- abuse prevention act : under this law you may obtain a restraining and vacate order from the court if you are threatened with abuse or have been abused - family support : find those friends or relatives who support you and will offer you shelter if needed no one deserves to be threatened, hit or beaten. violence against another person is a crime. the abuse prevention act was created to protect people who are battered. a restraining order can be obtained 24 hours a day, 7 days a week, including holidays, with the assistance of the police and an on - call judge. a restraining order directs the alleged abuser to cease abusing the victim, to stay away from the victim and to have no contact with the victim. violation of such orders is a criminal offense and violators are subject to mandatory arrest by the police. any person who has been abused physically or sexually, even by members of the same sex, or threatened with abuse may obtain a temporary restraining order. the boston college police will assist you in obtaining a restraining order. there is no cost to the victim. in massachusetts a stalking law is in effect. this new law aims at halting a pattern of threats and harassment. the boston college police offer the assistance of specially trained officers to victims of relationship violence. we also recommend that victims of abuse seek counseling services available on campus. bc womens resource center the women ' s resource center ( wrc ) is an advocacy collaborative focused on women and gender issues. it provides the boston college community with a forum to discuss contemporary social topics through empowering educational programs ; nurturing peer - to - peer support groups ; and outreach awareness campaigns. boston area rape crisis center as the second oldest rape crisis center in the united states, the boston area rape crisis center ( barcc ) has been highly visible locally and nationally in the fight against violence against women. asian task force against domestic violence 617 - 338 - 2355 ( boston, ma ) issues literature in various asian languages for abused women, support groups, advocacy, referrals. casa myrna vazquez safelink hotline : 877 - 785 - 2020 ( boston, ma ) emergency shelter for battered women, support services, hotline, spanish. counseling and education to stop domestic violence. for people who batter. the network / la red is a survivor - led, social justice organization that works to end partner abuse in lesbian, gay, bisexual, transgender communities. gay mens domestic violence project gay men ’ s domestic violence project is a grassroots, non - profit organization founded by a gay male


have you ever looked down at your pup ’ s droppings and said to yourself “ wow, that ’ s an odd color. ” your pup ’ s poop can come in a variety of colors, each with their own story to tell you. as a pup owner, studying your pup ’ s poop is important to ensure that they remain healthy. so when you discover that your pup has pooped the color orange, you have to ask “ what does it mean? ” your pup ’ s poop is naturally darker on the outside and light on the inside. a healthy pup ’ s droppings will normally be a tan or brown color when they first unload. so if you notice that your pup has left a few orange droppings behind them, there are two possibilities to consider. is it something he ate? often times orange poop will be the outcome of certain things they ate. a change in diet or new treats can affect the tone of their droppings. usually if the color shows up once and then disappears, it is likely that your pup ’ s diet has changed, or perhaps even a neighbor has slipped them a treat. if your pup ’ s droppings are dark orange or continuously orange in color, this may be signs of intestinal problems. some infections can cause internal bleeding, and though most times a pup ’ s poop will be black or extreme brown when this happens, bleeding in the lower intestines can lead to fresh blood in the stool, giving it an orange color. along with infections, parasites such as worms can also damage your pup ’ s digestive track. if you suspect that this is a problem, take your pup to the vet immediately. remember to always keep track of your pup ’ s poop, whether on walks, in the yard or in their litter box. droppings come in all different sizes and consistencies, so those must also be factored into your analysis. you don ’ t want to jump to conclusions, but it is always better to be safe than sorry. so next time you take your pup out for their daily walk, stop and check out their droppings, ( you should pick it up to be polite to your neighbor too ) and make sure that your pup ’ s health is in tip - top shape.


what is alternative therapy? in some cases, physicians will recommend, or patients may request, treatment alternatives that are not considered conventional medicine. “ conventional ” refers to medicine typically practiced by persons who have m. d. ( medical doctor ) or d. o. ( doctor of osteopathy ) degrees, and who suggest treatments that have been scientifically tested, found to be safe and effective, and approved by the us food and drug administration ( fda ). sometimes, however, these physicians may also recommend some non - conventional therapies that may be used to complement, or complete, a treatment plan. complementary medicine is any form of therapy used in combination with other alternative treatments or standard / conventional medicine. complementary therapy usually serves to relieve symptoms and improve quality of life. alternative medicine is used alone, without recommended standard treatment. when the term “ cam ” is used, that means that the treatment combines complementary and alternative medicine. the national center for complementary and alternative medicine ( nccam ) points out that what is considered to be cam changes continually because once those therapies are proven to be safe and effective, they become incorporated into conventional medicine. what are the different types of complementary and alternative therapies? the following are some complementary and alternate therapies that may be included in a patient ’ s treatment plan : diet and herbs before considering complementary and alternative therapy : most complementary and alternative medicine ( cam ) fields are not standardized or controlled by any western medical guidelines. you should consult your physician before beginning any complementary or alternative therapy, as some therapies may interfere with standard treatment. it is important to be an informed healthcare consumer when considering complementary or alternative medicine. before starting therapy, you should consider the following : consult with your physician. use your library to research books, articles, and scientific journals. use the internet to do research. look for information on controlled, scientific studies on the therapy you are considering. talk to others who have actually tried the therapy. what warning signs may indicate a fraudulent therapy? according to the american cancer society, it is better to avoid treatment with the following warning signs : the treatment is based on unproven theories. the treatment promises a cure. the treatment is a secret and can only be given by certain providers. the treatment requires travel to another country. those who provide the treatment discount standard or conventional medicine and / or tell the patient not to use standard or conventional medicine.


encyclopedia of islam myths : islamic belief in jinn is superstitious paganism! refuting the arab claims refuting the islamic claims islamic belief in jinn is superstitious arab paganism. jinn are unique to arab paganism. jinn are the " mythical bad guys " of arab culture. rather than discarding the wide spread concept of the " jinn " believed by the pagan arabs, muhammad rubber stamped these mythical manmade creatures and brought them right into the koran! - early arab history is a mixture of fact and fantasy... tradition tells us that allah made the jinn two thousand years before he made adam. though invisible, they loved and married, begat children and died. in the beginning, all jinn were good, but long before the time of adam they rebelled against their settled existence and tried to change the order of things. during the course of the revolt, one of the evil jinn, iblis, gained great power and became the satan of the arab world. iblis retained his power even after the angels of allah had quelled the rebellion. jinn haunted ruins and dwelt in rivers and oceans. the arab saw them in whirlwinds and waterspouts. the jinn ' s main abode, however, was a mysterious mountain called kaf which, in the imagination of the arab, was founded on an immense emerald. indeed, this sparkling gem gave the azure tint to the sun ' s rays so often in evidence over desert regions. ( islam and the arabs, rom landau, 1958 p 11 - 21 ) - the bedouin peopled the desert with living things of beastly nature called jinn or demons. these jinn differ from the gods not so much in their nature as in their relation to man. the gods are on the whole friendly ; the jinn, hostile. the latter are, of course, personifications of the fantastic notions of the terrors of the desert and its wild animal life. to the gods belong the regions frequented by man ; to the jinn belong the unknown and un - trodden parts of the wilderness. a madman ( majnun ) is but one possessed by the jinn. with islam the number of jinn was increased, since the heathen deities were then degraded into such beings. ' ( history of the arabs, philip k. hitti, 1937, p 96 - 101 ) - " before islam, the religions of the arabic world involved the worship of many spirits, called jinn


what is mumps? | what is the mumps vaccine? | who should get vaccinated and when? | what are the risks associated with the mumps vaccine? | who should not get vaccinated? | what other ways can mumps be prevented besides vaccination? | what happens in the event of an outbreak? what is mumps? is a highly contagious infection. it results in fever and swelling of the parotid glands. these are salivary glands located near the front of the ear. mumps is caused by a virus. the virus is usually spread through contact with an infected person ' s saliva. since the virus is highly contagious, it spreads easily among people in close contact. once a common childhood illness, mumps is now rarely seen in the unite states. this is largely because of the use of the vaccine, which provides lifelong immunity. - painful swelling of the parotid glands ( under the cheeks and jaw ) - stiff neck - nausea and vomiting - swelling and pain under the tongue, jaw, or front of the chest - in males : painful inflammation of the testicles - in females : inflammation of the ovaries, which results in pain or tenderness in the abdomen in some cases, people have no symptoms. if symptoms do occur, it is generally 2 - 3 weeks after exposure. there are no medicines or specific treatments for mumps. since the illness is caused by a virus, it cannot be treated with antibiotics. mumps should be treated with aspirin. treatment is aimed at improving comfort, which may include : - applying hot or cold compresses to swollen areas - gargling with warm saltwater - using non - aspirin pain relievers - using fever - reducing medicines ( eg, acetaminophen, ibuprofen ) - drinking plenty of fluids - avoiding tart or acidic drinks ( eg, orange juice, lemonade ) - eating a soft, bland diet what is the mumps vaccine? the mumps vaccine is usually given in combination with : who should get vaccinated and when? all children ( with few exceptions ) should receive the vaccine two times : - 12 - 15 months - 4 - 6 years ( school entry ) — can be given earlier, but the two doses must be separated by at least four weeks the vaccine can also be given to infants aged 6 - 11 months who will be traveling internationally. these infants should also get the two routine shots at ages 12 - 15 months and 4 - 6 years


the two doses must be separated by at least four weeks the vaccine can also be given to infants aged 6 - 11 months who will be traveling internationally. these infants should also get the two routine shots at ages 12 - 15 months and 4 - 6 years. for those 18 years of age or younger who have not been vaccinated, two doses of mmr are given. the doses are separated by four weeks. adults born after 1957 who have not been previously vaccinated may need 1 - 2 doses. talk with your doctor if you were not previously vaccinated. what are the risks associated with the mumps vaccine? like any vaccine, the mmr vaccine could cause serious problems. while most people do not have any problems with the mmr vaccine, some have reported : - mild problems : fever, a mild rash, or swelling of the glands in the cheeks or neck - moderate problems : seizure caused by fever, temporary pain and stiffness in the joints, and low platelet count - very rare : serious allergic reactions who should not get vaccinated? you should not get the vaccine if you : had a life - threatening allergic reaction to gelatin, the antibiotic, or a previous dose of mmr vaccine - are moderately or severely ill — wait until you recover. - pregnant women — wait until after you have given birth. if you are planning on becoming pregnant, wait until four weeks after getting the vaccine. talk to your doctor before getting the vaccine if you have the following conditions : a condition that affects the immune system ( eg, - are being treated with drugs that affect the immune system ( eg, long - term steroids ) or are being treated for cancer - low blood platelet count have had a what other ways can mumps be prevented besides vaccination? other than getting the vaccine, the best way to prevent mumps is to avoid contact with an infected person. what happens in the event of an outbreak? a case of mumps needs to be reported to public health authorities. if you think you or your child has mumps, call the doctor right away. anyone who may have been exposed and has not been fully immunized will need to receive the vaccine.


vocalisation has been recognised as one of the important modes of animal communication. in one anabantoid fish, the croaking gourami trichopsis vittata, both sexes produce loud, croaking sounds during agonistic encounters and courtship. it is known that sound emission of this fish is mostly involved with the ritualised portion of the contest, which is likely to convey information between the opponents about their respective strength and status. the sound is produced by a complex mechanism that involves two modified tendons, located behind each pectoral fin. due to the external position of these soft structures, parasites, sickness, or injury from fights can easily damage the tendons, leading to muteness. reduction or even loss of the croaking ability may result in a substantial decreasing of the overall fitness. experiments were designed to test whether or not croaking gouramis can repair damaged tendons and regain fully functional sound producing organs, as well as to evaluate the effect of muting and recovery on the outcomes of agonistic interactions. fishes were muted by surgically cutting one or both the tendons that connect the " sonic ' ' muscle with the fin rays. the occurrence and timing of recovery was evaluated for 30 specimens of t. vittata after surgical muting. croaking sounds produced by the fish were recorded during staged contests after recovery. sound from each specimen was previously recorded before and after muting as well, for comparison. the elapsed time of reconnection of each tendon to the relative fin ray was also recorded. some fishes were found to recover completely within less than 30 days, while others needed up to three months. however, evidence for the beginning of the recovery process was noticed as early as 4 days after operation. behavioural performance after recovery was normal. details of sounds produced and changes of behavioural repertoires are discussed ( supported by national organization for hearing research, nimh - 58198, institute of museum and library service - ll90187 ). nicola novarini, tomonari akamatsu & hong y. yan ( 2002 ). effects of muting and recovery on sound production in the croaking gourami trichopsis vittata ( pisces : anabantoidei ) [ abstract ]. bioacoustics 13 ( 2 ) : 202 - 203


the scrapbook collection acquired by h. r. forrest of manchester in 1890 is remarkable and forms part of the shakespeare library which can be found in arts, languages and literature, floor 3, central library see also new! king lear | new! the merchant of venice hamlet | macbeth | othello | romeo and juliet | a midsummer night ' s dream introduction to william shakespeare he took illustrated editions of kenny meadows, knight, staunton and cassell and added to them illustrations by boydell, fuseli, howard, smirke, chodwiecki, retzch and ruhl, together with every other illustration he could procure, including portraits of shakespeare and his contemporaries and of shakespearean actors. the collection fills 76 folio volumes. on the left is a poster for the princes theatre, manchester, 1864 on the right is a drury lane playbill, 1771 act 1 scene 1 a ship at sea a tempestuous noise of thunder and lightning. enter a shipmaster, a boatswain and mariners boatswain here, master. what cheer? master good ; speak to th ' mariners. fall to ' t yarely, or we run ourselves aground. bestir, bestir! ( exit ) boatswain heigh, my hearts! cheerly, cheerly, my hearts! yare, yare! take in the topsail. tend to th ' master ' s whistle. ( to the storm ) blow till thou burst thy wind, if room enough! act 1 scene 2 the island enter prospero and miranda if by your art, my dearest father, you have put the wild waters in this roar, allay them. the sky it seems would pour down stinking pitch, but that the sea, mounting to th ' welkin ' s cheek, dashes the fire out. o i have suffered with those that i saw suffer! a brave vessel, who had no doubt some noble creature in her, dashed all to pieces. o the cry did knock against my very heart! poor souls they perished, had i been any god of power, i would have sunk the sea within the earth, or ere it should the good ship so have swallowed, and the fraughting souls within her. no more amazement. tell your piteous heart there ' s no harm done. o, woe the day. i have done nothing but in care of thee - of thee my dear one, thee my daughter - who art ignorant of what thou art, nought knowing of whence


full fathom five thy father lies, of his bones are coral made ; those are pearls that were his eyes ; nothing of him that doth fade, but doth suffer a sea - change into something rich and strange. sea - nymphs hourly ring his knell. hark, now i hear them, ' ding dong bell '. ( spirits echo the burden ' ding dong bell ' ) the ditty does remember my drowned father. this is no mortal business, nor no sound that the earth owes. i hear it now above me. act 2 scene 1 a remote part of the island ( waking ) now, good angels preserve the king. ( he shakes alonso ) why, how now? ho! awake? why are you drawn? wherefore this ghastly looking? whats the matter? whiles we stood here securing your repose, even now, we heard a hollow burst of bellowing, like bulls, or rather lions ; did ' t not wake you? it struck mine ear most terribly. act 2 scene 2 near caliban ' s cave all the infections that the sun sucks up from bogs, fens, flats, on prosper fall, and make him by inch - meal a disease. his spirits hear me, and yet i needs must curse. but they ' ll nor pinch, fright me with urchin - shows, pitch me i ' th mire, nor lead me like a firebrand in the dark out of my way, unless he bid ' em ; but for every trifle are they set upon me, sometime like apes, that mow and chatter at me and after bite me ; then like hedgehogs, which lie tumbling in my barefoot way and mount their pricks at my footfall ; sometime am i all wound with adders, who with cloven tongues do hiss me into madness. lo, now lo! here comes a spirit of his, and to torment me for bringing wood in slowly. i ' ll fall flat, perchance he will not mind me. ( he lies down, and covers himself with a cloak ) if thou beest trinculo, come forth! i ' ll pull thee by the lesser legs. if any be trinculo ' s legs, these are they. ( pulls him out ) thou art very trinculo indeed! how cam ' st thou to be the seige of this moon - calf? can he vent trinculos? act 3 scene 2 near caliban ' s cave tell not me.


him out ) thou art very trinculo indeed! how cam ' st thou to be the seige of this moon - calf? can he vent trinculos? act 3 scene 2 near caliban ' s cave tell not me. when the butt is out we will drink water, not a drop before ; therefore bear up, and board ' em. servant monster, drink to me. servant monster? the folly of this island! they say there ' s but five upon this isle ; we are three of them - if th ' other two be brained like us, the state totters. trinculo, keep a good tongue in your head. if you prove a mutineer, the next tree. the poor monster ' s my subject, and he shall not suffer indignity. i thank my noble lord. wilt thou be pleased to hearken once again to the suit i made to thee? marry will i. kneel, and repeat it. i will stand, and so act 4 scene 1 near prospero ' s cave silver! there it goes, silver. fury, fury! there, tyrant, there! hark, hark! ( exeunt caliban, stephano and trinculo, pursued by spirits ) go, charge my goblins that they grind their joints with dry convulsions, shorten up their sinews with aged cramps, and more pinch - spotted make them, than pard, or cat o ' mountain. act 5 scene 1 near prospero ' s cave where the bee sucks, there suck i ; in a cowslips bell i lie ; there i couch when owls do cry ; on the bats back i do fly, after summer merrily. merrily, merrily, shall i live now, under the blossom that hangs on the bough. here prospero discovers ferdinand and miranda, playing at chess sweet lord, you play me false. no, my dearest love, i would not for the world. yes, for a score of kingdoms you should wrangle, and i would call it fair play. ( gesturing to caliban ) this is as strange a thing as ere i looked on. he is as disaproportioned in his manners as in his shape. go, sirrah, to my cell ; take with you your companions. as you look to have my pardon, trim it handsomely. ay that i will ; and ill be wise hereafter, and


his manners as in his shape. go, sirrah, to my cell ; take with you your companions. as you look to have my pardon, trim it handsomely. ay that i will ; and ill be wise hereafter, and seek for grace. what a thrice - double ass was i to take this drunkard for a god and worship this dull fool! and promise you calm seas, auspicious gales, and sail so expeditious that shall catch your royal fleet far off. my ariel, chick, that is thy charge. then to the elements be free, and fare thou well. please you draw near. exeunt all ( exceptprospero ) now my charms are all orthrown, and what strength i have mine own which is most faint. now is true i must be here confined by you, or sent to naples, let me not, since i have my dukedom got and pardoned the deceiver, dwell in this bare island, by your spell ; but release me from my bands with the help of your good hands. gentle breath of yours my sails must fill, or else my project fails, which was to please. now i want spirits to enforce, art to enchant, and my ending is despair, unless i be relieved by prayer which pierces so, that it assaults mercy itself, and frees all faults. as you from crimes would pardoned be, let your indulgence set me free.


please be aware that this discussion guide may contain spoilers! institutions loom large in the book, from public school ( which is the equivalent of private school in the us ), to the communist party, to the catholic church. how do the main characters reinforce and / or defeat them? bernie begins the book as a devoted communist, yet eventually becomes disillusioned with its ideology. disillusionment with the catholic church also plays a large role in the book. why does the author juxtapose the two? what are the dangers of ideology? the threat of approaching winter permeates the book. what does the cold weather symbolize? why did the author choose to set the book during the each of the books main characters is tempted by corruption and bribery. is corruption a by - product of war? can corruption ever be positive? bernie is a fervent believer in communism and also an atheist. yet in the labor camp, he is threatened by the power - hungry estalbo, a fellow prisoner and communist, and shown kindness by father eduardo, a catholic priest. why did the author choose to upend bernies perceived notions of good and bad? what does bernie learn about kindness and cruelty? how does harrys parentless background and experiences at dunkirk shape his character? is his reluctance to spy on sandy justified? have you read any other novels about the spanish civil war? how does this book compare? bernie and sandy are very different characters, yet barbara forms a relationship with both of them. what draws her to each? is her relationship with sandy believable? why or why not? harry, sandy and bernie are all classmates at rookwood, but each of them has a vastly different experience at the school. why did the author choose to connect sandy, harry and bernie in this way? how do their experiences at rookwood define them as characters? how do you feel about the books conclusion? unless otherwise stated, this discussion guide is reprinted with the permission of penguin books. any page references refer to a usa edition of the book, usually the trade paperback version, and may vary in other editions. judge rules unused borders gift cards to be worthless ( may 23 2013 ) borders owes nothing to holders of roughly $ 210. 5 million of gift cards that had not been used by the time the bookstore chain shut down, a manhattan federal...


since this test of emotion is fundamentally sound, it is not surprising that the nervous man is in a state of distress. indigestion, fatigue, over - sensibility, sound like problems in physiology, but we cannot go far in the discussion of any of them without coming face to face with the emotions as the real factors in the case. when we turn to the mental characteristics of nervous folk, we even more quickly find ourselves in the midst of an emotional disturbance. worried, fearful, anxious, self - pitying, excitable, or melancholy, the nervous person proves that whatever else a neurosis may be, it is, in essence, a riot of the emotions. there is small wonder that a riot at the heart of the empire should lead to insurrection in every province of the personality. it is only for the purpose of discussion that we can separate feeling from thinking and doing. every thought and every act has in it something of all three elements. an emotion is not an isolated phenomenon ; it is bound up on the one hand with ideas and on the other with bodily states and conduct. whoever runs amuck in his emotions runs amuck in his whole being. the nervous invalid with his exhausted and sensitive body, his upset mind and irrational conduct is a living illustration of the central place of the emotions in the realm of the personality. but it is not the nervous person only who needs a better understanding of his emotional life. the well man also gets angry for childish reasons ; he is prejudiced and envious, unhappy and suspicious for the very same reason as is the nervous man. since the working - capital of energy is limited to a definite amount, the control of the emotions becomes a central problem in any life, — a deciding factor in the output and the outcome, as well as in comfort and happiness by the way. nothing is harder for the average man to believe than this fact that he really has the power to choose his emotions. he has been dissatisfied with himself in his past reactions, and yet he has not known how to change them. his anger or his depression has appeared so undesirable to his best judgment and to his conscious reason that it has seemed to be not a part of himself at all but an invasion from without which has swept over him without his consent and quite beyond control. most of the confusion comes from the fact that we know only a part of ourselves. what we do not consciously enjoy we believe we do not enjoy at all. what we do not consciously choose we believe to be beyond our


yet the experience of that year was not lost. it was the first instance of a company of settlers in that northern climate passing the winter without illness, discord or trouble with the indians. later, in the little new settlements of quebec and montreal, some of the colonists met again under the wise and kindly rule of champlain. little helene lived to bring her own roses to a garden in new france, and teach indian girls the secrets which old jacqueline taught her. and it is recorded in the history of the voyageurs, priests and adventurers of france in the new world that wherever they went they were apt to take with them seeds and plants of wholesome garden produce, which they planted along their route in the hope that they might thus be of service to those who came after them. amsterdam ’ s the cradle where the race was rocked — all the ships of all the world to her harbor flocked. rosy with the sea - wind, solid, stubborn, sweet, played the children by canals, up and down the street. neltje, piet and hendrik, dirck and myntje too, — little nick of leyden sailed his wooden shoe. “ quarter - deck and cabin — rig thus he murmured wisely as he launched his craft. “ cutlass, pike and musquetoun, howitzer and shot — but our knives and mirrors and beads are worth the lot. ” room enough for cargo to last a year or two, in the round amidships of a wooden shoe! bobbing on the waters of the see the bantam galleot, short and broad and high. laden for the indies, trading all the way, frank and shrewd and cautious, fiery in a fray, — sagamore and mandarin are all the same to you, little nick of leyden with your wooden shoe! the fires that talked all along the coast of britain, from john o ’ groat ’ s to beachey head, from saint michael ’ s mount to cape wrath, twinkled the bonfires on the headlands. henry hudson, returning from a voyage among icebergs, guessed at once what this chain of lights meant. the son of mary queen of scots had been crowned in london. hudson ’ s keen eyes were unusually grave and thoughtful as the muscovy duck sailed up to london pool on the incoming tide. the sailors looked even more sober, for most of them were english protestants, with a few flemings, and john williams the pilot was an anabaptist. it was


why no explosion? science brain teasers require understanding of the physical or biological world and the laws that govern it. it is scientific fact that if all else is held constant, the pressure of a gas varies directly with its temperature. in other words, if you have a gas in a sealed, insulated, rigid container and you double its temperature, its pressure will also double. if you triple the temperature, the pressure will triple, etc. this is not exactly true, but it is close enough for the purpose of this teaser. why is it, then, that if i were to fill my tires with 32 psi of air on a day that is 2 degrees celsius, the tires won ' t explode if the temperature later increases to 20 degrees celsius ( which would seemingly increase the pressure 10 - fold to 320 psi, well beyond the capacity of most tires )? assume that the temperature of the air in the tire always matches the temperature outdoors : it starts at 2 degrees and ends at 20 degrees. also ignore the fact that the tires will expand. hintthis problem is really more mathematical than scientific. here ' s a hint : say you have a temperature of - 10 degrees celsius. now double that temperature. you get - 20 degrees. doesn ' t it seem a little odd that when you double something ' s temperature that it actually goes down?? when you double something ' s length, it never goes down. what ' s wrong here? answerlike the hint implies, the key to this teaser is understanding what you are really doing when you multiply numbers. for example, if you have the number 3 on a number line and you want to double it, what you could do is put your thumb at 0 and your index finger at 3, and then measure off that distance past 3 one time, which will of course bring you to 6. you are essentially doubling the distance that 3 is from 0 to get 6. the only reason this works, however, is because at 0 you really have zero length. 0 really means " nothing " in this case. with the celsius temperature scale, however, 0 degrees does not mean that you have " no temperature ". 0 degrees was chosen arbitrarily to coincide with the freezing point of water. other than that, it has no real significance. so if you want to multiply 2 degrees c by 10, you have to increase its distance from absolute zero by 10, not its distance from the arbitrary 0. absolute zero is about - 273 degrees c


you exercise your body to stay physically in shape, so why shouldn ' t you exercise your brain to stay mentally fit? with these daily exercises you will learn how to flex your mind, improve your creativity and boost your memory. as with any exercise, repetition is necessary for you to see improvement, so pick your favorite exercises from our daily suggestions and repeat them as desired. try to do some mentalrobics every single day! amnesia is a condition characterized by the inability to form new memories or the inability to recall existing memories. amnesia is caused when the hippocampus or thalamus becomes damaged. this can be the result of a blow to the head, a stroke, surgery, alcoholism or certain types of infections. one of the most common misconceptions about amnesia is that people forget everything that they ever knew. in reality, it ' s episodic memory which is most impaired. intelligence, attention and creativity are generally unaffected. anterograde amnesia refers to a condition where the sufferer cannot make new memories. they can still recall memories from before the condition started, but not from any experiences that occur after the onset of amnesia. this is because the brain becomes unable to convert short - term memories into long - term memories. retrograde amnesia is when the person is capable of forming new memories, but is unable to remember anything that happened before the onset of amnesia. amnesia patients may experience both types of amnesia to different degrees. another misconception, fueled by cartoons and hollywood movies, is that a second impact to the head can completely reverse the condition. in reality, a second impact would cause increased memory impairment. there are no specific treatments for amnesia, but conditions generally improve over time as the injury that caused it heals. short term memory test interactively test your short term memory. mentalrobics public forums chat about these articles and other mind related topics. sudoku logic puzzle this puzzle requires logic and a good memory.


veliky knyaz constantinearticle free pass veliky knyaz constantine, ( “ grand prince, ” or “ duke ” : ) russian in full konstantin pavlovich ( born may 8 [ april 27, old style ], 1779, tsarskoe selo, russia — died june 27 [ june 15 ], 1831, vitebsk ), son of the russian emperor paul i ( reigned 1796 – 1801 ), younger brother of alexander i ( reigned 1801 – 25 ) and elder brother of nicholas i ( reigned 1825 – 55 ) ; he was the virtual ruler of the congress kingdom of poland ( 1815 – 30 ). educated by a swiss tutor under the supervision of his grandmother, the empress catherine ii the great ( reigned 1762 – 96 ), constantine participated in general a. v. suvorov ’ s campaign in italy against napoleon bonaparte ( 1799 ). he was present at the russo - austrian defeat at austerlitz ( dec. 2, 1805 ), which forced the austrians to conclude a separate peace with france, and took part in the russian campaigns of 1807, 1812, 1813, and 1814 against napoleon. after the congress of vienna ( 1815 ) set up the constitutional kingdom of poland with the emperor of russia as its king, alexander appointed constantine commander in chief of poland ’ s armed forces with the powers of viceroy ( november 1815 ). although constantine organized the polish army, he failed to win its support, and he also alienated the parliament and the general populace with his harsh rule. he nevertheless sympathized with the poles ’ desire for autonomy. after his morganatic marriage to a polish countess, joanna grudzinska, may 24 ( may 12, old style ), 1820, he renounced all of his claims to the russian throne ( january 1822 ). when alexander i died ( dec. 1 [ nov. 19 ], 1825 ), however, there was confusion over his successor. on the day that the guards were to swear allegiance to constantine ’ s younger brother nicholas ( dec. 26 [ dec. 14 ], 1825 ), a group of revolutionaries, including many officers ( later known as the dekabrists, or decembrists ), convinced the soldiers to call for “ constantine and constitution ” in an attempt to start a rebellion. though constantine had played no part in the rising, which was swiftly suppressed, differences soon arose between him and nicholas because constantine insisted that the polish army and bureaucracy were loyal to the russian empire despite the large role poles had played in the


solar scholars to lead three solar energy workshops bucknell environmental facts - 95 percent of campus energy is produced by co - generation plant - greenhouse gas emissions are down 45 percent from pre - 1998 level - all campus stationery is chlorine - free and contains 100 percent post - consumer fiber content - environmental studies major created in 1979 - bucknell environmental center established in 2006 the saturday workshops will be held feb. 16, march 1, and april 5 from 9 a. m. to 2 p. m. at the " attendees can expect to learn the basics of designing, siting, and installing a small - scale residential solar array, " said jess scott, a bucknell senior and member of the campus solar scholars program. " they can expect to learn how solar energy works - - from the time the sun hits a solar panel to the time a light bulb turns on in their home. " scott, the student organizer behind the recent focus the nation teach - in, a daylong effort to focus attention on global climate issues and potential solutions, said that participants can expect to " come out of this workshop with an understanding of solar energy strong enough to play an integral role in the design and installation of their own array. " among the topics that will be discussed at each of the five - hour workshops are how to determine the correct type and size of solar system, the steps of installing and operating a solar system at a home or small business, solar cost analysis, battery and wiring basics, and system comparisons. to attend the solar workshops, contact jess scott. the workshops are the continuation of the work of the solar scholars program, a solar energy design and education program started on six electricity from the solar array, when not fully used at the center, is fed to the national electric grid. another solar scholars design and installation project was recently completed on the bucknell campus with the construction of two arrays at bucknell west. electricity from the panels - - one stationary and one that tracks the sun - - is powering a student living space and panel data are being collected for classroom analysis and being shared with the other schools participating in the solar scholars education program. bucknell university environmental center co - director craig kochel with the center ' s solar panel. contact : office of communications posted feb. 5, 2008 next story > >


by michael f. potter, extension entomologist university of kentucky college of agriculture anyone who has ever battled fleas knows how difficult they are to eradicate. once a home becomes infested, control can be difficult, time - consuming and expensive. a flea - infested dog or cat can introduce hundreds of new flea eggs into the home each day. by mid - to late summer, pet owners often find themselves fighting a losing battle against established flea populations that are enormous. a better way to manage fleas is through prevention. by taking action before fleas are abundant, pet owners can avoid severe infestations later in the season. preventive flea control has been made possible by new product innovations and insights into flea biology. we now know that adult fleas ( the biting stage ) spend virtually their entire life on the pet, not in the carpet. eggs are laid on the fur and fall off into carpeting, beneath furniture cushions, and wherever else the pet lays, sleeps or spends time. after hatching, the eggs transform into larvae, pupae, and eventually adults to renew the cycle. pet owners can break the cycle of flea development and prevent future generations by killing the eggs as they are laid on the pet, or by eliminating the egg - laying adults. the easiest way to do this is to take action before flea problems get out of control. several products are available which are convenient and effective. the “ pill ” ( program™ ) - this product prevents flea eggs from hatching when administered orally to pets once a month at mealtime. dogs are fed program in tablet form, whereas cats are fed a liquid suspension mixed with their food. different tablet sizes and suspension doses are prescribed according to the weight of the animal. when an adult female flea bites a program - treated dog or cat, the flea ingests the active ingredient ( lufenuron ) which then passes into her eggs and prevents them from hatching. program is dispensed only through veterinarians. a companion product, sentinel™, contains both the flea control ingredient and heartworm medication all in one dosage. “ egg - stopper ” collars - unlike conventional flea collars, these contain an insect growth regulating ingredient ( methoprene or pyriproxyfen ) which prevents egg hatch for several months. thus, the overall effect is much like program. pet owners should carefully read the “ active ingredients ” panel on the package of the collar to verify that methoprene or pyriproxyfen are


which prevents egg hatch for several months. thus, the overall effect is much like program. pet owners should carefully read the “ active ingredients ” panel on the package of the collar to verify that methoprene or pyriproxyfen are present. one such brand, the ovitrol / ovitrol plus™ flea egg collar is available through veterinarians. retail versions include the fleatrol™ flea egg collar and relieve™ collar, sold in pet stores and discount chains. once installed, the egg - inhibiting substance releases from the collar and rapidly distributes over the fur of the entire animal, killing flea eggs on contact. this breaks the life cycle and infestations never become established. the methoprene and pyriproxyfen - impregnated collars are virtually 100 % effective at preventing new flea eggs from hatching for at least 6 months ( essentially season - long ) on both dogs and cats. spot - ons - another effective, convenient treatment method involves applying a few droplets of material between the shoulder blades of the animal. two veterinarian - supplied products, advantage™ and frontline™, control adult fleas on pets for at least 1 month. on dogs, frontline top spot lasts up to 3 months. another ‘ spot - on ’ product, available through retail stores, is biospot™, which contains the egg - inhibiting ingredient pyriproxyfen. the best way to use any of the above - mentioned products is to initiate treatment before flea season begins, typically in the spring. by doing so you will greatly reduce the chances of developing a serious flea problem later in the summer. any stray fleas the pet happens to pick up around the home or at the kennel will be unable to lay viable eggs. breaking the cycle of flea development on the pet also reduces the need to apply insecticides throughout the living areas of the home. ( each of these on - animal products is of negligible hazard to people and pets, and there is seldom any adverse reaction with other petmedications. ) methoprene or pyriproxyfen - based products may need to be supplemented, periodically, with a topical spray or dip to knock down any adult fleas irritating the pet, especially if the animal is flea allergic. this should not be necessary with advantage and frontline. in any case, the occasional adult flea spotted on the pet will be unable to reproduce and soon will die off. if you were frustrated by


the summit is designed to provide information to the entire community to raise the level of awareness of education issues. the theme of this year ’ s summit is “ preparing our children for their future. ” our students will be competing for jobs with others from around the world. employers are now looking for 21st century skills such as creativity, problem solving, communication, innovation, and critical thinking. kentucky has adopted new curriculum standards to address the new skills. the keynote by gene wilhoit will address the new standards and how these standards will prepare our students and the community for the future. i have heard mr. wilhoit speak a couple of times in the last year ; he will inspire you about the future of education. the kentucky department of education must change to meet the demands of the future. therefore, kde associate commissioner for the office of next generation learners, felicia cumings smith, will be discussing the next generation learners concept. mrs. smith is overseeing much of the work related to the implementation of the new standards. the process of preparing our children for their future must start with the early years. it is in those years that a child ’ s brain is developing and habits are being formed. therefore, there will be a session on the importance of laying a strong foundation to help students learn at high levels. there will also be a session explaining on how schools can help each and every student learn. active parent involvement in education raises student achievement. many times parents simply do not know the opportunities for involvement. as a parent you will be able to attend a breakout session where a local parent will share how he became involved in trigg county public schools. even if you are not an educator or a parent, education is important to the local community as a whole. ultimately, the quality of education our students receive affects the wellbeing of the community and the life we all enjoy. a strong education system will help to recruit new business and industry which in turn creates new jobs. as a community member, we need you to be involved to help make a difference in our schools, no matter your role. while the entire summit will help raise your awareness, local business members will share how they have become strategic partners with the schools. the education summit will be held on saturday, february 5, 2011 from 8 : 00 a. m. until 12 : 00 p. m. at hopkinsville community college, 720 north drive, hopkinsville, ky 42240 we want to see you at this year ’ s regional education summit. it is a tremendous opportunity to learn more


about this booklet this national cancer institute ( nci ) booklet is for you — a woman who has just been diagnosed with breast cancer. this booklet is about medical care for women with breast cancer. learning about medical care for breast cancer can help you take an active part in making choices about your care. you can read this booklet from front to back. or, you can read only the sections you need right now. this booklet has lists of questions that you may want to ask your doctor. many people find it helpful to take a list of questions to a doctor visit. to help remember what your doctor says, you can take notes. you may also want to have a family member or friend go with you when you talk with the doctor — to take notes, ask questions, or just listen. breast cancer also develops in men. in 2013, more than 2, 200 american men will learn they have breast cancer. nci ' s website has information about breast cancer in men at http : / / www. cancer. gov / cancertopics / types / breast. in addition, nci ' s cancer information service at 1 - 800 - 4 - cancer ( 1 - 800 - 422 - 6237 ) and at livehelp can answer questions about breast cancer in men. this picture shows the lobes and ducts inside the breast. it also shows lymph nodes near the breast. normal cells in the breast and other parts of the body grow and divide to form new cells as they are needed. when normal cells grow old or get damaged, they die, and new cells take their place. sometimes, this process goes wrong. new cells form when the body doesn ' t need them, and old or damaged cells don ' t die as they should. the buildup of extra cells often forms a mass of tissue called a lump, growth, or tumor. - are usually not harmful - rarely invade the tissues around them - don ' t spread to other parts of the body - can be removed and usually don ' t grow back - may be a threat to life - can invade nearby organs and tissues ( such as the chest wall ) - can spread to other parts of the body - often can be removed but sometimes grow back breast cancer cells can spread by breaking away from a breast tumor. they can travel through blood vessels or lymph vessels to reach other parts of the body. after spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. for example, breast cancer cells may spread first to nearby


travel through blood vessels or lymph vessels to reach other parts of the body. after spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. for example, breast cancer cells may spread first to nearby lymph nodes. groups of lymph nodes are near the breast under the arm ( axilla ), above the collarbone, and in the chest behind the breastbone. when breast cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary ( original ) tumor. for example, if breast cancer spreads to a lung, the cancer cells in the lung are actually breast cancer cells. the disease is metastatic breast cancer, not lung cancer. for that reason, it ' s treated as breast cancer, not lung cancer. breast cancer is the most common type of cancer among women in the united states ( other than skin cancer ). in 2013, more than 232, 000 american women will be diagnosed with breast cancer. the most common type of breast cancer is ductal carcinoma. this cancer begins in cells that line a breast duct. see the picture of breast ducts. about 7 of every 10 women with breast cancer have ductal carcinoma. the second most common type of breast cancer is lobular carcinoma. this cancer begins in a lobule of the breast. see the picture of lobules. about 1 of every 10 women with breast cancer has lobular carcinoma. other women have a mixture of ductal and lobular type or they have a less common type of breast cancer. after you find out that you have breast cancer, you may need other tests to help choose the best treatment for you. lab tests with breast tissue the breast tissue that was removed during your biopsy can be used in special lab tests : - hormone receptor tests : some breast cancers need hormones to grow. these cancers have hormone receptors for the hormones estrogen, progesterone, or both. if the hormone receptor tests show that the breast cancer has these receptors, then hormone therapy is often recommended as part of the treatment plan. ( see the hormone therapy section. ) - her2 test : some breast cancers have large amounts of a protein called her2, which helps them to grow. the her2 test shows whether a woman ' s breast cancer has a large amount of her2. if so, then targeted therapy against her2 may be a treatment option. ( see the


a protein called her2, which helps them to grow. the her2 test shows whether a woman ' s breast cancer has a large amount of her2. if so, then targeted therapy against her2 may be a treatment option. ( see the targeted therapy section. ) it may take several weeks to get the results of these tests. the test results help your doctor decide which cancer treatments may be options for you. triple - negative breast cancer about 15 of every 100 american women with breast cancer have triple - negative breast cancer. these women have breast cancer cells that … - do not have estrogen receptors ( estrogen negative ) - do not have progesterone receptors ( progesterone negative ) - do not have a large amount of her2 ( her2 negative ) staging tests can show whether cancer cells have spread to other parts of the body. when breast cancer spreads, cancer cells are often found in the underarm lymph nodes ( axillary lymph nodes ). breast cancer cells can spread from the breast to almost any other part of the body, such as the lungs, liver, bones, or brain. your doctor needs to learn the stage ( extent ) of the breast cancer to help you choose the best treatment. staging tests may include … - lymph node biopsy : if cancer cells are found in a lymph node, then cancer may have spread to other lymph nodes and other places in the body. surgeons use a method called sentinel lymph node biopsy to remove the lymph node most likely to have breast cancer cells. the nci fact sheet sentinel lymph node biopsy has more information, including pictures of the method. if cancer cells are not found in the sentinel node, the woman may be able to avoid having more lymph nodes removed. the method of removing more lymph nodes to check for cancer cells is called axillary dissection. - ct scan : an x - ray machine linked to a computer takes a series of detailed pictures of your chest or abdomen. you may receive contrast material by mouth and by injection into a blood vessel in your arm or hand. the contrast material makes abnormal areas easier to see. the pictures from a ct scan can show cancer that has spread to the lungs or liver. - mri : a strong magnet linked to a computer is used to make detailed pictures of your chest, abdomen, or brain. an mri can show whether cancer has spread to these areas. sometimes contrast material makes abnormal areas show up more


lungs or liver. - mri : a strong magnet linked to a computer is used to make detailed pictures of your chest, abdomen, or brain. an mri can show whether cancer has spread to these areas. sometimes contrast material makes abnormal areas show up more clearly on the picture. - bone scan : the doctor injects a small amount of a radioactive substance into a blood vessel. it travels through the bloodstream and collects in the bones. a machine called a scanner detects and measures the radiation. the scanner makes pictures of the bones. because higher amounts of the substance collect in areas where there is cancer, the pictures can show cancer that has spread to the bones. - pet scan : you ' ll receive an injection of a small amount of radioactive sugar. the radioactive sugar gives off signals that the pet scanner picks up. the pet scanner makes a picture of the places in your body where the sugar is being taken up. cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. a pet scan can show cancer that has spread to other parts of the body. questions you may want to ask your doctor about tests - what did the hormone receptor test show? - what did the her2 test show? - may i have a copy of the report from the pathologist? - do any lymph nodes show signs of cancer? - what is the stage of the disease? has the cancer spread? - would genetic testing be helpful to me or my family? the stage of breast cancer depends on the size of the breast tumor and whether it has spread to lymph nodes or other parts of the body. doctors describe the stages of breast cancer using the roman numerals 0, i, ii, iii, and iv and the letters a, b, and c. the stage often is not known until after surgery to remove the tumor in the breast and one or more underarm lymph nodes. stage 0 is carcinoma in situ. in ductal carcinoma in situ ( dcis ), abnormal cells are in the lining of a breast duct, but the abnormal cells have not invaded nearby breast tissue or spread outside the duct. the breast tumor is no more than 2 centimeters ( no more than 3 / 4 of an inch ) across. cancer has not spread to the lymph nodes. © 2007 terese winslow. u. s. govt has certain rights a tumor that is 2 centimeters is about the size of a peanut, and a tumor that is 5 centimeters is about the size of


has not spread to the lymph nodes. © 2007 terese winslow. u. s. govt has certain rights a tumor that is 2 centimeters is about the size of a peanut, and a tumor that is 5 centimeters is about the size of a lime. the tumor is no more than 2 centimeters across. cancer cells are found in lymph nodes. the tumor is no more than 2 centimeters across, and the cancer has spread to underarm lymph nodes. or, the tumor is between 2 and 5 centimeters ( between 3 / 4 of an inch and 2 inches ) across, but the cancer hasn ' t spread to underarm lymph nodes. the tumor is between 2 and 5 centimeters across, and the cancer has spread to underarm lymph nodes. or, the tumor is larger than 5 centimeters across, but the cancer hasn ' t spread to underarm lymph nodes. the breast tumor is no more than 5 centimeters across, and the cancer has spread to underarm lymph nodes that are attached to each other or nearby tissue. or, the cancer may have spread to lymph nodes behind the breastbone. or, the tumor is more than 5 centimeters across. the cancer has spread to underarm lymph nodes that may be attached to each other or nearby tissue. or, the cancer may have spread to lymph nodes behind the breastbone but not spread to underarm lymph nodes. the breast tumor can be any size, and it has grown into the chest wall or the skin of the breast. the breast may be swollen or the breast skin may have lumps. the cancer may have spread to underarm lymph nodes, and these lymph nodes may be attached to each other or nearby tissue. or, the cancer may have spread to lymph nodes behind the breastbone. the breast cancer can be any size, and it has spread to lymph nodes behind the breastbone and under the arm. or, the cancer has spread to lymph nodes above or below the collarbone. the tumor can be any size, and cancer cells have spread to other parts of the body, such as the lungs, liver, bones, or brain. inflammatory breast cancer - inflammatory breast cancer is a rare type of breast cancer. it occurs in about 1 of every 100 american women with invasive breast cancer. - the breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast. - when a doctor diagnoses inflammatory


of breast cancer. it occurs in about 1 of every 100 american women with invasive breast cancer. - the breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast. - when a doctor diagnoses inflammatory breast cancer, it ' s at least stage iiib, but it could be more advanced. women with breast cancer have many treatment options. treatment options include … you may receive more than one type of treatment. the treatment that ' s best for one woman may not be best for another. the treatment that ' s right for you depends mainly on … - the stage of breast cancer - whether the tumor has hormone receptors - whether the tumor has too much her2 - your general health in addition, your treatment plan depends on … - the size of the tumor in relation to the size of your breast - whether you have gone through menopause at any stage of disease, care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. you can get information about coping on nci ' s website at http : / / www. cancer. gov / cancertopics / coping. also, you can get information about coping from nci ' s cancer information service at 1 - 800 - 4 - cancer ( 1 - 800 - 422 - 6237 ). or, chat using nci ' s instant messaging service, livehelp. doctors who treat breast cancer your health care team will include specialists. there are many ways to find doctors who treat breast cancer : - your doctor may be able to refer you to specialists. - you can ask a local or state medical society, or a nearby hospital or medical school for names of specialists. - nci ' s cancer information service can give you information about treatment centers near you. call 1 - 800 - 4 - cancer ( 1 - 800 - 422 - 6237 ). or, chat using livehelp, nci ' s instant messaging service. - other sources can be found in the nci fact sheet how to find a doctor or treatment facility if you have cancer. your health care team may include the following specialists : - surgeon : this type of doctor can perform surgery. you may want to find a breast cancer surgeon. - medical oncologist : a medical oncologist is a doctor who specializes in treating cancer with drugs, such as chemotherapy, hormone therapy, and targeted therapy. - radiation oncologist : a radiation oncologist is a doctor who specializes in treating cancer with radiation therapy


: a medical oncologist is a doctor who specializes in treating cancer with drugs, such as chemotherapy, hormone therapy, and targeted therapy. - radiation oncologist : a radiation oncologist is a doctor who specializes in treating cancer with radiation therapy. your health care team can describe your treatment choices, the expected results of each treatment, and the possible side effects. because cancer treatments often damage healthy cells and tissues, side effects are common. these side effects depend on many factors, including the type of treatment. side effects may not be the same for each woman, and they may even change from one treatment session to the next. before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. you and your health care team can work together to develop a treatment plan that meets your medical and personal needs. you may want to talk with your health care team about taking part in a research study ( clinical trial ) of new treatment methods. research studies are an important option for women at any stage of breast cancer. see the cancer treatment research section. questions you may want to ask your doctor about treatment choices - what are my treatment choices? which do you recommend for me? why? - what are the expected benefits of each kind of treatment? - what are the risks and possible side effects of each treatment? - how can the side effects be managed? - what can i do to prepare for treatment? - will i need to stay in the hospital? if so, for how long? - what is the treatment likely to cost? will my insurance cover it? - how will treatment affect my normal activities? - would a research study ( clinical trial ) be right for me? before starting treatment, you might want a second opinion about your treatment plan. some women worry that the doctor will be offended if they ask for a second opinion. usually the opposite is true. most doctors welcome a second opinion. and many health insurance companies will pay for a second opinion if you or your doctor requests it. some companies actually require a second opinion. if you get a second opinion, the second doctor may agree with your first doctor ' s treatment plan. or, the second doctor may suggest another approach. either way, you have more information and perhaps a greater sense of control. you can feel more confident about the decisions you make, knowing that you ' ve looked at all of your options. it may take some time and effort to gather your medical records and see another doctor. in most cases, it ' s not a


. you can feel more confident about the decisions you make, knowing that you ' ve looked at all of your options. it may take some time and effort to gather your medical records and see another doctor. in most cases, it ' s not a problem to take several weeks to get a second opinion. the delay in starting treatment usually will not make treatment less effective. to make sure, you should discuss this delay with your doctor. surgery is the most common treatment for breast cancer. there are several kinds of surgery. your surgeon can describe each kind of surgery, compare the benefits and risks, and help you decide which kind might be best for you : - removing part of the breast : breast - sparing surgery is an operation to remove the cancer and a small amount of the normal tissue that surrounds it. this is also called breast - conserving surgery. it can be a lumpectomy or a segmental mastectomy ( also called a partial mastectomy ). a woman usually has radiation therapy after breast - sparing surgery to kill cancer cells that may remain in the breast area. some women will have more tissue removed but not the whole breast. for these women, the surgeon will remove lymph nodes under the arm and some of the lining over the chest muscles below the tumor. - removing the whole breast : surgery to remove the whole breast ( or as much of the breast tissue as possible ) is a mastectomy. in some cases, a skin - sparing mastectomy may be an option. for this approach, the surgeon removes as little skin as possible. - in total ( simple ) mastectomy, the surgeon removes the whole breast but not the underarm lymph nodes. - in modified radical mastectomy, the surgeon removes the whole breast and most or all of the lymph nodes under the arm. often, the lining over the chest muscles is removed. a small chest muscle may also be taken out to make it easier to remove the lymph nodes. the choice between breast - sparing surgery and mastectomy depends on many factors : - the size, location, and stage of the tumor - the size of your breast - certain features of the cancer - how you feel about how surgery will change your breast - how you feel about radiation therapy - your ability to travel to a radiation treatment center for daily treatment sessions the surgeon usually removes one or more lymph nodes from under the arm to check for cancer cells. if cancer cells are found in the lymph nodes,


about radiation therapy - your ability to travel to a radiation treatment center for daily treatment sessions the surgeon usually removes one or more lymph nodes from under the arm to check for cancer cells. if cancer cells are found in the lymph nodes, other cancer treatments will be needed. ( for more about information about lymph node biopsy, see the tests section. ) after mastectomy, you may choose to have breast reconstruction. this is plastic surgery to rebuild the shape of the breast. if you ' re considering breast reconstruction, talk with a plastic surgeon before having cancer surgery. see the breast reconstruction section. it ' s common to feel tired or weak for a while after surgery for breast cancer. the time it takes to heal is different for each woman. surgery causes pain and tenderness, and the skin where your breast was removed may feel tight. your arm and shoulder muscles may feel stiff and weak, and your neck and back may hurt. medicine can help control your pain. before surgery, discuss the plan for pain relief with your health care team. after surgery, they can adjust the plan if you need more pain control. any kind of surgery carries a risk of infection, bleeding, or other problems. tell your health care team right away if you develop any problems. removing the underarm lymph nodes slows the flow of lymph fluid. the fluid may build up in your arm and hand and cause swelling. this swelling is called lymphedema. it can develop soon after surgery or months or even years later. always protect the arm and hand on the treated side of your body from cuts, burns, or other injuries. remind nurses not to measure your blood pressure or give you injections on the treated side of your body. information about preventing and treating lymphedema is available on nci ' s website at http : / / www. cancer. gov / cancertopics / coping and from nci ' s cancer information service at 1 - 800 - 4 - cancer ( 1 - 800 - 422 - 6237 ) or livehelp. the doctor, nurse, or physical therapist can suggest exercises to help you regain movement and strength in your arm and shoulder. exercise can also reduce stiffness and pain. you may be able to begin gentle exercise within days of surgery. because nerves may be injured or cut during surgery, you may have numbness and tingling in your chest, underarm, shoulder, or upper arm. these feelings may go away within a few weeks or months. you can


exercise within days of surgery. because nerves may be injured or cut during surgery, you may have numbness and tingling in your chest, underarm, shoulder, or upper arm. these feelings may go away within a few weeks or months. you can find pictures and more information about breast cancer surgery on nci ' s website at http : / / www. cancer. gov / cancertopics / types / breast. questions you may want to ask your doctor about surgery - what kinds of surgery can i consider? is breast - sparing surgery an option for me? is a skin - sparing mastectomy an option? which operation do you recommend for me? why? - will any lymph nodes be removed? how many? why? - how will i feel after the operation? will i have to stay in the hospital? - what are the risks of surgery? - how many surgeries for breast cancer have you done? - will i need to learn how to take care of myself or my incision when i get home? - where will the scars be? what will they look like? - if i decide to have plastic surgery to rebuild my breast, how and when can that be done? can you suggest a plastic surgeon for me to contact? - will i have to do special exercises to help regain motion and strength in my arm and shoulder? will a physical therapist or nurse show me how to do the exercises? radiation therapy uses high - energy rays to kill cancer cells. it affects cells only in the part of the body that is treated. radiation therapy may be used after surgery to destroy breast cancer cells that remain in the chest area. women usually have radiation therapy after breast - sparing surgery, but it ' s sometimes used after mastectomy too. you can get radiation therapy to treat breast cancer in two ways : - machine outside the body ( external radiation therapy ) : the radiation comes from a large machine outside the body. you ' ll go to a hospital or clinic for treatment. usually, women get treatment once a day, 5 days a week for 3 to 6 weeks. each treatment session lasts only a few minutes. external radiation is the most common type used for breast cancer. - material inside the body ( brachytherapy ) : the doctor will place one or more thin tubes inside the breast through a tiny incision. a radioactive substance is loaded into the tube. the treatment session may last for a few minutes, and the substance is removed. when it ' s removed, no radioactivity remains in your


more thin tubes inside the breast through a tiny incision. a radioactive substance is loaded into the tube. the treatment session may last for a few minutes, and the substance is removed. when it ' s removed, no radioactivity remains in your body. this method of radiation therapy may be repeated every day for a week. side effects depend mainly on the type of radiation and how much is given. ask your health care team to describe what you can expect. it ' s common for the skin in the treated area to become red, dry, tender, and itchy. check with your doctor before using lotion, cream, or deodorant on the treated area. after treatment is over, the skin will slowly heal. however, there may be a lasting change in the color of your skin. with either type of radiation therapy, your breast may feel heavy and tight. internal radiation therapy may make your breast look red or bruised. these problems usually go away over time. bras and tight clothes may rub your skin and cause soreness. you may want to wear loose - fitting cotton clothes during this time. you ' re likely to become tired during radiation therapy, especially in the later weeks of treatment. although getting enough rest is important, most people say they feel better when they exercise every day. try to go for a short walk, do gentle stretches, or do yoga. you may wish to discuss with your doctor the possible long - term effects of radiation therapy. for example, radiation therapy to the chest may harm the lung or heart. also, it can change the size of your breast and the way it looks. if any of these problems occur, your health care team can tell you how to manage them. the nci booklet radiation therapy and you has helpful ideas for coping with side effects. questions you may want to ask your doctor about radiation therapy - which type of radiation therapy can i consider? are both types an option for me? - when will treatment start? when will it end? how often will i have treatment? - how will i feel during treatment? will i need to stay in the hospital? will i be able to drive myself to and from treatment? - what can i do to take care of myself before, during, and after treatment? - how will we know the treatment is working? - will radiation therapy harm my skin? - how will my chest look afterward? - are there any lasting effects? - what is the chance that the cancer will come back in my breast? hormone therapy can also be


we know the treatment is working? - will radiation therapy harm my skin? - how will my chest look afterward? - are there any lasting effects? - what is the chance that the cancer will come back in my breast? hormone therapy can also be called anti - hormone treatment. if lab tests show that your breast cancer cells have hormone receptors, then hormone therapy may be an option. ( see the part about lab tests with breast tissue. ) hormone therapy keeps the cancer cells from getting or using the natural hormones ( estrogen and progesterone ) they need to grow. if you have not gone through menopause, the options for hormone therapy include … - a drug that blocks estrogen ' s activity in the body ( tamoxifen ) - surgery to remove your ovaries ( which make estrogen ) - a drug that reduces the amount of estrogen made by the ovaries ( lh - rh agonist ) if you have gone through menopause, the options include … - a drug that prevents the body from making estrogen ( aromatase inhibitor ) the side effects of hormone therapy depend on the type used. the most common side effects are hot flashes, vaginal discharge, and nausea. the nci fact sheet hormone therapy for breast cancer has information about the use and side effects of hormone therapy. chemotherapy uses drugs to kill cancer cells. it may be given to women with stage i, ii, iii, or iv breast cancer. chemotherapy may be given before or after surgery. the drugs for breast cancer are usually given directly into a vein ( intravenously ) through a thin needle or as a pill. you may receive a combination of drugs. you may receive chemotherapy in a clinic, at the doctor ' s office, or at home. it ' s unusual for a woman to need to stay in the hospital during treatment. the side effects depend mainly on which drugs are given and how much. chemotherapy kills fast - growing cancer cells, but the drugs can also harm normal cells that divide rapidly : - blood cells : when drugs lower the levels of healthy blood cells, you ' re more likely to get infections, bruise or bleed easily, and feel very weak and tired. your health care team will check for low levels of blood cells. if your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. there are also medicines that can help your body make new blood cells. - cells in hair roots : chemotherapy may cause hair loss. if you lose


low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. there are also medicines that can help your body make new blood cells. - cells in hair roots : chemotherapy may cause hair loss. if you lose your hair, it will grow back after treatment, but the color and texture may be changed. - cells that line the digestive tract : chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. your health care team can give you medicines and suggest other ways to help with these problems. some drugs used for breast cancer can cause tingling or numbness in the hands or feet. this problem often goes away after treatment is over. other problems may not go away. for example, some of the drugs used for breast cancer may weaken the heart. your doctor may check your heart before, during, and after treatment. a rare side effect of chemotherapy is that years after treatment, a few women have developed leukemia ( cancer of the blood cells ). if you have not yet gone through menopause, some anticancer drugs may damage the ovaries and cause hot flashes, vaginal dryness, and other menopause symptoms. your menstrual periods may no longer be regular or may stop, and you may lose the ability to become pregnant. the older you are, the more likely that this damage to the ovaries will be permanent. women who may want to get pregnant later on should ask their health care team about ways to preserve their eggs before treatment starts. on the other hand, other anticancer drugs don ' t damage the ovaries and you may remain able to become pregnant during chemotherapy. before treatment begins, talk with your doctor about birth control because many anticancer drugs given during the first trimester are known to cause birth defects. the nci booklet chemotherapy and you has ideas for coping with side effects. women whose lab tests show that their breast cancer cells have too much her2 protein may receive targeted therapy. the targeted therapies used to treat breast cancer block cancer cell growth by blocking the action of the extra her2 protein. these drugs may be given intravenously or as a pill. the side effects depend mainly on which drug is given. possible side effects include nausea, vomiting, and diarrhea. the drugs may also cause heart damage, heart failure, and serious breathing problems. during treatment, your doctor will watch for signs of heart and lung problems. you may want to read the


possible side effects include nausea, vomiting, and diarrhea. the drugs may also cause heart damage, heart failure, and serious breathing problems. during treatment, your doctor will watch for signs of heart and lung problems. you may want to read the nci fact sheet targeted cancer therapies. questions you may want to ask your doctor about hormone therapy, chemotherapy, or targeted therapy - what drugs will i be taking? what will they do? - when will treatment start? when will it end? how often will i have treatments? - where will i have treatment? - what can i do to take care of myself during treatment? - how will we know the treatment is working? - which side effects should i tell you about? - will there be long - term side effects? a woman who plans to have a mastectomy has a choice about whether or not to have surgery to rebuild the shape of the breast ( breast reconstruction ). instead of breast reconstruction, a woman could choose to wear a breast form ( a device that replaces the breast ), wear padding inside her bra, or do nothing. all of these options have pros and cons. what is right for one woman may not be right for another. breast reconstruction may be done at the same time as the mastectomy, or it may be done later on. if radiation therapy is part of the treatment plan, some doctors suggest waiting until after radiation therapy is complete. if you ' re thinking about breast reconstruction, talk to a plastic surgeon before the mastectomy, even if you plan to have your reconstruction later on. a surgeon can reconstruct the breast in many ways. some women choose to have breast implants, which are filled with saline or silicone gel. you can read about breast implants on the food and drug administration ' s website at http : / / www. fda. gov. another method of breast reconstruction is to create a breast shape using tissue taken from another part of your body. the plastic surgeon can take skin, muscle, and fat from your lower abdomen, back, or buttocks. the type of reconstruction that is best for you depends on your age, body type, and the type of cancer surgery that you had. a plastic surgeon can help you decide. questions you may want to ask your doctor about breast reconstruction - which type of surgery would give me the best results? how will i look afterward? - when can my reconstruction begin? - how many surgeries will i need? - what are the risks at the time


want to ask your doctor about breast reconstruction - which type of surgery would give me the best results? how will i look afterward? - when can my reconstruction begin? - how many surgeries will i need? - what are the risks at the time of surgery? later? - will i have scars? where? what will they look like? - if tissue from another part of my body is used, will there be any permanent changes where the tissue was removed? - what activities should i avoid after surgery? when can i return to my normal activities? - will i need follow - up care? - how much will reconstruction cost? will my health insurance pay for it? eating well is important before, during, and after cancer treatment. you need the right amount of calories to maintain a good weight. you also need enough protein to keep up your strength. eating well may help you feel better and have more energy. sometimes, especially during or soon after treatment, you may not feel like eating. you may be uncomfortable or tired. you may find that foods don ' t taste as good as they used to. in addition, poor appetite, nausea, vomiting, mouth blisters, and other side effects of treatment can make it hard for you to eat. on the other hand, some women treated for breast cancer may have a problem with weight gain. your doctor, a registered dietitian, or another health care provider can suggest ways to help you meet your nutrition needs. also, the nci booklet eating hints has many useful recipes and lists of foods that can help with side effects. you ' ll need regular checkups ( such as every 3 to 6 months ) after treatment for breast cancer. checkups help ensure that any changes in your health are noted and treated if needed. if you have any health problems between checkups, contact your doctor. checkups help detect … - breast cancer that comes back after treatment : breast cancer may return in the breast or chest wall. or, it may return in any other part of the body, such as the bones, liver, lungs, or brain. - health problems that can result from cancer treatment - a new breast cancer checkups usually include an exam of the neck, underarm, chest, and breast areas. since a new breast cancer may develop, you should have regular mammograms. you probably won ' t need a mammogram of a reconstructed breast or if you had a mastectomy without reconstruction. your doctor may order other imaging procedures or lab tests.


may develop, you should have regular mammograms. you probably won ' t need a mammogram of a reconstructed breast or if you had a mastectomy without reconstruction. your doctor may order other imaging procedures or lab tests. sources of support learning that you have breast cancer can change your life and the lives of those close to you. these changes can be hard to handle. concerns about treatments and managing side effects, hospital stays, and medical bills are common. you may also worry about caring for your family, keeping your job, or continuing daily activities. it ' s normal for you, your family, and your friends to need help coping with such worries. several organizations offer special programs for women with breast cancer. women who have had the disease serve as trained volunteers. they may talk with or visit women who have breast cancer, provide information, and lend emotional support. they often share their experiences with breast cancer treatment, breast reconstruction, and recovery. here ' s where you can go for support : - doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities. - social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. often, social workers can suggest resources for financial aid, transportation, home care, or emotional support. - support groups can also help. in these groups, women with breast cancer or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. groups may offer support in person, over the telephone, or on the internet. you may want to talk with a member of your health care team about finding a support group. women with breast cancer often get together in support groups, but please keep in mind that each woman is different. ways that one woman deals with cancer may not be right for another. you may want to ask your health care provider about advice you receive from other women with breast cancer. - nci ' s cancer information service can help you locate programs, services, and nci publications. call 1 - 800 - 4 - cancer ( 1 - 800 - 422 - 6237 ). or, chat using livehelp, nci ' s instant messaging service. - your doctor or a sex counselor may be helpful if you and your partner are concerned about the effects of breast cancer on your sex life. ask your doctor about possible treatment of side effects and whether these effects are likely to last.


instant messaging service. - your doctor or a sex counselor may be helpful if you and your partner are concerned about the effects of breast cancer on your sex life. ask your doctor about possible treatment of side effects and whether these effects are likely to last. whatever the outlook, you and your partner may find it helps to discuss your concerns. for tips on coping, you may want to read the nci booklet taking time : support for people with cancer. cancer treatment research doctors all over the world are conducting many types of cancer treatment studies ( clinical trials ) in which people volunteer to take part. research has already led to advances in the prevention, detection, and treatment of breast cancer. doctors continue to search for new and better ways to treat breast cancer. nci is sponsoring many studies with women who have breast cancer, such as studies that combine surgery, chemotherapy, hormone therapy, and radiation therapy. even if a woman in a research study doesn ' t benefit directly from the treatment under study, she may still make an important contribution by helping doctors learn more about breast cancer and how to control it. although research studies may pose some risks, researchers do all they can to protect their patients. if you ' re interested in being part of a research study, talk with your doctor. you may want to read the nci booklet taking part in cancer treatment research studies. it describes how treatment studies are carried out and explains their possible benefits and risks. nci ' s website has a section on research studies at http : / / www. cancer. gov / clinicaltrials. it has general information about research studies as well as detailed information about specific ongoing studies of breast cancer. nci ' s cancer information service can answer your questions and provide information about research studies. contact cis at 1 - 800 - 4 - cancer ( 1 - 800 - 422 - 6237 ) or at livehelp.


technical report on cdc guidance for responses to influenza for institutions of higher education during the 2009 - 2010 academic year this website is archived for historical purposes and is no longer being maintained or updated. for updated information on the current flu season, see the cdc seasonal flu website. february 22, 2010 2 : 00 pm et cdc has released guidance to help decrease the spread of influenza ( flu ) among students, faculty, and staff of institutions of higher education ( ihe ) and post - secondary educational institutions during the 2009 - 2010 academic year. the guidance expands upon earlier guidance for these settings by providing a menu of tools that ihe and health officials can choose from based on conditions in their area. it recommends actions to take now ( during this academic year ), suggests strategies to consider if flu severity is increasing compared with april through december 2009 of the 2009 h1n1 influenza outbreak, and provides a checklist for making decisions. based on the severity of 2009 h1n1 flu - related illness thus far, this guidance also recommends that students, faculty, and staff with flu - like illness remain home until 24 hours after resolution of fever without the use of fever - reducing medicines. for the purpose of this document, ihe is used to refer to public and private, residential and nonresidential, degree - granting and non - degree - granting institutions providing post - secondary education in group settings regardless of the age of their students. portions of this guidance pertaining to dormitories and residence halls may be useful for residential ( boarding ) schools providing primary and secondary education, with adaptations as needed for their younger population. this guidance represents cdc ’ s current thinking on this topic. it does not create or confer any rights for or on any person or operate to bind the public. this technical report includes a more in depth explanation of the strategies presented in the cdc guidance for responses to influenza for institutions of higher education during the 2009 - 2010 academic yearand gives suggestions on how to use them. the guidance is designed to decrease exposure to regular seasonal flu and 2009 h1n1 flu while limiting the disruption of day - to - day activities and the vital learning that goes on in institutions of higher education ( ihe ). more than 17 million students attend the 4, 300 degree - granting post - secondary institutions in the united states and more than 3 million people work as faculty and staff. an additional 2, 222 non - degree - granting institutions offer vocational post - secondary education. ihes are extremely varied and include : - public and private institutions - residential and nonres


united states and more than 3 million people work as faculty and staff. an additional 2, 222 non - degree - granting institutions offer vocational post - secondary education. ihes are extremely varied and include : - public and private institutions - residential and nonresidential institutions - degree - granting and non - degree - granting institutions - educational or training programs that last from a few weeks to 4 or more years - student population sizes ranging from fewer than one hundred to tens of thousands - community colleges and vocational education and training programs that serve their local communities - colleges and universities with students from across the country and around the world institutions will need to tailor the guidelines to their own unique circumstances, taking into account the size, diversity and mobility of their student body, faculty, and staff ; their location and physical facilities ; programs ; and student and employee health services. decisions about which strategies to implement should balance the goal of reducing the number of people who become seriously sick or die from flu with the goal of minimizing educational and social disruption. ihes should examine and revise, as necessary, their current crisis or pandemic plans and procedures, including updating contact information for students, their families, faculty, and staff. communication plans should be shared with students, their families, faculty, and staff before an outbreak so that they know how the ihe will contact them and what types of information to expect. establishing mechanisms to contact students ’ families in the event of a flu outbreak on campus, or to notify them that their student is sick, may decrease the number of inquiries coming into the ihe and therefore the burden on ihe staff. ihes also should communicate with vendors who supply critical products or services to plan for continuation of those services throughout the flu season. critical services may include food service, hygiene supplies, security, and personal protective equipment for staff. this planning is especially important when suppliers may be small businesses in the local area that could also be affected by a flu outbreak. visit http : / / www. flu. gov / plan / school / collegeschecklist. html for the colleges and universities pandemic influenza planning checklist. the purpose of this document is to provide updated guidance for reducing the spread of flu in ihes. we provide recommendations for the 2009 - 2010 flu season, assuming that severity of illness is similar to what was seen during april through december 2009 of the 2009 h1n1 flu outbreak, as well as recommendations that could be added if the severity of illness worsens. flu is unpredictable. cdc will continue to


assuming that severity of illness is similar to what was seen during april through december 2009 of the 2009 h1n1 flu outbreak, as well as recommendations that could be added if the severity of illness worsens. flu is unpredictable. cdc will continue to monitor the spread of flu, the severity of the illness it is causing, and for possible changes in flu viruses ; cdc will provide periodic updates of these assessments. if the information cdc gathers indicates that flu is causing more severe disease than during april through december 2009 of the 2009 h1n1 flu outbreak, or if other developments indicate more aggressive mitigation measures should be taken, cdc may recommend additional strategies. flu symptoms, transmission, and risk : symptoms of flu can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue, and sometimes diarrhea and vomiting. people may be infected with the flu, including 2009 h1n1 flu and have respiratory symptoms without a fever. like seasonal flu, 2009 h1n1 flu infection in humans can vary in severity from mild to severe. visit http : / / www. cdc. gov / h1n1flu / qa. htm for more information on flu symptoms. like seasonal flu, the 2009 h1n1 flu virus is spread mainly from person to person through coughs or sneezes of infected individuals. people may also become infected by touching something – such as a surface or object – with flu virus on it and then touching their mouth, nose, or eyes. some people are at higher risk than others for serious complications from flu. these people include : - children younger than 5 years old, but especially children younger than 2 years old - people aged 65 years or older - pregnant women - adults and children who have : - neurological and neurodevelopmental conditions - chronic lung disease - heart disease - blood disorders - endocrine disorders ( such as diabetes ) - kidney, liver, and metabolic disorders - weakened immune systems due to disease or medication - people younger than 19 years of age who are receiving long - term aspirin therapy for more information on people at high risk for flu complications, visit http : / / www. cdc. gov / h1n1flu / highrisk. htm. the most important things ihes can do are to encourage flu vaccination for all those recommended for vaccination ; suggest early treatment for people at higher risk for flu complications ; facilitate use of respiratory etiquette


highrisk. htm. the most important things ihes can do are to encourage flu vaccination for all those recommended for vaccination ; suggest early treatment for people at higher risk for flu complications ; facilitate use of respiratory etiquette and hand hygiene by students, faculty, and staff ; and to separate sick and well people as soon as possible. administrators should frequently remind students, faculty, and staff about the importance of these. educational materials ( for example, posters ) to enhance compliance with recommendations should be visible in the ihe setting. examples of these materials are available at http : / / www. cdc. h1n1flu / flyers. htm. there are many ways to employ these strategies ; not all can be described in this document. the following recommendations provide a framework to determine the most appropriate and feasible strategies for each ihe. isolating sick people is a critical strategy for addressing 2009 h1n1 flu for two reasons : ( 1 ) 2009 h1n1 flu may result in more serious complications for people at higher risk for flu complications and these measures help protect these people ( see list below ) ; and ( 2 ) a widespread pandemic may result in many more hospitalizations and medical care visits than usually associated with seasonal flu. measures to limit the spread of flu, if effective, may reduce demand on the healthcare system. other measures, such as suspending classes, are recommended for conditions of increased flu severity, but might also be necessary during periods of increased flu activity with the same severity as during april through december 2009 of the 2009 h1n1 flu outbreak in the community, on a case - by - case basis, if the ihe is not able to maintain normal functioning. ihes should review, and revise if necessary, their current crisis or pandemic plans and procedures ; develop contingency plans to cover key positions when staff are absent from work ; update contact information for families and staff ; and share their plans with students, faculty, staff, and community. administrators should review and revise, if necessary, their sick leave policies to remove barriers to faculty and staff staying home while sick or to care for a sick family member. for students, ihes may consider altering policies on missed classes and examinations and late assignments so that students ’ academic concerns do not prevent them from staying home when sick or prompt them to return to class or take examinations while still symptomatic and potentially infectious. do not require a healthcare provider ’ s note for students, faculty, or staff