercises practiced
in yoga meditations would be of benefit to persons with hypertension.
Sixty men and women (twenty to sixty years of age) with stage I essential
hypertension were equally divided into groups of controls: those who did
slow-breathing exercises and those who did fast-breathing exercises. Subjects were
assessed using parameters including baseline and postintervention measurements of
blood pressure, standing-to-lying ratio, Valsalva ratio, and the hand-grip and
cold pressor response; both types of breathing exercises appeared to benefit
persons with hypertension. Improvement in both sympathetic and parasympathetic
reactivity was associated with those in the slow-breathing group.

Manipulative
and body-based systems include massage and therapeutic touch;
their clinical correlates to CVD unite both the social and the biological aspects
of CVD. The real benefit of energy treatments might be as adjuncts to improve
optimism by restoring a sense of peace, serenity, and emotional connection. This
approach may be helpful as long as it does not preclude conventional therapy and
does no harm.

Therapeutic touch was tested by meta-analysis; of the eleven trials evaluated, seven demonstrated a positive effect, including anxiety reduction in a coronary care unit, reduced need for postsurgical pain medications, and enhanced wound healing. Because many of these techniques are unproven or may result from a placebo effect, it is best to consult a physician before undergoing therapy.

Energy
therapies, which use natural energy fields to promote health
and healing, include qigong, Reiki, therapeutic touch, and
acupuncture. Acupuncture has become increasingly popular among those
wanting to treat or prevent CVD. This ancient Chinese medicine employs tiny
needles that are carefully and strategically inserted in the body to improve
health. The basis for this improvement is the movement, throughout the body, of
energy that may have become blocked; it is believed that acupuncture helps to
unblock and redirect energy. Studies have shown that acupuncture can be used to
reduce high blood pressure and reduce the incidence of angina and blood vessel
spasms; those who were treated by acupuncture for angina recovered more quickly
from an attack than those who had been taking drugs. Reliable acupuncturists are
usually certified by the National Certification Commission for Acupuncture and
Oriental Medicine. Acupuncture is covered by some medical insurance; the cost of
visits varies widely, so one should consult several practitioners to find out
about their fees.

Biologically based therapies use substances found in nature, such as vitamins, herbs, and omega-3 fatty acids, and special diets to lose weight or prevent CVD. Herbal supplements have been used for thousands of years in the East and have had a recent resurgence in popularity among consumers in the West; more than fifteen million people in the United States consume herbal remedies or high-dose vitamins, and the total number of visits to CAM providers far exceeds those to primary physicians, amounting to more than $34 billion in out-of-pocket costs for CAM annually. Multiple factors contribute to the increased use of CAM, including the obesity epidemic, the prevalence of chronic disorders and pain syndromes, anxiety, depression, the general desire for good health and wellness, disease prevention, the increasing cost of conventional medicines, and the often mistaken belief that CAM remedies are safer and more effective.

The use of herbal remedies in the United States is widespread and increasing dramatically. Generally defined as any form of plant or plant product, herbs make up the largest proportion of CAM use in the United States. Because herbs are regarded as food products, they are not subject to the same scrutiny and regulation as traditional medications; manufacturers are exempt from premarket safety and efficacy testing and from any surveillance after marketing. Although herbal remedies are perceived as being natural, and therefore safe, many have adverse effects that can sometimes produce life-threatening consequences. Thus, one should consult a physician or other health-care professional about using herbs. Physicians are often unaware of their patients’ use of such products because they do not ask about it; also, patients rarely volunteer such information.

Tetrandine. This vasoactive alkaloid is used in Chinese medicine
to treat hypertension and angina. Because its vasodilation effect comes from the
inhibition of the L-type calcium channels, there is possible competition with
other calcium-channel blockers.

Aconite. Traditional Chinese practitioners use aconite for relief of pain caused by trigeminal and intercostal neuralgia, rheumatism, migraine, and general debilitation. Aconite is also a mild diaphoretic and is used to slow a rapid pulse. Atrial or ventricular fibrillation, however, may result from the direct effect of aconite on the myocardium. Side effects may occur following contact with leaves or sap from Aconitum plants and can range from bradycardia and hypotension to fatal ventricular arrhythmia.

Gynura. Widely used in Chinese folk medicine, gynura purportedly improves microcirculation and relieves pain; however, it has been associated with hepatic toxicity and has been shown to inhibit angiotensin-converting enzyme activity, resulting in hypotension in animals.

Ginseng. To determine whether there was a link between
ginseng intake and mortality in a Korean population, 6,282
persons age fifty-five years and older were followed from March 1985, to December
2003. After adjusting for age, education, smoking, body mass index, and blood
pressure, the all-cause mortality rate for males who used ginseng was lower. This
effect was not observed in female cohorts. Mortality caused by cardiovascular
disease was not related to ginseng consumption in either females or males.

Ginkgo biloba. This herb has been used to treat intermittent
claudication in persons with peripheral artery blockage. A meta-analysis looked at
eight randomized, placebo-controlled, double-blind studies of 415 persons. The
results from the trials showed that Ginkgo biloba significantly
increased walking distance in tested persons by 111.54 feet. Ginkgo should
not be given with digitalis, warfarin, aspirin, nonsteroidal anti-inflammatory
drugs, or thiazide diuretics.

Cinnamon. Two daily doses of a dried water-soluble
cinnamon extract seemed to lower the risk factors for heart
disease and diabetes in a small study led by a U.S. Department of Agriculture
chemist. It was found that the daily doses of the cinnamon extract improved the
antioxidant status of the subjects, a group of obese men and women, and also
decreased their fasting blood sugar (glucose) levels. For this twelve-week study,
the twenty-two participants were randomly divided into two groups; one group
received 250 milligrams of cinnamon extract twice per day with their usual diets,
and the other group was given placebos. The positive changes seen in the lab
values of the cinnamon group suggested a reduction in the risk of both diabetes
and cardiac disease.

Hawthorn. A peripheral vasodilator, hawthorn has been used to treat high blood pressure, ischemic heart disease, arrhythmia, coronary heart disease, cor pulmonale (pulmonary heart disease), and atherosclerosis. Several double-blind studies of persons with heart failure have shown objective improvement in cardiac performance using bicycle ergometry. In some studies of persons with mild heart failure, hawthorn outperformed digitalis. Care should be taken, however, when taking hawthorn with drugs such as digitalis, beta-blockers, and anti-arrhythmics.

Vitamins. Vitamins used to prevent or treat CVD include B12, B6, and folate. Having elevated blood levels of the amino acid homocysteine (found in high amounts in animal protein) is a strong risk factor for CVD. Studies have also shown that when high homocysteine levels are reduced, the incidence of heart attack is cut by 20 percent, the risk of blood-clot-related strokes by 40 percent, and the risk of venous blood clots elsewhere in the body by 60 percent. Studies have shown that dietary intake of vitamins B12, B6, and folate can help to lower elevated homocysteine levels, as can lowering the amount of animal-based protein ingested. At least 10 percent of the population, however, has a genetic propensity for elevated levels of homocysteine. Persons should consult their health care providers to determine homocysteine level; if above 7, activated folic acid (L-methyl folate), vitamin B12
, and vitamin B6
should be added to the diet.

Observational data suggest that fruit and vegetable consumption lower the risk of developing CVD. It has been postulated that the antioxidant component of fruits and vegetables accounts for the observed protection. Decreased risk of cardiovascular death has been associated with higher blood levels of vitamin C and coenzyme Q10
(CoQ10). In addition, vitamin C, vitamin E, and CoQ10 have demonstrated antioxidant effects, including beneficial effects on oxidation of low-density lipoprotein. There is evidence that these vitamins may affect other risk factors for CVD, such as hypertension. Vitamin E may also reduce coronary artery blockage by decreasing blood platelet aggregation. Thus, supplementation with these antioxidants could decrease the risk of developing CVD.

CoQ10 is produced in all body tissues, acting like a
free-radical scavenger that can stabilize membranes. There
have been more than forty clinical trials of CoQ10 use in persons with
CVD, demonstrating both subjective and objective benefits. Both a recent review
and a meta-analysis have shown the benefits of CoQ10, which has also
been shown to significantly reduce cardiotoxicity of cancer drugs such as
Adriamycin (doxorubicin). Although not serious, side effects have been
reported with CoQ10 usage, most frequently insomnia, higher levels of
liver enzymes, upper abdominal pain, sensitivity to light, irritability, headache,
dizziness, heartburn, and extreme fatigue.

Heart Healthy Diets

In 2006, American Heart Association (AHA) dietary guidelines underscored the importance of limiting “bad fats” and stated that less than 7 percent of calories consumed daily should come from saturated fats (and less than 1 percent from trans-fats). A range between 25 to 35 percent for total fat consumption is suggested for most people, not just for those trying to lose weight. Saturated fats are typically found in meat products and in tropical oils, such as coconut and palm oil. Trans-fat, also known as partially hydrogenated fat, is human-made and is found mostly in commercially baked goods.

The AHA promotes two types of dietary guidelines. The first restricts
cholesterol consumption to less than 200 milligrams per day and less than 7
percent of calories as saturated fat, and the second recommends eating foods such
as margarine, which contains plant sterols. In 2010, a Tufts University study
found that eating such margarine with three meals per day lowered LDL. Other
suggestions include soy products, soluble fiber, and walnuts and almonds to lower
LDL (low-density lipoprotein), or bad cholesterol. Soy-based phytoestrogen foods
have been found to reduce oxidation of lipids. Favorable effects of soy
phytoestrogens on lipid profiles and thrombosis and vascular reactivity have been
reported. Intake of foods containing phytoestrogens have been linked to a
favorable cardiovascular risk profile, as demonstrated by 939 postmenopausal women
participating in the Framingham Off-Spring Study.

Eating protein-rich foods other than red meat could play an important role in lowering the risk of heart disease. In a recent study, Harvard School of Public Health researchers found that women who consumed higher amounts of red meat had a greater risk of coronary heart disease (CHD). Substituting other foods high in protein, such as fish, poultry, and nuts, in place of red meat was associated with a lower risk of CHD; eating one serving per day of nuts in place of red meat was linked to a 30 percent lower risk of CHD; substituting a serving of fish showed a 24 percent lower risk, poultry a 19 percent lower risk, and low-fat dairy a 13 percent lower risk.

Many previous studies have focused on either the nutrient composition of protein-rich foods (the amount of saturated fat or iron) or dietary patterns (Mediterranean-style diet or Western-style diet) and how they relate to heart disease risk. This study, which appeared in the August 16, 2010, issue of Circulation, evaluated the substitution of one protein-rich food for another, which may be easier for a person to do, compared with substituting one nutrient or one dietary pattern for another, to reduce the risk of heart disease. The researchers followed 84,136 women age thirty to fifty-five years in the Nurses’ Health Study (based at Brigham and Women’s Hospital) over a period of twenty-six years. The participants had no known cancer, diabetes, stroke, angina, or other cardiovascular disease. To assess diets, the participants filled out a questionnaire every four years about the types of food they ate and how often.

A low-carbohydrate diet based on animal products was associated with higher all-cause mortality in both men and women. According to a study published in the September 7, 2010, issue of Annals of Internal Medicine, a low-carbohydrate diet may reduce the risk of death from all medical causes in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause mortality and cardiovascular disease mortality. Researchers had followed more than 85,000 women for twenty-six years and 44,000 men for twenty years as a follow-up to earlier studies.

This wide-ranging study gives credence to the Eco-Atkins diet popularized by David Jenkins (Archives of Internal Medicine, 2009), who created a diet high in plant proteins, fruits, and vegetables. In the Jenkins study, forty-seven overweight hyperlipidemic men and women consumed one of two diets: a low-carbohydrate (26 percent of total calories), high vegetable protein (31 percent from gluten, soy, nuts, fruit, vegetables, and cereals), and vegetable oil (43 percent) plant-based diet or a high-carbohydrate lacto-ovo (milk and eggs) vegetarian style diet (58 percent carbohydrate, 16 percent protein, and 25 percent fat). The dieting lasted four weeks and had a parallel-study design. The study food was provided at 60 percent of calorie requirements. While the Jenkins study does not suggest that the diet will result in longevity, Eco-Atkins (the low-carbohydrate diet) was shown to improve cholesterol levels and promote weight loss.

The Ornish diet, designed by Dean Ornish, is a low-fat vegetarian
diet with less than 10 percent of daily calories derived from fat (an average of
15 to 25 grams per day), 70 to 75 percent from carbohydrates, and 15 to 20 percent
from protein. The diet encourages consumption of beans, fruits, vegetables, and
whole grains and restricts intake of processed foods, high-fat dairy products,
alcohol, and simple sugars. There are two versions of the Ornish diet: the
reversal diet, for people with existing heart disease wanting to reduce their risk
of heart attack or other coronary event, and the prevention diet, for otherwise
healthy persons with levels of LDL cholesterol greater than 150 milligrams per
deciliter or for those with a ratio of total cholesterol to high-density
lipoprotein (HDL, or good cholesterol) that is less than 3.0.

The Ornish diet is completely vegetarian. Excluded are cholesterol, saturated fat, and animal products, except egg whites and nonfat dairy products. All nuts, seeds, avocados, chocolate, olives, coconuts, and oils are eliminated too, except for a small amount of canola oil for cooking and for oil that supplies omega-3 essential fatty acids. The Ornish diet also prohibits caffeine but allows a moderate intake of alcohol and salt. There is no restriction on calorie intake, but the diet suggests several small meals each day rather than three large meals. Based on available research, the Ornish diet appears to be more successful in lowering the risk of heart disease than other diets, but it also has been described as one of the more difficult diets to follow.

The Zone diet, designed by Barry Sears, determines total daily caloric intake based on daily protein intake. Once the amount of daily protein is established, the next step is to divide this protein into “blocks,” each of which contains approximately 7 grams of protein, then divide the protein blocks into five or more meals to be eaten throughout the day. For example, one can consume four blocks at breakfast, three at lunch, two as afternoon snacks, four at dinner, and two as late-night snacks. For each protein block eaten, one carbohydrate block and one fat block should also be consumed. Each carbohydrate block contains 9 grams of carbohydrate, and each fat block has 1.5 grams of fat. Suggested daily protein intake will vary based on daily activity and lean body mass. For the average overweight American, total caloric intake might be 1,400 calories per day. For an average marathon runner, the daily intake might be about 1,750 calories per day. The program's daily protein recommendation is 75 grams for women and 100 grams for men.

The Pritikin diet is a low-fat diet largely based on vegetables, grains, and fruits. Fat in the diet accounts for 10 percent of daily intake. Nathan Pritikin promoted the concept of wellness through lowering cholesterol and helping diabetics normalize their blood sugar without taking insulin. That people lost weight was a plus. Pritikin’s son, Robert, then altered the diet; its staples remained the same plant-based foods of the original diet, and the fat content remained very low. Again altered by Robert, the diet now focuses on caloric density: Not just calories are important, but also how dense these calories are in a given food. For example, one pound of broccoli has fewer calories than one pound of cookies, which is also rich in simple sugars and saturated fat. Between 1975 and 2015, more than 100,000 people have attended Pritikin Longevity Centers.

An article in the Journal of the American Medical Association (2005) reported on a single-center randomized trial at an academic medical institution in Boston of overweight or obese adults age twenty-two to seventy-two years with known hypertension, dyslipidemia, or fasting hyperglycemia. The study compared the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction. The study set out to assess adherence rates and the effectiveness of the four popular diets for weight loss and cardiac risk factor reduction. A total of 160 people were randomly assigned to four diet groups: Atkins (carbohydrate restriction), Zone (macronutrient balance), Weight Watchers (calorie restriction), and Ornish (fat restriction) diet groups.

Each diet was found to significantly reduce the LDL/HDL-cholesterol ratio by approximately 10 percent, with no significant effects on blood pressure or glucose at one year. The amount of weight loss was associated with self-reported dietary adherence, but not with diet type. For each diet, decreasing levels of total/HDL cholesterol, C-reactive protein, and insulin were significantly associated with weight loss with no significant difference among diets. Each popular diet modestly reduced body weight and several cardiac risk factors at one year. Overall dietary adherence rates were low, although increased adherence was associated with greater weight loss and cardiac risk factor reductions for each diet.

Those persons looking for a CAM practitioner who can address heart health should contact national organizations such as NCCIH, the American Heart Association, and the National Institutes of Health, and also specific therapy organizations such as the American Association of Oriental Medicine. One can also consult his or her health care provider for suggestions.

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Natl. Center for Complementary and Integrative Health. National Center for Complementary and Integrative Health. US Dept. of Health and Human Services, NIH, 8 July 2015. Web. 28 Jan. 2016.

Peplow, Philip, et al. Cardiovascluar and Metabolic Disease: Scientific Discoveries and New Therapies. N.p.: Royal Soc. of Chemistry, 2015. eBook Collection (EBSCOhost). Web. 28 Jan. 2016.

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