What is the distance between crests of a wave called?

The highest point on a wave is called its crest, while the lowest point is known as the trough. Waves are characterized by a number of parameters, including wavelength, frequency, and amplitude. The distance between any two successive crests is known as the wavelength. It is the same as the distance between any two successive troughs. In fact, the distance between the same point on any two successive waves is the same distance as the wavelength. Since wavelength is a distance, it has the units of length—that is, meters, feet, etc. Wavelength is generally denoted by the symbol `lambda` . 

This definition of wavelength is valid for transverse waves. In case of longitudinal waves, wavelength is the distance between any two successive compressions or rarefactions.

Hope this helps.

What is whooping cough?

Causes and Symptoms

The etiological agent of whooping cough is Bordetella pertussis, a small, gram-negative, rod-shaped bacterium. A similar organism, Bordetella parapertussis, causes a less severe form of the disease. Symptoms and tissue damage are the result of a toxin secreted by the organism.

The diagnosis of pertussis is primarily clinical, based on the characteristic whoop that accompanies the paroxysmal stage. The most definitive diagnosis involves the actual isolation of the organism. Most pathogenic strains of Bordetella are fastidious in their requirements. Nasal swabs from the patient are obtained, with the organism grown on a special Bordet-Gengou medium.

The clinical manifestation of whooping cough is arbitrarily divided into the catarrhal, paroxysmal, and convalescent stages. The average incubation period following exposure is about seven days. During this period, the patient develops a dry cough, often accompanied by sneezing. A mild fever may be present. Early symptoms resemble those of bronchitis or influenza.

The severity of the cough gradually increases over the next ten to fourteen days; it may be triggered by exercise or even eating. As the patient enters the paroxysmal stage, the cough becomes deeper and more pronounced. It is often characterized as a series of short bursts, followed by a whooping sound as the patient attempts to inhale; the sound itself is caused by possible spasm of the epiglottis.

Large quantities of mucus may be expelled during the coughing spells, which in severe cases may occur forty to fifty times a day. The patient may exhibit dyspnea and become cyanotic from lack of air. In infants, choking is common during this stage and can prove fatal. The severity of the cough has also been known to result in hemorrhaging from the throat.

The paroxysmal stage of the disease lasts from four to six weeks. Gradually, the cough disappears as the patient enters the convalescent stage. The entire period of illness may last ten weeks, with the cough persisting for months afterward; coughing may recur during another respiratory illness.

The disease is highly contagious, with the agent passing from person to person by means of respiratory droplets. The patient is most infectious during both the catarrhal stage and the early portion of the paroxysmal stage, a period lasting two to three weeks.

Treatment and Therapy

Routine treatment of whooping cough consists of bed rest and the provision of adequate food and water. Infants are most at risk and are generally hospitalized. The administration of oxygen may be helpful in the relief of dyspnea and cyanosis. If there is prolonged vomiting, intravenous therapy may be necessary. Administration of corticosteroids has also been shown to ameliorate the severity of the cough.

Because paroxysmal symptoms are associated with production of a toxin secondary to the initial infection, antibiotics are of little help. An antibiotic such as erythromycin, however, may be administered to reduce secondary infections or to limit transmission to other persons. If erythromycin is administered early during the development of the disease, during the incubation period, or even during the first week of the catarrhal stage, it may prevent the disease or limit its severity. Persons coming into contact with the patient should also receive a course of antibiotic treatment.

Immunoglobulin is available, but its effectiveness is in dispute. Active immunization with pertussis vaccine is recommended to protect against the initial infection. Usually, this is a portion of the DTaP vaccine administered in a series of injections beginning at about two months of age.

Perspective and Prospects

The earliest known description of whooping cough was that by G. Baillou in 1578. It was Robert Watt, an English physician, who in 1813 provided the first complete clinical description of the disease. Watt also described the results of autopsies that he had performed on children who had died of the disease during his thirty years of observations; two of these children were his own. Watt also noted the highly contagious nature of whooping cough.

In 1906, Jules Bordet and his brother-in-law, Octave Gengou, isolated the infectious agent from the sputum of Bordet’s son, who had contracted the disease. Known initially as Haemophilus pertussis, the organism was eventually renamed Bordetella pertussis after its discoverer. Bordet also determined that the virulent nature of the disease resulted from the production of a toxin. The special substance needed to grow the organism in the laboratory became known as Bordet-Gengou medium.

Initial attempts to develop a pertussis vaccine by Bordet and Gengou using inactivated toxin were largely unsuccessful. In the 1940s, however, an inactivated whole cell suspension was introduced and proved effective in immunizing children against the disease. In the United States, the pertussis vaccine was combined with inactivated diphtheria and tetanus preparations into a trivalent vaccine, DPT, that proved effective in immunizing children against all three diseases simultaneously.

Because of side effects in some children receiving the pertussis preparation, such as fever, vomiting, and mild seizures, questions developed as to the safety of the vaccine. In 1997, a new vaccine, DTaP, was introduced after researchers learned it was much less likely to cause the adverse reactions found with the DPT vaccine. The a in DTaP stands for “acellular,” which means there are no whole bacteria in the vaccine. While the DPT vaccine uses whole, inactivate pertussis bacteria, the DTaP uses only the parts of the bacteria that help children develop immunity to it. Since human beings represent the only reservoir of whooping cough, the disease may eventually face eradication.

Bibliography

Alan, Rick, and Brian Randall. "Whooping Cough." Health Library, Nov. 26, 2012.

Cohen, Jonathan, et al, eds. Infectious Diseases. 3d ed. St. Louis, Mo.: Mosby, 2010.

Kliegman, Robert M., et al, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders/Elsevier, 2011.

Larsen, Laura. Childhood Diseases and Disorders Sourcebook: Basic Consumer Health Information About Medical Problems Often Encountered in Pre-adolescent Children. 3d ed. Detroit, Mich.: Omnigraphics, 2012.

"Pertussis (Whooping Cough)." Centers for Disease Control and Prevention, May 7, 2013.

"Pertussis (Whooping Cough) – What You Need to Know." Centers for Disease Control and Prevention, May 8, 2013.

Ryan, Kenneth J., and C. George Ray, eds. Sherris Medical Microbiology: An Introduction to Infectious Diseases. 4th ed. New York: McGraw-Hill, 2004.

"Whooping Cough." MedlinePlus, May 21, 2013.

Woolf, Alan D., et al., eds. The Children’s Hospital Guide to Your Child’s Health and Development. Cambridge, Mass.: Perseus, 2002.

What is the thematic statement or life lesson learned from The Land of the Dead in The Odyssey?

When Odysseus has an opportunity to speak with Achilles in the underworld, Achilles questions him about why he would dare to come to the land of the dead because it is not a place for the living.  Odysseus tells Achilles not to worry too much about being dead because, Odysseus assures him, he is as revered and respected as any of the immortal gods as a result of his deeds during his life.  Achilles, however, sets him straight, saying that it would be far better to live a lowly and insignificant life than to be the most revered of the dead.  In so saying, Achilles conveys the idea that life is precious and any life, even an inconsequential one, is better than being dead.

In Incidents in the Life of a Slave Girl, the author shows that the slave masters often did which of the following? A. Lied in order to make the...

Harriet Jacobs continually proves that the answer to your question is most definitely that masters lie to inspire fear in their slaves.  One of the quotations that proves this is as follows:

Ah, if he had ever been a slave he would have known how difficult it was to trust white men.

While this quotation proves that masters lie, Harriet Jacobs also proves that these lies inspire fear through examples from the book.  For example, at one point Dr. Flint "swore" that he would end Linda's life if she "was not not as silent as the grave" about his sexual advances.  Later Dr. Flint verbally abuses Linda again and asks Linda if she would "like to be sent to jail for your insolence."  This was yet another empty threat given by Dr. Flint.  His continual lies prove that the answer to your question is most definitely "A."

Why is it necessary to use a safety valve before heating is stopped?

There is an old saying in chemical labs: never heat a closed system.  If you are heating up a glassware system or a metal container system to perform a chemical reaction at high temperatures and the system is sealed up gas-tight to the atmosphere, then as the chemicals and gasses inside the system are heated up they will expand.  If there is no place for this excess volume to fill other than the existing rigid system, there will be pressure put against the system walls.  In the case of glassware, most of it is not designed to operate under pressure so you run the risk of glass shards exploding which is obviously a dangerous situation.  If you are heating up a metal system that is designed to operate under pressure, it is usually designed to safely operate under a certain pressure limit.  If the pressure exceeds this limit for any reason, then there can be a dangerous explosion.  A safety valve allows for a controlled emergency release of pressure before an explosion can occur.  It is an important safety feature of closed, pressurized chemical systems.

Why doesn't Maniac Magee want to go to school in the book Maniac Magee?

As a little boy, Maniac Magee went to school like other children his age. When he ran away from his aunt and uncle's house, he left school behind. He did not return when he arrived in Two Mills.

When Grayson asks Maniac about going to school, the boy tells him that he refuses to go. Grayson asks him why. Ever since Maniac left his aunt and uncle's house, he had yearned for a home and an address of his own. To Maniac,

a school seems sort of like a big home, but only a day home, because then it empties out; and you can't stay there at night because it's not really a home, and you could never use it as your address, because an address is where you stay at night, where you walk right in the front door without knocking, where everybody talks to each other and uses the same toaster.

Maniac knows that if he goes to school in Two Mills, at the end of the day he will have no home to return to. The other children will go back home after school gets out each day. Maniac would be the only one with no home to return to. He decides that he will not attend school until he has a home to go back to at night.

How do mental health issues affect women?

Introduction

During their lifetimes, women undergo multiple biological and psychological changes involving hormonal fluctuations, childhood trauma, physical and emotional stress, and role changes. Combined with genetic dispositions and environmental factors, these events can result in mental diseases such as depression, schizophrenia, and bipolar disorder.

During their lifetimes, women undergo multiple biological and psychological changes involving hormonal fluctuations, childhood trauma, physical and emotional stress, and role changes. Combined with genetic dispositions and environmental factors, these events can result in mental diseases such as depression, schizophrenia, and bipolar disorder.

Depression, in particular, is highly prevalent in women, with women having twice the incidence of depression as men do. The menstrual cycle, pregnancy, infertility, childbirth, and menopause are associated with depression in women. Although there are many studies examining possible links between abnormalities in sex hormone levels and depression, no conclusive relationships have been established. In the absence of identifiable markers and biochemical diagnostic tests, practitioners have to rely on careful evaluation of symptoms and the taking of medical and mood histories. A variety of diagnostic tools are available to aid in the collection of this information. For women suspected of having depression related to the menstrual cycle, childbirth, or menopause, records of how their moods and symptoms fluctuate over time are important for diagnosis.

Unlike depression, schizophrenia and bipolar disorder are equally prevalent in men and women. However, these diseases may manifest differently in women and men. There are a variety of pharmacological and cognitive and behavioral treatment options for women with mental disorders. In some cases, treatment with a single therapy works well, and in other cases, a combination of different therapies results in optimal outcomes.

Prevalence and Causes of Depression

Majordepressive disorder, which affects twice as many women as men, is characterized by decreased energy, reduced concentration, loss of interest or pleasure in activities that an individual used to enjoy, feelings of hopelessness, and disordered sleep (sleeping too much or too little). Some depressed patients may also have suicidal thoughts. Depression in women may be triggered by hormonal changes, stressful events, and seasonal fluctuations. Apart from the psychological effects, depression also causes problems in work and social functioning and is associated with comorbid diseases and a 10 to 15 percent suicide rate. Although depression has many causes, with both biological and environmental influences, there are specific conditions in women that are associated with especially high rates of depression. These conditions include the experience of childhood trauma, the presence of certain personality traits, hormonal changes associated with the menstrual cycle, infertility, the aftermath of giving birth (postpartum), and the experiences of entering into and undergoing menopause.

Women are more likely than men to experience childhood trauma such as childhood sexual abuse, which predisposes for adult depression. Certain personality traits such as strong interpersonal sensitivity and a more passive, ruminative type of coping are more prevalent in women and are also associated with depression. Some women experience depressive symptoms, mood fluctuations, and social and work impairment in the ten days before the onset of menses. This condition, termed premenstrual dysphoric disorder, is gaining recognition as a bona fide mood disorder separate from major depression. Infertility is an increasingly prevalent condition in women, with a 1995 study reporting 6.1 million infertile women aged fifteen to forty-four and 9.3 million women using infertility services in the United States. This condition is frequently associated with symptoms of depression and anxiety. Women experiencing infertility report twice the depression rates of fertile women. For women undergoing in vitro fertilization (IVF), depression appears to fluctuate with the phases of the IVF cycle. Depression rates are particularly high after a failed IVF attempt, with a high percentage (13 percent) of women having thoughts of suicide. Postpartum depression occurs in 8 to 22 percent of women, depending on the diagnostic method used. Women with a history of depression and other psychiatric illnesses, teenage mothers, and mothers living in poverty are more prone to developing postpartum depression, with the latter two groups having incidence rates of approximately 26 percent and 27 percent, respectively. The causes of postpartum depression are unclear; although there are many hypotheses and some circumstantial evidence about the role of abnormal sex hormone levels (cortisol is elevated and serum thyroid hormone suppressed in women with postpartum depression), there is a lack of reproducible and conclusive studies.

Menopause
is a process that stretches out over a number of years. Perimenopause starts one year before a woman’s last period and ends one year after her last period. When the woman has gone one year without a period, she can be referred to as postmenopausal. Perimenopausal and postmenopausal women experience hormonal changes, resulting in a wide range of physical and emotional symptoms. One of these symptoms is depression, which is especially common in women with a history of depression. This may be due to the reduced levels of estrogen and other sex hormones in menopausal women.

Diagnosis of Depression

To treat women with depression, accurate diagnosis is essential. An important consideration in diagnosis is that depression manifests differently in men and women, with depressed women having more abnormal eating problems (either loss of appetite or overeating), anxiety, and atypical symptoms, while depressed men have higher rates of substance and alcohol abuse as well as higher rates of completed suicide. Women also tend to have longer depressive episodes and are more likely to have chronic or recurrent depression. Physicians make use of information such as a patient’s symptoms and history of depression and other psychiatric disorders, as well as the patient’s past responses to medications to make a diagnosis of depression. Diagnostic tools may help in the process of obtaining important information and making an accurate diagnosis.

One tool that is especially conducive to the primary care setting, where there is limited time for patient evaluations, is the two-question depression screen. This consists of the following two questions:

•In the last month, have you lost pleasure in the activities you normally enjoy?

•In the last month, have you felt sad, down, depressed, or hopeless?

If the answer is yes to both questions, the patient is considered positive by this depression screen and is likely to be depressed. Additional information should be obtained to make a definitive diagnosis of major depression.

Other, more complex diagnostics tools include the BATHE technique, the SIG-E-CAPS system, and the PHQ-9 questionnaire. The BATHE technique includes questions about life events, emotions, what is troubling the patient most, and the patient’s methods for dealing with these emotions. The last component of the BATHE technique is empathizing with the patient. The SIG-E-CAPS system determines the degree to which a patient is experiencing each of the diagnostic symptoms of depression, according to the American Psychiatric Association’s Diagnostic and Statistic Manual of Mental Disorders: DSM-5 (5th ed., 2013). The PHQ-9 contains nine questions and allows the severity of depression to be determined.

For depression occurring in specific conditions, additional symptoms and characteristics may be helpful in establishing an accurate diagnosis. Postpartum depression usually occurs in the first month postpartum and remains through the first six months postpartum, after which symptoms tend to lessen and resolve. Symptoms of postpartum depression include fatigue, sleep problems, decrease in libido, and disruptions in appetite, features that are commonly mistaken as part of the normal course of childbirth and the postpartum period. Rating scales such as the Edinburgh Postnatal Depression Rating Scale and the Postpartum Depression checklist may be helpful in diagnosing postpartum depression.

Treatment Options for Depression

Once a diagnosis of depression is made, appropriate treatment can be initiated. Depression may be treated with various medications, including those that block the reuptake of specific neurotransmitters. This class of agents includes selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Older antidepressants such as monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) may also be used, although these therapies are accompanied by more adverse effects than are SSRIs and SNRIs. There is some evidence that women respond more slowly to antidepressants than men do, and that women respond better to treatment with SSRIs, SNRIs, and MAOIs than to treatment with TCAs. Whenever antidepressants are used to treat depression, three factors are important in ensuring successful treatment outcomes: sufficient length of treatment, adequate antidepressant dose, and frequent monitoring for symptomatic or functional improvement. In addition, antidepressant treatment may be combined with psychotherapy, cognitive behavior therapy, or both if patients do not respond completely to antidepressants alone. Cognitive behavior therapy has also been shown to maintain remission and prolong the time to relapse in patients who have responded well to antidepressants.

There are additional considerations that need to be considered when treating depression in specific groups of women. Treatment with estrogen appears to improve depressive and physical symptoms in perimenopausal and postmenopausal women, but more research is required to confirm this benefit. The addition of estrogen therapy also appears to boost the response of perimenopausal women to SSRIs but not to SNRIs. In postmenopausal women, on the other hand, evidence suggests that SNRIs may promote remission more effectively than SSRIs. However, because of the potential risks of estrogen treatment, risk-benefit assessments need to be determined for each patient before initiating estrogen therapy. Prophylactic antidepressant treatment has been used in women who have given birth and who have a history of postpartum depression or recurrent depression.

Prevalence and Causes of Schizophrenia

Schizophrenia is a disease in which internal realities are separated from external realities, and thought is separated from perception. The behavior of schizophrenics appears to be motivated by inner demons that confuse senses, disrupt logical thinking, and interfere with social functioning. There is an equal incidence of schizophrenia in women and men, but the peak age of onset differs between the genders. Schizophrenia is most likely to develop in men between the ages of seventeen and twenty-seven. In women, the peak onset of schizophrenia occurs three to four years later than in men, followed by another peak around menopause. Schizophrenia afflicts all ethnic groups and social classes, although it appears to be more prevalent among people of lower socioeconomic status. Although there appears to be a genetic component, with children of schizophrenic parents having a 35 percent probability of developing the disease, cases have been reported in people who lack a family history of schizophrenia. External factors that have been suggested to play a role in schizophrenia onset include complications in birth and pregnancy, in utero exposure to a viral agent, and influenza infection. Another factor that has been recently linked to schizophrenia in women is reduced estrogen levels. Reduced estrogen and androgen levels in men have also been associated with more severe schizophrenia symptoms.

Diagnosis of Schizophrenia

Symptoms of schizophrenia can generally be classified as either positive symptoms, which are the result of an excess or abnormality of normal functions, or negative symptoms, which are the result of attenuation or loss of normal functions. Positive symptoms include hallucinations (visual, auditory, or olfactory), delusions, disjointed speech, and loss of logical association. Negative symptoms include apathy, poverty of speech (reduced speech and decreased vocabulary), social withdrawal, blunted or inappropriate emotional responses, and dysphoric mood (depressed, anxious, or irritable). The DSM-IV diagnostic criteria for schizophrenia include having two or more positive symptoms for at least one month, unless hallucinations or delusions are particularly bizarre, in which case only one positive symptom is required. Negative symptoms are harder to diagnose, because they are an absence or reduction in normal functioning. This is especially true in treated schizophrenic patients, in whom an adverse effect of antipsychotics may be a blunted affect.

Treatment Options for Schizophrenia

The most frequently prescribed treatments for schizophrenia are
antipsychotics, both the first-generation antipsychotics, such as haloperidol (Haldol), and the newer atypical antipsychotics, including aripiprazole (Abilify), clozapine (Clorazil), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon, Zeldox), and paliperidone (Invega). The newer atypical antipsychotics generally cause fewer extrapyramidal side effects (EPS), which include repetitive, involuntary movements, and prolactin elevation, which are major adverse effects that plague the first generation antipsychotics. Atypical antipsychotics, however, are associated with weight gain, hyperglycemia, and insulin resistance, with varying effects depending on the particular drug. When treated with the appropriate psychopharmacological regimens, schizophrenia can be effectively controlled, with only 10 to 15 percent of patients suffering a relapse. Without treatment, 65 to 70 percent of schizophrenic patients suffer relapses. Cognitive behavioral therapy has not been used to much success in treating schizophrenia. Women with schizophrenia may also benefit from estrogen therapy administered together with their regular medications for schizophrenia. In a study conducted in Melbourne, Australia, schizophrenic women were treated with either a combination of estradiol (a type of estrogen) administered through the skin and oral antipsychotics, or with antipsychotics alone. The women who received estradiol and antipsychotics showed improvement in positive symptoms of schizophrenia compared with women treated with antipsychotics alone.

Prevalence and Causes of Bipolar Disorder

Bipolar disorder affects women and men equally. The first manifestation of bipolar disorder usually occurs as a manic episode in men and as a depressive episode in women. Bipolar I disorder is present in 0.4 percent to 1.6 percent of the population and appears to have a genetic component, with offspring of people with bipolar disorder or depression being more likely to have bipolar disorder. A small proportion of bipolar patients experience symptoms of psychosis, such as hallucinations, delusions, and paranoia; this is often accompanied by violent behavior. In rare cases, women may experience psychosis in the first four to six weeks postpartum. This is a psychiatric emergency in which mothers exhibit obsessive thoughts about the baby, hallucinations, paranoia, and disturbed sleep.

Diagnosis of Bipolar Disorder

Bipolar disorder is underdiagnosed in both primary care and psychiatry. There are several reasons for this, including the fact that patients frequently seek medical help while in a depressive rather than a manic episode. Another reason is that approximately 50 percent of bipolar patients do not realize that they have manic symptoms, and either fail to seek treatment or do not report their manic symptoms to their practitioner. Bipolar disorder is thus often misdiagnosed as depression. The DSM-IV details diagnostic criteria for bipolar disorder, including bipolar I disorder, bipolar II disorder, and bipolar disorder with rapid cycling.

Bipolar I disorder is characterized by one or more manic episodes or mixed episodes (featuring rapidly alternating symptoms of mania and depression) for at least one week. Bipolar II disorder is characterized by one or more hypomanic episodes (a less severe form of mania) and major depression for at least one week. A manic episode or mania is defined by the DSM-5 as the presence of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week, plus three or more of the following symptoms (or four if the mood is only irritable): inflated self-esteem or grandiosity, decreased need for sleep, unusually talkative or expansive mood, flight of ideas (many ideas appearing at once or in rapid succession), distractibility, increase in goal-directed activity, and excessive involvement in pleasurable activities that have a high potential for painful consequences (for example, risky investments and sexual indiscretions). In addition, the episode must be severe enough to cause marked impairment in work or social functioning or to necessitate hospitalization to prevent harm to the self or others, or if psychotic features are present. The diagnostic criteria for a hypomanic episode is similar to that for a manic episode, with the exception that work and social functioning are not severely affected, hospitalization is not warranted, and there are no psychotic features.

Some individuals suffer from bipolar disorder with rapid cycling; in these patients, four or more manic or depressive episodes occur in one year. Some experts, however, believe that the DSM-5 criteria are overly strict and may exclude individuals who have some symptoms of bipolar disorder but do not precisely fulfill the criteria. An alternative view of bipolar disorder has been proposed that presents a spectrum of mood conditions, with depression at one end and mania at the other. All individuals fall somewhere along this spectrum. Those with some symptoms of both depression and mania are considered to be in the bipolar spectrum and may benefit from therapy.

Bipolar disorder with psychosis is typically characterized by hallucinations, delusions, or paranoia. Some people with this condition also exhibit violent behavior and are in danger of hurting themselves and others. The rare cases of women with postpartum psychosis appear to be linked to bipolar disorder. Women with a personal and family history of bipolar disorder have a higher risk of developing postpartum psychosis.

Treatment Options for Bipolar Disorder

Bipolar disorder can be most effectively treated with a combination of medications and psychotherapy, including cognitive behavioral therapy. Expert guidelines recommend that bipolar patients should typically be treated first with a mood stabilizer such as lithium, lamotrigine (Lamictal), or valproic acid (Valproate, Depakene), or with a mood stabilizer and an antipsychotic. Patients with depressive symptoms that do not respond to mood stabilizers may be treated with a combination of mood stabilizers and antidepressants. A bipolar patient should never be treated with antidepressants alone, because this can trigger rapid cycling or the emergence of a manic episode. Many bipolar patients mistakenly diagnosed as having major depression are discovered to have bipolar disorder when mania occurs in response to antidepressant treatment. A major problem for patients with mental diseases is poor adherence to medications. Bipolar patients often stop taking their medications because of a lack of insight into their condition or because of their inability to tolerate adverse effects, such as the weight gain that is often experienced with lithium, antidepressants, and some antipsychotics.

Bibliography

Abma, Joyce C., et al. “Fertility, Family Planning, and Women’s Health: New Data from the 1995 National Survey of Family Growth.” National Center for Health Statistics: Vital Health Statistics 23.19 (1997). Print.

American Psychiatric Association. American Psychiatric Association Practice Guideline for the Treatment of Patients with Bipolar Disorder. 2d ed. Arlington: Author, 2002. Print.

Daniel, Jessica H., and Amy E. Banks. The Complete Guide to Mental Health for Women. Boston: Beacon, 2003. Print.

Kohen, Dora. Oxford Textbook of Women and Mental Health. Oxford: Oxford UP, 2010. Print.

Kulkarni, Jayashri, et al. “Estrogen in Severe Mental Illness: A Potential New Treatment Approach.” Archives of General Psychiatry 65.8 (2008): 955–60. Print.

Lundberg-Love, Paula K., Kevin L. Nadal, and Michele A. Paludi. Women and Mental Disorders. Santa Barbara: Praeger, 2012. Print.

Markward, Martha J., and Bonnie L. Yegidis. Evidence-Based Practice with Women: Toward Effective Social Work Practice with Low-Income Women. Thousand Oaks: Sage, 2011. Print.

Office on Women’s Health of the U.S. Department of Health and Human Services. “Achieving Remission in Depression: Managing Women and Men in the Primary Care Setting.” Clinical Courier 21.28 (2003). Print.

Parikh, Rakesh M. “Depression and Anxiety in Couples Presenting for In Vitro Fertilization.” In Women’s Health and Psychiatry. Philadelphia: Lippincott, 2002. Print.

From Chapters 27-31, what is one major quote and why is it significant in To Kill a Mockingbird?

One passage that is significant is found in Chapter 30:

"If this thing's hushed up it'll be a simple denial to Jem of the way I've tried to raise him....Before Jem looks at anyone else he looks at me, and I've tried to live so I can look squarely back at him... if I connived at something like this, frankly I couldn't meet his eye, and the day I can't do that I'll know I've lost him.

This passage is important because it relates to the motifs of Morals and Ethics, as well as Family. Throughout the narrative, Atticus Finch has been, as Miss Maudie says, the same "in his house as he is on the public streets." So, when he confers with Sheriff Tate who insists that Jem has not killed Bob Ewell because Ewell fell upon his own blade, Atticus tells him that he does not want any special favors done for his son because of his position in town. Nor can he "connive" a falsification of what has happened in order to spare his son notoriety. He must continue to be the same "inside his house" or he will lose his own self-respect as well as the respect of his son. Setting a good example for his children is extremely important to Atticus; being a fair and upright man is also important to Atticus in his community as a lawyer, and in his life as a man.

These words of Atticus emphasize his ethical nature. Being a moral and ethical man is of paramount importance to Atticus Finch. If he is not morally and ethically right, Atticus cannot feel that he is an attorney or a father worthy of respect.

As it turns out, however, Tate convinces Atticus that Jem did not kill Bob Ewell. However, with having Bob Ewell fall on his own knife, Tate tries to protect Boo Radley from having to appear in court. While Atticus has been willing to allow Jem to appear in court because he does not wish to lose his son's respect, he sees the wisdom of what Tate says by letting retribution be the justice against Ewell.

In The Odyssey by Homer, why is Odysseus happy with the outcome?

Odysseus is happy with the outcome of his tale because he has finally returned to his home, Ithaca, after a protracted and dangerous twenty years away.  His main goal was always to make it back to his loyal wife, Penelope, and his son, Telemachus.  Further, he had sought and achieved revenge on the 100+ suitors who had taken advantage of the ancient Greeks' notion of hospitality, threatening his wife and son, corrupting some of their servants, and so on.  Though this revenge had been bloody and violent, he felt that it was deserved, and Athena, at least, seems to agree.  Although the suitors' families are enraged that Odysseus has slaughtered these hale and hearty men, they are unable, ultimately, to seek retribution.  In addition, Odysseus has had to fight a war, escape several monsters, endure the betrayal of his crew, deal with a vengeful Poseidon, manipulate moody goddesses, travel to the Underworld, and a great deal more, and, on some level, he is happy to be alive.  It took a long time, but he's finally gotten what he wanted.

Explain how the nitrogenous bases pair together with one another in DNA and RNA.

Nitrogenous bases, along with a phosphate group and a 5-carbon sugar, constitute nucleotides, which are the monomers for nucleic acids. Namely, DNA (dioxyribonucleic acid) and RNA (ribonucleic acid). The nitrogenous bases can be classified as either purine or pyrimidine bases. A DNA molecule contains 4 types of nitrogenous bases: adenine (denoted as A), guanine (denoted as G), cytosine (denoted as C) and thymine (denoted as T). Out of these, A and G are purine bases, while C and T are pyrimidine bases. 

These nitrogenous bases pair up with a complementary nitrogenous base on the complementary strand. Adenine pairs up with thymine and cytosine pairs up with guanine in the case of a DNA molecule.

In the case of an RNA molecule, uracil (denoted as U) is present instead of thymine. In an RNA molecule, A pairs with U and C pairs with G. 

This complementary base pairing is due to the hydrogen bonds between the pairing bases.

Hope this helps.

During the trial, what do Bob and Mayella say happened to Mayella?

During the trial, Bob and Mayella say Tom Robinson raped Mayella.

When Bob is questioned, he says the rape occurred on the night of November the twenty-first. He claims he was coming out of the woods with a load of kindling when he heard Mayella scream in the house. He then dropped the bundle of wood and ran towards the house. When he looked in the window, he saw Tom raping his daughter.

Bob testifies that he ran around the house to get at Tom, but Tom escaped through the front door. He also states that Tom left Mayella with a black eye and other injuries on her head, neck, and arms. Atticus points out Bob failed to get Mayella medical attention for her injuries.

Meanwhile, Mayella testifies that Tom attacked her right after she asked him to chop up a chiffarobe (dresser) for her. According to her testimony, Tom choked her, beat her about the face, and then raped her.

How can one write a follow-up letter about a cashier position?

If an individual has interviewed for a position as a cashier, or pretty much any other position with most companies, and wishes to follow-up with the office that interviewed him or her, there are two ways to proceed. One is through a phone call to the hiring office, inquiring as to whether a decision has been made with respect to filling the vacant position in question. The other option, and the one specified in the question, is through letter or email. This option can be preferable, as it provides the prospective applicant an opportunity to reemphasize his or her desire to be hired.

A letter to a human resources office or to any other hiring office (not all companies have human resources offices, especially small businesses) should begin with an expression of gratitude for the opportunity to be considered for the position in question, in this case, as a cashier. This expression of gratitude (e.g., "Thank you for the opportunity to be interviewed for the position of cashier") should be followed with emphasis, without going overboard, on the prospective applicant's desire to work for this particular company and to have a future with this company. Interest in a future with the company displays a commitment to stick-around and not bolt at the first opportunity. Companies strongly prefer, unless the position is explicitly advertised as "temporary," applicants who display an interest in being with the company for a long time. This does not mean that the prospective applicant should display a willingness to remain there forever; it simply means that the applicant won't be looking for a better job as soon as he or she is hired for this one.

Finally, a follow-up letter or email should end with an expression of hope for hearing from the company. In other words, the applicant is looking forward to a decision from the company as to whether a job will be offered.

Most managers appreciate displays of commitment and maturity on the part of prospective employees. A follow-up letter is a useful way to check that box.

Please discuss a recent example of a domestic or foreign policy which has been covered in the media. In particular, remember to mention which...

In this context, a policy refers to a law, rule, or regulation that applies to the people of the United States or the nation's relationships with other countries. Given that the United States is currently in its presidential primary season, there are many domestic and foreign policies being discussed and proposed.

A good example of a contemporary albeit controversial domestic policy is the Affordable Care Act (ACA) that was signed into law in 2010. The act requires that every person have health insurance and that subsidies would be provided for those that couldn't afford the total cost.

This has been a hotly debated policy in the Congress and the Senate, so there are many different actors. Primarily, the issue has been an important part of Obama's presidency and he has lobbied hard to ensure that it passed. Others include the Senate Finance Committee, which includes Senators Chuck Grassley, Olympia Snowe, and Max Baucus.

The ACA has been heavily criticized by many Republicans, including Senate majority leader Mitch McConnell and many others who have tried on several occasions to block or repeal the act. In most cases, opponents have been unsuccessful and the ACA remains intact.

In recent years, there are few bills that have been as contentiously debated as the ACA. Many conservatives feel as though it is governmental overreach, which has contributed to a greater divide between the Democrats and Republicans. Although it was passed into law about six years ago, it remains a popular topic of discussion in the current presidential debates, with many on the Republican side saying they will repeal the act and some Democrats wanting to expand it. The ongoing debates over the ACA demonstrate the current dysfunction between the political parties and it seems to be a significant barrier to bipartisan efforts.

What were three positive and negative effects of the Industrial Revolution?

The Industrial Revolution had both positive and negative consequences, many of which represent two sides of the same dramatic shift in lifestyles. 

First, let's address some of the negative consequences of the Industrial Revolution. As the means of production were shifting from a household or estate basis to a factory setting, many people flocked to the cities in search of work. Unfortunately, housing and infrastructure could not really keep  up with such drastic population growth. Much of the new working class lived in cramped and unsanitary homes, rife with disease. The conditions in their places of work-- factories or mines-- were not much better! Many forms of work were dirty and hazardous to health. Some were at greater risk in the work place than others; children were often injured when climbing into machinery to perform repairs. Altogether, the living and working conditions of the working class were very poor, and you could almost be certain that if someone did not die of illness or injury in the work place, they would die of illness spread at home.

Until the establishment of labor unions, many people in the working class received terribly low wages. While a low wage was still something, and more than they might have earned if they had stayed in the country, it was not enough. Those who were ill could not afford medical treatment, and many people worked to manufacture goods they would never be able to purchase. Many suffered malnutrition as a result of not being able to afford enough nutritious food, which had to be transported from the countryside. Poor-houses (also called workhouses) became a staple in Industrial Revolution era Britain, where impoverished people would labor in exchange for a place to sleep and food. Despite sounding like a safe haven, the poor-houses were some of the most unsanitary and dehumanizing institutions to develop.

So, what positive effects represent the other side of the Industrial Revolution? For those able to afford it, the Revolution made available a greater diversity of products. Additionally, there was a greater degree of standardization, so that one might be assured of the same quality in different places or at different times. The Industrial Revolution also had the effect of improving overall quality of life. Though many lived in dirty, cramped homes, cities began making changes to provide clean water, gas, and electricity to all citizens. 

Though employment conditions really suffered in the beginning, one of the long-term effects of the Revolution was an improvement in both employment rates and ethics. The dissatisfaction of factory laborers lead to the establishment of unions who fought for better wages, safer working conditions, and the banning of child labor. It depends on how long after the start of the Revolution you are willing to consider, but improvement in working conditions is certainly one of the positive developments.

What are the main ideas in Hamlet's soliloquy in Hamlet, Act II, Scene II?

A critical part of this scene is the arrival of a group of actors at the castle. Hamlet listens to one of the players perform a speech about the death of Priam and Hecuba, the royalty of Troy. Hamlet decides that the players shall perform The Murder of Gonzago, slightly altered with a speech penned by him; the narrative of this play is very similar to the events of Hamlet's life, including the murder of a king.

Hamlet's soliloquy begins with him cursing himself for his inaction. He wonders how an actor could present such forceful passion over a work of fiction that has no personal significance to him while Hamlet himself is unable to act. Hamlet is in possession of great feeling, but lacks conviction. He considers his own apparent apathy, asking:

...Am I a coward?

Who calls me "villain"? Breaks my pate across?

Plucks off my beard and blows it in my face?

Tweaks me by the nose? Gives me the lie i' th' throat

As deep as to the lungs? Who does me this?

Hamlet wants someone to strike him or attack his character, for he believes he deserves it. If he was not such a coward, he would "have fatted all the region kites / With this slave's offal"... meaning that he would have fed the intestines of Claudius to vultures. Hamlet, thus, brands himself "an ass" for failing to revenge his father.

He starts to think that the play may be just the thing to get Claudius to confess his crimes, believing that murder will always announce itself eventually:

May be the devil, and the devil hath power

T' assume a pleasing shape.

Suspecting that perhaps the Ghost who has told him of this murder might be toying with him "to damn" him, Hamlet plans to watch Claudius' reaction to the play-within-a-play. He believes that in doing so he will be able to determine his uncle's guilt is real—to "catch the conscience of the king."

In Gathering Blue by Lois Lowry, what are ten of the most important events that happened?

Ten key events in Gathering Blue are:

1. Kira's mother's spirit drifts away. As the story opens, Kira's mother has been dead for four days, but the drifting away of her spirit means Kira can return to the village from where she has been watching over the body in the Field of Leaving.

2. Vandara and the women challenge Kira for the space on which her family cott had stood. Vandara agrees to bring Kira before the Council of Guardians.

3. Kira goes to trial before the Council of Guardians, and her life is spared.

4. Kira moves into the Council Edifice and becomes Kira the Threader.

5. Kira meets Thomas and they become friends.

6. When Kira visits Annabella in the forest and learns about the dyes, Annabella tells her "there be no beasts."

7. Kira and Thomas befriend the child Singer, sparking the realization that the guardians are gathering artists to perform at their command.

8. Kira and Thomas visit the Fen in search of Matt and find he has gone on a journey to get his friends a "giftie."

9. Kira meets her father and learns the truth about her community and Jamison. 

10. Kira decides to stay behind when her father returns to his village.

What are some messages that the audience takes away from the play The Lion and the Jewel?

Soyinka suggests that maintaining traditional customs is essential in light of colonial development. Baroka, a symbol of traditional Yoruba culture, successfully wins the heart of the village belle, Sidi. His triumph over Lakunle, a symbol of modernity and progress, represents the importance and success of maintaining traditional customs and ways of life in a progressing world. Soyinka also portrays the role of females in traditional African culture. Women are marginalized and viewed as property in the village of Ilujinle, and when they seek to break free of their social restraints, they are unsuccessful. Soyinka also relays the message that the wisdom of the elderly is superior to the knowledge of youth. Baroka uses his wisdom to conduct a plan that works to perfection while Lakunle chooses to criticize traditional culture and loses Sidi. Lakunle's Western ideas are viewed as abnormal and dismissed by the majority of villagers. However, Baroka understands the importance of blending traditional culture with modern ideas. Soyinka is suggesting that progress is not such a negative thing if traditional culture can be incorporated into it. Soyinka also relays several moral messages throughout the play. He suggests that vanity and pride are destructive, and that gossip is misleading. Soyinka also portrays how many individuals are insincere and have ulterior motives.

Identify and provide a critical discussion of the linguistic/language features that the poet uses to create meaning in the poem "The Sick Rose".

“The Sick Rose” consists of two stanzas, with each stanza having four lines. Each stanza serves a specific purpose and central thought.

The first stanza serves to introduce the reader to the rose and the worm. The central thought of this first stanza is that the rose is sick. Foreshadowing is apparent as the worm is introduced as flying in a terrible storm. The reader can sense that something is going to happen--a possible clash between the rose and the worm.

The second stanza serves to show the reader the result of the clash between the rose and the worm. The central thought of this second stanza is that the rose has been found out by the worm and that the worm seeks to raze and destroy the rose.

The linguistic/language features that the English poet William Blake employs in his poem “The Sick Rose” include:

1. Personification

Blake likens the “invisible worm” to a person, and talks in this poem as if this worm is indeed a human being. This is evident in the following line where the worm keeps a secret:

“And his dark secret love

Does thy life destroy.”

2. Rhyme

Rhyme is a poetic device that lends a formal quality to the poem’s language. In stanza 1, line two rhymes (imperfectly) with line 4 – the words “worm” and “storm”.

In stanza two, line two rhymes (perfectly) with line four – the words “joy” and “destroy”.

3. Enjambment

This language device lends a particular flow to a poem. Enjambment is when a thought expressed does not end at the end of a line; it carries forward into the next line. There is no comma or period or other punctuation to make one pause at the end of the line. The reader just continues reading into the next line seamlessly to complete the thought the writer is expressing. An example is this line:

“Has found out thy bed

Of crimson joy”

The reader doesn’t stop momentarily at the end of the first line, but rather continues on smoothly into the next line and this second line completes the phrase.

4. Imagery

This language feature conjures up mental images when read. In this poem, the area that the rose inhabits is likened to a:

 “…bed

Of crimson joy”

The reader can immediately picture a bright, blossoming, vibrant red rose bed in a garden somewhere.

In "The Ransom of Red Chief" by O. Henry, how does the little boy respond at first to being kidnapped?

Sam and Bill select the son of Ebenezer Dorset as their victim. After storing their provisions in a cave on the mountain, they drive their rented buggy into town and spy the boy throwing rocks at a kitten. They try to entice him into the buggy by offering him candy and a ride. The boy, whose name is Johnny, throws a piece of brick at Bill that hits him him in the eye. The men have to struggle with Johnny to get him into the buggy; in fact, he "put up a fight like a welter-weight cinnamon bear." This means that the boy does not go willingly, nor is he convinced by the bribe they offer him.

However, once Johnny is at the camp of the kidnappers, he begins to enjoy himself. He pretends to be Red Chief, an "Indian" who has captured Hank the Trapper, played by Bill. Bill has bruises all over his shins where Johnny has kicked him. Ironically, Johnny is very happy in his captivity; he "seemed to be having the time of his life." He thinks camping out in a cave is a lark. In fact, during dinner he assures the men he doesn't want to go home at all because he doesn't have any fun there. He would much rather camp out with his friends "Snake-eye" and "Hank."

Although Johnny fights the men during his initial capture, he soon warms to the idea of camping out with the men and declares he has "never had such fun in all [his] life."

How does El Nino affect the world?

El Nino is a term that is used to describe the increase in the surface water temperature of the central Pacific Ocean.  This occurs when north-easterly trade winds which serve to keep the surface of the water cool are weakened.  The area of ocean affected is a large area of water that when warmed, has a significant effect on the weather systems throughout the world.   

El Nino results in more rainfall in parts of South America and the southwest United States.  In addition, there is an increase in hurricane activity.  Furthermore, El Nino increases high pressure over much of Europe resulting in drier weather with higher temperatures.  The weather in Canada is warmer than usual when an El Nino event occurs.  Moreover, snowfall is reduced in central U.S. states.

These weather changes can produce significant changes in agriculture for the year in which the event occurs.  Furthermore, it can have an effect on the abundance and price of many commodities and goods; this can have a significant effect on developing countries.  Deadly storms may be more likely to occur in some places throughout Earth.  In addition, countries face a significant financial burden as a result of the aforementioned occurrences.  

Who were the critics of Roosevelt's policies? What did they think?

From the left, Franklin Roosevelt was accused of too much inaction.  Men such as Senator Huey Long from Louisiana thought that wealth should be redistributed by a one hundred percent tax on the highest incomes.  Francis Townsend gained support in California as he devised what would later become the Social Security Act.  Leftists in government thought that Roosevelt should nationalize the steel industry, banking, and other utilities.  They also thought that he should look to Stalin's Five Year Plans as a future model for American economic success.  

On the right, Roosevelt was called a traitor to his class in that he did not do enough to help the rich and tried to reform Wall Street and banking.  His National Industrial Recovery Act was deemed unconstitutional and his court-packing plan ran afoul of those who interpreted the Constitution strictly.  Roosevelt was denounced as a socialist for getting the government involved in the utility business with Tennessee Valley Authority.  Others pointed out that the economy still dipped and wavered no matter what the government did and that all of these programs were creating a large debt and not fixing any greater problems.  Others claimed (correctly) that Roosevelt had no strategy and that he was only trying programs to see which would work.  

Provide textual evidence that portrays Scout Finch as an honest individual in the novel To Kill a Mockingbird.

There are several scenes throughout the novel that depict Scout Finch as being an honest individual. In Chapter 2, Scout is asked to read most of My First Reader and stock-market quotations from The Mobile Register on her first day of school. Miss Caroline tells Scout to tell her father that he is no longer allowed to teach Scout anymore because it would interfere with her reading. Scout says, "He hasn't taught me anything, Miss Caroline. Atticus ain't got time to teach me anything" (Lee 12). When Miss Caroline comments that Scout wasn't born reading, Scout says,

"Jem says I was. He read in a book where I was a Bullfinch instead of a Finch. Jem says my name's really Jean Louise Bullfinch, that I got swapped when I was born and I'm really a---" (Lee 12).

Scout then mentions that Miss Caroline thought she was lying when Miss Caroline told her not to let her imagination run away with her.

Despite the fact that Scout was not a "Bullfinch" who was switched at birth, she naively believes Jem's story. Scout is a typical innocent child who believes anything that her older brother tells her. Scout actually believed that she was born reading and that Atticus didn't teach her. In Scout's mind, she is being completely honest which is why she is confused at Miss Caroline's response.

Another scene that depicts Scout being honest takes place in Chapter 4 when Jem is explaining to Dill what a Hot-Steam is. Scout interrupts Jem and tells Dill, "Don't you believe a word he says, Dill...Calpurnia says that's nigger-talk" (Lee 24). Scout knows that her brother is lying about the existence of Hot-Steams and tells Dill the truth about them.

How is Tellson's Bank described at the beginning of book two of Five Years Later?

Tellson’s Bank is described as “very small, very dark, very ugly, very incommodious.” It is an old-fashioned place, and the bank managers are proud of that fact. All this is testimony of its conservative (and therefore safe and reliable) way of doing business. It is not a product of the changing times. It is what it has always been and always will be. It is unchanging in a world that is in a state of flux. The American colonies are rebelling, and France is unsettled and will soon have a revolution. But Tellson’s Bank is always the same.

England at that time was a country firmly grounded in tradition. Not since the English Civil War over a hundred years previously has there been any question of things drastically changing in England itself. Tellson’s Bank thus serves as a symbol of the nation, unlike the situation in France. Mr. Lorry is very proud of his bank, and lives his life by the same principles as does Tellson’s. In this he serves as a bedrock, along with the bank, in the midst of the storms rocking Europe.

Discuss why Eliezer lied to Stein, his relative, about Stein’s family. Discuss whether or not you think he was morally right and what choices he...

After having been in Auschwitz for eight days, Eliezer and his father came upon Stein, a relative. Stein told them that he was from Antwerp and that Reizel, his wife, was the niece of Eliezer's mother. Stein and Reizel had two little boys, and Stein was anxious for news of his little family. Eliezer's father did not remember Stein, but Eliezer did; he remembered that they had not received any letters from Reizel since 1940. Stein himself was deported in 1942.

However, Eliezer lied to Stein and told his relative that his wife and sons were fine. Because Stein was so grateful for the news, he always brought small portions of food to share with Eliezer and his father when he visited them. During his visits, Stein admonished his relatives to eat so as not to face the danger of selection. Despite his emaciated figure, Stein was in good spirits; the thought that his wife and sons might still be alive was what kept his courage up.

In due time, another batch of prisoners arrived from Antwerp, and Stein was rapturous. The thought that he was finally to be reunited with his family made him very happy. However, Eliezer admitted that they never saw Stein again, presumably because he must have found out the real news about his family. The implication was that Stein might have given up hope and died after he received the likely news of his family's demise.

Two major considerations to guide you as you decide on an answer to your question:

1) If a lie lessens another person's suffering, the lie is a moral action. For example, Eliezer's lie allowed Stein to live his last moments in some semblance of peace and happiness.

2) If a lie prevents another person from seeing the full truth and adjusting to it, the lie is an immoral action. For example, Eliezer's lie may have cruelly intensified Stein's suffering when he finally received news of his family's demise.

Basically, you will have to decide which you agree with. Was Stein better served because his last moments were happy? Or would he have been better served if he had known the truth immediately? The answer boils down to how you and I define morality when the situation is dire and escape impossible.

What is a mastectomy, and what is a lumpectomy?

Indications and Procedures

The early indications of breast cancer are often quite subtle, although in this stage it may be revealed by routine mammograms. In some cases, no overt symptoms exist until the cancer is well advanced. Women between forty and fifty years of age without risk factors are advised to have a mammogram every two years. Women over fifty or in the high-risk category because of a family history of breast cancer should have a mammogram once every year. If palpation of the breast reveals a lump, then immediate mammography is indicated.

It is necessary to be constantly vigilant for any sign that an abnormality exists in the breast. Clear indications of possible breast cancer include lumps or thickening of the tissue in the breast or in the area under the arms. Symptoms such as discoloration of the breasts or dimpling, thickening, scaling, or puckering of one or both breasts may also arouse suspicion of breast cancer. A significant change in the shape of the breast or a swelling of it are also symptomatic. A bloody discharge from the nipple, scaly skin on the nipple or surrounding area, inversion of the nipple, or discoloration of the area surrounding the nipple may presage the presence of breast cancer.

Monthly palpation of the breasts, preferably seven or eight days after menstruation, may reveal lumps that could be harmless growths but that might be cancerous. This procedure is referred to as breast self-examination (BSE). Because the female breast contains many glands, it is not uncommon in some women for lumps to appear regularly—often profusely—particularly in the week prior to menstruation. Women with notably lumpy breasts are said to have fibrocystic breasts. Often, the lumps diminish in size in the week following menstruation. If they do not recede, however, then these lumps should be regarded with suspicion and the patient should be examined by a physician, preferably a surgeon, gynecologist, or oncologist.

Once a problem is detected, a number of procedures must be considered for dealing with it. The initial procedure in treating suspected breast cancer usually involves a mammogram to reveal irregularities in the breast. If the results of the mammogram are negative and the patient is still convinced that there is a lump in the breast, an ultrasound or sonographic examination may be indicated. In such tests, harmless sound waves are focused on the breast. These sound waves are reflected so that they create an image of formations within the breast. Although ultrasound cannot definitively indicate whether a lump is cancerous, it can at least verify whether a lump exists. It can also show whether the lump is hollow and filled with fluid, in which case it is usually a benign cyst rather than a cancerous growth.

If a growth is detected, the next, least-invasive means of determining whether it is cancerous is through a needle biopsy.
In this procedure, the patient, under local anesthetic, has a hollow needle inserted into the growth. Fluids and cells are then harvested from it. If the growth is a cyst,
a clear or light yellow fluid will be withdrawn, causing the cyst to collapse. This may be all the treatment required. In all cases, however, the substances withdrawn from the growth are examined by a pathologist for the presence of cancer cells.

Not all growths are so positioned that needle biopsies are possible. In such cases, a surgical biopsy is probably necessary. If the lump is small, then a lumpectomy, or the removal of the entire lump, may occur. Larger lumps often cannot be removed at this stage, so portions are excised for pathological examination. A pathologist carefully studies the tissue removed to determine whether it contains cancer cells.

In the past, biopsies often occurred while patients were anesthetized and, if the pathological report was positive for cancer, then a radical mastectomy was performed immediately while the patient was still under anesthetic. Since the late twentieth century, however, a two-step procedure has usually replaced this one-step method. If cancer is detected, then surgery is delayed, giving physicians the opportunity to consult with their patients about the treatments available to them.

The major decision in such cases usually is whether a total mastectomy or a partial mastectomy, commonly referred to as a lumpectomy, should be performed. Total mastectomy involves the total removal of the breast and the surrounding lymph nodes.

A radical mastectomy, done under general anesthetic, involves making a large, elliptical incision on the breast, including the nipple and often the entire breast. The incision normally extends into the armpit. All the breast tissue is excised, including the skin and the fat down to the chest
muscles. The incision extends into the armpit to remove as much of the breast tissue as possible, including the lymph nodes, which may be cancerous. Once the bleeding has been controlled, a drainage tube is inserted and the incision is closed with sutures, clips, or adhesive substances.

This drastic form of treatment can be traumatic both physically and psychologically to patients. Many women fear the disfigurement that follows it. Some women, especially those with a family history of breast cancer, may decide that the total removal of the breast is their safest option. In some cases, to prevent future threats of breast cancer, they demand the removal of both breasts.

A lumpectomy, usually performed under local anesthetic, involves the removal only of cancerous tissue. The incision is made under the breast, and the lump, with surrounding tissue, is removed. The appearance of the breast remains much the same as it was before the surgery. In some cases, physicians recommend a quadrantectomy, which involves the removal of the cancerous tissue as well as significant amounts of the surrounding tissue. Quite often, the lymph nodes are removed as well. When this treatment is used, the breast will appear slightly smaller than it previously was, but it can be enhanced through plastic surgery.

Subcutaneous mastectomy is frequently indicated in situations in which the tumor is small. In this procedure, the surgeon makes an incision under the breast. Most of the skin and the nipple remain intact, although the milk ducts that lead into the nipple are cut. Following the surgery, sometimes immediately, a breast implant can be inserted, restoring the breast to its normal appearance. Mastectomy and lumpectomy are routinely followed by a course of radiation and/or chemotherapy designed to kill any fugitive cancer cells that the surgery has missed.

While the goal of mastectomy is to create as little scarring as possible, considerable scarring may occur, particularly with radical mastectomy, and the absence of one or both breasts usually requires significant psychological adjustments on the part of women who have undergone the procedure. The breast reconstruction performed by a plastic surgeon following a mastectomy is often accompanied by treatment from a psychologist or psychiatrist.

Some women with family histories of breast cancer, particularly if the disease has occurred in first-level relatives (mother or sisters), may opt for a mastectomy rather than a lumpectomy to relieve themselves of the fear of contracting the disease, although most oncologists make such women fully aware of other, less drastic procedures available to them.

Certainly a consideration in reaching a decision about whether to have a lumpectomy or the more drastic mastectomy must include many factors. High on the list of such factors is heredity. In many patients who suffer from this disease, BRCA1
and BRCA2, mutated genes, are an early indication that breast cancer may eventually occur. The BRCA gene is frequently present in the female members of families with histories of breast cancer and ovarian cancer. About 85 percent of women with the BRCA gene will develop breast cancer if they live a normal life span. Women who have the BRCA gene may decide to have a prophylactic mastectomy before symptoms occur, although many women in this situation prefer treatment with tamoxifen, which appears to hold breast cancer at bay.

Advances in treating cancers of all kinds progressed rapidly during the last half of the twentieth century, and even greater impetus characterizes current advances. The four major treatments—often used in combination with each other—are surgery, radiation therapy, chemotherapy, and hormonal therapy. In the treatment of breast cancer, radiation may be used initially to shrink existing tumors that, once reduced in size, will be removed surgically. However, when surgeons remove cancerous tumors, they also remove large numbers of surrounding cells that might be affected; such a procedure is usually followed by additional radiation aimed at killing any lingering cancer cells the surgery has missed.

Uses and Complications

The salient use of surgery in cases of breast cancer is to remove its source, not only clearing away any tumors that may be found but also removing additional cancerous tissue as well as lymph nodes that might be affected.

Cancer cells can exist either in the breast’s lobules, which contain the cells that produce milk, or in the ducts that carry the milk to the nipples. Cancer cells in either of these locations can be of two types, invasive or noninvasive (also called in situ). The major complication with invasive cancer is that it can and usually does metastasize, spreading often to the lymph nodes, into the lungs and to other parts of the body. In such cases, a radical mastectomy is indicated. It must be performed as quickly as possible and followed by a strenuous course that typically includes radiation or chemotherapy. Noninvasive cancer is less likely to metastasize, although it sometimes does. Lumpectomy or quadrantectomy is often used to treat such cancers, but these procedures must be followed by close monitoring over the rest of the patient’s life and by radiation or chemotherapy following surgery.

Chemotherapy is used less often than radiation in the postsurgical treatment of breast cancer but is occasionally used along with it. Some physicians use anticancer drugs to reduce the possibility of recurrence. This treatment, as well as hormone treatment, is designed to kill any fugitive cancer cells that have strayed from the immediate site of the cancer that has been removed. Whereas surgery and radiation are local, affecting only the part of the body being focused upon, chemotherapy is systemic: the drugs used in chemotherapy travel through the bloodstream to all parts of the body. The disadvantage of chemotherapy is that it nearly always has significant side effects. In rare cases, complications are so extreme that they result in death. Usually, chemotherapy is indicated only for women who have not yet undergone the menopause and whose tumors are an inch or larger in size. It may also be employed in cases in which the patient’s tumor shows signs of growing rapidly and aggressively invading and attacking other parts of the body.

Related to chemotherapy is hormonal therapy.
Hormones
are chemicals produced by the body for various purposes. For example, when one is under sudden, undue stress, the body produces adrenaline, which provides a rush of energy and causes the heartbeat to accelerate. In women, the body produces estrogen every month during the menstrual cycle. Estrogen causes the cells in the milk ducts and lobules to grow in preparation for pregnancy. This chemical stimulates the growth of normal cells but can also stimulate the growth of cancer cells. Hormonal therapy is systemic. It involves introducing into the bloodstream a synthetic chemical, usually tamoxifen, which makes it impossible for the body’s natural estrogen to find its way to cancer cells that would be nourished by it. A complete biopsy report can determine whether hormonal therapy is appropriate in individual cases.

Perspective and Prospects

Until the middle of the twentieth century, a diagnosis of cancer, particularly of breast cancer, was viewed as a death sentence. Diagnosis generally occurred after the cancer had metastasized. In the first half of the century, general practitioners were much more prevalent than the specialists who, working as a team, are now generally mustered to provide cancer treatment once a diagnosis is made.

With the proliferation of sophisticated medical equipment, including the highly sensitive X-ray machines used in mammography and the various forms of ultrasound and sonograph equipment that are part of nearly every hospital’s arsenal of diagnostic equipment, an increasing number of cancers are discovered before they become symptomatic, so that they can be treated with considerable success.

Historically, mastectomies have been performed for centuries. President John Adams’s daughter underwent this excruciating surgery early in the nineteenth century, enduring this procedure without the benefit of anesthesia. As was usually true in such cases, the surgery extended her life for only a little while because her cancer was discovered in an advanced stage and had metastasized.

By the late nineteenth and early twentieth centuries, accepted treatment for breast cancer was a radical mastectomy that involved the removal of the affected breast and of as many surrounding cancer cells and lymph nodes as possible. William Halsted, a pioneer in the field of breast cancer surgery and a professor of surgery at the highly respected Johns Hopkins University Medical School, championed the cause of the radical mastectomy, which he viewed as a procedure that could extend substantially the survival of his patients. Little was said about curing breast cancer patients of their cancers. The radical surgery that physicians across the country performed following Halsted’s lead was viewed simply as a means of adding months or years to the life of the cancer patient. Until 1970, about 70 percent of women in the United States who had breast cancer were subjected to radical mastectomy.

Several factors brought about a major change in the treatment of breast cancer during the 1960s and 1970s, when social activism was very much in the forefront of American life. Feminists pointed out that most of the surgeons treating breast cancer were men. As an increasing number of women entered medical schools and eventually established medical practices, greater attention was paid to treating breast cancer in less disfiguring ways than had been common earlier.

Along with this change came advances in medical technology that made early diagnosis and more focused treatment a reality. As the chemical treatment of all cancers came to be better understood and more widely employed, the focus was more on preventing and curing cancer than on merely prolonging the lives of those who suffered from it.

Laboratory tests for detecting a woman’s predisposition for breast cancer have become increasingly sophisticated and accurate. Where the BRCA1 or BRCA2 gene is present, the possibility of developing breast cancer is greatly increased; women shown to possess this gene have been made more vigilant than ever before in monitoring their conditions and in seeking immediate medical intervention if even the slightest symptom appears.

Shortly after the end of World War II, some oncologists rejected Halsted’s emphasis on radical mastectomy. Surgeon Jerome Urban garnered numerous followers in his call for superradical surgeries in cancer cases. His procedures involved the removal of ribs, various internal organs, and even limbs in order to find and destroy every cancer cell. Surgeon Bernard Fisher stood in opposition to Urban, championing the effectiveness of smaller surgeries, such as the simple mastectomy, which involved the removal of one breast but not of all the lymph nodes and, in some cases, the lumpectomy, involving the removal only of the tumor and its surrounding cells.

The lumpectomy has gained acceptance through the intervening years. It is less disfiguring than either the radical or the simple mastectomy, leaving only a small scar on the underside of the breast. In cases where lumpectomy is viewed as a viable option, survival rates and cure rates are comparable to those of patients who have undergone more radical surgery.

Advances in medical science are accelerating substantially. Stem cell research offers great promise in the treatment and cure of diseases such as breast cancer. Researchers appear to be on the threshold of developing cells designed to destroy specific errant cells, such as those that cause cancer, while leaving healthy cells intact.

Bibliography

Abouzied, Mohei. "Lumpectomy." Health Library, Nov. 26, 2012.

"Breast Cancer." MedlinePlus, June 12, 2013.

Chisholm, Andrea. "Mastectomy." Health Library, Oct. 31, 2012.

Fowble, Barbara, et al. Breast Cancer Treatment: A Comprehensive Guide to Management. St. Louis: Mosby Year Book, 1991.

Friedewald, Vincent, and Aman U. Buzdar, with Michael Bokulich. Ask the Doctor: Breast Cancer. Kansas City, Mo.: Andrews McMeel, 1997.

Hirshaut, Yashar, and Peter I. Pressman. Breast Cancer: The Complete Guide. 5th ed. New York: Bantam Books, 2008.

Lange, Vladimir. Be a Survivor: Your Guide to Breast Cancer Treatment. 5th rev. ed. Los Angeles: Lange Productions, 2010.

Lerner, Barron H. The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America. New York: Oxford University Press, 2001.

Link, John S. The Breast Cancer Survival Manual: A Step-by-Step Guide. 5th ed. New York: Henry Holt, 2012.

"Mastectomy." MedlinePlus, May 24, 2013.

Mayer, Musa. Examining Myself. London: Faber & Faber, 1994.

Morris, Peter J., and William C. Wood, eds. Oxford Textbook of Surgery. 2d ed. New York: Oxford University Press, 2000.

Phippen, Mark L., and Maryann Papanier Wells, eds. Patient Care During Operative and Invasive Procedures. Philadelphia: W. B. Saunders, 2000.

Sproul, Amy, ed. A Breast Cancer Journey: Your Personal Guidebook. 2d ed. Atlanta: American Cancer Society, 2004.

"Surgery for Breast Cancer." American Cancer Society, Feb. 26, 2013.

Sutton, Amy L., ed. Breast Cancer Sourcebook: Basic Consumer Health Information About Breast Cancer. 4th ed. Detroit: Omnigraphics, 2012.

Before Romeo departs for Mantua, Juliet shares with him her premonition. What is it?

Juliet's premonition, which she says is the product of an "ill-divining soul," is of Romeo's dead body, lying in a tomb.

Methinks I see thee, now thou art below,
As one dead in the bottom of a tomb.
Either my eyesight fails, or thou look'st pale.

Romeo downplays the vision, but the audience knows, having been told as much by the Chorus, that this vision is fated to come true for the "star-cross'd lovers." Romeo's banishment from Mantua proves to be fatal to the lovers, as a quarantine prevents Friar Laurence from telling Romeo that Juliet is only pretending to be dead. Balthasar, Romeo's servant, knows nothing of the Friar's plan, and he reports to Romeo that Juliet is actually dead. This causes Romeo to go to the Capulet family crypt and commit suicide next to Juliet's seemingly lifeless body. When Juliet wakes up, she sees Romeo's corpse lying in a tomb, just as she envisioned. Her premonition comes eerily and tragically true.

What is trichomoniasis?

Causes and Symptoms

Flagellated motile protozoans known as Trichomonas vaginalis cause trichomoniasis, one of the most widespread and common of Sexually transmitted diseases (STDs). The disease is common among people with multiple sex partners, those who engage in unprotected sex, and those who seek services at STD clinics. Trichomoniasis in pregnant women is a leading cause of premature birth in the United States.

Some estimates suggest that 180 million people a year are infected with trichomoniasis worldwide. The most common population found to be infected is females sixteen to thirty-five years old, which is prime childbearing age. This is an important epidemiological group, as trichomoniasis infections are a leading cause of premature rupture of the placenta, premature birth, and low birth weight.

After infection, there is an incubation period of about seven days, with a range from about four to twenty days. Although up to 70 percent of infected women may remain asymptomatic, T. vaginalis infections may sometimes produce a frothy yellow or green vaginal discharge. Women’s symptoms may also include urethritis, vaginitis, and itching of the vulva. Sometimes, vaginal inspection shows a distinctive “strawberry cervix”
(red patches on the cervix) and red spots on the vaginal walls. Men’s symptoms sometimes include urethritis, dysuria, a frothy or purulent urethral
discharge, and, in rare cases, scrotal pain as the tube connecting the testicle with the vas deferens becomes inflamed.

The symptoms of infection by T. vaginalis are of questionable value in diagnosing the infection. In addition, many infected people remain asymptomatic for many years, and most existing tests, such as microscopic viewing of wet mounts, Pap tests, and polymerase chain reaction (PCR), often fail to show the infectious agent in people with symptoms. Culture of vaginal and urethral smears is considered to be the most effective way of detecting T. vaginalis infection. These factors add to the difficulty in reducing infection rates.

Treatment and Therapy

The CDC’s
Sexually Transmitted Diseases Treatment Guidelines 2006, which includes trichomoniasis, focuses on microbiological cure, alleviation of signs and symptoms, prevention of sequelae, and prevention of transmission.

The infection is treated with a single oral dose of either metronidazole or tinidazole. Any sex partner should be treated simultaneously even if he or she is asymptomatic. Treatment is successful in 90 to 100 percent of cases. Treatment during pregnancy is controversial, but no case of fetal malformation has been attributed to metronidazole. Studies have shown that trichomoniasis is associated with low infant birth-weight, premature rupture of the membranes, and preterm births. However, studies of pregnant women with trichomoniasis who are treated failed to show an improvement in preterm deliveries and even trended toward more preterm deliveries; therefore, treatment remains controversial.

Perspective and Prospects

Many men and women infected by the organism remain asymptomatic for years, spreading the disease to other people through sex. Safer sex practices help prevent transmission. People with multiple sex partners should use latex or polyurethane condoms to help curtail the spread of this disease. It is crucial that sex education programs emphasize that people with any unusual genital symptoms, including urethritis and vaginal discharge, seek medical treatment.

People infected by T. vaginalis may also be infected by other STD organisms, especially the bacterium that causes gonorrhea. Medical professionals believe that infection by the Trichomonas protozoan predisposes a person to infection by the human immunodeficiency virus (HIV) upon exposure through unprotected sex with infected partners.

Trichomoniasis in young children may indicate sexual abuse, and health professionals may be obligated to report such infections, if local regulations require it.

Bibliography

Boston Women’s Health Collective. Our Bodies, Ourselves: A New Edition for a New Era. 35th anniversary ed. New York: Simon & Schuster, 2005.

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines. http://www.cdc.gov/std/treatment.

Heymann, David L., ed. Control of Communicable Diseases Manual. 19th ed. Washington, D.C.: American Public Health Association, 2008.

Scharbo-DeHaan, Marianne, and Donna G. Anderson. “The CDC 2002 Guidelines for the Treatment of Sexually Transmitted Diseases: Implications for Women’s Health Care.” Journal of Midwifery and Women’s Health 48 (February, 2003): 96-104.

Sommers, Michael. Yeast Infections, Trichomoniasis, and Toxic Shock
Syndrome (Girls' Health). New York: Rosen Publishing Group, 2007. Print.

Sutton, Amy L., ed. Sexually Transmitted Diseases Sourcebook. 3d ed. Detroit, Mich.: Omnigraphics, 2006.

What are some similarities and differences between the American Civil War and World War II?

The American Civil War and World War II are without a doubt the two most pivotal conflicts in the history of the United States. Let us look at a few similarities and differences between them, beginning with what the two wars had in common. 

Both wars required a massive effort and sacrifice on the part of the American people. Nearly 2.5 million men served in the Union Army during the Civil War, amounting to over 10 percent of the overall population. About 16.5 million men served during World War II, a similar proportion to the overall population. Casualties were horrific in both conflicts. While the Civil War had a higher overall death toll (especially when one includes Confederate casualties) over 400,000 men died in battle or of other causes during World War II. Both wars had a strong ideological aspect. The Civil War began as a war to reunite the Union, but by its end had become a fight to end slavery. World War II was always a war against the forces of fascism and militarism, one which was, at its heart, about the survival of democracy. 

Many of the differences are fairly obvious. The Civil War was an internal struggle, fought on American soil, while World War II was fought overseas. All sides made war on civilian populations in World War II. More civilians than combatants perished in the war, a fact with no parallel in the American Civil War. Another difference was that the emergence of new technologies meant that tactics and strategy had changed considerably between the two wars. The airplane, in particular, completely changed the face of war in World War II. 

What is the revolving period of Venus?

In order to find the rotation of a planet, near daily information should be taken of a planet through an intense telescope capable of following a specific reference point on a planet. This works for most planets except Venus, which has such a dense atmosphere that it is impossible to see any surface structures through the thick acid clouds. To find the rotational speed of the planet Vesto Slipher, an American born astronomer, used spectroscopy which allowed him to see how light was filtered through the atmosphere and found that the rotation was extremely slow, shorter in fact than the time it took to orbit once around the Sun! Later in the 1970's NASA sent probes to the surface that were able to "see" the surface using radio waves and even one that could land on the surface of the planet. This last probe found our now accepted rotational speed for Venus of 243.02 Earth Days, the slowest of any planet in our solar system.

Another great way to learn more about Celestial bodies is to check NASA websites or books at your local library. NASA is a wealth of knowledge when it comes to different stars, planets, and other space structures. 

What are some political events that happened in the 1950s?

There were several political events that happened in the 1950s. Some involved the United States and other countries while some only impacted the United States.

In the realm of foreign affairs, there were several significant events that occurred. In 1953, the conflict in Korea came to an end. This conflict, which began in 1950, left the boundary between North Korea and South Korea unchanged. Additionally, South Korea remained noncommunist. In 1956, the Vietnam War began. When South Vietnam didn’t hold the elections that were scheduled to be held in 1956, North Vietnam went to war against South Vietnam. In the 1950s, our involvement in the Vietnam War was minimal. That would change dramatically in the 1960s. The United States and the Soviet Union entered the Space Race. The Soviet Union was the first country to launch a satellite into space in 1957. This set off a panic in the United States that we were falling behind the Soviet Union. In 1958, we launched our first satellite into space.

Domestically, there were several major events, especially in the area of civil rights. The Supreme Court ruled that the concept of “separate but equal” was unconstitutional in the Brown v Board of Education case in 1954. The Montgomery Bus Boycott began in 1955 and ended when segregation on buses was declared unconstitutional. Martin Luther King, Jr. became the leader of the nonviolent civil rights movement.

The 1950s was a time of significant progress and development. People began to move to the suburbs. There were new medical breakthroughs such as the development of the polio vaccine. People were buying new items such as air conditioners and television sets. Many new highways were built as a result of the passage of the Federal Highway Act. Dwight D. Eisenhower was elected President in 1952. He won reelection in 1956.

The 1950s was a busy decade both at home and abroad.

While stirring a beaker of water, a student adds sugar until no more sugar will dissolve. Which of these most likely shows how the beaker will look...

Sugar, like all other substances, has a limit to its solubility in water. That is why we cannot dissolve more than a particular quantity of sugar in a given volume of water. Any sugar added after that will simply stay undissolved and will be collected at the bottom of the beaker. When this happens, we say the sample is "saturated" with sugar. 

However, this solubility is related to the temperature of the solvent (water, in this case). When we heat water, the solubility of sugar increases and we will see that any solid sugar collected at the base of the beaker will simply dissolve and disappear in front of our eyes (the quantity of sugar thus dissolved will depend upon the temperature of the water). When the water (containing sugar) is heated, the kinetic energy of the molecules increases and it is easier to overcome the bonds between sugar molecules. Higher kinetic energy also means that water and sugar molecules will interact more often and thus, will have higher chances of dissolution. 

Thus, upon heating, we will see the sugar particles (collected at the bottom of the beaker) being progressively dissolved in the water and less and less undissolved sugar will be observed.

Hope this helps.