What is home health? |

Natural Pollutants

Every home contains natural pollutants that require regular removal to reduce health risks, prevent offensive odors, and eliminate stains and structural damage that devalue the structure. Most of these pollutants become airborne and are inhaled, creating subsequent health problems that range in severity from sneezing to difficulty breathing. Other pollutants may be unintentionally ingested, causing illness.

Airborne pollutants are collectively called dust. The most common component of
dust in a home is dead skin particles shed by the home’s residents. Dust also
contains hair, ash, pollen, fibers, and minerals from outdoor soil. Overexposure
to dust can lead to allergies, respiratory diseases, and
asthma. Dust mites feed on the organic matter in dust. They
most commonly live on mattresses, sheets, and pillows. Their excrement contains
substances that can cause severe allergic reactions. Companies are now making
tightly woven anti-allergy encasings for mattresses and pillows. The use of air
filters in the furnace, air conditioner, and vacuum cleaner reduces airborne
contaminants.

The inhabitants of a house, such as humans, pets, and occasionally rodents, naturally shed hair, dander, saliva, urine, and feces. Such substances may trigger an allergic reaction in people or may carry bacteria, viruses, or parasites that infect humans. Hair and dander may be removed by frequent vacuuming and dusting; excretions should be cleaned up with soap and water. Toilets should be disinfected regularly; closing the lid before flushing prevents the contents from being dispersed into the room as an aerosol.

Also living in homes may be insects such as flies, termites, ants, spiders,
fleas, lice, cockroaches, and bedbugs. Many of these insects feed on garbage, food
spills and crumbs that are not cleaned up, and food supplies that are not
adequately packaged. Insects can transmit diseases to
humans either directly by biting or indirectly by contaminating food with eggs or
droppings. Insects may be eliminated from the home by natural or chemical
pesticides or by swatting or vacuuming, or with flypaper. Adequate containment of
garbage, keeping kitchen floors swept and counters wiped clean, and storing food
in airtight containers will discourage their return.

Pollen from houseplants and cut flower arrangements may
diminish indoor air quality. Pollen may also drift inside through open windows and
doors and be brought in on shoes and clothing, especially from plants next to the
house. Indoor pollen may be reduced by keeping houseplants and floral arrangements
well hydrated. Outdoor plants near windows and doors should be trimmed away from
openings. Although silk floral arrangements do not contain pollen, their complex
surfaces trap dust, so they should be cleaned regularly by spraying with
compressed air.

Mold, which is a fungus, grows in warm, damp areas such as inadequately
ventilated bathrooms, kitchens, and basements. Mold releases spores into the air,
which, when inhaled, may cause symptoms such as a dry cough, nasal congestion, eye
irritation, and wheezing. Mold may be visible, but it is usually detected
initially by its musty odor. It may be destroyed by scrubbing first with a
detergent without ammonia in hot water and then with a 10 percent bleach solution.
Porous materials such as carpeting and insulation that remain damp should be
discarded.

Bacteria and viruses may make a person ill when ingested or inhaled. They may be found on unwashed, uncooked fruits and vegetables and on uncooked meats. Raw foods should be thoroughly washed before they are eaten. Handling raw meat and neglecting to wash one’s hands and the food preparation surface afterward may result in the contamination of other foods and subsequent pathogen ingestion. Surfaces that come in contact with raw meat juices should be thoroughly disinfected.

Bacteria and viruses may also be transmitted on surfaces that are commonly used by many people, surfaces such as doorknobs and telephones. Such surfaces should be wiped with a disposable disinfectant cloth regularly and more frequently during cold and flu season.

Chemical Pollutants

Among other causes, the degassing of synthetic materials in newer homes, and
poor ventilation that keeps the house airtight, may lead to sick building
syndrome. Symptoms of sick building syndrome include eye
irritation, scratchy or sore throat, nasal congestion, skin rash, and difficulty
concentrating. The symptoms typically begin within one hour of entering a polluted
structure and disappear within one hour of leaving the structure.

Another chemical pollutant is tobacco smoke. The ash becomes a component of dust; the odor lingers in soft surfaces such as curtains, upholstery, and clothing; and the secondhand smoke is inhaled by the other residents of the home, causing increased respiratory problems.

Carbon
monoxide is an odorless, colorless gas that may be given off
by faulty furnaces or space heaters. Exposure may cause flulike symptoms, severe
headache, dizziness, trouble breathing, and even death. Carbon monoxide detectors
in the home are recommended and may be found in combination with smoke
detectors.

Radon is another invisible, odorless gas that is also
radioactive. It results from the decay of uranium in the soil and seeps into a
home through the foundation, where it can build up to dangerous levels. Radon
increases the risk of lung cancer for those who breathe it. The U.S. Environmental Protection
Agency recommends that all homes be tested for radon below
the third floor. Commercial radon reduction systems are available too.

Asbestos, used as pipe insulation, may be a pollutant in
homes that were built between 1920 and 1978. Breathing high levels of exposed
asbestos may result in an increased risk of cancer and lung disease. Homes built
before 1978 may also contain lead paint. Flakes of this paint have a sweet taste,
making the paint tempting to children. If they ingest the paint flakes, they can
become ill with lead poisoning.

U.S. Department of Homeland Security, Federal Emergency Management Agency. “Dealing with Mold and Mildew in Your Flood Damaged Home.” Available at http://www.fema.gov/pdf/rebuild/recover/fema_mold_brochure_english.pdf. A clear, authoritative explanation of how to improve home health by finding and removing mold and mildew.

U.S. Environmental Protection Agency. “A Citizen’s Guide to Radon.” Available at http://www.epa.gov/radon/pubs/citguide.html. Information on what homeowners can do to protect themselves from radon.

_______, Office of Air and Radiation. “The Inside Story: A Guide to Indoor Air Quality.” Available at http://www.epa.gov/iaq/pubs/insidest.html#iaqhome1. A complete discussion of home air quality, common pollutants, and improvement measures.

When Bob Ewell accuses Atticus of being too proud to fight, what does Atticus say in reply?

In Chapter 23, Scout retells Miss Stephanie Crawford's account of how Bob Ewell approached Atticus outside the post office. Miss Stephanie said Bob cursed at Atticus, spat on him, and then threatened to kill him. According to Miss Stephanie, Atticus didn't bat an eye and simply wiped the spit off of his face with his handkerchief. Bob Ewell continued to curse at Atticus and said, "Too proud to fight, you nigger-lovin' bastard?" (Lee 134). Atticus...

In Chapter 23, Scout retells Miss Stephanie Crawford's account of how Bob Ewell approached Atticus outside the post office. Miss Stephanie said Bob cursed at Atticus, spat on him, and then threatened to kill him. According to Miss Stephanie, Atticus didn't bat an eye and simply wiped the spit off of his face with his handkerchief. Bob Ewell continued to curse at Atticus and said, "Too proud to fight, you nigger-lovin' bastard?" (Lee 134). Atticus responded by saying, "No, too old" (Lee 134). Atticus's calm response shows his tolerant demeanor. Following Atticus's run-in with Bob Ewell, Scout and Jem begin to worry about their father's safety. Atticus then explains to them that Bob Ewell had to have some kind of comeback, which was why Bob spit in his face. Atticus tells Jem and Scout that Bob had to take his anger out on someone and that Atticus would rather it be him than Mayella or her siblings.

What is neurofibromatosis type 1 (NF1)?

Related conditions:
Neurofibromas, iris Lisch nodules, optic gliomas, café-au-lait spots, freckling, learning disabilities, bone complications such as scoliosis or bone overgrowth

Definition:
Neurofibromatosis type 1 (NF1) is a hereditary disorder of the nervous system that affects growth and development of nerve cell tissues. This disorder is associated with neurofibromas (bumplike tumors under the skin or elsewhere in the body that develop anywhere along a nerve), café-au-lait spots (flat spots on the skin that are darker than the surrounding area), freckling in places not exposed to the sun (such as the armpit and groin), eye developments such as optic glioma (a tumor growing on the nerve to the eye) and Lisch nodules (harmless growths on the colored part of the eye), and bone problems such as scoliosis (curvature of the spine) or bone overgrowth. Up to 10 percent of affected individuals have malignant peripheral nerve sheath tumors (tumors that form along the protective covering around nerves located outside the brain and spinal cord), which are the most common malignant tumors associated with NF1. Although rare, malignant brain tumors do occur. Fewer than 1 percent of people with NF1 have pheochromocytomas (adrenal gland tumors that release stress hormones) that cause dangerously high blood pressure. Approximately half of individuals with NF1 have a learning disability, although it is usually mild. The severity of the disorder varies within families, between families, and even within an individual at different times during life.

Risk factors: Because NF1 is hereditary, the main risk factor is having a family history of this disorder. Each child of a person with NF1 has a 50 percent chance of inheriting the disorder.

Etiology and the disease process: The underlying genetic cause of NF1 is a mutation, or a genetic change, in the NF1 gene. The purpose of the protein made by the NF1 gene is not fully understood, but it most likely helps stop uncontrolled cell growth and proliferation. Mutations in the NF1 gene either prevent the protein from being made or cause the protein to be made incorrectly, and the multistep process of tumorigenesis (formation or production of tumors) is left unchecked.

Usually, each person has two normal copies of the NF1 gene. A mutation in one copy of the gene is sufficient to cause NF1, which is why this condition is referred to as autosomal dominant (autosomal means the NF1 gene is located on one of the twenty-two pairs of autosomes, which are the nonsex chromosomes). An affected person has an NF1 gene mutation from the time of conception; however, symptoms of the disease may be present at birth or not manifest until later in life. Nearly all individuals with NF1 have signs and symptoms of the disorder by the end of childhood. The average life expectancy of affected individuals is reduced about fifteen years.

Incidence: Approximately 1 in 3,000 people has NF1, which makes it one of the most common dominantly inherited genetic disorders. Nearly half of people with NF1 inherit the disorder from a parent. The other 50 percent have a new gene mutation, meaning the mutation occurred for the first time in those individuals.

Symptoms: Symptoms vary and are usually mild to moderate and not life-threatening. Adults with NF1 may have anywhere from a few neurofibromas to hundreds or thousands, and these tumors, which continue to develop throughout life, can affect any organ in the body. Neurofibromas can cause pain and disfigurement and, more rarely, cause problems with organ function. Malignant peripheral nerve sheath tumors can cause pain, numbness, or paralysis. Optic gliomas can lead to blindness. Of the learning disabilities observed in more than half of people with NF1, visual-spatial performance and attention deficits are the most common.

Screening and diagnosis: Doctors diagnose NF1 based on certain criteria, which include having two or more of the following: six or more café-au-lait spots, two or more neurofibromas or one plexiform neurofibroma (weblike neurofibroma that entwines surrounding tissues), freckling in the armpit or groin, optic glioma, two or more Lisch nodules, an unusual bone complication, or a first-degree relative (parent, sibling, or child) with NF1.

Because NF1 is caused by mutations in the NF1 gene, genetic testing can be used to confirm a suspected diagnosis. However, diagnostic genetic testing is rarely needed, because doctors can easily diagnose the disease based on clinical findings. Genetic testing detects more than 95 percent of NF1 gene mutations in individuals who have been clinically diagnosed by a physician.

Treatment and therapy: The main focus of treatment for NF1 is controlling symptoms. Surgery can be performed to treat bone malformations or to remove tumors that cause pain or disfigurement. In the case of malignancy, the tumor is surgically removed if possible, and the patient may also have adjuvant chemotherapy and radiotherapy.

Prognosis, prevention, and outcomes: The way neurofibromatosis affects a person over a lifetime varies widely. Because NF1 is a genetic condition, its manifestations cannot be prevented. However, physicians recommend that individuals with NF1 have monitoring that includes a yearly physical examination, a yearly ophthalmologic examination (eye exam) for children (less frequently for adults), regular blood pressure checks, and regular assessment of development for children.

Barke, Jenny, Diana Harcourt, and Jane Coad. "'It's Like a Bag of Pick and Mix—You Don't Know What You Are Going to Get': Young People's Experience of Neurofibromatosis Type 1." Journal of Advanced Nursing 70.7 (2014): 1594–603. Print.

Ferner, R. E. “Neurofibromatosis 1.” European Journal of Human Genetics. 15 (2007): 131–38. Print.

Korf, Bruce R., and Allan E. Rubenstein. Neurofibromatosis: A Handbook for Patients, Families, and Health Care Professionals. New York: Thieme Medical, 2005. Print.

"Neurofibromatosis." MedlinePlus. Natl. Lib. of Medicine, 6 Mar. 2014. Web. 26 Nov. 2014.

Rosenblum, Laurie. "Neurofibromatosis Type 1." Health Library. EBSCO Information Services, 11 May 2013. Web. 26 Nov. 2014.

Tonsgard, J. H. “Clinical Manifestations and Management of Neurofibromatosis Type 1.” Seminars in Pediatric Neurology 13 (2006): 2–7. Print.

What is bioterrorism? |

Definition

Bioterrorism, or biological terrorism, is the intentional release of bacteria or viruses into a civilian population to harm that population and, thereby, achieve a political or social end.

Biological Agents

Found in nature, biological agents threaten human populations when terrorists engineer these agents for release. The agents are cultivated to make them more resistant to medicines and vaccines and more easily transmitted in a population. The Centers for Disease Control and Prevention (CDC) in the United States classifies biological terror agents by their likelihood for use by terrorist groups and by their risk to a population. The CDC groups bioterrorism agents into categories A, B, and C.

Category A Agents

Cited as highest priority are category A agents, which are rare in the United States. These agents are easily transmitted and would cause a high death rate and would demand a proactive public health preparedness strategy. A agents include anthrax (Bacillus anthracis ), botulism (Clostridium botulinum toxin), plague (Yersinia pestis ), smallpox (Variola major ), tularemia (Francisella tularensis ), and viral hemorrhagic fever filoviruses, such as Ebola and Marburg, and arenaviruses, such as Lassa and Machupo.

Anthrax. An anthrax infection is triggered by B. anthracis, a bacterium
that forms spores, or dormant cells that reawaken under certain conditions. There
are three types of anthrax infection: those that involve the skin (cutaneous), the
lungs (inhalation), and the digestive tract (gastrointestinal). Anthrax does not
spread from person to person. People normally contract an anthrax infection by
handling or ingesting infected animal products. Symptoms can appear within seven
days. For cutaneous anthrax infection, symptoms include the appearance of
nonpainful skin blisters with a black area in the center. For gastrointestinal
anthrax, symptoms are nausea, loss of appetite, bloody diarrhea, fever, and
stomach pain. For inhalation anthrax, symptoms are similar to those of a common
cold: significant chest congestion and shortness of breath.

Botulism
. Spread by the bacterium C. botulinum, botulism is a muscle-paralyzing disease. It is not spread from person to person. People normally contract botulism from infected food or from an infected wound. Infants can contract the disease from the presence of the bacterium in their digestive tract. The food-borne form of botulism has a potential for becoming a public health emergency, as the toxin can contaminate large amounts of food. After ingesting the toxin, symptoms of double vision, dry mouth, slurred speech, and muscle weakness appear. Gradually, paralysis spreads throughout the body. Though most treated persons recover within weeks, untreated persons can die from paralysis of the breathing muscles.

Plague
. Caused by the Y. pestis bacterium, plague originates with rodents and their fleas. Though bubonic plague is transmitted through a rodent or flea bite, pneumonic plague can be transmitted through the air from person to person or through a deliberate aerosol release. Once exposed, a person experiences symptoms within one to six days that include cough, shortness of breath, chest pain, nausea, and abdominal pain. Plague is diagnosed through blood, sputum, or lymph-node aspirate sampling and is treated with antibiotics. Untreated, plague results in respiratory failure.

Smallpox
. The two forms of smallpox are V. major, which is severe and most common, and the less common and less deadly V. minor. The four types of V. major smallpox are ordinary, modified, flat, and hemorrhagic. Ordinary V. major, causing 90 percent of known cases, has a fatality rate of 30 percent, according to the CDC. The flat and hemorrhagic types are rare and usually fatal. Humans are the only known carriers of smallpox, and they spread the disease to others through close personal contact. Following an incubation period of seven to seventeen days, an infected person becomes contagious and experiences fever, head and body aches, and a rash of small red spots (first in the mouth and throat, then over the entire body). The last known case of smallpox in the United States was in 1949, and the last known case worldwide was in Somalia in 1977. The Variola virus exists only in science laboratories.

Tularemia
. Tularemiais caused by the bacterium F. tularensis, which is found in rodents and rabbits. A human contracts the disease upon being bitten by an infected tick or fly, by handling an infected carcass, by ingesting contaminated food or water, or by inhaling the airborne bacteria. Appearing within three to five days after exposure, symptoms include spiked fever, chills, headache, diarrhea, muscle aches, joint pain, dry cough, and weakness. Tularemia is treated with antibiotics.

Viral hemorrhagic fevers. Filovirus viral hemorrhagic fevers (VHFs), such as Ebola and Marburg, and arenavirus VHFs, such as
Lassa and Machupo, are known by the CDC as severe multisystem syndrome diseases.
VHFs attack multiple systems of the body, an attack accompanied by bleeding.
Persons experience symptoms of fever, achiness, and fatigue before seeing bleeding
under the skin and from the mouth, eyes, and ears. VHF may progress to nervous
system damage or kidney failure. Initially transmitted from contact with rodents
and their bodily excretions or by mosquito or tick bites, some VHFs (as Ebola,
Marburg, and Lassa) can spread through human-to-human contact. Though there is no
direct treatment for VHFs, the antiviral drug ribavirin is sometimes administered
to persons with a VHF disease.

Category B Agents

Ranked by the CDC as second highest priority, category B agents are moderately
easy to transmit and result in lower mortality rates. B agents include
brucellosis (Brucella
species); epsilon toxin of Clostridium perfringens
; food safety threats (Salmonella
, Escherichia coli
, and Shigella
); glanders (Burkholderia mallei
); melioidosis (B. pseudomallei); psittacosis (Chlamydophila psittaci
); Q fever (Coxiella burnetii
); ricin toxin from Ricinus communis
(castor beans); staphylococcal enterotoxin B; typhus fever (Rickettsia prowazekii
); viral encephalitis Alphaviruses, such as Venezuelan equine encephalitis,
eastern equine
encephalitis, and western equine encephalitis; and
water-safety threats, such as Vibrio cholerae
and Cryptosporidium parvum
.

Category C Agents

The agents with the third highest priority are those in category C; they
include emerging pathogens. Newly discovered diseases such as nipah virus and hantavirus infections are in category C and are rated according to
availability, ease of production, and potential for causing death.

History of Biological Weapons

At the end of the nineteenth century, scientists discovered a link between microorganisms and the outbreak of illness. They began to understand how diseases are spread through air, food, and water supplies, person-to-person contact, and insect bites. Upon uncovering these facts, scientists rapidly found ways to protect people against the outbreak of several diseases.

By the early twentieth century, some Western governments began to explore the harvesting and use of biological agents for use as weapons. In World War I, Germany undertook the first-known state-sponsored biological weapons program, deliberately infecting the horses and mules of enemy forces. In the 1920s, the French conducted research in biological weapon aerosols, increasing research in the mid-1930s.

In 1942, American biologists Theodor Rosebury and Elvin A. Kabot noted that B. anthracis, in its dormant-spore state, can easily be used as a biological weapon. The spores can withstand disbursement in hot or cold environments. Viewing this pathogen as a potential threat, Rosebury and Kabot recommended the development of an anthrax vaccine. They also described how plague bacillus, if freeze-dried, could also be weaponized in an aerosol. As a result of Rosebury and Kabot’s findings on the potential for use of biological weapons, Allied soldiers were administered antibiotics and vaccines during World War II.

The September 11, 2001, terrorist attacks in the United States prompted a surge in support and funding for defense against bioterror threats. This support and funding led to the development of technologies for detecting airborne threats and for treatment of disease caused by bioterror attacks. In Biological Weapons (2005), Jeanne Guillemin writes that the establishment of the US Department of Homeland Security (DHS) in 2003 “far outweighed the diffuse, decentralized domestic preparedness project of the previous decade.”

Threats

The Homeland Security Act of November 25, 2003, incorporated the Federal Emergency Management Agency (FEMA), which immediately dedicated resources to investigate the
threat of biological terrorism. FEMA concluded that three groups of biological
agents could be used as weapons: bacteria, viruses, and toxins. Though terrorists
may choose biological warfare over other tactics, most known agents are difficult
to cultivate and are quickly destroyed once exposed to dry air and sunlight. For
example, though the airborne spread of plague is possible, Y.
pestis bacteria survive up to one hour only once released. Some
agents, like the smallpox virus, are spread only through human contact, while
others, like anthrax, infect only those exposed to a primary source of the germs.
However, terrorists could choose to release germs that infect animals bred for
human consumption or could choose to contaminate water supplies.

In December 2008, a bipartisan panel commissioned by the US Congress to analyze the threat of unconventional weapons warned that, unless the international community commits to preventive measures and additional security, “it is more likely than not that a weapon of mass destruction will be used in a terrorist attack somewhere in the world by the end of 2013.” The panel called for the strengthening of international organizations dedicated to preventing unconventional warfare, to improving rapid-response and bioforensic capabilities, to heightening security at research institutions housing biological pathogens, and to forming an international conference on biosecurity. Notably, the report concluded that weaponizing biological agents is extremely difficult and likely outside the range of capabilities for a rogue, non-state-supported group. Before leaving office in January 2009, US president George W. Bush signed an executive order on laboratory biosecurity that established an interagency body dedicated to regulating and overseeing research programs and laboratories.

The warning about the potential for breaching the security of state-sponsored programs relates to lessons learned following events in 2001, when anthrax was spread through an infected powder sent with letters through the US postal system. The anthrax-laced letters were targeted to persons in media and politics, resulting in twenty-two documented cases of anthrax infection. Analysis of the infected letters pointed to the Ames strain, the form grown and studied in the US program. A federal investigation later identified the anthrax source as the laboratory of Bruce Ivins of the US Army research facility at Fort Detrick, Maryland.

Federal agencies and politicians continue to incorporate the threat of biological terrorism into national security regulations and policies. The next-generation threat to US security is lax security at labs researching diseases that could be cultivated for biological weapons. In mid-October 2010, Jacek Bylica, head of the Weapons of Mass Destruction Centre of the North Atlantic Treaty Organization, said that the spread of weapons of mass destruction, their delivery, and the chance that terrorists will acquire them are major, significant threats. In November, bioterrorism security concerns were again raised when US senator Richard G. Lugar and Pentagon officials visited Uganda’s ministry of agriculture, animals, industry, and fisheries. Discovered there were research specimens of anthrax and the Ebola and Marburg viruses, stored in an unlocked refrigerator in an unsecured building.

Government watchdogs have also continued to audit the BioWatch program that was put in place by the DHS two years after the anthrax attacks of 2001. The second adaptation of the system has been in place since 2005 and consists of aerosol collectors positioned in thirty cities across the country designed to detect pathogens that could signal the threat of a biological attack. Filters must be manually removed and checked for the presence of pathogens regularly. Because this process has proved time consuming, by 2015 the DHS had proposed instituting a more automated system. However, such plans were put on hold and the system was once again questioned after the Government Accountability Office released a report stating that the costly system had not yet proven its current capabilities and had recorded several false positives since 2003.

Response

In response to the threat of bioterrorism, the DHS works to determine the agents that are easiest to grow and deliberately release and seeks to develop methods for identifying the natural outbreak of a disease from a bioterrorism attack. In 2004, the DHS established the Knowledge Center, which provides a collaborative forum for experts in biological pathogens and political terrorism to share information and assess bioterror threats.

The CDC and the American Red Cross prepare populations for a bioterrorism attack through multimedia educational programs that urge families to store supplies, that show how to detect signs and symptoms of biological terror agents, and that show how to deal with exposure to suspected biological agents, among other topics. According to FEMA, optimal prevention against a bioterrorism attack includes installing a high-efficiency particulate-air filter in furnaces and ensuring that recommended immunizations are updated for all persons.

In preparation for a possible aerosol attack of the pneumonic plague agent or the tularemia agent, national and state health centers have stockpiled antibiotics. The CDC also maintains an antitoxin to treat botulism. Though there have been no known cases of smallpox since 1977, and routine vaccination against the disease has been discontinued, the United States now secures research and treatment stockpiles of the Variola virus. No plague vaccine is available in the United States, but research for such a vaccine continues.

Prevention

A June 2010 report from the Center for Biosecurity at the University of Pittsburgh Medical Center stated that from 2008 through 2010, government spending to support biodefense programs increased. Bioterrorism prevention and intervention are top priorities, according to Department of Health and Human Services secretary Kathleen Sebelius, who, in early 2010, announced a new national health security strategy of focusing resources on first-responder teams and front-line health care. On October 7, the National Institute of Allergy and Infectious Diseases announced its investment of $68 million in research projects for the development of vaccines to protect against biological terror. These projects include those looking into a needle-free dengue vaccine, an orally administered anthrax vaccine, and an anthrax vaccine administered with an adjuvant to stimulate the immune system. On November 5, the Biomedical Advanced Research and Development Authority of the HHS awarded Northrop Grumman a one-year contract to develop a biodefense system to allow first-responders to rapidly screen and triage persons exposed to a biological agent.

Impact

Because there have been few incidents of bioterrorism, there is little historical data on its impact. However, scientific predictions about likely effects on populations have led to response strategies and to investment in prevention and detection technologies.

Bibliography

Guillemin, Jeanne. Biological Weapons. New York: Columbia UP, 2005. Print.

Isikoff, Michael. “The Case Still Isn’t Closed.” Newsweek 18 Aug. 2008: 152. Print.

Kron, Josh. “Uganda Seen as a Front Line in the Bioterrorism Fight.” New York Times 11 Nov. 2010: A8. Print.

Markon, Jerry. "A Decade in, DHS Program to Detect Bio-Threats May Not Be Able to Detect Bio-Threats, Auditors Say." Washington Post. Washington Post, 25 Nov. 2015. Web. 29 Dec. 2015.

Miller, Judith, et al. Germs: Biological Weapons and America’s Secret War. New York: Simon, 2002. Print.

Rosebury, Theodor. Peace or Pestilence: Biological Warfare and How to Avoid It. New York: McGraw, 1949. Print.

Spiers, Edward M. A History of Chemical and Biological Weapons. London: Reaktion, 2010. Print.

How does insurance coverage for complementary or alternative medicine work?

Criteria for Coverage

There are many complementary and alternative medicine (CAM) therapies, but only
a few have been accepted by traditional medicine and are covered by
health
insurance plans, even when ordered by a medical doctor or an
osteopathic doctor. A covered CAM therapy is reimbursed directly to either the
provider or the patient by the patient’s health insurance company. If the payment
goes directly to the CAM provider, then the patient is responsible for a copayment
(the patient’s up-front share of the cost of treatment). Other health insurance
companies have negotiated a discount with selected CAM providers. The patient pays
this discounted amount out-of-pocket. This discounted payment, however, is not
considered insurance coverage.

Several factors are considered by health insurance companies when deciding whether to cover a CAM service. These factors include whether the treatment is experimental; whether it is ordered by a medical doctor or an osteopathic doctor; whether the CAM provider is licensed by his or her respective state; whether the treatment provided is generally known; and whether the treatment has been adequately researched and found to be effective. Treatments or therapies that are considered experimental are rarely covered by health insurance, and services ordered by a medical doctor or an osteopath are more likely to be covered.

CAM providers who are licensed by their states have had their education and training validated and meet the standards of their states of practice. Licensing standards vary from state to state. Therapies that have been adequately researched are those that have been proven effective by a body of research. The therapy does not have to be 100 percent effective, but it should demonstrate a reasonable amount of effectiveness in treating patient conditions. Medical doctors and osteopaths are more likely to accept therapies that have been adequately researched. Often medical doctors reject CAM therapies because they are not knowledgeable about them.

Coverage for Specific Types of CAM

Some CAM services are accepted by traditional medicine and covered by health
insurance. Biofeedback and nutritional therapy are covered if they are
ordered by a medical doctor. Midwives and osteopathic physicians are covered in
most states. The midwife, for example, must be a registered nurse midwife with a
master’s degree in midwifery and must be working in a
hospital or office with a medical doctor. Midwives who are not registered nurses
are not covered. Osteopaths, because they have been educated in ways similar
to medical doctors, are considered to be physicians, and they function like
medical doctors within their medical specialty. Another CAM service, pet therapy,
is usually provided at no charge. The pets, usually dogs, visit patients in
hospitals or extended care facilities.

The CAM therapies that are most often covered by health insurance are
chiropractic, acupuncture, and massage.
Chiropractic is almost universally covered by insurance, although there are often
limits on the number of office visits that will be covered.

Acupuncture and massage therapy are covered less often, and they may be covered only for certain conditions. Acupuncture is often covered only for pain management for persons with cancer, and massage therapy may be covered only for persons with fibromyalgia.

Implications of Limited Coverage

Despite the limited insurance coverage for CAM services, the services remain popular with consumers. Annually, the CAM industry earns about $34 billion in the United States. It seems, then, that a lack of insurance coverage for CAM has not interfered with the use of these providers. People who use CAM do tend to be wealthier and better educated. They also seem to feel that CAM treatment is helpful to them.

One effect of limited insurance coverage for CAM services is the relatively low cost for these services. This is good for consumers but not necessarily good for providers. CAM providers often earn much less than their counterparts in traditional medicine and are more likely to keep their business expenses low with, for example, a small staff and a small leased office.

Bibliography

Cleary-Guida, Maria B., et al. “A Regional Survey of Health Insurance Coverage for Complementary and Alternative Medicine: Current Status and Future Ramifications.” Journal of Alternative and Complementary Medicine 7, no. 3 (2001): 269-273.

Lafferty, William E., et al. “Insurance Coverage and Subsequent Utilization of Complementary and Alternative Medical (CAM) Providers.” American Journal of Managed Care 12, no. 7 (2006): 397-404.

Nahin, Richard L., et al. “Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007.” National Health Statistics Reports: Department of Health and Human Services, July 30, 2009. Available at http://www.cdc.gov/nchs/data/nhrs018.pdf.

National Center for Complementary and Alternative Medicine. “Paying for CAM Treatment.” Available at http://nccam.nih.gov/health/financial.

White House Commission on Complementary and Alternative Medicine. “Coverage and Reimbursement.” Available at http://www.whccamp.hhs.gov/fr7.html.

Who was the first president of the United States?

The first president of the United States was George Washington. He was unanimously chosen by the Electoral College in the election of 1788, the only president to achieve such a distinction. His Vice President was John Adams, who finished second in the voting (in those days, each elector cast two votes, and the candidate who received the second-highest total became Vice President--every elector voted for Washington). While President, Washington faced a number of challenges. He...

The first president of the United States was George Washington. He was unanimously chosen by the Electoral College in the election of 1788, the only president to achieve such a distinction. His Vice President was John Adams, who finished second in the voting (in those days, each elector cast two votes, and the candidate who received the second-highest total became Vice President--every elector voted for Washington). While President, Washington faced a number of challenges. He had to set a precedent for presidential power and behavior. He had to supervise a plan laid out by Alexander Hamilton to deal with the nation's fiscal crisis. He had to figure out the correct response to the outbreak of the French Revolution and the resulting French war with England. He faced challenges from Native peoples in the Ohio Valley (which resulted in open war) and the Southwest. And he had to deal with the development of political factions, or parties, as a result of differences on how to deal with these issues. Most historians credit Washington with handling these crises and challenges with diplomacy and restraint, but many of the issues persisted after his presidency. 

Who is a static character in Raymond Carver's Cathedral?

When we're talking about characters in literature, "static" means "staying the same," and "dynamic" means "experiencing an important change." They are opposites, and it's helpful to look at which characters are static and which are dynamic so we can understand what's going on in the characters' development.

In "Cathedral" by Raymond Carver, the static characters are the blind man, named Robert, and the narrator's wife, whose name we don't know.

These static characters are, by...

When we're talking about characters in literature, "static" means "staying the same," and "dynamic" means "experiencing an important change." They are opposites, and it's helpful to look at which characters are static and which are dynamic so we can understand what's going on in the characters' development.

In "Cathedral" by Raymond Carver, the static characters are the blind man, named Robert, and the narrator's wife, whose name we don't know.

These static characters are, by definition, the ones who basically stay the same, who don't experience any major changes in how they see the world or how they think.

It would be important to note who they are in comparison to the more important "dynamic" character: the narrator himself, whose name we also don't know, and who does undergo a serious change in his personality. Let's take a closer look.

As the story begins, we know that Robert and the narrator's wife are very close friends. Ever since she met him when she responded to an ad in the paper that called for someone to read to a blind man, they have been close, and they confide in each other. Their friendship is evident throughout the story as they have a good time together at dinner, despite the husband's grouchiness. Both of them are sensitive and open, both in the narrator's recollections of their early friendship and in his description of their behavior at dinner. So, those aspects of their personalities don't change, and we don't see either the wife or Robert talking about changing their minds about something, or seeing something important in a different way.

But we do see the narrator change his mind about something important. That means he's the dynamic one, not the static one, and it's why the story is really about him. 

At the beginning, he's bothered by the fact that his wife's friend is blind and has a very unwelcoming attitude toward Robert:

"My idea of blindness came from the movies. In the movies, the blind moved slowly and never laughed. Sometimes they were led by seeing-eye dogs. A blind man in my house was not something I looked forward to."

But then the three of them share the meal together, and they smoke together and watch television. The narrator starts to realize that the blindness isn't that important, that Robert is just a person he can connect with, like any other human. And when Robert and the narrator draw a cathedral together, that experience cements the narrator's change of heart:

"So we kept on with it. His fingers rode my fingers as my hand went over the paper. It was like nothing else in my life up to now. ... I was in my house. I knew that. But I didn’t feel like I was inside anything."

Although the narrator doesn't come right out and say "I am more accepting and understanding toward blind people now, not like I was before," we can still tell that his transformation is complete because he's hanging out with Robert, doing something meaningful and enjoyable with him, and making physical contact with him as well.

In contrast, the static characters (the wife and Robert) don't experience that kind of spiritual growth. They are just the people who happened to be involved in the narrator's experience.

What is the scientific explanation that suggests the universe is expanding? What two main concepts does it rely on?

The theory that the universe is expanding began with one important observation made by Edwin Hubble: red shift. In 1929, Hubble stated that all galaxies were moving away from us and from each other. He based this on the observation that the light being emitted from the galaxies was "shifted" toward the red end of our visible light spectrum.  You experience a somewhat similar effect when the frequency of sound appears higher as an object approaches you and lower as it recedes away (commonly known as the Doppler Shift).  Light being emitted from the galaxies is being "stretched" as the galaxies move away, increasing their wavelength and decreasing their frequency.  We perceive this as a shift towards red (as it has a longer wavelength than the other colors).

What becomes more interesting is that if one is to assume that the galaxies are all moving apart from each other, then they must have been closer together in the past.  This is an essential concept for the Big Bang Theory--all matter and energy in the universe was compressed into a tiny point approximately 13.8 billion years ago.  It then "exploded" outward--though thinking of it as an explosion as we understand it doesn't actually illustrate what happened.  Space is literally flowing into existence between matter pockets.

What's even more interesting is that the relative level of red shift increases the further away you look.  One would assume that since gravity would be the only force acting on distant galaxies, they should be slowing down, ultimately coming to a stop, and hurling back together (proposed as a Big Crunch).  The exact opposite has been observed--galaxies are accelerating away from each other (and the universe is increasing in size at an increasing rate).  Since we have no force in our four fundamental force model (gravity, EM, strong, and weak nuclear), scientists have proposed something unseen is acting in the space between galaxies--dark energy. 

So one would have to argue that dark energy is the most compelling explanation of why the universe is expanding.

In F. Scott Fitzgerald's "Winter Dreams," what does Judy represent to Dexter?

For Dexter, Judy represents all that glitters. That is, she is the embodiment of ambition and success, money, and beauty.

That's what Dexter wants, and that's why he never sees her as she truly is. Judy is just human, but Dexter sees her as perfect, as the key to his happiness. She isn't, and Dexter's bubble is burst at the end of the story when he finally realizes this.

Let's take a look at some...

For Dexter, Judy represents all that glitters. That is, she is the embodiment of ambition and success, money, and beauty.

That's what Dexter wants, and that's why he never sees her as she truly is. Judy is just human, but Dexter sees her as perfect, as the key to his happiness. She isn't, and Dexter's bubble is burst at the end of the story when he finally realizes this.

Let's take a look at some evidence for this idea that Judy represents all that is desirable to Dexter: beauty, riches, and success.

First, let's note that Dexter is highly ambitious, even in his youth. He doesn't even have to work as a teenager, since his dad makes enough money to support their family, but Dexter works anyway--day in and day out, he caddies at the golf course, all for a few dollars a day. He wants the "pocket-money," or the money he can have on his own to spend.

More evidence of Dexter's ambition and success appears when the narrator informs us of it directly, and when we see Dexter climbing higher in the social and financial hierarchies:

• "He wanted not association with glittering things and glittering people--he wanted the glittering things themselves. Often he reached out for the best without knowing why he wanted it--and sometimes he ran up against the mysterious denials and prohibitions in which life indulges."


• "He made money. It was rather amazing."


• "Before he was twenty-seven he owned the largest string of laundries in his section of the country."


• (Spoken by Dexter to Judy) "I'm probably making more money than any man my age in the Northwest." 

So we know that Dexter wants to possess wealth, specifically "the glittering things" in life, and we know he wants to possess Judy, although she continually torments him. (She's constantly drawing him in, then pushing him away.) Dexter realizes that he can never truly have her, but he still desires her because for him, she's not just the epitome of beauty, but also his loftiest, most unattainable goal in life.

Why would we say she represents money then, or "all that glitters"? Because, in the story, Judy literally glitters.

Every time her beauty is described in the story, you get a mental image of a figure bathed in golden light. Here's the most relevant of these images:

"Judy Jones, a slender enamelled doll in cloth of gold: gold in a band at her head, gold in two slipper points at her dress's hem. The fragile glow of her face seemed to blossom as she smiled at him."

She's dressed in gold, wearing a halo, and glowing. She glimmers. That image of Judy as something that glitters, and as a creature who's more than human (part angel and part doll) helps support the idea that she represents success, beauty, and money for Dexter, which is what he wants.

What are T lymphocytes? |

Definition

T lymphocytes are specialized white blood cells that are essential components of the immune system. Although they are produced in bone marrow, T lymphocytes migrate to the thymus gland to mature until they are needed. Normal lymphocytes and other types of white blood cells are always present in sufficient numbers to fight infection, but special T lymphocytes are released into the bloodstream by the immune system to perform as mediators of cellular immunity. As such, they help humans respond at the cellular level to different types of disease-causing organisms (pathogens), foreign cells (non-self-cells) that have entered the body, tumor cells, and abnormal self-cells that attack the body’s own tissues.

Cell Activation and Function

T lymphocytes participate in hypersensitivity reactions, reactions to allergens or toxic substances, graft-versus-host reactions (as in
transplantation), and other types of immune reactions. The immune system activates
what are called helper T cells (CD4+ T cells) when it detects specific types of proteins
(antigens) on the surface of non-self-cells that have invaded
the body. Helper T cells secrete cytokines and lymphokines
(interleukins) that signal other white cells to increase
their numbers and reinforce their normal functions.

Killer T cells (CD8+ cells) are activated to attack specific tumor cells and
certain viruses and parasites whose surface antigens they recognize. Regulatory T
cells perform a slightly different function, protecting against self-cells that
mistakenly attack certain body tissues (such as joint tissue in rheumatoid
arthritis or eye tissue in thyroid eye disease) in autoimmune disease.

Role in Disease

The role of the immune system in protecting the body relies on layers of defense provided by different activities of the innate immune system and the adaptive immune system. Consequently, the immune response can range from general, everyday protection against invaders by a relatively nonspecific response of the innate immune system to increasingly specific responses of the adaptive immune system, whose immunologic memory allows it to recognize certain invaders. Infectious organisms, foreign cells, and tumor cells all have unique protein-based antigens on their cell surfaces that can be detected by the adaptive immune system. These antigen-presenting cells (APCs) are targeted by immune system cells, which then bind to the antigens. This process, in turn, activates other immune system components, such as macrophages, growth factors, and natural killer cells, forming an integrated defense mechanism.

As a critical component of the adaptive immune system, T lymphocytes make up the body’s special reserve forces. They are called on when antigen-specific action is needed to halt the harmful activity of bacteria, viruses, parasites, tumor cells, cells from foreign tissue, or out-of-control self-cells that may be responsible for progressive disease.

Bibliography

Chatilla, Talal A. “Role of Regulatory T Cells in Human Diseases.” Journal of Allergy and Clinical Immunology 116 (2005): 949–959.

Martin, Stefan F. T Lymphocytes as Tools in Diagnostics and Immunotoxicology. Basel: Springer, 2014. Digital file.

Monroe, John G., and Michael J. Lenardo. “Regulation of Activation of B and T Lymphocytes.” In Hematology: Basic Principles and Practice, edited by Ronald Hoffman et al. 6th ed. Philadelphia: Churchill Livingstone/Elsevier, 2009.

Sompayrac, Lauren M. How the Immune System Works. 5th ed. Ames, Ia.: Wiley-Blackwell, 2016.

“T-Cell Mediated Immunity.” In Janeway’s Immunobiology, by Kenneth Murphy, Paul Travers, and Mark Walport. 8th ed. New York: Garland Science, 2014.

What is Stachybotrys? |

Definition

The pathogen
Stachybotrys is a mold that grows on wet cellulose-containing
materials. Stachybotrys produces a number of mycotoxins,
including several trichothecenes and a hemorrhagic protein called hemolysin.
Memnoniella
is a related fungus that has similar growth characteristics and
produces similar mycotoxins.

Natural Habitat and Features

Stachybotrys is a black or grey fungus (mold) with worldwide distribution. Stachybotrys grows on wet cellulose-containing material such as hay, leaves, paper, wood, wall board, textiles, rugs, drywall, and insulating materials. Stachybotrys is a fairly slow grower and may be overrun by other molds growing on cellulose-containing substrates.

Stachybotrys requires wet conditions to grow; however, Stachybotrys spores can remain dormant under dry conditions for several years and can resume active growth and mycotoxin production when water becomes available. The Stachybotrys mycotoxins can also retain their potency over several years without active Stachybotrys growth. Stachybotrys frequently grows in buildings that have been flooded by leaking pipes or toilets, rain infiltration, or natural disasters, including hurricanes.

Stachybotrys spores are often hard to grow in culture. Some studies have reported that cellulose-based media or cornmeal media is best for cultured Stachybotrys growth.

Stachybotrys spores are not as readily spread by air as are most mold spores. Several published studies have been unable to collect any airborne Stachybotrys spores, even though the buildings in question may be contaminated with many square meters of Stachybotrys growth. Relying on airborne samples only has led many indoor air investigators to falsely conclude that Stachybotrys was not growing in the structures under investigation. Because Stachybotrys spores are not readily dispersed in the air and are hard to grow in culture, all mold sampling studies that suspect Stachybotrys growth should take surface, tape, or building material samples from the building.

Pathogenicity and Clinical Significance

Localized Stachybotrys infections have been reported. Viable Stachybotrys was isolated from the lungs of a seven-year-old boy living in a water damaged farmhouse with heavy Stachybotrys growth. The boy, who experienced severe fatigue, chronic coughing, and lung hemorrhage, completely recovered after cleanup of his mold-infested home. Unpublished observations have reported Stachybotrys growth in nasal sinuses; however, the main health concerns are connected to the mycotoxins and allergens produced by Stachybotrys.

The Stachybotrys mycotoxins were first reported as contaminants of animal feed and human food. In the 1940’s, there were reports of domestic animals dying in the Soviet Union after eating Stachybotrys-infested hay. In later years, attention has been focused on humans who are exposed to high levels of Stachybotrys and its mycotoxins in indoor air and dust.

Stachybotrys produces a wide range of mycotoxins, including the
trichothecenes satratoxin, roridan, and deoxynivalenol. The amounts and types of
triochothecenes produced vary considerably depending on environmental conditions
and the Stachybotrys strain. The trichothecene mycotoxins damage
the immune and nervous systems, inhibit
protein
synthesis, and can cause vomiting. Animal studies have
reported that exposure to small amounts of trichothecenes can damage brain
cells.

Stachybotrys also produces a protein called hemolysin, which causes lung hemorrhage in nonhuman animals and may be linked to human lung hemorrhage. In the 1990’s, life-threatening lung hemorrhage was reported in ten infants in Cleveland, Ohio, who lived in water-damaged homes. Airborne levels of Stachybotrys, Aspergillus, and other molds were much higher in the homes of the infants with lung hemorrhage than in the control homes.

The allergens and mycotoxins from Stachybotrys can also worsen
asthma and nasal problems. Several studies have reported
that heavy indoor exposure to Stachybotrys and other molds is
associated with significantly poorer lung function and significant deficits in
many neuropsychiatric parameters, such as reaction times, color vision, memory,
concentration, grip strength, and vocabulary.

The ideal way to control Stachybotrys and its mycotoxins is to
prevent exposure to the mold. The best way to control
Stachybotrys growth is to prevent indoor water damage. All
cases of indoor water damage, standing water, or visible mold growth should be
cleaned within twenty-four hours to prevent growth of
Stachybotrys and other fungi and bacteria. For large cases of
water damages, one should contact a flood remediation company. Several guides are
available for mold remediation, including the U.S. Environmental Protection Agency’s
“Guide to Mold Remediation in Schools and Commercial Buildings” (available at
http://www.epa.gov/mold/mold_remediation.html).

Several studies have reported that clean up and water remediation of homes with heavy Stachybotrys growth are associated with less asthma, fatigue, and concentration and memory problems in the occupants of the contaminated home.

Drug Susceptibility

Because Stachybotrys does not appear to cause human infection, antifungal drugs are generally not used to treat persons who have been exposed to Stachybotrys. However, some studies have reported that the use of the bile-binding drug cholestryamine may be useful in speeding human excretion of trichothecene mycotoxins. Other research has suggested that eating a well-balanced diet that is high in antioxidants (vitamins A, C, and E, and l-carnitine and coenzyme Q10) can reduce the toxic effects of many mycotoxins.

Bibliography

Elidemir, Okam, et al. “Isolation of Stachybotrys from the Lung of a Child with Pulmonary Hemosiderosis.” Pediatrics 104 (1999): 964-966. A case report of viable Stachybotrys growing in the lungs of a seven-year-old boy.

Etzel, Ruth, et al. “Acute Pulmonary Hemorrhage in Infants Associated with Exposure to Stachybotrys atra and Other Fungi.” Archives of Pediatric and Adolescent Medicine 152 (1998): 757-762. This study reports on ten previously healthy infants who experienced sudden pulmonary hemorrhage. Airborne levels of Stachybotrys and Aspergillus were much higher in case homes versus control homes.

Kilburn, Kaye. “Neurobehavioral and Pulmonary Impairment in 105 Adults with Indoor Exposure to Molds Compared to 100 Exposed to Chemicals.” Toxicology and Industrial Health 25 (2009): 681-692. This paper provides thorough documentation that a group of 105 mold-exposed persons experienced significant deficits in lung function, reaction times, color vision, memory, grip strength, and vocabulary.

Samson, Robert, Ellen Hoesktra, and Jens Frisvad. Introduction to Food and Airborne Fungi. 7th ed. Utrecht, the Netherlands: Central Bureau for Fungal Cultures, 2004. This guide provides much information about Stachybotrys and many other indoor fungi. Includes useful identification keys, photographs, and diagrams.