Conan Doyle and Ronald Dahl Essay

In this essay I am going to examine the two stories by Sir Arthur Conan Doyle and Ronald Dahl, The Speckled Band and Lambs to the Slaughter. I will do so by comparing, contrasting, and explaining what the two writers are trying to say in each story because both stories are very different but both are the same genre. I will also explain what a genre is, and give examples of their many types. I will start with The Speckled Band by Sir Arthur Conan Doyle. The story contains one of the most famous fictional detectives the world has ever known, Sherlock Holmes. This character was created by Sir Arthur and surfaced in 1887 in Victorian times. The Victorians completely fell for the fictional character because crime was high in London at this time no one was safe. They also liked the character because he cracked every case and always defeated evil. When Doyle tried to kill of the character in 1893, there was a public outcry and Doyle received death threats warning him to keep Holmes alive. The language used is first person and it seems like the story is aimed at a type of upper class because it uses more sophisticated words for intelligent people. Where as Lambs to the Slaughter is third person and it is aimed at average people with average intellectual. Dahl has made it that way because this is his style. This makes the story easier to read. The Speckled Band begins with a very long opening paragraph and this is just to explain the scene and setting. The story starts with Watson explaining how many cases him and Holmes have got to deal with and this lasts for 9 lines which is unusual for an opening sentence. This doesn’t give the story any atmosphere, suspense or tension and it’s really up to you if that little bit can make you want to read on. They usually are short to give you an instant view of what is going on. Dr Watson is telling the story and he is one of Holmes’s assistants and probably best friend, who help him with cases. He looks up to Holmes and admires him, he is devoted to him. In Lambs to the Slaughter it starts by giving you the setting and the mood of the story straight away by saying â€Å"The room was warm and clean, the curtains drawn, the two table lamps alight – hers and the one by the empty chair opposite†. This gives you an image in your head of exactly what the room looks like and how it feels and you can tell this all from the first sentence! This adds to the atmosphere. Another character in this is Dr Grimesby Roylott who is the other main character in the story and he is the villain. Dr Roylott comes across as a very strong, aggressive and nasty man. Not one to mess with. This is a title people have given him because of past criminal offences, selfish, evil, uncivilised, rude behaviour, greed for financial gain, his brutality towards women and his frightening expressions of his savage, primitive nature (i. e. his mania, violent temper and physical cruelty). Even before Dr Roylott enters the story you get a picture of what type of man he is when Helen Stoner comes to Holmes for help and protection. This is where we hear most of the things about him. That he has uncontrollable anger, terrifying power to intimidate and threaten, etc. Holmes and Watson have the job of consoling Miss Stoner. With his appearance he is a huge man with brown hair down to the shoulder and blood shoot eyes. He also has very large hands. Three words I would use to describe him are intelligent, cunning and aggressive. He also isolates him self from the outside world and I think that’s another reason why people are suspicious of him. This is every different from the villain in Lambs to the Slaughter. Mrs Mary Maloney is the very nice and pleasant wife for her husband. She does everything he ask of him, has the dinner on the table each night when he comes in at five o’clock. She cooks, cleans and washes for him! Mary is extremely happy in her relationship until one day her husband tells her that he has been having an affair. She decides to take it as a dream at first and believes if she carries on as normal she might have imagined it. So she goes down to the cellar to get the meat for supper. As she comes back up he says, â€Å"For God’s sake, don’t make me supper I’m going out! † and at that moment without any pause she simply walked up behind him, swung the leg of lamb high in the air and brought it down as hard as she could on his head. The mysterious thing about these two villains is that when Dr Roylott gets caught for the murder of Miss Stoner’s sister you feel happy and glad that he has been rightly accused and he deserves what he gets! The twist is that when Mrs Maloney gets completely away with the murder of her husband you get a sense of feeling that pleases you because even though she has done wrong and should be punished. She has been calm and cunning about the situation and handled it well. Its as if you want her to get away with it! Out of the two Stories I prefer Lambs to the Slaughter because it is easier to read and understand but I like both because a lot of thought has gone into the plot and that makes it more interesting. Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Arthur Conan Doyle section.

Overcoming Foreign Language Anxiety

OVERCOMING FOREIGN LANGUAGE ANXIETY By Saranda Nuredini Instructor: Luiza Zeqiri Course: ESP Communication I January 2012 â€Å"Sweaty palms, shaking hands, dry mouth and muscle tension mean for many of us, that we are about to speak in public. Couple this fear of speaking in public with performing or speaking in another language and the success of the speaker may be dramatically compromised† (Leigh, 2009). By having to speak in a foreign language, the amount of fear in us grows and transforms into the feeling of anxiety, which is scientifically named as a Foreign Language Anxiety (FLA).The fear of dealing in a foreign language environment is most felt when a student must perform orally in some way but it can also occur when listening, reading or writing (Brantmeier, 2005). FLA has been the subject of many scholarly surveys and papers as overcoming it can lead to better and faster language acquisition as well as a much more pleasurable learning experience (Guess, 2007). Betwee n one third and one half of second language learners suffer from FLA (Von Worde, 2003; Randall 2007) and it is important to be aware that many of these students have not come up with a way to deal with their anxiety (Hauck & Hurd, 1991).This research paper aims to outline the causes and effects of FLA as well as the ways that help overcoming it. Despite the fact that Foreign Language Anxiety has been proven to be the main concern to the modern teaching environment, a progress has been noticed at the development of the overcoming strategies. The overcoming foreign language anxiety process includes strategies that can be implemented by the teacher, a tutor and the students. The causes of this kind of anxiety vary from the student itself.According to the article â€Å"Factors Associated with Foreign Language Anxiety†, there are variables like age, previous academic success or previous high school experience with foreign languages which may contribute to the fear of learning a fo reign language (Leigh, 2009). Nevertheless, the most common causes according to Ph. D. Renee Von Worde (2003) are the non-comprehension of the target language, speaking activities during language class and the public error correction by the teacher. Moreover, it is interesting to note that FLA occurs more commonly in mandatory language classes.This is because students who are not language inclined are ‘‘forced’’ to take them (Guess, 1997). Feeling insecure about the knowledge at a certain foreign language can have drastic side effects for the foreign language student. The extreme stress, the beating heart or clammy hands are the most common ones. There may also appear problems with attainment, preservation and production in the foreign language (Von Worde, 2003). According to Professor Von Worde (2003), â€Å"If anxiety impairs cognitive function, students who are anxious may learn less and also may not be able to demonstrate what they have learned.Therefo re, they may experience even more failure, which in turn escalates their anxiety†. In extreme cases, the student may even not show up to classes just to avoid speaking (Von Worde, 2003). If we could find and isolate what it is that makes us nervous, we could increase our learning abilities and have a more enjoyable learning experience (Leigh, 2009). Ideally, teachers can provide a learning environment that may reduce the fear associated with learning another language for their students (Guess, 1997; Von Worde, 2003).However, not only the teacher can help to the overcoming foreign language anxiety process. The question remains how someone can overcome their fears in language learning to develop language skills to their full potential (Leigh, 2009). There are implementable ways that beside the teachers, the tutor and the students themselves can use to reduce the anxiety and insecurity they feel. The methods and the behavior of a language teacher during language classes play a si gnificant role at the development of a student speaking confidence.There are several things that a teacher may do to decrease anxiety felt in the classroom according to Von Worde (2003): * Pick topics to teach that are relevant to the students. * Try and make the learning ‘‘fun’’. * Try to create a sense of community where the students feel more comfortable in front of each other. One suggestion made was to have the students sit in a circle. * Avoid calling on people or putting them on the spot. Besides the above mentioned suggestions, a teacher can take the initiative to create a â€Å"mistake happy zone†.Teachers can avoid correcting students during certain sections of the day (e. g. for 30 minutes we will talk amongst ourselves). In this way, students do not need to fear working on perfect grammar, but rather they can just talk without feeling judged. This allows students to get a feel for fluency and letting go (Leigh, 2009). A tutor can also be very helpful to its students when it comes to overcoming those language obstacles. By judging of the state of its student, a tutor has the freedom to choose which of the above mentioned suggestions will be used during the overcoming process.Although there may not be a classroom of students to whom the tutor is teaching, the one-on-one environment allows a greater sense of intimacy and a safer atmosphere (Leigh, 2009). Alongside to the teachers and tutors effort, the most significant role still remains the one from the student itself. According to Amanda Leigh, a student should take the following recommendations in action to â€Å"boost their self-confidence in speaking, reading and writing a language†: * Be aware of Foreign Language Anxiety- Knowing that you are not alone in feeling self-conscious or afraid of speaking in a foreign language is half the battle (Von Worde, 2003).Fear of speaking in front of people is normal and so is performing in another language, even if it i s just with your friends. * Set 4 or 5 SMART (specific, measurable, attainable, realistic, timely) language goals for yourself in your academic term- Attach numbers to your learning so that you can see your improvement. Make measurable goals and make sure that they are realistic. Do some research to see what level you should be at by end of your term in a different country. Do not expect to be bilingual on your return to your home country. Be prepared- If you are prepared for your class or presentation then you will feel more confident in front of people. Feeling more prepared makes you feel relaxed which allows for better communication and language skills (Guess, 2007). Prepare by going over your work or presentation at least twice reading, then at least twice out loud. Get someone to help proofread. * Maintain a positive attitude- Even though it may seem hard, try and have a positive attitude. Happy people will learn faster and have a more pleasurable learning experience (Bayer, 2 004).Smile. Make native speakers aware that you are happy to be corrected. * Do some research- Find out how other students handle their anxiety. Many of their suggestions may work for you. Look online or ask around. Alter their strategies so they work for you. By adopting some of these suggestions, there is a chance that a student will personally begin to overcome their foreign language learning fears. Students may choose to adopt one of these strategies and tailor it towards their needs until they find something that works for them (Leigh, 2009).To sum up, Foreign Language Anxiety has been labeled as an issue that should not be ignored and should be handled carefully. Therefore, the overcoming FLA process includes effort that should be made from the students as well as from the teachers and tutors. This will not only help students to overcome their fear and anxiety, but will also enable language teachers and tutors to reach a higher progress at their subject. In my opinion, the mai n goal of the overcoming progress should be to create a comfortable teaching environment where a speaking accent or grammar mistake will not mean the end of the world.As Guess claims, â€Å"the trick is to convince the students that discomfort is a good thing- that’s when the real learning process will begin. †. References Bayer, R. (2004). Benefits of happiness; Upper Bay Counseling and Support Services, Inc. Retrieved Jan 03, 2012, from: http://www. upperbay. org/articles/benefits%20of%20happiness. pdf . Brantmeier, C. (2005). Anxiety about L2 reading or L2 reading tasks. A study with advanced language learners. The Reading Matrix. Vol. 5, No. 2. Retrieved Jan. , 2012, from:http://74. 125. 95. 132/search? q=cache:4pmdX6G7bwJ:www. readingmatrix. com/articles/brantmeier/article4. df+reading+matrix. +2005+Foreign+Language+Anxiety&hl=en&ct=clnk&cd=1&gl=ca Guess, A. (1997, June). Overcoming Language Anxiety. Inside Higher Ed. Retrieved Jan. , 2012, from http://www. inside highered. com/news/2007/06/29/language. Hauck, M. &Hurd, S. (1991). Exploring the link between language anxiety and learner self-management in open language learning contexts. European Journal of Open, Distance and E- learning. Retrieved Jan 05, 2012, from: http://www. eurodl. org/materials/contrib/2005/Mirjam_Hauck. htm. Randall, K. (2007). Words fail me. The University of Texas at Austin. Retrieved Jan. 06,

Introduction to Psychology Essay Example | Topics and Well Written Essays - 1500 words - 3

Introduction to Psychology - Essay Example Solomon Asch: Group Pressure and Conformity Social psychologist Solomon Asch’s 1951 study of the impact of group pressure on decisions is noted as one of the most important and conclusive. The conduct of the study was fairly simple. Ache showed students in groups of eight to ten--all of whom except one in each group had been coached beforehand to pick the wrong answer on twelve of the eighteen cards. Each card had a group of three bar lines on the right, and one bar line. Students were asked to pick one bar from a series of three on the right that best matched the one bar on the left. Most subjects were told to deliberately give the wrong answer. Asch arranged the questioning so that most wrong answers would be given before the test subject in the group made his or her decision. The results were significant and according to Zimbardo and Gerrig (2010): â€Å"50 and 80 percent†¦conformed with the false majority estimate†¦a third†¦yielded to the majority’s wrong judgments on half or more of the critical trials† (p. 550). ... more complex psychological elements at work which according to Zimbardo and Gerrig (2010) may indicate impulses at play beyond our simple â€Å"desire â€Å"to be liked, accepted and approved† (p. 549). For instance, Asch noted that the fewer people who gave wrong answers the fewer test subjects did the same, indicating a strong mistrust element in the views of the few versus those of the majority. As might be concluded, a decided lack of independence and confidence was clear when it came to one’s rational judgment over that of the pack. Considering the often incomprehensible election habits of individuals, this becomes particularly relevant in terms of electorate behavior. The 25 percent who always conformed was roughly equal to the same percentage who never conformed (Zimbardo and Gerrig, 2010) indicating a possible polar aspect to the behavior. On the positive side, it should be noted that significant change in most aspects of life come from the minority generally c onsidered non-conformers. As Zimbardo and Gerrig (2010) found, â€Å"The conflict between entrenched majority view and the dissonant minority perspective is an essential precondition of innovation†¦Ã¢â‚¬  ( p. 551). As evidenced in the recent film, â€Å"The Social Network,† Facebook creator, Marc Zuckerman’s insistence on thinking independently ultimately produced a multi-billion dollar empire. For the others who conform even in the face of obvious evidence that they should not conform, there may very well be serious psychological disorders underpinning the behavior. The major disorders according to Zimbardo and Gerrig (2010) are categorized based their affect on the individual as follows: the individual experiences personal distress or dysfunction; behaves in ways that hinder goals and wellbeing or

Better Use Computer Assisted Auditing Techniques for Auditing Thesis

Better Use Computer Assisted Auditing Techniques for Auditing - Thesis Example Over the recent years many audit firms have shifted towards using this technique, as this technique has helped in analyzing audit data more quickly and rapidly. The other discussion point in this report is the flexibility of CAAT with auditing and other standards such as SOX. The other issue in this report is the concern of using this technique after having proper analysis of the business being audited. Finally, the report is concluded by pointing out that its benefits clearly outweigh its risk. The purpose of this project is to discuss the main features of Computer Assisted Audit Techniques (CAATs) and how the use of such technique can assist in better auditing procedures being followed up by auditors. With such better procedures being followed by auditors, the conclusion that they draw would be considered stronger as CAATs help in huge data to be analyzed. To give the reasoning as to why CAATs are better than traditional audit techniques, it is compared with those techniques. Practical examples and case studies are given to further elaborate the upper hand that CAATs have over other techniques and how they assist auditors in drawing better conclusions. Finally its advantages and disadvantages are looked upon which suggest that the advantages prevail over its disadvantages. (Warren, 2007) An auditing process is automated by the use of techniques such as CAAT. The adoption of this technique has led many audit firms to change their way of auditing any particular company i.e. rather than using the traditional audit techniques, CAAT is hugely used and encouraged by audit firms. The basic aim of this technique is to assist the auditor in reducing his manual work; major data can be processed with ease hence leading to a better opinion being made by the auditor. Auditors using manual audit technique have to manually select sample data upon which to base their conclusion, while selecting this sample data

Response to 4 students assignment posting with 2 references each Coursework

Response to 4 students assignment posting with 2 references each - Coursework Example The student settles on Ms McClung as the individual who represents great leadership. He takes out passion as an outstanding trait in Ms McClung that makes her a great leader. According to the student, she possesses emotional intelligence and approaches complex problems within her team besides not being afraid to take action in her leadership role (Hackman, 2010). She makes decisions that take into full account the welfare of both employees and the organization. Her leadership style is therefore one that has decisions taking into account the needs of employees at a personal level, this the student says, is a good trait in a leader but according to Ltd ( 2004-2010), should not be a dominant factor in the overall leadership style. The student chose Charles Edwards as his great leader to discuss and provided a brief but elaborate history of Edwards fro when he was a young soldier in 1987 to when he worked his way up to the top. As a life changing moment, the student quotes Hackman’s (2002) comments that; â€Å" a great team leader does not rely on a single strategy for promoting team effectiveness but instead works the course of team seamlessness as a result reinforcing the outcome of hands on training†. This comments, he says, changed the point of view of Edwards and in as much as he found the cruel at the start, he later embodied them and that changed his entire future as a leader. He highlights self confidence as the trait that makes Edwards a great leader. Marlana chooses R. Wilson, the local Chief of Police as the effective leader for this discussion. She explains that Chief Wilson has worked through the ranks and understands both the formal and informal environment of not just the agency but the community as well. Effective managers according to Cohen, Eimicke and Heikkila (2008), are those in regular touch with the informal set up and have a excellent understanding of their

Independent Television (ITV) Essay Example | Topics and Well Written Essays - 1500 words

Independent Television (ITV) - Essay Example Companies Strengths and Weaknesses ITV Comprehensive income statement year ended 31st December 2011 indicated that, the company was able to attain a cost saving of twenty million pounds through its wastage and efficiency program (ITV, 2012). It was predicted that the company was going to attain another cost saving of twenty million pounds by the end of 2012 fiscal year (ITV, 2012). The report further indicated that, ITV was able to obtain net advertisement revenue of 1% by the end of 2011 fiscal year (ITV, 2012). During this year, ITV subsidiaries reported higher positive growth, for example, 1% growth was obtained from viewers followed by a 10% in digital growth (ITV, 2012). The report indicates that ITV was able to attain 21% growth through online revenues which translates to thirty four millions pounds as on 31st December 2012. Additionally, the company was able to achieve a 44% growth through distribution of its content (ITV, 2012). Connectively, revenue of thirty five million po unds was obtained from international production and another seven million pounds from investments (ITV, 2012). However, despite having a positive growth, the company has also been faced with some challenges. This is because, by the end of 2011, the company revenues from distribution business declined substantially by four million pounds (ITV, 2012). In above connection, another 5% decline in growth was reported by the end of 2011. Additionally, the company incurred a loss of thirty nine million pounds; the loss was attributed to bond that was purchased during this period (ITV, 2012). On the contrary, the financial statement of Wire and Plastic Product (WPP) reported operating profits of ?14.0 millions by the end of 31st December 2011, while in the previous year; the company reported... Independent Television (ITV) Independent Television was one of the ancient business networks established in the United Kingdoms in 1995 with an aim of channelling news and eradicating monopoly business that was dominated by BBC during that period. The company consists of broadcasting Channels that include the following; City television, Itv1, Itv2, Itv3 and Itv4. ITV Company sells formats and programs in the United Kingdom as well as in other parts of the world. The major sources ITV revenues emanates from sales and advertisement. Additionally the company provides online services to its clients through itv.com. Among the services being rendered by ITV include; online advertisement and online sponsorship. In above connection, the company conduct other operations through its ITV studios such as; entertainment, dramas, factual to name just but a few. In 1958, ITV directors issued 300,000 common stocks at four dollars each to the public through initial public offer.The company had been expanding across the world and has been portraying positive growth in the stock market. Therefore, based on the above report on portfolio analysis, I would advice Mike to invest his savings in ITV company because the company has higher returns that Mike can obtain and retain the rest given the fact that he is a conservative investor. Additionally, the company has lower risk exposure as indicated by its gearing ratio. Therefore, if Mike invests his savings in ITV securities he is guaranteed security of his investments.

The Reformation of Christianity in Late Medieval and Early Modern Essay

The Reformation of Christianity in Late Medieval and Early Modern Europe - Essay Example At the time the Christian faith was developed in Antioch, and the apostles of Jesus Christ first called Christians, the church was a single community of believers proclaiming the same faith and doctrines. Despite the existence of opinion differences among the faithful, there were amicable solutions to the questions of faith and ethical teachings that were mainly borrowed through inference to the work of Jesus. After setting of the first church in Vatican, Christianity remained as single religion of the same church, with Catholic being the church of Christ at the moment; it was not until the 16th century that eminent cracks developed among the followers and leaders of the church resulting to reformations within the church Reformation of Christianity can thus be termed as a religious revolution that that took place in the 16th century. The greatest leaders of reformation were Martin Luther and John Calvin. With highly developed social, economic and political effects, the Reformation became the foundational basis of the Protestantism that is one of the branches of Christianity. Reformation in the late medieval Europe resulted from a complex intricate of the factor with the office of the papacy pointed as the pinnacle of the genesis of the Reformation. Over the years before actualization of reformation ideas, the office of the papacy had become deeply involved in the political affairs of the Western Europe .

The philosophy of nonviolent protest Term Paper

The philosophy of nonviolent protest - Term Paper Example This was substituted with active voices and progressive actions that led to change against injustices. The basis of nonviolent protest came from the philosophies of Henry David Thoreau. This followed with several political and cultural leaders that followed the main philosophies of Thoreau and which focused on creating higher levels of equality and freedom for the cultural and social aspects of society. More importantly, each of these leaders was able to create a voice that was based outside of violence and which instead gained prestige from the use of actions and alternative forces to change the current political environment. The basis of the philosophy of non – violent protest was known to come from Thoreau’s book, Civil Disobedience, which was written in 1848. The main concept that is pointed out in this book is based on the current government and the injustices and lack of freedom that came from policies of the government. Thoreau points out that any violent protests are an arm of the government and represent a sense of injustice that is associated with politics. Thoreau believes that the use of violence and the army is one that creates a lack of integrity from the government. More importantly, Thoreau points out that the army alone is one that eventually leads to the inability for a country to be free or to function through the democratic ideals in which it is founded on. The challenge that Thoreau places is to create a better environment, which is specifically based on adding in integrity and an initiation to end violence through the country. The first ideology that Thoreau gives with the basic concept of the government and using non – violent protest is based on the moral obligations that are in the government. Thoreau believes that the use of violence is one that initiates a lack of integrity and the inability to have responsibility to humans and life. More importantly, the use of violent force doesn’t allow men to act with

Visitor Impacts on Public Parks Research Paper Example | Topics and Well Written Essays - 750 words

Visitor Impacts on Public Parks - Research Paper Example This paper will look at the effects of uncontrolled continual streams of visitors to my local park and the solutions to the problems they cause while enjoying the privilege. Parking at our local park has become a nightmare due to limited zonal spots for everyone involved. In fact, the numbers of vehicles lined up at the gate of the park have become a nuisance as they are preventing access to the park itself and discouraging more people from gaining access. This is a menace as the image of the park is tainted since they are regarded as negligent in providing for the needs of the visitors. In addition, the cars pollute the environment, with the effects being carried over to the protected resources inside the park1. In my view, people should be made to leave their personal means of transport at home and the park should have the mandate of providing public transport to people at designated times and venues. Such a move will ensure that the number of visitors gaining access to the facilit y is controlled in any one time. While inside the park, it has become apparent that the standard of cleanliness is deteriorating each day as the visitors are trashing everywhere they go. Plastics are the order of the day not mentioning the unsightly array of leftover food at every footpath in the surrounding environment. Some of the caged animals can be seen munching on some of these foods which they may have been offered by the visitors or perhaps collected as they roamed freely in their habitats. Ingestion of these foods can be dangerous since of it may not blend in well with their natural diets. There have been cases of food poisoning reports at alarming rates for the last quarter of the year. The management should provide more employees to investigate into the matter while drawing a keen eye that would help identify the culprits. These visitors should be fined heavily for their acts and given restriction from gaining access to the park until deemed necessary2. Some sections of t he park do not access to public foot paths or bridges across water bodies. This has forced visitors to find their own way around thus they have resulted in a lot erosion of the ground and destruction of vegetation and leading to deterioration of the environment. Some of them have penetrated sensitive parts of the forest which have led to some animals strayed into areas of the park they are not supposed to. These animals can be dangerous to the general public making the park to be hazardous for visitors and could lead to closure of the park. Measures should be taken to ensure that a guard is placed at strategic positions in the park where they can prevent such destructions from taking place in the first place. In another instance, campsites have been devouring parts of the forest since some extreme campers have brought down trees to create room for their tents or just for the mere advantage of the experience. The fires that have been made are frightening the wild animals and eating a way at the vegetation that may have been growing for thousands of generations. The animals have disappeared into the heart of the forests and are not seen during day which has proved to be very disappointing to the visitors of the park. This has also led to loss of enthusiasm for the diehard animal lovers who come to the park with the sole intention of sighting the fascinating creatures. Poaching is another vice that has risen lately amongst the visitors.

Local Economic Development Essay Example | Topics and Well Written Essays - 500 words - 127

Local Economic Development - Essay Example Local economic professionals also have a role to play to ensure that the community groups that are formed do not only focus on poverty alleviation, but also on economic development. This includes making the community members pioneers of entrepreneur skills and job creation for other members. Economic professionals also have to provide assistance to local community groups in terms of access to technology and capital support and creating a link between private and public institutions of the community. The North Texas area will impact marketing as a place for establishing the new business. This is because a new environment is going to be created in this area, which means that customers in this area will have different wants and needs compared to customers from the other areas. As such, new businesses will be formed to satisfy the needs of customers in this environment. These include food, shelter, and clothing. Therefore, entrepreneurs and business people dealing with such items will fo cus on delivery of the items and ensure that the local people do not suffer from lack of such items. The response to this challenge will involve conducting a market analysis of this new area. This will entail determining the various needs of the people, conducting the feasibility study of the area, and establishing whether the area will provide sufficient market for new products and services. Results of this analysis will aid in making decisions as to whether to establish new businesses in the area or not to establish such businesses. Dallas is a city in North Texas, which uses good urban planning policies and regulations that enhance the attainment of sustainable economic development (Federal Reserve Bank of Dallas 1).

Morality and Religion Essay Example for Free

Morality and Religion Essay There is a close relationship between morality and ethics but they do not mean the same thing. On the other hand, anti-morality and anti-nature are aspects, which negate vital instincts. Friedrich Nietzsche is a renowned philosopher who criticized social laws, religion, and honorable in a radical manner. Nietzsche argues that, â€Å"anti-nature refers to the idea of allowing human beings to coerce others into adopting their beliefs and morals† (Friedrich 404). Friedrich Nietzsche had a personal belief that morality is anti-nature. In fact, Nietzsche states that, â€Å"Every naturalism in morality-that is every health morality-is dominated by an instinct of life† (349). Indeed, Nietzsche helps us to define the idea of anti-nature by asserting that a human being is seemingly refuting the reality by denying their personal passion. In fact, according to Nietzsche and his moral philosophy, the healthiest moralities accommodate natural aspects while the unhealthy moralities negate nature. Nature derives human desires, which consequently define individual personality and how human beings behave. Nietzsche observes that human beings should have the free will to choose what they want without coercion from any external forces. He further quotes that, â€Å"Anti-natural molarity-that is almost every morality which has so far been taught, revered, and preached-turns conversely against the instincts of life: it is condemnation of these instincts† (349). He also disputes the common notion that religions like Christianity drive human life and consequently asserts that religion and dominance of morality inhibits human nature. In this context, Nietzsche argues that ardent followers of a certain religion ignore the nature of humanity since religion forces individuals to behave in a manner that will please the supreme ruler of the reference religion. Friedrich Nietzsche holds that religion especially Christianity opposes human nature because it gives a leeway to individuals to adopt religious doctrines about human life hence limiting individuals from celebrating nature. Indeed, Nietzsche states that the most general foundation of every religion and morality is, â€Å"Do this and that, refrain from this and that,-then you will be happy† (352)! He uses this explanation to support the concept of anti-nature in morality. Notably, Nietzsche refers to morality as anti-nature by asserting that human desires control what individuals do, do not do, and confirms that morality draws away the course of nature. Nevertheless, various philosophers identify with the fact that nature generates human desires that consequently define human personality and morality. However, I strongly oppose Nietzsche’s notion that human nature is prone to alternation by both morality and religion. Most specifically, I note that Nietzsche depicts religious people like Christians as hypocrites who can do anything to please God at the expense of altering their human nature. Ideally, Christians are rational beings who do not have such morality. Indeed, very few Christians would identify with Nietzsche’s argument since his ideas discourage Christians from following their religion. Notably, Nietzsche’s argument that religion alters human nature by allowing Christians to adopt different aspects of life that prevent them from celebrating life is misguided. This is because Christians have morals that allow them to enjoy their lives just like any other person. In fact, his argument is not universal since it only addresses Christians thus leaving a significant population out. Assuredly, Nietzsche discourages people from adopting religion’s doctrines that alter human passions but encourages people to follow their human desires (Jacobus 67). I also oppose Nietzsche’s argument since it does not support religion and thus discourages many Christians from adopting his views. In fact, I will compare Nietzsche’s moral philosophy with Iris Murdoch’s philosophy with a view of disregarding the assertions of Nietzsche’s reference to morality as anti-nature. Notably, Iris Murdoch addresses the concept of morality where she incorporates religion in addressing morality. In fact, her argument does not discourage the adoption of religious doctrines in morality thus attracting the attention of Christians and other religious people. Unlike, Nietzsche who blames religion for altering human nature and passions, Murdoch believes that religion affects morality in a positive manner. Nietzsche uses the naturalistic perspective to support his argument where the naturalistic perspective on religion contradicts with the idea of human beings by taking the responsibility of controlling their given passions and nature. More so, Nietzsche’s criticism on the effects of religion on human morality does not correlate with any religious, philosophical, social, or historical example and hence its irrationality. As such, Nietzsche’s argument lacks logic to me. On the other hand, Nietzsche does not incorporate the idea of human responsibility, which every human being should adopt. In fact, the act of satisfying individual responsibility is a moral behavior that resides outside the premises of religion. Actually, some philosophers like Murdoch claims that religion improves right morals by instilling a conviction and belief of doing the right things while out of control. Indeed, religion plays a noble role of encouraging humans to abide by the code of ethics set by the government or any relevant institution. In fact, Murdoch asserts that religion plays a huge role in generating someone’s morals by instilling the urge to remain focused on individual objectives. She further confirms that human nature accommodates the aspect of fulfilling one’s responsibility. With this argument, we can derive that religion does not alter human nature and that responsibilities propel human beings to decide and behave in a certain manner. Again, this assertion is stronger than that of Nietzsche, which claims that religion inhibits human nature. Michael Gazzaniga seemingly opposes Nietzsche ideologies in some way. According to Gazzaniga, people who believe in religion would only be classified under Nietzsche ideology of anti-nature if they allowed religion to take over their life (Jacobus 415-420). It is agreeable that some religion fanatics have taken religion to control everything in their life. Therefore, such people would simply be anti-nature as argued by Nietzsche. However, the majorities of religious people have not gone to the extremities of religion and therefore, according to Gazzaniga, they are living normal lives naturally. Nietzsche limits discussions and contributions of other philosophers and commands the audience to believe in his beliefs. Indeed, Nietzsche is an anti-realist about morality. This is because he does not abhor his positive views on morality and equally refutes all criticism against his views. In fact, he disregards any opinion that contradicts his own and thus his rhetoric character on morality. Indeed, he denies the objective of morality by believing that human beings have the responsibility of determining their morality, a fact Gazzaniga negates when he says that those who have control of religion have control of nature and morality as well (Jacobus 415-420). At the same time, Nietzsche’s argument lacks the support of any political philosophy since his views lack a systematic approach about the society. On the other hand, Murdoch does not speak with finality, encourages the participation of other philosophers, and accords the audiences’ free will to accept his argument. Such a leeway only allows individuals to buy Murdoch’s argument with a view of improving it and rejecting Nietzsche’s argument since it is discouraging to Christians and is seemingly irrational. Moreover, Nietzsche’s argument only presents what is wrong but does not present what is right while Murdoch helps us to derive the difference between right and wrong morals. Notably, Nietzsche argues that human beings cannot redeem themselves after neglecting their nature desires. This assertion is wrong since human beings always have a desire to fix their wrongs with a view of becoming better people in the society. Moreover, contrary to Nietzsche’s argument, it is factual that individuals can only achieve their goals by following their convictions and beliefs and denying their human desires, which mostly lead to immorality. Notably, religion derives this conviction, which encourages followers to adopt good morals and avoid sin as it leads to punishment. This negates Nietzsche’s claim that religion alters human nature and that human desires define morality. As such, I dispute Nietzsche’s views, which discourage religion from instilling the right morals and consequently identify with the idea that humans have the capacity to define their morals naturally. I agree that our morals depend on our conviction and not our desires as Nietzsche claims. Additionally, I disagree with Nietzsche’s idea that nature plays no role in defining our morals since nature plays a significant role in determining our behaviors. As such, I reject Friedrich Nietzsche’s assumption that morality is anti-nature. Works Cited Friedrich, Nietzsche. The Selected Writings of Friedrich Nietzsche. Lanham: Start Publishing LLC, 2013. Internet resource. Jacobus, Lee. A World of Ideas: Essential Readings for College Writers. New York: Bedford/St. Martins, 2009. Print. Nietzsche, Friedrich. â€Å"Morality as Anti-Nature. † 347-356. Murdoch, Iris, â€Å"Morality and religion. † Jacobus 363-371 Gazzaniga, Michael. â€Å"Toward a Universal Ethics. † Jacobus 419-431.

Representation of mental health problems in the media

Representation of mental health problems in the media Media tends to use harsh words such as psycho and maniac as the headline when referring to people with mental health problem, which can influence the public perception. Previous research suggests that there is a strong rink between negative portray of mental health and public attitude towards people with those conditions (Rose, 1998). This essay, aims to examine negative representation of mental health problems in the media. It will be based on qualitative research method and will take a view of thematic analysis of the sun newspaper. Result indicated that media tends to focus on the negative news as it is more news worthy, exaggerate and generalising people with mental health problems. Recommendations suggested; media should stick to facts in relation to mental health and should stop producing negative information in this field. Introduction and aims Data from 2010 survey by the UK Office of National Statistics showed that 1 in 6 adult experience at least one diagnosable mental health problem at any given time and that severity will vary from mild anxiety to conditions such as bipolar disorder (http://www.guardian.co.uk). Previous studies in this area found that people perception were influenced by media negative representation of mental health disorders (Rose,1998), this was supported by philo (1993) who found that public attitude towards crime and mental health was based on what was presented in the media. Media representation of mental health problems tends to be shadowed with negative comments and always emphasises on the link between people with mental health and violent crimes. A study by Cutcliffe and Hannigan (2001) examined media reporting of people with mental health problems and concluded that media stories tends to be focused on violence dangerousness and criminality toward others in relation to a person with a mental illness. Anderson (2003) also suggest that the media only focus on reporting negative events such as murder committed by those with mental health problems more than then the awareness of mental health. Yet there is evident that people with mental health problems do not commit more crimes than the rest of the population. According to large et al (2008) study on homicides due to mental health between 1950-200, they suggested that only a small proportion of people with mental health do commit violent crimes compared to those with no mental health problems. The relationship between mental health problems and violent crimes are mostly linked to alcohol and substance abuse and not just mental health condition. Although a small proportion of pe ople with mental health problems tends to be violent, the majority are victims of violent attacks and the media seems to forget produce this (www.guardian.co.uk). Furthermore, Edney (2004) Argue that even though media always features stories relating to mental health, those stories tend to be exaggerated and negative in torn. Anderson (2003) claimed that media stories which portray people with mental health negatively tend to gain more publicity than those which dont. The purpose of this essay is to examine the impact of portraying people with mental health negatively in the media which will be achieved by thematically analysing article from the sun newspaper. Studies such as that of Stuart (2006) claimed that, media negative presentation on mental health does have a significant effect on people with mental health problems. Analytic approach Article on coverage story of Raoul moat 37 was chosen from the sun newspaper from the internet dated (10th July, 2010), who shoot his ex-lover through the window of her house and killed her then boyfriend while trying to protect her as well as living a police officer blind after gunning him down while on duty. Before going on a run for almost a week and turning the gun on himself after a police standoff. The sampling method used was probability sampling. Thematic analysis was employed In order to explore how people with mental health problems are portrayed by the media. Thematic analysis procedure involves different stages. First stage involved; Students being instructed to develop a research question which related to the representation of mental health illness. Stage two; students had to read the article which was based on a story of Raoul Moat in order to be familiar with the data. Stage three; here students had to transcribe data from the article into text stage four is coding for themes; this involves organizing words which relate to similar topics into categories which requires reading text and note down words of interest for the chosen research question, Text needs to be examined closely, line by line. Stage five includes; Text being re-examined to see if all the information is relevant to themes. The final stage is reporting each theme by writing its description and illustrating it with a few quotations from the original text. This will be coved in the findings section. (Boyatzis, 1998). Findings and discussion The following themes where identified within the text. Theme 1: Paranoid about the cops. Moat hated the police whom he called animals, He hated the policeà ¢Ã¢â€š ¬Ã‚ ¦.called them pigs. He believed that they had something against him due to the amount of time he had been stopped before going to prison, They harassed him on the outside by pulling him over in his car every five minutes for no reason. More crucially, having being dumped over the phone by his then lover while saving time in prison for attacking a relative left him convinced that she had left him for a cop. he was fixated on the other man being a police officerà ¢Ã¢â€š ¬Ã‚ ¦.. Shes dumped me for a fucking pig. Theme 2: Emotional meltdown. Prior to calling Samantha from the prison phone booth, moat was in good mood he was fine beforeà ¢Ã¢â€š ¬Ã‚ ¦..he said he was going to ring Samantha. But after making that call he came back a different person, the colour of his skin had changed to red and he was in ties. He completely changedà ¢Ã¢â€š ¬Ã‚ ¦His neck and face had turned red. He was crying like a baby. Moat took all the feeling of being rejected on the fellow prisoners fuck off scam- get out of my face. he went mental one time because Eric had stuck out the place. the articles looked at referred to mental health in general and exaggerate on the actual information. Most of the information reported was descriptive e.g. media called him psycho even though there was no evidence to support that he was suffering from psychosis.These articles where published by journalist who may have little or no back ground knowledge on mental health, they are business driven and therefore look for news worth in order to sell the papers instead of focusing on the actual facts. Media create a label for people with mental health problems such as mentally ill, and psycho. Character of information Most publications relating to mental health problems tend to be exaggerated. Media we use one particular incidence (e.g. how moat had mental health) to generalised everyone with mental health condition. Most of the information the media report tends to be descriptive (e.g. how person with mental illness has committed murder). Very little place is devoted to explanatory information example, about causes or symptoms of mental illnesses) recommendations for good practice when reporting on violent crime stories which may be linked to mental illness: Media should Avoid using offensive words like psycho and nutter, be certain about the information they report instead of speculating news. They should make it clear to the reader that only a very few people with mental health problems are violent. Conclusions Publications in media relating to people with mental health problems are negatively which paints a picture of people with mental health problems as dangerous criminals which can live them being labelled and stereotypes with society. In order to remove this stigma, journalists should be provided with some guidelines where they can find information on mental health problems In general media coverage of mental health problems tends to be negative, Media uses harsh words such as crazed, maniac or monster to referrer to people with mental health problems. Specific conditions were less likely to be mentioned in headlines than general references like mental illness. Media representation of mental health tends to be more sensational headlines than sensational stories.

Chronic Opiod Use after Hysterectomy

Chronic Opiod Use after Hysterectomy Specific Aims The rapid increase in the incidence of opioid-related overdoses and deaths has become a big public health threat in the United States. This opioid epidemic affects more women than men due to higher opioid prescribing and dose, longer period use, and more opioid dependence in women.1 From 1999 to 2010, the rate of opioid overdose caused death increased 5-fold among women.2 Besides the illicit purchase for some women, the initial exposure to opioids for many others may likewise come from the regular medical treatment as prescription opioids are widely used for pain management after surgery.3 As such, the critical research gap on opioids use is that the evidence is insufficient to draw conclusions about optimal strategies for initiation and titration of opioid therapy.4 Several observational studies have investigated the patterns of opioid use for noncancer pain in patients pre and post-surgery, and identified the risk factors of chronic opioid use post-surgery.5-11 Most of these studie s examined the prediction of baseline demographic and clinical characteristics of patients for prolonged opioid postoperative use and suggested that surgery is a risk factor for chronic opioid postoperative use.5-9 Only two studies examined the initial opioid exposure within 6 or 7 days of the surgery date and results are controversial.10,11 One study reported that initial exposure of opioid poses 44% increase risk of chronic postoperative opioid use and another one suggested that this risk would be low and statistically insignificant.10,11 Similar investigation has not been done specifically for hysterectomy, the most frequently performed non-obstetric surgeries in the United States for women of reproductive age.3,12 Pain has been demonstrated as a common symptom before and after hysterectomy.13,14 A small cross-sectional study has examined the predictors for opioid prescription in women of productive age and identified that opioid use was significantly associated with hysterectomy status and pain-related dysfunction.15 Another cross-sectional survey study reported that 32% patients had chronic pain after hysterectomy.14 Neither chronic opioid postoperative use nor initial opioid exposure for acute surgery pain was examined in these two studies.14,15 Filling this gap in knowledge is critical since identifying the risk factors of chronic opioid postoperative use could lead to optimized initial opioid prescribing for acute pain management and reduced chronic opioid postoperative use and improved women health. Our long-term goal is to help reduce chronic use of opioids and optimize the pain management in women after obstetric and gynecologic surgery through identification and dissemination the safer initial opioid prescribing for acute post-operative pain. Our objective here, which is the next step in our long-term goal, is to compare the patters of opioid use pre and post hysterectomy and determine the important risk factors that associate with chronic use of opioids in women post hysterectomy. The national OptumInsight Clinformatics data offers an essential resource to investigate these aims. The availability of clinical diagnoses and pharmacy medical dispensing offers a significant advantage for investigating drug utilization with corresponding clinical conditions in large population. Our team is well suited to conduct this research given extensive expertise in contemporary pharmacoepidemiology, many years of experience on opioid abuse research, prior drug utilization studies using large claims data, and clinical expertise from obstetric and gynecologic physicians. Our specific aims are to investigate patterns and predictors of chronic opioid use in women pre and post hysterectomy with the following analyses: Aim 1: To characterize the patterns of chronic opioid use in women after hysterectomy. Aim 2: To determine the significant risk factors for chronic use of opioids in women after hysterectomy. The first specific aim for this study is to identify patients who chronically take opioids during six months post hysterectomy, and investigate the time and geographical patterns of chronic opioid use in women after hysterectomy. The pattern of chronic opioid use pre- and post-surgery will also be compared in women with varied age, comorbidities, co-medications, as well as types and doses of initial opioid prescribing. The second specific aim is to determine the risk factors that significantly relate to chronic opioid use, and determine if characteristics of initial filled opioid prescriptions significantly associate with the chronic use of opioids after adjusting for other potential risk factors. Many pain related studies have demonstrated that long term opioid prescribing was significantly predicted by patients clinical characteristics and psychosocial factors, including pain conditions, psychiatric disorders, frequency of medical visits, smoking, and pain-related dysfunction.16-18 Therefore, the adjusted covariates in this study would include both demographic and clinical characteristics. B. Significance and Innovation Currently the United States is experiencing an unprecedented opioid epidemic. According to the Centers for Disease Control and Prevention (CDC), opioid-related deaths increased 200% overall from 2000 to 2014.19 During 2014, about 1.9 million people had an addiction of opioids, with overall 47,055 overdose deaths, 18,243 overdose deaths in women, and 18,893 overdose deaths related to prescription pain relievers.20,21 Based on the data reported by the CDC, women are more likely to have chronic pain, be prescribed opioids with higher dose and longer period, and hence progress to dependence.22 Although opioid abuse is a public health crisis, opioid analgesics are still the mainstay for treatment for acute pain after major surgery. In 2014, total 245 million prescriptions for opioids were dispensed from U.S. retail pharmacies.23,24 During 1998-2010, approximately 7.4 million hysterectomies were performed, making hysterectomy one of the most frequently performed surgeries for women in the United States.25 With over 60% of hysterectomies performed abdominally and up to 85% of patients experiencing moderate-to-severe pain after hysterectomy, postoperative pain management becomes very important.26,27 Evidence suggests that intense and long-lasting postsurgical pain can increase postsurgical morbidity, delay recovery, and lead to chronic pain.28 Opioids such as morphine, meperidine, and oxycodone are widely used postoperatively to reduce and manage pain in patients after hysterectomy.29 Women with hysterectomy and high levels of pain-related dysfunction were almost twice as likely to have opioid prescription. More than 85% of women with hysterectomy and a high level of pain-related dysfunction were found to use opioid.15 Hormonal disturbance, hyperalgesia, and iatrogenic effects are potential adverse effects from op ioid use in women after hysterectomy.14,15 The interaction of opioid-induced adverse effects and post-hysterectomy hormonal dysregulation may intensify pain and promote continued use of opioids.15 There are no known studies that evaluate the connection between acute and chronic postsurgical opiate prescription in women experienced hysterectomy. In consideration of the current opioid epidemic it is important to understand how post-surgical pain is managed, and if this setting presents increased risk of opioid addiction among certain groups, or related to particular prescribing practices. The goal of this proposed study is to examine whether opioids prescribed in women following hysterectomy is associated with chronic use of opioids, and to evaluate which factors may predict patterns of opioid use that indicate overuse or addiction. Accordingly, this study first aims to describe the incidence pattern of chronic opioid use in women post hysterectomy. The second aim is to explore the significant risk factors and determine if the characteristics of initial opioid prescribing significantly associate with chronic opioid use after adjusting for other potential risk factors. This study will reveal important insights regarding post-surgical pain management for a common procedure, and determine if certain patient or treatment characteristics increase the risk of chronic opioid use in this setting. We expect that this research will provide evidence for the need to improve clinical practice towards optimized pain management and reduced chronic opioid use in women after hysterectomy through identification the specific opioid, drug type (short-acting or long-acting), and doses that significantly associate with chronic opioid use in women after hysterectomy. Our study will provide sufficient evidence to draw conclusion about optimal strategies for initiation and titration of post-surgery opioid therapy, and enhance evidence-based medicine for opioid use in Rhode Island, and also the United State. This award would enhance my capabilities on handling interdisciplinary studies and further help me to develop my own research projects and seek for external funding. Innovation Our proposed observational studies based on the administrative claims data will allow for investigation of time trends and geographic variation of drug use in large population and address for well-characterized clinical conditions. Our approach will employ state of the art, innovative pharmacoepidemiologic study designs and statistical models, to improve the precision of outcome definition and minimize measured and unmeasured confounding and bias in our estimation of significant predictors for chronic opioid use after hysterectomy. The unintended outcomes from adverse drug effects make the prospective trials unethical. In this circumstance, a well-designed, retrospective observational study with sufficient sample size offers an efficient design to determine if there is an adequate signal for impropriate opioid prescribing to women post obstetrics and Gynecology surgery. The generalizability of study results are guaranteed due to the nationwide large health plan data that the analyses are based upon. C. Approach Data Sources Study data will be derived from the national OptumInsight Clinformatics Data MartTM, a research database spanning January 01, 2010 through December 31, 2013. The Optum Research Database includes about 23 million beneficiaries from the nationwide commercial health insurer, United Healthcare. The data contains health care utilization with transactional reimbursement data from outpatient pharmacy dispensing, inpatient and outpatient services.30 It links administrative enrollment data with the important medical codes including the national drug code (NDC) for pharmacy dispensing, the Current Procedural Terminology (CPT) code for medical procedure, and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for diagnosis. The claims data in this database have been adjudicated, ascertained, and deidentified for research purpose. The University of Rhode Island (URI) and OptumInsight Inc have approved utilization of these data. URI already licenses thi s database that it is freely available for faculties to use. Study Population This study will include adult women who receive the hysterectomy surgery between July 01 2010 and June 31 2013 and have at least 6 months of continuous prior coverage under this health insurance plan. This continuous 6-month coverage provides a baseline for defining new drug users, as well as baseline clinical characteristics, such as comorbidities and co-medications. The hysterectomy procedures will be derived from the ICD-9-CM diagnostic codes 68.3x-68.7x, and 68.9x, where 68.3x indicates a subtotal abdominal hysterectomy, 68.4x indicates a total abdominal hysterectomy, 68.5x indicates a vaginal hysterectomy, 68.6x indicates a radical abdominal hysterectomy, 68.7x indicates a radical vaginal hysterectomy, and 68.9x indicates other and unspecified hysterectomy.13,31 Patients with pelvic evisceration (ICD-9-CM: 68.8x) will be excluded. We also will exclude patients with any cancer diagnoses, including malignant neoplasm of the female genitourinary organs-cancer (ICD-9-CM: 179-184), a nd carcinoma in situ of female genitourinary system (ICD-9-CM: 233). Exposure Assessment Opioids in this study include the following medications: codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, and oxymorphone. Tramadol and propoxyphene, considered as weak opioids or already off market, will not be included.11,15 The exposure group involves adult women who receive the hysterectomy surgery and fill more than one prescription for opioids on the day of hospital discharge or within 7 days after hysterectomy surgery, provided that they have no exposure to opioids for at least 6 months prior to hysterectomy.11 The 7 days of window is based on the assumption that a filled prescription during this period would likely to treat acute postoperative pain caused by hysterectomy. A comparison group, defined as the patients with no opioids use on the day of hospital discharge or within 7 days after hysterectomy surgery, will serve as a control to make a comparison of risks for chronic use of opioids. The control patients also have no exposure to opioids for at least 6 months prior to hysterectomy. The exposure of opioids will be identified using NDC codes from pharmacy claims data. In this study, exposure assessment includes all characteristics of the initial filled opioid prescription at the day of hospital discharge from hysterectomy or during 7 days post-hysterectomy. The different type of opioids (classified as long or short acting), number of supply days, and oral morphine equivalent daily dose (milligrams) will be assessed and analyzed. Outcome Assessment Since the study focuses on the risk of chronic opioid use after initial exposure to opioids following hysterectomy, patients were followed from the 8th day after hysterectomy to the first day of outcome occurrence. The outcome, chronic use of opioids after hysterectomy, will be defined using trajectory models.11 in which patients with similar patterns of medication filling during follow-up will be grouped together. The trajectory model was initially generated for the purpose of the assessment of medication adherence.32,33 In order to classify the trajectory groups for opioid use during the defined follow-up window, we first generate 6 dichotomous variables to indicate if a study participant fills a prescription of an opioid medication during each of 6 consecutive 30 day follow-up periods.11 we then model these 6 binary indicators of using opioids in each 30 day follow-up period as a longitudinal response in a logistic group-based trajectory.34,35 With a trajectory model, we will estimate the probability of membership of patients in each group, and the probability of the certain opioid exposure over time as a smooth function of time. We will fit the model using 2 to 4 opioid exposure groups with comparison of the Bayesian Information Criterion.36 The number of groups will be chosen based on the value of the Bayesian Information Criterion. In each group, a third-order polynomial (including linear, squared, and cubic terms) of time will be used to model the probability of being exposed to opioids. Patien ts will be assigned to different trajectory groups, which are generated from these models and have highest probability of the membership. Based on the model results, the group of patients with the highest probability of filling opioids over time will be defined as the chronic use. Other trajectory groups were classified as nonchronic users. The trajectory models provide new advanced approaches to utilize the observed data to determine distinct filling patterns of opioids in our study population during the year after hysterectomy surgery. It classifies patients into groups with similar opioid exposure patterns without relying on a priori and subjective cutoff line for the definition of chronic opioid use. The trajectory models will be conducted using SAS Proc Traj (SAS, version 9.4, SAS Institute Inc., Cary, NC, USA). Patterns of Chronic Opioid Use After chronic opioid use is defined using trajectory models, we will compare the frequency of the incidence of chronic opioid use over time from 2010 to 2013. The secular trend will be analyzed using Joinpoint regression program (National Cancer Institute, Calverton, MD) to identify the joint points and slopes. The rates of chronic opioid use in women post hysterectomy will also be compared with varied age, comorbidities, co-medications, as well as characteristics of initial opioids exposure, including opioid types and doses. The geographic variation of chronic opioid use will be mapped and analyzed using ArcGIS 10.5 geographic information systems software (ESRI, Redlands, CA). The opioid prescription policies and socioeconomic status in different states will be compared with the geographic variation of chronic opioid use. Predictors of Chronic Opioid Use We will identify the predictors of chronic opioid use at baseline or the time of the initial opioid prescription. A previous study demonstrated that hysterectomy, older age, and higher levels of pain-related dysfunction were associated with opioid prescription.15 Potential predictors in this study would include age, year of surgery, smoking, illicit substance abuse, alcohol abuse, hysterectomy type, psychotropic medication use, pre-operative depression, pre-operative pain condition, primary indication for hysterectomy, co-medications, and characteristics of the initial opioid exposure. Although the benefits of minimally invasive surgical procedures have been documented,37 hysterectomies performed for benign indications in 2010 in the US still consisted of 40.1% total or subtotal abdominal hysterectomies, 30.5% laparoscopic hysterectomy, 19.9% vaginal hysterectomy, and 9.5% robotic-assisted hysterectomy.21,25 Hysterectomy type has been related to the initial opioid prescription,15 how ever, the results from randomized clinical trials showed that abdominal hysterectomies didnt increase postoperative chronic pain.38,39 The primary indication for hysterectomy is defined based on the following algorithm: (i) precancerous conditions will be assigned the primary indication if endometrial cystic hyperplasia or carcinoma in situ of female genitourinary system is listed as an indication associated with hysterectomy surgery; (ii) whichever is listed first of endometriosis, uterine prolapse, or uterine leiomyoma will be assigned the primary diagnosis associated with hysterectomy if cancer or a precancerous condition is not listed; (iii) endometrial cystic hyperplasia is combined with in situ under precancerous and that pain and bleeding were included as reported reasons for hysterectomy, and (iv) other was assigned the leading for the remaining diagnoses.19 Over 60% of patients have reported pain as pre-operative symptoms for hysterectomy.39 After hysterectomy, the prevalent pain was reduced to 4.7% to 31.9% during 1-2 years after surgery, while new onset pain at follow-up was reported in 1-14.9% patients and increased pain was in 2.9-5% of patients with pre-operative pelvic pain.39 Therefore, in our study, we plan to assess pre- and post-operative pain, as well as the pain conditions, including pelvic pain, back pain, fibromyalgia, and migraine or other headache syndromes using ICD-9-CM codes. Patients with pharmacy claims for opioids or diagnoses for opioid abuse (ICD-9-CM: 304.xx) during the 6-month baseline period will be identified as opioid users prior to hysterectomy. Preoperative depression that has been found significantly associated with postoperative chronic pain,40 will be identified using diagnoses, as well as medication use at baseline. Antipsychotropic medication use will be obtained using prescription information. The psychiatric comorbidity, will be assessed using prescription information instead of ICD-9-CM codes for greater specificity.11 Co-medications refer to the use of other medications on postoperative pain management. The postoperative use of Nonsteroidal anti-inflammatory drugs (NSAIDs) or Acetaminophen with opioids has been found safe and effective on pain relieve with reduced opioid dose.41 All potential predictors, including characteristics of initial opioid use, will be adjusted in multivariate analyses to identify the significant predictors for chronic use of opioids in patients post hysterectomy. Statistical Analysis Statistical tests and modeling will be conducted to identify potential significant risk factors for chronic use of prescribed opioids in women post-hysterectomy. Categorical variables will be examined and compared using Chi square or the Fisher exact test. Continuous variables will be compared using the student t test. The covariates will be selected from all demographic and clinical variables using statistical modeling. A univariate analysis will be performed with the initial opioid exposure variable and then with each covariate added one at a time to monitor the change of the estimate of the major exposure variable. The covariates that modify the estimate of opioid exposure (variable >5%) or significantly predict the chronic use of opioids will be selected for further multivariate analysis. To account for many confounding factors, we will also utilize propensity score matching method to combine all confounding factors into a propensity score. The patients with initial opioid exposu re will be 1:5 matched with the patients without initial opioid exposure using the propensity score with a caliper of 0.01. A multivariate conditional logistic regression model will be utilized to measure the adjusted odds ratio of initial opioid exposure on chronic opioid use in two matched groups. A probability of type 1 error (alpha) = 0.05 will be considered to be the threshold of statistical significance. Tukey-Kramer method will be applied to correct the inflated p value due to multiple comparisons. Statistical analysis will be performed using SAS software (version 9.4, Cary, NC). Sensitivity Studies In order to address unmeasured confounding factors, sensitivity analyses will be conducted in two sections: subgroup analyses and instrumental variables. Subgroup analysis In order to investigate the effects of initial opioid exposure in women post hysterectomy, multivariate analysis will be conducted in the following subgroups: women with postoperative chronic pain, women without postoperative chronic pain, women with postoperative NSAIDs use, women without postoperative NSAIDs use, women with postoperative Acetaminophen use, and women without postoperative Acetaminophen use. Interactions between the drug exposure and the important factors will be examined in the multivariate analyses. Subgroup analyses will likewise be conducted if the interaction is statistically significant. Instrumental Variable We plan to use propensity score matching to address all measurable confounding factors and generate two balanced comparison groups. However, the unmeasurable confounding factors, like confounding by indication, may still impact the study validity. Instrumental variable is an advanced methodology that has been utilized in pharmocoepidemiological studies to control for the unmeasurable confounding factors, such as confounding by indication. In the sensitivity study, we will use the physicians preference as an instrumental variable and reexamine the initial opioid exposure on chronic use of opioids post hysterectomy. D. Timeline Table. Study Timeline of the Study. Time Period Study Progress Before 07/01/2017 Obtain IRB approval and Optum data use permission 07/01/2017 08/01/2017 Complete data cleaning, manipulating, and variable editing. 08/01/2017 10/01/2017 Complete analyses for demographic and clinical characteristics 10/01/2017 01/31/2018 Complete trajectory modeling to determine chronic opioid use. Analyze the time and geographic trends. 02/01/2018 02/28/2018 Submit an abstract to the annual meeting of International Society of Pharmacoepidemiology (ISPE) 03/01/2018 06/30/2018 Complete analyses for specific aim 1 07/01/2018 01/31/2019 Complete predictive modeling as described in specific aim 2 02/01/2019 02/28/2019 Submit an R21 to NIH, and an abstract to the annual meeting of ISPE 03/01/2019 06/30/2019 Compete analyses for specific aim 2, including all sensitivity studies. Submit a final paper to a high impact journal 09/01/2017 12/15/2017 Complete course PHP 2090 01/01/2018 05/15/2018 Complete course PHP 2470

Justifying Mutual Deceit in William Shakespeares Sonnet 138 Essay exa

Justifying Mutual Deceit in William Shakespeare's Sonnet 138 A common conception of William Shakespeare’s poetry entails complex language and hidden meanings. Shakespeare is famous for his ability to author a web of images that creates layers of interpretations and understandings. In Sonnet 138 however, Shakespeare is more direct in describing his relationship with his lover by avoiding imagery and metaphors, explaining to the reader that this seemingly unconventional relationship is indeed justified. Shakespeare constructs a persona of the speaker in a way that establishes a casual and conversational relationship with the reader. This allows for an open disclosure of the mutual hypocrisies between himself and his lover while leaving his steadfast candor to convince the reader that Shakespeare’s affirmations concerning love are acceptable. Shakespeare’s elimination of imagery allows for a reliance on diction that he takes advantage of by selecting words with double meanings, creating a reflexive manner about the poem for the reader to explore. Shakespeare conveys the meaning of the poem, that mutual deceit is compatible with love, with the seemingly straightforward language that connects the reader to the speaker while forcing the reader to think twice about certain words that deepen the surface understanding. As in all Shakespearean sonnets, the structure of the poem plays an important role, as the three quatrains and final couplet often represent transitions in tone, language and meaning. However, Sonnet 138 differs from the norm as the first two quatrains do... ...as such a connection with the speaker and wants to understand the speaker’s situation, Shakespeare justifies the hypocrisies on the surface of this love scenario. The speaker takes hold of his audience in an inviting conversational manner that forces them to appreciate what he has to say. As the speaker asserts his knowledge of the way love works, the reader agrees because the speaker articulates every word for the explicit purpose of reader understanding. The speaker’s honed and efficient language makes the reader hang on every word, creating realizations in the puns with several words that deepen the meaning of the poem and better illustrate to the reader that seeming truth, mutual deceit and love can exist in harmony.

Grandpa Blakeslee in Burns Cold Sassy Tree :: essays research papers

In life, people crave guidance. At some point, everyone needs a helping hand. Some people turn to one another, while other turn to great forces of power, such as God. Many people live accordingly to the rules of God, and in turn are directed in leading a better life. In the brilliant novel Cold Sassy Tree, by Olive Ann Burns, Grandpa Blakeslee is such a person. Whenever Grandpa faces an obstacle, he turns to God. Grandpa turns to God whenever he needs true help. Grandpa is a type of person who is mild, witty, and rather religious. Grandpa uses religion to solve many of his problems. At the beginning of the story, Miss Love was the target of gossip. The entire town viewed her as an outsider and couldn’t understand why she married Grandpa, especially after his wife had recently died. After Grandpa elopes, he comes back to the house and finds a group of people mourning the sad death. When Grandpa prays, â€Å"Lord above, afore this gatherin’ assembled, I ask You to bless the memory of Miss Mattie Lou† (99). Everyone stood shockingly, in silence as Grandpa continued the prayer. When he finishes singing the praises of his deceased wife, and asking for guidance for his new one, the crowd has a change of heart. It was a strange thing that happened then. My mama went up to her pa and kissed him and, crying, hugged Miss Love, who, crying, hugged her back. My daddy kissed Miss Love on the cheek and then shook hands with Grandpa. Uncle Camp naturally did the same thing (100). Slyly, Grandpa used the power of God to divert the feelings of the crowd. While Will is talking to Grandpa about his frightening encounter with the train, he asks Grandpa if â€Å"[he is] alive [because] of God’s will† (97). Without fail, Grandpa responds with wise words. He tells Will that â€Å"God gave [him] a brain† (97). This shows that Grandpa believes God doesn’t deal with the everyday mumbo jumbo, only the things that are life altering. He believes that God doesn’t need to be there for us twenty-four hours a day, but will give us certain abilities that assist you when you need assistance. Conclusively, Grandpa starts to give Will a sermon.

Renting Software :: essays research papers

Renting Software The life expectancy of software, especially purchased software, has become shorter and shorter over the years. While in the past an organization could be on the cutting edge of technology for five or six years with the software it had, now some applications become obsolete within two or three years. If you personally want to use the most current application, such as word processors and spreadsheets, you must pay several tens or hundreds of dollars to upgrade your version every two or three years. Now imagine how much money organizations have to pay for the same privilege for hundreds of thousands of employees. Worse, unlike households and small firms, many organizations spend millions of dollars on enterprise-wide applications, such as supply-chain management, ERP, and Web-based transaction systems only to find that two or three years later their version is old and lags behind the newer versions that their competitors use. Also, for small companies, the cost of even a single module o f an enterprise-wide system may be too high for purchasing. They prefer a monthly payment to a single, but large allocation of capital for the software. The answer to these challenges may be a relatively new approach to acquiring applications – renting. There are two approaches to renting: in one, the organization pays for the use of an application over a limited period of time at its site; in the other, the organization pays to use the application through the web. On-site Renting Many IS executives would rather rent software for a limited period of time and pay less than own it for a much higher cost. To satisfy this need, many software vendors now offer rental programs. For example, many organizations rent antivirus software rather than purchase it. Network Associates, Inc., the company that owns the popular McAfee antivirus software offers rental contracts for limited periods, as short as one year. The company realized that since thousands of new computer viruses are launched every years, its customers prefer to rent a version of the application for only one year, and when the next version, which takes care of new virus, is available, rent the newer version. When a company rents software, the rental rate is determined by the number of users and the period for which the software is rented. At the end of that period, the company must delete all copies of the software from its computers, or renew the rental agreement. Renting Software :: essays research papers Renting Software The life expectancy of software, especially purchased software, has become shorter and shorter over the years. While in the past an organization could be on the cutting edge of technology for five or six years with the software it had, now some applications become obsolete within two or three years. If you personally want to use the most current application, such as word processors and spreadsheets, you must pay several tens or hundreds of dollars to upgrade your version every two or three years. Now imagine how much money organizations have to pay for the same privilege for hundreds of thousands of employees. Worse, unlike households and small firms, many organizations spend millions of dollars on enterprise-wide applications, such as supply-chain management, ERP, and Web-based transaction systems only to find that two or three years later their version is old and lags behind the newer versions that their competitors use. Also, for small companies, the cost of even a single module o f an enterprise-wide system may be too high for purchasing. They prefer a monthly payment to a single, but large allocation of capital for the software. The answer to these challenges may be a relatively new approach to acquiring applications – renting. There are two approaches to renting: in one, the organization pays for the use of an application over a limited period of time at its site; in the other, the organization pays to use the application through the web. On-site Renting Many IS executives would rather rent software for a limited period of time and pay less than own it for a much higher cost. To satisfy this need, many software vendors now offer rental programs. For example, many organizations rent antivirus software rather than purchase it. Network Associates, Inc., the company that owns the popular McAfee antivirus software offers rental contracts for limited periods, as short as one year. The company realized that since thousands of new computer viruses are launched every years, its customers prefer to rent a version of the application for only one year, and when the next version, which takes care of new virus, is available, rent the newer version. When a company rents software, the rental rate is determined by the number of users and the period for which the software is rented. At the end of that period, the company must delete all copies of the software from its computers, or renew the rental agreement.

Nel Noddings Essay

Noddings went to Montclair State College in New Jersey where she received her bachelor’s degree in mathematics, and moved on to gain her master’s degree in mathematics from Rutgers University, in New Jersey as well. Noddings received a doctorate in educational philosophy from Stanford University where she presently is the Jacks Professor Emeriti of Child Education. Lastly, she received her Ph. D. in 1975 after changing from mathematics and education to a broader field of educational theory and philosophy. She also currently occupies the John W. Porter Chair in Urban Education at Eastern Michigan University. As Noddings makes clear in many of her works, schooling played a central role in her life, and her early experiences with caring teachers contributed to her life long interest in student – teacher relations. She also contributes her professional life as a result of â€Å"various accidents and awareness of opportunity† (Johnson, Reed, 2011). As Noddings states, (1997, cited in Johnson & Reed, 2011) † all of these accidents†¦ involve love, or led to love, and these loves, like bits of colored glass, are the elements from which my life has been composed. Her approach to education begins with the idea that caring is basic to human life. She believes that all people want to be cared for and that the need to be good comes out of the remembered experience of being cared for. Her approach to caring is described as a feminine approach because it is based on the voice of the mother as a nurturer. It is her belief that if women created the educational system and its disciplines, they would have organized the curriculum around the stages of life. Noddings ideally wants the home to be viewed as the primary educator. She feels this is the best form of educating because it is done non-threatening and conversational matter. Critics of Noddings would claim that making the home be viewed as the primary educator, it would force teachers to go beyond what is expected in today’s educational environment. Noddings suggests teachers to involve themselves in all of their student’s lives. She recommends three approaches for teachers to follow: dialogue, practice, and confirmation. In dialogue, the teacher is open to any opinions on any topics. In practice, Noddings would encourage the teacher to involve the class in community service activities. In confirmation, the teacher must speak only positively about a child. Noddings would rather the teacher not give an exam and semester grades, but instead have the student and the teacher work together to create positive evaluations. Nel Noddings wants students to be comfortable enough in the classroom to feel at home. She used her three approaches to create an environment of love, and prevent hate. Her approach also would require teachers to get to know all aspects of their students including their likes and dislikes, wants and needs, and ideas. In doing so, the teachers will be able to create activities that cater to each child individuality and therefore, making learning for interesting. She also wanted the students to learn core subject through experience to make the students want to keep learning. Noddings views about teaching by caring can be useful in that it forces a teacher to really get to know her students, and give them the best possible learning environment. She suggests that children will work hard for people they like and trust. She takes this approach from her own educational experiences. Noddings view about education based on caring suggests that it â€Å"speaks to the existential heart of life- †¦ that draws attention to our passions attitudes, connections, concerns, and experienced responsibilities† (Johnson & Reed, 2011). She believes this approach will eventually create adults capable of caring for themselves and the world we live in. However, the teacher is walking a fine line by doing this. The teacher could nd up becoming too involved in the student’s life, and end up causing more harm then good. She could end up interfering in the family environment instead of helping it. The basic principle to be taken from Noddings is that dialogue is of the utmost importance in a relationship. Without it, a teacher will be unable to establish a bond based on truth, and trust. All of Noddings ideas, once explained make sense and fit very well with the times we live in and the students that we teach, but there needs to be a model to help implement her ideas. As an educator that’s life and professional career was also attributed to the experiences I had in the classroom as a child both positive and negative, I understand her view about how a positive student – teacher relationship is important for the success of what the student is learning. It is my opinion that her beliefs are still an influence on todays learning. I also believe that many teachers unconsciously do practice the beliefs of Noddings. Many times are forced to be more structured in our teachings due to state testing and are unable to be more â€Å"caring† with our teachings.

Ancient Rome Essay

†¢ It is not acceptable to simply say â€Å"the two civilizations were similar and different† – specify specifically how they are similar and different †¢ Possible Prompt: Analyze similarities and differences in techniques of imperial administration in TWO of the following empires. – Han China (206 B. C. E. –220 C. E. ) – Mauryan/Gupta India (320 B. C. E. –550 C. E. ) – Imperial Rome (31 B. C. E. –476 C. E. )Example †¢ The political system of Han China is similar to the Guptan Empire in that both included strict laws and stressed the importance of your role in society. A major difference between these administrations is that in Han China the king was fully in charge, even revered, while in the Mauryan/Guptan Empire priests were at the top of the hierarchy. Example †¢ The imperial administration of Han China and Imperial Rome were similar because they were both headed by an emperor. However, they differed in their treatment of the emperor. In Han China a ruler’s decisions, if detrimental to society, could be questioned. While in Rome, what the emperor decreed could not be questioned. What do I need for my thesis? †¢ You must address 1 specific similarity and 1 specific difference. †¢ i. e. Both the Empires of China and Rome were ruled by an emperor who maintained imperial control, however, the Chinese instituted a system of scholar bureaucrats that gained their position through merit, while the Romans never achieved such an elaborate bureaucracy. What is a direct comparison? †¢ This is a comparison that is not split between paragraphs or by other sentences. It must be one or two sentences that compare one subject of the comparison to another. †¢ Your comparisons should be supported by evidence to support your statement. Example Direct Comparison: While both the Roman and Han (or Gupta) Empires left behind many achievements, the Han (or Gupta) were much more technologically and culturally creative. Evidence: – The Romans took much of their culture from the Greeks, such as their religion, artwork and architecture. – While the Romans had aqueducts, roads and other great works, much of this was taken from others and improved upon. The Gupta on the other hand came up with the concept of zero and a base 10 number system that is still in use today. – The Romans relied on slavery for their source of labor, while the Chinese relied upon free peasants. This led to technological stagnation on the part of the Romans, while the Chinese were able to (insert pieces of specific evidence here). What is analysis? †¢ This is where you explain why. †¢ You tell the reader what caused this similarity or difference to occur. †¢ This is usually a because sentence and the most difficult part of the comparison essay. †¢ The reason that the Guptan bureaucracy was never as elaborate as that of the Chinese was because†¦. 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