8 January 2011: Puccini, La Fanciulla del West (The Girl of the Golden West)
(Based on a play of the same title by David Belasco.) Metropolitan Opera HD live broadcast, seen in the West Springfield Cinemas. Conducted by Nicola Luisotti; production Giancarlo del Monaco. Cast: Minnie: Deborah Voigt; Dick Johnson: Marcelo Giordani; Jack Rance: Lucio Gallo. Plus five horses, unnamed. Performance time 4.5 hours.
Puccini is a celebrated practitioner of the verismo style of opera. A helpful definition of the term may be found in Wikipedia: “Internationally, the term is more widely understood to refer to a style of Italian opera that began in 1890 with the first performance of Mascagni’s Cavalleria rusticana, peaked in the early 1900s, and lingered into the 1920s. The style is distinguished by realistic – sometimes sordid or violent – depictions of everyday life, especially the life of the contemporary lower classes. It by and large rejects the historical subjects associated with Romanticism, or mythical ones.”
Del Monaco’s production, revived this year at the Met, can be seen to accord with this description, just as Puccini’s opera does. But if we consider the origins of the opera, in Belasco’s hit play of 1905, The Girl Of the Golden West, we would want to be careful to remember that Belasco is not to be confused with the French naturalists of the mid-to-late nineteenth century. Belasco is at heart a romanticist of the first order, and his heart is in the right place. The title character of his play, and of Puccini’s opera, is Minnie, a prostitute with a heart of gold, so golden that, where realism would dictate that she was a woman in a frontier situation where sexual purity was not possible, this character has been transformed by Belasco into a selfless sweetheart of a virgin, who explains that she has never been kissed. But this same sweetheart of a golden girl, in the course of Act Two, offers us a kind of “facts-of-the-matter” revelation: I, she says, am no one, a tavern keeper in a frontier outpost; you, she says to Dick Johnson, otherwise identified as the Mexican bandit Ramirrez, are nothing more than a robber; and the Sheriff, Jack Rance, is no more than a gambler. We are nobodies, she means to say, and the implication is that they are not worth anyone’s attention. And yet they are much more than nobodies. Belasco has romanticized their very undistinguished origin and social place into a quasi-mythical drama in which we are led to understand that these persons are fully representative of common humanity, with ambitions, feelings, doubts, and soul-felt needs that make them eminently worth our caring about. Notwithstanding their ordinariness, they are special, even unique persons, and we must want them to do well for themselves, to survive and, if luck will have it, thrive and love. If they can’t outlive fate and time, they can at least be true to one another.
So much for verismo. This was not the first time that Puccini had put his stamp of musical approval on the Belasco view of the universe. Madama Butterfly was, I believe, the first time that Puccini and Belasco had a meeting of hearts, and minds. Fanciulla was the second, and at least equally successful instance. Even though Deborah Voigt is hardly believable as a never-kissed maiden — she is forty if she is a day and has evidently gained back some of the weight she lost after the “little black dress” fiasco, when she was denied a role at Covent Garden for being so much overweight — she is a very good actress, and she gives us a completely believable Minnie, a “girl” who goes through much difficulty before finally rescuing her lover, Ramirrez, the bandit who has stolen her heart, as he is about to be hanged, and going off with him into the gathering dusk, as Jack Rance, the sheriff who has been cheated at cards by Minnie, stands silhouetted and watches them depart, a figure of despondency and an emblem of futility.
A recent New Yorker sidebar deplored the alleged shabbiness of this production. Seeing the opera for the first time, we couldn’t understand what the fuss was about. The first act barroom is convincingly if operatically real (adapted to the oversize precincts of the Metropolitan Opera stage); and there are fight scenes that are good enough, and one especially good moment when a very well-trained stunt man dives from a balcony twelve feet high into the waiting arms of his fellows. Puccini seems to be “into” an early Italian version of western Americana environmental studies here, and he doesn’t quite know how to proceed. The first half-hour of the opera is rather a bore, although the music is very pleasant to listen to. A little sympathetic patter involving the miners’ longing for home hearth and field can go a long way. But all of this is not the fault of the scene designer, Michael Scott, or of del Monaco himself. And the first act picks up quite a bit when we come to the long twosome between Minnie and Jack Johnson, the bandit Ramirrez in disguise.
The second act is set at the site of Minnie’s cabin halfway up the mountain. A fine example of replicated early twentieth-century realism, it shows the interior of the cabin and the surrounding exterior, snow-covered, with steep hills. The cabin has been enhanced somewhat by the addition of a semi-automatic staircase leading to an attic; the staircase can be lowered simply by using a long pole to push up against its release mechanism, whereupon it lowers itself to the cabin floor. It is a handsome device, and it functions flawlessly. Ramirrez, wounded by the fanatical Jack Rance, who has been maintaining a vigil outside the cabin, waiting for his bitter rival to show up, staggers up that staircase; and because the exterior wall of the attic, like that of the main cabin, has been taken away to reveal the interior, we can see Ramirrez there, ready to bleed through the attic floor onto the space beneath, and right onto Jack Rance’s outstretched hand, on cue. He does, and Rance (who somehow also knows how to operate the staircase) lowers the staircase, rushes up and drags the hapless Ramirrez down onto the cabin floor. There, improbably, he lies inert (though thankfully not creating a pool of blood on the floor) while Minnie proposes a do-or-die, winner-take-all game of poker with Jack Rance for possession of the bandit: if Jack Rance wins, he gets both the bandit and Minnie; if she wins, she gets the bandit and Jack Rance loses both of them. And that, of course, is what happens, thanks to the resourceful Minnie’s ability to beat the sheriff at his own game by cheating him out of his prize. Three kings and a pair is the winning hand.
It seems to me that Michael Scott’s setting design here is fully appropriate to the action, inspired by Belasco’s play and appropriated by Puccini. And here it’s appropriate to say something about the brilliant atmospheric lighting designed by Gil Wechsler (whom I knew distantly when we were fellow students at the Yale School of Drama in 1956-57). From the very beginning of the opera, in the barroom, the lighting is a good bit dimmer than what we might have expected. Likewise, the exterior surroundings presented in Act Two are quite dim and shadowy; and even the comparatively brighter light in the interior of Minnie’s cabin still gives the feeling of authentic nighttime illumination, in which the real candle carried from a mantelpiece to a table can be perceived to be the major source of light. The shadowy, dusk-like lighting of the mining town — a broken down one-street place obviously fallen on hard times and very much unlike the homespun prosperity signaled by most film sets of spaghetti Westerns — carries out the same general theme. The whole opera seems to be performed in waning light, if not in actual semidarkness. Given the fact that this is still Belasco and Puccini, this design decision does not by any means cast a pall over the production. But it gives it a convincing sense of, yes, realism instead of what could have degenerated into an all too obvious sense of artificially bright light, which could show what the magnificent equipment of the Metropolitan Opera stage can achieve but which would overshadow (sorry) the idea of the idealized ordinary that grounds the efforts of both dramatist and composer. How this could all be described by the New Yorker as “shabby” remains a puzzle.
And then there are the wonderful voices. In an interview between acts Deborah Voigt was asked about her approach to the role of Minnie. She explained that in her view this is the most difficult of Puccini soprano roles. There are some unprepared-for high C’s, for one thing, and in various other ways the role is musically quite demanding. But in the same breath Voigt added that the character is also demanding because of the many changes that occur for her in the course of the action. And then there is the question of all the props that she has to use, particularly the various firearms and the playing cards, with a prepared “winning hand” that is first privately concealed in her sock, and then is put into play while Jack Vance, at her urging, rises and retrieves a bottle of whiskey that she has asked for and says she needs a drink from. Voigt ingenuously explained that in most operas it is the mezzo who has to handle the props. Here it is the soprano, that is, the central character, who is clearly not above such things; this adds an element of even greater complexity to the performer’s requirements. It is a positive tribute to Deborah Voigt that she rose to the challenge of these many demands beautifully, while singing in her full and wonderfully accurate and musical voice the mellifluous, rolling melodic lines, replete with pentatonic sequences, lushly supported by that truly wonderful Met orchestra, that are Puccini’s distinctive stock in trade.
The other two major characters, sung by Marcello Giordani and Lucio Gallo, were also all that we needed them to be. Giordani, who is quite capable of all the major Puccini and Verdi tenor-heroes, based his interpretation of the bandit Ramirrez (he explained between acts) on an amalgam of the heroes of all the spaghetti Westerns he had seen in his misspent youth. Gallo, for his part, thought that it was unfair for the representative of justice in the play and in the opera to be cast as the villain who loses the girl. For the moment, he seems to have forgotten that, with a few notable exceptions, a baritone voice is the voice of the villain. This amounts to destiny in Italian opera. Gallo has sung Scarpia in Tosca and assorted other villainous baritone roles and so should have remembered this ineluctable fact. The baritones, of course, are the smart guys who lose out to the cosmic destiny that is the golden heritage of tenors, who are invariably stupid, ill-prepared, and naïve and yet who win the woman in the end. That is, unless it’s the other way around, or works out as some unorthodox variation on it, as in Il Trovatore, where the tenor is an insufferably self-indulgent member of the ruling class and nobody wins.
As we departed West Springfield Cinemas for a dash to Boston for a performance of two more operas, by Stravinsky and Bartok, in concert versions by the Boston Symphony Orchestra, we speculated once again about the alleged shabbiness of the setting. How else might the Belasco play and the Puccini opera be staged, if not in this relatively realistic way? A play like Hamlet is timeless and classic enough to survive and thrive on almost any style of setting, whether medieval Scandinavian or modern kabuki, or something else. We now have come to understand that such stylistic treatments are essentially metaphors. Such treatment is even possible with plays that seem completely embedded in their historical moment, like The Cherry Orchard, but it’s considerably more of a stretch. The whole of the Puccini corpus has that kind of embedded quality, it seemed to us. We need the well-rendered verismo details of wintry rooming houses and outdoor cafés of La Bohème. Madama Butterfly is perhaps susceptible of freer treatment, but the general need for a recognized historical moment remains.
All of this is of course partly a function of our sense of our own historical moment. We are as of this month eleven years into a new century, and we are still just getting used to referring to something “twentieth century” as other, now officially distant from us and perceptibly different. There may come a time when Puccini operas can be staged, perhaps by some adventurous latter-day Peter Sellars, in some bleak, ice-bound Arctic zone, some heartless high-rise Los Angeles office building and antiseptic city park, some luxuriant central American tropical rain forest, or some equally out-of-range place. But for now, still, we seem to need a place that appears to be one we are confident we know. That Arctic setting might give a whole new meaning to the aria in Bohème “Che gelida manina” (“Your tiny hand is frozen”), but I don’t think we’re quite ready for that just yet.


4.3 Classification of Igneous Rocks
Igneous rocks are classified into four categories: felsic, intermediate, mafic, and ultramafic, based on either their chemistry or their mineral composition. The diagram in Figure 4.3.1 can be used to help classify igneous rocks by their mineral composition. An important feature to note on this diagram is the red line separating the non-ferromagnesian silicates in the lower left (K-feldspar, quartz, and plagioclase feldspar) from the ferromagnesian silicates in the upper right (biotite, amphibole, pyroxene, and olivine). In classifying intrusive igneous rocks, the first thing to consider is the percentage of ferromagnesian silicates. In most igneous rocks the ferromagnesian silicate minerals are clearly darker than the others, but it is still quite difficult to estimate the proportions of minerals in a rock.
Based on the position of the red line in Figure 4.3.1, it is evident that felsic rocks can have between 1% and 20% ferromagnesian silicates (the red line intersects the left side of the felsic zone 1% of the distance from the top of the diagram, and it intersects the right side of the felsic zone 20% of the distance from the top). Intermediate rocks have between 20% and 50% ferromagnesian silicates, and mafic rocks have 50% to 100% ferromagnesian silicates. To be more specific, felsic rocks typically have biotite and/or amphibole; intermediate rocks have amphibole and, in some cases, pyroxene; and mafic rocks have pyroxene and, in some cases, olivine.
If we focus on the non-ferromagnesian silicates, it is evident that felsic rocks can have from 0% to 35% K-feldspar, from 25% to 35% quartz (the vertical thickness of the quartz field varies from 25% to 35%), and from 25% to 50% plagioclase (and that plagioclase will be sodium-rich, or albitic). Intermediate rocks can have up to 25% quartz and 50% to 75% plagioclase. Mafic rocks only have plagioclase (up to 50%), and that plagioclase will be calcium-rich, or anorthitic.
Practice Exercise 4.3 Mineral proportions in igneous rocks
The dashed blue lines (labelled a, b, c, d) in Figure 4.3.2 represent four igneous rocks. Complete the table by estimating the mineral proportions (percent) of the four rocks (to the nearest 10%).
Hint: Rocks b and d are the easiest; start with those.
| Rock | Biotite/amphibole | Pyroxene | Olivine | Plagioclase | Quartz | K-feldspar |
|---|---|---|---|---|---|---|
| a | ||||||
| b | ||||||
| c | ||||||
| d |
See Appendix 2 for Practice Exercise 4.3 answers.
Figure 4.3.3 provides a diagrammatic representation of the proportions of dark minerals in light-coloured rocks. You can use that when trying to estimate the ferromagnesian mineral content of actual rocks, and you can get some practice doing that by completing Practice Exercise 4.4. Be warned! Geology students almost universally over-estimate the proportion of dark minerals.
Practice Exercise 4.4 Proportions of ferromagnesian silicates
The four igneous rocks shown below have differing proportions of ferromagnesian silicates. Estimate those proportions using the diagrams in Figure 4.3.3, and then use Figure 4.3.1 to determine the likely rock name for each one.
| ___% | ___% | ___% | ___% |
| __________ | __________ | __________ | __________ |
See Appendix 2 for Practice Exercise 4.4 answers.
Igneous rocks are also classified according to their textures.  Typically that means they are larger than about 0.5 millitmeres (mm) — the thickness of a strong line made with a ballpoint pen. The intrusive rocks shown in Figure 4.2.4 are all phaneritic, as are those shown in Practice Exercise 4.4. If the crystals are too small to distinguish, which is typical of most extrusive (volcanic) rocks, we use the term aphanitic (from the Greek word aphanos – unseen). Although the individual crystals in an aphantic rock cannot be observed with the naked eye, they still influence the physical properties of the rock, specifically its colour. In an aphanitic rock, the colour of the groundmass, as seen on a fresh non-weathered surface, can provide clues about its mineral composition. Mafic rocks (basalt) tend to be dark black to grey in colour, intermediate rocks (andesite) tend to be a lighter grey, and felsic rocks (rhyolite) tend to be pale grey, white, cream or pale pink in colour.
In general, the size of crystals is proportional to the rate of cooling. The longer it takes for a body of magma to cool, the larger the crystals can grow. As already described, if an igneous rock goes through a two-stage cooling process, its texture will be porphyritic (Figure 4.2.5).
Igneous rocks that form when lava cools so rapidly that few, if any, crystals form, are often glassy. Two common glassy rocks formed rapid cooling (or quenching) of lava are pumice and obsidian. Pumice is typically light in colour owing to its felsic composition, and is distinguished by its frothy glassy texture and low density. Obsidian is distinguished by its vitreous lustre and pronounced conchoidal fracture. Although obsidian is typically black to dark brown in colour, it is actually felsic in composition.
One final textural term for igneous rocks is vesicular. The vesicles in vesicular rocks form when gasses exsolve from the magma as it rises toward the surface of the Earth. When magma is deep beneath the surface and under high pressure from the surrounding rocks, the gases remain dissolved in the magma, much like the dissolved CO2 gas in an unopened bottle of pop. As magma approaches the surface, the pressure exerted on it decreases, and gas bubbles start to form, much like once a bottle of pop has been opened. The more gas there is in the magma, the more bubbles form. If the magma is runny enough, the gases will rise up through it and escape to surface. In some cases, however, the bubbles of gas are “frozen” in the lava as it cools and form vesicles as it crystallizes into solid rock at the surface.
Names of igneous rocks, based on both composition and texture as described above, can be enhanced by adding using terms like vesicular or porphyritic as modifiers. For example, an andesite that contains hornblende and plagioclase phenocrysts would be described as a hornblende plagioclase porphyritic andesite. A basalt that contains olivine phenocrysts and vesicles would be called an olivine porphyritic vesicular basalt.
Image Descriptions
| Igneous Rocks | Felsic | Intermediate | Mafic | Ultramafic |
|---|---|---|---|---|
| K-feldspar | 0 to 35% | 0% | 0% | 0% |
| Quartz | 25 to 35% | 0 to 25% | 0% | 0% |
| Plagioclase feldspar | 25 to 50% | 50 to 70% | 0 to 50% | 0% |
| Biotite and/or Amphibole | 0 to 20% | 20 to 40% | 0 to 30% | 0% |
| Pyroxene | 0% | 0 to 20% | 20 to 75% | 0% to 75% |
| Olivine | 0% | 0% | 0 to 25 % | 25% to 100% |
| Intrusive | Granite | Diorite | Gabbro | Peridotite |
| Extrusive | Rhyolite | Andesite | Basalt | Komatiite |
Media Attributions
- Figure 4.3.1, 4.3.2, 4.3.3: © Steven Earle. CC BY.
A silicate mineral that does not contain iron or magnesium (e.g., feldsspar).
 Has obvious conchoidal fracture.
an igneous texture characterized by holes left by gas bubbles
a small open cavity in a volcanic rock, produced by gas bubbles


11.3 The Kidneys and Osmoregulatory Organs
Mary Ann Clark; Jung Choi; and Matthew Douglas
Learning Objectives
By the end of this section, you will be able to do the following:
- Explain how the kidneys serve as the main osmoregulatory organs in mammalian systems
- Describe the structure of the kidneys and the functions of the parts of the kidney
- Describe how the nephron is the functional unit of the kidney and explain how it actively filters blood and generates urine
- Detail the three steps in the formation of urine: glomerular filtration, tubular reabsorption, and tubular secretion
Although the kidneys are the major osmoregulatory organ, the skin and lungs also play a role in the process. Water and electrolytes are lost through sweat glands in the skin, which helps moisturize and cool the skin surface, while the lungs expel a small amount of water in the form of mucous secretions and via evaporation of water vapor.
Kidneys: The Main Osmoregulatory Organ
The kidneys, illustrated in Figure 11.4, are a pair of bean-shaped structures that are located just below and posterior to the liver in the peritoneal cavity. The adrenal glands sit on top of each kidney and are also called the suprarenal glands. Kidneys filter blood and purify it. All the blood in the human body is filtered many times a day by the kidneys; these organs use up almost 25 percent of the oxygen absorbed through the lungs to perform this function. Oxygen allows the kidney cells to efficiently manufacture chemical energy in the form of ATP through aerobic respiration. The filtrate coming out of the kidneys is called urine.
Kidney Structure
Externally, the kidneys are surrounded by three layers, illustrated in Figure 11.5. The outermost layer is a tough connective tissue layer called the renal fascia. The second layer is called the perirenal fat capsule, which helps anchor the kidneys in place. The third and innermost layer is the renal capsule. Internally, the kidney has three regions—an outer cortex, a medulla in the middle, and the renal pelvis in the region called the hilum of the kidney. The hilum is the concave part of the bean-shape where blood vessels and nerves enter and exit the kidney; it is also the point of exit for the ureters. The renal cortex is granular due to the presence of nephrons—the functional unit of the kidney. The medulla consists of multiple pyramidal tissue masses, called the renal pyramids. In between the pyramids are spaces called renal columns through which the blood vessels pass. The tips of the pyramids, called renal papillae, point toward the renal pelvis. There are, on average, eight renal pyramids in each kidney. The renal pyramids along with the adjoining cortical region are called the lobes of the kidney. The renal pelvis leads to the ureter on the outside of the kidney. On the inside of the kidney, the renal pelvis branches out into two or three extensions called the major calyces, which further branch into the minor calyces. The ureters are urine-bearing tubes that exit the kidney and empty into the urinary bladder.
Visual Connection
Which of the following statements about the kidney is false?
- The renal pelvis drains into the ureter.
- The renal pyramids are in the medulla.
- The cortex covers the capsule.
- Nephrons are in the renal cortex.
Because the kidney filters blood, its network of blood vessels is an important component of its structure and function. The arteries, veins, and nerves that supply the kidney enter and exit at the renal hilum. Renal blood supply starts with the branching of the aorta into the renal arteries (which are each named based on the region of the kidney they pass through) and ends with the exiting of the renal veins to join the inferior vena cava. The renal arteries split into several segmental arteries upon entering the kidneys. Each segmental artery splits further into several interlobar arteries and enters the renal columns, which supply the renal lobes. The interlobar arteries split at the junction of the renal cortex and medulla to form the arcuate arteries. The arcuate “bow shaped” arteries form arcs along the base of the medullary pyramids. Cortical radiate arteries, as the name suggests, radiate out from the arcuate arteries. The cortical radiate arteries branch into numerous afferent arterioles, and then enter the capillaries supplying the nephrons. Veins trace the path of the arteries and have similar names, except there are no segmental veins.
As mentioned previously, the functional unit of the kidney is the nephron, illustrated in Figure 11.6. Each kidney is made up of over one million nephrons that dot the renal cortex, giving it a granular appearance when sectioned sagittally. There are two types of nephrons—cortical nephrons (85 percent), which are deep in the renal cortex, and juxtamedullary nephrons (15 percent), which lie in the renal cortex close to the renal medulla. A nephron consists of three parts—a renal corpuscle, a renal tubule, and the associated capillary network, which originates from the cortical radiate arteries.
Visual Connection
Which of the following statements about the nephron is false?
- The collecting duct empties into the distal convoluted tubule.
- The Bowman’s capsule surrounds the glomerulus.
- The loop of Henle is between the proximal and distal convoluted tubules.
- The loop of Henle empties into the distal convoluted tubule.
Renal Corpuscle
The renal corpuscle, located in the renal cortex, is made up of a network of capillaries known as the glomerulus and the capsule, a cup-shaped chamber that surrounds it, called the glomerular or Bowman’s capsule.
Renal Tubule
The renal tubule is a long and convoluted structure that emerges from the glomerulus and can be divided into three parts based on function. The first part is called the proximal convoluted tubule (PCT) due to its proximity to the glomerulus; it stays in the renal cortex. The second part is called the loop of Henle, or nephritic loop, because it forms a loop (with descending and ascending limbs) that goes through the renal medulla. The third part of the renal tubule is called the distal convoluted tubule (DCT) and this part is also restricted to the renal cortex. The DCT, which is the last part of the nephron, connects and empties its contents into collecting ducts that line the medullary pyramids. The collecting ducts amass contents from multiple nephrons and fuse together as they enter the papillae of the renal medulla.
Capillary Network within the Nephron
The capillary network that originates from the renal arteries supplies the nephron with blood that needs to be filtered. The branch that enters the glomerulus is called the afferent arteriole. The branch that exits the glomerulus is called the efferent arteriole. Within the glomerulus, the network of capillaries is called the glomerular capillary bed. Once the efferent arteriole exits the glomerulus, it forms the peritubular capillary network, which surrounds and interacts with parts of the renal tubule. In cortical nephrons, the peritubular capillary network surrounds the PCT and DCT. In juxtamedullary nephrons, the peritubular capillary network forms a network around the loop of Henle and is called the vasa recta.
Link to Learning
Go to the website Interactive Human to see another coronal section of the kidney and to explore an animation of the workings of nephrons.
Kidney Function and Physiology
Kidneys filter blood in a three-step process. First, the nephrons filter blood that runs through the capillary network in the glomerulus. Almost all solutes, except for proteins, are filtered out into the glomerulus by a process called glomerular filtration. Second, the filtrate is collected in the renal tubules. Most of the solutes get reabsorbed in the PCT by a process called tubular reabsorption. In the loop of Henle, the filtrate continues to exchange solutes and water with the renal medulla and the peritubular capillary network. Water is also reabsorbed during this step. Then, additional solutes and wastes are secreted into the kidney tubules during tubular secretion, which is, in essence, the opposite process to tubular reabsorption. The collecting ducts collect filtrate coming from the nephrons and fuse in the medullary papillae. From here, the papillae deliver the filtrate, now called urine, into the minor calyces that eventually connect to the ureters through the renal pelvis. This entire process is illustrated in Figure 11.7.
Glomerular Filtration
Glomerular filtration filters out most of the solutes due to high blood pressure and specialized membranes in the afferent arteriole. The blood pressure in the glomerulus is maintained independent of factors that affect systemic blood pressure. The “leaky” connections between the endothelial cells of the glomerular capillary network allow solutes to pass through easily. All solutes in the glomerular capillaries, except for macromolecules like proteins, pass through by passive diffusion. There is no energy requirement at this stage of the filtration process. Glomerular filtration rate (GFR) is the volume of glomerular filtrate formed per minute by the kidneys. GFR is regulated by multiple mechanisms and is an important indicator of kidney function.
Link to Learning
To learn more watch the interactive review The Vascular System of the Kidneys By Becky Polk-Pohlman.
Tubular Reabsorption and Secretion
Tubular reabsorption occurs in the PCT part of the renal tubule. Almost all nutrients are reabsorbed, and this occurs either by passive or active transport. Reabsorption of water and some key electrolytes are regulated and can be influenced by hormones. Sodium (Na+) is the most abundant ion and most of it is reabsorbed by active transport and then transported to the peritubular capillaries. Because Na+ is actively transported out of the tubule, water follows it to even out the osmotic pressure. Water is also independently reabsorbed into the peritubular capillaries due to the presence of aquaporins, or water channels, in the PCT. This occurs due to the low blood pressure and high osmotic pressure in the peritubular capillaries. However, every solute has a transport maximum and the excess is not reabsorbed.
In the loop of Henle, the permeability of the membrane changes. The descending limb is permeable to water, not solutes; the opposite is true for the ascending limb. Additionally, the loop of Henle invades the renal medulla, which is naturally high in salt concentration and tends to absorb water from the renal tubule and concentrate the filtrate. The osmotic gradient increases as it moves deeper into the medulla. Because two sides of the loop of Henle perform opposing functions, as illustrated in Figure 11.8, it acts as a countercurrent multiplier. The vasa recta around it acts as the countercurrent exchanger.
Visual Connection
Loop diuretics are drugs sometimes used to treat hypertension. These drugs inhibit the reabsorption of Na+ and Cl– ions by the ascending limb of the loop of Henle. A side effect is that they increase urination. Why do you think this is the case?
By the time the filtrate reaches the DCT, most of the urine and solutes have been reabsorbed. If the body requires additional water, all of it can be reabsorbed at this point. Further reabsorption is controlled by hormones, which will be discussed in a later section. Excretion of wastes occurs due to lack of reabsorption combined with tubular secretion. Undesirable products like metabolic wastes, urea, uric acid, and certain drugs, are excreted by tubular secretion. Most of the tubular secretion happens in the DCT, but some occurs in the early part of the collecting duct. Kidneys also maintain an acid-base balance by secreting excess H+ ions.
Although parts of the renal tubules are named proximal and distal, in a cross-section of the kidney, the tubules are placed close together and in contact with each other and the glomerulus. This allows for exchange of chemical messengers between the different cell types. For example, the DCT ascending limb of the loop of Henle has masses of cells called macula densa, which are in contact with cells of the afferent arterioles called juxtaglomerular cells. Together, the macula densa and juxtaglomerular cells form the juxtaglomerular complex (JGC). The JGC is an endocrine structure that secretes the enzyme renin and the hormone erythropoietin. When hormones trigger the macula densa cells in the DCT due to variations in blood volume, blood pressure, or electrolyte balance, these cells can immediately communicate the problem to the capillaries in the afferent and efferent arterioles, which can constrict or relax to change the glomerular filtration rate of the kidneys.
Career Connection
Nephrologist
A nephrologist studies and deals with diseases of the kidneys—both those that cause kidney failure (such as diabetes) and the conditions that are produced by kidney disease (such as hypertension). Blood pressure, blood volume, and changes in electrolyte balance come under the purview of a nephrologist.
Nephrologists usually work with other physicians who refer patients to them or consult with them about specific diagnoses and treatment plans. Patients are usually referred to a nephrologist for symptoms such as blood or protein in the urine, very high blood pressure, kidney stones, or renal failure.
Nephrology is a subspecialty of internal medicine. To become a nephrologist, medical school is followed by additional training to become certified in internal medicine. An additional two or more years is spent specifically studying kidney disorders and their accompanying effects on the body.
Section Summary
The kidneys are the main osmoregulatory organs in mammalian systems; they function to filter blood and maintain the osmolarity of body fluids at 300 mOsm. They are surrounded by three layers and are made up internally of three distinct regions—the cortex, medulla, and pelvis.
The blood vessels that transport blood into and out of the kidneys arise from and merge with the aorta and inferior vena cava, respectively. The renal arteries branch out from the aorta and enter the kidney where they further divide into segmental, interlobar, arcuate, and cortical radiate arteries.
The nephron is the functional unit of the kidney, which actively filters blood and generates urine. The nephron is made up of the renal corpuscle and renal tubule. Cortical nephrons are found in the renal cortex, while juxtamedullary nephrons are found in the renal cortex close to the renal medulla. The nephron filters and exchanges water and solutes with two sets of blood vessels and the tissue fluid in the kidneys.
There are three steps in the formation of urine: glomerular filtration, which occurs in the glomerulus; tubular reabsorption, which occurs in the renal tubules; and tubular secretion, which also occurs in the renal tubules.
Exercises
Visual Connection Questions
Figure 11.5 : Which of the following statements about the kidney is false?
- The renal pelvis drains into the ureter.
- The renal pyramids are in the medulla.
- The cortex covers the capsule.
- Nephrons are in the renal cortex.
Figure 11.6 : Which of the following statements about the nephron is false?
- The collecting duct empties into the distal convoluted tubule.
- The Bowman’s capsule surrounds the glomerulus.
- The loop of Henle is between the proximal and distal convoluted tubules.
- The loop of Henle empties into the distal convoluted tubule.
Figure 11.8 : Loop diuretics are drugs sometimes used to treat hypertension. These drugs inhibit the reabsorption of Na+ and Cl– ions by the ascending limb of the loop of Henle. A side effect is that they increase urination. Why do you think this is the case?
Review Questions
The macula densa is/are:
- present in the renal medulla.
- dense tissue present in the outer layer of the kidney.
- cells present in the DCT and collecting tubules.
- present in blood capillaries.
The osmolarity of body fluids is maintained at ________.
- 100 mOsm
- 300 mOsm
- 1000 mOsm
- it is not constantly maintained
The gland located at the top of the kidney is the ________ gland.
- adrenal
- pituitary
- thyroid
- thymus
Critical Thinking Questions
- Why are the loop of Henle and vasa recta important for the formation of concentrated urine?
- Describe the structure of the kidney.
Glossary
- afferent arteriole
- arteriole that branches from the cortical radiate artery and enters the glomerulus
- arcuate artery
- artery that branches from the interlobar artery and arches over the base of the renal pyramids
- ascending limb
- part of the loop of Henle that ascends from the renal medulla to the renal cortex
- Bowman’s capsule
- structure that encloses the glomerulus
- calyx
- structure that connects the renal pelvis to the renal medulla
- cortex (animal)
- outer layer of an organ like the kidney or adrenal gland
- cortical nephron
- nephron that lies in the renal cortex
- cortical radiate artery
- artery that radiates from the arcuate arteries into the renal cortex
- countercurrent exchanger
- peritubular capillary network that allows exchange of solutes and water from the renal tubules
- countercurrent multiplier
- osmotic gradient in the renal medulla that is responsible for concentration of urine
- descending limb
- part of the loop of Henle that descends from the renal cortex into the renal medulla
- distal convoluted tubule (DCT)
- part of the renal tubule that is the most distant from the glomerulus
- efferent arteriole
- arteriole that exits from the glomerulus
- glomerular filtration
- filtration of blood in the glomerular capillary network into the glomerulus
- glomerular filtration rate (GFR)
- amount of filtrate formed by the glomerulus per minute
- glomerulus (renal)
- part of the renal corpuscle that contains the capillary network
- hilum
- region in the renal pelvis where blood vessels, nerves, and ureters bunch before entering or exiting the kidney
- inferior vena cava
- one of the main veins in the human body
- interlobar artery
- artery that branches from the segmental artery and travels in between the renal lobes
- juxtaglomerular cell
- cell in the afferent and efferent arterioles that responds to stimuli from the macula densa
- juxtamedullary nephron
- nephron that lies in the cortex but close to the renal medulla
- kidney
- organ that performs excretory and osmoregulatory functions
- lobes of the kidney
- renal pyramid along with the adjoining cortical region
- loop of Henle
- part of the renal tubule that loops into the renal medulla
- macula densa
- group of cells that senses changes in sodium ion concentration; present in parts of the renal tubule and collecting ducts
- medulla
- middle layer of an organ like the kidney or adrenal gland
- nephron
- functional unit of the kidney
- perirenal fat capsule
- fat layer that suspends the kidneys
- peritubular capillary network
- capillary network that surrounds the renal tubule after the efferent artery exits the glomerulus
- proximal convoluted tubule (PCT)
- part of the renal tubule that lies close to the glomerulus
- renal artery
- branch of the artery that enters the kidney
- renal capsule
- layer that encapsulates the kidneys
- renal column
- area of the kidney through which the interlobar arteries travel in the process of supplying blood to the renal lobes
- renal corpuscle
- glomerulus and the Bowman’s capsule together
- renal fascia
- connective tissue that supports the kidneys
- renal pelvis
- region in the kidney where the calyces join the ureters
- renal pyramid
- conical structure in the renal medulla
- renal tubule
- tubule of the nephron that arises from the glomerulus
- renal vein
- branch of a vein that exits the kidney and joins the inferior vena cava
- segmental artery
- artery that branches from the renal artery
- transport maximum
- maximum amount of solute that can be transported out of the renal tubules during reabsorption
- tubular reabsorption
- reclamation of water and solutes that got filtered out in the glomerulus
- tubular secretion
- process of secretion of wastes that do not get reabsorbed
- ureter
- urine-bearing tube coming out of the kidney; carries urine to the bladder
- urinary bladder
- structure that the ureters empty the urine into; stores urine
- urine
- filtrate produced by kidneys that gets excreted out of the body
- vasa recta
- peritubular network that surrounds the loop of Henle of the juxtamedullary nephrons
Chapter 33 in OpenStax Concepts of Biology 2E


11.1 What Is an Earthquake?
An earthquake is the shaking caused by the rupture (breaking) and subsequent displacement of rocks (one body of rock moving with respect to another) beneath Earth’s surface.
A body of rock that is under stress becomes deformed. When the rock can no longer withstand the deformation, it breaks and the two sides slide past each other. Most earthquakes take place near plate boundaries, but not necessarily right on a boundary, and not necessarily even on a pre-existing fault.
The engineering principle of elastic deformation, which can be used to understand earthquakes, is illustrated in Figure 11.2. The stress applied to a rock — typically because of ongoing plate movement — results in strain or deformation of the rock (Figure 11.2b). Because most rock is strong (unlike loose sand, for example), it can withstand a significant amount of deformation without breaking. But every rock has a deformation limit and will rupture (break) once that limit is reached. At that point, in the case of rocks within the crust, the rock breaks and there is displacement along the rupture surface (Figure 11.2c). The magnitude of the earthquake depends on the extent of the area that breaks (the area of the rupture surface) and the average amount of displacement (sliding).
The concept of a rupture surface, which is critical to understanding earthquakes, is illustrated in Figure 11.3. An earthquake does not happen at a point, it happens over an area within a plane, although not necessarily a flat plane. Within the area of the rupture surface, the amount of displacement is variable (Figure 11.3), and, by definition, it decreases to zero at the edges of the rupture surface because the rock beyond that point isn’t displaced at all. The extent of a rupture surface and the amount of displacement will depend on a number of factors, including the type and strength of the rock, and the degree to which it was stressed beforehand.
Earthquake rupture doesn’t happen all at once; it starts at a single point and spreads rapidly from there. Depending on the extent of the rupture surface, the propagation of failures out from the point of initiation is typically completed within seconds to several tens of seconds (Figure 11.4). The initiation point isn’t necessarily in the centre of the rupture surface; it may be close to one end, near the top, or near the bottom.
Figure 11.5 shows the distribution of immediate aftershocks associated with the 1989 Loma Prieta earthquake. Panel (b) is a section along the San Andreas Fault; this view is equivalent to what is shown in Figures 11.3 and 11.4. The area of red dots is the rupture surface; each red dot is a specific aftershock that was recorded on a seismometer. The hexagon labelled “main earthquake” represents the first or main shock. When that happened, the rock at that location broke and was displaced. That released the stress on that particular part of the fault, but it resulted in an increase of the stress on other nearby parts of the fault, and contributed to a cascade of smaller ruptures (aftershocks), in this case, over an area about 60 km long and 15 km wide.
So, what exactly is an aftershock then? An aftershock is an earthquake just like any other, but it is one that can be shown to have been triggered by stress transfer from a preceding earthquake. Within a few tens of seconds of the main Loma Prieta earthquake, there were hundreds of smaller aftershocks; their distribution defines the area of the rupture surface.
Aftershocks can be of any magnitude. Most are smaller than the earthquake that triggered them, but they can be bigger. The aftershocks shown in Figure 11.5 all happened within seconds or minutes of the main shock, but aftershocks can be delayed for hours, days, weeks, or even years. As already noted, aftershocks are related to stress transfer. For example, the main shock of the Loma Prieta earthquake triggered aftershocks in the immediate area, which triggered more in the surrounding area, eventually extending for 30 km along the fault in each direction and for 15 km toward the surface. But the earthquake as a whole also changed the stress on adjacent parts of the San Andreas Fault. This effect, which has been modelled for numerous earthquakes and active faults around the world, is depicted in Figure 11.6. Stress was reduced in the area of the rupture (blue), but was increased at either end of the rupture surface (red and yellow).
Stress transfer isn’t necessarily restricted to the fault along which an earthquake happened. It will affect the rocks in general around the site of the earthquake and may lead to increased stress on other faults in the region. The effects of stress transfer don’t necessarily show up right away. Segments of faults are typically in some state of stress, and the transfer of stress from another area is only rarely enough to push a fault segment beyond its limits to the point of rupture. The stress that is added by stress transfer accumulates along with the ongoing buildup of stress from plate motion and eventually leads to another earthquake.
Episodic tremor and slip
Episodic tremor and slip (ETS) is periodic slow sliding along part of a subduction boundary. It does not produce recognizable earthquakes, but does produce seismic tremor (rapid seismic vibrations on a seismometer). It was first discovered on the Vancouver Island part of the Cascadia subduction zone by Geological Survey of Canada geologists Herb Dragert and Gary Rogers.*
The boundary between the subducting Juan de Fuca Plate and the North America Plate can be divided into three segments, as shown below. The cold upper part of the boundary is locked. The plates are stuck and don’t move, except with very large earthquakes that happen approximately every 500 years (the last one was M8.5+ in January 26, 1700). The warm lower part of the boundary is sliding continuously because the warm rock is weaker. The central part of the boundary isn’t cold enough to be stuck, but isn’t warm enough to slide continuously. Instead it slips episodically, approximately every 14 months for about 2 weeks, moving a few centimetres each time.
You might be inclined to think that it’s a good thing that there is periodic slip on this part of the plate because it releases some of the tension and reduces the risk of a large earthquake. In fact, the opposite is likely the case. The movement along the ETS part of the plate boundary acts like a medium-sized earthquake and leads to stress transfer to the adjacent locked part of the plate. Approximately every 14 months, during the two-week ETS period, there is a transfer of stress to the shallow locked part of the Cascadia subduction zone, and therefore an increased chance of a large earthquake.
Since 2003, ETS processes have also been observed on subduction zones in Mexico and Japan. [SE drawing]
*Rogers, G. and Dragert, H., 2003, Episodic tremor and slip on the Cascadia subduction zone: the chatter of silent slip, Science, V. 300, p. 1942-1943.


Chapter 4: Civil Liberties
Interpreting the Bill of Rights
LEARNING OUTCOMES
By the end of this section, you will be able to:
- Describe how the Ninth and Tenth Amendments reflect on our other rights
- Identify the two senses of the “right to privacy” embodied in the Constitution
- Explain the controversy over privacy when applied to abortion and same-sex relationships
As this chapter has suggested, the provisions of the Bill of Rights have been interpreted and reinterpreted repeatedly over the past two centuries. However, the first eight amendments are largely silent on the status of traditional common law, which was the legal basis for many of the natural rights claimed by the framers in the Declaration of Independence. These amendments largely reflect the worldview of the time in which they were written. New technology, societal norms, and economic realities furnish challenges that fail to fit neatly into the framework established in the late eighteenth century.
In this section, we consider the final two amendments of the Bill of Rights and the way they affect our understanding of the Constitution as a whole. Rather than protecting specific rights and liberties, the Ninth and Tenth Amendments indicate how the Constitution and the Bill of Rights should be interpreted, and lay out the residual powers of the state governments. We will also examine privacy rights, an area the Bill of Rights does not address directly. Rather, the emergence of defined privacy rights demonstrates how the Ninth and Tenth Amendments have been applied to expand the scope of rights protected by the Constitution.
THE NINTH AMENDMENT
We saw above that James Madison and the other framers were aware they might endanger some rights if they listed a few in the Constitution and omitted others. To ensure that those interpreting the Constitution would recognize that the listing of freedoms and rights in the Bill of Rights was not exhaustive, the Ninth Amendment states:
“The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.”
These rights “retained by the people” include the common-law and natural rights inherited from the laws, traditions, and past court decisions of England. To this day, we regularly exercise and take for granted rights that aren’t written down in the federal constitution, like the right to marry, the right to seek opportunities for employment and education, and the right to have children and raise a family. Supreme Court justices over the years have interpreted the Ninth Amendment in different ways, with some arguing that it was intended to extend the rights protected by the Constitution to those natural and common-law rights and others arguing that it does not prohibit states from changing their constitutions and laws to modify or limit those rights as they see fit.
Critics of a broad interpretation of the Ninth Amendment point out that the Constitution provides ways to protect newly formalized rights through the amendment process. For example, in the nineteenth and twentieth centuries, the right to vote was gradually expanded by a series of constitutional amendments (the Fifteenth and Nineteenth), even though at times this expansion was the subject of great public controversy. However, supporters of a broad interpretation of the Ninth Amendment point out that the rights of the people—particularly people belonging to political or demographic minorities—should not be subject to the whims of popular majorities. One right the courts have said may be at least partially based on the Ninth Amendment is a general right to privacy, discussed later in the chapter.
THE TENTH AMENDMENT
The Tenth Amendment is as follows:
“The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”
Unlike the other provisions of the Bill of Rights, this amendment focuses on power rather than rights. The courts have generally read the Tenth Amendment as merely stating, as Chief Justice Harlan Stone put it, a “truism that all is retained which has not been surrendered.”[1] In other words, rather than limiting the power of the federal government in any meaningful way, it simply restates what is made obvious elsewhere in the Constitution: the federal government has both enumerated and implied powers, but where the federal government does not (or chooses not to) exercise power, the states may do so. Others read this final “or” as capturing the essential question of U.S. political history: do the states who agreed to unite in a federal system remain sovereign, or once united, is it the federal government’s responsibility to protect the power of the people—including against states that might infringe upon them?
At times, politicians and state governments have argued that the Tenth Amendment means states can engage in interposition or nullification by blocking federal government laws and actions they deem to exceed the constitutional powers of the national government. But the courts have rarely been sympathetic to these arguments, except when the federal government appears to be directly requiring state and local officials to do something. For example, in 1997 the Supreme Court struck down part of a federal law that required state and local law enforcement to participate in conducting background checks for prospective gun purchasers, while in 2012 the court ruled that the government could not compel states to participate in expanding the joint state-federal Medicaid program by taking away all their existing Medicaid funding if they refused to do so.[2]
However, the Tenth Amendment also allows states to guarantee rights and liberties more fully or extensively than the federal government does, or to include additional rights. For example, many state constitutions guarantee the right to a free public education, several states give victims of crimes certain rights, and eighteen states include the right to hunt game and/or fish.[3] A number of state constitutions explicitly guarantee equal rights for men and women. Starting with Wyoming in 1869, some some states permitted women to vote before the Nineteenth Amendment secured the franchise for all women in 1920. Similarly, people aged 18–20 could vote in a few states before the Twenty-Sixth Amendment came into force in 1971. As we will see below, several states also explicitly recognize a right to privacy. State courts at times have interpreted state constitutional provisions to include broader protections for basic liberties than their federal counterparts. For example, though people do not generally have the right to free speech and assembly on private property owned by others without their permission, California’s constitutional protection of freedom of expression was extended to portions of some privately owned shopping centers by the state’s supreme court (Figure 4.18). [4]
These state protections do not extend the other way, however. If the federal government passes a law or adopts a constitutional amendment that restricts rights or liberties, or a Supreme Court decision interprets the Constitution in a way that narrows these rights, the state’s protection no longer applies. For example, if Congress decided to outlaw hunting and fishing and the Supreme Court decided this law was a valid exercise of federal power, the state constitutional provisions that protect the right to hunt and fish would effectively be meaningless. More concretely, federal laws that control weapons and drugs override state laws and constitutional provisions that otherwise permit them. While federal marijuana policies are not strictly enforced, state-level marijuana policies in Colorado and Washington provide a prominent exception to that clarity.
GET CONNECTED!
Student-Led Constitutional Change
Although the United States has not had a national constitutional convention since 1787, the states have generally been much more willing to revise their constitutions. In 1998, two politicians in Texas decided to do something a little bit different: they enlisted the help of college students at Angelo State University to draft a completely new constitution for the state of Texas, which was then formally proposed to the state legislature.[5] Although the proposal failed, it was certainly a valuable learning experience for the students who took part.
Each state has a different process for changing its constitution. In some, like California and Mississippi, voters can propose amendments to their state constitution directly, bypassing the state legislature. In others, such as Tennessee and Texas, the state legislature controls the process of initiation. The process can affect the sorts of amendments likely to be considered; it shouldn’t be surprising, for example, that amendments limiting the number of terms legislators can serve in office have been much more common in states where the legislators themselves have no say in whether such provisions are adopted.
What rights or liberties do you think ought to be protected by your state constitution that aren’t already? Or would you get rid of some of these protections instead? Find a copy of your current state constitution, read through it, and decide. Then find out what steps would be needed to amend your state’s constitution to make the changes you would like to see.
THE RIGHT TO PRIVACY
Although the term privacy does not appear in the Constitution or Bill of Rights, scholars have interpreted several Bill of Rights provisions as an indication that James Madison and Congress sought to protect a common-law right to privacy as it would have been understood in the late eighteenth century: a right to be free of government intrusion into our personal life, particularly within the bounds of the home. For example, one could see the Second Amendment as standing for the common-law right to self-defense in the home; the Third Amendment as a statement that government soldiers should not be housed in anyone’s home; the Fourth Amendment as setting a high legal standard for allowing agents of the state to intrude on someone’s home; and the due process and takings clauses of the Fifth Amendment as applying an equally high legal standard to the government’s taking a home or property (reinforced after the Civil War by the Fourteenth Amendment). Alternatively, one could argue that the Ninth Amendment anticipated the existence of a common-law right to privacy, among other rights, when it acknowledged the existence of basic, natural rights not listed in the Bill of Rights or the body of the Constitution itself.[6] Lawyers Samuel D. Warren and Louis Brandeis (the latter a future Supreme Court justice) famously developed the concept of privacy rights in a law review article published in 1890.[7]
Although several state constitutions do list the right to privacy as a protected right, the explicit recognition by the Supreme Court of a right to privacy in the U.S. Constitution emerged only in the middle of the twentieth century. In 1965, the court spelled out the right to privacy for the first time in Griswold v. Connecticut, a case that struck down a state law forbidding even married individuals to use any form of contraception.[8] Although many subsequent cases before the Supreme Court also dealt with privacy in the course of intimate, sexual conduct, the issue of privacy matters as well in the context of surveillance and monitoring by government and private parties of our activities, movements, and communications. Both these senses of privacy are examined below.
Sexual Privacy
Although the Griswold case originally pertained only to married couples, in 1972 it was extended to apply the right to obtain contraception to unmarried people as well.[9] Although neither decision was entirely without controversy, the “sexual revolution” taking place at the time may well have contributed to a sense that anti-contraception laws were at the very least dated, if not in violation of people’s rights. The contraceptive coverage controversy surrounding the Hobby Lobby case shows that this topic remains relevant.
The Supreme Court’s application of the right to privacy doctrine to abortion rights proved far more problematic, legally and politically. In 1972, four states permitted abortions without restrictions, while thirteen allowed abortions “if the pregnant woman’s life or physical or mental health were endangered, if the fetus would be born with a severe physical or mental defect, or if the pregnancy had resulted from rape or incest”; abortions were completely illegal in Pennsylvania and heavily restricted in the remaining states.[10] On average, several hundred American women a year died as a result of “back alley abortions” in the 1960s.
The legal landscape changed dramatically as a result of the 1973 ruling in Roe v. Wade,[11] in which the Supreme Court decided the right to privacy encompassed a right for women to terminate a pregnancy, at least under certain scenarios. The justices ruled that while the government did have an interest in protecting the “potentiality of human life,” nonetheless this had to be balanced against the interests of both women’s health and women’s right to decide whether to have an abortion. Accordingly, the court established a framework for deciding whether abortions could be regulated based on the fetus’s viability (i.e., potential to survive outside the womb) and the stage of pregnancy, with no restrictions permissible during the first three months of pregnancy (i.e., the first trimester), during which abortions were deemed safer for women than childbirth itself.
Starting in the 1980s, Supreme Court justices appointed by Republican presidents began to roll back the Roe decision. A key turning point was the court’s ruling in Planned Parenthood v. Casey in 1992, in which a plurality of the court rejected Roe’s framework based on trimesters of pregnancy and replaced it with the undue burden test, which allows restrictions prior to viability that are not “substantial obstacle[s]” (undue burdens) to women seeking an abortion.[12] Thus, the court upheld some state restrictions, including a required waiting period between arranging and having an abortion, parental consent (or, if not possible for some reason such as incest, authorization of a judge) for minors, and the requirement that women be informed of the health consequences of having an abortion. Other restrictions such as a requirement that a married woman notify her spouse prior to an abortion were struck down as an undue burden. Since the Casey decision, many states have passed other restrictions on abortions, such as banning certain procedures, requiring women to have and view an ultrasound before having an abortion, and implementing more stringent licensing and inspection requirements for facilities where abortions are performed. Although no majority of Supreme Court justices has ever moved to overrule Roe, the restrictions on abortion the Court has upheld in the last few decades have made access to abortions more difficult in many areas of the country, particularly in rural states and communities along the U.S.–Mexico border (Figure 4.19). However, in Whole Woman’s Health v. Hellerstedt (2016), the Court reinforced Roe 5–3 by disallowing two Texas state regulations regarding the delivery of abortion services.[13] Yet, the issue is far from settled, as the Supreme Court decided in May 2021 to hear in their next term a Mississippi case that would roll back abortion rights considerably. The case would disallow abortions after fifteen weeks.[14]
Beyond the issues of contraception and abortion, the right to privacy has been interpreted to encompass a more general right for adults to have noncommercial, consensual sexual relationships in private. However, this legal development is relatively new; as recently as 1986, the Supreme Court ruled that states could still criminalize sex acts between two people of the same sex.[15] That decision was overturned in 2003 in Lawrence v. Texas, which invalidated state laws that criminalized sodomy.[16]
The state and national governments still have leeway to regulate sexual morality to some degree; “anything goes” is not the law of the land, even for actions that are consensual. The Supreme Court has declined to strike down laws in a few states that outlaw the sale of vibrators and other sex toys. Prostitution remains illegal in every state except in certain rural counties in Nevada; both polygamy (marriage to more than one other person) and bestiality (sex with animals) are illegal everywhere. And, as we saw earlier, the states may regulate obscene materials and, in certain situations, material that may be harmful to minors or otherwise indecent; to this end, states and localities have sought to ban or regulate the production, distribution, and sale of pornography.
Privacy of Communications and Property
Another example of heightened concerns about privacy in the modern era is the reality that society is under pervasive surveillance. In the past, monitoring the public was difficult at best. During the Cold War, regimes in the Soviet bloc employed millions of people as domestic spies and informants in an effort to suppress internal dissent through constant monitoring of the general public. Not only was this effort extremely expensive in terms of the human and monetary capital it required, but it also proved remarkably ineffective. Groups like the East German Stasi and the Romanian Securitate were unable to suppress the popular uprisings that undermined communist one-party rule in most of those countries in the late 1980s.
Technology has now made it much easier to track and monitor people. Police cars and roadways are equipped with cameras that can photograph the license plate of every passing car or truck and record it in a database; while allowing police to recover stolen vehicles and catch fleeing suspects, this data can also be used to track the movements of law-abiding citizens. But law enforcement officials don’t even have to go to this much work; millions of car and truck drivers pay tolls electronically without stopping at toll booths thanks to transponders attached to their vehicles, which can be read by scanners well away from any toll road or bridge to monitor traffic flow or any other purpose (Figure 4.20). The pervasive use of GPS (Global Positioning System) raises similar issues.
Even pedestrians and cyclists are relatively easy to track today. Cameras pointed at sidewalks and roadways can employ facial recognition software to identify people as they walk or bike around a city. Many people carry smartphones that constantly report their location to the nearest cell phone tower and broadcast a beacon signal to nearby wireless hotspots and Bluetooth devices. Police can set up a small device called a Stingray that identifies and tracks all cell phones that attempt to connect to it within a radius of several thousand feet. With the right software, law enforcement and criminals can remotely activate a phone’s microphone and camera, effectively planting a bug in someone’s pocket without the person even knowing it.
These aren’t just gimmicks in a bad science fiction movie; businesses and governments have openly admitted they are using these methods. Research shows that even metadata—information about the messages we send and the calls we make and receive, such as time, location, sender, and recipient but excluding their content—can tell governments and businesses a lot about what someone is doing. Even when this information is collected in an anonymous way, it is often still possible to trace it back to specific individuals, since people travel and communicate in largely predictable patterns.
The next frontier of privacy issues may well be the increased use of drones, small preprogrammed or remotely piloted aircraft. Drones can fly virtually undetected and monitor events from overhead. They can peek into backyards surrounded by fences, and using infrared cameras they can monitor activity inside houses and other buildings. The Fourth Amendment was written in an era when finding out what was going on in someone’s home meant either going inside or peeking through a window; applying its protections today, when seeing into someone’s house can be as easy as looking at a computer screen miles away, is no longer simple.
In the United States, many advocates of civil liberties are concerned that laws such as the USA PATRIOT Act (i.e., Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act), passed weeks after the 9/11 attacks in 2001, have given the federal government too much power by making it easy for officials to seek and obtain search warrants or, in some cases, to bypass warrant requirements altogether. Critics have argued that the Patriot Act has largely been used to prosecute ordinary criminals, in particular drug dealers, rather than terrorists as intended. Most European countries, at least on paper, have opted for laws that protect against such government surveillance, perhaps mindful of past experience with communist and fascist regimes. European countries also tend to have stricter laws limiting the collection, retention, and use of private data by companies, which makes it harder for governments to obtain and use that data. Most recently, the battle between Apple Inc. and the National Security Agency (NSA) over whether Apple should allow the government access to key information that is encrypted has made the discussion of this tradeoff salient once again. A recent court outcome in the United States suggests that America may follow Europe’s lead. In Carpenter v. United States (2018), the first case of its kind, the U.S. Supreme Court ruled that, under the Fourth Amendment, police need a search warrant to gather phone location data as evidence to be used in trials.[17]
LINK TO LEARNING
Several groups lobby the government, such as The Electronic Frontier Foundation and The Electronic Privacy Information Center, on issues related to privacy in the information age, particularly on the Internet.
All this is not to say that technological surveillance tools do not have value or are inherently bad. They can be used for many purposes that would benefit society and, perhaps, even enhance our freedoms. Spending less time stuck in traffic because we know there’s been an accident—detected automatically because the cell phones that normally whiz by at the speed limit are now crawling along—gives us time to spend on more valuable activities. Capturing criminals and terrorists by recognizing them or their vehicles before they can continue their agendas will protect the life, liberty, and property of the public at large. At the same time, however, the emergence of these technologies means calls for vigilance and limits on what businesses and governments can do with the information they collect and the length of time they may retain it. We might also be concerned about how this technology could be used by more oppressive regimes. If the technological resources that are at the disposal of today’s governments had been available to the East Germany Stasi and the Romanian Securitate, would those repressive regimes have fallen? How much privacy and freedom should citizens sacrifice in order to feel safe?
CHAPTER REVIEW
See the Chapter 4.4 Review for a summary of this section, the key vocabulary, and some review questions to check your knowledge.
- United States v. Darby Lumber, 312 U.S. 100 (1941). ↵
- Printz v. United States, 521 U.S. 898 (1997); National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012). ↵
- See Douglas Shinkle, “State Constitutional Right to Hunt and Fish.” National Conference of State Legislatures, November 9, 2015. http://www.ncsl.org/research/environment-and-natural-resources/state-constitutional-right-to-hunt-and-fish.aspx (March 4, 2016). ↵
- Pruneyard Shopping Center v. Robins, 447 U.S. 74 (1980). ↵
- The Texas Politics Project, “Trying to Rewrite the Texas Constitution,” https://texaspolitics.utexas.edu/archive/html/cons/features/0602_01/slide1.html (March 1, 2016). ↵
- See Griswold v. Connecticut, 381 U.S. 479 (1965). This discussion parallels the debate among the members of the Supreme Court in the Griswold case. ↵
- Samuel Warren and Louis D. Brandeis. 1890. “The Right to Privacy,” Harvard Law Review 4, No. 193. ↵
- Griswold v. Connecticut, 381 U.S. 479 (1965) ↵
- Eisenstadt v. Baird, 405 U.S. 438 (1972). ↵
- See Rachel Benson Gold. March 2003. “Lessons from Before Roe: Will Past be Prologue?” The Guttmacher Report on Public Policy 6, No. 1. https://www.guttmacher.org/pubs/tgr/06/1/gr060108.html (March 4, 2016). ↵
- Roe v. Wade, 410 U.S. 113 (1973). ↵
- Planned Parenthood v. Casey, 505 U.S. 833 (1992). ↵
- Whole Woman’s Health v. Hellerstedt, 579 U.S. ___ (2016). ↵
- Nina Totenberg, "In Challenge to Roe, Supreme Court to Review Mississippi Abortion Law," NPR, 17 May 2021, https://www.npr.org/2021/05/17/997478374/supreme-court-to-review-mississippi-abortion-ban. ↵
- Bowers v. Hardwick, 478 U.S. 186 (1986). ↵
- Lawrence v. Texas, 539 U.S. 558 (2003). ↵
- Carpenter v. United States, No. 16-402, 585 U.S. ____ (2018). https://www.supremecourt.gov/opinions/17pdf/16-402_h315.pdf. Alfred Ng. 22 June 2018. "Supreme Court Says Warrant Necessary for Phone Location Data in Win for Privacy." cnet.com. https://www.cnet.com/news/supreme-court-says-warrant-necessary-for-phone-location-data/. ↵
the right to be free of government intrusion
a means of deciding whether a law that makes it harder for women to seek abortions is constitutional
a law passed by Congress in the wake of the 9/11 attacks that broadened federal powers to monitor electronic communications; the full name is the USA PATRIOT Act (Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act)


Libraries and Learning
The Fix Isn’t In
March 3, 2016
By now, you’ve probably heard of Sci-Hub, a collection of millions of articles being gathered through borrowed or stolen library logins, then loaded onto servers abroad for anyone to download. The woman who started it has been called a modern-day Robin Hood. Also, a criminal. There has also been heated debate about why librarians aren’t doing more to back publishers in this fight. After all, these thieves are taking advantage of licensed scholarship that costs libraries billions of dollars annually! Surely we want to stop this rampant theft!
To which I’m tempted to respond “when did we sign on to become your guards, and when do we get a check for this labor?” Because it is labor – lots of labor – to maintain link resolvers, keep license agreements in order, and deal with constant changes in subscription contents. We have to work a lot harder to be publishers’ border guards than people realize.
While this runs completely counter to our values, we really have no choice but to provide this free labor. Libraries run the risk of having their institutional access cut off if a publisher finds their institutional IP address is involved in a massive download. More troubling is the fact that stolen or leaked credentials can seriously compromise both network and individual security.
In other words, whatever you think of Sci-Hub, it’s not the fix for the mess we’re in.
So why are scholars using Sci-Hub? I can think of a couple of reasons: they may have no other access to these articles, not being affiliated with a well-funded first world library (the Robin Hood version) or because getting access is a hassle and hey, I need those articles! Give me those articles right now! For many folks, Sci-Hub is simply a more convenient library that doesn’t make you mess around with logins and interlibrary loans. Hey, we’re busy. Paywalls are a pain.
Librarians are in a nasty spot. Sometimes I wonder if we can even call ourselves librarians anymore. We feel we are virtually required to provide access to whatever researchers in our local community ask for while restricting access from anyone outside that narrowly-defined community of users. Instead of curators, we’re personal shoppers who moonlight as border guards. This isn’t working out well for anyone. Unaffiliated researchers have to find illegal work-arounds, and faculty who actually have access through libraries are turning to the black market for articles because it seems more efficient than contacting their personal shopper, particularly when the library itself doesn’t figure in their work flow. In the meantime, all that money we spend on big bundles of articles (or on purchasing access to articles one at a time when we can’t afford the bundle anymore) is just a really high annual rent. We can’t preserve what we don’t own, and we don’t curate because our function is to get what is asked for.
This is how to dig a grave for libraries as a common good.
I’ve been thinking about this while also mulling over Scott McClemee’s take on the Ithaka study of how much it costs for a university press to publish a book. TL;DR – it costs a lot, not including the work of doing the research and writing it up. Though there’s no profit margin like that of the big commercial journal publishers to factor in, those costs are built into the price of books because . . . well, publishers are supposed to make money, not lose it. So prices are high because each book is handcrafted artisanal scholarship. A few hundred copies of the average scholarly book enters the marketplace of ideas, where they might connect with an audience – or not. Libraries aren’t a major market anymore because we’re spending all of our money on articles. Yet for some reason we still insist on book-shaped badges for tenure and measure the worth of scholars in many fields by their publisher’s brand.
This is how to dig a grave for knowledge as a common good. Spend a lot of money writing and publishing books that few people will have a chance to read.
It seems to me both issues raise some big questions we have to answer:
- What are we trying to do with our research?
- Who benefits?
- Who pays?
- How can all the parties involved get on the same page so that we can fix this mess?


4. Robust
Introduction to Robust
Principle 4: Robust
Content must be robust enough that it can be interpreted reliably by a wide variety of user agents, including assistive technologies.
The Principle Explained
If you open the browser’s View Source feature while viewing a web page, you will find a document that consists of all the words that appear on the page (the content). Thickly interspersed with those words, there are non-words, numbers, and symbols (the code). The code describes how the content should be formatted and what purpose it serves.
During the process of creating a web page, errors tend to creep into the code. In fact, mistakes are almost inevitable. These errors almost always affect the appearance and functionality of the page. The effects may be minor (the formatting is slightly off) or major (the page does not display at all).
Principle 4 is about making websites robust. A robust web page meets the following conditions:
- It displays content as the author intends
- It functions as the author intends
- It is compatible with current and future browsers, web-enabled devices, and assistive technologies
Browsers, web-enabled devices, and assistive technologies do their best to compensate for coding errors. But there are limits to what can be repaired. To conform to Principle 4, web authors are required to avoid specific kinds of coding errors.


62 Diagnostic Sonography Program Curriculum
Students are eligible for graduation upon successful completion of all of the following program courses with a “C” grade or better.
Professional Courses for the Medical Sonography Track
| Junior Summer II | ||
| Description | Course | Credits |
| Sonography Orientation | RADI-S 410 | 2.0 |
| Medical Sonography Lab Fundamentals | RADI-S 430 | 3.0 |
| Medical Sonography Clinical Practicum Introduction | RADI-S 450 | 1.0 |
| Total Credits | 6.0 | |
| Junior Fall | ||
| Medical Sonography Procedures I | RADI-S 420 | 4.0 |
| Medical Sonography Lab I | RADI-S 431 | 3.0 |
| Sonographic Physical Principles I | RADI-S 440 | 3.0 |
| Medical Sonography Clinical Practicum I | RADI-S 451 | 3.0 |
| Total Credits | 13.0 | |
| Junior Spring | ||
| Medical Sonography Procedures II | RADI-S 421 | 4.0 |
| Medical Sonography Lab II | RADI-S 432 | 3.0 |
| Sonographic Physical Principles II | RADI-S 441 | 3.0 |
| Medical Sonography Clinical Practicum II | RADI-S 452 | 3.0 |
| Total Credits | 13.0 | |
| Senior Summer | ||
| Medical Sonography Clinical Practicum III | RADI-S 453 | 6.0 |
| Total Credits | 6.0 | |
| Senior Fall | ||
| Medical Sonography Lab III | RADI-S 433 | 1.0 |
| Medical Sonography Professional Life | RADI-S 460 | 3.0 |
| Medical Sonography Clinical Practicum IV | RADI-S 454 | 4.0 |
| Total Credits | 8.0 |
Professional Courses for the Adult Echocardiography Track
| Junior Summer II | ||
| Description | Course | Credits |
| Sonography Orientation | RADI-S 410 | 2.0 |
| Echocardiography Lab Fundamentals | RADI-E 430 | 3.0 |
| Echocardiography Clinical Practicum Introduction | RADI-E 450 | 1.0 |
| Total Credits | 6.0 | |
| Junior Fall | ||
| Echocardiography Procedures I | RADI-E 420 | 4.0 |
| Echocardiography Lab I | RADI-E 431 | 3.0 |
| Sonographic Physical Principles I | RADI-S 440 | 3.0 |
| Echocardiography Clinical Practicum I | RADI-E 451 | 3.0 |
| Total Credits | 13.0 | |
| Junior Spring | ||
| Echocardiography Procedures II | RADI-E 421 | 4.0 |
| Echocardiography Lab II | RADI-E 432 | 3.0 |
| Sonographic Physical Principles II | RADI-S 441 | 3.0 |
| Echocardiography Clinical Practicum II | RADI-E 452 | 3.0 |
| Total Credits | 13.0 | |
| Senior Summer | ||
| Echocardiography Clinical Practicum III | RADI-E 453 | 6.0 |
| Total Credits | 6.0 | |
| Senior Fall | ||
| Echocardiography Lab III | RADI-E 433 | 1.0 |
| Echocardiography Professional Life | RADI-E 460 | 3.0 |
| Echocardiography Clinical Practicum IV | RADI-E 454 | 4.0 |
| Total Credits | 8.0 |


195 Author Introduction: Frances Ellen Watkins Harper
FRANCES ELLEN WATKINS HARPER (1825-1911)
Tammie Jenkins
Introduction
The years immediately following the abolishment of slavery in the United States signified a transition in the expectation of the larger society and their role in the development of their community and acquirement of citizenships. Newly freed, Black people endeavored to integrate themselves into these narratives and to consider ways that they could achieve the American Dream. During these critical years, Black activists and scholars such as W. E. B. DuBois, Booker T. Washington, and Marcus Garvey, who began proposing ways that Black Americans could either assimilate or leave the United States as part of a mass exodus back to Africa. DuBois was expounding his notions of a double consciousness which he felt that Black Americans possessed, as vehicle for viewing the world from multiple perspectives including their own. Whereas, Washington taunted the idea that Black Americans needed to adapt skills that demonstrated their usefulness and conformity to the expectations of the larger society. Meanwhile, Garvey encouraged Black Americans to return to Africa and build communities in their homeland. These men were highly vocal and used their words as well as oratorical attributes to present their thoughts in public spaces. Women such as Frances Ellen Watkins Harper began entering these spaces and expressing their ideas regarding the role of Black people in a post-slavery United States through their written and oral texts.
Frances Ellen Harper (née Watkins) was born on September 24, 1825, in Baltimore, Maryland. Her parents have been identified as free persons of color who passed away while she was a young girl. Frances was reared by her maternal uncle, Reverend William Watkins, a civil rights activist, and his wife, Harriet. Harper received her academic and vocational education at Academy for Negro Youth. At the age of fourteen, Frances worked as a seamstress before moving to Ohio and acquiring employment as a school teacher at Union Seminary. By age twenty, Frances had published a book of poetry titled Forest Leaves. She resigned her teaching position and pursued employment as a traveling lecturer with the American Anti-Slavery Society. Harper continued to publish poetry and deliver speeches until she met and married Fenton Harper, a widower with three children in 1860. From their union a daughter, Mary Frances Harper was born. Following her marriage, Frances withdrew from public life and assumed the roles of wife, mother, and homemaker until the death of her husband, Fenton.
Harper returned to public life as a professional lecturer, abolitionist, and author in an effort to provide for her family and to bring socially relevant subject matter such as temperance, women’s suffrage, and civil rights into larger societal conversations. Frances possessed an oratorical style commonly associated with masculinized speech patterns; yet, her written texts such as Iola Leroy or Shadows Uplifted, Bury Me in a Free Land, and Slave Auction transcended the binary of gender. This enabled her to rewrite many of the social expectations and stereotypes regarding Black women through her engagement in meaningful and reciprocal relationships with her audiences and readers. The Slave Auction is a poem first published in 1854, in which Harper draws on the history of African enslavement in the United States. She retells the story of Black mothers helplessly watching as their daughters were sold to the highest bidder. While Bury Me in a Free Land addresses slavery and its atrocities from the perspective of the enslaved and that of their descendants. However, her better known work Iola Leroy or Shadows Uplifted, in which each of the Black female characters embarked on a search for a personal “truth”. Iola Leroy, the protagonist, uses her lived experiences and social interactions with other characters to reconstruct her understandings of the larger society and her role in these discourses. Harper’s texts embodied the expectations of the Black community blended with larger societal discourses in ways that challenged or recreated these issues. She uses thematic or situationally constructed knowledge to redefine her narratives by providing the historical context or fictionalized testimonials for events such as slavery, miscegenation, and freedom in ways that recreated these narratives as intergenerational conversations. Similar, to the philosophical perspectives which were integral attributes in the works of DuBois, Washington, and Garvey, Harper used her lived experiences and social interactions to articulate ways for Black people to build their communities and uplift the race. She encouraged education and activism as vehicles for social change and communal advancement.
Works Cited:
Hollis, Robbin, Ed. “Introduction” Iola Leroy or Shadows Uplifted, New York: Penguin Press, 2010.
Sanborn, Geoffrey. Mother’s Milk: Frances Harper and the Circulation of Blood. ELH, vol. 72, no. 3, 2005, pp. 691-715.
Stancliff, Michael. Frances Ellen Watkins Harper: African American Reform Rhetoric and the Rise of a Modern State. New York: Routledge, 2010.
********
Citation:
Jenkins, Tammie. “FRANCES ELLEN WATKINS HARPER (1825-1911).” Open Anthology of Earlier American Literature. Ed. Timothy Robbins. Accessed January 17, 2023.
https://press.rebus.community/openamlit/chapter/frances-ellen-watkins-harper/.


Ohio’s Noxious Weeds
Apple of Peru
Nicandra physalodes, apple of Peru
Family: Nightshade, Solanaceae.
Habitat: Habitats include areas adjacent to flower gardens, areas along roadside ditches, cropland, and fallow fields. This species is occasionally cultivated in flower gardens because of the moderately attractive flowers. It prefers disturbed areas.
Life cycle: Summer annual.
Growth habit: 2-5 ft tall.
Leaves: Alternate leaves are up to 8″ long and 4″ across (excluding the petioles). They are ovate-cordate and sparsely pubescent. Their margins are shallowly lobed, bluntly dentate, or undulate.
Stem: Five angled (pentagon) hollow stem, spreading branches.
Flower: Trumpet-shaped lavender flowers that may occasionally be white, 5 cm or more across, and are produced from July to September.
Roots: Fibrous root system.
Similar Plants: The foliage of the Apple of Peru, or Shoofly, plant resembles an oversized Ground Cherry, but its flowers are quite different.
The Problem is……………Apple of Peru germinates continuously (spring, summer, and fall) in agricultural fields if moisture is available. It has low sensitivity to most commonly used herbicides. Poor control results in heavy infestations because it is a prolific seed producer. Large, persistent seed banks quickly accumulate in the soil due to seed dormancy. Very competitive with soybean and vegetable crops. Also confirmed alternative host for cucumber mosaic virus.


8.11 Anti-Parkinson’s Medications
Parkinson’s disease is believed to be related to an imbalance of dopamine and acetylcholine and a deficiency of dopamine in certain areas of the brain, so drug therapies are aimed at increasing levels of dopamine and/or antagonizing the effects of acetylcholine. Drug therapy does not cure the disease but is used to slow the progression of symptoms. Common medications used to treat Parkinson’s disease are carbidopa/levodopa, selegiline, and amantadine.
Carbidopa/Levodopa
Carbidopa/levodopa is the most common drug used to treat Parkinson’s disease and is usually started as soon as the client becomes functionally impaired.
Mechanism of Action: Administration of dopamine is ineffective in the treatment of Parkinson’s disease because it does not cross the blood-brain barrier, but levodopa, the metabolic precursor of dopamine, does cross the blood-brain barrier and presumably is converted to dopamine in the brain. Carbidopa is combined with levodopa to help stop the breakdown of levodopa before it is able to cross the blood-brain barrier. Additionally, the incidence of levodopa-induced nausea and vomiting is less when it is combined with carbidopa.
Indications: Carbidopa/levodopa is indicated for Parkinson’s disease. It is also used to treat restless leg syndrome.
Nursing Considerations: Carbidopa/levodopa is recommended for use in clients older than age 18. It can take several weeks to see positive effects, and this should be explained to clients and their caregivers.
The drug is contraindicated for use with MAOIs. All clients should be observed carefully for the development of depression with concomitant suicidal tendencies.
Clients taking carbidopa and levodopa have reported suddenly falling asleep without prior warning of sleepiness while engaged in activities of daily living (including operation of motor vehicles). Clients should be advised to exercise caution while driving or operating machines during treatment with carbidopa and levodopa.
Sporadic cases of symptoms resembling neuroleptic malignant syndrome (NMS) have been reported in association with dose reductions or withdrawal of certain anti-Parkinsonian agents. Therefore, clients should be observed carefully when the dosage of levodopa is reduced abruptly or discontinued.
Periodic evaluations of hepatic, hematopoietic, cardiovascular, and renal functions are recommended during extended therapy. The most common adverse effect of carbidopa/levodopa is dyskinesia, which may require dosage reduction.
Clients should be instructed to plan their mealtimes around medication times to improve the ability to use their utensils and to avoid diets high in protein due to decreased absorption of the medication.
Side Effects/Adverse Effects: Hallucinations and psychotic-like behavior have been reported with dopaminergic medications. Clients taking dopaminergic medications may experience intense gambling urges, increased sexual urges, intense urges to spend money, binge eating, and/or other intense urges, and the inability to control these urges. These urges stopped when the dosage was decreased or the medication discontinued.
A higher risk for melanoma has been reported. Occasionally, dark red, brown, or black color may appear in saliva, urine, or sweat after ingestion of carbidopa and levodopa. Although the color appears to be clinically insignificant, garments may become discolored.
Health Teaching & Health Promotion: Clients should take their medications at regular intervals as directed. If gastric irritation is experienced, clients may eat food shortly after taking medications, but high-protein foods may impair drug action. Medications may cause increased drowsiness, dizziness, and orthostatic changes. Clients should carefully assess their skin to monitor for new lesions, and any abnormality should be reported to the health care provider.[1]
Now let’s take a closer look at the medication grid for carbidopa-levodopa in Table 8.11a.[2]
Table 8.11a Carbidopa-Levodopa Medication Grid
| Class/Subclass | Prototype/Generic | Nursing Considerations | Therapeutic Effects | Side/Adverse Effects |
|---|---|---|---|---|
| Anti-Parkinson’s Agent | carbidopa/levodopa | Avoid high-protein diets due to decreased absorption
Monitor for sudden somnolence and increased depression Contraindicated with MAOIs Periodically monitor hepatic, renal, and hematopoietic functions |
Slow progression of symptoms of Parkinson’s disease (tremors, rigidity, and mobility issues) | Depression, suicidal ideation, hallucinations, and intense urges with inability to control them
Somnolence and fatigue NMS symptoms with dose reductions or when discontinued Dyskinesia Discolored body fluids Hypomobility with long-term use |
Selegiline
Selegiline is often used conjunction with carbidopa-levodopa when clients demonstrate a deteriorating response to this treatment. It is helpful to control symptom fluctuations.
Mechanism of Action: Selegiline inhibits MAO-B, blocking the breakdown of dopamine.
Indications: Selegiline capsules are indicated as an adjunct in the management of Parkinsonian clients being treated with levodopa/carbidopa who exhibit deterioration in the quality of their response to this therapy. There is no evidence from controlled studies that selegiline has any beneficial effect in the absence of concurrent levodopa therapy.
Nursing Considerations: Large doses of selegiline may inhibit MAO-A that promotes metabolism of tyramine in the GI tract, which can cause a hypertensive crisis.
Side Effects/Adverse Effects: Side effects are dose-dependent, with larger doses posing a hypertensive crisis risk if there is consumption of food or beverages with tyramine.
Health Teaching & Health Promotion: Clients should be advised to avoid foods high in tyramine. Additionally, medications may cause increased drowsiness, dizziness, and orthostatic changes. If clients experience abnormal behaviors such as hallucinations, sexual urges, gambling, etc., this should be reported promptly to the health care provider.
Now let’s take a closer look at the medication grid for selegiline in Table 8.11b.[3]
Table 8.11b Selegiline Medication Grid
| Class/Subclass | Prototype/Generic | Nursing Considerations | Therapeutic Effects | Side/Adverse Effects |
|---|---|---|---|---|
| Anti-Parkinson’s Agent, MAO Type B Inhibitor | selegiline | Avoid food with tyramine if on a large dose (above 10mg/day) | Minimize progression of Parkinson’s disease symptoms | Higher doses increase risk for hypertensive crisis |
Amantadine
Amantadine is used in early stages of Parkinson’s disease but can be effective in moderate or advanced stages in reducing tremor and muscle rigidity.
Mechanism of Action: The exact mechanism of action is unknown. Amantadine is an antiviral drug that acts on dopamine receptors.
Indications: Amantadine is used for Parkinson’s disease, medication-induced extrapyramidal symptoms, and influenza A.
Nursing Considerations: Use cautiously with renal impairment. This drug may cause suicidal ideation and should not be stopped abruptly or can cause Parkinsonian crisis. Neuroleptic malignant syndrome (NMS) has been reported in association with dose reduction or withdrawal of amantadine therapy.
Side Effects/Adverse Effects: Suicide ideation, congestive heart failure, and peripheral edema can occur. This drug can cause intense gambling urges, increased sexual urges, intense urges to spend money uncontrollably, and other intense urges with an inability to control them. There is an increased risk of melanoma.
Adverse reactions reported most frequently are nausea, dizziness (light-headedness), and insomnia. This drug can also cause anticholinergic side effects, impaired thinking, and orthostatic hypotension.
Health Teaching & Health Promotion: Clients should take medications as directed and ensure they do not skip or double doses. Medications may cause drowsiness, dizziness, and orthostatic blood pressure changes. Clients should avoid using this medication with OTC cold medications or alcoholic beverages. If clients, family, or caregivers note worsening depression or suicidality, this should be reported immediately to the health care provider.[4]
Now let’s take a closer look at the medication grid for amantadine in Table 8.11c.[5]
Table 8.11c Amantadine Medication Grid
| Class/Subclass | Prototype/Generic | Nursing Considerations | Therapeutic Effects | Side/Adverse Effects |
|---|---|---|---|---|
| Anti-Parkinson Agent, Antiviral | amantadine | Monitor renal function
Monitor mental state Assess blood pressure |
Improve Parkinson’s disease symptoms | Increased suicidal ideation and urges
Congestive heart failure and peripheral edema Neuroleptic malignant syndrome (NMS) when dosage decreased Orthostatic hypotension Nausea, dizziness, and insomnia Anticholinergic side effects |
Critical Thinking Activity 8.11
A 76-year-old client in a long-term care center has developed a shuffling gait with a stooped posture, along with a hand tremor at rest. The nurse practitioner prescribed carbidopa/levodopa.
- The nurse knows that Parkinson’s disease is related to dopamine, but dopamine can’t cross the blood-brain barrier. How will carbidopa/levodopa assist with dopamine levels?
- The client states, “I am looking forward to spending next weekend with my grandson. He even said he would let me drive his new Mustang!” What teaching should the nurse provide the client and his grandson (with the client’s permission) regarding the new medication and his weekend plans?
- The nurse reads that the most common side effect of carbidopa-levodopa is dyskinesia. What is dyskinesia? If it occurs, what is the likely treatment?
Note: Answers to the Critical Thinking activities can be found in the “Answer Key” section at the end of the book.
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
A nearly impenetrable barricade that is built from a tightly woven mesh of capillaries cemented together to protect the brain from potentially dangerous substances such as poisons or viruses.