What does the Valley of Ashes symbolize in The Great Gatsby by Fitzgerald?

The Valley of Ashes, which is the dumping ground of industrial waste, represents a moral wasteland.

This valley, hidden between the city of New York and West and East Eggs, symbolizes the moral decay of the nouveau-riche, who indulge themselves in material pleasures with no regard for others or anything else that interferes with this enjoyment.

Furthermore, the valley of waste and corruption is "bounded on one side by a small foul river." This polluted river represents, too, the moral pollution of the souls of the reckless, "careless people" such as Tom Buchanan, who exploits other people, like George Wilson, as well as his wife Daisy, who recklessly wastes the life of Myrtle Wilson.

In addition, the Valley of Ashes signifies the "dead end" in which its residents live. For instance, Wilson himself has lost vitality from residing in the moral wasteland. Described as "a spiritless man" who is anemic and moves around with "white ashen dust" covering his pale hair and clothes, he holds the desperate hope that Buchanan will make a business deal with him that will elevate his condition some. Likewise, his wife Myrtle becomes the mistress of Tom in the hopes that he will bring her joy and take her out of this death-invoking valley where men crumble just as the industrial waste turns to ashes. 

What role do plants play in the nitrogen cycle?

Of all of the gases in the atmosphere, nitrogen gas (N2) is the most abundant. One would think that this would be great for plants and animals as they need nitrogen to build macromolecules like nucleic acids and proteins, but plants and animals cannot use nitrogen in its most common form (N2).

Some plants, called legumes, form symbiotic relationships with bacteria that are able to change the gaseous nitrogen to a form that can be used by plants. Bacteria like Rhizobioum can live in root nodules of legumes like peas, alfalfa, and soybeans. It is a mutualistic relationship because the bacteria benefit as they are given a home and a carbon source from the legume roots and the plants benefit because the bacteria are able to convert the N2 into ammonia and then to organic molecules that can be used by the plants. These legumes and their symbiotic bacteria can be used to add nitrogen to nitrogen-poor soils. Legumes are often planted after corn (which takes a lot of nitrogen out of the soil) in crop rotation cycles.

Denitrifying bacteria do the opposite of the nitrogen fixing bacteria associated with legumes. Denitrification involves converting nitrates that come from nitrifying bacteria back to nitrogen gas (N2).

What is the meaning of the beginning phrase "The world is too much with us" in the poem "The World is Too Much with Us" by William Wordsworth?

"The world is too much with us" can be interpreted as meaning that people have become too concerned with worldly, material things and are now unconcerned with the natural world.

The renowned social psychologist and humanistic philosopher Erich Fromm wrote in 1955,

We live in a world of things, and our only connection with them is that we know how to manipulate or to consume them.

Fromm's words echo the meaning of the first line of Wordsworth, a Romantic poet who stressed the importance of emotion and connection to Nature. In fact, Romanticism meant a return to nature and an escape from the contamination of modern civilization. Like other Romantics, Wordsworth was concerned that people were becoming materialistic during his time. Industrialization was occurring, thus causing people to "give their hearts away." In this poem, then, since their only connection to life is through consumption of the "world of things," people have become "out of tune" with the beauty of the natural world that even the "Pagan suckled in a creed outworn" knew how to appreciate.

What theme is explored in Tuck Everlasting? How is this a theme that we can relate to?

The theme is that when you get what you want, you may not want it when you get it. 

The theme is the message of the story.  A lot of people think they want to live forever.  Dying is frightening, so why wouldn’t it be great to never die?  The Tucks teach us that dying is a part of life, and if you wish to live forever you should be careful what you wish for. 

Pa Tuck uses an example of a rowboat on a river to explain to Winnie what it’s like to live forever. 

"But this rowboat now, it's stuck. If we didn't move it out ourself, it would stay here forever, trying to get loose, but stuck. That's what us Tucks are, Winnie. Stuck so's we can't move on. We ain't part of the wheel no more. Dropped off, Winnie. Left behind. (Ch. 12) 

The Tucks did not ask to be immortal.  When they drank from the spring, they had no idea that would be the result.  However, now they have what so many people want.  They cannot die.  In the end, this is not all that it’s cracked up to be.  The Tucks feel like they cannot participate fully in life, because the world leaves them behind. 

Winnie has a similar experience, albeit on a smaller scale.  She desperately wanted adventure.  She wanted to run away from home and see the world.  She felt stifled at home with her family 

I'm tired of being looked at all the time. I want to be by myself for a change. … I'm not exactly sure what I'd do, you know, but something interesting—something that's all mine. Something that would make some kind of difference in the world. (Ch. 3) 

Winnie got her wish.  She had an adventure.  However, it was not the adventure she was expecting.  After she accidentally saw Jesse Tuck drink from the magic spring, the Tucks kidnapped her.  They wanted to have time to explain.  Winnie got involved in the death of the man in the yellow hat and a prison-break. 

Winnie learned that she is lucky to have a family.  She wished to be on her own, but she saw what that did to Miles and Jesse.  They could never have a real family, because their wives and children would not be immortal.  Winnie realizes that her quiet, family-centered life is actually a luxury.

This is a theme anyone can relate to.  We have all longed for something, and then realized we didn't really want it.  Most of us have also wanted change until we had it, when we wished for things to be the way they were instead.

Where, in Julius Caesar, does Brutus connect with the reader, specifically during Act 3, Scene 2?

When he addresses the waiting multitude in the forum to explain the reasons for Caesar's assassination, Brutus is particularly engaging. He shows courage by even daring to face the crowd and being frank and direct. He is not at all apologetic or whimpering. The reader can only admire his commanding tone. He does not plead with the tumult but tells them to be quiet. His language is sincere and he uses persuasive rhetoric, telling all and sundry to respect his honour so that they may believe him.

What is even more impressive and engaging is that Brutus does not alienate himself from those he addresses. He places himself in their position, stating that what they felt or feel is equal to his sentiment. If they loved Caesar, so did he. He beautifully conveys the idea that his role in the assassination was not bred from malice. He pre-empts the crowds' thoughts by stating that if they should wish to know why he killed Caesar, it was not because he loved him less but that he loved Rome more.

This statement most effectively conveys the idea that Brutus acted not out of selfish ambition but rather in the interest of the common good. The reader can only admire him for having such depth because he follows this statement with a remarkably loaded rhetorical question:

Had you rather Caesar were living and
die all slaves, than that Caesar were dead, to live
all free men?

The answer is most pertinently obvious and logical and, therefore, requires no response. To add to this grand rhetoric, Brutus presents a number of contrasting statements which provide greater credence to his argument as to why Caesar's death had become a necessity:

As Caesar loved me, I weep for him;
as he was fortunate, I rejoice at it; as he was
valiant, I honour him: but, as he was ambitious, I slew him. There is tears for his love; joy for his
fortune; honour for his valour; and death for his
ambition.

This damning accusation of Caesar provides the crowd with a reason to have feared his rise to power. The implication is that he would have become a dictator. Once again, Brutus follows this with a string of rhetorical questions which tie in with the earlier one and for which there can only be a negative response. Even as a reader, one can only agree that Brutus had done the right thing at this point.

We have even greater admiration for Brutus when he most nobly mentions that he would make available to his country the same dagger with which he had slain Caesar if it should need to punish him for doing wrong. What a man!

Further respect for this virtuous man is gained when he graciously and generously extends a welcome to Antony to address the crowd. He asks the multitude to be courteous and to not depart. They should give him an opportunity to speak.

This generosity was probably Brutus' greatest faux pas because when Antony stands at the pulpit, he delivers such a rousing speech that the crowd becomes rebellious and turns against the conspirators. All the good in Brutus' speech is forgotten.

How did westward expansion change the world?

American westward expansion changed the world in several ways. Of course, it permanently altered the lives of the millions of Native Americans who lived in the West, but it also had major geopolitical implications. For example, the expansionist ambitions of the American colonies were a major cause of the French and Indian War, which in turn gave rise to the Seven Years' War, a massive conflict with major implications. The importance of the port city of New Orleans to westward expansion played a major role in diplomatic maneuvering between the United States, Spain, and France in the period following the American Revolution. This situation was resolved with the conclusion of the Louisiana Purchase. In the 1840s, westward expansion led to war with Mexico, which lost a vast swath of its territory to the United States in the Treaty of Guadalupe Hidalgo in 1848. In the late nineteenth century, westward expansion had two major effects. First, the west became a destination for millions of immigrants, both from the eastern United States and the rest of the world--from China to Ireland. Second, westward expansion increased the strategic and commercial role of the United States in the Pacific, a development that contributed to American imperialism in the late nineteenth and early twentieth centuries. Conflict between the United States and Japan over influence in the Pacific would erupt in war between the two nations in the 1941. Overall, westward expansion was a major factor in the emergence of the United States as a major world power by the end of the nineteenth century.

How does the play Antigone portray divine law vs. civic law?

The conflict between divine law and civic law drives much of the plot in the tragedy Antigone. Antigone represents divine law because she has chosen to bury her brother to fulfill the requirements of the gods rather than leave him unburied in compliance with the decree of Creon, who stands for civic law. In the first scene of the play, Antigone explains to her sister Ismene that she intends to bury Polyneices, and she insists that she will be sinless in her crime. She tells Ismene she is free to obey their uncle, but in doing so she will "be guilty of dishonoring laws which the gods have stablished in honor." When Creon proclaims to the Chorus that he now possesses the throne and all its powers and intends to govern the State for the good of its people, the Chorus acknowledges that he has "power ... to take what order thou wilt, both for the dead, and for all us who live."

The two opposing laws face off when Antigone, accused of violating civic law, is brought before Creon. When Creon asks her if she has broken his law, she answers that she has because "it was not Zeus that had published me that edict," asserting that divine law trumps civic law. When Haemon comes to plead for Antigone, saying the people do not want her to be put to death, Creon insists that as the ruler, he has the right to dictate the laws to the city; the people do not have the right to tell him what to do. Creon only relents to the point of having her entombed alive rather than executed outright.

When Teiresias, the prophet, appears, he advocates for divine law in Antigone's absence. Creon accuses the prophet of acting based on greed, but the prophet informs him that his violation of divine law has loosed the Furies of Hades on him--executors of divine law. Creon quickly acts to reverse his civic law, stopping to oversee the burial of Polyneices himself on the way to the tomb to free Antigone. As he leaves, he states, "My heart misgives me, 'tis best to keep the established laws, even to life's end." This line is ambiguous; it is unclear whether the "established law" he refers to here is civic or divine and whether his misgivings come from breaking civic or divine law. 

Creon comes to revere divine law over civic law too late, for he loses both his son and his wife. In the end, the Chorus comments, "Reverence towards the gods must be inviolate. Great words of prideful men are ever punished with great blows." This final pronouncement clarifies the play's decision that divine law must be revered over civic law, as Antigone argued from the beginning. 

Where does Ralph hide, and how did Jack and his savages force Ralph out of his hiding spot?

In the last chapter of the novel, Ralph tells Samneric that he plans on hiding in a thicket next to Castle Rock. Ralph hopes that by hiding close to Castle Rock, the savages will never think to look for him and pass by him while they begin their search. While Ralph is eating the piece of meat that Samneric gave to him, he thinks about how he will crawl deep into the thicket and cover himself with creepers so that he will not be seen. The next morning, Ralph buries himself into the thicket and hears the savages searching for him. Unfortunately, Samneric give away Ralph's position and the savages roll a massive boulder in his direction. After the boulder narrowly misses Ralph, he begins to smell smoke. The savages decided to set the thicket on fire and smoke Ralph out. Ralph is forced to leave the thicket and the chase begins as Ralph runs into the forest. 

What is a hip replacement?

Indications and Procedures

The most common reason for hip replacement
surgery is the decline in efficiency of the hip joint that often results from osteoarthritis. Osteoarthritis is a common form of arthritis
that causes joint and bone deterioration, which may lead to the wearing down of cartilage and cause the underlying bones to rub against each other. This may result in severe pain
and stiffness in the affected areas. Other conditions that may lead to the need for hip replacement include rheumatoid arthritis
(a chronic inflammation of the joints), avascular necrosis (loss of bone caused by insufficient blood supply), and
injury.

Generally, physicians may be more inclined to choose less invasive techniques such as physical therapy, medication, or walking
aids before resorting to surgery. In some cases, exercise programs may help reduce hip pain. In addition, if preliminary treatment does not improve the patient’s condition, doctors may use corrective surgery that is not as invasive as hip replacement.

Typically, a candidate for total hip replacement surgery (THR) possesses a hip that has worn out from arthritis, falls, or other conditions. The hip consists of a ball-and-socket joint wherein the head of the femur (thigh bone) fits into the hip socket, or acetabulum. In a normal hip, this arrangement provides for a relatively wide range of motion. For some older adults, however, deterioration caused by arthritis and other conditions reduces the effectiveness of this arrangement, compromising the integrity of the hip socket or the femoral head. This state can lead to extreme discomfort.

Total hip replacement may provide the best long-term relief for these symptoms. Total hip replacement involves the removal of diseased bone tissue and the replacement of that tissue with prostheses (artificial devices used to replace missing body parts). Usually, both the femoral head and the hip socket are replaced. The femoral head is replaced with a metal ball that is attached to a metal stem and placed into the hollow marrow space of the femur. The hip socket is lined with a plastic socket. Other materials have also been used effectively as hip replacements.

In some cases, the surgeon will use cement to bond the artificial parts of the new hip to the bone tissue. This approach has been the traditional method of ensuring that the artificial parts hold. One problem with this method is that over time, cemented hip replacements may lose their bond with the bone tissue. This may result in the need for an additional surgery. However, a cementless hip replacement has been developed. This approach includes a prosthesis that is porous so that bone tissue may grow into the metal pores and keep the prosthesis in place.

Both procedures have strengths and weaknesses. In general, recovery time may be shorter with cemented prostheses, since one does not have to wait for bone growth to attach to the artificial prostheses. However, the potential for long-term deterioration of the replaced hip must be considered. A cemented hip generally lasts about fifteen years. With this in mind, physicians may be more likely to use a cemented prosthesis for patients over the age of seventy. Cementless hip replacement may be more advisable for younger and more active patients. Some physicians have used a combination of approaches, known as a “hybrid” or “mixed” hip. This combination relies on an uncemented socket and a cemented femoral head.

Uses and Complications

Total hip replacements are generally quite successful, with about 98 percent of surgeries proceeding without serious complications. In rare instances, however, complications occur, including blood clots and infections during surgery and hip dislocation or bone fracture after surgery. In addition, in some cases, bone grafts may be used to assist in the restoration of bone defects. In these instances, bone may be obtained from the pelvis or the discarded head of the femur. Other postoperative complications may include some pain and stiffness.

Patients recovering from total hip replacement usually remain in the hospital up to ten days if there are no complications. However, physical therapists may initiate therapy as soon as the day after surgery. Physical therapy involves the use of exercises that will improve recovery. Many patients are able to sit on the edge of their bed, stand, and even walk with assistance as early as two days after surgery. Patients must remember that their artificial hip may not provide the same full range of motion as an undiseased hip. Physical therapists teach patients how to perform daily activities without placing an undue burden on their new hips. This may require learning a new method of sitting, standing, and performing other activities.

While many factors may affect recovery time, full recovery from surgery may take up to six months. At that point, many patients enjoy such activities as walking and swimming. Doctors and physical therapists may discourage patients from participating in such high-impact activities as jogging or playing tennis, which may burden the new hip. Despite these restrictions, many patients are able to perform normal activities without pain and discomfort. Nonetheless, people who have undergone hip replacement surgery are advised to consult with their doctors about proper exercise and activity levels.

Perspective and Prospects

Total hip replacement is one of the most common surgical interventions that older adults face. The American Academy of Orthopedic Surgeons estimates that more than 285,000 hip replacement surgeries are performed in the United States each year. The majority of hip replacements are performed on individuals over the age of sixty-five. One of the reasons for this is that the activity level of older adults is lower than that of younger adults, therefore reducing the concern that the new hip will wear out or fail. However, technological advances have improved the quality of the artificial hip, making hip replacement surgery a more likely intervention for younger adults as well.

Bibliography

A.D.A.M. Medical Encyclopedia. "Hip Joint Replacement." MedlinePlus, June 22, 2012.

Bucholz, Robert, and Joseph A. Buckwalter. “Orthopedic Surgery.” Journal of the American Medical Association 275, no. 23 (June 19, 1996).

Duffey, Timothy P., Elliott Hershman, Richard A. Sanders, and Lori D. Talarico. “Investigating the Subtle and Obvious Causes of Hip Pain.” Patient Care 31, no. 18 (November 15, 1997)..

Dunkin, Mary Anne. “Hip Replacement Surgery.” Arthritis Today 12, no. 2 (March/April, 1998).

Finerman, Gerald A. M., et al., eds. Total Hip Arthroplasty Outcomes. New York: Churchill Livingstone, 1998.

Kellicker, Patricia Griffin. "Hip Replacement." Health Library, May 6, 2013.

Lane, Nancy E., and Daniel J. Wallace. All About Osteoarthritis: The Definitive Resource for Arthritis Patients and Their Families. New York: Oxford University Press, 2002.

MacWilliam, Cynthia H., Marianne U. Yood, James J. Verner, Bruce D. McCarthy, and Richard E. Ward. “Patient-Related Risk Factors That Predict Poor Outcome After Total Hip Replacement.” Health Services Research 31, no. 5 (December, 1996).

Morrey, Bernard, ed. Joint Replacement Arthroplasty. 3d ed. Philadelphia: Churchill Livingstone/Elsevier, 2003.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. "Hip Replacement." National Institutes of Health, April 2012.

OrthoInfo. "Total Hip Replacement." American Academy of Orthopaedic Surgeons, December 2011.

Silber, Irwin. A Patient’s Guide to Knee and Hip Replacement: Everything You Need to Know. New York: Simon & Schuster, 1999.

Trahair, Richard C. S. All About Hip Replacement: A Patient’s Guide. New York: Oxford University Press, 1999.

Van De Graaff, Kent M., and Stuart Ira Fox. Concepts of Human Anatomy and Physiology. 5th ed. Dubuque: Iowa: Wm. C. Brown, 2000.

A solution with a hydrogen ion concentration of 1.00 x 10E-3 M would have what hydroxide ion concentration? a 1.00 x 10E3 M b 1.00 x...

Choose a Formula

The relationship between the concentration of hydrogen ions (`~H^+` ) and hydroxide ions (`~OH^-` ) is given by the following formula:

    [`~H^+` ][`OH^-` ] = 1.0 x `~10^-^14` ` `

The square brackets in the formula stand for "the concentration of"

1.0 x `~10^-^14`  is the ionization constant for water (`~K_w` )

Solve for the Hydroxide Concentration

We can rearrange the above formula to isolate the hydroxide ion [`~OH^-` ]. To rearrange the formula, divide both sides of the formula by [`~H^+` ]:

    [`~OH^-` ] = 1 x `~10^-^14`/[`~H^+` ]

Now, we can plug in the given value for the [`~H^+` ] and solve for [`~OH^-` ]:

   [`OH^-` ] = 1 x `~10^-^14`/1 x `~10^-^3`  

                = 1 x `~10^-^11`  M

So, the answer would be b.

What is Atticus' "Golden Rule"?

Atticus is a morally upright individual who shares numerous life lessons with his daughter, Scout, throughout the novel. There are several significant rules that Atticus lives by which could be considered "Golden." In my opinion, Atticus' "Golden Rule" is, follow your conscience and do the right thing, even if it means disagreeing with other people. In Chapter 11, Atticus has a conversation with Scout, and she tells him that he must be wrong for defending Tom Robinson because the entire community disagrees with him. Atticus says, "The one thing that doesn't abide by majority rule is a person's conscience" (Lee 140). Atticus is essentially telling his daughter that despite what others say about him, the most important thing is to follow his conscience. Atticus believes in justice and equality, which is why he chooses to defend Tom. Maycomb's prejudiced community opposes Atticus' decision simply because Tom Robinson is an African American. Atticus goes on to tell Scout that he couldn't live with himself if he didn't try his best to prove that Tom is innocent. Scout learns from Atticus to be true to herself and to always do the right thing, even if it means disagreeing with popular opinions.

How can people with virtues fall prey to human instincts?

First of all, we must note that we cannot prove that any answer to this question is objectively true.  We cannot do experiments to find out what would cause “people with virtues” to lose those virtues and “fall prey to human instincts.”  In addition, we would have a very hard time identifying which people are “people with virtues” and we would have a very hard time defining what it means to “fall prey to human instincts.”  For example, let us say that a man has never been violent in his life.  Does that mean he has virtues or does it mean he has not been put in situations where he needed to be violent?  Then let us say he does something violent for the first time.  In what circumstances will we say he has “fallen prey to human instincts?”  If he is violent to protect someone else, is that human instinct or virtue?  In short, it is not possible to answer this question in a scientific way.

When we do answer this question, we also have to realize that people might disagree on the answer.  A religious person, for example, might say that the person has been tempted by Satan.  Meanwhile, a non-religious person, or a person from a different religious tradition, might disagree.  My own view is that our human nature causes every person to act, at least sometimes, according to instinct and not to virtue.

It seems clear to me that our human nature prevents us from being perfectly virtuous.  We human beings feel urges at almost all times that are not virtuous.  We feel greed, anger, lust, and other things that most people say are not virtuous.  In order to always be virtuous, we would have to suppress those feelings successfully 100% of the time.  This is surely impossible.  Even if we normally suppress our instincts almost all the time, there will be times when we do not. 

When will those times be?  I would argue that they will be A) when temptation is greatest and/or B) when our ability to control ourselves is low.  So, when might a person “fall prey to human instincts?”  They might do this when there is a great temptation.  Let us say you are a fundamentally honest person but you are suddenly presented with a chance to take $1 million that does not belong to you without much risk of being caught.  Let us say that you are usually not violent, but someone has said terrible things to you and spit on your shoes.  At times like these, the temptation to give in to our instincts might overwhelm our ability to suppress them.  Humans might also give in to temptation when they are at a weak point in their lives.  Let us say that we are under great stress because of our job or our family life.  Let us say that we are very tired.  At times like these, we might lack the strength to resist temptation and we might give in to our human instincts.

My own view, then, is that a virtuous person can fall prey to their human instincts if the temptation is strong enough and/or if they are in a situation where they are not as strong as usual.  However, this is not an answer that can be proven scientifically and other people might disagree with it.

Describe at least 2 scenes from "Fahrenheit 451", which feature fire and use them to explain what/fire/flames symbolize in the novel. How has the...

Two scenes from Ray Bradbury’s "Fahrenheit 451" that feature fire are:

1. The opening scene in Part One of the novel

This first part of the novel is entitled “The Hearth and the Salamander”. In this opening scene in Part One, Montag, the story’s protagonist, is engaged, with his other team members (firemen), in the burning down of a house. The owner is being punished by the totalitarian government because books were found in the house. Books are banned in this futuristic society. As a result, when banned books are found at a residence, firemen are dispatched to destroy the house and the books contained therein.

The fire/flames in this opening scene symbolize the power of the totalitarian government to do whatever it desires in response to illegal activities by certain citizens. These destructive flames symbolize that the government has complete power. The fire symbolizes that the government will not tolerate dissent; that the government will forcefully enforce its edicts.

2. The scene where the woman ignites her own home

In addition, in Part one of the novel, the firemen arrive at a house where a woman lives. She has been found to have books in her house as well. She refuses to leave her home and says, “You can’t ever have my books.” She resists all attempts to get her to leave the house before it is incinerated to the ground. She stands her ground and pulls out an ordinary kitchen match. She’s not afraid to stand up for her beliefs. She is willing to die for her beliefs – in fact, willing to become a martyr for her cause.

The fire/flames in this scene symbolize the courage of those who are willing to fight for what they believe in. The fire that results from the woman scraping the kitchen match on the porch railing, and igniting the trail of kerosene leading up to her porch, symbolizes righteous opposition to a decadent and immoral government.

The meaning of fire has changed in this story in that fire was once looked upon as something to quench. Now, under this totalitarian government, fire is looked upon as something to start. This government, in this oppressed society, sees fire as a cleansing tool. It uses fire to clean up neighborhoods that have homes where books are found – they simple destroy these homes. If need be, the government also engages in cleansing society of undesirables - people who oppose the government’s laws.

What are speech disorders?

Causes and Symptoms

Learning to speak correctly is of great importance to all people. It involves the brain-coordinated use of the mouth, jaws, lips, and tongue, as well as of the vocal cords, lungs, and diaphragm. On average, children learn to talk during their second year by imitating the speech of those persons, mostly family members, with whom frequent and close contact is maintained. Hence, it is important that young children hear correct speech.

The development of speech is viewed as occurring in several distinct stages. First, babies make involuntary noises in response to physical stimuli. Then, they begin to enjoy making these noises at about two months of age. Next, about nine months after birth, they start to imitate the sounds and inflections of the speech of others around them. Beginning at twelve to eighteen months of age, children start to vocalize in a meaningful way, and in due time, they learn to speak.

In many cases, however, a child is quickly found to have some difficulties with the use of speech or with its development to levels viewed as appropriate within expected time spans. Such children suffer from speech disorders including
stuttering,
lisping, and lack of speech comprehension. They should receive appropriate professional help as soon as possible. Others are born with physical problems, such as cleft palate, which make appropriate speech impossible without medical intervention. Smaller numbers of people develop speech disorders later in life for various reasons, including accidents that damage the brain or the mechanical organs of speech, as well as the physical and mental ravages of advanced age.

Speech disorders fall into three main categories: problems associated with speech production, difficulties of articulation, and dysfunction in the ability to utilize language. These disorders have been known since antiquity and although they are frequently hereditary, the genetic cause is often unclear. In fact, there is often a psychogenic aspect to their origin as well.

Another broad means of categorizing speech disorders is by dividing them into causative organic and nonorganic groups. The term “organic speech disorder” is used to indicate
birth defects or later injuries to the brain or the structures, muscles, and connective tissues that are required to produce speech. The disorders for which no such origin can be clearly identified with existing techniques fall into the nonorganic group. Usually, they are attributed solely to psychogenic factors. It is probable, however, that they have subtle organic causes that are beyond present methods of identification.

Speech disorders may be associated with articulation, voice, fluency, language, and dementia. The cures for all these types of speech disorders vary; they include the interactive participation of teachers in school systems and the attention of speech professionals such as speech-language pathologists, audiologists, surgeons, psychiatrists, and physical therapists. Each case must be analyzed carefully and then treated individually. Even so, varied success is obtained from patient to patient, regardless of the disorder, the nature of the therapeutic procedures utilized, and the therapists who are involved.

Articulation disorders are attributable to the inappropriate sequential movement of the jaw, tongue, and related speech structures. Minor, nonpathological differences result in regional differences (accents) in the spoken language within a country. Pathological problems that cause speech that cannot be understood are most often organic in nature. Examples include
cleft palate and neurologic dysfunction. Voice disorders include inappropriate pitch, sound quality (for example, hoarseness), lack of audibility, or inappropriate loudness. Fluency disorders are most often identified with stuttering, speech rate problems, and speech rhythm problems. The best-known language disorders are the aphasias, which are characterized by poor language comprehension and childhood language impairment (often resulting from developmental problems). Dementia can impair speech at any age, but it is most common in the elderly, for whom memory, language, and
cognitive ability may be greatly impaired.

Treatment and Therapy

Many viewpoints exist concerning the treatment of speech disorders. All agree, however, that interaction between family, patient, teachers, and various clinicians is essential. Disorders of articulation are quite common and range from mild problems (for example, a lisp) to those that are so extreme that the speech of afflicted individuals becomes unintelligible. Many of the most severe of these speech disorders arise from the organic impairment of motor control in the speech musculature, which may be attributable to stroke, cleft palate, or even the loss of lips or other speech system components.

Frequently, efforts at remediating such problems must include surgical and dental treatment. After any necessary corrective surgery and/or dentistry, many treatment regimens focus on behavior modification. Affected individuals receive instruction regarding the physical basis of their problems and are then trained to overcome them as effectively as possible.

In many cases, the use of psychological and psychiatric counseling is considered to be of great value. Some experts suggest, however, that the main effect of such therapy is to enable afflicted individuals to live comfortably with the imperfections in articulation that remain after all treatments are tried.

Voice disorders occur when the phonatory mechanism is dysfunctional. They range from the consequences of laryngeal, oral, or respiratory disease to the misuse of the phonatory system, which may reflect psychological state. Such functional disorders, if left untreated for too long, may lead to organic damage. In the case of pitch abnormalities, causative factors may include psychological tension, an undersized larynx, misformed vocal cords, and hearing problems, either individually or in various combinations.

Disorders of voice quality likewise have many physical sources, including larynx and vocal cord abnormalities, and ones of psychogenic origin. The disorders associated with loudness range from overly loud voices caused by workplace noise or hearing loss to extremely soft ones that are generally psychogenic. Treatment of all such disorders begins with the disqualification of treatable organic problems. In the case of psychogenic disorders, psychiatric counseling can be extremely helpful. Psychological and medical treatments must be followed, however, by very thorough interaction with speech-language pathologists if optimum results are to be obtained.

Disorders of fluency most often involve stuttering, also called dysfluency, which features spasmodic hesitation and the prolongation or repetition of sounds. In addition,
stuttering is often accompanied by
tics and other uncontrolled body movements. The basis for the problem is unclear, and different experts point to learned behavior, psychogenic origins, or organic roots. There is no cure for dysfluency, but it (and the accompanying nonspeech problems) can be greatly diminished. Treatment usually involves both psychiatric counseling and behavior and/or speech modification by speech-language pathologists as well as by other related speech professionals. Such therapy varies widely from individual to individual and with the age of the patient.

Language disorders are characterized by the diminished ability to use or to understand spoken language. In children, these disorders are often identified as language delay or development aphasias. They are most often thought to be attributable to developmental disabilities,
hearing loss, or
autism. When lost hearing is not the main problem, the treatments for such language problems often involve behavior modification techniques. In all cases in which hearing loss is an important component, its correction is the first effort; such efforts may work wonders. When hearing problems cannot be remediated entirely, however, the overall treatment will be much less successful because hearing the speech of others is so important to speech development.

True aphasia is very often viewed as speech impairment; it occurs in adults as a result of stroke, accidents that produce severe head trauma, or dementia. It is desirable to begin treatment of afflicted persons as soon as possible after aphasia is observed. Some rapid and spontaneous healing of lost language ability occurs, and this healing can be maximized by the efforts of speech-language pathologists. The continued treatment of aphasias is very important and usually follows careful evaluation of its causes. It is often possible to make progressive, long-term advances in healing aphasias. Complete recovery is rare, however, and the use of sign language or personal computers for interpersonal communication may be necessary.

Perspective and Prospects

For many years, it was thought that speech disorders were caused only by insoluble psychological problems in the very young or by severe head, facial, and brain trauma later in life. It is now clear that they have other causes, ranging from hearing loss to dementia. Furthermore, it is currently understood that speech problems of every type can attack anyone—young children, adolescents, and adults of all ages.

These problems often have disastrous psychological and economic effects on the afflicted person. Young children may be traumatized if speech disorders are not treated early; in severe cases, they may later be unable to enter the workforce in meaningful positions or to receive anything above the most rudimentary education. This is unfortunate because many such problems of childhood, adolescence, and even young adulthood can be almost completely solved by careful medical examination, followed quickly by appropriate corrective action.

There is also help available for older people who develop speech problems because of aging, dementia, or harmful workplace conditions. In all cases, once a sound treatment plan is developed, it is essential that the afflicted person follow it rigorously. Miracles should not be expected; rather, sustained interaction between the treatment team—especially the patient and a speech-language pathologist—must be undertaken. Furthermore, the psychological support of the patient’s family and friends has been recognized as a crucial factor in many successful treatment plans.

In the case of the young child, the diagnosis of speech problems by schoolteachers can be another important means to treatment. Once a problem is observed, the child’s family can be advised concerning

special education available through the school system or local programs. Teachers should be cautioned, however, against attempts to treat the child in question unless they have adequate training. The job of unspecialized teachers should be diagnosis and the recommendation of an appropriate treatment group. When speech disorder therapy results in less-than-adequate treatment of extremely serious problems, the use of sign language, special typewriters, and computer-assisted communication, as well as psychotherapy, should be considered.

Overall, the treatment of speech problems has improved, and its sensible application can enable patients to enter into or return to the workforce at levels commensurate with their abilities, can prevent them from becoming maladjusted, and can enrich society as a whole. Dealing with such problems in the young is particularly important because it may help to prevent neuroses and psychoses from developing. It is hoped that ongoing research will continue to increase the avenues available for the prevention and cure of speech disorders, to identify additional methods for treating them, and to result in their eradication.

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, Va.: Author, 2013.

Beers, Mark H., et al., eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, N.J.: Merck Research Laboratories, 2006.

Cole, Patricia R. Language Disorders in Preschool Children. Englewood Cliffs, N.J.: Prentice Hall, 1982.

Gelfand, Stanley A. Essentials of Audiology. 3d ed. New York: Thieme, 2009.

Lubinski, Rosemary, and Carol M. Frattali, eds. Professional Issues in Speech-Language Pathology and Audiology. 4th ed. San Diego, Calif.: Thomson/Delmar Learning, 2013.

Paul, Rhea. Language Disorders from Infancy Through Adolescence: Assessment and Interventions. 3d ed. St. Louis, Mo.: Mosby/Elsevier, 2007.

"Speech and Communication Disorders." MedlinePlus, May 7, 2013.

"Voice, Speech, and Language." National Institute on Deafness and Other Communication Disorders, May 13, 2011.

Winitz, Harris, ed. Human Communication and Its Disorders: A Review. Vol. 4. Timonium, Md.: York Press, 1995.

Zieve, David, and Neil K. Kaneshiro. "Speech Disorders – Children." MedlinePlus, June 12, 2012.

What did Mae hit the stranger with in Tuck Everlasting?

Mae hit the man in the yellow suit in the head with the shotgun.

The man in the yellow suit is looking for the spring that made the Tucks immortal.  He heard the story passed down through his family, and he believes it.  When he hears the music box in the woods, he is convinced that it is real. 

The man meets Winnie outside her house, and he sees her being carried away by the Tucks.  She is therefore really worried about him finding her.  She does not want her new friends to be found out.

"He knows me, though," said Winnie. She had forgotten, too, about the man in the yellow suit, and now, thinking of him, she felt a surge of relief. "He'll tell my father he saw me."

"He knows you?" said Mae, her frown deepening. "But you didn't call out to him, child. Why not?" (Ch. 11) 

Mae Tuck is very nervous.  She is not a violent person, but she has tried so hard not to let anyone find out about her secret.  The man in the yellow suit does not seem well-intentioned.  Mae is concerned about what he will do know that he has found the Tucks.  He tells them that the Fosters gave him the woods, and he is to bring Winnie home. 

Things take an ugly turn when the man in the yellow suit threatens Winnie.  He tells the Tucks she will drink from the spring water and be his demonstration.  This horrifies Mae, and she acts.  She hits him in the head with a shotgun. 

With a dull cracking sound, the stock of the shotgun smashed into the back of his skull. He dropped like a tree, his face surprised, his eyes wide open. And at that very moment, riding through the pine trees just in time to see it all, came the Treegap constable. (Ch. 19) 

Unfortunately, she seems to have hit him hard.  As far as the constable is concerned, it was murder.  They will try Mae, and then she will be hanged.  This is terrible enough, but Mae cannot die so hanging her will give away the family secret.

How do Chris McCandless' writings relate to Ralph Waldo Emerson?

In his essay "Self Reliance," Emerson tells his readers to trust themselves and to look into their own hearts and souls to find their unique destinies. For Emerson, self-reliance was the opposite of conformity. It meant finding the path that God meant for you to follow when you were born. If this put you at odds with societal norms, that was fine: none of us will have peace of mind until we follow the path we were meant to pursue:

Trust thyself: every heart vibrates to that iron string. Accept the place the divine providence has found for you ... Great men have always done so ... And we are now men... obeying the Almighty effort, and advancing on Chaos and the Dark.

Chris McCandless takes this advice to heart. He trusts himself and follows his own path. After graduating from college, he gives an inheritance that was meant to pay for law school to Oxfam, hits the road, burns his money and gets rid of his car. He wants to own as few material goods as possible as he goes in quest of his own destiny. He writes about this to an older friend named Ron who he meets on the road, advising him to do the same. Chris echoes Emerson in telling Ron to break away from a life of security and conformity:  

I think you really should make a radical change in your lifestyle and begin to boldly do things which you may previously never have thought of doing, or been too hesitant to attempt. So many people live within unhappy circumstances and yet will not take the initiative to change their situation because they are conditioned to a life of security, conformity, and conservatism, all of which may appear to give one peace of mind, but in reality nothing is more damaging to the adventurous spirit within a man than a secure future. The very basic core of a man's living spirit is his passion for adventure. The joy of life comes from our encounters with new experiences, and hence there is no greater joy than to have an endlessly changing horizon, for each day to have a new and different sun. 

What is torticollis?

Causes and Symptoms

Torticollis occurs equally in the sexes and may develop in childhood or adulthood. Its causes are unknown, but some cases seem to be genetic, while others are acquired from secondary damage to the nerves affecting the head or neck muscles. Congenital torticollis may be caused at birth by malpositioning of the head in the uterus or by prenatal injury of the muscles or blood supply in the neck. Torticollis results from abnormal functioning of the basal ganglia, situated at the base of the brain, which control all coordinated movements.

The first symptoms may appear gradually as the head tends to rotate or turn to one side involuntarily. Other symptoms may involve asymmetry of an infant’s head from sleeping on the affected side, enlargement or stiffness of the neck muscles, limited range of head motion, neck pain, and even headaches.

Treatment and Therapy

Because the cause of torticollis is unknown in most cases, presently no certain cure exists. Drug therapy is frequently employed, but these medications often produce only unpredictable, short-term benefits. Some patients experience relief when treated by physiotherapists, who may use local moist heat, ice, ultrasonography, or a custom-fitted soft collar. Surgery is not recommended as an initial treatment, but it has proven helpful in cases unresponsive to medication.

Perspective and Prospects

Torticollis is easiest to correct in infants and children and in adults who receive early treatment. With chronic conditions, tingling and numbness may develop as nerve roots in the cervical spine become depressed. Recent innovative surgical procedures are helpful, but they are not a complete cure for chronic spasmodic torticollis. Patients with long-term torticollis will probably retain some degree of head tilt or rotation.

Bibliography:

American Medical Association. American Medical Association Family Medical Guide. 4th rev. ed. Hoboken, N.J.: John Wiley & Sons, 2004.

"Dystonias Fact Sheet." National Institute of Neurological Disorders and Stroke, February 21, 2013.

Litin, Scott C., ed. Mayo Clinic Family Health Book. 4th ed. New York: HarperResource, 2009.

Moore, Keith L., and Arthur F. Dalley II. Clinically Oriented Anatomy. 6th ed. Philadelphia: Kluwer/Lippincott Williams & Wilkins, 2010.

Nagler, Willibald. “Rehabilitating a Stiff Neck.” Family Practice News 36, no. 3 (February 1, 2006): 38.

Noback, Charles R., et al. The Human Nervous System: Structure and Function. 6th ed. Totowa, N.J.: Humana Press, 2005.

Pathak, Mayank, Karen Frei, and Daniel Truong. The Spasmodic Torticollis Handbook: A Guide to Treatment and Rehabilitation. New York: Demos Health, 2003.

Savitsky, Diane. "Torticollis." Health Library, November 26, 2012.

Tomczak, Kinga K., and N. Paul Rosman. "Torticollis." Journal of Child Neurology 28, no. 3 (March 2013): 365–78.

Why would it be much worse for the community to release Jonas instead of let him run away in Lois Lowry's The Giver?

If Jonas was released, the memories would all immediately flow back into the community. When he runs away, the memories trickle in as he gets farther away. We can tell this because Jonas has increasing difficulty accessing memories the farther he gets from the community. 

The Giver explains to Jonas that the memories a Receiver has will return to the community if the Receiver is lost. 

The Giver was quiet for a moment, obviously thinking. "You know," he said, finally, "if they lost you, with all the training you've had now, they'd have all those memories again themselves" (Chapter 18).

When Rosemary committed suicide, the community had to receive her memories. They were almost all positive, but it was still a very confusing and difficult time for them. The Giver was there to help them through it, though, because Rosemary was only in training. The Giver tells Jonas that he has many more memories, so things would be much more difficult for the community if he was to die. This is why the Giver tells Jonas to stay away from the river. 

After Jonas finds out what release means from watching the video of his father release the newborn twin, he and The Giver make a plan for Jonas to escape and for The Giver to help the community with the memories they will receive. 

If I go with you, and together we take away all their protection from the memories, Jonas, the community will be left with no one to help them. They'll be thrown into chaos. They'll destroy themselves (Chapter 20). 

Jonas and The Giver develop a complicated plan for Jonas to escape on Ceremony Day, when no one will look as hard for him. By the time Jonas is away, The Giver will be able to address the entire community and help them “change and become whole.” 

Their attention would turn to the overwhelming task of bearing the memories themselves. The Giver would help them (Chapter 20). 

Jonas has to flee early when he finds out Gabe is about to be released. He takes Gabe with him and leaves without saying good-bye. He knows if he is found he will have broken enough rules to be released, so it is very important that they make it away from the community. 

Since Jonas has to leave unexpectedly, he did not get all the memories of strength from The Giver. Also, the farther he gets from the community, the less he can rely on the memories he has because they are being returned to the community. 

Sometimes, urging the memories into Gabriel, Jonas felt that they were more shallow, a little weaker than they had been. It was what he had hoped, and what he and The Giver had planned: that as he moved away from the community, he would shed the memories and leave them behind for the people (Chapter 21).

The escape is successful in that Jonas and Gabe get away.  They have to go through rougher and rougher terrain, and finally reach Elsewhere. Since the ending of the book is ambiguous, it is unclear whether they pass out and die or are rescued. Either way, they are no longer in the community and the memories are back with the people.

Which of the following is a pure substance? soda gasoline salt water carbon dioxide

A pure substance is one which contains molecules of just a single type. If a substance contains molecules of 2 or more kinds, then it is a mixture. Among the given options, only carbon dioxide is a pure substance. Carbon dioxide consists of only one type of molecule: CO2, formed by the combination of carbon and oxygen atoms in a 1:2 ratio. The other options consist of more than one types of molecule. Gasoline, for example, is a mixture consisting of isooctane, butane, MTBE, and others. Soda and salt water are also mixtures.  

Elements are the purest form of substances, since they contain atoms of only 1 type (excluding the isotopes). Some examples of elements include iron, aluminum, etc. Carbon dioxide, water, etc. are compounds and are made up of two or more elements, combined in a fixed ratio.

Hope this helps. 

What is the relationship between aging and infectious disease?

Definition

The elderly population, which includes persons who are sixty-five years of age or older, makes up about 13 percent of the total population of the United States and is expected to grow to about 20 percent of all Americans by the year 2030. Infectious diseases are the cause of one-third of all deaths in the elderly. The most common infectious diseases among older people can be categorized as follows: urinary tract infections (UTIs), respiratory tract infections (RTIs), skin and soft tissue infections (SSTIs), and gastrointestinal tract infections (GTIs).

Risk Factors, Etiology, and Pathogenesis

As a person ages, his or her immune system weakens and becomes less effective (immunosenescence). Studies have shown that increasing age is associated with a decline in the number of (or with functional alterations in) CD8+ cells, naive T cells, and B cells, all of which are involved in fighting infections. Other causes may include the impact of other diseases (comorbidities) and a decline in bodily functions. Malnutrition may also play a role, as approximately 10 to 25 percent of elderly persons have nutritional deficiencies and up to 50 percent of the elderly who are hospitalized have some kind of caloric or micronutrient deficiency. Malnutrition is a risk factor for infection, and infection can lead to malnutrition, particularly in the geriatric population.

UTIs are the most common infection in the elderly. Although urine is normally sterile, older persons are more likely to have bacteria in their urine (bacteriuria), with a prevalence of 15 to 30 percent in men and 25 to 50 percent in women. Factors contributing to this increased bacterial colonization include reduction in bladder capacity, decreased urinary flow, incomplete voiding, prostatic disease in men, and prolapsed bladder and lower estrogen levels in women.

An indwelling urinary catheter, common among institutionalized and elderly persons, is another risk factor for UTIs, as catheters contain stagnant urine in a warm environment, which promotes the growth of microorganisms. Thinning of the urinary epithelium also contributes to increased bacterial colonization, particularly in women, as does a higher vaginal pH and deficiencies in vaginal and periurethral antibodies that occur with age. Regular urination and strong urinary flow are protective against infectious bacteria, but the aging bladder is less able to sense the need to void. Urinary flow rates are slower in the elderly, and the elderly are more likely to experience incomplete bladder emptying.

Escherichia coli is the main pathogen responsible for UTIs in women, but about one-third of elderly persons have polymicrobial infections, which are rarely seen in younger persons. Infection with multiple organisms is more common in catheterized persons.

RTIs such as pneumonia and influenza are
the second-most common infections in the elderly. Older people are at increased
risk relative to younger people because they frequently have deficiencies in
protective airway reflexes (such as coughing) and mucus clearance. Decreased
elasticity of the alveoli (air sacs in the lung), poorer lung capacity, smoking,
and preexisting conditions such as chronic obstructive pulmonary disease
(COPD) and congestive heart failure are also common risk
factors for lung infections. The elderly are also more prone to active
tuberculosis
(TB) infections. Latent (inactive) TB is prevalent in all
ages, but decreasing immune function with age can lead to the infection becoming
active.

The epithelial cells of the skin, bladder, bronchus, and digestive system form a physical barrier to
bacteria, fungi, and viruses that may become compromised with age. For example,
the skin becomes thinner, dryer, and more easily breached, leading to a higher
risk of skin infections. Skin also loses collagen over time, affecting the
ability to resist trauma. Epidermal renewal time (the time it takes the body to
make all new skin cells) increases from twenty days in younger adults to thirty
days in older people, delaying wound healing and making wounds more likely to be
colonized by microorganisms. Cellulitis, a bacterial infection often
seen in the legs, is much more common in the elderly, especially those with
diabetes. Shingles are caused by the reactivation of the varicella
zoster virus (chickenpox), which is dormant after the initial infection (usually
in childhood) but can flare up in old age.

GTIs, including gastroenteritis and colitis, are also more common in older adults. Predisposing factors include pH changes in the stomach, decreased intestinal movement, and changes in the composition of the gut bacteria. The risk of gastrointestinal infections is also affected by the presence of Helicobacter pylori , which is found in 40 to 70 percent of elderly people. H. pylori causes chronic gastritis in about one-third of those infected, which can lead to lower acid levels in the stomach and a higher risk of infections from other pathogens. Treatment with antibiotics and proton pump inhibitors can change the composition of the stomach’s normal bacteria, which can lead to susceptibility to infectious organisms such as Clostridium difficile.

Other factors that increase the risk of infectious diseases among the elderly
include a higher likelihood of being bedridden, which increases the risk of
pressure ulcers and subsequent skin infections, and more frequent
institutionalization and hospitalization, which increase the risk of nosocomial
(hospital-acquired) infections and higher exposure to pathogens in confined
settings. In addition, older people are more likely to have comorbid conditions
such as diabetes, cancer, and heart disease; both the diseases and their
treatments (for example, chemotherapy) can weaken the immune system and lead to a
higher risk for infections.

Symptoms

Older people often do not have the same symptoms associated with infections that younger people do. For example, the classic symptoms of infection include fever, inflammation, pain, chills, and vomiting. However, elderly people with infections often have nonspecific symptoms such as delirium, confusion, fatigue, loss of appetite, decline in function, mental status changes, incontinence, falls, or subnormal temperature. This atypical presentation can potentially lead to a delay in diagnosis and treatment, especially because the same symptoms are also present in noninfectious diseases in the elderly. The average body temperature for older adults is often lower too, meaning that if a baseline temperature is unknown, a fever may be missed. In an institutional setting, cognitive comorbidities increase the risk of a missed infection. For example, about one-half of nursing home residents have dementia and are unable to describe symptoms at all.

UTIs generally cause symptoms such as an urgent need to urinate, increased frequency of urination, and pain. Fever may also be present. However, these symptoms may be hidden by preexisting incontinence. In some cases, delirium, confusion, and rapid functional decline are the main symptoms of a UTI, and these infections may even manifest with respiratory symptoms such as cough or shortness of breath. Diagnosis relies on symptoms, urinalysis, and urine culture, although elderly persons with symptomatic UTIs may have lower bacterial counts than younger persons: Although 105 or more colony-forming units (CFU) per milliliter (mL) of urine is the standard definition, bacterial counts in the elderly may be only 102 to 103 CFU/mL.

RTIs can affect the nose, throat, airways, and lungs and are typically associated with cough, fever, weakness, sore throat, irritability, difficulty breathing, and aches and pains. Often, any type of RTI is attributed to the flu, because the different types of infections are difficult to distinguish; other types of infections have not been studied as thoroughly. In persons with COPD, even a simple cold can cause an acute exacerbation, leading to hospitalization and even death.

SSTIs such as cellulitis generally present with redness, warmth, and swelling.
The primary symptom associated with shingles is pain, and even after the infection
clears, persons frequently experience postherpetic neuralgia, or nerve pain,
which can last up to one year or longer.

GTIs are typically associated with gastrointestinal pain, diarrhea, fever, cramping, nausea, and vomiting. Diarrhea may be bloody in the case of E. coli infections but typically is not bloody among persons infected with C. difficile. As with other infectious diseases, GTIs may be hard to distinguish from other conditions in the elderly, including incontinence, irritable bowel, or medication-induced diarrhea. Initial infection with H. pylori is associated with nausea, upper abdominal pain, vomiting, and fever lasting anywhere from three days to two weeks; after the original infection subsides, the bacteria tend to colonize the gastrointestinal tract, triggering subsequent gastritis episodes, unless treated.

Prevention and Treatment

UTIs may be prevented through personal hygiene, avoidance of catheterization wherever possible, and possibly certain nutritional approaches such as cranberry juice. Although asymptomatic bacteriuria is very common, the guidelines of the Infectious Diseases Society of America do not recommend screening for or treating the condition because of a lack of proof that doing so prevents future UTIs or reduces morbidity; in addition, overtreatment for asymptomatic infections may contribute to antibiotic resistance. In persons with symptomatic UTIs, existing catheters are removed and the infection is treated with an oral antibiotic specific to the pathogen involved. If the infection is serious, intravenous antibiotic therapy may be required. Polymicrobial infections may require a broad-spectrum antibiotic.

The most reliable ways to prevent RTIs include smoking cessation and vaccination. In addition, vigilance on the part of health care providers and caregivers is required, because symptoms can be subtle, particularly for TB. Vaccines for both pneumonia and influenza are available and recommended for all adults age sixty years and older. The United States has one of the highest rates of influenza and pneumonia vaccination in elderly persons in the world, at about 80 percent for flu and 70 percent for pneumonia, although the rate is still less than the government target of 90 percent.

Although the preventive efficacy of the influenza and pneumonia vaccines is lower in older persons, vaccination has been shown to reduce the severity of cases in terms of length of hospital stays and in terms of mortality, when they do occur. Some health care institutions are now instituting standing orders for vaccinations for the elderly, a strategy that takes the physician out of the equation and allows pharmacists, nurses, and physician assistants to provide routine vaccinations after a simple screening. Treatment for RTIs varies from simple bed rest to complex antiviral or antibiotic regimens lasting weeks.

SSTIs are best prevented through awareness and through good hygiene by both older people and their caregivers. Pressure ulcers may be prevented through regular repositioning of persons restricted to their bed, using supportive devices and surfaces, and keeping skin hydrated. Diabetics and people with poor circulation, who are at higher risk of cellulitis, can wear supportive stockings and keep the lower extremities elevated whenever possible to prevent swelling. A vaccine is approved for herpes zoster, indicated for all adults age sixty years and older, regardless of their history of zoster infection. The vaccine has been shown to be both effective and cost-effective in the elderly.

GTIs are best prevented through scrupulous personal hygiene, proper food-safety measures, and avoidance of antibiotics and proton pump inhibitors unless necessary. Institutional settings should ensure against transmission from infected persons, including visitors and staff, to healthy residents. Risk-based food-safety programs and ongoing food safety education for staff are necessary. Treatment for GTIs includes hydration and supportive care and the discontinuation of any antibiotic that may have caused the problem. Treatment with antidiarrheal agents is not recommended in infections related to C. difficile or E. coli. Oral metronidazole or vancomycin may be used to treat C. difficile infections. Alcohol-based hand sanitizers are not effective at killing C. difficile, so soap and water should be used if that is the infectious agent. Treatment regimens for H. pylori infections may include proton pump inhibitors, amoxicillin, clarithromycin, and metronidazole.

Impact

Infectious diseases are major causes of death, disability, morbidity, cost, and health-services utilization in the elderly. The infectious disease hospitalization rate in the United States increased by about 12 percent from 1998 to 2006 and is about four times higher among the elderly than among younger adults.

UTIs accounted for 13 percent of infections in 2011, according to the Multistate Point-Prevalence Survey of Health Care–Associated Infections, published in the New England Journal of Medicine. Among institutionalized elderly persons, prevalence ranges from 0.1 to 2.4 cases per 1,000 resident days, and 12 to 30 percent of residents have a minimum of one UTI every year.

RTIs such as pneumonia, influenza, and chronic bronchitis are the fourth-leading cause of death in this age group, after heart disease, cancer, and stroke. In 2012, the elderly accounted for about 35 percent of all inpatient stays in the United States, totaling close to $160 billion in costs. Pneumonia was the second-most common reason for admission in this age group (after congestive heart failure). Among those age sixty-five years and older, there were nearly 600,000 discharges costing more than $5 billion for influenza and pneumonia in 2008. COPD, which is an umbrella diagnosis that includes chronic bronchitis and emphysema and is generally related to smoking, is found in approximately 10 percent of all adults and is more common in older persons. According to a 2014 study published by Respiratory Research and another by the World Health Organization, in 2010, in the United States, COPD was the cause of 1.5 million emergency department visits, 700,000 hospitalizations, and 134,700 deaths. Most were a result of acute exacerbations of the disease, which are caused by viral, bacterial, or fungal infections in about two-thirds of cases. People age sixty-five years and older make up more than 50 percent of cases of active TB in the United States, and nursing home residents have higher infection rates than do community-dwelling older people.

Bacterial, viral, and fungal SSTIs that are common in the elderly include shingles (herpes zoster), cellulitis, pressure ulcers, scabies, and chronic fungal infections of the nails (onychomycosis). Other SSTIs that have a higher incidence in older people include necrotizing fasciitis, methicillin-resistant Staphylococcus aureus infections of the skin, and surgical site infections. In 2010, the incidence of herpes zoster is 3.25 per 1,000 person years; approximately two-thirds of people age seventy years and older have a minimum of one skin problem.

GTIs caused by H. pylori are common in elderly persons, and if left untreated, chronic infection with H. pylori can lead to gastritis, gastric ulcers, and even stomach cancer, which is the second-most frequent cause of cancer-related death worldwide. The incidence and severity of C. difficile-associated diarrhea has increased since the 1970s, when it was first identified, so that it is now endemic to hospitals and long-term care facilities. An antibiotic-resistant strain has been identified and is associated with a high rate of recurrent infection.

Bibliography

Assaad, Usama, et al. "Pneumonia Immunization in Older Adults: Review of Vaccine Effectiveness and Strategies." Clinical Interventions in Aging 7 (2012): 452–61. Print.

Castle, Steven C., et al. “Host Resistance and Immune Responses in Advanced Age.” Clinics in Geriatric Medicine 23 (2007): 463–79. Print.

Gavazzi, Gaetan, and Karl-Heinz Krause. “Ageing and Infection.” The Lancet: Infectious Diseases 2 (2002): 659–66. Print.

High, Kevin. “Immunizations in Older Adults.” Clinics in Geriatric Medicine 23 (2007): 669–85. Print.

Htwe, Tin Han, et al. “Infection in the Elderly.” Infectious Disease Clinics of North America 21 (2007): 711–43. Print.

Liang, Stephen Y., and Philip A. Mackowiak. “Infections in the Elderly.” Clinics in Geriatric Medicine 23 (2007): 441–56. Print.

Mouton, Charles P., et al. “Common Infections in Older Adults.” American Family Physician 63 (2001): 257–68. Print.

Pilotto, Alberto, and Marilisa Franceschi. "Helicobacter pylori Infection in Older People." World Journal of Gastroenterology 20.21 (2014): 6364–73. Print.

Weiss, Audrey J., and Anne Elixhauser. "Overview of Hospital Stays in the United States, 2012." Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality, Oct. 2014. PDF file.

Yoshikawa, Thomas T. “Epidemiology and Unique Aspects of Aging and Infectious Diseases.” Clinical Infectious Diseases 30 (2000): 931–33. Print.

Describe Daisy Buchanan in The Great Gatsby.

Daisy Buchanan is a very rich denizen of East Egg, the more fashionable and upscale of the two Eggs.  She is married to a man, Tom Buchanan, who also comes from "old money," meaning that he hasn't worked for it but has, instead, inherited his fortune.  She is selfish, chastising her cousin, the narrator, Nick, for not coming to her wedding (even though he'd been away fighting in the war).  She is also fairly cynical, preferring her daughter be "'a beautiful little fool'" because she thinks that the best thing for a woman to be, presumably because she won't be smart enough to be unhappy.  When "Her eyes flashed around her in a defiant way, rather like Tom's, [...] she laughed with thrilling scorn.  'Sophisticated -- God, I'm sophisticated," she says.  Nick felt in this moment that she'd "asserted her membership in a rather distinguished secret society to which she and Tom belonged."  Thus, she is spoiled and entitled and elitist as well.

By the end of the story, she's killed a woman and allowed her lover, Jay Gatsby, to take the blame for it.  Daisy abandoned Gatsby when she found out how he'd made his fortune, returning to her husband, a man she'd recently described as "'disgusting'" because he was the right kind of rich, the kind that brings status and power with it.  In the end, Nick says, "They were careless people, Tom and Daisy -- they smashed up things and creatures and then retreated back into their money or their vast carelessness [...] and let other people clean up the mess they had made. . . ."  He was right when he'd called them "'rotten'" earlier to Gatsby; they ultimately care nothing for anyone but themselves.  It is no coincidence that Gatsby, Wilson, and Myrtle all wind up dead as a result of their interactions with this terrible couple.

In the short story "Hills Like White Elephants" the woman says: "And we could have everything and every day we make it impossible." What does she...

In the biography, Hemingway: A Life Without Consequences, James R. Mellow suggests that all of Hemingway's stories had a basis in the writer's life. At the time he was writing "Hills Like White Elephants" he was having an affair with Pauline Pfeiffer and in the midst of a break-up with his first wife Hadley. Mellow writes that during their last trip together in Spain, Hemingway suspected Hadley was pregnant. This may have provided the basis for the story. If that's the case, the comment by Jig, "And we could have everything and every day we it make more impossible" may have been a direct reflection on Hemingway's idea that his life with Hadley had been idyllic but was coming to an end. They had spent Hemingway's formative years as a writer together and Hemingway dedicated his first novel to Hadley and his first son, Bumby. Hemingway also wrote fondly of their relationship in his memoir about Paris, A Moveable Feast.

In the short story, the man and Jig are verbally dancing around whether she will have an abortion or not. She is generally compliant with what he wants, even taking back her statement about the hills looking like white elephants. But, in this comment, she seems to be indicating that there is nothing left for her and the man. They could have "everything," each other and a baby, but since the man is eager for her to abort they have nothing left that can sustain the relationship. While Hemingway is ambiguous about the final decision of the woman, the reader could posit that the relationship is at an end. 

Was Athens guilty of corrupting the ideals of democracy?

The Athenians, and a few other Greek city-states, were the first ever to use a democratic form of government. In Athens, “any citizen could speak to the assembly and vote on decisions by simply holding up their hands. The majority won the day” (Athenian Democracy, the Ancient History Encyclopedia). Citizen participation was limited to males 18 years and older. Of course, that left women, foreigners and slaves without a voice. Though not all male citizens became actively involved in the politics of the day, the expectation was so extraordinarily high that the ancient historian Thucydides wrote: “We consider a citizen who does not participate in politics not only one who minds his own business but useless.” Rather than corrupt democracy, Athens, i.e., the Greeks, modeled it. 

The word democracy comes from the ancient Greek word demos (meaning the people, i.e., the whole citizen body) and katas (meaning rule). Thus, rule by, for and of the people can be attributed to the Greeks. Most references to Greek democratic rule rely on the Athenian model because it was the most advanced democracy of the Ancient Greek world, and sources describing democracy in other city-states are rare.

Freedom of speech allowed for debate on many issues concerning Ancient Athenian citizens, and all male citizens 18 and over were able to vote on 

military and financial magistracies, organizing and maintaining food supplies, initiating legislation and political trials, deciding to send envoys, deciding whether or not to sign treaties, voting to raise [tax] or spend funds, and debating military matters. The assembly could also vote to ostracize from Athens any citizen who had become too powerful and dangerous for the polis.  In this case there was a secret ballot where voters wrote a name on a piece of broken pottery (ostrakon from which the word ostracism comes).

Athenian democracy changed over time, even being replaced by an oligarchy to win Persia’s support against Sparta in the Peloponnesian War. Democracy did return to Athens after 409 B.C., but in a “slightly altered form.”  The legacy of Athen's unique democratic system are the world’s modern democracies. However, modern democratic systems have corrupted the kind of democracy practiced by the Ancient Athenians. One particular example, and there are many, of such modern corruption of democracy is the professional politician. The Athenians were not professional politicians as we see so many are today. Even though some of the wealthiest and best speakers were the most influential, profiting from participation in political life was not only frowned upon, but punished severely (see information on ostracism in the quotation above). Payment was not for services rendered, but to help cover travel expenses of citizens who lived far away. 

While pure, direct democracy is a great idea, it is unlikely direct democracy would work in today’s world. The number of male citizens in Athens ranged from 30,000 to 60,000 and their meeting place held only 6,000 people. The Athenian city-state was far smaller than many of the world’s cities today. Of the top 125 largest cities mentioned at the City Mayors Statistics website, #1 is Tokyo, Japan—33,200,000; #2 New York City, USA—17,800,000; #3 Sao Paulo, Brazil—17,000,000; and still larger than Athens at #125 Accra, Ghana— 1,500,000. 

Not all the 125 largest cities are within democratic countries, but to say modern democracies are a corruption of Athenian Democracy may be disingenuous. More appropriately, they are inspired from, molded after, and/or influenced by the unique form of government practiced by ancient Athens.

What has Jem Finch left behind in the novel? Support the answer with a quote from the text.

This question checks on your understanding of the story. The answer is that Jem leaves his pants behind when he gets them caught on a fence. 

You can find this part of the story in Chapter 6:

"Jem held the bottom wire; Dill and I rolled through and were halfway to the shelter of the schoolyard’s solitary oak when we sensed that Jem was not with us. We ran back and found him struggling in the fence, kicking his pants off to get loose. He ran to the oak tree in his shorts."

In the Warner Books version of this book (the one that has the bird and the tree on the cover,) that quote is on pages 53-54. But you can find the quote in any version of the book by flipping to Chapter 6, then looking at right about the middle of that chapter. 

Of course, once you've determined that Jem's pants got snagged on a fence and that Jem continued escaping with Scout and Dill in just his underwear, which is hilarious, you'll also want to know why they were running away in the first place!

They had been sneaking up on Boo Radley's house, wanting to get a peek at him through the window. But then someone inside the house seems to see the kids and starts approaching them. They freak out and run away all helter-skelter, back through the tight squeeze of the fence, the same way they came in--and that's how Jem lost his pants, and some of his dignity, too, when he had to show up at home without them!

What does Vera in "The Open Window" make Frampton believe about her aunt? What does Vera explain to her aunt about Frampton?

First, Vera makes sure that Framton Nuttel knows nothing about her aunt. After confirming this, she knows that she can tell him anything because he only knows her name and address. Vera draws Framton in by telling him that her aunt experienced a tragedy three years ago. This would have occurred after Framton's sister had already left. Vera then tells Framton that her aunt's husband, two brothers, and their spaniel went snipe-hunting three years ago and never returned. They were engulfed in a bog (a swampy quicksand) and their bodies were never recovered. Vera claims that, to this day, her aunt keeps the window open with the futile hope that they will return. 

Vera is lying of course and when they do return, the already nervous Framton runs away. Vera resumes lying and tells her aunt that Framton was once hunted by a pack of wild dogs near the Ganges. He was chased into a cemetery and forced to sit in a freshly dug grave to wait them out. Vera concludes that, because of this experience, Framton must have been frightened by Mr. Sappleton's spaniel when they returned from hunting. 

Compare and contrast indentured servants and slaves in US History.

There were some similarities and some differences between slaves and indentured servants. One similarity is that both groups had to work for another person. As a result, their owners determined how good or how bad their working conditions would be. Both slaves and indentured servants got their basic needs covered. Their owners provided them with food and shelter. They often worked in the fields of their owner.

There were some differences between a slave and an indentured servant. An indentured servant signed a contract for a specific period of time. In return for getting transportation to the colonies, the person agreed to work for that individual for a specific period of time. After the contract was completed, the indentured servant was freed and was paid a bonus that was agreed to when the contract was signed. Slaves were slaves forever. There was no contract, and there was no end date of being a slave. Thus, the indentured servant had something to look forward to after the contract was completed. The slave would remain a slave forever.

There were some similarities and some differences between indentured servants and slaves.

Who may have murdered Sam Westing in The Westing Game?

No one murdered Sam Westing because he isn’t dead, but all of the residents of Sunset Towers are suspects. 

The Sunset Towers apartment building was specifically designed for a select group of people who had a special connection to Sam Westing.  Technically, they are all suspects at one time or another.  This is why they are chosen to live there and to participate in the Westing Game.  However, it turns out that Westing has been alive and watching them under various aliases all along. 

Westing was a paper products tycoon who made a lot of money and then disappeared. No one has seen him in years, and until the heirs moved into Sunset Towers, the Westing mansion was empty.  You can see the Westing mansion from the apartment building, and one day there was smoke coming from the chimney. 

Westing specifies in his will that he was murdered. 

I, Samuel W. Westing, hereby swear that I did not die of natural causes. My life was taken from me—by one of you!

The police are helpless. The culprit is far too cunning to be apprehended for this dastardly deed. (Ch. 6) 

This pronouncement is obviously intended to pit the heirs against each other and make them suspicious of one another. The heirs are not sure what the purpose of gathering them together is.  They realize they all have a connection to Sam Westing in some way.  When the will is read, they are paired off to participate in a game to win his inheritance.  However, most of them still think that he was murdered. 

“Murder? Does that mean Westing was murdered?” Sandy asked the heir on his left.

Crow turned away in silence.

“Does that mean murder?” he asked the heir on his right.

“Murder? Of course it means murder. Sam Westing was murdered,” Mr. Hoo replied. … (Ch. 6) 

A lot of them have motive.  Crow is Westing's ex-wife, and she definitely has bad blood with him because they divorced after their daughter died the night before her wedding.  Mr. Hoo sued Westing, claiming he stole his invention.  The others could easily just want to kill him for his money.  Someone has been stealing, and bombs keep going off.

It is actually the youngest player in the game who figures out that Sam Westing has been there all along.  He has masqueraded as Barney Northrup, Sandy McSouthers, and Julian R. Eastman.  This way, he could keep an eye on his game.  Turtle discovers the truth, and wins the game.  They become good friends.  Sam Westing later dies of natural causes.

How does Ars Poetica/On the Art of Poetry by Horace contribute to our knowledge of the drama and dramatical conventions of his age?

Horace’s Ars Poetica, composed around 15 B.C.E., guides potential poets in developing their art, and thereby reveals several conventions of favorable Roman poetry. It’s important to note that “poetry” here includes Roman drama.

First, he states that the aim of poetry should be to simultaneously delight and instruct its audience: “He who joins the instructive with the agreeable, carries off every vote, by delighting and at the same time admonishing the reader.” Here, Horace reveals that Roman poetry was valued by how well it merged aesthetic qualities with useful or practical insights. In Latin, these aims are dolce, or delight, and utile, or utility.

Next, Horace advises that poetry shouldn’t be protracted, but instead, concise. He reasons, “All superfluous instructions flow from the too full memory.” Whatever can’t be remembered isn’t useful; a poem or dramatic work should then be easy to recollect, and not be too excessive in length.

Finally, Horace insists that poetry should be harmonious, or possess a certain musical quality. At several points he instructs the reader in the use of stressed and unstressed syllables, and claims that one can always look to Homer for perfect examples of harmonious verse.

How could I formulate a thesis for an essay on Ray Bradbury's Fahrenheit 451? My topic is censorship. I want to talk about Beatty's role in...

It seems like you are showing how each of these three characters reacts to censorship. Being a fireman, Montag takes part in censoring (burning) books and literature. His wife, Mildred, is complicit with the idea of censorship. Therefore, she represents those in the population (perhaps the majority) who passively agree to live in this oppressive state. 

Clarisse, on the other hand, does not accept the status quo. She doesn't actively engage in a public or political revolution. But she does rebel in her own way. She questions things. She would rather have interesting conversation than watch the mind-numbing shows that Mildred loves so much. 

Later in the novel, Montag recalls a prior meeting with Faber. This may have been one of the first eyeopening moments for Montag. But he does not really start to question things until he meets Clarisse. His conversations with her spark an awakening in him. Perhaps, you might formulate a thesis about how Clarisse helps catalyze this awakening in Montag. Using all three characters in a statement, one might say: Ignoring censorship of thought, Clarisse awakens something in Montag that Montag tries but fails to awaken in Mildred. 

There are 70 m^3 of calcium hydroxide and a gas mixture that is 7% CO2. What volume of CO2 is needed to convert the calcium hydroxide to CaCO3?

Calcium hydroxide (Ca(OH)2) is converted to calcium carbonate (CaCO3) by treating it with carbon dioxide (CO2).  The equation is shown below:

Ca(OH)2 + CO2 --> CaCO3 + H2O

We have 70 m3 (cubic meters) of calcium hydroxide.  If we convert this to milliliters (also called cubic centimeters), then we can use the density of calcium hydroxide (2.211 g/mL) to find the mass in grams.

70 m3 * (1 x 10e6 mL / m3) * (2.211 g / mL) = 1.55 x 10e8 g Ca(OH)2

Now divide by the molecular weight of Ca(OH)2 to get the amount in moles.

1.55 x 10e8 g * (1 mole / 74.093 g) = 2,091,965.5 moles Ca(OH)2

We can see from the chemical equation above that one mole of CO2 will react with one mole of Ca(OH)2, so we will need the exact same number of moles of CO2.  The molar volume of any ideal gas is 22.414 L per mole, so we can use this as a conversion factor to convert the moles of CO2 into a volume in liters.

2,091,965.5 moles * (22.414 L / mole) = 46,889,314.7 L CO2

So that is the amount of pure CO2 gas needed for the reaction.  Since you stated that the gas on hand is 7% CO2, divide the volume by 0.07 to find the volume of that particular gas mixture required for the reaction.

46,889,314,7 L / 0.07 = 669,847,353.1 liters of gas

What are some good metaphors Ayi Kwei Armah uses in The Healers? I need some quotes that express metaphors throughout The Healers.

In his novel, Armah develops his vision of a return to the unified, united way of life of Africa's ancient times, before divisiveness engendered separate kingships and disunity. Armah sees the great ill of African peoples as disunity and, in The Healer, works out the prose of the novel through an extended metaphor of healing. Consequently the individual metaphors Armah uses in The Healer often employ the language of healing or of growing (Nwahunanya, "The Writer as Physician").

Armah's vision is an end to "division," the beginning of "seed time" and the future "harvest," with a restoration, as Khondlo Mtshali says, of "individual, social and divine purposes" ("Psychopathology and Healing"). Some individual metaphors from The Healer follow.

Damfo teaches Densu that there are "two forces, unity and division. The first creates. The second destroys; it's a disease, disintegration." This is a metaphorical statement of Armah's vision that disunity through division causes disintegration within individuals, societies and cultures.

Damfo says to Densu about Asamoa, who is serving the Asante royaly, that "royalty is part of the disease ... whoever serves royalty serves the disease" and that "kings and chiefs suck their power" from the divided people. Carrying the disease metaphor further, Armah compares ruling families to a symptom of disease by which he means that after division is driven in, individuals set themselves as kings because disunity and disintegration allows for the usurpation of authority. Obedience to these rulers furthers the disintegration. He also means that kings and chiefs have no innate power but that they dishonestly take power from weakened people who are disunified.

Ababio says to Densu "we shall be left by the roadside ... they will grind us ... [to be] less than grains of bad snuff...." The first metaphor compares the conquered people to something worthless left by the side of a road. It gives the picture of the African people as completely valueless and expendable. The subsequent metaphors compare the Asante, awaiting imminent defeat by the British, to grains being ground down to powder, and not to grains valuable for food but to grains of rotted ground tobacco, "grains of bad snuff."

Damfo says of the time ahead of them, "This is seed time, far from harvest time" and "In the future there will be the harvest." He means that with the departure of the British and with the unintentional congregation of African peoples in one spot--dancing a "new dance," each moving to the music in his own way--the renewal of unity and creation can begin; the reclaiming of the traditions of the people can begin. Yet the metaphorical "harvest," the sought after relationship with the way of the ancients, will be generations away.