In the novel The Underdogs by Mariano Azuela, in what ways is the theme of "futility" demonstrated?

Mariano Azuela's novel Los de Abajo, or The Underdogs reads, almost in its entirety, as an essay on futility in a variety of ways. 

Let's start with Demetrio's entry in the Revolution. Rather than joining to defend his principles, he actually does it just to get back at los federales. Being that the revolution is bloody and futile on its own, joining it for shallow reasons makes everything all the more senseless. 

Then come the products of the revolution itself. What starts as a united front ends up in disaster. The relationship between Camila and La Pintada, for example, becomes marred by jealousy and ends with the killing of Camila by La Pintada.

Another example of futility is that, as much as the revolutionaries shouted and attempted to battle against the federales and oppression, their inner factions and ongoing fighting and dissatisfaction contributed to the disbanding of many revolutionary groups, making the struggle even more futile: They were fighting within a fight, against one another and against the system that wanted to put them down at the same time. What is purposeful, useful, or even sensible about that?

More futility: Pancho Villa and Venustiano, once united by the vision of revolutionary victory, become rivals. El Manteca and Pancracio, also meant to be comrades, literally kill one another over a game of cards. El güero Margarito commits suicide.

Meanwhile, the revolution keeps roaring along, taking lives with it and changing absolutely nothing. The oppression continues, as well as the injustice.

The ending of the novel is perhaps more ironic than anything else. Demetrio and the few left in his troop make one last attempt at fighting the Carranza troops as one last futile act of rebellion...only to get killed, each and every one of them, by the enemy.

What are iatrogenic infections?

Definition

Iatrogenic infections are those infections transmitted during medical treatment and care. A study published by the Journal of the American Medical Association reported that iatrogenic infection contributes to about 225,000 deaths in the United States each year. After heart disease and cancer, iatrogenic illness is the third leading cause of death in the United States.

Causes

Iatrogenic infection is complex because it has so many causes, including chance, negligence, medical error, and interactions of prescription drugs. Nosocomial infections, another leading cause of iatrogenic illness, are those that occur during hospitalization or through treatment in another health care setting. Vectors for infection in these facilities include vomit, blood, urine, and feces. Some microorganisms can be spread through the air. Postsurgical patients are particularly vulnerable to hospital-acquired infection. Illnesses can be transmitted by health care providers who neglect proper methods of sanitation.

Risk Factors

The risks associated with adverse drug reactions typically occur when health care providers lack understanding and education about the prescribed drug. One of the most significant issues in drug-drug interactions resulting in iatrogenic illness is a change in the gastrointestinal tract and liver that leads to metabolic problems. Alcohol intake and smoking can also affect the way drugs are metabolized.

One study of hospitalized patients showed that up to one-half of drug-related problems occur because of errors in prescribing, administering, dispensing, and transcribing records of drugs. Inadequate monitoring of patients was cited in another study, meaning that the appropriate laboratory tests were either not ordered or were incorrectly interpreted.

Also, a lack of sanitation frequently leads to iatrogenic illness. This could happen in a wide range of settings, from food waste and dirty restrooms to devices, such as surgical equipment, catheters, and wound dressings, that are supposed to be sterile.

Rare diseases can be transmitted during corneal
transplants, by contaminated dura matter (the layers
surrounding the brain and spinal cord), through blood
transfusion, and by dental pulp, which has been implicated in
the spread of the incurable Creutzfeldt-Jakob disease.

Symptoms

Affected persons experience a wide range of symptoms, illnesses, disorders, and conditions. Some of the most frequently studied include ovarian hyperstimulation syndrome, fat intolerance after cholecystectomy, rupture of the tracheobronchial tree, colitis, hypoglycemia, back pain, neuropathy after hysterectomy, rectourethral fistula, acute estrogen deficiency, temporomandibular joint symptoms, and small perforations of the colon during colonoscopy.

Screening and Diagnosis

By applying rigorous methodology, researchers can study, for example, the epidemiology of drug-induced illnesses. Such research includes a consideration of the frequency of a drug-induced disease, nonmedical contributing factors, the dose and route of administration of all drugs taken by the patient, the time and place of drug-induced diseases, and the specific characteristics of each patient. Other kinds of iatrogenic illness, such as nosocomial infections, are often monitored by the medical provider’s risk-management or quality-assurance departments.

Treatment and Therapy

Measures for the treatment of iatrogenic illness include antiseptics,
antibiotics, and better surgical techniques.
Anesthesia may be used to control pain.

Because there are hundreds of varieties of iatrogenic illness, each requiring individualized treatment, this section will outline the therapeutic course for a patient who is at high risk for developing a common type of iatrogenic, adverse drug reaction: dyspepsia caused by treatment with ibuprofen.

Patients with dyspepsia, or indigestion, have symptoms such as
upper abdominal pain, belching, nausea, vomiting, abdominal bloating, and satiety.
For patients taking ibuprofen, there is also a risk of internal bleeding, and the
medical team will have to screen for this. The patient may also experience warning
signs such as weight loss, blood in the stool, fever, and vomiting. The medical
team also needs to check on the patient’s diet, and it needs to screen for
depression and anxiety. Other factors under consideration should include the
patient’s age, medical history, concurrent drug use, use of herbal medicines, and
use of food supplements. Treatment cannot safely begin until all differential
diagnoses have been excluded.

If the dyspepsia is caused by abnormal function of the gastrointestinal
muscles, a smooth muscle relaxant will increase motility and improve symptoms.
Dyspepsia with the production of stomach acid may be treated with a
proton pump
inhibitor or misoprostol. After weighing the risks and
benefits, the physician may ask the patient to reduce or stop the ibuprofen.

Prevention and Outcomes

Nosocomial infection can be addressed by decontamination measures such as
cleaning, disinfection, sterilization, and ventilation. Vulnerable patients with wounds can
be protected with sterile dressings and isolation precautions. Adequate air flow
and moisture control help to keep microorganisms such as bacteria and
fungi in check. Health care providers can limit the risk of
iatrogenic illness by containing or removing infectious materials, instituting
single-use devices, and standardizing drug equipment. Some hospitals are
experimenting with financial incentives for handwashing, as studies have shown
that medical staff fail to wash their hands more than half of the time.

Many quality improvement approaches to iatrogenic illness focus on the design
of systems for control of hospital infections and adverse drug reactions.
Targeting people has been less effective. In a system-focused environment,
mechanisms such as medical audit, peer review, and risk management offer valuable
feedback to every member of the health care team, making it easier to implement
evidence-based preventive measures. The evidence-based environment also fosters
meta-analysis to improve clinical practice.

Bibliography

Archibald, Lennox K. and Theresa J. McCann. "Surveillance of Healthcare-associated Infections." Concepts and Methods in Infectious Disease Surveillance. Ed. Nkuchia M. M'ikanatha and John K. Iskander. Hoboken: Wiley, 2015. 78–91. Print.

Ayliffe, Graham A. J., et al. Hospital-Acquired Infection: Principles and Prevention. Oxford: Butterworth-Heinemann, 1999. Print.

Brown, Paul, et al. "Iatrogenic Creutzfeldt-Jakob Disease, Final Assessment." Emerging Infectious Diseases 18.6 (2012): 901–07. Print.

Merry, Alan, and Alexander McCall Smith. Errors, Medicine, and the Law. New York: Cambridge UP, 2003. Print.

Morath, Julianne M., and Joanne E. Turnbull. To Do No Harm: Ensuring Patient Safety in Health Care Organizations. San Francisco: Jossey-Bass, 2005. Print.

Nikkels, Peter G. J. "Iatrogenic Disease." Keeling's Fetal and Neonatal Pathology. Ed. T. Yee Khong and Roger D. G. Malcomson. New York: Springer, 2015. 413–48. Print.

Preger, Leslie, ed. Iatrogenic Diseases. 2 vols. Boca Raton, Fla.: CRC 1986. Print.

Sharpe, Virginia A., and Alan I. Faden. Medical Harm: Historical, Conceptual, and Ethical Dimensions of Iatrogenic Illness. New York: Cambridge UP, 1998. Print.

Starfield, Barbara. “Is U.S. Health Really the Best in the World?” Journal of the American Medical Association 284.4 (2000): 483–85. Print.

Steele, K. “Iatrogenic Illness on a General Medicine Service at a University Hospital.” Quality and Safety in Health Care 13 (2004): 76–81. Print.

Tisdale, James E., et al., eds. Drug-Induced Diseases: Prevention, Detection, and Management. Bethesda: Amer. Soc. of Health-System Pharmacists, 2005. Print.

What are common shoulder injuries?

Common shoulder injuries are frequently occurring problems relating to the human shoulder. The shoulder is composed of bones, muscles, and connective tissues. Millions of people suffer injuries to their shoulders every year. Many of these injuries—such as separations, dislocations, and fractures—are the result of sudden trauma. Many other problems—including frozen shoulder, arthritis, and rotator cuff damage—are more often the result of old age, disease, or general wear and tear on the shoulder. Physicians may prescribe a wide range of treatments for these ailments including rest, ice, stretching, medication, and surgery.

Shoulder Parts and Injuries

The shoulder comprises several parts that work together to allow movement while maintaining stability. The bone structure of the shoulder consists of three parts, the humerus (upper arm bone), the clavicle (collarbone), and the
scapula
(shoulder blade). These bones form a ball-and-socket joint with a wide range of motion.

Around these bones are muscles, tendons, and ligaments. Tendons and
ligaments
are both forms of strong connective tissue, but their functions in the body differ. Tendons connect muscles with bones and help to facilitate movement. Ligaments connect bones with other bones and help the body stay strong and stable.

Shoulders can move more freely than any other joints in the body, and their function is safeguarded by an intricate system of parts. These factors make shoulders immensely useful, but they also present many opportunities for injuries and other maladies. People of all ages, genders, sizes, and backgrounds may develop shoulder problems. According to the American Academy of Orthopaedic Surgeons, about 7.5 million people in the United States sought medical attention for shoulder-related problems in 2006.

Many shoulder-related problems are caused by sudden injuries while many others result from consistent overuse of the shoulders. In both cases, athletes are particularly at risk for shoulder problems. According to a study published in 2009 in the Journal of Athletic Training, a group of high-school athletes experienced shoulder injuries most often during football, wrestling, and baseball activities. Of these injuries, most were not serious, with athletes able to return to their sports in less than a week. However, a small percentage (6.2 percent) of the cases required surgery.

The pain from shoulder injuries varies greatly. In some cases, patients feel one concentrated area of pain. In other cases, the pain extends over a large region, or even the entire arm. Various diseases and nerve reactions can greatly alter, and generally worsen, the effects of shoulder injuries.

Injuries from Sudden Trauma

Many kinds of common shoulder injuries exist. Some types are generally caused by sudden trauma such as falls, automobile accidents, and mishaps during sporting events. This group of injuries includes separation, dislocation, and fracture.

Separation involves serious injury to the ligaments that connect the scapula and clavicle bones. People most often suffer this injury due to falls, blows, or other forms of sudden trauma. In most cases, with rest, simple treatments such as application of ice, and possibly a medical sling, the injury will heal itself. In serious cases, though, surgery may be necessary to repair torn ligaments.

Dislocation
occurs when the ball-shaped end of the humerus comes out of the socket at the shoulder joint. This injury most frequently occurs if the arm is pulled or twisted in a manner that puts too much pressure on the shoulder. Although dislocation may be very painful and upsetting, the treatment is relatively simple. A physician can usually push the humerus back into place and repair the joint, leaving the patient with no lasting ill effects except temporary soreness. In some instances, however, severe dislocations may cause lasting damage to tendons, ligaments, or nerves, or ongoing weakness of the joint that may contribute to future injuries.

A shoulder fracture is an injury in which one or more of the bones of the shoulder are cracked, usually by falls or other trauma. The most commonly fractured bones in the shoulder are the humerus and clavicle. Fractures may vary in severity. Usually, a doctor can set the bones back together and allow them to heal; if this treatment is not successful, surgery may be necessary. After the initial treatments, patients usually have to wear a sling to keep the damaged bones in place while they heal.

Other Injuries and Problems

Some kinds of common shoulder ailments are not typically associated with sudden trauma. These shoulder problems may be caused by old age, disease, or repeated wear and tear over a long period. These shoulder maladies include frozen shoulder, arthritis, and rotator cuff problems.

Frozen shoulder is a medical problem that occurs when the shoulder no longer moves easily or the range of movement is restricted. People may experience frozen shoulder due to abnormal growths in the shoulder, diseases, or too much friction in the joint. This condition may also develop if a person does not move his or her shoulder for a long time. As with other ailments, surgery may be necessary, but often frozen shoulder will clear up with medicine, injections, and careful exercises.

Arthritis
is a disease that harms the joints, sometimes including the shoulder. Different forms of arthritis may be caused by autoimmune disorders or by ongoing wear and damage to the cartilage of a joint. Medication, exercise, and physical therapy are among the most commonly prescribed treatments for arthritis, though in serious or advanced cases surgery may be needed.

Some of the most common injuries and problems relating to the shoulder occur in the rotator cuff, an assortment of tendons and muscles that help the shoulder function. The rotator cuff tendons may suffer a tear due to repeated use, injury, or the degenerative effects of aging. They may also be affected by diseases such as
bursitis
and
tendinitis
, which cause irritation to parts of the shoulder. Medication, electrical and ultrasound treatments, and rest are often prescribed for ailments of the rotator cuff.

Bibliography

Bonza, John E., Sarah K. Fields, Ellen E. Yard, and R. Dawn Comstock. "Shoulder Injuries Among United States High School Athletes During the 2005 – 2006 and 2006 – 2007 School Years." Journal of Athletic Training 44.1 (Jan. – Feb. 2009): 76 – 83. Web. 16 Jan. 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629044/

"Common Shoulder Injuries." OrthoInfo. American Academy of Orthopaedic Surgeons. 2009. Web. 16 Jan. 2015. http://orthoinfo.aaos.org/topic.cfm?topic=a00327

"Shoulder Problems and Injuries." WebMD. Healthwise, Inc. Web. 16 Jan. 2015. http://www.webmd.com/a-to-z-guides/shoulder-problems-and-injuries-topic-overview

"What Are Shoulder Problems?" National Institute of Arthritis and Musculoskeletal and Skin Diseases. National Institutes of Health. Jun. 2010. Web. 16 Jan. 2015. http://www.niams.nih.gov/Health_Info/Shoulder_Problems/shoulder_problems_ff.asp

How are the Greasers and the Socs different?

One obvious difference between the Socs and the Greasers is their socioeconomic status.  The Greasers are poor and from poor families.  Often, the Greaser families are broken families as well.  Ponyboy and his brothers don't even have parents any longer.  Their welfare is dependent entirely upon themselves and the gang.  The Socs, on the other hand, are from much wealthier families.  They have nice clothes, nice things, and even have cars.  

I really couldn't see what Socs would have to sweat about--- good grades, good cars, good girls, madras and Mustangs and Corvairs--- Man, I thought, if I had worries like that I'd consider myself lucky.

Another difference between the two groups is their emotional base.  It's something that Ponyboy begins to see and understand after talking to Cherry early in the novel.  The Greasers feel their emotions very quickly and act on them.  Their emotions and responses are very visceral.  Conversely the Socs are an emotional wasteland.  They don't feel anything.  They have every need met, and everything is provided for them, so they don't ever have a deeply felt need or desire.  They are numb.  

That was the truth. Socs were always behind a wall of aloofness, careful not to let their real selves show through. I had seen a social-club rumble once. The Socs even fought coldly and practically and impersonally.

"That's why we're separated," I said. "It's not money, it's feeling--- you don't feel anything and we feel too violently."

What does Mildred reveal about society?

In Fahrenheit 451, Bradbury uses the character of Mildred to make some important points about the nature of the book's society. 

Firstly, Mildred's addiction to technology reveals the dangers of censorship and government control. Mildred is so dependent on the Seashell radio, for example, that she has become an "expert at lip-reading" and cannot sleep without its presence. This addiction has turned Mildred into an empty shell: she rarely expresses feelings and prefers to immerse herself in the world of the parlour walls.

In addition, Mildred does not make any emotional connection with the people around her, not even her own husband, Montag. She cannot remember, for instance, how she met her husband. Furthermore, the conversations she has with Mrs Phelps and Mrs Bowles reflect the nature of her friendships: they are shallow and based purely on a mutual love of television. 

But Mildred's true significance in the book lies in her unhappiness. Her suicide attempt, for example, reveals the extent of Mildred's misery and the fact that she denies it to Montag shows that she is unable to face her demons. Ultimately, Bradbury uses Mildred to show that a dependence on technology and the pursuit of mindless entertainment will never make a person happy. We see this most clearly in Mildred's imagined, yet incredibly violent, death:

It was such a wildly empty face...she recognized it as her own and looked quickly up at the ceiling as it and the entire structure of the hotel blasted down upon her.

How do medium-chain triglycerides work as a therapeutic supplement?

Overview

Medium-chain triglycerides (MCTs) are fats with an unusual chemical structure that
allows the body to digest them easily. Most fats are broken down in the intestine
and remade into a special form that can be transported in the blood. However, MCTs
are absorbed intact and taken to the liver, where they are used directly for
energy. In this sense, they are processed very similarly to carbohydrates.

MCTs are different enough from other fats that they can be used as fat substitutes by people (especially those with AIDS) who need calories but are unable to absorb or metabolize normal fats. MCTs have also shown a bit of promise for improving body composition and enhancing athletic performance.

Requirements and Sources

There is no dietary requirement for MCTs. Coconut oil, palm oil, and butter contain up to 15 percent MCTs (plus a lot of other fats). MCTs can be purchased as purified supplements.

Therapeutic Dosages

MCTs can be eaten as salad oil or used in cooking. When taken as an athletic supplement, dosages around 85 milligrams (mg) daily are common.

Therapeutic Uses

Preliminary evidence suggests that MCTs are a useful fat substitute for those who
have difficulty digesting fat. This makes MCTs potentially helpful for people with
AIDS, who need to find a way to gain weight but cannot
digest fat easily. MCTs might theoretically be helpful for those who have trouble
digesting fatty foods because they lack the proper enzymes (pancreatic
insufficiency), but taking digestive enzymes appears to be more effective.

Although this may sound paradoxical given the above, some evidence suggests that MCT consumption might also enhance the body’s natural tendency to burn fat. On this basis, the supplement has been proposed as a weight-loss aid. The results of studies have generally failed to find any weight-loss benefits. Some studies have, however, found that use of MCTs might produce improvements in body composition (ratio of fat to lean tissue). A related supplement called structured medium- and long-chain triacylglycerols (SMLCT) has been created to provide the same potential benefits as MCTs, but in a form that can be used as cooking oil. In a preliminary double-blind trial, SMLCT has also shown some promise for enhancing body composition. One placebo-controlled study found hints that use of MCTs by people with type 2 diabetes might improve insulin sensitivity and aid weight loss.

Athletes often sip carbohydrate-loaded drinks during exercise. MCTs may provide an alternative. Like other fats, they provide more energy per ounce than carbohydrates; but unlike normal fats, this energy can be released rapidly. A number of double-blind trials using MCTs for improving high-intensity or endurance exercise performance have been conducted, but the results have been thoroughly inconsistent. This is not surprising, as none of these studies enrolled enough participants to provide trustworthy results. Larger studies are necessary to discover whether MCTs are really as useful for athletes as the supplement’s proponents claim.

Scientific Evidence

Fat malabsorption. A double-blind, placebo-controlled study on
twenty-four men and women with AIDS suggests that MCTs can help improve
AIDS-related fat malabsorption. In this disorder, fat is not digested; it
passes unchanged through the intestines, and the body is deprived of calories as
well as of fat-soluble vitamins.

The study participants were split into two groups: One received a liquid diet containing normal fats, whereas the other group received mostly MCTs. After twelve days, the participants on the MCT formula showed significantly less fat in their stool and better fat absorption than the other group. Another double-blind study found similar results in twenty-four men with AIDS-related fat malabsorption.

The body depends on enzymes from the pancreas to digest fat. In one study,
individuals with inadequate pancreatic function due to chronic pancreatitis
appeared to be better able to absorb MCTs than ordinary fatty acids. However, this
did not turn out to mean much on a practical basis, because without taking extra
digestive enzymes, they could only just barely absorb the MCTs, whereas, if they
took digestive enzymes, they absorbed ordinary fats as well as MCTs without
difficulty.

Safety Issues

Studies in animals and humans reveal that MCTs are quite safe when consumed at a level of up to 50 percent of total dietary fat. However, some people who consume MCTs, especially on an empty stomach, experience annoying (but not severe) abdominal cramps and bloating. The maximum safe dosage of MCTs in young children, pregnant or nursing women, and people with serious kidney or liver disease has not been established.

Bibliography

Beermann, C., et al. “Short Term Effects of Dietary Medium-Chain Fatty Acids and n-3 Long-Chain Polyunsaturated Fatty Acids on the Fat Metabolism of Healthy Volunteers.” Lipids in Health and Disease 2 (2003): 10.

Han, J. R., et al. “Effects of Dietary Medium-Chain Triglyceride on Weight Loss and Insulin Sensitivity in a Group of Moderately Overweight Free-Living Type 2 Diabetic Chinese Subjects.” Metabolism 56 (2007): 985-991.

Matsuo, T., et al. “Effects of a Liquid Diet Supplement Containing Structured Medium- and Long-Chain Triacylglycerols on Body Fat Accumulation in Healthy Young Subjects.” Asia Pacific Journal of Clinical Nutrition 10 (2001): 46-50.

Nosaka, N., et al. “Effects of Dietary Medium-Chain Triacylglycerols on Serum Lipoproteins and Biochemical Parameters in Healthy Men.” Bioscience, Biotechnology, and Biochemistry 66 (2002): 1713-1718.

St-Onge, M. P., et al. “Medium-Chain Triglycerides Increase Energy Expenditure and Decrease Adiposity in Overweight Men.” Obesity Research 11 (2003): 395-402.

_______. “Medium- Versus Long-Chain Triglycerides for Twenty-seven Days Increases Fat Oxidation and Energy Expenditure Without Resulting in Changes in Body Composition in Overweight Women.” International Journal of Obesity Related Metabolic Disorders 27 (2003): 95-102.

Tsuji, H., et al. “Dietary Medium-Chain Triacylglycerols Suppress Accumulation of Body Fat in a Double-Blind, Controlled Trial in Healthy Men and Women.” Journal of Nutrition 131 (2001): 2853-2859.

What are the most important to write about when it comes to the Revolutionary Period (1764-1789)?

There are several important items to consider when writing about the Revolutionary War period from 1764-1789. I will outline some of these items in a bulleted format.

• I would write about causes of the American Revolution. I would include an explanation of why the colonists were unhappy with unpopular laws such as the Proclamation of 1763 and the Quartering Act. I would write about why the colonists were displeased with the tax laws including the Stamp Act and the Townshend Acts. I would also discuss the Boston Massacre, the Boston Tea Party, and the Intolerable Acts. I would conclude this section with some of the battles that occurred before the Revolutionary War began.

• Next, I would write about the American Revolution. I would start with the Declaration of Independence and explain what it meant. Then I would write about critical battles such as the Battle of Saratoga, the Battle of Fort Vincennes, and the Battle of Yorktown. I would explain what happened in these battles and explain why they were important. I would explain the main points of the peace treaty ending the Revolutionary War.

• My final area I would cover would be to write about the two plans of government that we have had. I would explain the main points of the structure of the government created by Articles of Confederation. I would also explain about the problems that existed under the Articles of Confederation and why a new plan of government was needed. This would lead me to write about the Constitutional Convention. I would explain the issues that had to be resolved. Then, I would give a brief overview of the structure of the government created by the Constitution. I would explain why some people strongly believed in the Constitution while other people had some concerns about it.

These would be the main topics I would cover in giving a summary of this time period.