What are hearing tests?

Indications and Procedures

Hearing tests are done to establish the presence, type, and severity of hearing impairment in children and adults. Such tests are conducted by an audiologist, although screening tests can also be done by a technician under the supervision of an audiologist. The severity of hearing loss is classified as mild, moderate, moderately severe, severe, and profound. It is also classified according to the anatomic region affected: conductive, sensorineural, or mixed hearing loss.

The selection of tests to evaluate hearing will depend on the patient’s age and ability to follow directions and the ability of the audiologist to elicit responses from the patient. When a patient cannot follow instructions such as lifting a hand or pressing a button, a test that does not require the patient’s cooperation is used. Two tests that do not require the patient’s cooperation are the auditory brainstem potential (ABR) test and the evoked otoacoustic emissions (EOAE) test. Both tests require only that the patient be quiet. For this purpose, the patient may need sedation if normal sleep cannot be induced.

The ABR test requires the placement of four electrodes on the patient’s head: in both mastoid regions and in the mid forehead and upper center of the head. A stimulus is sent through a small microphone placed in the patient’s external ear canal or via headphones. The instrument records the average of the electrical discharges generated by the auditory nerve in response to sound stimuli and produces a tracing of waves that correspond to the different electrical potentials generated in response to the stimuli. Analysis of the waves can determine the presence of hearing loss and measure its severity. The ABR test may be used for screening, to determine whether the subject can hear, or for the clinical evaluation of hearing loss. It can be done at any age. An automated method of ABR testing is available for screening newborn infants for hearing loss; it automatically determines if the patient has passed or failed. The clinical ABR test requires specially trained personnel and takes from forty-five to fifty minutes to perform. The automated method can be applied by a technician.

The EOAE test involves recording the sound produced by hair
cells within the cochlea by way of a microphone placed in the outer ear canal. Normally, when sound enters the cochlea, the hair cells produce a sound that bounces backward and can be recorded. This sound correlates with the sound sent to the auditory nerve. If there is damage to the hair cells in the cochlea, then no sound is elicited. The EOAE test can be performed without sedation if the patient cooperates by staying quiet. It can be done by a technician and takes approximately ten minutes or less. The EOAE test is used for universal screening of newborn infants. It can be done at all ages to help determine the integrity of the cochlea and thus whether an observed hearing defect is within the cochlea.

Behavioral techniques are the most practical, cost-effective, and time-efficient methods for the accurate assessment of hearing. They give more complete information on the child’s hearing as well as functional information about how the child uses his or her hearing. The simplest test is behavioral observation audiometry, in which the audiologist records the behavioral response to an applied sound stimuli of a known frequency. This test can be done with infants up to six months of age, toddlers, and uncooperative patients, such as children or adults with developmental delays. Visual reinforcement audiometry (VRA) is done with infants and toddlers from six months to twenty-four months of age. It is also used with uncooperative patients. In this test, the patient is submitted to sounds of different intensity and trained to respond to the sound stimuli by means of an attractive stimulus. Every time that the sound appears, the stimulus illuminates. When the patient hears the sound, he or she will look for the reinforcement. Play audiometry is a test that can be used in children over two
years of age. The child is taught to move a block or place a puzzle piece every time he or she hears a sound.

In 2002, Ruth Litovsky, an University of Wisconsin–Madison communicative disorders professor, introduced a binaural hearing test to evaluate how people respond to sounds in a noisy environment resembling public areas and schools. Using computers showing images related to words being broadcasted on loudspeaker, her test assesses which sounds people ignore and which sounds secure their attention.

In 2003, the Ear, Nose, and Throat Journal provided information describing the Otogram from Tympany, a Sonic Innovation subsidiary. This device enables patients to test their hearing at sites using automated technology. During the twenty-minute testing period, patients undergo an audiogram that thoroughly evaluates their acoustic capabilities with tympanometry and other standard diagnostic tests, responding to the tests via touchscreens with results recorded by computer.

In 2005, Bio-Logic Systems Corporation and House Ear Institute researchers introduced the hearing in noise test (HINT), which assesses how hearing functions in police and emergency personnel whose hearing is vital to their work. The test involves subjects repeating sentences while exposed to a variation of noise and quiet. The source azimuth identification in noise test (SAINT) evaluates subjects’ ability to detect where sounds are located.

Perspective and Prospects

Early detection of hearing loss has become a priority among intervention services because it has devastating effects on language development and consequently on social adaptation. It has been found that the mean age at which deafness is diagnosed is around three, which is after speech development should have occurred. Thus, children with hearing loss are placed at a disadvantage with their peers.

In 1993, the National Institutes of Health (NIH) developed a consensus statement by which all newborn infants in the United States were to be screened for hearing loss. The aim was that by the year 2000, all newborns would have been screened before being discharged from the hospital. By 1999, many US states had passed legislation requiring hearing screening of newborns, but a study described in the July, 1999, issue of American Journal of Otology recommended screening only babies with a risk for impaired hearing, stating that pediatricians and child care providers would detect deafness in infants and toddlers.

The October, 2001, the Journal of the American Medical Association
evaluated nineteen studies, emphasizing that screening newborns was not superior to tests by pediatricians when infants were several months old and stressing that determining the value of newborn screening required additional study. In October, 2005, the Archives of Pediatrics & Adolescent Medicine estimated that more than half of children whose hearing test results revealed that they needed additional tests never underwent such testing.

The role of otitis media (middle-ear infections
) in producing hearing impairment is an area of great concern and controversy. Special attention to the hearing evaluation of children with recurrent and chronic otitis media is indicated.

Bibliography

"Audiometry." MedlinePlus, August 30, 2012.

Bess, Fred H., and Judith S. Gravel, eds. Foundations of Pediatric Audiology. San Diego, Calif.: Plural, 2006.

Dobie, Robert A. and Susan B. Van Hemel, eds. Hearing Loss: Determining Eligibility for Social Security Benefits. Washington, D.C.: National Academies Press, 2005

de la Rocha, Kelly. "Audiometry." Health Library, November 11, 2012.

Elder, Nina. “Now Hear This—Check Your Baby’s Hearing.” Better Homes and Gardens 78, no. 5 (May, 2000): 264.

Glaser, Gabrielle. “Pediatricians Urge Hearing Tests at Birth.” The New York Times, April 6, 1999, p. 7.

Hall, James W., III. New Handbook of Auditory Evoked Responses. Boston: Pearson Education, 2006.

Hearing Exchange. http://www.hearingexchange.com.

Koike, Kazunari J. Everyday Audiology: A Practical Guide for Health Care Professionals. San Diego, Calif.: Plural, 2006.

Montemayor-Quellenberg, Marjorie. "Newborn Hearing Test." Health Library, March 15, 2013.

McCormick, Barry, ed. The Medical Practitioner’s Guide to Paediatric Audiology. New York: Cambridge University Press, 1995.

Martin, Frederick N., and John Greer Clark. Introduction to Audiology. 10th ed. Boston: Pearson, 2010.

Northern, Jerry L., and Marion P. Downs. Hearing in Children. San Diego, Calif.: Plural, 2011.

Roush, Jackson, ed. Screening for Hearing Loss and Otitis Media in Children. San Diego, Calif.: Singular, 2001.

Sataloff, Robert T., and Joseph Sataloff. Hearing Loss. 4th ed. New York: Taylor & Francis, 2005.

What theme is illustrated by Désirée's acceptance of blame for the baby's skin color?

Kate Chopin leaves many ambiguities in her short story "Desiree's Baby." Whether Desiree does or does not accept that she is the reason her baby has African features is unclear. In fact, initially she protests vehemently when Armand says, "It means that the child is not white. It means that you are not white." She shows Armand her hand and declares that it is whiter than his. She writes to her mother urging her to "tell them it's not true." Madame Valmonde writes back, telling her to come back home to her with the baby. There is no indication that Desiree ever believes she herself is of mixed race. On the contrary, Chopin's word choice seems to reinforce that Desiree continues to believe in her whiteness. When she lays the letter before Armand, she stands there "silent, white, motionless." When she leaves the house with the baby, "Desiree had not changed the thin white garment" that she wore, and presumably had not changed her conviction about her racial heritage. 

The only indication that suggests Desiree accepts Armand's explanation of their child's looks is that Desiree leaves the plantation when Armand says he wants her to go. However, Desiree no doubt has enough pride to not stay with a husband who expressly wants her to leave. In addition, she realizes that if she is not of mixed race, that Armand must be, and that he will never tolerate such a fact to be made known. She will need to be sacrificed for his secret.

Whether Desiree accepts Armand's explanation or whether she merely acquiesces to it, the theme her actions support is the same. The theme Chopin presents is that in a patriarchal society, a woman is powerless even if she is in the right, and she is at the complete mercy of her husband's whims, beliefs, and desires. 

What major themes and comments on life are evident in the poem "Song of Myself"?

This long poem, a piece of Leaves of Grass, is a spontaneous self-portrait in prose form, celebrating Whitman’s individuality while acknowledging how all humanity is alike (like “leaves of grass”). 

“I harbor for good or bad, I permit to speak at every hazard,/
Nature without check with original energy.”

Whitman’s consistent and unequivocal comment on life is to live it, every day, every moment, to savor and enjoy and be ultra-conscious of your own facticity:

 “My respiration and inspiration, the beating of my heart, the
     passing of blood and air through my lungs,
The sniff of green leaves and dry leaves, and of the shore and
     dark-color'd sea-rocks, and of hay in the barn,”

A second, related theme is that the universe is infinite, that our immediate existence is but a fraction of all that is:

     “You shall possess the good of the earth and sun, (there are
     millions of suns left,)”

Whitman’s “song” is that there is no limit to our experience as living creatures, as spirits given the blessing of our existence.  While it is difficult for us as common men to see the grandeur, Whitman manages to point to it and invite our souls to celebrate the fact of being.

These themes are so large in concept, so vital to our understanding of Whitman's life-message, that paraphrasing or condensing them is "murdering to dissect,"  that is the "life" of the poem itself is diminished; reading the poem is all the "analysis" you need in order to understand his connection to the reader.

What process causes volcanoes to form along the mid-ocean ridge?

The mid-ocean ridge is a continuous underwater range of mountains which virtually encircle the globe. These mountains are formed along the boundaries of tectonic plates where new ocean floor is created when tectonic plates move apart.

Tectonic plates are moved apart by convection in the upper mantle. As the tectonic plates move apart, molten rock ascends, right through to the sea floor, producing huge volcanic eruptions of lava, called basalt. The enormous force of the lava eruption further aggravates the divergence of the tectonic plates.

Tectonic plates spread apart at varying rates. Plates with slow spreading rates of about 2 to 5 cm per year develop deep rift valleys along their crest but fast spreading ones with rates of about 6 to 16 cm per year develop a smooth volcanic summit with only a crack along their crests.

What are the differences between Banquo and Macbeth with relation to the witches' prophecies?

Macbeth is prophesied to be king, while Banquo will be the father of kings. At the beginning of the play, these two soldiers had been friends, fighting together in the battle. With the prophecy, however, things begin to change. Macbeth, believing wholeheartedly in the prophecy, immediately sees murder as the means by which he can get rid of Duncan, as well as Duncan’s sons, Malcolm and Donalbain. When he contemplates the witches’ prophecy of Banquo’s sons becoming kings, he puts two and two together: his own sons will not inherit the crown. Instead, it will go to the offspring of Banquo (a historical note: Banquo’s descendant was James I, the king of England when Shakespeare wrote the play). Therefore, Banquo must die (even though he is not prophesied to be king himself). His sons also must be killed.

Macbeth’s hubris (pride) easily twists his soul, seeing murder as a requirement to achieve his destiny. He had momentarily thought that he should do nothing, and that his fate would happen without his own effort. Then he decides that he cannot take that risk. Previously a loyal subject and friend, his relationship with Duncan as well as Banquo is twisted.

Banquo, understanding the prophecy as well, does not see it as “fate.” He believes it is the work of the devil, in order to get Macbeth and himself to commit evil. He rejects this, and begins to distance himself from Macbeth, at least emotionally.

The difference between the two men, therefore, is the nature of the souls. Macbeth is easily corrupted, while Banquo is strong in character. In the end, it is this difference that brings about the result of the prophecy. Macbeth does not live long enough to pass the crown onto his son, which the witches didn’t prophesy. Banquo, who chooses righteousness, does nothing to help the prophecy along; as a result, it comes true.

Why is the world we live in today interested in not only the quality of goods we buy but in how those goods and services are produced?

Have you ever seen references to the internet meme “first world problems?”  I believe that we care not only about the quality of the products we buy, but about how they are produced, because we are so rich that we have the ability to do so.

In the past, we were not nearly as rich as we are now.  Before WWII, the average American did not live the sort of affluent lifestyle that we now have.  Even in the boom years after the war, the typical American did not live as well (in material terms) as we do now.  Most people did not have two cars.  Houses were much smaller than they are now.  People did not go out to eat all the time or spend their money on fancy cups of coffee products.  It is only in the last few decades (no matter how much we complain about the weak economy or rising inequality) that the vast majority of Americans have come to have so much material wealth.

The psychologist Abraham Maslow said that human beings have to have their basic needs fulfilled before they can care about other things.  Speaking of individual people, he said that a person has to have food and shelter, for example, before they can worry about things like morality. I think that the same sort of thing applies to our society as a whole.  When we were worried about having enough material goods, we were not able to care about other things.  Now, we have enough material goods.  We have the luxury of worrying about how they are made.  We have the luxury of wondering if they were made in ways that harmed the environment or exploited workers in other countries.  When we were poorer, we did not care about these things because we just wanted to fulfill our more basic needs.  Now that our basic needs are amply provided for (and have been for at least a couple of decades), we have been able to move on to thinking about things like the morality of how our goods and services are made.

What is the proper chemical formula and model for water?

The chemical formula of water is H2O. One molecule of water contains 2 atoms of hydrogen and one atom of oxygen. It is a covalent molecule and has a definite geometry. The central atom is oxygen.   The electronic configuration of Oxygen in the ground state is

1s2 2s2 2p4. (atomic number of oxygen is 8).

The 2s orbital containing 2 electrons and the three 2p orbitals containing a total of 4 electrons of oxygen undergo  sp3 hybridization. Hybridization is the process of mixing up of orbitals of slightly different energies of an atom to give same number of equivalent orbitals. The hybrid orbitals will have the same energy and shape. In this case 4  sp3 hybrid orbitals are formed. According to VSEPR theory these hybrid orbitals will get themselves arranged around the central atom in such a way that repulsion between them is minimum. Here the orbitals are arranged tetrahedrally around the central oxygen atom. The angle between the orbitals in the tetrahedral arrangement is 109028’. As an orbital can accommodate only two electrons, the 6 electrons are distributed among the 4 hybrid orbitals such that two orbitals contain two electrons each (paired electrons) and the remaining two contain one electron each (unpaired electron). Only half filled orbitals containing one electron (unpaired electron) can form covalent bond. Hence the two half-filled sp3 hybrid orbitals of oxygen form covalent bonds with two hydrogen atoms.

The electronic c configuration of Hydrogen atom is   1s1. (atomic number of hydrogen is 1).

The 1s orbital of hydrogen is half-filled (contains only 1 electron).

According to Valence Bond theory, a covalent bond is formed by the overlap of two half-filled orbitals containing electrons of opposite spin of two atoms. Thus in water, the two half-filled sp3 hybrid orbitals of oxygen  overlap with the half-filled 1s orbitals of 2 hydrogen atoms to form covalent bonds. The overlap of the orbitals takes place along the inter-nuclear axis resulting in the formation of sigma type covalent bonds. (if the overlap takes place sideways, a pi bond is formed). In water the two O-H bonds are of sigma type.

In water, the central oxygen atom has two bond pair electrons (from two covalent bonds) and two lone-pair of electrons (from two completely filled orbitals not involved in bond formation) .According to VSEPR theory the repulsion between the orbitals are in the order

Lone pair-lone pair> lone pair- bond pair > bond pair-bond pair.

As there are 2 lone pair electrons, the bond pairs get repelled and the H-O-H bond angle decreases from the normal tetrahedral angle of 109028’ to 104.50. Water is thus a bent molecule. It is a V-shaped molecule.

The atomic radius of Oxygen is greater than that of hydrogen. Hence oxygen is bigger in size than hydrogen.

Oxygen is more electronegative than hydrogen.Electronegativity is a measure of the tendency of an atom to attract the shared pair of electron s (bonded pair of electrons) of a covalent bond towards itself in a molecule. Since oxygen is more electronegative than hydrogen the shared pair of electrons in the O-H bond is displaced towards oxygen atom. As a result a partial negative charge develops at the oxygen atom and a partial positive charge at each hydrogen atom. The O-H bond is thus polar. Each O-H bond has a dipole moment. Dipole moment is a vector quantity, having both magnitude and direction. Since H2O is a bent molecule, the bond moments do not cancel each other and the molecule has a net dipole moment. Water is thus a polar molecule.

The image at ‘b’ represents the water molecule.

Why does the narrator of "The Cask of Amontillado" by Edgar Allan Poe want revenge?

The narrator of "The Cask of Amontillado" wants revenge against his friend and fellow nobleman, Fortunato, because Fortunato has insulted him in some fashion. The exact details of this transgression are never named within the text; rather, the narrator only asserts, "The thousand injuries of Fortunato I had borne as I best could, but when he ventured upon insult I vowed revenge." With a soon-to-be murderer acting as our sole perspective in this story, it is hard to discern whether or not this insult was as grave as is implied. Is this a matter of actual slander? Or is the narrator simply paranoid, bloodthirsty, or mad? We are never given any definitive answer... That being said, Fortunato certainly does not seem to think he has committed any wrongdoings, as he greets the narrator "with excessive warmth." 

Nonetheless, the narrator assures us that "[a]t length [he] would be avenged," and proclaims proudly, "I must not only punish but punish with impunity" for "[a] wrong is unredressed when retribution overtakes its redresser... It is equally unredressed when the avenger fails to make himself felt as such to him who has done the wrong." 

When does Lady Macbeth use flattery on Macbeth whilst persuading him to kill Duncan in Act 1, Scene 7?

In this particular scene, Lady Macbeth uses a great deal more insult that she does flattery to sway her husband.  However, after calling him a coward and saying that he's not really acting "like a man" at this point -- now that he's ambivalent about committing the murder of Duncan -- she does say, "When you durst do it, then you were a man; / And to be more than what you were, you would / Be so much more the man.  Nor time nor place / Did then adhere, and yet you would make both" (1.7.56-59).  In other words, she says that the decision Macbeth had made earlier, to kill the king, was a really manly decision, and he will be even more manly if he goes through with that decision now.  At the time, when he'd initially conceived of the plot to murder Duncan, nothing was ready -- it wasn't the time or the place -- and yet he still thought of and determined to enact this plan.  She seems to admire this and think it courageous and masculine.

Further, Lady Macbeth claims that if Macbeth can just pluck up the courage to move forward, there is no way that they will fail to succeed.  She says, "screw your courage to the sticking place / And we'll not fail" (1.7.70-71).  She makes it sound as though the whole plan hinges on him: if he can muster his courage then there is no possible way for things to go wrong.  This is relatively complimentary.

Why does water contract while increasing temperature from 0 to 4 degree C?

Water molecules are composed of one oxygen bound to two hydrogen atoms through a single covalent bond with each. These bonds are not evenly shared; oxygen has more positive charges in its nucleus and is able to exert a stronger pull on the electrons in the bond. Therefore, the electrons spend more of their time closer to the oxygen, which gives the oxygen a partial negative charge. The hydrogens, having less time around the electrons, do not have their single positive charge completely cancelled out, so they have a partial positive charge. We call this type of condition polarity. Water is one of the most polar molecules, and this explains a great deal about its properties.

The reason for the phenomenon observed when water is at 4 and 0 degrees is due both to the nature of this polarity, and to the behavior of molecules in their different phases. Liquids are typically higher in energy than their solid counterparts of the same substance under the same conditions. This means the liquid molecules are moving around more, and therefore will have a lower density. So, it shouldn't surprise us that as water cools, the trend is, on average, for the density to increase.

The polarity of water factors into the cooling as well. When water cools, the decreased motion of the molecules allows the molecules to "lock" themselves into the arrangement that best satisfies their polar charges; oxygens are near hydrogens, and vice versa. Due to the geometric shape of the water molecule, this results in a specific hexagonal crystal shape. These shapes are less dense, on average, than the liquid form of water because they don't have the energy to squeeze themselves into the less-favorable spaces.

When the water reaches 4 degrees, these shapes are beginning to take form, and the water is both increasing in density (as it cools) and decreasing in density (as the crystal shapes form and lock the molecules into a particular arrangement). By the time the water has reached 0 degrees Celsius, the locking effect is complete, and there's actually "wasted" space in the crystal that was once occupied by the slightly more energetic 4 degree water.

The molality of a 1L Solution with x percent H2SO4 is 9. The weight of solvent present in the solution is 910 grams. What is the value of x?

Molality is a measure of concentration defined as moles of solute per kg of solvent.  So if the molality of the sulfuric acid solution is 9, then that means that there are 9 moles of sulfuric acid per 1 kg of solvent.  So we have a solution that is 9 molal in concentration and the amount of solvent in it is 910 g which is the same as 0.910 kg.  So we multiply the two to get the moles of sulfuric acid in the solution.

(9 mole / kg) * 0.910 kg = 8.19 moles sulfuric acid

Multiply this by the molecular weight of sulfuric acid (98.079 g/mole) to convert into grams.

8.19 moles * (98.079 g / mole) =  803.3 g sulfuric acid

Now divide by the density of sulfuric acid (1.84 g/mL) to convert the grams into mL's.

803.3 g * (1 mL / 1.84 g) = 436.6 mL sulfuric acid

So we have 436.6 mL of sulfuric acid total.  Since we know that we have 1 L (the same as 1,000 mL) of total solution, we know that means that the percentage of the sulfuric acid in the solution can be calculated as shown below.

436.6 mL H2SO4 / 1,000 mL total solution = 0.437 = 43.7%

So we know that the value of x in the original question (percentage of H2SO4 in the solution) is 43.7%

I need to know who Hamlet really trusts. Who is loyal to Hamlet?

Hamlet really trusts Horatio and no one else. And Horatio is completely loyal to Hamlet. Hamlet confides everything to Horatio. Horatio is the only one to whom Hamlet has confided the substance of his meeting with the Ghost on the battlements and who knows that Claudius murdered Hamlet's father to seize the throne. In one scene Hamlet expresses his confidence in Horatio.

Horatio, thou art e'en as just a man
As e'er my conversation cop'd withal.
....................................................
Nay, do not think I flatter;
For what advancement may I hope from thee,
That no revenue hast but thy good spirits
To feed and clothe thee? Why should the poor be flatter'd?
No, let the candied tongue lick absurd pomp,
And crook the pregnant hinges of the knee
Where thrift may follow fawning. Dost thou hear?
Since my dear soul was mistress of her choice,
And could of men distinguish her election,
Sh'hath seal'd thee for herself. For thou hast been
As one, in suff'ring all, that suffers nothing;
A man that Fortune's buffets and rewards
Hast ta'en with equal thanks; and blest are those
Whose blood and judgment are so well commeddled
That they are not a pipe for Fortune's finger
To sound what stop she please. Give me that man
That is not passion's slave, and I will wear him
In my heart's core, ay, in my heart of heart,
As I do thee.       (Act III, Scene 2)

Hamlet expresses these sentiments to Horatio just before asking him to help observe the King during the course of the play-within-a-play. Hamlet wants to have a witness to verify his own observations of Claudius when it comes to the place where the actor playing the villain pours poison in the ear of the actor playing the sleeping King. It turns out that Hamlet hardly needs a witness, since Claudius makes such a scene that he brings the play-within-a-play to a halt as he flees the room. Horatio is convinced that the Ghost who appeared to Hamlet on the battlements was indeed the ghost of Hamlet's father and was telling him the exact truth.

Horatio acts like a true friend to Hamlet throughout the remainder of the play, and he proves his complete loyalty when he endeavors to commit suicide and join Hamlet in death at the very end. But Hamlet wrests the poisoned goblet out of his friend's hand and asks him to "absent himself from felicity" for a while in order to tell his story to the members of the court. Horatio is necessary for this function, since he is the only person still alive who knows the whole truth. Without him, everyone in the Danish court would assume that Hamlet had committed a wilful murder in an attempt to usurp the throne from Claudius. Horatio could not have been more loyal to Hamlet.

How are the themes of kindness and trust communicated in the story?

The themes of a piece of literature are implied messages the author conveys to the reader. In “Thank You, M’am” by Langston Hughes, the themes of kindness and trust are evident throughout the story.

The theme of trust is developed from the beginning of the story when Roger attempts to steal Mrs. Luella Bates Washington Jones’ “kitchen sink” pocketbook. Although, she has him in her grasp, she trusts him to pick up the purse and not run away. After she drags him back to her rooming house, the pair carry on a conversation during which Mrs. Jones reveals things from her past. She trusts Roger to understand her reasons for divulging her own desperate times.

The door to her room remains open while she instructs Roger to wash up, and when she goes behind the curtain to cook their meal. Her purse sits in plain sight so that if Roger chose to, he could grab it and run. He does not because at this point he wants to be trusted.

In another corner of the room behind a screen was a gas plate and an icebox. Mrs. Jones got up and went behind the screen. The woman did not watch the boy to see if he was going to run now, nor did she watch her purse which she left behind her on the day-bed. But the boy took care to sit on the far side of the room where he thought she could easily see him out of the corner of her eye, if she wanted to. He did not trust the woman not to trust him. And he did not want to be mistrusted now.

In addition, the theme of kindness runs throughout the story. Mrs. Jones decides not to call the authorities when Roger tries to steal her purse, instead she takes him home to teach him a lesson with her actions. She notices he is a hungry, neglected young man, which prompts her to encourage him to look presentable, and share her meager supper with him. This includes splitting a ten cent dessert. While she is preparing the meal, Roger offers to run to the store for anything she might need as he tries to reciprocate for her kindness towards him.

Her greatest kindness may have been the respect she shows him by not asking him questions about his home life so as not to embarrass him. Others would argue the utmost kindness occurred at the end of the story when Mrs. Luella Bates Washington Jones hands him money so he can buy the blue suede shoes he so desperately wants.

When they were finished eating she got up and said, “Now, here, take this ten dollars and buy yourself some blue suede shoes.  

He is rendered practically speechless by this act of kindness towards him.

The boy wanted to say something else other than “Thank you, m’am” to Mrs. Luella Bates Washington Jones, but he couldn’t do so as he turned at the barren stoop and looked back at the large woman in the door. He barely managed to say “Thank you” before she shut the door. And he never saw her again.

Explain why Amir's task is to not only atone for his own sins but for his father's as well in the novel The Kite Runner.

The protagonist in Khaled Hosseini's novel The Kite Runner, Amir, is motivated by guilt for most of his adult life for an act he committed in childhood. More specifically, it was an act he did not commit: he witnessed the rape of his best friend, Hassan, but did nothing to intervene. In fact, Amir violently rejected Hassan, desperately ashamed and discomfited by interacting with him. 

Later, Amir's guilt leads him to return to Afghanistan and rescue Hassan's son. However, it is not solely Amir's guilt that pushes him to this, some might say courageous, decision. As is revealed later in the text, Hassan is in fact Amir's half brother, fathered by Baba. In returning to Afghanistan for Sohrab, Amir recognizes Hassan's relationship with Baba as legitimate, complete with the responsibilities due to a family member in need. 

What is a good thesis statement for the nature of sin and grace in "A Good Man Is Hard to Find" that can lead me into a discussion of the...

Thesis Statement: In Flannery O'Connor's "A Good Man Is Hard to Find," violence is a means to redeeming grace.

Miss O'Connor once wrote,

Redemption is meaningless unless there is a cause for it in the actual life we live.

In "A Good Man Is Hard to Find," when the grandmother is confronted with death as she faces the Misfit and hears the report of pistols firing as the other men execute her family, she tries to tell the Misfit that he is really a good man, a superficial assessment of hers used earlier in the story. In this previous incident, she speaks to Red Sammy and he tells her that he let three men charge their gas, but then asks, "Now why did I do that?" She instantly replies, "Because you're a good man," without really knowing what kind of person Red Sammy truly is.

So, it is not until the family car turns over on the dirt road and they are confronted by the Misfit and his companions that the grandmother becomes truly compassionate.

Faced with death in the person of the Misfit, who has no interest in her false compassion—

"I just know you're a good man" she said desperately. "You're not a bit common!"
"Nome [No ma'am], I ain't a good man...."—

the grandmother's shallow emotion has no effect on her salvation. The Misfit's only goal is survival, and the family and the grandmother are threats to this survival since they can identify the three men.

Then, as the Misfit talks about how Jesus threw everything off balance by supposedly dying on the cross for people, the "old lady" mumbles and sinks down into the nearby ditch with her legs twisted beneath her. Ignoring her, the Misfit says he is not certain of this salvation offered by Jesus because he was not there. He says that if he were there, he would know for certain what is right.

...the grandmother's head cleared for an instant. She saw the man's face twisted close to her own as if he were going to cry and she murmured, "Why you're one of my babies. You're one of my own children!"

Now, with real compassion, her sincere words touch the Misfit, who is repelled "as if a snake had bitten him," and he shoots her three times in the chest. Indeed, the grandmother's real compassion has made her a victim of his violence. But with this violence the grandmother has received grace by means of her maternal compassion. She has her moment of redemption:

...the grandmother...half sat and half lay in a puddle of blood with her legs crossed under her like a child's and her face smiling up at the cloudless sky.

The violent catastrophe that the grandmother has experienced becomes a redemptive catastrophe as it affects her conversion and grace, symbolized by her "legs crossed under her" much as Christ's were when taken down from the cross after He, according to Christian belief, redeemed mankind by dying. Her grace, too, comes only at the moment of grisly death.

Miss O'Connor describes this story as well as her other works in this way:

I have found, in short, from reading my own writing, that my subject in fiction is the action of grace in territory held largely by the devil.

How does O. Henry widen the vision of the reader in addition to telling interesting stories?

O. Henry's short but powerful short stories are masterpieces of irony, as the outcome of the stories often involves an unexpected twist. For example, in "Heart and Hands," the man who the reader thinks is the marshal winds up being the prisoner. 

O. Henry's stories also widen our vision because they challenge our prejudices and preconceived notions. For example, in "Heart and Hands," the reader might assume that the attractive character, Mr. Easton, is the representative of the law. However, although he is young and handsome, he is the prisoner. At the end of the story, the reader learns that his or her prejudices have been wrong and that the less attractive, older member of the pair on the train is the marshal and that Easton is the prisoner. In "Gifts of the Magi," a young couple named Jim and Della buy Christmas gifts for each other that don't work out. Jim buys Della combs for her hair, but she has cut off her hair to buy him a chain for the watch he sold to buy her the combs. This story expands our vision because it makes us realize that our preconceived notions of what we need to buy on Christmas--that is, material goods--are often flawed. Instead, as Jim and Della realize, the ultimate gift they can give each other is love. 

What are stomach, intestinal, and pancreatic cancers?

Causes and Symptoms

The section of the gut from the esophageal sphincter in the upper stomach to the ileocecal valve at the end of the small intestine digests food taken into the body and absorbs its nutrients. This vital function also exposes the gut and its organs, the liver and pancreas, to ingested toxins that can initiate cancer and to materials that damage the gut lining, also potentially leading to cancer. Because diet greatly influences the chances for contracting these cancers, it is understandable that stomach cancer is the world’s most common type. Surprisingly, however, cancers of the small bowel are rare. Pancreatic cancer is the most lethal of these cancers and one of the most difficult to detect before irreversible damage has been done: Few patients live long after diagnosis. These facts and the large number of suspected carcinogens make the stomach and pancreatic cancers a pressing challenge for physicians and public health.

Broad similarities characterize the types of cancers throughout the upper gastrointestinal (GI) tract. The majority, adenocarcinomas, grow in and mimic gland tissue, but possible as well are cancers of the lymph tissue (lymphoma), hormone-secreting cells (carcinoid tumors), and the muscle wall of the bowel (sarcoma). Early symptoms tend to be vague and do not necessarily point specifically to cancer: abdominal pain, loss of appetite, weight loss, and perhaps diarrhea or vomiting.

While diet is a major factor in stomach cancer, its role in pancreatic and intestinal cancers is not as clear. A diet consisting mainly of pickled, smoked, or salted food with few fruits and vegetables, especially those containing vitamins A and C, is thought to be risky. In fact, countries with the highest rates of gastric cancer, such as Japan, are those that have long relied on such chemical preservation techniques rather than on refrigeration. It is probably no coincidence that the stomach cancer rate in the United States declined sharply after refrigeration became widespread in the 1930s; moreover, Japanese immigrants to the United States have sharply fewer gastric cancers than do their relatives in the homeland.

The presence of nitrites in the diet, alcohol consumption, radiation exposure, chronic gastritis (inflammation of the stomach lining), and cigarette smoking have also been suspected as gastric carcinogens. Hereditary susceptibility may sometimes play a role, although it is also possible that family members, living under the same conditions, are simply exposed to the same carcinogens and that no genetic susceptibility is involved. Finally, chronic stomach infection with the bacterium Helicobacter pylori has been linked to gastric cancer development.

Risk factors for the
pancreas and
small intestine are much less clear. Chronic pancreatitis, gallstones, and cirrhosis (scarring) of the liver pose some danger of initiating pancreatic cancer, and smokers and diabetics are twice as likely to develop it than are others. In March 2013, scientists at the Institute of Social and Preventive Medicine at the University of Zurich published a study of 450,000 subjects that found that consumption of processed meats increased the risk of premature death by cancer and other health problems. Chemists and others who work with organic solvents and petrochemicals also run a slightly higher risk. Intestinal cancer becomes more likely after the immune system has been damaged or late in the course of chronic intestinal diseases, such as Crohn’s disease and sprue.

Risky foods, diseases, or occupations do not inevitably lead to cancers. Tumor growth requires at least three factors: some agent that initiates a change in a cell’s genetic structure so that a new type of cell is created, called a
mutation; an agent that enhances the cell’s response to the initiator, encouraging it to reproduce; and the failure of the immune system to destroy the abnormal cells. Most small bowel and gastric cancers probably result from long-term overstimulation of the glands or mucosa. This overstimulation occurs when the body fights chemical irritants that have been ingested with food, drink, or air; the body’s defense mechanisms lead to inflammation in the damaged area. Chronic inflammation and continually stimulated cell division to repair damage eventually is likely to produce a mutated cell. If adapted to the harsh environment that produced it, the cell can multiply unchecked, overwhelm the immune system, and invade normal tissue; eventually, it may metastasize. A potentially lethal cancer can grow for months or years before its victim notices any definite changes in particular body functions or general health.

Eventually, however, danger signs begin. After initially complaining of abdominal pain, loss of appetite, and difficulty keeping food down, stomach cancer patients may have black, digested blood in the stool, weight loss, general weakness, bouts of vomiting blood, a swollen abdomen, a noticeable mass in the stomach, and iron-deficiency anemia. When the disease is well advanced, metastases become increasingly common, invading the lymph nodes, bile ducts, and liver and eventually spreading to the lungs, bones, and brain. The cancer becomes symptomatic relatively quickly. On average, patients go to their doctors about six months after noticing symptoms.

Pancreatic cancer is much less likely to cause early symptoms, and by the time patients seek medical help, the cancer is usually too far advanced to cure. Physicians suspect pancreatic adenocarcinoma when a patient complains of food aversion, progressive weight loss, and abdominal and back pain, especially when accompanied by vomiting, diarrhea, and jaundice. A rare form of pancreatic cancer (less than 5 percent of cancers in the pancreas) develops from the insulin-producing cells of the organ and makes abnormally high amounts of insulin; in this case, the symptoms are attributable to low blood sugar (hypoglycemia) and include weakness, loss of energy, dizziness, chills, muscle spasms, double vision, and, in extreme cases, coma.

Adenocarcinomas, lymphomas, carcinoid tumors, and sarcomas may form in the small bowel, and most of these grow slowly. Intestinal adenocarcinomas show up primarily in the jejunum or duodenum of elderly patients. Often, they first become apparent when they clog the bowel or bleed. Usually appearing in the stomach, lower jejunum, or ileum, lymphomas are suspected when the patient has fever, night sweats, weight loss, and abdominal pain. Intestinal carcinoid tumors may actively secrete hormones. If they metastasize, release of the hormones sometimes causes a bizarre group of symptoms that are collectively known as carcinoid syndrome: diarrhea, flushing, itching, low blood pressure, and heart disease. Intestinal sarcomas can occur anywhere in the small bowel and reveal themselves by bleeding.

Treatment and Therapy

Since other diseases also cause the weight loss, abdominal pain, and nausea common to these cancers—for example, pancreatitis, malabsorption, inflammatory bowel disease, and gastritis—the diagnosis of cancer requires specific evidence from chemical tests, imaging, endoscopic procedures, or surgery. Suspecting stomach cancer, the physician may send the patient for an upper GI barium study. For this procedure, the patient drinks a mixture containing barium sulfate; the radio-opaque barium coats the stomach and under X-ray photography can be seen to outline a tumor if one is present. Tests to check for anemia and blood in the stool may also be ordered. If imaging and tests support a diagnosis of cancer, a gastroenterologist, inserting an endoscope through the patient’s mouth, will obtain biopsies of the tumor so that a pathologist can determine if the tumor is malignant. Since biopsies remove such small samples and can miss a cancerous portion of a tumor (especially a lymphoma or sarcoma), surgical biopsy may be necessary to settle the diagnosis beyond doubt.

Similarly, initial tests for pancreatic and intestinal cancer rely on imaging and chemical assays. A barium X-ray study of the small bowel, a computed tomography (CT) scan, or ultrasonography may locate the tumor. Again, endoscopic or surgical biopsy alone can verify the diagnosis of malignancy. Tumors in the small bowel usually lie beyond the reach of endoscopy, so when a barium study reveals a tumor, surgical biopsy is most often necessary to obtain tissue samples; at the same time, the tumor is usually removed to relieve or prevent obstruction of the bowel.

If a tumor has not spread and is well defined, cutting it out provides the best chance of a cure for cancers throughout the stomach, pancreas, and small bowel. Such surgeries are often technically difficult, however, because the patients are typically malnourished and weak and have difficulty enduring the rigors of surgery. When a stomach tumor is single and small, surgeons remove it and a small margin of tissue around its edges. Larger or multiple tumors force the removal of larger portions of the stomach and adjacent lymph nodes. For pancreatic cancer, if more than a single area of the pancreas is involved, the surgeon may remove the entire organ and, depending on the size and location of the tumor, parts of the duodenum and stomach as well. Cancers of the intestines are cut away along with a section of bowel, whose ends are then reconnected by suturing. Chemotherapy and radiation on their own have not proved reliable for shrinking stomach, pancreatic, and intestinal cancers (except lymphomas) and are usually used in conjunction with surgery, especially when a primary tumor has metastasized.

Sometimes endoscopic maneuvers can stop bleeding or relieve pain by clearing out obstructions or, in the case of an obstructed bile duct, by inserting a small perforated tube called a stent to ensure that bile and pancreatic juices flow freely. Pain management, whether with manipulative procedures or with drugs, becomes the primary focus of treatment when surgical cure for a cancer is unlikely. Surgeons do not attempt curative operations if the cancer has metastasized. At this point, surgery, if possible at all, is for relieving pain, preventing blockage, or minimizing blood loss.

Perspective and Prospects

The frequency of these cancers and their distribution in the world vary considerably. Intestinal cancers make up less than 1 percent of all cancers and less than 5 percent of gastrointestinal cancers; pancreatic cancer accounts for only about 3 percent of all cancers. Yet the incidence of both cancers has been rising. In the United States, for example, pancreatic cancer increased about 25 percent from the 1950s to the 1990s. By 2002, it was the fourth leading cause of cancer death, and more than 30,000 Americans were diagnosed with the disease annually. At the same time, stomach cancer decreased dramatically, dropping from the United States’ most common cancer in the 1930s to about 2 percent of all cancers in the 1990s. Yet in Japan, Iceland, and parts of Central and South America and of Eastern Europe, the stomach cancer rate is very high, accounting for most of the nearly 700,000 new cases yearly. In 2008, the World Cancer Research Fund International listed stomach cancer as the fourth most common cancer in the world. Approximately 990,000 new cases of stomach cancer were diagnosed in 2008. The highest rates of stomach cancer are in Eastern Asia; specifically South Korea, Mongolia, and Japan. Worldwide, incidence of stomach cancer occur in men twice as often as women. In 2013, the American Cancer Society estimated that 21,600 cases of stomach cancer are diagnosed annually in the United States . In the United States, African Americans get these cancers more often than Caucasians. Probably because of their diet, poor people develop intestinal cancer more often than middle-class or upper-class people. The peak age group is fifty to fifty-nine years for stomach cancer and seventy to seventy-nine years for pancreatic and intestinal cancer.

The chances for successfully treating or drastically curtailing small bowel cancer are reasonably good; 20 percent of patients with adenocarcinomas in the small intestine survive for at least five years following diagnosis, and patients with carcinoid tumors have lived ten and even fifteen years after surgery. Treatment of small bowel or stomach lymphomas can result in a cure or prolonged survival in a significant percentage of cases. The prospects for pancreatic and stomach adenocarcinomas, however, are another story entirely. Overall, in the United States about 10 percent of gastric cancer patients are alive five years later. Pancreatic cancer is even deadlier, with 90 percent of patients dying in the first year after diagnosis, regardless of treatment. Of those with cancer of the pancreatic duct, only about 4 percent survive three years. Those with cancer in the insulin-producing cells fare better—a 30 percent survival rate—but this is a very rare type of cancer.

Because gastric cancer is common in Japan, doctors routinely screen patients for it by endoscopy or photofluorography (a type of X ray). Prescreening in Japan increases the overall survival rate of patients in the country. Many more cancers are caught early, while they are still surgically treatable. Endoscopic and chemical screenings for pancreatic cancer are also possible, but since the disease is so much less common, doctors do not perform the tests unless they already have good reason to suspect cancer. Avoidance of carcinogens, especially alcohol, remains the most promising way to escape gut cancers.

Bibliography

American Cancer Society (ACS). http://www.cancer .org.

Daly, John M., Thomas P. J. Hennessy, and John V. Reynolds, eds. Management of Upper Gastrointestinal Cancer. New York: W. B. Saunders, 1999.

Eyre, Harmon J., Dianne Partie Lange, and Lois B. Morris. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery. 2d ed. Atlanta: American Cancer Society, 2002.

Ferlay, J. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10.  Lyon, France: International Agency for Research on Cancer, 2010.

Kapadia, Cyrus R., James M. Crawford, and Caroline Taylor. An Atlas of Gastroenterology: A Guide to Diagnosis and Differential Diagnosis. Boca Raton, Fla.: Parthenon, 2003.

Levine, Joel S., ed. Decision Making in Gastroenterology. 2d ed. Philadelphia: B. C. Decker, 1992.

O’Reilly, Eileen, and Joanne Frankel Kelvin. One Hundred Questions and Answers About Pancreatic Cancer. 2d ed. Sudbury, Mass.: Jones and Bartlett, 2010.

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

Rustgi, Anil K., and James M. Crawford, eds. Gastrointestinal Cancers. New York: W. B. Saunders, 2003.

Sachar, David B., Jerome D. Waye, and Blair S. Lewis, eds. Pocket Guide to Gastroenterology. Rev. ed. Baltimore: Williams & Wilkins, 1991.

What is an insightful research question about the creation of the Volkswagen and the connection to Hitler's vision?"

Volkswagen is one of the most recognizable brands in the auto industry. Despite the success of the auto maker, most Americans probably do not realize that this company was created by Adolf Hitler with great pride and enthusiasm.  This was a well known fact in the 1950's and the car's association with the Fuhrer resulted in sluggish sales in the United States even in the booming economy of the decade.  

As a teacher, I would focus on how Volkswagen overcame this tremendous public perception problem.  This would require research on the marketing strategies that Volkswagen utilized in the 1950's to make the car one of America's top imports.  An insightful question would be one that asks the students to apply some of the concepts of their research.  This is the prompt that I would assign:

Research the marketing strategies of the Volkswagen and provide a short critique of the company strategy.  Create your own marketing campaign for Volkswagen for the years between 1951-1953.

Another option:

Create a research strategy for Volkswagen that attempts to separate the automaker form Adolf Hitler's vision of the car company.

While traveling in England, you purchase 8.91 gallons of gas (or petrol there). The price posted is €1.98 per liter. How many U.S. dollars...

I suppose the prices in England are listed in pounds £, not in euros €.

To answer this question we need the conversion ratio between pounds and U.S. dollars. I got it from the attached link, and it says  `1 GBP approx 1.328 USD.` 

Also we need to know how many liters are in one gallon, it is about  `3.785.`

Now we can perform the calculations: `8.91` gallons are about  `8.91*3.785` liters, they cost about  `8.91*3.785*1.98` pounds, and in dollars it will be

`8.91*3.785*1.98*1.328,`  which is equal to about  88.68 U.S. dollars.

What is the Earth's crust made of?

The outermost layer of our planet, called the crust, is made up of minerals in the form of solid rock and loose dirt. The crust sits atop the mantle, although the liquid magma of the mantle sometimes breaks through. When this magma cools, it hardens into part of the outer crust. In some places, like the bottom of the ocean, the crust is quite thin. The crust is far thicker when it is part of land masses. We call the crust that makes up land masses the continental crust, and the composition here is primarily granite rock. The oceanic crust at the sea-floor has higher levels of basalt and gabbro rock. Both kinds of crust also contain the minerals aluminum, uranium, iron, and silicon.