Despite her best efforts, Helen could not communicate with her dog or make the pet a friend as she did with Martha Washington. Why was this?

Before Annie Sullivan came to teach Helen, the little girl struggled to communicate.  Helen wanted to communicate with everyone around her, but her hand signals and gestures were crude and sometimes difficult to understand.  The family's dog, Belle, "was old and lazy and liked to sleep by the open fire rather than to romp with" young Helen.  Helen made many attempts to communicate with the animal.  The child tried on numerous occasions to teach her hand signs to Belle.  Helen described the dog's reactions to her attempts at communication as being "dull and inattentive."  Sometimes Belle's reactions to Helen's signs confused her.  Occasionally Belle "started and quivered with excitement, then she became perfectly rigid, as dogs do when they point a bird."  Helen got very upset and frustrated when Belle did not respond the way she wanted.  

When Helen was disappointed with Belle, she ran off to find Martha Washington.  Martha was a little girl who was the cook's daughter.  Helen's signs were understood by Martha and they became friends.  Unfortunately, Helen was very bossy with Martha.  If Martha did not do as Helen wished, she would be the victim of "a hand-to-hand encounter."

Why is Chekhov's "The Bet" a story of situational Irony?

Situational irony is said to occur when there is an incongruity between what is expected to happen and what actually happens instead. In Anton Chekhov's story "The Bet," we see there are striking incongruities between what both the banker and the lawyer expect to happen and what actually happens to them and to each other by the end. The banker felt sure when he made the bet that the lawyer would not be able to tolerate more than a few years of solitary confinement. He tried to talk the other man out of going through with the bet.

"Think better of it, young man, while there is still time. To me two million is a trifle, but you are losing three or four of the best years of your life. I say three or four, because you won't stay longer. Don't forget either, you unhappy man, that voluntary confinement is a great deal harder to bear than compulsory. The thought that you have the right to step out in liberty at any moment will poison your whole existence in prison. I am sorry for you."

However, when the story opens, the entire fifteen years specified in the bet are nearly over and the lawyer is still in solitary confinement in the lodge on the banker's estate. Not only that, but two million rubles are no longer a "trifle" to the banker. He would probably have to give his prisoner all his money and liquidate all his assets, including selling his estate, in order to put together that amount of money. He can't bear the thought of being left destitute at his age. He is even seriously considering murdering his prisoner to get out of paying the debt.

For his part, the lawyer was confident when he made the bet that he would be able to stick it out for fifteen years, and he has done so. In order to pass the time without going crazy, he buried himself in reading. What he didn't anticipate was that fifteen years of solitary study and meditation have changed him into a different man. His sole motivation when he made the bet was to collect a lot of money and live in luxury for the remainder of his life. Instead, he has come to despise money, and he intends to forfeit the bet and the two million rubles just to show that material things are worthless.

The final situational irony in the story is that when the banker goes into the lodge to murder the prisoner, he finds it is completely unnecessary to do so. He can keep his two million rubles and continue to live his life of vanity. The lawyer has even left him documentary evidence that he is forfeiting the bet:

Next morning the watchmen ran in with pale faces, and told him they had seen the man who lived in the lodge climb out of the window into the garden, go to the gate, and disappear. The banker went at once with the servants to the lodge and made sure of the flight of his prisoner. To avoid arousing unnecessary talk, he took from the table the writing in which the millions were renounced, and when he got home locked it up in the fireproof safe.

The story is told entirely from the banker's point of view. The dramatic conflict is his. He has been tormented for fifteen years because the lawyer astonished him by remaining imprisoned. The banker knows he is morally and legally obligated to pay the two million rubles, but he can't bring himself to part with everything he owns. His conflict is resolved when he finds the lawyer doesn't care a bit about the money. The banker can keep his estate and his servants, but he will have to live with the realization that he was willing to become a murderer to preserve his wealth.

How can I soften hard water?

The hardness of water is the result of the presence of salts of magnesium and calcium. If carbonates and bicarbonates of these metals are present, then the hardness is temporary. The presence of nitrates, sulphates and chlorides of calcium and magnesium causes permanent hardness. Hard water deters the formation of lather with soap and detergents and also causes the scaling of water containers, boilers, etc.

The hardness of the water can be removed in a number of ways. The temporary hardness of water can be partially removed by boiling the water. This is the reason we sometimes observe white floating material in water after boiling. Excess amount of lime will also help remove temporary hardness. To remove permanent hardness, a lime-soda ash treatment process or demineralization or zeolite process can be used. The last two (demineralization and the zeolite process) are ion-exchange processes and can help achieve a zero-hardness water.

Hope this helps. 

What is the theme or central message of The BFG by Roald Dahl?

The BFG by Roald Dahl is a children's book. The book is narrated through the eyes of Sophie, a young orphan, and describes her life after she encounters the BFG (Big Friendly Giant). Initially, Sophie is frightened of the BFG and worries he will eat her, but they eventually become friends and save England from evil giants.

The main message of the story has to do with real morality versus conventions. Although the BFG appears frightening on the surface and does not follow the conventions of polite society, he is a morally good character, showing what matters is character, not external appearances or circumstances. The BFG and Sophie are both despised outcasts, but prove themselves heroic. Trust and friendship can overcome the barriers between even the most superficially different people. As shown in BFG's treatment of his opponents, it is always important to choose fair and just means to achieve one's ends.

In Arthur Miller's The Crucible, what does Giles Corey believe is motivating the witch-hunt? How did he inadvertently cause trouble for his wife?...

Giles Corey believes that greed is motivating the witch hunt.  In Act Three, he presents Deputy Governor Danforth with a statement that Thomas Putnam was overheard, on the day his daughter accused George Jacobs, of saying that she'd given him "a fair gift of land."  Jacobs' land will go up for auction when he is convicted, and Putnam is the only person with enough money to purchase it.  Therefore, Giles believes greed is behind the accusations.

He inadvertently caused trouble for his wife, Martha, by talking about how much she likes to read, the fact that she hides her books from him, and that he once had trouble praying while she was in the room but could pray again once she left the house.  He spoke of all this to Mr. Hale in Act One, but he never intended to accuse his wife of witchcraft.  Nonetheless, she is brought in and eventually convicted and hanged.

Giles attempts to save his wife by bringing his statement to the court, but he does it in such a way that Danforth holds him for contempt.  He refuses to name the man who claimed to have overheard Putnam, and so Danforth believes that he is untruthful and has come to overthrow the court with John Proctor.  In the end, Giles is taken to jail.  He is eventually pressed to death for refusing to enter a plea in court.

Who is Calvin O'Keefe?

Calvin O'Keefe is a character featured in a number of books by Madeleine L'Engle. We first encounter Calvin in the book, A Wrinkle in Time, when he is a poor student. He is a charming and friendly young man, but he feels misunderstood and out of place with his family. Calvin is deeply impacted by the struggles he has faced growing up in a neglectful family and is very empathetic, always seeking to be respectful to others. He works hard to provide for himself to compensate for what his parents have not provided him.

Throughout the stories by L'Engle, Calvin grows up to become a marine biologist and marries the protagonist, Meg. Calvin and Meg share a telepathic bond called kything and understand each other better than anyone else. Though Calvin's presence as an active character throughout the Time series is a little spotty, he is mentioned regularly with regards to his work on marine life.

Why does Scout describe the wait for Atticus to come home after the bush incident as "geological ages later" in To Kill a Mockingbird?

"Geological ages later" is a more poetic — and hyperbolic —way of saying, "That took a long time." You may also hear of things moving at a "glacial pace," which is another geological means of indicating an extremely long and slow process. Saying, "We didn't get in until geological ages later because the line was moving so slowly" is an example of using this in a modern context.

Geologic time is used to emphasize the extraordinary length, or duration, of an event or process. We often cannot comprehend the amount of time a geological process takes. For instance, the universe came into being about 13.7 billion years ago. Our Milky Way galaxy formed about 13.2 billion years ago. The difference between 13.7 and 13.2 may seem insignificant, but it accounts for 500 million years! Our solar system, which contains the sun, the Earth, and the rest of the planets, came into being around 4.6 billion years ago. This means it took about 8 billion years for our sun to form. The Earth itself is considered to be 4.5 billion years old. Thus, the earth took about 100 million years to form from the dust and rock orbiting the new sun. Scientists confirm that primitive, single-celled life forms were present on the earth 2.7 billion years ago. Early Humans evolved around 6 million years ago, but the modern form of humans evolved only around 200 thousand years ago. Human civilization itself is only about six thousand years old. Think about how long ago one hundred years seems. 1916 is very different from 2016. The average human lifespan is around 80 years. Thus, compared to life of the universe, the existence of a human would barely register on that scale. 

Examine and explain an important idea in The Catcher in the Rye by J.D. Salinger.

Rebellion is the strongest idea expressed in The Catcher in the Rye, although author J.D. Salinger explores multiple social themes throughout the work. As a young man who is left with an important decision to make after failing his prep school classes, Holden is saddled with the pressures of other people's expectations. He must choose between returning home and facing his parents after his failure or setting out on his own.

Throughout The Catcher in the Rye, it clear Holden can either take the path of least resistance by returning home or choose to rebel against the expectations of his parents and society. Without fully knowing his own mind, he asks Sally, a girl he dated previously, to run away with him. This arc in the story demonstrates Holden's rebellion is contingent upon having another person to join him, validating his choices as a result.

The idea of rebellion is also expressed through Holden's misanthropy and his excessive use of foul language. Holden is also seen abandoning his family's 1950s values by hiring a prostitute at a hotel, but he ultimately decides not to go through with the encounter. Holden himself acknowledges his rebellion likely stems from the fact that he feels society has already rejected him as a misfit.

It has been suggested that Holden's hunting hat is a physical symbol of his rebellion. While he otherwise dresses appropriately for a young man in his era, Holden is consistently seen wearing a hunting hat that is notably out of place. By wearing the hat, Holden is rebelling against society's expectations in a significant way, even if he meets them in most others.

What are the possible objections to the proposal in "A Modest Proposal"?

If you mean what possible objections people might have to the proposal itself, the most common would be that is it inhumane to solve the problem of poverty by making it possible for poor women to sell their year-old babies as food to be eaten at rich people's tables. Cannibalism is unpleasant at any age, but most people are revolted by the idea of eating a freshly killed baby served "hot off the knife." Swift meant for people to react with horror to this proposal. He hoped it would lead them to embrace a more humane solution to problem of rampant poverty in Ireland and even proposed several humane ideas in his essay (while having his narrator brush them off). It's important to note that Swift himself is not proposing eating babies. It is his clueless narrator, representing the kind of mindless bureaucrats who dealt with the poor as objects, not real human beings.

However, if you mean what possible objections people might have to the essay itself, some early audiences were horrified. They missed the satire--that Swift was in fact poking fun at this hard-hearted approach to poverty--and thought his suggestion was serious. Naturally, they reacted by thinking he was a very sick individual. Today, however, the essay is considered one of the greatest, if not the greatest, example of a satiric essay in the English language. 

What is aging?

Physical and Psychological Factors

Aging takes place over the course of life, and the rate of change varies between individuals and groups. Differences in aging are genetically determined in part, but there is also a substantial environmental component. These environmental factors can include nutrition, lifestyle choices, and toxins in the environment. Primary aging
relates to the genetic components of aging, while secondary aging
focuses on environmental factors.

Aging is influenced by a number of normative age-graded factors that typically take place at a particular chronological time. These factors can be biological, as reflected in puberty and menopause, as well as environmental, having an impact on the socialization of the individual, such as the changes needed to enter school or to assume a work role. Normative history-graded factors refer to events that are shared by a society and have an impact, either positive or negative, on the aging process. The Great Depression in the 1930s, World War II, and the Vietnam War are examples of normative history-graded events. When a major event has an impact on a single generation in a society, it is known as a cohort effect. When an event affects the entire population, it is termed a period effect. The Great Depression is considered to be a period effect, while the Vietnam War is labeled a cohort effect. Normative age-graded factors are considered to be most important during childhood and in old age, while normative history-graded events are considered to have their greatest impact on aging in the early and middle adulthood periods of life. Nonnormative factors recognize that each individual experiences unique factors that influence the personal aging process. A natural disaster, a divorce, and winning the lottery are considered to be nonnormative factors.

A multitude of age-related changes are typically benign and permit an individual to function, perform daily functions, and remain active in society. With increasing age, however, a number of biological changes lead to a decline in efficiency of function and performance. Some general signs of bodily aging include decreases in physical stature and loss of bone mineral density. A quantitative loss of cells in the body results in a decrease in overall muscle mass, perhaps as high as 80 percent. A loss of fat beneath the skin results in an increased sensitivity to temperature extremes. In general, the skin of the aging person atrophies with shrinking of the sweat and sebaceous glands, leading to dry and itchy skin. A decline in blood vessels causes a slowing of healing, and a loss of skin elasticity occurs with the breakdown of elastin.

Age-related changes in the cardiovascular system include narrowing of the blood vessels due to the thickening of the endothelial lining and a decline in smooth muscle mass. The blood vessels become rigid and contribute to a gradual elevation of blood pressure. Changes in the heart include thickening of the myocardium, a reduction in size of the ventricular cavities, and a decrease in volume of blood pumped per contraction. Heart rate may slow with age, as the cells in the sinus node can decline up to 90 percent. Consequently, elderly people may show limited heart rate increases when experiencing stress or trying to increase activity level. Changes in the respiratory system show a number of functional declines. Smooth muscle in the bronchi, diaphragm, and chest wall becomes weakened as a result of an increase of collagen deposits, contributing to a diminished work capacity in late life. Reductions in the lung surface area, decreased maximum ventilatory volume of the lungs, and limitations on maximum oxygen utilization can produce senile emphysema.
This age-related condition limits the amount of exercise and energy that an older person can expend at any given time. By age sixty-five, an individual cannot fully expand the chest when seated. Secondary aging factors can contribute significantly to the diminished function of the respiratory system, as pollutants in the environment and smoking have been found to exaggerate these changes.

Musculoskeletal changes caused by aging include a loss of muscle mass, with striated musculature diminishing by approximately 50 percent by age eighty. As these cells are lost, they are replaced by fat cells. With age, the mineralization of bone declines for both men and women, but women experience osteoporosis at an accelerated rate after menopause. Both older men and older women are at increasing risk of fractures with age, but women experience this enhanced risk ten years sooner than do men.

In the nervous system, the brain shows a number of normative changes with age. In general, the brain decreases in size, primarily due to loss of mass in the white matter. Gray matter loss contributes significantly to this decrease after age seventy-five. Brain weight also diminishes beginning at age forty. The somatosensory system provides information from nerve endings located in the skin, joints, and muscles. As people age, the ability of the somatosensory system to detect stimuli in the environment and to provide accurate sensory information declines. Older adults have difficulty perceiving joint movement and position; this decline places them at an increased risk for falls.

Significant changes take place in the gastrointestinal system, with impaired gastric acid production in the stomach, slowing of the transit time in the large intestine, and decreased absorptive surface areas in the small intestine. The liver decreases in size and weight and shows a reduction in function. Other significant age-related changes to biological function include decreased renal blood flow; impaired function of the immune system; diminished levels of estrogen, progesterone, and testosterone; and decline in thyroid hormone levels.

Most noticeable to many older adults are the age-related changes to the sensory systems, as visual and auditory losses can routinely have an adverse effect on the performance of daily activities. With age, the lens and cornea of the eye thicken and show a yellowing. The lens is less flexible and increases in opaqueness, making focus more difficult. Production of the aqueous humor, the clear liquid that fills the anterior chamber of the eye, is reduced, leading to the increase in intraocular pressure associated with glaucoma. The ability to track moving objects declines as smooth pursuit eye movements show decrements. With advancing age, the auditory system shows a diminished capacity for sensitivity to higher frequencies, a condition known as presbycusis. According to the National Center for Health Statistics, 25 to 40 percent of
adults over age sixty-five report concerns about a decline in speech perception. The problem is worsened in noisy environments. Taste and smell decrease in sensitivity with age to a degree that eating experiences become less pleasurable.

Although one unifying biological theory of aging does not exist, the National Institute on Aging has proposed two categories of aging theories: program theories and error theories. The program theories suggest that aging is due to a switching on and off of specific genes. When defects develop in the switching process, people experience the biological changes and functional declines associated with primary aging. The genetic nature of aging is shown in the maximal life spans that are found in all species. These species-specific differences in life span suggest an underlying genetic basis for aging. Since aging involves a complex array of normative age-related changes, it is expected that many interacting genes are involved in the overall process of growing old. One example of a program theory is the deliberate biological programming theory. This theory evolved from the research of Leonard Hayflick, who identified a limit for cell duplication. The theory holds that within a normal cell is a store of memory that dictates its life expectancy.

In contrast, the error theory approach maintains that aging is due in part to the wear and tear process that takes place over time. This approach posits that important components in the biological makeup of individuals wear out and cannot be repaired or replaced. Toxins in the environment and free radicals may contribute to the reduction in function of various systems as a result of wear and tear. Free radicals are chemical molecules with an odd number of electrons, which makes them highly reactive with other chemical compounds. Free radicals are produced through normal metabolic processes as well as by exposure to ionizing radiation, ozone, and chemical toxins. Research has shown that free radicals are associated with deoxyribonucleic acid (DNA) damage, cross-linkage with collagen to alter the characteristics of connective tissue, and cancer.

Psychological theories of aging usually are concerned with explaining the differences in behavior, changes in behavior, and patterns of action shown among persons of various ages. The psychological theories can be divided into three major categories: stability template, orderly change, and random change. The stability template approach emphasizes that the primary factors associated with development take place during infancy and childhood. It is during the early years of life that one’s personality is formed, and this provides a template for all future behaviors. As the aging individual faces new situations or challenges from the environment, behavior can be predicted based on the outcomes of early childhood experiences. From the stability template perspective, the older adult often demonstrates regressive behaviors, acting in childlike fashion, when normative age-related biological changes produce excessive stress. The resulting anxiety causes the older person to seek behaviors that were rewarding or comforting in the past. The theories of Sigmund Freud are an example of the stability template approach and promote the idea that the essentials of personality development are concluded at age five or six.

The orderly change theories suggest that aging takes place in a predictable pattern throughout the life span. This pattern is defined by specific stages that accompany the progression through life. Orderly change theorists believe that each stage of life—adolescence, young adulthood, middle age, and late life—presents specific challenges or tasks that must be completed in order to experience successful aging and avoid negative emotions such as depression. The eight stages of development described by Erik Erikson are an example of an orderly change theory.

The random change perspective emphasizes the nonnormative factors of aging and suggests that development takes place as a result of a variety of events that may or may not have an impact on individuals at different points in life. This approach is highlighted by the work of Paul B. Baltes, who concludes that a wide variation occurs in the behavior of people as they age, which in turn is dependent upon each individual’s particular circumstances.

In addition to general developmental theories, the psychological factors of aging focus on the changes in mental processes. Psychology differentiates between fluid intelligence and crystallized intelligence. Fluid intelligence is considered to be the basic abilities and cognitive skills found in a person. It reflects on the quality of one’s brain and how quickly information is perceived and processed, how well associations and patterns are recognized, and the efficiency of memory function. This is analogous to a computer’s hardware structure. Crystallized intelligence refers to culturally based and acquired cognitive functions. Development is dependent on experience with the world and the formal education system. The computer analogy would be its software. Development of cognitive ability is usually viewed as a stage phenomenon that begins during infancy when the child interacts with the surrounding environment through his or her reflexes and continues throughout life. Exposure to an enriched environment facilitates the development of crystallized intelligence. As a person reaches old age, tests of intelligence requiring speed or reaction time typically show a decline in ability. The developmental theory of Jean Piaget is an example of a well-known and highly researched approach to explain cognitive development from infancy onward.

Another significant approach to explain aging has been through the formation of social theories focusing on activity level throughout the life span. Disengagement theory suggests that aging inevitably requires a process of separating or disengaging oneself from physical, social, and psychological efforts. This disengagement is needed in response to the biological changes associated with old age. Activity theory was designed as an alternative view of aging and holds that normative aging requires remaining active throughout life. High activity levels are seen as positively related to good health, longevity, and life satisfaction. Most recently, continuity theory has been proposed as a compromise position between disengagement and activity theories. The continuity approach promotes the notion that older adults must maintain behavior according to the pattern of life that had been established before old age.

Disorders and Effects

Hutchinson-Gilford progeria syndrome and Werner’s syndrome are two forms of accelerated aging called progeria. The person with Hutchinson-Gilford syndrome experiences dwarfism and pseudosenility. Individuals with this genetic form of accelerated aging appear like very old and small humans. They usually die in their teenage years of coronary heart disease. Werner’s syndrome, also caused by genetic factors, affects persons in their late twenties and thirties and produces a shortened life span. The afflicted person ages very rapidly and develops a pinched facial expression, cataracts, diabetes, hypogonadism, a beak-like nose, prominent teeth, and a recessive chin.

Dementia is a fairly common condition that increases in frequency with age. It involves deficits in two or more areas of cognition that have a negative impact on daily functioning. Dementia produces impairment of memory and orientation and disruption in the ability to plan, organize, sequence, and make decisions. The majority of persons in old age who experience dementia have Alzheimer’s disease. That Alzheimer's Association estimated that in 2012, over five million Americans were living with the disease and that the number of cases of Alzheimer’s disease would increase to nine million by the year 2025. The risk for Alzheimer’s disease increases by approximately 1 percent with each year of life after age sixty-five. It is a progressive deteriorating disorder that attacks memory first before progressing through wandering, aggressiveness, and confusion of time and space to an eventual loss of self-awareness and a total inability to assume self-care. The characteristic brain pathology of Alzheimer’s disease includes cell loss, neurofibrillary tangles, and senile plaques found throughout the neocortex of the brain but concentrated in the hippocampus, frontal, parietal, and temporal lobes. Persons with Alzheimer’s disease can experience loss of approximately 40 percent of their brain mass. Four different chromosomes have been identified that heighten risk for the development of Alzheimer’s disease. Currently, there is no cure for the disorder and treatment is primarily supportive. Cholinesterase inhibitors and memantine, which improve the naturally occurring neural transmitter acetylcholine in the brain and have been shown to delay the progression of the disease, have been the medications of choice in treatment. Vascular dementia is caused by underlying cerebrovascular disease and has a more abrupt onset compared to Alzheimer’s disease.

Many of the age-related changes experienced among older adults have been suggested as contributing to the development of late-life depression. Depression is the most common emotional disturbance found in the elderly population. The prevalence of depression is highest among those older adults experiencing some medical illness or functional impairment. Suicide rates are high among older adults and highest among white men over the age of eighty-five. Many older adults experience “chronic suicide,” a slow steady decline in health and function caused by personal neglect of one’s needs.

One of the major effects of age-related changes is the need to compensate for functional declines. For many older adults to live independently, often requires some degree of home care. Impairments are measured in terms of daily living activities, which include eating, bathing, toileting, and moving in and out of chairs and bed. Remaining in the home can take on a significant level of psychological importance, since it is part of an older person’s identity and helps to maintain a sense of autonomy and control in one’s life.

Perspective and Prospects

Historically, the ancient Greeks provided some of the first writings on aging in discussing how old age brings increased anxiety about death. During the Roman era, Cicero suggested ways for elderly people to make themselves useful in advisory and administrative roles. He emphasized the importance of a developed mind and enhanced character as compensations for physical decline. The first manual to describe the problems associated with aging was published in the fifteenth century. Overall, however, historical writers had little to say about the positive attributes of aging.

Many common beliefs about aging have often resulted in oversimplified and biased stereotypes about older adults. These stereotypes may portray elderly persons as uninterested, weak, unattractive, undesirable, rigid, incapable of sexual activity, conservative, and lacking in intellectual acuity. This perspective encourages discrimination against older persons and is termed ageism. Senility is not a medical term but is commonly used in US society. It implies that old people lose the intellectual capacity to make intelligent decisions. As the number of older adults has increased and the importance of scientific investigations of aging has been expanded, positive counterpoints to aging have emerged. A new realistic image of older adults portrays the healthy elderly population as resourceful, optimistic, intelligent, flexible, and sexual beings. The study of aging has increased in importance as the geriatric population continues to grow in number and proportion of the population. According to census conducted in 2010 by the US Census Bureau, the sixty-five and over population in the United States is growing at a faster rater than is the general population. People are living longer as a result of the control of infectious diseases and improvements in health care, sanitation, and nutrition. The segment of the population aged sixty-five and older grew from 5 percent of the population in 1900 to 13 percent in 2010, and it is projected to increase to 22.9 percent by the year 2050. In 2000, there were approximately 35 million Americans over the age of sixty-five; in 2010, there were 40.3 million over the age of sixty-five; and this number is projected to increase to 70 million by 2030. Life expectancy at birth increased from forty-nine years in 1900 to approximately eighty-one years for women and seventy-six years for men in 2010. (Women tend to outlive men because of higher male mortality caused by heart disease, lung cancer, and emphysema.)

Despite the increases in the older population, aging is a relatively new topic of study. Initially, the pioneers in the fields of development focused on describing, explaining, and understanding the infancy and childhood periods of life. Researchers next moved to the study of adolescence, and they considered old age as a period of deterioration with a focus on chronic disease. Gerontology, the formal study of the phenomena of aging from maturity to old age, began producing significant research only in the 1950s. Geriatrics, the medical treatment of elderly patients, was proposed as an academic discipline in 1987 by the National Institute of Medicine.

Bibliography

Arking, Robert. The Biology of Aging: Observations and Principles. 3d ed. New York: Oxford University Press, 2006.

Cohen, Gene D. The Mature Mind: The Positive Power of the Aging Brain. New York: Basic Books, 2006.

Eaton, William W., ed. Medical and Psychiatric Comorbidity over the Course of Life. Washington, D.C.: American Psychiatric Publishing, 2006.

Hill, Robert D. Positive Aging: A Guide for Mental Health Professionals and Consumers. New York: W. W. Norton, 2005.

Kunkel, Suzanne R., J. Scott Brown, and Frank Whittington, eds. Global Aging: Comparative Perspectives on Aging and the Life Course. New York: Springer Publishing, 2014.

Markut, Lynda A., and Anatole Crane. Dementia Caregivers Share Their Stories: A Support Group in a Book. Nashville, Tenn.: Vanderbilt University Press, 2005.

Sugar, Judith A., et al. Introduction to Aging: A Positive, Interdisciplinary Approach. New York: Springer Publishing, 2013.

Whitbourne, Susan Krauss, and Martin J. Sliwinski, eds. The Wiley-Blackwell Handbook of Adulthood and Ageing. Chichester, England: Blackwell Publishing, 2012.

`int (cos(x) + sin(x))/sin(2x) dx` Evaluate the integral

`int(cos x+sin x)/sin(2x) dx`

Let us denote the above integral wit `I.`

Use formula for sine of double angle: `sin2theta=2sin theta cos theta`

`int(cos x+sin x)/(2sin x cos x)dx=1/2int cos x/(sin x cos x)dx+1/2int sin x/(sin x cos x)dx=`

`1/2(int dx/sin x+int dx/cos x)`

Let us denote the above two integrals with `I_1` and `I_2` respectively.

To calculate `I_1` we use sine of double angle formula.

`I_1=int dx/(2sin(x/2) cos (x/2))`

Using the fact that `tan theta=sin theta/cos theta` we can write the above as

`int (1/2 cdot1/(cos^2(x/2)))/(tan(x/2))dx`

Now we use the fact that `int (f'(x))/(f(x))dx=ln|f(x)|+C.`

Therefore, since `(tan(x/2))'=1/2cdot1/(cos^2(x/2))` we have

`ln|tan(x/2)|+C`

Let us now calculate `I_2.`

`I_2=int dx/cosx`

Use the following formula: `cos theta=sin(theta+pi/2).`

`int dx/(sin(x+pi/2))`

Now we proceed as we did in calculating `I_2.` We use formula for sine of double angle.

`int dx/(2sin(x/2+pi/4)cos(x/2+pi/4))=int(1/2cdot1/(cos^2(x/2+pi/4)))/(tan(x/2+pi/4))dx`

Since `(tan(x/2+pi/4))'=1/2cdot 1/(cos^2(x/2+pi/4))` we get

`ln|tan(x/2+pi/4)|+C`

We can now calculate our starting integral `I.`

`I=1/2(I_1+I_2)=1/2(ln|tan(x/2)|+ln|tan(x/2+pi/4)|)+C`                                                                                                         

How does Heck Tate show support for Atticus, Judge Taylor, and others?

As an officer of the law, it is Heck Tate's duty to respect those who represent the laws of the county he serves, such as Judge Taylor and Atticus Finch. Outside of his official position, Sheriff Tate also affords personal respect to Atticus, Tom Robinson, and Boo Radley.

• Judge Taylor

On the day that the trial begins, Scout observes that Sheriff Tate is not in his usual attire when he comes to the witness stand. Instead, he is neatly dressed in a business suit, out of respect for the judge and the court of law. He answers questions honestly and directly. At one point in the trial when Judge Taylor interjects, "He's answered the question three times, Atticus..." Sheriff Tate remains compliant with the court process.

In Chapter 10 when Sheriff Tate is called because there is a rabid dog in the Finch's neighborhood, Heck Tate defers to Atticus to shoot Tim Johnson, who staggers down the street, because the dog may soon turn into the Radley yard and there is only time for one shot. 

"Take him, Mr. Finch....
"Don't waste time, Heck," said Atticus. "Go on."
"Mr. Finch, this is a one-shot job."

In Chapter 30 Sheriff Tate comes to the Finch house after the children are attacked; Jem's arm is broken, and Bob Ewell lies dead. Shortly after he arrives, Sheriff Tate respectfully tells Atticus that Jem has not killed Bob Ewell. However, Atticus does not believe him:

"Heck, it's might kind of you and I know you're doing it from that good heart of yours, but don't start anything like that."
"....Like what?" he [Tate] said.
"...nobody's hushing this up. I don't live that way."
"Nobody's gonna hush anything up, Mr. Finch."

Sheriff Tate goes on to explain, and Atticus finally accepts that Bob Ewell has died as a result of falling on his own knife, especially after Sheriff Tate claims he can prove it and does.

Sheriff Tate tells Atticus respectfully that he has solved the murder--"Bob Ewell fell on his knife," and there is no need to draw attention to anyone.

• Tom Robinson

"....Lived in this town all my life...Know everything that's happened here since before I was born. There's a black boy dead for no reason, and the man responsible for it's dead. Let the dead bury the dead this time, Mr. Finch...."

• Boo Radley

Heck Tate tells Atticus that he has never heard that it is against the law for a citizen to try to prevent a crime from being committed. This, he adds, is all that Boo Radley has done. But, if Boo's actions are made public, Boo's privacy will surely be violated as the ladies of the town will start bringing him food and be curious about what is in his house, etc. Tate adds,

"...draggin' him with his shy ways into the limelight--to me that's a sin."

Clearly, Sheriff Tate is a considerate and fair-minded man who believes in justice and respect for all decent people.

How do the rebukes presented in Thoreau's "Civil Disobedience" and Emerson's "Self-Reliance" differ? What do the two authors criticize their fellow...

Henry David Thoreau’s “Civil Disobedience” and Ralph Waldo Emerson’s “Self-Reliance” touch on many of the same thematic elements. Chief among them is the authors’ shared calls for their fellow citizens to be independent thinkers who resist the temptations inherent with conformity. Indeed, the transcendentalist philosophers are especially critical of society’s negative effects on personal agency.

Thoreau specifically challenges the government and the way that it oversteps its boundaries. Moreover, he chastises his fellow Americans for being complacent in the government’s abuses. He argues that even voting is insufficient in addressing the injustices imposed by laws and governmental structures. He rallies citizens to be more proactive and vocal in addressing the government:

But, to speak practically and as a citizen, unlike those who call themselves no-government men, I ask for, not at once no government, but at once a better government. Let every man make known what kind of government would command his respect, and that will be one step toward obtaining it. (http://thoreau.eserver.org/civil1.html)

While Thoreau emphasizes the failings of the government and citizens within the system, Emerson addresses society and man’s desire for conformity in a more general way. Much like Thoreau, Emerson argues that citizens are too content being members of a questionable society, and that this conformity robs men of their individuality:

Society everywhere is in conspiracy against the manhood of every one of its members. Society is a joint-stock company, in which the members agree, for the better securing of his bread to each shareholder, to surrender the liberty and culture of the eater. The virtue in most request is conformity. Self-reliance is its aversion. It loves not realities and creators, but names and customs (http://www.emersoncentral.com/selfreliance.htm)

Both Thoreau and Emerson emphasize personal agency over conformity to a corrupt—and corrupting—society. They value, in Emerson’s terms, self-reliance and independence while questioning the oppressive influence of society and the government.

Citations:

http://thoreau.eserver.org/civil1.html

http://www.emersoncentral.com/selfreliance.htm

What are osteoporosis?

Causes and Symptoms

Bone is constantly being remodeled by cells: old bone is reabsorbed by the
osteoclasts, and new bone is formed by the osteoblasts.
Several factors control these processes of bone
formation and resorption, which are about equal in adults. In
children, formation exceeds resorption, and the bone mass increases. In old age,
however, bone resorption exceeds bone formation and bone mass is lost. When bone
mass is reduced, the bone becomes mechanically weak and vulnerable to fractures.
This condition of reduced bone mass is known as osteoporosis and is part of the
aging process. At this time, there is no known cure for osteoporosis. Prevention
is the only strategy for combating bone mineral loss and the development of
osteoporosis. A balanced diet including adequate calcium and vitamin D intake as
well as regular weight-bearing and muscle-strengthening exercises can prevent bone
loss.

Type I osteoporosis is related to aging alone. It has two forms: postmenopausal
(occurring in women between the ages of fifty-one and sixty-five) and senile
(occurring in both men and women past the age of seventy). Type II osteoporosis is
associated with an underlying disease such as hyperparathyroidism or
multiple
myeloma and may occur in younger as well as older
individuals. A third type has been found in young women who are amenorrheic
(having no menstrual cycles) in association with eating
disorders such as anorexia nervosa. Osteoporotic
fractures are occurring in women in their twenties and thirties who have been
amenorrheic for several years. Because it was found in athletic women, the link
between eating disorders, amenorrhea, and osteoporosis was named
the Female Athlete Triad. No matter the type of osteoporosis, it remains a
clinically silent disease and is usually asymptomatic until a fracture occurs. The
frequency of osteoporosis and related fractures is expected to increase in
parallel with the increase in the older population. Women are more vulnerable to
this condition, especially after the menopause. As the life span for men
increases, however, so will their risk for osteoporosis.

In the early postmenopausal period, the distal end of the radius and ulna (wrist)
are particularly susceptible to fractures; a few years later, the patient is
likely to sustain vertebral fractures. The most common presentation of such a
fracture is a sudden onset of very severe, localized back pain,
often occurring spontaneously. The pain is so severe that it incapacitates the
patient and may require the administration of narcotics for relief. Unlike the
pain caused by a disk rupture, this pain does not radiate to the legs, although
some radiation anteriorly may be present. The pain usually lasts about four weeks
and is then spontaneously relieved unless nerve compression or secondary arthritic
changes complicate the condition.

When multiple vertebrae have collapsed, the body height is reduced and the
patient’s arms appear to be disproportionately long. Normally, both
measurements—body height and arm span—are equal. In osteoporosis complicated by
several vertebral fractures, body height is reduced, but the arm span is
unchanged. When multiple thoracic vertebrae collapse, kyphosis (an
increased spinal curvature) develops. The space between the ribs and the pelvic
cavity is also reduced. When lumbar vertebrae are collapsed, the lower end of the
ribs may lie over the pelvic cavity. At this stage, the patient’s lung functions
may be compromised because the chest movements are limited. Pneumonia is
a common, sometimes fatal complication.

Progressive and long-standing osteoporosis may be complicated by fractures of the
femoral neck. Although most of these fractures are preceded by a fall, it is
probable that in some cases the bones are so weakened and fragile that they
fracture spontaneously and cause the patient to fall. Fractures of the femoral
neck are associated with significant mortality and morbidity risks, with 12 to 20
percent of the patients dying within six months of the fracture and about half
losing the ability to live independently.

A number of factors predisposing an individual to osteoporosis have been
identified. Some of these factors cannot be changed. For example, advanced age
increases the risk of developing osteoporosis. Furthermore, although both sexes
are affected by osteoporosis, women tend to be more vulnerable because, in
addition to the accelerated rate of bone loss that occurs after menopause, women
tend to have smaller skeletons than men do and, therefore, are likely to reach the
threshold at which bone fragility is increased well before men do. Caucasians and
Asians are more susceptible to osteoporosis than are Africans or Latinos, in whom
this condition is relatively rare. The reasons for these racial differences are
not well known. Finally, people with large body frames are less likely to develop
osteoporosis than those with small body frames, probably because their bone
reserve allows them to lose bone for a longer period before reaching the threshold
at which the bone fragility is significantly increased. Genetic research has also
determined that variations in the gene for the vitamin D receptor (VDR) may
contribute to 7 to 10 percent of the difference in bone mass density because of
its influence on calcium intake. For those with a family history of osteoporosis
or hip fracture, this factor could lead to identification of an individual’s risk
factor and enable early intervention.

A number of risk factors that can be reversed have also been identified. A low
dietary calcium intake is associated with a reduced bone mass and an increased
fracture rate. Conversely, an elevated calcium intake, particularly before
puberty, is associated with an increased mass. In 1994, the US National Institutes
of Health consensus statement recommended an increase in daily calcium, and in
1997 the National Academy of Sciences’ recommended dietary allowance (RDA)
increased from 800 milligrams per day to 1,300 milligrams at age nine up to age
eighteen. Men from age nineteen to seventy years should take in 1,000 milligrams,
increasing to 1,200 milligrams at age seventy-one. Women from age nineteen to
fifty should take in 1,000 milligrams, increasing to 1,200 milligrams after the
age of fifty-one. Higher doses may be detrimental, as they may cause the formation
of kidney stones, so the benefit must be weighed against the risk in each case.
Getting the greatest percentage of the calcium from the diet is preferred, but, if
it is to be taken as a supplement, no more than 500 milligrams should be taken at
one time and always with meals. Calcium is not absorbed well, so having stomach
acid present, as well as vitamin D and protein, enhances the absorption. Vitamin D
deficiency and excess vitamin A intake are also risk factors for the development
of osteoporosis.

Physical inactivity is associated with a reduced bone mass and therefore an
increased predisposition to developing osteoporosis. There is also evidence that
people who have a sedentary lifestyle are more susceptible to osteoporosis than
those who are physically active. During the formative years, exercise is
imperative to develop the highest bone density possible. Then throughout the rest
of life, exercise is essential to slow the rate of bone loss, particularly
weight-bearing and muscle-strengthening exercises. Several factors modulate the
response of the skeleton to exercise. These include the subject’s age and gender;
the intensity, frequency, and type of exercise; and the subject’s endocrinal
status. The current recommendation for exercise in relationship to osteoporosis is
preventive: a variety of exercise, both weight-bearing and vigorous, to be done
regularly (thirty to sixty minutes per day, three to five days per week)
throughout life. Variety is essential because no single exercise stresses all
bones equally. The stimulus to build bone comes from the muscle that is attached
to the bone pulling on the attachment site, which makes the bone remodel itself to
resist the stress.

In the elderly, exercise may have a secondary benefit. Often, a fracture is
precipitated by a fall, and the cause of the fall may be a loss of balance or
coordination. Maintaining an active lifestyle helps with balance and coordination,
all of which may help in the prevention of a fall. Studies in the elderly have
demonstrated that a general exercise such as walking is not enough to maintain
gains in bone density in the long term. Exercise studies of one or two years’
duration show a decline begins after about one year. To combat that loss, a
regular strength training regimen, targeting the most common fracture sites, done
two or three times a week for twenty minutes to stimulate specific bones, should
be added to any other activities that are done.

Cigarette smoking is associated with osteoporosis; however, the underlying
mechanism is not clearly understood. It is possible that cigarette smokers are
more likely to lead a sedentary life and have a reduced dietary calcium intake
compared to nonsmokers. Cigarette smoking may have a direct effect on the bone
cells, or it may have an indirect effect by modulating the release of substances
that may affect the activity of these cells, such as the parathyroid hormone or
calcitonin secretion. Smoking cessation is highly recommended
to reduce one's risk of developing osteoporosis. Alcohol abuse
is also a risk factor for the development of osteoporosis, and cirrhosis of
the liver further increases an individual's risk for osteoporosis. Excessive
alcohol intake should be avoided.

A number of drugs may induce osteoporosis. These include long-term anticoagulation
medications, hormonal therapies, glucocorticosteroids, some immunosuppressants,
lithium, thiazolidinediones (glitazones), and long-term proton pump inhibitor use.
For a person at risk for osteoporosis, anytime that medications are prescribed,
calcium interaction should be considered.

A number of diseases and disorders are associated with osteoporosis, including
genetic factors such as cystic fibrosis, hemochromatosis, and porphyria. Endocrine
disorders associated with osteoporosis include hyperparathyroidism, anorexia
nervosa, diabetes
mellitus, Cushing syndrome, and excess thyroid hormone.
Gastrointestinal disorders such as celiac disease, Crohn disease, cirrhosis, and
malabsorption can increase the risk of osteoporosis.
Rheumatoid arthritis and hematologic disorders such as multiple myeloma,
thalassemia, and leukemia also put individuals at risk of developing
osteoporosis.

Treatment and Therapy

Several tests are available to confirm the diagnosis of osteoporosis, quantify its degree, and identify underlying diseases that might cause or aggravate the osteoporosis.

X-rays used to be the only way to evaluate patients with osteoporosis. Although
they are helpful in assessing bone involvement from other diseases, they are not
useful for the detection of early osteoporosis because the characteristic
appearances are seen only when at least 40 percent of the bone mass has been lost.
In the 1990s, a new analysis technique was developed using a simple X-ray of the
hand and then computer analysis. It is able to reveal as little as 1 percent bone
loss.

The most accurate technique now available to measure bone density uses a technique
called dual energy X-ray absorptiometry (DEXA). DEXA is based on the principle
that if a beam of radiation is directed at a bone, the amount of radiation trapped
by the bone is proportional to the amount of mineral and calcium inside. By
knowing the amount of radiation aimed at the bone and the amount reaching a
detector crystal across the bone, the amount of mineral can be calculated. To
differentiate the radiation trapped by the surrounding muscles and fat from the
radiation trapped by the bone itself, radiation with two different peaks (which
are absorbed to a different extent by bone and soft tissue) is used. The exposure
to radiation is minimal, one-fiftieth the radiation as in a chest X-ray. The same
densitometry machine can do whole-body or single-site readings, making it even
more useful for diagnosis.

Osteoporosis therapy includes several options. Several drugs are currently being
used or investigated for use. Bisphosphonates are usually the first-line choice
when pharmacological therapy is indicated. Bisphosphonates include alendronate,
ibandronate, risedronate, and zoledronic acid. Parathyroid hormone (teriparatide)
delivered subcutaneously may also be a first-line treatment choice among patients
with the highest risk for fracture. Teriparatide works by increasing the action of
osteoblasts and causes bones to become denser and more resistant to fractures.
Other medications such as estrogen receptor modulators (raloxifene, lasofoxifene,
tibolone) are recommended for postmenopausal women with osteoporosis.

Calcitonin, a hormone produced by the thyroid gland, specifically inhibits
the osteoclasts, which are the bone resorbing cells. As a result, there is a
relative increase in the rate of bone formation, and the bone mass increases.
After the initial increase, however, the bone mass tends to stabilize, and the
continued administration of calcitonin beyond this point may be associated with an
actual decline in bone mass. Therefore, the risks of calcitonin may outweigh the
benefits.

Calcium supplements are useful if the patient’s dietary calcium intake is less
than recommended. Similarly, if the daily vitamin D intake is below the
recommended level of 600 to 800 international units in the elderly population,
supplementation is recommended. Vitamin D supplements may also be necessary in
patients who are taking a medication that interferes with vitamin D metabolism. An
excessive vitamin D and calcium intake, however, may lead to the development of
kidney stones.

Several nonpharmacological treatments may also improve quality of life and
functional status in persons with osteoporosis. Progressive quadriceps strength
and proprioception training and balance training are associated with a decrease in
falls in postmenopausal women with osteoporosis. Pilates and weight-bearing
exercises may also improve function in persons with osteoporosis, and tai chi may
improve balance and lessen the risk of falls.

Perspective and Prospects

The early diagnosis of osteoporosis and the ability to quantify its degree have
represented major strides in the diagnosis, management, and prevention of this
disease. It is now recommended that all women approaching the menopause be checked
to determine a baseline bone density reading and to help with prevention and
possible treatment options. Indeed, physicians can now identify patients with
early osteoporosis and assess their response to treatment accurately.
Additionally, modifiable risk factors increasing the likelihood of developing
osteoporosis have been identified; these include a low dietary calcium and vitamin
D intake, cigarette smoking, excessive alcohol use, anorexia nervosa or bulimia
nervosa, and a sedentary lifestyle. Education of the public, therefore, has an
important part to play in the prevention and management of osteoporosis.

Working with young people may be the best way to combat osteoporosis. For many
people, making the right choices early in life may have great influence in
preventing this debilitating disease later in life. For the older adult, attempts
are being made to develop “risk profiles” that can be used to estimate the
individual patient’s fracture risk. This in turn will allow physicians to identify
those in the population who are particularly likely to benefit from specific
therapy. Moreover, the increased understanding of bone formation, bone resorption,
and bone metabolism has led to a considerable amount of research work on the
development of effective treatment programs. Drugs that can build strong bones, or
ones that can prevent further bone loss, will need to be continually studied in
both men and women, and everything that can be done to reduce side effects from
these or other drugs that affect calcium stores in the bones must be a top
priority of research dollars spent.

Bibliography

Bartl, Reiner, and Bertha Frisch.
Osteoporosis: Diagnosis, Prevention, Therapy. 2nd ed.
Berlin: Springer, 2009. Print.

Bresler, Priscilla A.
“Osteoporosis.” Primary Care Reports 19.4 (2013): 45–59.
Print.

Clarke, Bart.
Mayo Clinic Guide to Preventing and Treating
Osteoporosis. Rochester: Mayo Clinic, 2008. Print.

Marcus, Robert, et al., eds.
Osteoporosis. 4th ed. 2 vols. Amsterdam: Academic, 2013.
Print.

National Osteoporosis Foundation. http://www.nof.org.

Nelson, Miriam E., and
Sarah Wernick. Strong Women, Strong Bones: Everything You Need to
Know to Prevent, Treat, and Beat Osteoporosis. Rev. ed. New
York: Berkley, 2006. Print.

Peña, Alejandro Romero, and Virgilio
Ortega Perez, eds. Osteoporosis: Risk Factors, Symptoms and
Management. New York: Nova, 2012. Print.

Stovall, Dale W., ed.
Osteoporosis: Diagnosis and Management. Chichester:
Wiley, 2013. Print.

Zhang, J., et al. "Additive Effects of
Antiresorptive Agents and Exercise on Lumbar Spine Bone Mineral Density in
Adults with Low Bone Mass: A Meta-Analysis." Osteoporosis
International 25.5 (2014): 1585–94. Print.

George McClellan lost many chances to destroy the Southern army. If you had been Abraham Lincoln, how would you have reacted?

Abraham Lincoln was very frustrated with General George McClellan. General McClellan had many opportunities to defeat the Confederate army. However, he was very cautious and often didn’t advance his troops. This made President Lincoln unhappy.

President Lincoln urged General McClellan to move his troops several times. He even told General McClellan that if McClellan wasn’t going to use his army, then President Lincoln wanted to borrow it. At the Battle of Antietam, General Lee tried unsuccessfully to invade the North. He was forced to retreat to Virginia. When General McClellan failed to pursue General Lee and possibly secure a decisive victory, President Lincoln replaced General McClellan.

While there are many opinions regarding how President Lincoln could have handled this situation, I think President Lincoln made the right choice and acted properly. He gave General McClellan many opportunities by urging General McClellan to take action. When it became clear after several missed opportunities that General McClellan would continue to be slow to act or might not act at all, it was proper for President Lincoln to replace him. I would have followed the same course of action that President Lincoln followed in regards to dealing with the lack of activity of General McClellan.

What are some examples of local dialect in the first chapter of Of Mice and Men?

In Chapter 1 of Of Mice and Men, George uses local dialect in much of what he says. He tells Lennie, "You gonna be sick like you was last night" (page numbers  vary by edition). Steinbeck produces George's speech in a way that a ranch hand might have really sounded, using the word "gonna" instead of the more formal "going to" and "you was" instead of the correct "you were." Later, George says, “I ain’t sure it’s good water...Looks kinda scummy" (page numbers vary by edition). "Ain't" is a colloquialism, as is "kinda." He also says, "You never oughta drink water when it ain’t running, Lennie" (page numbers by edition). In this sentence, he uses "oughta" instead of "ought to" and uses several double negatives ("never" and "ain't), again sounding the way a real person might sound. Later, George says, "We could just as well of rode clear to the ranch if that bastard bus driver knew what he was talkin’ about. ‘Jes’ a little stretch down the highway,’ he says" (page numbers vary by edition). In this speech, George uses "of" instead of "have" and uses the incorrect verb "rode" instead of "ridden." In addition to using incorrect verb forms, he imitates the driver of the bus, using the pronunciation "jes" instead of "just." Steinbeck's use of dialect does not imply that George is unintelligent; George is clearly observant and astute. George's way of speaking does, however, imply that he is a working man who perhaps did not have the benefit of many years of formal education.

What does the following quote mean? "Thou wouldst be great; Art not without ambition, but without The illness should attend it. What thou...

This quote comes from scene five of the second act of Macbeth, when Macbeth sends a letter to his wife to tell her about the prophesy the witches have made about his rise to power. The speech Lady Macbeth gives here shows the intensity of her character's great ambition for power, as well as how thoroughly she plans on pushing Macbeth towards murder. To better understand this section, let's take a look at each line (I'm going to break some of the lines up too, so the meaning is easier to follow):

"[...] thou wouldst be great,"

"Wouldst" here means "would like to" so Lady Macbeth is saying that Macbeth wants to be great. 

"Art not without ambition,"

"Art" means "are," so Macbeth does have ambition enough to be a great man and even a king. However...

"but without / The illness should attend it." 

Macbeth is lacking "the illness" or the streak of ruthlessness (and a bit of madness) that needs to go with ambition in order for it to be effective. 

"What thou wouldst highly, / That wouldst thou holily;"

The things that Macbeth wants to do, he wants to do in a good or holy way.

"wouldst not play false, / And yet wouldst wrongly win."

He doesn't want to cheat ("play false"), but he does want to gain something that is not his ("wrongly win").

"Thou'ld’st have, great Glamis ...]" 

Lady Macbeth is continuing on here in the same way, basically saying that yes, Macbeth does want to be king, but he doesn't have the guts to do the dirty work needed to make it happen. She calls him "Glamis" in this line because he is the thane (like a noble ruler) of Glamis, which is a region of Scotland. 

How do Elie's religious beliefs change in the concentration camps?

As a twelve-year-old boy in his Transylvanian town of Sighet, Elie reveals that he was devoutly religious. In the opening lines of his memoir he focuses on Moshe the Beadle, who became Elie's master in the study of Jewish mysticism. Elie writes of his religious feelings on the first page:

I was twelve. I believed profoundly. During the day I studied the Talmud, and at night I ran to the synagogue to weep over the destruction of the temple. 

Despite his father's disapproval, Elie spends time with Moshe studying the Cabbala before Moshe is taken away when the foreign Jews are deported. When Moshe miraculously returns he is greatly changed after witnessing the atrocities of the Nazis. Elie reports that Moshe "no longer talked to me of God or of the cabbala, but only of what he had seen." The Jews don't listen to Moshe and even Elie admits he didn't believe him and pitied him. The ordeal of Moshe proves to be foreshadowing things to come for Elie.

Elie's own faith is cracked on his first day at Birkenau, reception center for Auschwitz. Just after the selection, as he and his father believe they are going to the crematory, Elie witnesses a truckload of children being dumped into a pit of fire. As men are praying all around him, he begins his rebellion against God:

For the first time, I felt revolt rise up in me. Why should I bless His name? The Eternal. Lord of the Universe, the All-Powerful and Terrible, was silent. What had I to thank Him for.

Elie and his father do survive and are installed in the barracks, but Elie continues his rant against God. He cannot fathom why God would allow this to happen and stand by quietly as the Jews are subjected to such death and terror:

Never shall I forget those moments which murdered my God and my soul and turned my dreams to dust. Never shall I forget these things, even if I am condemned to live as long as God Himself. Never.

This questioning goes on throughout the book and at some points Elie symbolically protests God's silence in the face of the extermination. The assassination of the young "pipel" in chapter four profoundly affects the men who have to witness the boy die an agonizing death when the initial hanging leaves him "between life and death." Elie overhears a man ask, "Where is God now?" Elie silently answers the question:

"Where is He? Here He is—He is hanging here on this gallows..."

Again, on the eve of Rosh Hashanah, Elie expresses his bitterness toward God. As the other men are reciting, "Blessed be the Name of the Eternal!", Elie has much different thoughts:

Why, but why should I bless Him? In every fiber I rebelled. Because He had had thousands of children burned in His pit? Because He kept six crematories working night and day, on Sundays and feast days? Because in His great might He had created Auschwitz, Birkenau and Buna, and so many factories of death? How could I say to Him: "Blessed art Thou, Eternal, Master of the Universe, Who chose us from among the races to be tortured day and night, to see our fathers, our mothers, our brothers, end in the crematory? Praised be Thy Holy Name, Thou hast chosen us to be butchered on Thine altar?"

Elie takes his outrage at God even further as he protests by not fasting on "Yom Kippur, the Day of Atonement." While other Jews believe it is the ultimate sign of their faith to fast (despite the starvation diet they are enduring) Elie will not:

I no longer accepted God's silence. As I swallowed my bowl of soup, I saw in the gesture an act of rebellion and protest against Him.

After being told of the brutality which Elie witnesses during his year in the concentration camps it should be easy for the reader to understand Elie's loss of devotion to God. He never doubts God's existence, but simply cannot understand or abide God's willingness to allow the Jews to be persecuted so horribly. 

What is the significance of Saussure's theory of structuralism in this line? "De Saussure studied linguistics as a system of signs which can be...

Although Saussure did study historical linguistics, with his work Course in General Linguistics, he chose to focus on language synchronically. Whereas a diachronic analysis would look at how language changes over time, a synchronic analysis looks at how a language works at one moment in time. 

Saussure says that "langue" (the system and structure of language) persists as a whole while "parole" (speech) consists of each individual speaking (or writing). In other words, langue is the structure and rules of language in the same way that a game has structure and rules. Each person is therefore a player, and each move (parole) is the person participating in the game. 

Saussure uses the game of chess to illustrate these notions of langue and parole as they apply to a synchronic perspective on language. The rules and structure of chess exist abstractly, but they continue to be put into practice because people, as a society agree to play by those rules. This is the langue component. Each move in the game is an example of parole. Saussure claimed that one could come into a game at any point and he/she would not need to know the previous moves (diachronic) in order to understand the game. Therefore, he figured a synchronic approach to language would be equally logical.

Even without knowing the rules, one could eventually understand the interaction of the pieces in order to understand the game. Likewise, one can understand how language works (and means things) by how the words relate to each other. For example, Saussure noted that the word itself ("tree") is not what carries the meaning. Rather, meaning is determined by how "tree" and the idea (tree) that it signifies relates to and interacts with other words. 

What is an example of a man vs. fate conflict in Fahrenheit 451 by Ray Bradbury?

In Part III of Fahrenheit 451, "Burning Bright," Montag's fate is to be hunted and killed. The Hound, programmed to kill Montag, is chasing him, and, as the TV says, "The Mechanical Hound never fails" (page numbers vary by edition). The Hound represents what seems like inescapable fate. Montag thinks to himself, "Nowhere. There was nowhere to go, no friend to turn to, really" (page numbers vary by edition). Montag himself doubts that he can escape his fate. In addition, as Montag tries to escape, the television asks everyone in the society to fling open their doors to look for him. It seems doubtful that he can escape his fate, and it seems probable that he will be killed.

However, at the last minute, Montag reaches the river. As he nears the water, "A storm of light fell upon the river and Montag dived under the great illumination as if the sun had broken the clouds" (page numbers vary by edition). In this passage, the river represents hope and deliverance, as it carries Montag and his scent away from the Hound and carries him away from the helicopters that are chasing him. By reaching the water, which is also a symbol of rebirth, Montag is able to outrun fate (in the form of the Hound) and be delivered to a better future. 

How much is Abigail to blame for the events that take place? Is she a victim of her society in The Crucible? What events in her past and...

Abigail is very much to blame for the events that take place in The Crucible. Though one could certainly make the case that she's had a difficult life -- life for Puritan girls, especially, was no picnic -- and though her parents were, evidently, killed by Native Americans right in front of her (as she tells Mary Warren and Betty Parris), it does not follow that her promises of violence can be excused.  She threatens to "bring a pointy reckoning" and torture the girls by night if they tell on her.  Further, Abigail's confession to John Proctor that Betty's illness has nothing to do with witchcraft but that "She took fright, is all" reveals her as a manipulative liar when she later claims that John's wife, Elizabeth, sent her spirit out to harm Abigail.  Both Elizabeth and John know that "[Abigail] thinks to take [Elizabeth's] place" and get John all to herself.  Thus, Abigail consciously and callously accuses innocent people of witchcraft, knowing that they will be hanged, for her own selfish and greedy purposes.  She is basically a murderer, and we cannot excuse this just because she's had a difficult childhood.

What is tramadol?

History of Use

Tramadol was first synthesized in 1962 by the German pharmaceutical company Grünenthal. Tramadol has been in clinical use in Germany since 1977. Originally marketed as a safe painkiller with a low risk of abuse, tramadol became the most prescribed opioid on the European market. It was introduced to the prescription drug market in the United States in 1995 as Ultram, a nontraditional, centrally acting analgesic. Tramadol has a nonscheduled status, meaning it has a low potential for abuse.

Tramadol produces pleasurable sensations and relaxation without increased drowsiness, enabling people to remain productive while managing pain. It is an easily available opiate and can be habit forming because of its morphine-like properties. Because of reports of increased tramadol misuse, it has been labeled a drug of concern by the US Food and Drug Administration and thus requires additional label warnings. Some US states have classified tramadol as a controlled substance.

Effects and Potential Risks

Tramadol is a nontraditional, centrally acting opioid analgesic with morphine-like pain-relieving activity. It has a dual mechanism of pain relief because it includes a mixture of enantiomers.

Studies suggest that tramadol activity is mediated through both opioid and non-opioid or monoaminergic mechanisms. It exhibits opioid activity by binding to specific opioid receptors in the brain that decrease pain perception. Monoaminergic activity is displayed by inhibiting the reuptake of norepinephrine and serotonin, neurotransmitters responsible for altering pain response in the brain.

The short-term effects of tramadol include feelings of euphoria, mood elevation, and relaxation. Tramadol is usually well tolerated but can be associated with negative short-term effects, including nausea, vomiting, constipation, drowsiness, dizziness, vertigo, weakness, and headache.

Long-term use of tramadol can be associated with drug dependence and possible addiction. Abruptly stopping tramadol may generate opiate-like withdrawal symptoms such as anxiety, agitation, sweating, abdominal upset, and hallucinations.

Bibliography

Grond, Stefan, and Armin Sablotzki. “Clinical Pharmacology of Tramadol.” Clinical Pharmacokinetics 43.13 (2004): 879–923. Print.

Raffa, Robert B. “Basic Pharmacology Relevant to Drug Abuse Assessment: Tramadol as Example.” Journal of Clinical Pharmacy and Therapeutics 33.2 (2008): 101–8. Print.

Senay, Edward C., et al. “Physical Dependence on Ultram (Tramadol Hydrochloride): Both Opioid-Like and Atypical Withdrawal Symptoms Occur.” Drug and Alcohol Dependence 69.3 (2003): 233–41. Print.

What are the similarities and differences between Of Mice And Men and The Glass Menagerie?

These two plays, besides being both authored by Americans, have very little in common.  Glass Menagerie is a family play, set in a small interior space, while Of Mice and Men is a play about a larger society, set in exteriors, mostly – farms and fields.  Furthermore, one play, Of Mice and Men, comes from the novel by John Steinbeck, while Tennessee Williams’ play is a play first, possibly autobiographical.  So let us look at some subtler similarities:  In both plays, sibling relationships play an important role:  Tom and Laura in Glass Menagerie, and George and Lennie in Of Mice and Men.  Both plays have a Southern U.S. setting, and both plays deal with future possibilities and hopes for the protagonists:  Tom’s hope to travel and have adventures, and George and Lenny’s desire to have a farm of their own.  Furthermore, both plays feature the inherent drama in “difference”:  Laura’s physical/emotional handicap and Lennie’s mental handicap.  Finally, the two plays have become staples in the American drama repertory, must-reads for any student of literature.

What sort of points could be given to back up the following statement? "Curley's wife is innocent."

Curley's wife is innocent because she is a victim and not a predator. She is lonely, she's more good looks than she is trouble, and she's harmless. First of all, Curley doesn't treat his wife with much trust or respect. They aren't really friends, either. He's always running around looking for her rather than tending to his duties. If he would treat her with more respect, and let her get out of the house once in awhile to do things with other women friends, he wouldn't be as suspicious of her getting with Slim or any other worker. Because of Curley's mistreatment of his wife, she wants to talk with other people; so, she settles for talking to the workmen to ease the loneliness.

When Curley's wife talks to the workmen, this causes great alarm among the workers; but, Curley's wife is just more good looks than she is trouble. She's a young girl who uses the excuse that she's out looking for her husband to have some interaction with other people. The men simply misunderstand how she presents herself because they find her attractive. For example, when George meets Curley's wife for the first time, her actions are described as follows:

"She put her hands behind her back and leaned against the door frame so that her body was thrown forward. . . Lennie's eyes moved down over her body, and though she did not seem to be looking at Lennie she bridled a little" (31).

Her body language may seem to be provocative, but it's Lennie who possibly has the tempting thoughts. Men always place the blame on women being dangerous rather than taking responsibility for their own thinking. She's not throwing herself at them; she's merely standing by the door. There's no evidence to show that Curley's wife ever asked anything inappropriate from any of the men. Therefore, she's just pretty, not trouble.

Finally, Curley's wife is harmless. She makes some good threats on the night all the men are gone and she's talking to Crooks, Lennie and Candy; but she doesn't go through with them. She made those threats to Crooks, mostly, so he would back down. But she's the only one who is really gentle and kind to Lennie. Curley's wife just really wants a friend, so when she talks to Lennie, she is kind and shows a true spirit of trust with him.

What are malignant tumors?

Related conditions:
Most cancers

Definition:

Malignant tumors are those that invade surrounding tissue. Commonly known as cancer, cells of malignant tumors are abnormal in morphology, tend to be larger than normal, and have odd shapes and large and irregular nuclei. By entering into the bloodstream or the lymphatic system, these cells spread to surrounding tissue, where they damage the tissues and organs. A sarcoma is a cancer of the connective tissue, and carcinomas are of epithelial origin. Malignant tumors are named using the Latin or Greek root of the organ of origin as a prefix and “sarcoma” or “carcinoma” as the suffix. For example, a malignant tumor of the liver is called hepatocarcinoma; a malignant tumor of the fat cells is called liposarcoma.

Risk factors: The most common risk factors for development of malignant tumors include tobacco use; exposure to ultraviolet (UV) radiation, ionizing radiation, certain chemicals, and viruses; and family history.

Etiology and the disease process: A mutated cell that continues to divide is a hallmark of cancer. The deoxyribonucleic acid (DNA) repair mechanisms are damaged, and the immune system is compromised such that the tumor cells rapidly multiply undeterred. Additionally, the tumor has an extensive vasculature that provides nutrients and oxygen for its growth.

Symptoms: Unusual bleeding or discharge, a change in the shape or coloration of a wart or mole, a sore throat that does not heal, unexplained weight loss, persistent cough, and anemia are some warning signs. Many symptoms are caused by the fatigue, pain, and stress imposed on the body by malignant tumors.

Screening and diagnosis: X rays, ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) scans are used to detect changes in tissues or organs, and blood tests are used to monitor abnormal cell counts. Presence of tumor markers such as prostate specific antigen (PSA), carcinoembryonic antigen (CEA), and human chorionic gonadotropin hormone in the blood are used to screen high-risk individuals.

Treatment and therapy: Malignant tumors can be removed before they metastasize (spread), but frequently they grow back. Besides a person’s age, general health, and response to treatment, the outcome depends on the type and location of the cancer, the stage of the disease (the extent to which the cancer has spread), or its grade (how abnormal the cancer cells look and how quickly the cancer is likely to grow and spread). Treatment includes surgery, radiation therapy, chemotherapy, hormone therapy, or biological therapy. However, most often a combination of therapies is required for complete eradication of the malignancy. Choice of a healthy, active, tobacco-free lifestyle with a minimum exposure to harmful UV rays can go a long way in preventing cancer.

Baykal, Can, and K. Didem Yazganoglu. Clinical Atlas of Skin Tumors. New York: Springer, 2014. Print.

Bloch, Orin, and Franco DeMonte, eds. Neurosurgery Clinics of North America: Malignant Tumors of the Skull Base 24.1 (2013): 1–142. Print.

Fletcher, Christopher D. M. Diagnostic Histopathology of Tumors. 4th ed. Philadelphia: Saunders-Elsevier, 2013. Print.

Gomez, Dhanwant, and Dileep N. Lobo. "Malignant Liver Tumours." Surgery 29.12 (2011): 632–39. Print.

Kaye, Andrew H., and Edward R. Laws, Jr. Brain Tumors: An Encyclopedic Approach. 3rd ed. New York: Saunders-Elsevier, 2012. Print.

What is the principle and working of a pressure cooker?

Cooking with a pressure cooker uses the principles of various gas laws, but specifically the Gay-Lussac's Law. This law states that the pressure of a system and the temperature are directly related; that is, if we can increase the pressure of a given system, the resulting temperature will be higher than that of a system with lower pressure but the same heat applied.

Using a pressure cooker takes advantage of this fact. A pressure cooker is essentially a strong, well-sealed pot. It has a very small vent for safety, but the pressure inside the cooking area is increased as the liquid inside turns to steam. The temperature of the fluid inside is raised to higher than boiling (212 degrees F.), higher than what could be reached in a saucepan, with the result that the food inside cooks more quickly.

After Dill wonders aloud what Boo Radley looks like, how does Jem describe Boo based on his imagination in Haper Lee's To Kill a Mockingbird? What...

In the opening chapter of Harper Lee's To Kill a Mockingbird, Dill becomes obsessed with Arthur (Boo) Radley the moment Scout and Jem inform him of their neighborhood enigma, whom the children call Boo Radley. Scout describes Dill as frequently standing with his arm around the light-pole positioned on the street corner near the Radleys' property and wondering about Boo Radley. At one point, Dill wonders aloud, "Wonder what he looks like?"

In response, Jem lets his imagination run wild. He describes Boo as being "six-and-a-half feet tall," pop-eyed, having a "long jagged scar" across his face, and rotten yellow teeth. Jem further describes Boo as eating any raw animals he can catch such as squirrels and cats. Jem's description of Arthur Radley evokes the image of a monster.

Though Jem's description comes entirely from his own imagination, it appears to have been influenced by things he has read. Since he is an avid reader of classics like Ivanhoe, as we see later in Chapter 11, it can be assumed he has also read Mary Shelley's Frankenstein and has derived inspiration from Shelley's monster creation to invent his own Boo Radley. We particularly see Shelley's influence in Jem's description of Boo having a scar across his face, since Shelley describes the creature Dr. Frankenstein developed as having scars across its face due to the fact that the it is made up of multiple parts stitched together. Otherwise, fascinatingly, Jem describes Boo in the exact opposite way Shelley describes Dr. Frankenstein's creature. For example, Jem says Boo eats animals raw, whereas Dr. Frankenstein's creature is actually a vegetarian. Plus, Jem describes Boo as having rotten yellow teeth, whereas Shelley describes the creature as having pearly white teeth, one of its only attractive characteristics. Due to these opposing images, we can speculate that Jem drew inspiration from Shelley and just changed the details that suited his own imaginings of what a monster should really be like.

What does it mean to say that exchange rate pass-through is incomplete or complete?

Exchange-rate pass-through is the effect that when the international market changes so that a country's currency changes in value relative to others (the exchange rate), it will also affect prices within that country's economy (it "passes through").

Complete pass-through would mean that the change in exchange rate is directly tied to the change in local prices---if the dollar becomes 1% more valuable in international markets, prices will become 1% lower within the US. This almost never happens.

Incomplete pass-through is what actually occurs: Only part of the exchange rate change is reflected in local prices. Sometimes it's a large portion, close to complete pass-through; but usually it's a very small portion.

In fact as the papers I've linked show (be warned, they're actual peer-reviewed economics literature, so they are quite advanced), exchange-rate pass-through is so incompleteit's actually a bit of a mystery. It makes sense for a big rich country like the US; but even tiny poor countries like Nicaragua still see only very weak pass-through of their exchange rates. Something is in effect "shielding" local prices from international exchange rate changes.

How would you describe Lakunle from Wole Soyinka's The Lion and the Jewel?

Lakunle is the village school teacher who opposes traditional Yoruba culture in favor of modern Western civilization. He continually criticizes Sidi, Baroka, and Sadiku for their way of life. At the beginning of the play, he tells Sidi, "Only spiders carry loads the way you do" when he sees her walking with a pail of water on her head, which is the traditional African way villagers transported water (Soyinka 2). Lakunle knows that he is ostracized and ridiculed by the villagers for his modern views but is unapologetic and arrogant. He says to Sidi,

"For that, what is a jewel to pigs? If now I am misunderstood by you and your race of savages, I rise above the taunts and remain unruffled" (Soyinka 3).

In his support of modernity, Lakunle refuses the pay Sidi's bride-price, claiming that it is a savage custom. Regarding the bride-price, he says, "An ignoble custom, infamous, ignominious shaming our neighbors our heritage before the world" (Soyinka 7). Lakunle is also clumsy and sounds like a fool by trying to impress people with his "big words." He is also a hopeless romantic. When he talks to Sadiku about the future of Ilujinle, he says,

"Within a year or two, I swear, this town shall see a transformation, bride-price will be a thing forgotten, and wives shall take their place by men. A motor road will pass this spot and bring the city ways to us. We'll buy saucepans for all the women; clay pots are crude and unhygienic. No man shall take more wives than one. That's why they're impotent too soon. The ruler shall ride cars, not horses. Or a bicycle at the very least. We'll burn the forest, cut the trees, then plant a modern park for lovers" (Soyinka 37).

Despite Lakunle's apparent affinity for Western civilization and modernity, he attempts to manipulate the traditional custom to his benefit. After learning that Sidi is no longer a virgin, he says to her, "But you will agree, it is only fair that we forget the bride-price totally since you no longer can be called a maid" (Soyinka 60). Lakunle's comments reveal his true intentions and portray him as an insincere individual.

What are intersex conditions?

Early Human Sexual Development

Up to the ninth week of gestation, the external genitalia (external sexual organs) are identical in appearance in both male and female human embryos. There is a phallus that will become a penis in males and a clitoris in females and labioscrotal swelling that will become a scrotum in males and labial folds in females. Sexual differentiation into a male or female is governed by his or her sex chromosomes (the X and Y chromosomes) and hormones. An individual who has two X chromosomes normally develops into a female, and one who has one X and one Y chromosome normally develops into a male. It is the Y chromosome that determines the development of a male. The Y chromosome causes the primitive gonads (the gonads that have not developed into either an ovary or a testis) to develop into testes and to produce testosterone (the male sex hormone). It is testosterone that acts on the early external genitalia and causes the development of a penis and scrotum. If testosterone is not present, or the receptors for it are lacking, regardless of the chromosome constitution of the embryo, female external genitalia will develop.

Intersexuality: Causes and Effects

Intersex individuals have both male and female gonads. At birth, intersex individuals can have various combinations of external genitalia, ranging from completely female to completely male genitalia. Many intersex individuals have external genitalia that are ambiguous (genitalia somewhere between normal male and normal female) and may consist of what appears to be an enlarged clitoris or a small penis, hypospadias (a urinary tract opening at the base of or along the penis or scrotum instead of the tip), and a vaginal opening. The extent to which the genitalia are masculinized depends on how much testosterone was produced and received by the testicular portion of the gonads during development. The gonadal structures of an intersex individual can range from a testis on one side and an ovary on the other side, to testes and ovaries on each side, to an ovotestis (a single gonad with both testicular and ovarian tissue) on one or both sides.

Intersexuality has different causes. The chromosomal or genotypic sex of an intersex individual can be 46,XX, 46,XY, 45 XO (Turner syndrome), 47,XXX (triple X), or 47 XXY (Klinefelter syndrome). Chromosomal mutations can cause intersexuality. The absence or dysfunction of the SRY locus produces an individual with normal female genitalia but a 46,XY karyotype. Individuals with a 46,XX karyotype who have the SRY locus transposed to one of their X chromosomes will have a normal male appearance. Likewise, the genes WT1, SOX9, and SF1 are necessary for normal testicular development.

Some affected individuals have different types of mosaicism, such as 46,XX/47,XXY or 45,X/46,XY. Individuals with a 46,XX/46,XY karyotype are known as chimeras. Chimerism usually occurs through the merger of two different cell lines (genotypes), such as when two separate fertilized eggs fuse together to produce one embryo. This can result in a single embryo with some cells being 46,XX and some being 46,XY. Mosaicism means having at least two different cell lines present in the same individual, but the different cell lines are caused by losing or gaining a chromosome from some cells early in development. An example would be an embryo that starts out with all cells having a 47,XXY chromosome constitution and then loses a single Y chromosome from one of its cells, which then produces a line of 46,XX-containing cells. This individual would have a karyotype written as 46,XX/47,XXY. In a chimera or mosaic individual, the proportion of developing gonadal cells with Y chromosomes determines the appearance of the external genitalia. More cells with a Y chromosome mean that more testicular cells are formed and more testosterone is produced.

Hormones also play a part in determining the sex of an individual. Abnormalities of testosterone production or abnormalities in the testosterone receptor at the cellular level can cause 46, XY intersex (formerly called "male pseudohermaphroditism"). One example is a deficiency in 5-alpha-reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT). When there is a deficiency of this enzyme, there will be a deficiency of DHT, which is the hormone primarily responsible for masculinization of external genitalia. An individual who is genetically male but lacks DHT will have female-appearing external genitalia or ambiguous genitalia at birth. Often these individuals are reared as females, but at puberty they will masculinize because of greatly increased production of testosterone. These individuals may actually develop into nearly normal-appearing males. Abnormalities of the testosterone receptor, known as androgen insensitivity syndrome, can also result in a range of different conditions in affected males, from normal female appearance (a totally defective receptor) to ambiguous genitalia (partially defective receptor). These individuals will not masculinize at puberty because no matter how much testosterone or DHT they produce, their bodies cannot respond to the hormones. Similarly, deficiency in aromatase (an estrogen-producing enzyme), overproduction of androgen due to congenital adrenal hyperplasia, and in utero exposure to testosterone can cause 46, XX intersex (formerly "female pseudohermaphroditism").

The cause of intersexuality in the majority of affected individuals is unknown, although it has been postulated that those intersex individuals with normal male or female karyotypes may have hidden chromosome mosaicism in just the gonadal tissue.

Impact and Applications

Intersex individuals with ambiguous genitalia are normally recognized at birth. It is essential that these individuals have a thorough medical evaluation, since some causes of ambiguous genitalia, such as congenital adrenal hyperplasia, can be life-threatening if not recognized and treated promptly. Once intersexuality is diagnosed in a child, the decision must be made whether to raise the child as a boy or a girl. This decision is made by the child’s parents working with specialists in genetics, endocrinology, psychology, and urology. Typically, the karyotype and appearance of the external genitalia of the child are the major factors in deciding the sex of rearing. Previously, most intersex individuals with male karyotypes who had either an absent or an extremely small penis were reared as females. The marked abnormality or absence of the penis was thought to prevent these individuals from having fulfilling lives as males. This practice has been challenged by adults who are 46,XY but were raised as females. Some of these individuals believe that their conversion to a female gender was the wrong choice, and they prefer to think of themselves as male. Intersex individuals with a female karyotype and normal or near-normal female external genitalia are typically reared as females.

The debate over what criteria should be used to decide sex of rearing of a child is ongoing. An increasingly important part of this debate is the concept of gender identity, which describes what makes people male or female in their own minds rather than according to what sex their genitalia are. This is an especially important issue for those individuals with chimerism or mosaicism who have both a male and female karyotype. The decision to raise these individuals as boys or girls is made primarily on the basis of the degree to which their external genitalia are masculinized or feminized.

Those intersex individuals who have normal female or male genitalia at birth are at risk for developing abnormal masculinization in the phenotypic females or abnormal feminization in the phenotypic males at puberty if both testicular and ovarian tissue remains present. Thus, the gonad that is not specific for the assigned sex of the individual may be surgically removed. Gonadal tissue may be also removed because the cells of the gonad(s) that have a 46,XY karyotype are at an increased risk of becoming cancerous. Medical professionals increasingly recommend that surgeries, other than those necessary for urinary function, be delayed until the affected individual is old enough to have input in the decision-making process.

Key terms




ambiguous genitalia


:

external sexual organs that are not clearly male or female




genotype

:

an organism’s complete set of genes




gonad

:

an organ that produces reproductive cells and sex hormones; termed ovaries in females and testes in males




karyotype

:

a description of the chromosomes of an individual’s cells, including the number of chromosomes and a physical description of them (normal female is 46,XX and normal male is 46,XY)




phenotype

:

the physical and biochemical characteristics of an individual based on the interaction of genotype and environment





Bibliography

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Gilbert, Ruth. Early Modern Hermaphrodites: Sex and Other Stories. New York: Palgrave, 2002. Print.

Harper, Catherine. Intersex. New York: Berg, 2007. Print.

Holmes, Morgan. Intersex: A Perilous Difference. Selinsgrove: Susquehanna UP, 2008. Print.

Hunter, R. H. F. Sex Determination, Differentiation, and Intersexuality in Placental Mammals. New York: Cambridge UP, 1995. Print.

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Moore, Keith L., T. V. N. Persaud, and Mark G. Torchia. The Developing Human: Clinically Oriented Embryology. 9th ed. Philadelphia: Saunders/Elsevier, 2013. Print.

Preves, Sharon E. Intersex and Identity: The Contested Self. 2003. New Brunswick: Rutgers UP, 2005. Print.

Reis, Elizabeth. Bodies in Doubt: An American History of Intersex. Baltimore: Johns Hopkins UP, 2012. Print.

Simpson, J. L. “Disorders of the Gonads, Genital Tract, and Genitalia.” Emery and Rimoin’s Principles and Practice of Medical Genetics. Ed. David L. Rimoin, Reed E. Pyeritz, and Bruce R. Korf. 6th ed. San Diego: Elsevier Science, 2007. Print.

Zucker, Kenneth J. “Intersexuality and Gender Identity Differentiation.” Annual Review of Sex Research 10 (1999): 1–69. Print.