The complete beginner’s guide to IPFS | by Myroslav Golub | VirtusLab3 Feb 2020 — IPFS stands for “Interplanetary File System”. Conceptually, it can be described as a cross between WWW, Git and BitTorrent. Despit...Medium

“Everyone on campus is so much happier. You see kids actually socializing, problem solving, enjoying themselves,” Lancaster said, choking up as she described the school atmosphere. “It’s true, it’s one more thing to enforce. But education matters, and now kids are learning. That’s the No. 1 reason we did this.”

The moves to limit smartphone use in California put it near the forefront of an increasingly national trend. In New York, Gov. Kathy Hochul has reportedly been mulling a statewide school smartphone ban for several months now.  Florida, Ohio, and Indiana have all imposed some degree of statewide restrictions on phones in schools, and several other states have introduced similar legislation.

“It’s great to say no phones, but I don’t think people realize the addiction of the phones and what students will go to to tell you ‘No, you’re not taking my phone.’”

Instead of putting their devices in magnetically locked pouches, like they’re supposed to, some kids will stick something else in there instead, like a disused old phone, a calculator, a glue bottle or just the phone case.

如果需要插入和更新结合可以使用ON DUPLICATE KEY UPDATE

数据库三大范式是什么？

every chunk of it becomes literally public.

cross between WWW, Git and BitTorrent

Juliet. O God!—O nurse, how shall this be prevented? 2320My husband is on earth, my faith in heaven; How shall that faith return again to earth, Unless that husband send it me from heaven By leaving earth? comfort me, counsel me. Alack, alack, that heaven should practise stratagems 2325Upon so soft a subject as myself! What say'st thou? hast thou not a word of joy? Some comfort, nurse. Nurse. Faith, here it is. Romeo is banish'd; and all the world to nothing, 2330That he dares ne'er come back to challenge you; Or, if he do, it needs must be by stealth. Then, since the case so stands as now it doth, I think it best you married with the county. O, he's a lovely gentleman! 2335Romeo's a dishclout to him: an eagle, madam, Hath not so green, so quick, so fair an eye As Paris hath. Beshrew my very heart, I think you are happy in this second match, For it excels your first: or if it did not, 2340Your first is dead; or 'twere as good he were, As living here and you no use of him. Juliet. Speakest thou from thy heart? Nurse. And from my soul too; Or else beshrew them both. 2345 Juliet. Amen! Nurse. What? Juliet. Well, thou hast comforted me marvellous much. Go in: and tell my lady I am gone, Having displeased my father, to Laurence' cell, 2350To make confession and to be absolved. Nurse. Marry, I will; and this is wisely done. [Exit] Juliet. Ancient damnation! O most wicked fiend! Is it more sin to wish me thus forsworn, 2355Or to dispraise my lord with that same tongue Which she hath praised him with above compare So many thousand times? Go, counsellor; Thou and my bosom henceforth shall be twain. I'll to the friar, to know his remedy: 2360If all else fail, myself have power to die.

Capulet. When the sun sets, the air doth drizzle dew; But for the sunset of my brother's son It rains downright. 2235How now! a conduit, girl? what, still in tears? Evermore showering? In one little body Thou counterfeit'st a bark, a sea, a wind; For still thy eyes, which I may call the sea, Do ebb and flow with tears; the bark thy body is, 2240Sailing in this salt flood; the winds, thy sighs; Who, raging with thy tears, and they with them, Without a sudden calm, will overset Thy tempest-tossed body. How now, wife! Have you deliver'd to her our decree? 2245 Lady Capulet. Ay, sir; but she will none, she gives you thanks. I would the fool were married to her grave! Capulet. Soft! take me with you, take me with you, wife. How! will she none? doth she not give us thanks? Is she not proud? doth she not count her blest, 2250Unworthy as she is, that we have wrought So worthy a gentleman to be her bridegroom? Juliet. Not proud, you have; but thankful, that you have: Proud can I never be of what I hate; But thankful even for hate, that is meant love. 2255 Capulet. How now, how now, chop-logic! What is this? 'Proud,' and 'I thank you,' and 'I thank you not;' And yet 'not proud,' mistress minion, you, Thank me no thankings, nor, proud me no prouds, But fettle your fine joints 'gainst Thursday next, 2260To go with Paris to Saint Peter's Church, Or I will drag thee on a hurdle thither. Out, you green-sickness carrion! out, you baggage! You tallow-face! Lady Capulet. Fie, fie! what, are you mad? 2265 Juliet. Good father, I beseech you on my knees, Hear me with patience but to speak a word. Capulet. Hang thee, young baggage! disobedient wretch! I tell thee what: get thee to church o' Thursday, Or never after look me in the face: 2270Speak not, reply not, do not answer me; My fingers itch. Wife, we scarce thought us blest That God had lent us but this only child; But now I see this one is one too much, And that we have a curse in having her: 2275Out on her, hilding! Nurse. God in heaven bless her! You are to blame, my lord, to rate her so. Capulet. And why, my lady wisdom? hold your tongue, Good prudence; smatter with your gossips, go. 2280 Nurse. I speak no treason. Capulet. O, God ye god-den. Nurse. May not one speak? Capulet. Peace, you mumbling fool! Utter your gravity o'er a gossip's bowl; 2285For here we need it not. Lady Capulet. You are too hot. Capulet. God's bread! it makes me mad: Day, night, hour, tide, time, work, play, Alone, in company, still my care hath been 2290To have her match'd: and having now provided A gentleman of noble parentage, Of fair demesnes, youthful, and nobly train'd, Stuff'd, as they say, with honourable parts, Proportion'd as one's thought would wish a man; 2295And then to have a wretched puling fool, A whining mammet, in her fortune's tender, To answer 'I'll not wed; I cannot love, I am too young; I pray you, pardon me.' But, as you will not wed, I'll pardon you: 2300Graze where you will you shall not house with me: Look to't, think on't, I do not use to jest. Thursday is near; lay hand on heart, advise: An you be mine, I'll give you to my friend; And you be not, hang, beg, starve, die in 2305the streets, For, by my soul, I'll ne'er acknowledge thee, Nor what is mine shall never do thee good: Trust to't, bethink you; I'll not be forsworn. [Exit]

Lady Capulet. Why, how now, Juliet! Juliet. Madam, I am not well. Lady Capulet. Evermore weeping for your cousin's death? What, wilt thou wash him from his grave with tears? An if thou couldst, thou couldst not make him live; 2175Therefore, have done: some grief shows much of love; But much of grief shows still some want of wit. Juliet. Yet let me weep for such a feeling loss. Lady Capulet. So shall you feel the loss, but not the friend Which you weep for. 2180 Juliet. Feeling so the loss, Cannot choose but ever weep the friend. Lady Capulet. Well, girl, thou weep'st not so much for his death, As that the villain lives which slaughter'd him. Juliet. What villain madam? 2185 Lady Capulet. That same villain, Romeo. Juliet. [Aside] Villain and he be many miles asunder.— God Pardon him! I do, with all my heart; And yet no man like he doth grieve my heart. Lady Capulet. That is, because the traitor murderer lives. 2190 Juliet. Ay, madam, from the reach of these my hands: Would none but I might venge my cousin's death! Lady Capulet. We will have vengeance for it, fear thou not: Then weep no more. I'll send to one in Mantua, Where that same banish'd runagate doth live, 2195Shall give him such an unaccustom'd dram, That he shall soon keep Tybalt company: And then, I hope, thou wilt be satisfied. Juliet. Indeed, I never shall be satisfied With Romeo, till I behold him—dead— 2200Is my poor heart for a kinsman vex'd. Madam, if you could find out but a man To bear a poison, I would temper it; That Romeo should, upon receipt thereof, Soon sleep in quiet. O, how my heart abhors 2205To hear him named, and cannot come to him. To wreak the love I bore my cousin Upon his body that slaughter'd him! Lady Capulet. Find thou the means, and I'll find such a man. But now I'll tell thee joyful tidings, girl. 2210 Juliet. And joy comes well in such a needy time: What are they, I beseech your ladyship? Lady Capulet. Well, well, thou hast a careful father, child; One who, to put thee from thy heaviness, Hath sorted out a sudden day of joy, 2215That thou expect'st not nor I look'd not for. Juliet. Madam, in happy time, what day is that? Lady Capulet. Marry, my child, early next Thursday morn, The gallant, young and noble gentleman, The County Paris, at Saint Peter's Church, 2220Shall happily make thee there a joyful bride. Juliet. Now, by Saint Peter's Church and Peter too, He shall not make me there a joyful bride. I wonder at this haste; that I must wed Ere he, that should be husband, comes to woo. 2225I pray you, tell my lord and father, madam, I will not marry yet; and, when I do, I swear, It shall be Romeo, whom you know I hate, Rather than Paris. These are news indeed! Lady Capulet. Here comes your father; tell him so yourself, 2230And see how he will take it at your hands.

Nurse. Madam! 2135 Juliet. Nurse? Nurse. Your lady mother is coming to your chamber: The day is broke; be wary, look about. [Exit] Juliet. Then, window, let day in, and let life out. 2140 Romeo. Farewell, farewell! one kiss, and I'll descend. [He goeth down] Juliet. Art thou gone so? love, lord, ay, husband, friend! I must hear from thee every day in the hour, For in a minute there are many days: 2145O, by this count I shall be much in years Ere I again behold my Romeo! Romeo. Farewell! I will omit no opportunity That may convey my greetings, love, to thee. 2150 Juliet. O think'st thou we shall ever meet again? Romeo. I doubt it not; and all these woes shall serve For sweet discourses in our time to come. Juliet. O God, I have an ill-divining soul! Methinks I see thee, now thou art below, 2155As one dead in the bottom of a tomb: Either my eyesight fails, or thou look'st pale. Romeo. And trust me, love, in my eye so do you: Dry sorrow drinks our blood. Adieu, adieu! [Exit] Juliet. O fortune, fortune! all men call thee fickle: If thou art fickle, what dost thou with him. That is renown'd for faith? Be fickle, fortune; For then, I hope, thou wilt not keep him long, But send him back. 2165 Lady Capulet. [Within] Ho, daughter! are you up? Juliet. Who is't that calls? is it my lady mother? Is she not down so late, or up so early? What unaccustom'd cause procures her hither?

Juliet. Wilt thou be gone? it is not yet near day: It was the nightingale, and not the lark, That pierced the fearful hollow of thine ear; 2100Nightly she sings on yon pomegranate-tree: Believe me, love, it was the nightingale. Romeo. It was the lark, the herald of the morn, No nightingale: look, love, what envious streaks Do lace the severing clouds in yonder east: 2105Night's candles are burnt out, and jocund day Stands tiptoe on the misty mountain tops. I must be gone and live, or stay and die. Juliet. Yon light is not day-light, I know it, I: It is some meteor that the sun exhales, 2110To be to thee this night a torch-bearer, And light thee on thy way to Mantua: Therefore stay yet; thou need'st not to be gone. Romeo. Let me be ta'en, let me be put to death; I am content, so thou wilt have it so. 2115I'll say yon grey is not the morning's eye, 'Tis but the pale reflex of Cynthia's brow; Nor that is not the lark, whose notes do beat The vaulty heaven so high above our heads: I have more care to stay than will to go: 2120Come, death, and welcome! Juliet wills it so. How is't, my soul? let's talk; it is not day. Juliet. It is, it is: hie hence, be gone, away! It is the lark that sings so out of tune, Straining harsh discords and unpleasing sharps. 2125Some say the lark makes sweet division; This doth not so, for she divideth us: Some say the lark and loathed toad change eyes, O, now I would they had changed voices too! Since arm from arm that voice doth us affray, 2130Hunting thee hence with hunt's-up to the day, O, now be gone; more light and light it grows. Romeo. More light and light; more dark and dark our woes

Capulet. Things have fall'n out, sir, so unluckily, That we have had no time to move our daughter: 2060Look you, she loved her kinsman Tybalt dearly, And so did I:—Well, we were born to die. 'Tis very late, she'll not come down to-night: I promise you, but for your company, I would have been a-bed an hour ago. 2065 Paris. These times of woe afford no time to woo. Madam, good night: commend me to your daughter. Lady Capulet. I will, and know her mind early to-morrow; To-night she is mew'd up to her heaviness. Capulet. Sir Paris, I will make a desperate tender 2070Of my child's love: I think she will be ruled In all respects by me; nay, more, I doubt it not. Wife, go you to her ere you go to bed; Acquaint her here of my son Paris' love; And bid her, mark you me, on Wednesday next— 2075But, soft! what day is this? Paris. Monday, my lord, Capulet. Monday! ha, ha! Well, Wednesday is too soon, O' Thursday let it be: o' Thursday, tell her, She shall be married to this noble earl. 2080Will you be ready? do you like this haste? We'll keep no great ado,—a friend or two; For, hark you, Tybalt being slain so late, It may be thought we held him carelessly, Being our kinsman, if we revel much: 2085Therefore we'll have some half a dozen friends, And there an end. But what say you to Thursday? Paris. My lord, I would that Thursday were to-morrow. Capulet. Well get you gone: o' Thursday be it, then. Go you to Juliet ere you go to bed, 2090Prepare her, wife, against this wedding-day. Farewell, my lord. Light to my chamber, ho! Afore me! it is so very very late, That we may call it early by and by. Good night.

Friar Laurence. Hold thy desperate hand: Art thou a man? thy form cries out thou art: 1990Thy tears are womanish; thy wild acts denote The unreasonable fury of a beast: Unseemly woman in a seeming man! Or ill-beseeming beast in seeming both! Thou hast amazed me: by my holy order, 1995I thought thy disposition better temper'd. Hast thou slain Tybalt? wilt thou slay thyself? And stay thy lady too that lives in thee, By doing damned hate upon thyself? Why rail'st thou on thy birth, the heaven, and earth? 2000Since birth, and heaven, and earth, all three do meet In thee at once; which thou at once wouldst lose. Fie, fie, thou shamest thy shape, thy love, thy wit; Which, like a usurer, abound'st in all, And usest none in that true use indeed 2005Which should bedeck thy shape, thy love, thy wit: Thy noble shape is but a form of wax, Digressing from the valour of a man; Thy dear love sworn but hollow perjury, Killing that love which thou hast vow'd to cherish; 2010Thy wit, that ornament to shape and love, Misshapen in the conduct of them both, Like powder in a skitless soldier's flask, Is set afire by thine own ignorance, And thou dismember'd with thine own defence. 2015What, rouse thee, man! thy Juliet is alive, For whose dear sake thou wast but lately dead; There art thou happy: Tybalt would kill thee, But thou slew'st Tybalt; there are thou happy too: The law that threaten'd death becomes thy friend 2020And turns it to exile; there art thou happy: A pack of blessings lights up upon thy back; Happiness courts thee in her best array; But, like a misbehaved and sullen wench, Thou pout'st upon thy fortune and thy love: 2025Take heed, take heed, for such die miserable. Go, get thee to thy love, as was decreed, Ascend her chamber, hence and comfort her: But look thou stay not till the watch be set, For then thou canst not pass to Mantua; 2030Where thou shalt live, till we can find a time To blaze your marriage, reconcile your friends, Beg pardon of the prince, and call thee back With twenty hundred thousand times more joy Than thou went'st forth in lamentation. 2035Go before, nurse: commend me to thy lady; And bid her hasten all the house to bed, Which heavy sorrow makes them apt unto: Romeo is coming. Nurse. O Lord, I could have stay'd here all the night 2040To hear good counsel: O, what learning is! My lord, I'll tell my lady you will come. Romeo. Do so, and bid my sweet prepare to chide. Nurse. Here, sir, a ring she bid me give you, sir: Hie you, make haste, for it grows very late. 2045 [Exit] Romeo. How well my comfort is revived by this! Friar Laurence. Go hence; good night; and here stands all your state: Either be gone before the watch be set, Or by the break of day disguised from hence: 2050Sojourn in Mantua; I'll find out your man, And he shall signify from time to time Every good hap to you that chances here: Give me thy hand; 'tis late: farewell; good night. Romeo. But that a joy past joy calls out on me, 2055It were a grief, so brief to part with thee: Farewell. [Exeunt]

Friar Laurence. Thou fond mad man, hear me but speak a word. Romeo. O, thou wilt speak again of banishment. Friar Laurence. I'll give thee armour to keep off that word: 1925Adversity's sweet milk, philosophy, To comfort thee, though thou art banished. Romeo. Yet 'banished'? Hang up philosophy! Unless philosophy can make a Juliet, Displant a town, reverse a prince's doom, 1930It helps not, it prevails not: talk no more. Friar Laurence. O, then I see that madmen have no ears. Romeo. How should they, when that wise men have no eyes? Friar Laurence. Let me dispute with thee of thy estate. Romeo. Thou canst not speak of that thou dost not feel: 1935Wert thou as young as I, Juliet thy love, An hour but married, Tybalt murdered, Doting like me and like me banished, Then mightst thou speak, then mightst thou tear thy hair, And fall upon the ground, as I do now, 1940Taking the measure of an unmade grave. [Knocking within] Friar Laurence. Arise; one knocks; good Romeo, hide thyself. Romeo. Not I; unless the breath of heartsick groans, Mist-like, infold me from the search of eyes. 1945 [Knocking] Friar Laurence. Hark, how they knock! Who's there? Romeo, arise; Thou wilt be taken. Stay awhile! Stand up; [Knocking] Run to my study. By and by! God's will, 1950What simpleness is this! I come, I come! [Knocking] Who knocks so hard? whence come you? what's your will? Nurse. [Within] Let me come in, and you shall know my errand; 1955I come from Lady Juliet. Friar Laurence. Welcome, then. [Enter Nurse] Nurse. O holy friar, O, tell me, holy friar, Where is my lady's lord, where's Romeo? 1960 Friar Laurence. There on the ground, with his own tears made drunk. Nurse. O, he is even in my mistress' case, Just in her case! O woful sympathy! Piteous predicament! Even so lies she, Blubbering and weeping, weeping and blubbering. 1965Stand up, stand up; stand, and you be a man: For Juliet's sake, for her sake, rise and stand; Why should you fall into so deep an O? Romeo. Nurse! Nurse. Ah sir! ah sir! Well, death's the end of all. 1970 Romeo. Spakest thou of Juliet? how is it with her? Doth she not think me an old murderer, Now I have stain'd the childhood of our joy With blood removed but little from her own? Where is she? and how doth she? and what says 1975My conceal'd lady to our cancell'd love? Nurse. O, she says nothing, sir, but weeps and weeps; And now falls on her bed; and then starts up, And Tybalt calls; and then on Romeo cries, And then down falls again. 1980 Romeo. As if that name, Shot from the deadly level of a gun, Did murder her; as that name's cursed hand Murder'd her kinsman. O, tell me, friar, tell me, In what vile part of this anatomy 1985Doth my name lodge? tell me, that I may sack The hateful mansion.

[Enter FRIAR LAURENCE] Friar Laurence. Romeo, come forth; come forth, thou fearful man: 1870Affliction is enamour'd of thy parts, And thou art wedded to calamity. [Enter ROMEO] Romeo. Father, what news? what is the prince's doom? What sorrow craves acquaintance at my hand, 1875That I yet know not? Friar Laurence. Too familiar Is my dear son with such sour company: I bring thee tidings of the prince's doom. Romeo. What less than dooms-day is the prince's doom? 1880 Friar Laurence. A gentler judgment vanish'd from his lips, Not body's death, but body's banishment. Romeo. Ha, banishment! be merciful, say 'death;' For exile hath more terror in his look, Much more than death: do not say 'banishment.' 1885 Friar Laurence. Hence from Verona art thou banished: Be patient, for the world is broad and wide. Romeo. There is no world without Verona walls, But purgatory, torture, hell itself. Hence-banished is banish'd from the world, 1890And world's exile is death: then banished, Is death mis-term'd: calling death banishment, Thou cutt'st my head off with a golden axe, And smilest upon the stroke that murders me. Friar Laurence. O deadly sin! O rude unthankfulness! 1895Thy fault our law calls death; but the kind prince, Taking thy part, hath rush'd aside the law, And turn'd that black word death to banishment: This is dear mercy, and thou seest it not. Romeo. 'Tis torture, and not mercy: heaven is here, 1900Where Juliet lives; and every cat and dog And little mouse, every unworthy thing, Live here in heaven and may look on her; But Romeo may not: more validity, More honourable state, more courtship lives 1905In carrion-flies than Romeo: they my seize On the white wonder of dear Juliet's hand And steal immortal blessing from her lips, Who even in pure and vestal modesty, Still blush, as thinking their own kisses sin; 1910But Romeo may not; he is banished: Flies may do this, but I from this must fly: They are free men, but I am banished. And say'st thou yet that exile is not death? Hadst thou no poison mix'd, no sharp-ground knife, 1915No sudden mean of death, though ne'er so mean, But 'banished' to kill me?—'banished'? O friar, the damned use that word in hell; Howlings attend it: how hast thou the heart, Being a divine, a ghostly confessor, 1920A sin-absolver, and my friend profess'd, To mangle me with that word 'banished'?

Juliet. Shall I speak ill of him that is my husband? Ah, poor my lord, what tongue shall smooth thy name, When I, thy three-hours wife, have mangled it? But, wherefore, villain, didst thou kill my cousin? That villain cousin would have kill'd my husband: 1825Back, foolish tears, back to your native spring; Your tributary drops belong to woe, Which you, mistaking, offer up to joy. My husband lives, that Tybalt would have slain; And Tybalt's dead, that would have slain my husband: 1830All this is comfort; wherefore weep I then? Some word there was, worser than Tybalt's death, That murder'd me: I would forget it fain; But, O, it presses to my memory, Like damned guilty deeds to sinners' minds: 1835'Tybalt is dead, and Romeo—banished;' That 'banished,' that one word 'banished,' Hath slain ten thousand Tybalts. Tybalt's death Was woe enough, if it had ended there: Or, if sour woe delights in fellowship 1840And needly will be rank'd with other griefs, Why follow'd not, when she said 'Tybalt's dead,' Thy father, or thy mother, nay, or both, Which modern lamentations might have moved? But with a rear-ward following Tybalt's death, 1845'Romeo is banished,' to speak that word, Is father, mother, Tybalt, Romeo, Juliet, All slain, all dead. 'Romeo is banished!' There is no end, no limit, measure, bound, In that word's death; no words can that woe sound. 1850Where is my father, and my mother, nurse? Nurse. Weeping and wailing over Tybalt's corse: Will you go to them? I will bring you thither. Juliet. Wash they his wounds with tears: mine shall be spent, When theirs are dry, for Romeo's banishment. 1855Take up those cords: poor ropes, you are beguiled, Both you and I; for Romeo is exiled: He made you for a highway to my bed; But I, a maid, die maiden-widowed. Come, cords, come, nurse; I'll to my wedding-bed; 1860And death, not Romeo, take my maidenhead! Nurse. Hie to your chamber: I'll find Romeo To comfort you: I wot well where he is. Hark ye, your Romeo will be here at night: I'll to him; he is hid at Laurence' cell. 1865 Juliet. O, find him! give this ring to my true knight, And bid him come to take his last farewell.

Juliet. Ay me! what news? why dost thou wring thy hands? Nurse. Ah, well-a-day! he's dead, he's dead, he's dead! We are undone, lady, we are undone! Alack the day! he's gone, he's kill'd, he's dead! 1760 Juliet. Can heaven be so envious? Nurse. Romeo can, Though heaven cannot: O Romeo, Romeo! Who ever would have thought it? Romeo! Juliet. What devil art thou, that dost torment me thus? 1765This torture should be roar'd in dismal hell. Hath Romeo slain himself? say thou but 'I,' And that bare vowel 'I' shall poison more Than the death-darting eye of cockatrice: I am not I, if there be such an I; 1770Or those eyes shut, that make thee answer 'I.' If he be slain, say 'I'; or if not, no: Brief sounds determine of my weal or woe. Nurse. I saw the wound, I saw it with mine eyes,— God save the mark!—here on his manly breast: 1775A piteous corse, a bloody piteous corse; Pale, pale as ashes, all bedaub'd in blood, All in gore-blood; I swounded at the sight. Juliet. O, break, my heart! poor bankrupt, break at once! To prison, eyes, ne'er look on liberty! 1780Vile earth, to earth resign; end motion here; And thou and Romeo press one heavy bier! Nurse. O Tybalt, Tybalt, the best friend I had! O courteous Tybalt! honest gentleman! That ever I should live to see thee dead! 1785 Juliet. What storm is this that blows so contrary? Is Romeo slaughter'd, and is Tybalt dead? My dear-loved cousin, and my dearer lord? Then, dreadful trumpet, sound the general doom! For who is living, if those two are gone? 1790 Nurse. Tybalt is gone, and Romeo banished; Romeo that kill'd him, he is banished. Juliet. O God! did Romeo's hand shed Tybalt's blood? Nurse. It did, it did; alas the day, it did! Juliet. O serpent heart, hid with a flowering face! 1795Did ever dragon keep so fair a cave? Beautiful tyrant! fiend angelical! Dove-feather'd raven! wolvish-ravening lamb! Despised substance of divinest show! Just opposite to what thou justly seem'st, 1800A damned saint, an honourable villain! O nature, what hadst thou to do in hell, When thou didst bower the spirit of a fiend In moral paradise of such sweet flesh? Was ever book containing such vile matter 1805So fairly bound? O that deceit should dwell In such a gorgeous palace! Nurse. There's no trust, No faith, no honesty in men; all perjured, All forsworn, all naught, all dissemblers. 1810Ah, where's my man? give me some aqua vitae: These griefs, these woes, these sorrows make me old. Shame come to Romeo! Juliet. Blister'd be thy tongue For such a wish! he was not born to shame: 1815Upon his brow shame is ashamed to sit; For 'tis a throne where honour may be crown'd Sole monarch of the universal earth. O, what a beast was I to chide at him! Nurse. Will you speak well of him that kill'd your cousin?

Juliet. Gallop apace, you fiery-footed steeds, Towards Phoebus' lodging: such a wagoner 1720As Phaethon would whip you to the west, And bring in cloudy night immediately. Spread thy close curtain, love-performing night, That runaway's eyes may wink and Romeo Leap to these arms, untalk'd of and unseen. 1725Lovers can see to do their amorous rites By their own beauties; or, if love be blind, It best agrees with night. Come, civil night, Thou sober-suited matron, all in black, And learn me how to lose a winning match, 1730Play'd for a pair of stainless maidenhoods: Hood my unmann'd blood, bating in my cheeks, With thy black mantle; till strange love, grown bold, Think true love acted simple modesty. Come, night; come, Romeo; come, thou day in night; 1735For thou wilt lie upon the wings of night Whiter than new snow on a raven's back. Come, gentle night, come, loving, black-brow'd night, Give me my Romeo; and, when he shall die, Take him and cut him out in little stars, 1740And he will make the face of heaven so fine That all the world will be in love with night And pay no worship to the garish sun. O, I have bought the mansion of a love, But not possess'd it, and, though I am sold, 1745Not yet enjoy'd: so tedious is this day As is the night before some festival To an impatient child that hath new robes And may not wear them. O, here comes my nurse, And she brings news; and every tongue that speaks 1750But Romeo's name speaks heavenly eloquence. [Enter Nurse, with cords] Now, nurse, what news? What hast thou there? the cords That Romeo bid thee fetch? Nurse. Ay, ay, the cords.

Benvolio. O Romeo, Romeo, brave Mercutio's dead! That gallant spirit hath aspired the clouds, 1625Which too untimely here did scorn the earth. Romeo. This day's black fate on more days doth depend; This but begins the woe, others must end. Benvolio. Here comes the furious Tybalt back again. Romeo. Alive, in triumph! and Mercutio slain! 1630Away to heaven, respective lenity, And fire-eyed fury be my conduct now! [Re-enter TYBALT] Now, Tybalt, take the villain back again, That late thou gavest me; for Mercutio's soul 1635Is but a little way above our heads, Staying for thine to keep him company: Either thou, or I, or both, must go with him. Tybalt. Thou, wretched boy, that didst consort him here, Shalt with him hence. 1640 Romeo. This shall determine that. [They fight; TYBALT falls] Benvolio. Romeo, away, be gone! The citizens are up, and Tybalt slain. Stand not amazed: the prince will doom thee death, 1645If thou art taken: hence, be gone, away! Romeo. O, I am fortune's fool! Benvolio. Why dost thou stay? [Exit ROMEO] [Enter Citizens, &c] First Citizen. Which way ran he that kill'd Mercutio? Tybalt, that murderer, which way ran he? Benvolio. There lies that Tybalt. First Citizen. Up, sir, go with me; I charge thee in the princes name, obey. 1655[Enter Prince, attended; MONTAGUE, CAPULET, their] Wives, and others] Prince Escalus. Where are the vile beginners of this fray? Benvolio. O noble prince, I can discover all The unlucky manage of this fatal brawl: 1660There lies the man, slain by young Romeo, That slew thy kinsman, brave Mercutio. Lady Capulet. Tybalt, my cousin! O my brother's child! O prince! O cousin! husband! O, the blood is spilt O my dear kinsman! Prince, as thou art true, 1665For blood of ours, shed blood of Montague. O cousin, cousin! Prince Escalus. Benvolio, who began this bloody fray? Benvolio. Tybalt, here slain, whom Romeo's hand did slay; Romeo that spoke him fair, bade him bethink 1670How nice the quarrel was, and urged withal Your high displeasure: all this uttered With gentle breath, calm look, knees humbly bow'd, Could not take truce with the unruly spleen Of Tybalt deaf to peace, but that he tilts 1675With piercing steel at bold Mercutio's breast, Who all as hot, turns deadly point to point, And, with a martial scorn, with one hand beats Cold death aside, and with the other sends It back to Tybalt, whose dexterity, 1680Retorts it: Romeo he cries aloud, 'Hold, friends! friends, part!' and, swifter than his tongue, His agile arm beats down their fatal points, And 'twixt them rushes; underneath whose arm 1685An envious thrust from Tybalt hit the life Of stout Mercutio, and then Tybalt fled; But by and by comes back to Romeo, Who had but newly entertain'd revenge, And to 't they go like lightning, for, ere I 1690Could draw to part them, was stout Tybalt slain. And, as he fell, did Romeo turn and fly. This is the truth, or let Benvolio die. Lady Capulet. He is a kinsman to the Montague; Affection makes him false; he speaks not true: 1695Some twenty of them fought in this black strife, And all those twenty could but kill one life. I beg for justice, which thou, prince, must give; Romeo slew Tybalt, Romeo must not live. Prince Escalus. Romeo slew him, he slew Mercutio; 1700Who now the price of his dear blood doth owe? Montague. Not Romeo, prince, he was Mercutio's friend; His fault concludes but what the law should end, The life of Tybalt. Prince Escalus. And for that offence 1705Immediately we do exile him hence: I have an interest in your hate's proceeding, My blood for your rude brawls doth lie a-bleeding; But I'll amerce you with so strong a fine That you shall all repent the loss of mine: 1710I will be deaf to pleading and excuses; Nor tears nor prayers shall purchase out abuses: Therefore use none: let Romeo hence in haste, Else, when he's found, that hour is his last. Bear hence this body and attend our will: 1715Mercy but murders, pardoning those that kill.

Romeo. Gentle Mercutio, put thy rapier up. Mercutio. Come, sir, your passado. 1585 [They fight] Romeo. Draw, Benvolio; beat down their weapons. Gentlemen, for shame, forbear this outrage! Tybalt, Mercutio, the prince expressly hath Forbidden bandying in Verona streets: 1590Hold, Tybalt! good Mercutio! [TYBALT under ROMEO's arm stabs MERCUTIO, and flies with his followers] Mercutio. I am hurt. A plague o' both your houses! I am sped. Is he gone, and hath nothing? 1595 Benvolio. What, art thou hurt? Mercutio. Ay, ay, a scratch, a scratch; marry, 'tis enough. Where is my page? Go, villain, fetch a surgeon. [Exit Page] Romeo. Courage, man; the hurt cannot be much. 1600 Mercutio. No, 'tis not so deep as a well, nor so wide as a church-door; but 'tis enough,'twill serve: ask for me to-morrow, and you shall find me a grave man. I am peppered, I warrant, for this world. A plague o' both your houses! 'Zounds, a dog, a rat, a mouse, a 1605cat, to scratch a man to death! a braggart, a rogue, a villain, that fights by the book of arithmetic! Why the devil came you between us? I was hurt under your arm. Romeo. I thought all for the best. 1610 Mercutio. Help me into some house, Benvolio, Or I shall faint. A plague o' both your houses! They have made worms' meat of me: I have it, And soundly too: your houses! [Exeunt MERCUTIO and BENVOLIO] Romeo. This gentleman, the prince's near ally, My very friend, hath got his mortal hurt In my behalf; my reputation stain'd With Tybalt's slander,—Tybalt, that an hour Hath been my kinsman! O sweet Juliet, 1620Thy beauty hath made me effeminate And in my temper soften'd valour's steel!

Tybalt. Well, peace be with you, sir: here comes my man. Mercutio. But I'll be hanged, sir, if he wear your livery: 1555Marry, go before to field, he'll be your follower; Your worship in that sense may call him 'man.' Tybalt. Romeo, the hate I bear thee can afford No better term than this,—thou art a villain. Romeo. Tybalt, the reason that I have to love thee 1560Doth much excuse the appertaining rage To such a greeting: villain am I none; Therefore farewell; I see thou know'st me not. Tybalt. Boy, this shall not excuse the injuries That thou hast done me; therefore turn and draw. 1565 Romeo. I do protest, I never injured thee, But love thee better than thou canst devise, Till thou shalt know the reason of my love: And so, good Capulet,—which name I tender As dearly as my own,—be satisfied. 1570 Mercutio. O calm, dishonourable, vile submission! Alla stoccata carries it away. [Draws] Tybalt, you rat-catcher, will you walk? Tybalt. What wouldst thou have with me? 1575 Mercutio. Good king of cats, nothing but one of your nine lives; that I mean to make bold withal, and as you shall use me hereafter, drybeat the rest of the eight. Will you pluck your sword out of his pitcher by the ears? make haste, lest mine be about your 1580ears ere it be out. Tybalt. I am for you.

Tybalt. Follow me close, for I will speak to them. 1535Gentlemen, good den: a word with one of you. Mercutio. And but one word with one of us? couple it with something; make it a word and a blow. Tybalt. You shall find me apt enough to that, sir, an you will give me occasion. 1540 Mercutio. Could you not take some occasion without giving? Tybalt. Mercutio, thou consort'st with Romeo,— Mercutio. Consort! what, dost thou make us minstrels? an thou make minstrels of us, look to hear nothing but discords: here's my fiddlestick; here's that shall 1545make you dance. 'Zounds, consort! Benvolio. We talk here in the public haunt of men: Either withdraw unto some private place, And reason coldly of your grievances, Or else depart; here all eyes gaze on us. 1550 Mercutio. Men's eyes were made to look, and let them gaze; I will not budge for no man's pleasure, I.

Benvolio. I pray thee, good Mercutio, let's retire: The day is hot, the Capulets abroad, 1500And, if we meet, we shall not scape a brawl; For now, these hot days, is the mad blood stirring. Mercutio. Thou art like one of those fellows that when he enters the confines of a tavern claps me his sword upon the table and says 'God send me no need of 1505thee!' and by the operation of the second cup draws it on the drawer, when indeed there is no need. Benvolio. Am I like such a fellow? Mercutio. Come, come, thou art as hot a Jack in thy mood as any in Italy, and as soon moved to be moody, and as 1510soon moody to be moved. Benvolio. And what to? Mercutio. Nay, an there were two such, we should have none shortly, for one would kill the other. Thou! why, thou wilt quarrel with a man that hath a hair more, 1515or a hair less, in his beard, than thou hast: thou wilt quarrel with a man for cracking nuts, having no other reason but because thou hast hazel eyes: what eye but such an eye would spy out such a quarrel? Thy head is as fun of quarrels as an egg is full of 1520meat, and yet thy head hath been beaten as addle as an egg for quarrelling: thou hast quarrelled with a man for coughing in the street, because he hath wakened thy dog that hath lain asleep in the sun: didst thou not fall out with a tailor for wearing 1525his new doublet before Easter? with another, for tying his new shoes with old riband? and yet thou wilt tutor me from quarrelling! Benvolio. An I were so apt to quarrel as thou art, any man should buy the fee-simple of my life for an hour and a quarter. 1530 Mercutio. The fee-simple! O simple! Benvolio. By my head, here come the Capulets. Mercutio. By my heel, I care not. [Enter TYBALT and others] Tybalt. Follow me close, for I will speak to them. 1535Gentlemen, good den: a word with one of you. Mercutio. And but one word with one of us? couple it with something; make it a word and a blow. Tybalt. You shall find me apt enough to that, sir, an you will give me occasion. 1540 Mercutio. Could you not take some occasion without giving? Tybalt. Mercutio, thou consort'st with Romeo,— Mercutio. Consort! what, dost thou make us minstrels? an thou make minstrels of us, look to hear nothing but discords: here's my fiddlestick; here's that shall 1545make you dance. 'Zounds, consort! Benvolio. We talk here in the public haunt of men: Either withdraw unto some private place, And reason coldly of your grievances, Or else depart; here all eyes gaze on us. 1550 Mercutio. Men's eyes were made to look, and let them gaze; I will not budge for no man's pleasure, I.

Albus Dumbledore says: "Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?"

市場にサービスを提供するための全てのオプションとしてサプライチェーンを見るなら、価格設定は明らかにそのうちのひとつです。将来の価格が分からなければ需要予測を行う意味はあまりなく、価格を下げれば需要が膨張するという機械的な側面があります。

The Clerk of the City shall at any time when directed by the City Council, or when petitioned in writing by at least five percent of the registered voters of the City and filed with the City Clerk no less than 40 days before the day of such meeting, call a special meeting of the legal voters of the City, for any legal purpose, in the same manner as is provided for the annual meeting, except as is hereinafter provided: (1) Whenever a petition is brought for a meeting to rescind or reconsider the action taken at a previously held City meeting, the number of names required shall be 10 percent of the legal voters, and the petition shall be filed with the City Clerk within 30 days following the date of that meeting.

§ 506. Petition for enactment of ordinance; special meeting (a) Subject to the provisions of section 505 of this charter, voters of the City may at any time petition in the same manner as in section 505 of this charter for the enactment of any proposed lawful ordinance by filing such petition, including the text of such ordinance, with the City Clerk. The Council shall call a special City meeting to be held within 45 days of the date of such filing, unless prior to such meeting such ordinance shall be enacted by the Council. The warning for such meeting shall include a short, concise one-paragraph description of the effects of the proposed ordinance and shall provide for an aye and nay vote as to its enactment. The warning shall also include reference to a place within the City where copies of the entire text of the proposed ordinance may be examined. Such ordinance shall take effect on the 10th day after the conclusion of such meeting, provided that the electors as qualified in section 505 of this charter, constituting a majority of those voting thereon, shall have voted in the affirmative. (b) Any such proposed ordinance shall be examined by the City Attorney before being submitted to the special City meeting. The City Attorney is authorized subject to the approval of the Council, to correct such ordinance so as to avoid repetitions, illegalities, and unconstitutional provisions and to ensure accuracy in its text and references and clearness and preciseness in its phraseology, but he or she shall not materially change its meaning and effect. (c) The provisions of this section shall not apply to any appointments of officers, members of commissions, or boards made by the Council, or to the appo

§ 13-505. Rescission of ordinances All ordinances shall be subject to rescission by a special City meeting, as follows: if, within 10 days after final passage by the Council of any such ordinance, a petition signed by electors of the City not less in number than 10 percent of the number of votes cast in the last municipal election is filed with the City Clerk requesting its reference to a special City meeting, the Council shall fix the time and place of such meeting, within 14 days after the filing of the petition, and notice thereof shall be given in the manner provided by law in the calling of a special City meeting. An ordinance so referred shall remain in effect upon the conclusion of such meeting unless electors not less in number than 10 percent of the number of votes cast in the last municipal election and constituting a majority of those voting thereon, shall have voted against the ordinance.

§ 305. Overrule of ordinances All ordinances shall be subject to overrule by a special Town meeting, as follows; if, within 20 days after final passage by the Selectboard of any such ordinance, a petition signed by voters of the Town not less in number than 10 percent of the largest number of votes cast by Australian ballot at the last annual Town meeting is filed with the Town Clerk requesting its reference to a special Town meeting, the Selectboard shall fix the time and place of such meeting, which shall be not less than 30 nor more than 40 days after the filing of the petition and notice thereof shall be given in the manner provided by law in the calling of a special Town meeting. An ordinance so referred shall become effective upon the conclusion of such meeting unless voters not less in number than 10 percent of the largest number of votes cast by Australian ballot at the last annual Town meeting and constituting a majority of those voting thereon, shall have voted against the ordinance. (Amended 2015, No. M-1, § 2, eff. Jan. 27, 2015.)

you can add heat to an object, you cannot say that "an object contains a certain quantity of heat." This is very different from the case of the fuel in your car: you can add fuel to your car, and you are quite entitled to say that your car "contains a certain quantity of fuel". You even have a gauge for measuring it! But heat is quite different. Objects do not and cannot have gauges which read out how much heat they contain, because heat only makes sense when it is "in transit".1To see this, consider your co

. Your main research question should be substantial enough to form the guiding principle of your paper—but focused enough to guide your research. A strong research question requires you not only to find information but also to put together different pieces of information, interpret and analyze them, and figure out what you think. As you consider potential research questions, ask yourself whether they would be too hard or too easy to answer.

A successful research process should go through these steps: Decide on the topic. Narrow the topic in order to narrow search parameters. Consider a question that your research will address. Generate sub-questions from your main question. Determine what kind of sources are best for your argument. Create a bibliography as you gather and reference sources.

After narrowing your focus, think about key search terms that will apply only to your subtopic. Develop specific questions that can be answered through your research process, but be careful not to choose a focus that is overly narrow. You should aim for a question that will limit search results to sources that relate to your topic, but will still result in a varied pool of sources to explore.

But the research process does not end when you have solved your mystery. Imagine what would happen if a detective collected enough evidence to solve a criminal case, but she never shared her solution with the authorities. Presenting what you have learned from research can be just as important as performing the research. Research results can be presented in a variety of ways, but one of the most popular—and effective—presentation forms is the research paper. A research paper presents an original thesis, or purpose statement, about a topic and develops that thesis with information gathered from a variety of sources.

While it is true that some young women in today’s society are more sexualized than in the past, that is not true for all girls. The writer of this thesis should ask the following questions: Which teenage girls? What constitutes “too” sexualized? Why are they behaving that way? Where does this behavior show up? What are the repercussions?

Examples of Appropriate Thesis Statements The societal and personal struggles of Troy Maxon in the play “Fences” symbolize the challenge of black males who lived through segregation and integration in the United States. Shakespeare’s use of dramatic irony in Romeo and Juliet spoils the outcome for the audience and weakens the plot. J. D. Salinger’s character in Catcher in the Rye, Holden Caulfield, is a confused rebel who voices his disgust with phonies, yet in an effort to protect himself, he acts like a phony on many occasions. Compared to an absolute divorce, no-fault divorce is less expensive, promotes fairer settlements, and reflects a more realistic view of the causes for marital breakdown. Exposing children from an early age to the dangers of drug abuse is a sure method of preventing future drug addicts. In a crumbling job market, a high school diploma is not significant enough education to land a stable, lucrative job.

Specificity A thesis statement must concentrate on a specific area of a general topic. As you may recall, the creation of a thesis statement begins when you choose a broad subject and then narrow down its parts until you pinpoint a specific aspect of that topic. For example, health care is a broad topic, but a proper thesis statement would focus on a specific area of that topic, such as options for individuals without health-care coverage. Precision A strong thesis statement must be precise enough to allow for a coherent argument and to remain focused on the topic.

A thesis is generally one to two sentences long and appears toward the end of your introduction. It is specific and focuses on one to three points of a single idea—points that will be demonstrated in the body. The thesis forecasts the content of the essay and suggests how you will organize your information. Remember that a thesis statement does not summarize an issue but rather dissects it.

When writing a personal narrative for class, first consider the prompt your teacher assigned you. Then, freewrite about topics that are of general interest to you.

The intention or purpose may be to expound on the grieving process (catharsis), or to encourage an emotional response from the reader, for example, making a person laugh or cry.

a personal narrative is a form of creative writing that tells a story about personal experiences.

Not all online search engines’ results will be useful or reliable.

When selecting a topic, you may also want to consider something that interests you or something based on your own life and personal experiences.

Effective writing can be simply described as good ideas that are expressed well and arranged in the proper order.

Just as you need a recipe, ingredients, and proper tools to cook a delicious meal, you also need a plan, resources, and adequate time to create a good written composition

Yet large “leaks” in the metaphorical STEM pipeline likely occur by early child-hood in the U.S.

A practical implication of these findings is that factors present before kindergarten may largely explain racial and ethnic underrepresentation in STEM.

This unexplained

However, the study’s antecedent, opportunity, and pro-pensity factors do not fully explain the observed racial dis-parities.

largely consistent

We hypothesized

followed from the fall of kindergarten to the spring of fifth grade

Asian students were initially less likely than White students to display advanced science achieve-ment in kindergarten (i.e., 7% versus 16%, respectively). Asian students then were more likely than White students to display advanced science achievement by fifth grade (i.e., 16% versus 13%, respectively).

operationalized consistently

We used White, non-Hispanic students as the reference group

Internalizing Problem Behaviors subscale consisted of four items (i.e., is the child lonely, sad, anxious, or displays low self-esteem). Problem behavior frequency was rated using a four-point response scale ranging from “never” to “very often.” Higher scores indicated that the behavior occurred more frequently. The internal consistency reliability coefficients for the externalizing and internalizing problem behaviors scales were .89 and .78, respectively (Tourangeau et al., 2019)

he science achievement measure was designed to assess a student’s understanding about the physical, life, and Earth and space sciences as well as scientific inquiry. The mathe-matics achievement measure was designed to assess a stu-dent’s conceptual knowledge, procedural knowledge, and problem solving. The mathematics achievement measure included items on number sense, properties, and operations; measurement; geometry and spatial sense; data analysis, sta-tistics, and probability; and patterns, algebra, and functions. The reading achievement measure was designed to assess basic reading skills (e.g., print familiarity), vocabulary, and reading comprehension

item response theory (IRT)

Emergent literacy (α = .57) was a standardized composite score of five items related to literacy activities. The first three items assessed the frequency of parents engaging in book reading and picture book reading with the child as well as the child reading outside school. The last two items reported the number of books that their child owned and how long the parent spent on reading to their child. We added standardized scores of the first three items and the last two items to obtain the standardized composite score

dichotomous

attrition

We analyzed the public-use version of the nationally repre-sentative Early Childhood Longitudinal Study

Hypothesis 1: Based on prior work examining the early onset and relative stability of racial or ethnic achievement disparities (e.g., Morgan et al., 2016; Von Hippel et al., 2018), we hypothesized that Black, Hispanic, or AINAPI students would be less likely than White students to dis-play advanced science or mathematics achievement during elementary school in unadjusted analyses. We expected the observed differences to be large (Morgan et al., 2016; Plucker & Peters, 2016; Rambo-Hernandez et al., 2019). We hypothesized that Black, Hispanic, or AINAPI stu-dents would be less likely than White students to display advanced levels of science or mathematics achievement by the end of kindergarten and throughout elementary school (Freyer & Levitt, 2004; Rambo-Hernandez et al., 2019; Von Hippel et al., 2018).

Use of universal screen-ing using standardized measures

Research Question 1: Are Black, Hispanic, or AINAPI students less likely than White students to display advanced science or mathematics achievement during elementary school? If so, how large are the observed gaps

Among antecedent, opportunity, and propensity factors, propensity factors most strongly predict student achievement

lead poisoning, environmental pollutants,

Black, Hispanic, and AINAPI students are more likely to experience concentrated poverty that results in fewer learn-ing opportunities and corresponding racial and ethnic achievement disparities during school because of histori-cally racialized policies and practices as well as ongoing residential and community segregation

(Fryer & Levitt, 2004; Henry et al., 2020; Morgan et al., 2016; National Assessment of Educational Progress [NAEP], 2015, 2020; Navarro et al., 2012; Reardon & Galindo, 2009; Von Hippel et al., 2018).

2.6 percentage point increase in publica-tions, a 4.3 percentage point increase in citations, and a .03

3% to 4%

13% to 16%

Researchers follow an iterative process to solve problems.

Part of becoming a skilled researcher is learning the epistemology of one’s discipline. Say

When scholarship is working right, publication of research results produces inquiry by other scholars, which in turn produces more research.

Each discipline has its own methods for making or vetting knowledge claims

On the other hand, doing research for other reasons than to answer a question can be half-hearted or sloppy.

If students, for example, research a topic only because they are required to by an assignment, and not from a desire to learn anything in particular, the results will often be subpar.

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Help missionaries plan the invitation based on the needs and progress of the person.

Invite missionaries to practice extending the invitation.

Demonstrate what this invitation might look like.

Discuss the needs of the person missionaries will be inviting

Fundo Nacional de Desenvolvimento Regional

help missionaries encourage members to invite friends to sacrament meeting and help them get there.

Help missionaries understand that these principles of love, share, and invite are for all members.

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Healing responses may include turning to music, art, religion, literature, nature, humor, or psychotherapy for solace and understanding. Spiritual questions of purpose and meaning in life become more immediate in the face of impending death.

Under the Medicare Hospice Benefit, hospices provide bereavement support for at least a year to families of patients they have served. They also provide bereavement services to partners and close friends. Often, hospices provide this support to people in their community even if the death did not occur with hospice care.

Physicians and nurses may want to call in clergy and social workers; each may have something to offer a family that is trying to integrate the shock and loss.

If patients have lost the capacity to express their wishes and family members are in conflict about a certain plan, it is best to focus on what the patient would have wanted, applying the ethical principle of substituted judgment.

The clinician needs to communicate clearly with the family members regarding plans for care, prognosis, complications, and who will make decisions should the patient be unable.

The search for love, a connection to others, and a sense of meaning are essential in helping patients through the dying process.

CASE ILLUSTRATION 9 A 64-year-old veterinarian, Richard, develops headaches so severe that he can no longer carry on his surgical practice.

Guidelines for assisted suicide have been published, and clinicians confronted with a reasonable request to end life should refer to these, as well as to colleagues experienced in palliative care, for help. In almost all cases, legally permissible and clinically preferable alternatives can be found.

A patient’s request to hasten death should be explored in detail. At first, it should be considered a cry for help. It may represent the wish to escape from depression, anxiety, uncontrolled physical pain, shame of dependency, and other psychosocial issues.

CASE ILLUSTRATION 8 Sara, a bedridden 84-year-old woman with end-stage congestive heart failure, is seen on rounds.

In assisted suicide, the physician provides the means (such as a prescription for barbiturates) at the request of the patient, but the patient must eventually take (or not take) the potentially lethal medication by his or her own hand.

Voluntary active euthanasia is the act of intentionally intervening to cause the patient’s death, at the explicit request of, and with the full informed consent of, the competent patient.

Table 42-2.Last resort interventions: definitions.

Withdrawing life-sustaining but burdensome treatments, even though the withdrawal leads to death, is also an accepted part of practice based on the patient’s right to bodily integrity.

CASE ILLUSTRATION 7 Marvin is a 63-year-old man with amyotrophic lateral sclerosis who has been on a respirator at home for one year.

Patients who recover from delirium and coma sometimes report experiences that range from nightmarish, terrifying visions, on the one hand, to very pleasant out-of-body travel or visions of light and angelic beings on the other. Some may not be able to remember anything about the experience. Occasionally, the disorientation becomes profound and the sense of the world is lost. ++

CASE ILLUSTRATION 6 Caleb, a 101-year-old rugged dairy farmer, has become partly deaf and then blind in the last 5 years of his life but remains alert and communicative.

Patients have the right to forgo therapies such as intravenous fluids, nasogastric feeding, and supplemental oxygen, among others. Documentation of these choices is vital if the patient does not wish to undergo treatments and can be done on the MOLST form.

The notion that being resuscitated from cardiopulmonary arrest will not add appreciably to the quality and/or quantity of life is an open acknowledgment that death might be near—and that reversing the dying process is not within the power of medicine.

The “do-not-resuscitate” (DNR) order refers to the withholding of CPR, specifically closed-chest cardiac massage, defibrillation, and artificially supplied respiratory support. For most patients with a terminal disease, CPR is ineffective, and its harshness makes it a cruel, expensive, technological death ritual. Many studies have shown that CPR provides no increase in out-of-hospital survival for patients with progressive multisystem disease, particularly patients with advanced cancers and renal failure.

Advance directives are formal documents that direct health care decisions should patients lose the capacity to speak for themselves in the future.

There are two types of advance directives: living wills and health care proxies (also called durable powers of attorney). ++

Invasive interventions that exceed the usual boundaries of hospice care but that extend meaningful life and improve quality of life are sometimes appropriate even within a hospice approach, as long as the patient consents. Remaining flexible in the face of changing, difficult situations and allowing the patient’s goals to guide the treatment as much as possible permit the clinician to hope along with the patient for a death with as little meaningless suffering as possible.

CASE ILLUSTRATION 5 Rhea, a 64-year-old woman with metastatic breast cancer, is on high-dose long-acting morphine because of bone pain.

CASE ILLUSTRATION 4 Max, a 63-year-old, recently retired, and previously healthy man, develops abdominal pain and is found to have widely metastasized colon cancer.

Providing ranges of survival times and allowing for outliers on either end is better than predicting an exact amount of time. (“The average person with your illness will live two to six months. It could be longer, and we will try to make that happen, but it could also be shorter, so you may want to make sure everything is prepared just in case things don’t go as we hope.”)

CASE ILLUSTRATION 3 At 68 years old, Albert has severe end-stage emphysema from years of smoking, severe mitral regurgitation, congestive heart failure, cardiac arrhythmias, and alcoholism.

For some, dying may be a time for personal growth, reflection, and meaning, but for others, personal factors and emotional reactions block an acceptance of death.

CASE ILLUSTRATION 2 Carlos, a 70-year-old man, has been diagnosed with advanced hepatocellular carcinoma.

Progressive declines initially may be treated as another form of bad news, but they also potentially provide the opportunity for enhanced meaning and control in the dying process.

Table 42-1.End-of-life issues to be discussed with patients.

This sadness, which may be a way of preparing for death, has been called preparatory or anticipatory grief.

Hospice programs provide comprehensive care to dying patients, with a multidisciplinary team of nurses, physicians, social workers, clergy, and volunteers. These programs, which accept only patients who are more likely than not to die in the next 6 months and are willing to forgo disease-directed therapies and hospitalizations, help patients and their families live as fully as possible by providing quality palliative care.

The advantage of hospice programs is the expertise brought to techniques of palliative care by the multidisciplinary staff, as well as the added support for patient and family at home, including payment for palliative medications and medical equipment.

Unlike Medicare-sponsored hospice programs, palliative care does not require patients to give up on aggressive treatment of their underlying disease, to accept a prognosis of less than 6 months, or to accept palliation as the central goal of therapy. Thus, it allows “hospice-like” treatments to be made available to those seriously ill patients who want to continue some or all disease-directed treatments.

This “both/and” approach has been one of the most important conceptual breakthroughs for palliative care, for it allows quality-of-life issues to be addressed for all seriously ill patients, not just those who are referred to hospice.

CASE ILLUSTRATION 1 Ella, a 71-year-old woman

Figure 42-1. The place of palliative care in the course of illness.

Enhancing the quality of life for those afflicted with serious chronic illness is the cornerstone of the rapidly developing specialty of palliative care.

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Equal justice between man and man (sometimes vitiated by partiality to Europeans).

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dmission of natives to high office must be effected by slow degrees

Bias Blind Spot: The tendency to see oneself as less biased than other people, or to be able to identify more cognitive biases in others than in oneself.

Patients with undetected trauma histories are often seen as “difficult” or “hostile,” frequently are late or miss appointments, are often in crisis, have poor self-care, and chronic pain. Such patients also may be labeled as “noncompliant,” with seemingly intractable health behavior problems.

When trauma-focused psychotherapy is not available, national guidelines recommend pharmacotherapy, in particular sertraline, paroxetine, fluoxetine, or venlafaxine as first-line monotherapies.

In addition to the misuse of substances, another common comorbidity of PTSD is insomnia.

Chronic pain, smoking, and obesity are also common comorbidities with PTSD.

Other primary prevention strategies for primary care practices include support for new parents, support for home visiting programs, and universal preschool options, and firearm access reduction.

In addition to risk reduction strategies, characteristics that promote resilience in survivors such as self-esteem, trust, humor, internal locus of control, secure attachments, and social relationships, as well as a personal sense of safety, religious affiliation, strong adult role models, and use of existing resources can be reinforced by primary care clinicians.

Table 41-3.First steps to trauma-informed primary care.

Unlike recent trauma, disclosures of past trauma do not require an immediate intervention. Rather, clinicians can express empathy (“I’m so sorry that happened to you. You didn’t deserve that”) and provide information about the availability of services to help cope with and heal from past trauma (“I am available to talk more with you about that.

An appropriate response to recent IPV affirms that the patient does not deserve to be treated in this way and expresses concern for his/her safety. It also typically also includes a “warm handoff” to a domestic violence agency by telephone and/or to an onsite psychosocial team member who can construct a safety plan; lethality assessment, referrals for safe housing, legal, police, and other community resources; individual and/or group therapy; and peer support.

Figure 41-1. Trauma-informed health care.

PTSD symptoms are grouped into four distinct clusters: re-experiencing the trauma (memories, nightmares, flashbacks), avoidance (emotional/cognitive vs. situational), negative changes in thinking/mood (not remembering aspects of the trauma, changes in beliefs about self/others/the world, self/other-oriented blame, persistent negative emotions, anhedonia, isolation, difficulty experiencing positive emotions), and arousal (sleep disturbances, irritability/anger outbursts, exaggerated startle, hypervigilance, attentional disruption, self-destructive behavior).

When referrals are not available for your patients, primary care clinicians can be reasonably confident in their diagnosis of posttraumatic symptomatology and need for trauma-focused treatment referral when a patient:

A score of 3 or more on the PC-PTSD-5 confers a high likelihood of trauma-related psychological distress and/or PTSD.

Table 41-2.The Primary Care PTSD Screen for DSM-5.

The most common forms of posttraumatic psychopathology include acute stress disorder (ASD) and posttraumatic stress disorder (PTSD).

Patients with trauma exposure commonly present to primary care and other settings with seemingly unrelated acute or chronic physical and mental health conditions at much higher rates than patients without trauma exposure.

Table 41-1.Four steps to inquire about trauma.

Techniques described by Dr. Leigh Kimberg as the “Four C’s” can help prepare you to inquire about, and respond to, recent or past trauma:

Examples of patient education include: posters and flyers in the waiting area, brief informational pamphlets given to patients when taking their vital signs, and invite conversations as part of routine practice and/or when trauma-related conditions are discussed.

Demographic factors such as female gender, age, socioeconomic status, and African American race often are thought of as nonmodifiable risk factors, but it is increasingly clear that societal response to race, gender, or age, and the resultant chronic stress, may create the actual risk in these populations.

More than one-third of U.S. women experience stalking, physical violence, and/or rape from an intimate partner during their lifetimes. One in five men experiences sexual violence in their lifetimes.

Individuals who reported four or more ACE categories had 2 times the rates of lung and liver disease, 3 times the rate of depression, 3 times the rate of alcoholism, 11 times the rate of intravenous drug use, and 14 times the rate of attempting suicide than those who reported ACE scores of 0.

The study revealed a strong dose–response relationship between childhood trauma and adult heart, lung, and liver disease; depression; substance abuse; obesity; diabetes; sexually transmitted infection risk; and intimate partner violence (IPV).

Notably, 25% of women and 16% of men reported having experienced childhood sexual abuse

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects.”

consumer studies continue to find that working-class, middle-class, andsub-working-class populations of color purchase conspicuous luxury goods,such as jewelry, cars, and clothing, at a higher rate than white populationsof the same socioeconomic groups

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WELLBY is a reasonably useful measure in this context

Given the available collected data [...], how should [funders] measure the impact on wellbeing? [...] What measures of well-being should charities, NGOs, and RCTs collect for impact analysis?

How reliable is the WELLBY measure [...] relative to other available measures in the 'wellbeing space'? How much insight is lost by using WELLBY and when will it steer us wrong?

More detailed questions on WELLBY reliability

The ability to producenovice teachers who are resilient and persistent in the face of the complex problemsencountered in todayís schools is a goal to which every teacher education programaspires.

Both teachers spoke of their new positions as being an excellent fit for them