How would you compare Bernard Pomerance's The Elephant Man, Carson McCullers' The Ballad of the Sad Café, and Toni Morrison's Song of Solomon?

While Bernard Pomerance’s play The Elephant Man, Carson McCullers’ novella The Ballad of the Sad Café, and Toni Morrison’s Song of Solomonmay all initially seem like wildly different works that address disparate characters, settings, and themes, there is one thread that ties these seemingly different texts together: Pomerance, McCullers, and Morrison all use grotesque elements to emphasize the troubling relationships contained within their works. These three authors use grotesque characters to foreground...

While Bernard Pomerance’s play The Elephant Man, Carson McCullers’ novella The Ballad of the Sad Café, and Toni Morrison’s Song of Solomon may all initially seem like wildly different works that address disparate characters, settings, and themes, there is one thread that ties these seemingly different texts together: Pomerance, McCullers, and Morrison all use grotesque elements to emphasize the troubling relationships contained within their works. These three authors use grotesque characters to foreground the uncanny and horrific qualities of their stories.

Indeed, Pomerance centers his play on John Merrick, the famously deformed sideshow performer better known as the Elephant Man. Not only does Pomerance use the grotesque figure of Merrick, but he also incorporates “pinheads” in an effort to make his play even more surreal. The pinheads are meant to be unnerving figures and grotesque caricatures. Their unsettling qualities are wholly on display as the pinheads tuck Merrick into bed:

“We are the Queens of the Cosmos

Beautiful darkness’ empire

Darkness darkness, light’s true flower,

Here is eternity’s finest hour

Sleep like others you learn to admire

Be like your mother, be like your sire” (56).

Similarly, McCullers uses grotesque characters to give her novella an eerie, melancholic feel. Amelia Evans falls in love with a hunchback claiming to be her cousin before he robs her at the end of the story. Much like Pomerance, McCullers incorporates an individual with a disability and gives this man unsettling qualities.

Finally, Morrison utilizes the grotesque in her characterization of the relationship between Macon Dead III and his mother. Their relationship has unusual undertones, and Morrison uses this uneasy mother and son bond to unsettle readers. More specifically, Macon was breastfed by his mother at an age that is unusual:

“My mother nursed me when I was old enough to talk, stand up, and wear knickers, and somebody saw it and laughed and—and that is why they call me Milkman and that is why my father never does and that is why my mother never does, but everybody else does” (78).

Thus, while these works initially seem to have little in common, they actually all incorporate grotesque characters and defamiliarize familial relationships in order to foreground the unusual interactions that these writers emphasize.

What is Patau syndrome? |

Risk Factors

The only consistently reported risk factor is advanced maternal age, since the extra copy of chromosome 13 most commonly arises from an error in meiosis during egg cell maturation. Sex does not appear to be a significant risk factor, with the incidence in female fetuses being 52 percent as compared to 48 percent in males, as reported in a 2012 Pediatricsstudy by K. E. Nelson, K. R. Hexem, and C. Feudtner.

Etiology and Genetics

The presence of an extra chromosome 13 in the cells of a developing fetus results from a type of error called nondisjunction, which can occur during gamete (sperm or egg) production in either parent. Either the failure of homologous chromosomes to separate from each other during the first meiotic division or the failure of sister chromatids to separate from each other during the second meiotic division will result in mature sperm cells or egg cells that have either one extra or one missing chromosome. Since each chromosome contains thousands of genes, it is not surprising that individuals with extra or missing chromosomes in all cells would have a severe imbalance of genetic information and suffer from multiple developmental anomalies. In fact, only three autosomal trisomies (conditions in which each cell has three copies of a nonsex chromosome) are generally known to be consistent with full-term delivery, and Patau syndrome is the least common and most severe of these. The most common and least severe is Down syndrome
(trisomy 21). Edwards syndrome
(trisomy 18), like Patau syndrome, results in affected newborns with multiple structural and developmental problems, and survival beyond the first year is rare.

Very occasionally, a case of trisomy 13 occurs in which the extra copy of chromosome 13 does not appear as a separate chromosome but rather is physically attached onto the end of another chromosome; such cases are known as translocation Patau syndrome. While the clinical features of the affected newborn do not differ from the usual form of the syndrome, it is particularly important to identify this variety of Patau, since it may be transmitted with high frequency by a normal-appearing parent who carries the translocation chromosome.

One additional variant that is infrequently encountered is known as mosaic trisomy 13. The bodies of mosaic individuals are composed of two distinctly different cell lines, in which only some of the cells have the extra chromosome 13, while the remainder have a normal chromosome complement. The severity of the clinical presentation in these cases depends on the type and number of cells that carry the extra chromosome, but in almost all cases a less severe form of the syndrome is manifested.

Symptoms

The most consistent symptoms present at birth include microcephaly (small head), cleft lip and/or palate, and polydactyly (extra fingers or toes). Ears are often low-set and malformed, and the nose can be oddly shaped or occasionally altogether absent. Most affected individuals are presumed to be hearing impaired, and many are blind as well. Other neurological problems are common, including profound intellectual disability and failure of the brain to divide into its proper hemispheres during gestation. About 80 percent of affected newborns are reported to have moderate to severe heart defects, as reported by the National Organization for Rare Diseases.

Screening and Diagnosis

According to the University of Chicago, Patau syndrome occurs in about 1 out of 5,000 live births, and diagnosis is most often immediately apparent, although there is some overlap of symptoms with Edwards syndrome. Genetic studies should be performed to confirm the diagnosis. Ultrasound examinations and imaging studies should be done to check for more extensive developmental problems. They include brain, heart, and kidney defects as well as an extra spleen, rotated intestines, and defects of the liver and pancreas. Males may have undescended testes, while females frequently have a divided uterus.

Treatment and Therapy

Because of the heterogeneous nature of each clinical presentation, treatment is usually specifically directed to the particular physical problems with which each affected child is born. As reported by the University of Chicago, about 44 percent of affected newborns die within the first month and more than 70 percent die within a year. Most die from serious heart defects or severe neurological problems. Historically, medical treatment has focused primarily on patient comfort and noninvasive symptom treatment rather than on prolonging life. Surgery may be performed to repair heart defects or cleft lip and palate. In those cases where survival extends beyond one or two years, additional surgeries and physical therapy are often undertaken to allow the affected child to reach his or her full developmental potential. Nelson, Hexem, and Feudtner's study indicates that children born with Patau syndrome are surviving for increasingly longer periods and that neonatal interventions may improve survival rates.

Prevention and Outcomes

Except for the rare translocation form of Patau syndrome, there is no effective means of prevention. Genetic counseling should always be available for parents of an affected child, and amniocentesis is an option for older at-risk mothers. According to the University of Chicago, only up to 30 percent of affected newborns survive the first year of life and survival into the teenage years is exceedingly rare.

Bibliography

Cummings, Michael R. Human Heredity: Principles and Issues. 10th ed. Belmont: Brooks/Cole, 2014. Print.

De la Rocha, Kelly. "Chromosomal Abnormalities: Trisomy 13 and 18." Health Library. EBSCO, 28 May 2014. Web. 5 Aug. 2014.

Lewis, Ricki. Human Genetics. 10th ed. New York: McGraw, 2011. Print.

Nelson, Katherine E., Kari R. Hexem, and Chris Feudtner. "Inpatient Hospital Care of Children with Trisomy 13 and Trisomy 18 in the United States." Pediatrics 129.5 (2012): 1–8. PDF file.

Nussbaum, Robert L., Roderick R. McInnes, and Huntington F. Willard. Thompson and Thompson Genetics in Medicine. 7th ed. New York: Saunders, 2007. Print.

"Trisomy 18 (Edwards), Trisomy 13 (Patau)." Pediatrics Clerkship, University of Chicago. U of Chicago, 2013. Web. 13 Aug. 2014.

Which is the best example of an adaptation?a) a Pulitzer Prize-winning newspaper articleb) a biography of the President of the United States...

An "adaptation" is, by dictionary definition, "a movie, television drama, or stage play that has been adapted from a written work, typically a novel." Answer C, "a musical based on the life of a popular band," meets the definition of an adaptation. 

A Pulitzer Prize-winning newspaper article and a poem written by a best-selling playwright are similar in that they both use indirect techniques (Pulitzer Prize-winning and best-selling) to distract from the correct answer. An adaptation...

An "adaptation" is, by dictionary definition, "a movie, television drama, or stage play that has been adapted from a written work, typically a novel." Answer C, "a musical based on the life of a popular band," meets the definition of an adaptation. 

A Pulitzer Prize-winning newspaper article and a poem written by a best-selling playwright are similar in that they both use indirect techniques (Pulitzer Prize-winning and best-selling) to distract from the correct answer. An adaptation has nothing to do with commercial success or critical acclaim; anyone, regardless of skill, can write an adaptation of any written work. An adaptation will not necessarily be successful, even if the original work on which the adaptation was based is well-known and successful. 

Biographies and autobiographies don't meet the criteria—meaning B is not the answer—because a biography, though a written work, is an account of someone else's life. It is possible, of course, to write an adaptation based on a biography, but the biography must exist first.

For someone learning about adaptations, it's possible for all four answers to be considered somewhat likely upon first glance. By using the definition of an adaptation and eliminating those choices that contradict the definition, however, we are left with only one possible answer: C, a musical based on the life of a popular band.

What is myopia? |

Causes and Symptoms

Nearsightedness (myopia) occurs when light from distant objects reaches a focal point in front of the retina, the photoreceptive tissue of the eye. Consequently, vision of distant objects is blurred

on the retina. The primary cause of myopia is an eyeball that is too long from front to back. People whose parents have myopia are more likely to have it, indicating a genetic cause; a few studies have also shown correlations between higher testosterone levels in the womb and later incidence of myopia. Research has also found that prolonged eyestrain, especially from long periods of reading or other close work, can distort the shape of the eye. This may be one reason why more highly educated people manifest higher rates of nearsightedness than individuals with less formal education.

All children are born nearsighted; by the age of six months, however, vision begins to improve. Myopia is an uncommon problem in younger school-age children but begins to increase in prevalence as children move into their teenage years. From the twenties until the forties, the rate of visual deterioration tends to slow down. As people enter middle and old age, however, the rate of visual decline accelerates again. People past the age of seventy are fourteen times as likely to experience myopia resulting in legal blindness
as those in their twenties.

Treatment and Therapy

For several centuries, nearsightedness has been corrected by the use of a concave lens, which moves the focal point of light in myopic eyes closer to the retina. The first eyeglasses, invented in late-thirteenth-century Italy, had convex lenses that corrected for farsightedness; not until the fifteenth century did glasses with concave lenses appear. As the twentieth century drew to a close, innovative surgical approaches were developed to correct for myopia. Most of these procedures, such as laser surgery, move the focal point of light closer to the retina by changing the shape of the cornea.

Bibliography

Buettner, Helmut, ed. Mayo Clinic on Vision and Eye Health: Practical Answers on Glaucoma, Cataracts, Macular Degeneration, and Other Conditions. Rochester, Minn.: Mayo Foundation for Medical Education and Research, 2002.

"Facts About Myopia." National Eye Institute, October, 2010.

Icon Health. Myopia: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: Author, 2004.

National Foundation for Eye Research. http://www .nfer.org.

"Nearsightedness." MedlinePlus, September 3, 2012.

Riordan-Eva, Paul, and John P. Whitcher. Vaughan and Asbury’s General Ophthalmology. 18th ed. New York: Lange Medical Books/McGraw-Hill, 2011.

Sutton, Amy L., ed. Eye Care Sourcebook: Basic Consumer Health Information About Eye Care and Eye Disorders. 3d ed. Detroit, Mich.: Omnigraphics, 2008.

What is children's health? |

Overview

Children’s health issues can range from mild to severe. For milder, common conditions, many parents turn to complementary and alternative medicine (CAM) to relieve their child’s symptoms. The 2007 National Health Interview Survey (NHIS) found that 12 percent of children in the United States had used some form of alternative medicine. The use is greater among children whose parents used CAM and whose parents had higher education levels, had multiple health conditions, and were white. The use of CAM was also greater among families who delayed conventional care because of cost.

While it is thought that CAM will spare the child from harsh conventional medications and treatments, caution is warranted. Many alternative treatments are not tested and regulated for safety in children. In addition, some treatments, such as restrictive diets, may be difficult for children to adhere to. Also, some parents may think that one can give children extra natural medicine without causing harm, but even natural substances in the wrong doses can be toxic.

While additional research needs to be done, evidence regarding CAM has increased for certain therapies. Many of these studies, however, were based on the testing of adults, not of children or adolescents. With a pediatrician’s guidance, conventional and alternative medicine can be used together safely.

The most commonly used natural therapies among children in the United States,
in descending order, are herbal products, chiropractic/osteopathic care, deep breathing, yoga,
homeopathic treatment, traditional healing, massage,
meditation, diet-based therapies, and progressive
relaxation. Children are most often using CAM for back and neck pain, head and
chest colds, anxiety and stress, musculoskeletal conditions, attention deficit
disorder (ADD), and insomnia.

The National
Center for Complementary and Alternative Medicine, part of
the National
Institutes of Health, places CAM into four major categories:
biologically based (supplementing the diet with nutrients, herbs, particular
foods, and extracts), manipulative and body-based (using touch and manipulation,
such as chiropractic and massage), mind/body (connecting the mind to the body and
spirit in practices such as yoga and meditation), and energy therapies (aiming to
restore balance to the body’s energy with therapies such as qigong).
Other whole, ancient, medical systems include traditional Chinese
medicine, Ayurveda, homeopathic medicine, and
naturopathic medicine.

Common Health Issues

There are a number of health issues that predominate during childhood, including infant colic and ear infections. CAM is one place to begin to address these issues. Other good starting points for optimum health during these growth years are proper nutrition, adequate rest, and good coping skills.

Alternative therapies for colic. Infant colic (excessive fussiness, crying, and discomfort for more than three hours at a time and for a minimum of three days per week) is a condition experienced by many parents and their newborns between about four and five months of age. There is supporting evidence that fennel oil improves symptoms and is effective in reducing crying time for infants with colic. Also used for indigestion, fennel is a carminative. That is, it helps the body expel gas. Herbal combinations such as fennel, chamomile, vervain, licorice, and balm mint have also been shown to help relieve colic.

Alternative therapies for ear infections. Xylitol is a sweetener and natural sugar found in plums, strawberries, and raspberries. It inhibits the growth of certain types of bacterial strains, such as Streptococcus mutans and related species, and of Haemophilus influenzae. Chewing gum with xylitol and ingesting xylitol sweetener five times per day can help to prevent middle ear infections. Lower doses, however, are not effective. Some homeopathic ear drops provide symptom relief in children with mild to moderate pain too.

Herbal and Nutrition Therapies

The NHIS reported the most common natural health products being used by children. These products include echinacea, fish oil/omega 3, combination herbal pills, and flaxseed oil/pills.

Echinacea is commonly used by children, teenagers, and adults for colds and flu. Double-blind, placebo-controlled studies enrolling more than one thousand people found that various forms and species of echinacea can reduce the symptoms and duration of a common cold, in adults. It is thought that echinacea works by temporarily stimulating, strengthening, and nourishing the immune system. There is limited scientific evidence, however, to support these claims. Although echinacea might stimulate the immune system temporarily, there is no evidence of long-term effectiveness.

As with all herbal medicines, the precise species and part or parts of
the plant being used are key. There are three main species of echinacea:
E. purpurea, E. angustifolia, and E.
pallida. The flowers, leaves, and stems of E.
purpurea, when used together, provide the best supporting evidence for
benefits in treating colds and influenza. The root of E. purpurea
has not been shown to be effective, while the root of E. pallida
may be the active, and effective, part of that species.

Echinacea may be beneficial in reducing symptoms or halting a cold once it has started. However, echinacea does not appear to prevent colds. It may not be effective in children and adolescents and has not been studied in these populations. As with all herbal supplements, the actual dosing, potency, and quality of the over-the-counter product are not regulated or guaranteed.

Omega-3 is the second most commonly used natural supplement in children. It has
been broadly studied for its impact on heart health and on arthritis, asthma,
cancer prevention, depression, and many more diseases. Many children’s natural
vitamin products include fish oil or some form of omega-3. Supportive evidence for
its benefits to heart health led the U.S. Food and Drug Administration (FDA)
to allow the following statement on products containing fish oil: “Supportive but
not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids
may reduce the risk of coronary heart disease.”

Omega-3 is also approved by the FDA as an aid in lowering levels of bad cholesterol. Evidence for omega-3’s benefits has been mounting. One randomized control trial even showed that women who took fish oil supplements during the third trimester of pregnancy helped to reduce the risk of asthma in their children for up to sixteen years. There is, however, no daily requirement or omega-3 standard recommended dose for children.

Parents should use caution before giving children herbs or supplements, because most of these alternative products have not been tested on children. Herbalists may suggest taking one-quarter the adult dose. Many common herbs, such as ephedra, kava kava, lavender, monkshood, wormwood, deadly nightshade, foxglove, desert herb, star anise, lobelia, and mistletoe, as well as Ayurvedic herbal remedies, have been shown to be toxic to the cardiac and central nervous systems. Parents should discuss with their family doctor any plans to use alternative medications or other products for their children, especially because these medications could alter the effectiveness of traditional medication or could otherwise threaten the child’s health.

Mind/Body Therapies

The power of the mind to heal and bring about well-being has been demonstrated
in self-reported quality-of-life measures. Strong evidence in the form of
randomized controlled trials is lacking, in part because of the difficulty in
devising placebo therapies and because of funding obstacles. Many practices, such
as yoga, meditation, and Tai Chi may help children reduce
symptoms and bring about a sense of relaxation.

Even young children are under a great deal of stress. Family and economic issues, the daily stresses of homework, chores, and being involved in every activity, can affect children deeply. Deep breathing and yoga are two of the more common mind/body therapies used by children, according to a national survey. Yoga emphasizes a healthy spine for a healthy body and incorporates deep-breathing exercises. Different poses and movements involving twisting and balancing are believed to stimulate the nerves along the spine and promote circulation and the flow of energy. Many professional athletes practice some form of yoga for increased flexibility, and yoga is often incorporated into cross-training exercise routines. Yoga practitioners claim that yoga can help children develop a good body- and self-image, self-control, flexibility, and body awareness. Children with ADD may also benefit from yoga poses, which can help instill a sense of calm and centeredness. Simple deep-breathing is a good coping strategy for children who feel overwhelmed or stressed.

Manipulative Therapies

After herbal products, chiropractic/osteopathic care is the second most commonly used complementary and alternative therapy. Pediatric conditions that are often treated by chiropractors and osteopaths include earache, asthma, allergies, colic, bed-wetting, sinus disorders, migraines, and muscle pain.

Chiropractic care is founded on the belief that adjustments to the spinal vertebrae (or other parts of the body) free the nerves from compression and maximize the body’s ability to heal itself and feel well. There are several chiropractic techniques, including diversified, activator, and sacrooccipital, to promote adjustments of the body and spine. Imaging studies are common in chiropractic care. In one study, chiropractors reported performing fewer imaging studies on children and charging less for pediatric visits. Chiropractors may also recommend herbal remedies or dietary supplements. There is scant research evidence to support or reject its effectiveness, especially in children.

A 2000 cross-sectional study done in the Boston area showed that 420,000 pediatric chiropractic visits were made in the area in one year, costing approximately $14 million (approximately one-half of the fees were covered by insurance). The study showed that pediatric chiropractic care was often inconsistent with recommended medical guidelines. More research is needed to assess its safety and effectiveness in children.

Similarly, osteopathic care is centered on touch therapy. Osteopaths manipulate muscles and joints by stretching, adding resistance and gentle pressure. It is thought that these movements help diagnose, treat, and prevent injury.

Bibliography

American Academy of Pediatrics: Provisional Section for Complementary, Holistic, and Integrative Medicine. http://www.aap.org/sections/chim. The complementary, holistic, and integrative medicine section of the American Academy of Pediatrics Web site.

EBSCO Publishing. Health Library: Children’s Health. Available through http://www.ebscohost.com. An overview of children’s health.

Freeman, Lyn. Mosby’s Complementary and Alternative Medicine: A Research-Based Approach. 3d ed. St. Louis, Mo.: Mosby/Elsevier, 2009. A comprehensive resource on CAM, from a research perspective.

Kemper, K., and P. Gardiner. “Herbal Medicines.” In Nelson Textbook of Pediatrics, edited by Richard E. Behrman, Robert M. Kliegman, and Hal B. Jenson. 18th ed. Philadelphia: Saunders/Elsevier, 2007. A thorough chapter examining the use of herbal medicines for children and adolescents.

Lee, A., D. Li, and K. Kemper. “Chiropractic Care for Children.” Archives of Pediatric Adolescent Medicine 154 (2000): 401-407. Focused on the use of chiropractic care in treating children and adolescents.

What is the main difference between geocentric and heliocentric planetary motion?

Both of these words are made out of Greek and Latin root words, which is one of my favorite aspects of scientific language because it allows you to understand many more words than just the ones you're defining.

"Heliocentric" is a compound of the roots "helio" or "helios" and "centric." Helio refers to the sun, and centric just means "in the center" or "focused upon. In contrast, geocentric uses the root word "geo," which means...

Both of these words are made out of Greek and Latin root words, which is one of my favorite aspects of scientific language because it allows you to understand many more words than just the ones you're defining.

"Heliocentric" is a compound of the roots "helio" or "helios" and "centric." Helio refers to the sun, and centric just means "in the center" or "focused upon. In contrast, geocentric uses the root word "geo," which means earth or ground, in the same way that geology or geography use it. 

Typically these root word compounds can seem a little awkward if you take their definitions literally, so you have to be slightly liberal in how you interpret them. Heliocentric, in astronomical terms, means moving primarily around the sun, and geocentric means moving primarily around the earth.

This is a little easier to understand through examples. All of the planets exhibit heliocentric motion, and not geocentric motion; the only thing at the "center" of their orbits is the sun. In contrast, our moon and most of our artificial satellites exhibit geocentric motion because their motion can most accurately be described as an orbit around the earth, even though they're also moving around the sun. Likewise, the moons of other planets could be described as having geocentric motion around their respective "earths," or you could be more descriptive by using the roots that are more appropriate for those specific planets. For example, the root word referring to Jupiter is jov or jovi, so an orbit focused on Jupiter would be jovicentric. 

What is the tone of "anyone lived in a pretty how town"?

There are two paradoxical yet complementary tones. On one hand, the poem celebrates the love between "anyone" and "noone." On the other hand, the poem is a bleak look at how most people do not care about those who are beyond their close family and friends. 

Consider the poem in terms of the couple (anyone and noone) living among everyone else. The character or hero, "Anyone," is in love with the character/heroine, "Noone." So, the...

There are two paradoxical yet complementary tones. On one hand, the poem celebrates the love between "anyone" and "noone." On the other hand, the poem is a bleak look at how most people do not care about those who are beyond their close family and friends. 

Consider the poem in terms of the couple (anyone and noone) living among everyone else. The character or hero, "Anyone," is in love with the character/heroine, "Noone." So, the love between these two is a joyous thing. But other people do not notice or care about him ("anyone"). 

Women and men(both little and small) 

cared for anyone not at all 

they sowed their isn't they reaped their same 

sun moon stars rain

Cummings uses the words "anyone" and "noone" to symbolize two characters, but the anonymity of these terms shows how little the other citizens ("Women and men") care about them or their love. This shows the two conflicting themes of love (between anyone and noone) and the indifference of the community. The phrase "sun moon stars rain" illustrates how time passes and these two themes (love and indifference) go on. 

When "anyone" dies, "noone stooped to kiss his face." That is, the character "noone" kissed him and but nobody else (noone) did. Note that the title says a "pretty how town." It asks how the town is pretty. It is pretty in terms of the love between couples like anyone and noone, but regarding the indifference people have toward their neighbors, the speaker asks, the town is pretty, but how? 

What are survivorship issues for cancer patients?

Cancer survival: The survival rate for various types of cancer is the number of people who are alive for a given period of time after diagnosis (usually defined as five years). As of 2012, more than 13 million people in the United States had survived cancer, according to the Centers for Disease Control. The overall death rate from cancer began to decline in 1992 and continues to decline. Reasons for the decline include the availability of more effective treatments and more people being diagnosed at earlier, treatable stages of cancer. Also, more people are reducing their cancer risk by stopping smoking, using sun protection, and undergoing screening tests. The number of people being diagnosed with some cancers (lung cancer, bladder cancer, and prostate cancer), however, is increasing.

Issues facing cancer survivors: With increasing survival rates, those involved in cancer care are realizing the importance of addressing the unique needs of cancer survivors. For many patients, enduring and surviving cancer and its treatment become the sole focus of life. Once treatment is over, patients often are faced with worries about the future and decisions about how to transition to life as a survivor. Survivors may face financial issues, difficulties obtaining or returning to employment, or discrimination in obtaining health and life insurance or in finding employment. The experience of surviving cancer also may create emotional reactions, such as depression, guilt, or anxiety, that can evolve into significant emotional difficulties without appropriate help.

Resuming daily life: Cancer affects very basic aspects of patients’ lives, such as their daily routines. Those undergoing treatment are faced with a daily, often painful battle simply to survive the illness. Their entire lives and those of their families are consumed by treatments, doctor visits, and hospitalizations. Suddenly, they no longer lead a “normal” life, and daily activities such as going to work or school, buying groceries, or simply visiting with friends become things of the past. Life no longer seems to stretch out in a straight line before them; it no longer is as predictable as it once was.

After treatment, this time line changes, often just as suddenly. Patients may be left wondering what to do. Their daily lives may begin to resume their precancer patterns. Survivors may expect to resume life exactly as it was before cancer but may be impeded by fatigue or other physical changes. It also is possible that survivors will expect the world (jobs, school, and relationships) to be the same as it was before cancer, and they may be disappointed to learn that some things have changed while they were absorbed in cancer treatment.

This change in a person’s perception of time can create feelings of anxiety, frustration, anger, sadness, and fear. Feelings of vulnerability, uncertainty, and fear about the future may cause the survivor to feel lost, abandoned by others, and depressed.

Physical changes: After cancer treatment, some patients must face permanent physical changes, such as loss of a limb or a breast. Others may gain significant weight because of medications. Some people must cope with damage to other parts of the body as a result of their treatment. Radiation treatment, for example, not only destroys cancer cells but also can damage organs such as the thyroid gland or the liver. Certain types of chemotherapy may cause toxic effects, such as eye damage or bone degeneration. Women may experience early menopause or infertility resulting from treatment. Survivors simply may look fatigued, with sallow skin and dark circles under the eyes. Some changes, such as hair and nail loss, may be temporary. Experiencing such physical changes may affect survivors psychologically and emotionally. Seeing their changed appearance in the mirror may affect the self-image, self-confidence, and self-identity of survivors.

Disruptions in relationships with others: After surviving cancer, people may expect more from their relationships with spouses or children. They may approach relationships with more intensity if they feel that their lives may be shortened. Likewise, fears that they may not survive for long can cause the survivor to break off relationships with others, to push others away through anger or other behaviors, and to withdraw from social activities. To address these issues, some treatment centers offer coordinated recovery programs for survivors that include continued medical care and help with exercise, nutrition, counseling, and advocacy services.

Cassileth, Barrie. Survivorship: Living Well during and after Cancer. Ann Arbor: Spry, 2014. Print.

Feuerstein, Michael, and Patricia Findley. The Cancer Survivor’s Guide: The Essential Handbook to Life after Cancer. New York: Marlowe, 2006. Print.

Foxhall, Lewis E., and Maria Alma Rodriguez, eds. Advances in Cancer Survivorship Management. New York: Springer, 2015. Print.

Hunter, Brenda. Staying Alive: Life-Changing Strategies for Surviving Cancer. Colorado Springs: WaterBrook, 2004. Print.

Levine, Margie. Surviving Cancer: One Woman’s Story and Her Inspiring Program for Anyone Facing a Cancer Diagnosis. New York: Broadway, 2001. Print.

Miller, Kenneth, ed. Excellent Care for Cancer Survivors: A Guide to Fully Meet Their Needs in Medical Offices and in the Community. Santa Barbara: Praeger, 2012. Print.

Nessim, Susan, and Judith Ellis. Can Survive: Reclaiming Your Life after Cancer. Boston: Houghton, 2000. Print.

How should I write a eulogy from Macbeth's point of view talking about his wife if I cannot discriminate against or diminish any of the characters?...

Readers sometimes have a tendency to belittle Lady Macbeth, insisting she is totally evil or crazy, and so I imagine it is statements or sentiments such as these that you are meant to avoid. Macbeth would likely not make such claims about his wife. I would recommend that you try to identify the qualities Macbeth would most admire in his wife. At the beginning of the play, at least, he seems to greatly respect her,...

Readers sometimes have a tendency to belittle Lady Macbeth, insisting she is totally evil or crazy, and so I imagine it is statements or sentiments such as these that you are meant to avoid. Macbeth would likely not make such claims about his wife. I would recommend that you try to identify the qualities Macbeth would most admire in his wife. At the beginning of the play, at least, he seems to greatly respect her, calling her his "dearest partner of greatness" in his letter and hastening home so that he can confer with her about what he should do. It's true that she held him to very high standards of conduct, especially in regard to keeping his promises, and she has never been afraid of calling him out on his faults, but you could certainly make the case that she does so in order to help him to become his best self (if you believe Macbeth would feel that way). It seems likely that he would credit her, at least in part, with his rise to power since it was she who coerced him to murder Duncan in the first place. Consider what Macbeth seems to value, and then try to assess how much he would feel his wife has helped him to acquire what he values.

What is arthritis? |

Causes and Symptoms

Approximately one in six people (more than 15 percent) suffers from one of
approximately one hundred varieties of arthritis, and 2.6 percent of the
population suffers from arthritis that limits their activities. Although many
people over seventy-five years of age experience arthritis, the disease can occur
in the young as a result of infections, rheumatic conditions, or genetic
conditions. Young and middle-aged adults experience the disease as a result of
trauma, infections, and rheumatic or autoimmune reactions. Arthritis may be
located in joints, joint capsules, the surrounding muscles, or
diffusely throughout the body. Inflammation of the joint lining (synovium) can
similarly afflict the linings of other organs: the skin, colon, eyes, heart, and
urinary passage. In addition to the characteristic symptoms of joint pain and
stiffness, individuals suffering from arthritis may also experience
psoriasis and rashes, spastic colitis,
dryness of the eyes, inflammations of the conjunctiva or iris, frequent urination,
discharge and burning upon urination, and other symptoms.

Arthritis has many causes. Infectious causes of arthritis include septic
arthritis, tuberculous arthritis, viral arthritis (potentially caused by the
hepatitis virus, parvovirus B19, or human immunodeficiency virus), acute
rheumatic
fever, and Lyme disease. Primary arthritic syndromes include
rheumatoid
arthritis and juvenile rheumatoid arthritis, which
are systemic inflammatory diseases characterized by chronic destructive synovitis.
Seronegative spondyloarthropathy—such as reactive arthritis, psoriatic arthritis,
and ankylosing
spondylitis—is another primary arthritic syndrome. Reactive
arthritis is a systemic inflammatory disorder that arises one to six weeks after
an infection, most often gastrointestinal or urogenital infections. A form of
reactive arthritis called Reiter’s syndrome affects the eyes and
urethra as well as the joints. Psoriatic arthritis is associated with mild to
severe psoriasis and joint pain. Osteoarthritis is brought on by
wear-and-tear degeneration of the joints and is associated with older age. Such
wear and tear can occur in the joints after years of trauma, repetitive use, and
(especially in the obese) weight-bearing. Osteoarthritis and rheumatoid arthritis
are the most common forms of arthritis.

Additionally, uric acid crystals associated with gout can
build up in the joints, causing arthritis. Gout sufferers experience painful, hot,
tender, and swollen joints—with symptoms often beginning in the big toe. Calcium
pyrophosphate dihydrate deposition disease is also associated with crystal-induced
arthritis. Arthritis is also associated with a number of other medical conditions.
Autoimmune causes of arthritis include systemic lupus erythematosus (SLE),
Sjögren’s
syndrome, and dermatomyositis (also known as
idiopathic inflammatory myopathy). Endocrine and metabolic disorders such as
thyroid disease, Gaucher’s disease, Wilson disease, and hemochromatosis can
also cause arthritis. Arthritis may also be associated with tumors that grow from
cartilage cells, blood vessels, synovial tissue, and nerve tissue. Blood
abnormalities may give rise to hemorrhages into joints (a side effect of
sickle cell
disease and hemophilia), causing joint conditions
that can be disabling and very painful and that may require surgery. Traumatic and
mechanical derangements—sports and occupational injuries, leg-length disparity,
and obesity—may elicit acute synovial inflammation with
subsequent degenerative arthritis.

The inflammatory reactions in response to injury or disease consist of fluid
changes—the dilation of blood vessels accompanied by an increase in the
permeability of the blood vessel walls and consequent outflow of fluids and
proteins. Injurious substances are immobilized with immune reactions and removed
by the cellular responses of phagocytosis and digestion of foreign
materials, resulting in the proliferation of fibrous cells to wall off the
injurious substances and, in turn, leading to scar formation and deformities. The
chemical reactions to injury commence with a degradation of phospholipids when
enzymes are released by injured tissue. Phospholipids—fatty material that is
normally present—break down into arachidonic acid, which is further broken down by
other enzymes, lipoxygenase and cycloxygenase, resulting in prostaglandins and
eicosanoid acids. Most anti-inflammatory medications attempt
to interfere with the enzymatic degradation process of phospholipids and could be
damaging to the liver and kidneys and to the body’s blood-clotting ability.

A physician bases the diagnosis of arthritic disease on the patient’s medical
history and a physical examination. Specific procedures such as joint aspiration,
laboratory studies, and X-ray or magnetic resonance imaging (MRI) may help to
establish the diagnosis and the treatment. The history will elicit the onset of
pain and its relation to time of day and difficulties performing the activities of
daily living. A functional classification has evolved that is similar to the
cardiac functional classification: Class 1 patients perform all usual activities
without a handicap; class 2 patients perform normal activities adequately with
occasional symptoms and signs in one or more joints but still do not need to limit
their activities; class 3 patients find that they must limit some activities and
may require assistive devices; and class 4 patients are unable to perform
activities, are largely or wholly incapacitated, and are bedridden or confined to
a wheelchair, requiring assistance in self-care.

A person’s medical history or surgical conditions and the medications that he or
she is taking can influence the physician’s diagnosis and prescription for
treatment. Patients may present a picture of the body to the physician showing the
joints involved in their symmetry (whether distal or proximal, and whether
weight-bearing or posttraumatic in distribution). Physicians may ask (verbally or
by questionnaire) for a history of other system complaints, which can then be
checked more thoroughly. During a physical examination, the physician will check
the joints, skin, eyes, abdomen, heart, and urinary tract. The neuromuscular
evaluation may reveal localized tenderness of the joints or muscles, swelling,
wasting, weakness, and abnormal motions. Joints may have weakened ligamentous,
muscular, and tendinous supports that could give rise to instability or grinding
of joints, with subsequent roughening of cartilage
surfaces.

Joint pathology is generally associated with some limitation in the range of
motion. Sensation testing, muscle strength, and reflex changes may also indicate
nerve tissue damage. Nerves occasionally pass close to joints and may be pinched
when the joint swelling encroaches upon the passage opening. This condition may
result in carpal
tunnel syndrome, in which the median nerve at the wrist
becomes pinched, causing pain, numbness, and weakness in the hand. Pinched nerves
may also be associated with tarsal tunnel syndrome, in which the nerve at the
inner side of the ankle joint may be compressed and cause similar complaints in
the feet. Other nerves may be constricted in exiting from the spine and when
passing through muscles in spasm.

Arthritis of the spine can lead to a progressive loss in motion. The amount lost
can be measured by comparing the normal motion with the restricted motion of the
patient. The neck may be limited in all directions, rotation of the head to the
sides can restrict driving ability, and the head may gradually tilt forward. The
lower back may also exhibit restriction in all directions; for example, it may be
limited in forward bending because of spasms in the muscles in the back. Tilting
backward of the trunk may be limited and painful when the vertebral body
overgrowth of degenerative arthritis restricts the space for the spinal cord. The
nerves pinched in their passage from the vertebrae may thus cause radiculitis,
irritation of the nerves as they exit from the spine that leads to pain and muscle
involvement. Circumferential measurements of the involved joints and the
structures above and below can confirm swelling, atrophy from disuse or inaction,
or atrophy from a damaged nerve supply. When measurements are repeated, they can
indicate improvement or deterioration. One type of arthritis that most often
affects the spine, ankylosing spondylitis, occurs predominantly in
males in their late teenage and early adult years.

Testing of blood for cells, chemicals, or enzymes is helpful. One test—the
erythrocyte sedimentation test (EST)—measures the inflammatory markers in the
blood. When the sedimentation rate exceeds the normal range, active inflammation
in the body is indicated. Comparisons of results from ESTs performed at different
stages can reveal the disease’s rate of progression or improvement. Blood tests
may also measure uric acid for gout and rheumatoid factor (RF) for rheumatoid
arthritis. Blood tests for immune substances and antibodies are also possible. The
joint fluid can be aspirated and analyzed, particularly for appearance, density,
number of blood cells, and levels of sugar. Cloudy fluid, the tendency to form
clots, a high cell count, and lower-than-normal levels of sugar in the joint fluid
(compared to the overall blood sugar level) indicate abnormalities. With
inflammatory arthritides, the X-rays will show the results of synovial fluid and
cellular overabundance. Clumps of pannus break off and may destroy the cartilage
and bone. Bones about these joints, because of increased vascularity and blood
flow, have less minerals and will appear less dense, a condition known as
osteoporosis.

Deformities in inflammatory arthritis may be the result of unequal muscle pulls or
the destruction or scarring of tissues; such deformities can occasionally be
prevented by the use of resting splints, which is most important for the
hands.

Degenerative and posttraumatic arthritis show joint narrowing, thinning of the
cartilage layer, hardening of the underlying bone (called eburnation), and
marginal overgrowth of the underlying bone (called osteophytes), resulting in
osteoarthritis. Osteophytes, or marginal lipping in the back, may enhance symptoms
of lower back
pain. The cushions between the vertebrae, called discs, are
more than 80 percent water, a figure which diminishes with aging, bringing the
joints in the back (the facets) closer together and compressing the facet joints
between the vertebrae. Irritation and arthritis of these joints are the result.
Other organ structures may be involved as well.

Treatment and Therapy

Treatment of arthritis depends on the type and the severity of the arthritis and
may vary from home treatment to outpatient treatment to hospitalization for
surgical and/or rehabilitative care. Education regarding the patient's condition,
prognosis, treatment goals, and methods of treatment is necessary. Patients must
be made aware of warning signs of progression, drug effects, and local and
systemic side effects of drug therapy. Surgical treatment such as joint
replacement, may be considered for the treatment of severe joint damage or if
symptoms are unsatisfactorily controlled with medical management. Postoperative
restrictions in the range of motion must be given prior to surgery; in
hip
replacement, for example, hip bending should not exceed
ninety degrees. The rotation and overlapping of legs must be limited initially
after surgery.

Some physicians provide a questionnaire that outlines the activities of daily
living and recommends how a patient should perform such activities and how much
time should be spent at rest. The goals generally are to maintain function, to
alleviate pain, to limit the progression of deformities, to prevent complications,
and to treat associated and secondary disease states. In patients with
degenerative arthritis—most often the elderly, who are at risk for other organ
failures—arthritides associated with systemic diseases and other organ
involvements may require care.

Medication is used for symptom control. Nonsteroidal anti-inflammatory drugs
(NSAIDs), such as aspirin and ibuprofen, are often used to ease pain and reduce
swelling. Short-term use of oral corticosteroids may also be prescribed to reduce
joint tenderness and pain. Topical capsaicin cream also reduces discomfort.
Disease-modifying antirheumatic drug (DMARDs), such as abatacept and tocilizumab,
are recommended as the first-line therapy for rheumatoid arthritis. Cyclooxygenase
2 (COX-2) inhibitors may also be used in the medical management of
osteoarthritis.

Other therapies can include assistive devices, counseling patients and their
families regarding home management, heat therapy, range-of-motion and
strengthening exercises, and biofeedback. The aim is to reduce the need for and
frequency of medical care, through a balance between rest and activity and between
effective drug dose and physical modalities. To protect joints and allow function,
various braces and assistive devices may be needed. Posture training may alleviate
postural muscle fatigue. In acute stages of inflammation, the treatment choices
are rest, ice, compression, and proper positioning and medicinals for pain and
inflammation.

Physicians may offer physical therapy, occupational
therapy, assistive devices for self-care, ambulation, or home
and automobile modifications. Assistive devices may include reachers, an elongated
shoehorn handle, thickened handles for utensils, walkers, canes, crutches, and
wheelchairs. Homes may require ramps for easier access, widened doors to allow
wheelchair passage, grab bars in bathtubs, or raised toilet seats for easier
transference from a wheelchair.

Heat therapy may reduce the pain, loosening tightened tissues. Patients frequently
will be stiffer after protracted rest periods (for example, on waking) and feel
better after some activity and exercise. Heated pools offer an excellent heating
and exercise modality. The type of heat modality used will depend upon the depth
of heating desired. Hot packs and infrared lamps will heat predominantly the skin
surface areas and some underlying muscles. Diathermy units heat the muscular
layers, and ultrasound treatments heat the deepest bony layers. Ultrasound (but
not diathermy) can even be used in patients who have metallic implants such as
joint replacements.

Perspective and Prospects

Historically, arthritis was treated with warm baths or sands. Some experimental
treatments presently being tried include transcutaneous electrical nerve
stimulation (TENS) to bring about reductions in intra-articular pressures and in
the fluid and cellular content in joints. Exercises continue to maintain and
improve strength, dexterity, the range of motion, and endurance. Good health
habits—including adequate rest, good nutrition, nutritional supplements, and
weight
management—can be beneficial.

Bibliography:

Bagchi, Debasis, Hiroyoshi Moriyama, and
Siba P. Raychaudhuri, eds. Arthritis: Pathophysiology, Prevention,
and Therapeutics. Boca Raton: CRC, 2011. Print.

Firestein, Gary S., et al.
Kelley's Textbook of Rheumatology. 9th ed. Philadelphia:
Elsevier, 2013. Print.

Fries, James F.
Arthritis: A Take-Care-of-Yourself Health Guide to Understanding
Your Arthritis. 5th ed. Reading: Addison, 1999.
Print.

Gladman, Dafna, Cheryl F. Rosen, and Vinod
Chandran. Psoriatic Arthritis. Oxford: Oxford UP, 2014.
Print.

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Mayo Clinic on Arthritis: How to Manage Pain and Lead an Active
Life. Rev. ed. Rochester: Mayo Clinic, 2013. Print.

Lahita, Robert G.
Rheumatoid Arthritis: Everything You Need to Know. Rev.
ed. New York: Avery, 2004. Print.

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

Lorig, Kate, and James
F. Fries, eds. The Arthritis Helpbook: A Tested Self-Management
Program for Coping with Arthritis and Fibromyalgia. Rev. ed.
Cambridge: Da Capo, 2007. Print.

Pelt, Marc N., ed. Arthritis:
Types, Treatment and Prevention. New York: Nova, 2011.
Print.

Shlotzhauer, Tammi L.,
and James L. McGuire. Living with Rheumatoid Arthritis. 2nd
ed. Baltimore: Johns Hopkins UP, 2003. Print.

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The Arthritis Action Program: An Integrated Plan of Traditional
and Complementary Therapies. New York: Fireside, 2001.
Print.

What is endoscopy? |

Indications and Procedures

Early endoscopes were simply rigid hollow tubes with a light source. They were inserted into body orifices, such as the anus or the mouth, to allow the physician to look directly at structures and processes within. Modern instruments are more sophisticated. They often use fiber optics in flexible cables to penetrate deep into body structures. For example, one form of colonoscope can be threaded though the entire lower intestine, allowing the physician to search for pathologies all the way from the anus to the cecum of the colon (large intestine).

There are eight basic types of endoscope: gastroscope, colonoscope, bronchoscope, cystoscope, laparoscope, colposcope, arthroscope, and amnioscope. Their primary uses are diagnostic; however, they can be fitted with special instruments to perform many different tasks, including taking bits of tissue for biopsy and carrying out surgical procedures.

Uses and Complications

The gastroscope and its variants are used to inspect structures of the gastrointestinal system. The name of one class of procedure gives an idea of how sophisticated the gastroscope has become: esophagogastroduodenoscopy. As the term implies, this technique can be used to investigate the esophagus (the tube leading to the stomach), the stomach itself, and the intestines all the way into the duodenum (the first link of the small intestine). Furthermore, in a procedure called "endoscopic retrograde cholangiopancreatography," the endoscope can be used to investigate processes in the gallbladder, the cystic duct, the common hepatic duct, and the common bile duct. By far the most common use of the gastroscope is in the diagnosis and management of esophageal and stomach problems. The gastroscope is used to confirm the suspicion of stomach ulcers and other gastroesophageal conditions and to monitor therapy.

The colonoscope and its variants are critical in the diagnosis of diseases in the lower intestine and in some aspects of therapy. The long, flexible fiber-optic tube can be threaded through the anus and rectum into the S-shaped sigmoid colon
(flexible fiber-optic sigmoidoscopy). The tube can be made to rise up the descending colon, across the transverse colon, and down the ascending colon to the cecum. With the colonoscope, the physician can discover abnormalities such as polyps, diverticula, and blockages and the presence of cancer, Crohn’s disease, ulcerative colitis, and many other diseases. The physician can also use the colonoscope to remove polyps; this is the major therapeutic use of colonoscopy.

Like most other forms of endoscopy, bronchoscopy is used for both diagnosis and treatment. The bronchoscope allows direct visualization of the trachea
(the tube leading from the throat to the lungs) and the bronchi (the two main air ducts leading into the lungs). It will show certain forms of lung cancer, various infectious states, and other pathologies. The bronchoscope can also be used to remove foreign objects, excise local tumors, remove mucus plugs, and improve bronchial drainage.

The cystoscope is used for visual inspection of the urethra and bladder. The bladder stores urine; the urethra is the tube through which it is eliminated. Cystoscopy
discovers many of the conditions that can afflict these organs: obstruction, infection, cancer, and other disorders.

The laparoscope is used to look into the abdominal cavity for evidence of a wide variety of conditions. It can inspect the liver, help evaluate liver disease, and take tissue samples for biopsy. Laparoscopy
can confirm the diagnosis of ectopic pregnancy (a condition in which a fetus develops outside the uterus, usually in one of the Fallopian tubes). It can confirm the presence or absence of abdominal and female reproductive cancers and diagnose disease conditions in the gallbladder, spleen, peritoneum (the membrane that surrounds the abdomen), diaphragm, ovaries, and uterus, as well as give some views of the small and large intestine. Importantly, the laparoscope is commonly used to remove gallbladders (cholecystectomy
). This procedure is far less traumatic than the old surgery, often permitting release of the patient a day or two after the operation rather than requiring weeks of recuperation. Likewise, many other surgeries, such as appendectomies, gastric bypasses, hysterectomies, and colectomies, are also now performed laparoscopically.

The colposcope is used to inspect vaginal tissue and adjacent organs. Common reasons for colposcopy include abnormal bleeding and suspicion of tumors.

Arthroscopy
, the investigation of joint structures by endoscopy, is now the most common invasive technique used on patients with arthritis or joint damage. In addition to viewing the area, the arthroscope can be fitted with various instruments to perform surgical procedures.

The term “amnioscope” comes from the amnion, the membrane that surrounds a fetus. This type of endoscope is used to enter the uterus and inspect the growing fetus in the search for any visible abnormalities.

Endoscopy is one of the most useful and most used techniques for diagnosis because it permits the investigation of many internal body organs without surgery. It is extraordinarily safe in the hands of experienced practitioners and is relatively free of pain and discomfort for patients, although there are risks of bleeding, pain, infection, and rarely, perforation of the tissue wall. In addition, specialized endoscopes are assuming greater roles in therapy. Many procedures that once involved major surgery can now be conducted through endoscopy, saving the patient pain, trauma, and expense.

Perspective and Prospects

Endoscopes have become highly sophisticated instruments with enormous range throughout the body and enormous potential. Colonoscopy, for example, promises to revolutionize the treatment of cancerous and precancerous polyps by helping physicians attain a clearer understanding of the polyp-to-cancer progression. The laparoscope has revolutionized gallbladder removal, as the arthroscope has revolutionized joint surgery. The gastroscope gives the physician new security and control in the management of gastrointestinal conditions, and the bronchoscope facilitates many lung procedures.

Similarly throughout the entire range of endoscopy, new opportunities are opening and leading to significant improvements in therapy, and these improvements will continue. Wireless electronic and video techniques are being introduced into endoscopy, and this new technology promises to widen the applications and therapeutic range of endoscopy still further.

Bibliography

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American Cancer Society. "What Is Endoscopy?." Cancer.org , February 6, 2013..

Classen, Meinhard, G. N. J. Tytgat, and C. J. Lightdale, eds. Gastroenterological Endoscopy. 2d ed. New York: Thieme Medical, 2010.

Emory, Theresa S., et al. Atlas of Gastrointestinal Endoscopy and Endoscopic Biopsies. Washington, D.C.: Armed Forces Institute of Pathology, 2000.

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

Scott-Conner, Carol E. H., ed. The SAGES Manual: Fundamentals of Laparoscopy, Thoracoscopy, and GI Endoscopy. 2d ed. New York: Springer, 2006.