The Big Mac Index and What About China Case Study

The Big Mac Index and What About China - Case Study Example tion of this theory is very simple and that states that the value of any particular good in one nation is equivalent to its value in other countries if one considers the same keeping in mind the concept of exchange rate of the currencies between those nations. But this is not always the case in real time. Big Mac Index, developed based on the prices of Big Mac in the USA and many other nations has proved that in various countries, the value of their currency is overrated compare to that of the USA where as in some other countries the currency is underrated in comparison to that of USA. In short run, the concept of PPP is not valid for various goods and the main reasons are organizations those are trading those items have to consider costs such as transportation cost, various kind of taxes such as VAT or government tax, Non traded service, competition in the existing market, Inflation etc. Along with all these factors, organization also needs to consider cost of labour while finalizin g the price of the same. If one considers the case of Big Mac, in the USA, the labour cost is $ 8 per hour where as in China; the labour cost is as low as $ 1 per hours, so the final price of the Big Mac is far lower than that of the USA. So it is very clear that the PPP theory is not always applicable while comparing the price of various goods across the countries as there are number of others factors play an important role is deciding the price. Many countries allow their currencies to grow at a slower pace compare to that of US Dollar or Euro. During 2013, the exchange rate of RMB was at $ 0.16. From 2005 onwards, Chinese government started allowing their currency to grow in a modest rate and in following five years, that is during 2005-2010, the Yuan rose total 20% in value compared to that of the US Dollar. The main reasons behind allowing the modest growth of the currency are: weaker exchange rates allows growth in the export as various countries like to purchase more goods from

Imperialism and Manhood Essay Example for Free

Imperialism and Manhood Essay Study question 1. 2. 3. To Roosevelt, the idea of race suicide was closely interlinked to manhood. Not only would the American men face competition from immigrant workers and be unable to provide for more children: thus leading to an excess of inferior immigrants but the American man would also be related to the impotent American man, unable to create more children. This would lead to the race’s elimination Race and Immigration 1. It allowed individuals to distinguish and separate themselves from immigrants thus creating a barrier that showed them as undesirable. 2. Certain policies and laws were created to separate the Chinese from other groups: Chinese Exclusion Act. 3. This act set a precedent on the treatment of other foreigners that would enter America. Urban Politics and Culture 1. It is preferable to have a community that has a degree of refinement than to live in one that is full of poverty. 2. The wealth should be divided amongst the immediate family to a degree that does not surpass them into leading unfulfilling and lazy lives. The rest should be distributed for the benefit of society. 1. Having undergone poverty himself, Riles shows stereotypes but presents them in an entertaining way to the audience. Also he mentions the roles these different cultures play in merging with the American way of life. 2. Riis and Carnegie are similar in their opinion that the poor exist and cannot be ignored but it is only the rich who can provide them with relief. Cultural Encounters in the Far West 1. The Bison went into extinction because of the cold and droughts bought in by the changing environment and human influence which resulted in colonial expansion that bought in new diseases and animals. 2. It was not the nomads alone who hunted the bison. They sold the animals to the Euro-American invaders. 1. Blacks could not vote unless their grandfathers had not been voters before the Civil War, literacy tests had to be passed, fees was charged for voting and democrats (always white individuals) were the only ones allowed to vote. 2. The South contained individuals who had the deepest hatred for the blacks which led the lynching in this area to be the worst. 3. Separate schools, hospitals, accommodations and even entrances were given to the two groups. Often enough the blacks were provided no facilities by certain states. 4. They decided to test out the marginzalation itself by acts like the one committed by Homer A Plessy Jim Crow Museum of Racist Memorabilia Website 1. Minstrels would perform music with black faced performers in the quest to ridicule black people. Also caricatures were made which were printed in novels and plays. 2. Churches taught that blacks were inferior. Politicians gave speeches supporting segregation and writers also wrote against the black man.

Telomere Shortening: Causes and Effects

Telomere Shortening: Causes and Effects Harry McLellan Introduction Telomeres are a repeating sequence TTAGGG, a couple thousand nucleotides long (Kim, et al, 1994) at the end of chromosomes that prevents the degradation of DNA and stops the ends of chromosomes binding together as well as preventing unnecessary repair. The main function of telomeres is preservation of DNA. During cell replication there is a shortening of the telomeric sequence with each cell division (Kim, et al, 1994). Once telomeres become short enough, approaching a critical length the cell begins senescence (Blasco et al. 1997). Therefore, it has been suggested telomere length produces a mitotic clock which could predict cell and organism death (Harley, 1991). Telomeres degrade naturally with each cell division but certain lifestyle factors may accelerate degradation and negatively affecting the health and fitness of an individual. This literature review will explore how telomere length is affected by lifestyle factors and ultimately how this has an effect on ageing. This literat ure review will specifically focus on the telomere length and aging process in humans. A subject gathering a lot of attention and understanding in recent years with the power to predict the longevity of an organism and opportunities to reduce the aging process. Structure and function of telomeres Telomeres cap the ends of chromosomes (Fig. 1) and protected the connected DNA sequences during cell division. Figure 1 a schematic of the end DNA replication problem and how base pairs are lost. Retrieved online at: http://senescence.info/telomeres_telomerase.html (viewed on 18/03/2017)       When the cell divides, DNA must be replicated. However, because DNA can only be replicated 5 to 3, the lagging strand is replicated through backwards stitching. While the leading strand is replicated continuously, the lagging strand requires RNA primers, which provide 3 hydroxyl groups to build from. Then once the primers are removed, a gap is left at the extreme end of the lagging strand template. To stop chromosomes shortening, the end of the DNA strand is a repeating sequence (a telomere) recognised by an enzyme telomerase, which fills in the missing nucleotides to complete the template and ensure no information is lost (Klapper et al. 1998). While telomerase activity is detected in cells with high proliferation potential, in somatic cells it is virtually undetected resulting in the overall shortening of telomeres with each cell division. In immortal or cancerous cells however, telomerase activity is reactivated providing the basis for unregulated and potentially infinite division s as telomere length is repaired after division (Dunham et al. 2000). Figure 2 human chromosomes (grey) capped with stained telomeres (white) retrieved online at: http://science.nasa.gov/media/medialibrary/2006/03/16/22mar_telomeres_resources/caps.gif (viewed on 11/03/2017) Effects of shortening It might be possible to predict a cells lifespan by measuring telomere length, an experiment using cultured human liver tissue reported results of 29-60 base pair loss per year (Takubo et al. 2000). Jiang et al. (2008) and Song et al. (2010) measured the levels of stathmin and EF-1a, which mark DNA damage and dysfunction and found that there is a steady increase with increasing age in humans. Resulting in the overall negative relationship with telomere length and age. Cawthon et al. (2003) found certain genetic disorders like dyskeratosis congenital, the progressive failure of bone marrow leading to early mortality can accelerate telomere shortening. Whilst normal cells loose telomere fragments with each cell division, sufferers of dyskeratosis congenital will experience premature deaths and early development of age related diseases. The same study also compared people of the same age group and lifestyle and found those with naturally shorter telomeres where likely to suffer from a wide range of diseases and had poor survival. Without being affected by life factors, telomere length changes between individual and can give an indication to the life span. Shorter telomeres can lead to genome instability and a higher risk of genetic disease. Gender, genetics and disease In humans there is a negative correlation between telomere length and age, Valdes et al. (2005) published a study that looked at one thousand women and concluded that the human telomere sequence is depleted by 27 base pairs a year by measuring the mean TRF (telomere restriction factor) length using a Southern blot method. Brouilette et al. (2003) found there was no significant difference in telomere shortening rates or length between males and females. Inherently, telomeres can be short and when shorter than average the individual becomes at risk of disease and a reduced lifespan (Farzaneh et al. 2008; Cawthon et al. 2003). Cardiovascular disease is commonly associated with short telomeres (Yang et al. 2009). Telomere length can also be affected by environmental factors (Steinert et al. 2004) not just genetic factors. Factors such as body mass, diet, smoking and exercise (Valdes et al. 2005; Cherkas et al. 2008) all cause a decrease in telomere length and eventual cell senescence (Stiewe and Pà ¼tzer 2001). Factors like smoking and poor diet will accelerate telomere shortening and lead to disease development. Coronary heart disease associated with short leukocyte telomeres (Brouilette   et al. 2003), increased risk of mitochondrial diseases (Zee et al. 2009), atherosclerotic diseases (Van der Harst et al. 2006), diabetes (Sampson et al. 2006) and increased risk in various cancers (Wu et al. 2003). In summary gender has no effect on telomere length but short telomeres are linked to a variety of cancers and disease. Cancer When telomere length becomes too short, the telomere can be subject to repair or recombination (Klapper, et al, 1998). De Lange (2005) published findings that repaired lesions are the probable cause of a cell turning cancerous. In conjunction with this Meeker (2006) stated that short dysfunctional chromosomes are involved in carcinogenesis. Using laser capture microdissection Shammas et al. (2008) looked at the function of telomeres and telomerase activity in adenocarcinoma (types of tumour) cells and found that when telomeres reach a critically short length telomerase activity increases. The same study also found when telomerase activity is suppressed the tumour cells did not proliferate; highlighting telomeres and telomerase involvement in cancerous cells. Poor diet and smoking Telomere shortening to a critical length can cause damage to the genome and potentially turn cancerous. Long term smoking is linked to carcinogenesis in cells (Valdes et al. 2005). Telomere length in circulating lymphocytes is show to be significantly shorter in long term smokers compared with the control none smokers. The exposure to tobacco has a negative effect on the telomere length and accelerates shortening (Morla, 2006). Using biomarkers accumulative DNA damage can be monitored. During ageing and or obesity there is a significant increase in biomarkers human blood. Smoking also caused there to be an increase in biomarkers (Song et al. 2010). When analysed telomeres shorten by roughly 27 base pairs a year but with introduction of smoking 20 cigarettes a day, around 31 base pairs are lost (Valdes et al. 2005); an overall detrimental effect on telomere length. In conjunction with this Epel et al. (2004) produced a study on oxidative stress linked to smoking and telomeres and resu lts showed cells under high oxidative stress had lower levels of telomerase activity and were more susceptible to telomere shortening, aiding the ageing process. Overall smoking has a negative effect and accelerates shortening of telomeres, which can lead to development of tumours or cell death (Meeker, 2006). Oxidative stress is linked with telomere shortening, which leads to DNA damage or premature cell death (Epel et al. 2004). Another factor that increases oxidative stress is poor diet and obesity. A study on obese mice (Furukawa, 2004) showed a positive correlation between fat accumulation and increase in oxidative stress. The study also introduced a NADPH oxidase inhibitor which caused a reduction in adipose tissue (fat/ loose connective tissue) highlighting that fat accumulation is directly linked to oxidative stress. The study concluded with the introduction of the NADPH oxidase inhibitor, caused the conditions of the mice to improve. The reduction in oxidative stress also reduces the telomere shortening (Valdes et al. 2005) and reducing damage to the genome. In summary an increase in oxidative stress has a negative impact on telomere length and ageing. Stress and environment Lifestyle choices impact telomeres length and so does environment an individual lives or works in. A study was conducted to look at the airborne pollutants like toluene and benzene within a city that humans are exposed to on a daily bases (Hoxha et al. 2009). 77 traffic officers and 57 office workers had blood samples taken that where later analysed using real time PCR. Hoxha et al. (2009) analysed the leukocyte telomere length and found a significant difference. Traffic officers who are exposed to traffic pollutants had shorter telomere length compared to office workers. Exposure to pollutants increases telomere shorting and risk from disease and ageing. In conjunction to this Pavanello et al. (2010) studied the leukocyte telomere length in 48 coke over workers compared to 44 controls. All none smokers and all in the same age group the coke oven workers are exposed to polycyclic aromatic hydrocarbons on a daily basis. Pavaello et al. (2010) concluded that coke oven workers exhibited a significantly shorter leukocyte telomere length and higher genome instability linked with disease and ageing (Farzaneh et al. 2008; Cawthon et al. 2003). When an individual becomes stressed, the adrenal steroid glucocorticoid is released. Glucocorticoid has the potential the increase oxidative stress as it is known to inhibit the activity of glutathione peroxidase (an antioxidant enzyme) (Patel et al. 2002). In rats corticosterone (adrenal steroids in rats) caused a decrease in NADPH which is an oxidase inhibitor, (Furukawa, 2004) leading to an increase in oxidative stress and telomere shortening. Stress is associated with oxidative pressure, which is linked to shorter telomeres and poor health. Epel et al. (2004) took a group of women who perceived to have a lot of stress in their life and compared them to a control group who had little stress in their life. The participants consisted of 58 mothers, 19 whom had healthy children and 39 who had chronically ill children. The women with chronically ill children where perceived to have a higher level of stress in their life. The study on shortening in response to stress concluded that women who have a high amount of perceived stress in their life had shorter telomeres equivalent to that of a decade of ageing compared to their control counterparts (Epel et al. 2004). Stress negatively affects telomere length and can lead to poor health and development of disease. Antioxidants Two groups of women and their dietary intake where monitored over the course of five years. The study looked at diets containing high amount antioxidants, mainly vitamin C and E rich foods (fish, fruit and vegetables) against diets which did not (Farzaneh-Far et al. 2008). By measuring telomere length, using quantitative PCR and monitoring the levels of fatty acids in blood, Farzaneh-Far et al. (2008) concluded that an increase in antioxidants correlated with a reduction in shortening of telomeres and the women participants with regular antioxidant intake generally had longer telomeres in comparison to the other dietary group. In a similar study involving 1,067 cases and 1,100 controls, the dietary intake of antioxidants is recorded to study its involvement with the development of breast cancer in women (Shen et al. 2009). In correlation to Farzaneh-Far et al. (2008), Shen et al. (2009) found the same link of a reduction in telomere shortening with increase in antioxidants in the die t. The same paper revealed women with poor diet and low antioxidant intake were far more at risk of developing breast cancer. Antioxidant reduce oxidative damage and telomere shortening. Oxidative stress and nutrition restriction Oxidative damage increases telomere shortening and telomeres are linked to cell senescence. Oxidative damage is therefore linked to the longevity of an organism (Jennings et al. 2000). Dietary restrictions have been placed on organisms such as rats to test whether a decrease in nutrition will decrease oxidative damage. Jennings et al. (2000) found that when nutrition is decreased so that optimal growth cannot be sustained there is an increase in longevity and this is true for a large range or organisms. In an earlier study, Jennings et al. (1999) made the link between early growth and shortened kidney telomeres in rats in later life. The rats with diet restrictions had a reduced maternal growth followed by a postnatal growth catch up but had longer kidney and liver telomeres, which are associated with increased longevity of up to 15% (Jennings et al. 1999). To summarise telomere shortening is accelerated by oxidative stress which in turn can be reduced by nutrition restrictions which will increase longevity. Exercise Oxidative stress from poor diet and general perceived stress can cause an acceleration in telomere shortening (Epel et al. 2004; Farzaneh-Far et al. 2009). Exercise can reduce the effects of stress shortening. Two groups of mice where placed into containers. A group given the option to exercise on a running wheel and the other group given no option to exercise. All running done was voluntary. At the end of the experiment, the mice given the option to exercise showed an increase in telomere stabilisation proteins and a suppression of cell apoptosis regulators (Werner et al. 2009). When tested on humans similar results occurred. When track and field athletes are compared to untrained individuals the data obtained showed an increase in expression of telomere stabilisation proteins in athletes and reduced leukocyte telomere shortening (Werner et al. 2009). Regular exercise will supress the effects of stress and reduce the effects of ageing by preservation of telomeres.    Conclusion Telomeres naturally shorten with time and are reflected in the aging of a human. A cell can only divide so many times before the genome becomes damaged (Klapper, et al, 1998), in this instance the cell must begin cell senescence or apoptosis. Many lifestyle factors like obesity, smoking, poor diet, genetic inheritance, pollution, and stress can accelerate telomere shortening and ageing causing premature death or disease. Other factors work the opposite way, consumption of antioxidants can reduces oxidative stress and slow down telomere shortening (Farzaneh-Far et al. 2008). Regular exercise can increase expression of telomere stabilising proteins (Werner et al. 2009). Restricting nutrition to limit optimal growth will increase the longevity of an organism (Jennings et al. 2000). Telomere length analysation using quantitative PCR can be used to predict the lifespan of an organism and help stop the onset of premature age related diseases.

Teen Workers Essay -- essays research papers

Teen Workers Fifteen years old and working seems to be becoming a norm and in fact there are many teenagers younger than fifteen who are already working at paying jobs. Some of these students are as young as 12 years old. More than half of the secondary school students have paying jobs. This number grows each grade level the student goes up. The number of hours also rises along with the grade level. The kind of job varies depending on the sex of the child. Boys tend to deliver newspapers and girls tend to babysit. As the teens grow older the job interest change with teenage girls turning to restaurants and retail outlets, while the boys will work in the family business , restaurants and other food related businesses. The hours that the kids have to chose from are usually form 6a.m. to 8a.m delivering newspapers and 8p.m to 6a.m. for babysitting. Most other jobs are scheduled 3pm till 10pm during the week while weekend jobs tend to have schedules of 7 to 8 hours per day. The Higher Education Board says that working more than 15 hours a week is bad for the academic career . As the work hours increase the study time decreases. Current research finds that a work schedule of 10 hours or less seems to be the best and for most teenagers a schedule of 10 hours does not effect their academic performance, in negative ways but in fact seems to help them do better in school shown by improved grades. Those teens working 10 to 15 hours per week are in a toss up situation with some doing... Teen Workers Essay -- essays research papers Teen Workers Fifteen years old and working seems to be becoming a norm and in fact there are many teenagers younger than fifteen who are already working at paying jobs. Some of these students are as young as 12 years old. More than half of the secondary school students have paying jobs. This number grows each grade level the student goes up. The number of hours also rises along with the grade level. The kind of job varies depending on the sex of the child. Boys tend to deliver newspapers and girls tend to babysit. As the teens grow older the job interest change with teenage girls turning to restaurants and retail outlets, while the boys will work in the family business , restaurants and other food related businesses. The hours that the kids have to chose from are usually form 6a.m. to 8a.m delivering newspapers and 8p.m to 6a.m. for babysitting. Most other jobs are scheduled 3pm till 10pm during the week while weekend jobs tend to have schedules of 7 to 8 hours per day. The Higher Education Board says that working more than 15 hours a week is bad for the academic career . As the work hours increase the study time decreases. Current research finds that a work schedule of 10 hours or less seems to be the best and for most teenagers a schedule of 10 hours does not effect their academic performance, in negative ways but in fact seems to help them do better in school shown by improved grades. Those teens working 10 to 15 hours per week are in a toss up situation with some doing...

God and Man in Dracula Essay

The cycle of films produced at Universal Studios in the early 1930s represents, in important ways, the advent and elaboration of the twentieth century horror genre. Among the many themes introduced in films such as Dracula (1930), The Mummy (1931) and Bride of Frankenstein (1935) is that of God and Man. In this paper, I intend to explore this theme by closely investigating the creation of the bride that takes place near the end of Bride of Frankenstein. Although a variety of narrative codes operating in this scene illuminate the film’s meaning, it is the fine line between God and Man that deserves critical scrutiny. The creation of the bride scene opens up with the kites being released into the oncoming storm in hope of catching the electricity from a lightening bolt. We then cut to a low angle shot of Frankenstein running down the stairs towards the laboratory. After reaching the bottom, he runs to a giant electrical machine, the view tilted so as to give the feeling of anticipation as he holds the switch and bites his lip. Dr. Pretorius is shown from a low angle, with light splayed across his face and dark machines looming in the background giving him an almost god-like status. The next shot is a high-angle shot of Dr. Frankenstein, making it seem like he’s cowering in submission, a slave to Dr. Pretorius. With various close-ups of machines crackling and sparking with electricity, we again come upon Frankenstein, looking around, waiting to throw the switch that would begin the process to start life in the dead. By this time he has fully accepted the fact that he is a part of this great misdeed. We then come to an extreme close-up of Frankenstein’s face, underlighting of his face, a serious look on his face like he knows he is meddling with the work of God. Dr. Pretorius then runs to the four large switches and dramatically clicks them on in a shower of sparks (a close-up of the switches hitting their connectors reveals a shower of sparks). A close-up of his face disappears when an electric explosion occurs right behind his head, illuminating the screen. His face reappears looking down upon the creation, wanting it to come alive, disregarding the fact that he is going against God and nature in his actions. Machines crackling and sparks flying from various angles, briefly looking at Dr. Frankenstein’s face again. A tilted shot of Dr. Frankenstein gives the impression that he’s lying down on the machine, trying eagerly to look at the reaction of the body. Cut to a close-up looking up at Dr. Pretorius, then back to Dr. Frankenstein with a top-view, going back to the master/slave relationship between the two. Explosions rock the laboratory, smoke rising to the roof in showers of spark. An eye-level full shot of the laboratory reveals arcing electric bolts and sparks showering the tables with fire. We then have a low-angle view of Dr. Frankenstein which then changes to a high-angle view as he yells upwards, â€Å"it’s coming up! † His gloves and white jacket, coupled with the pale make-up and dark lips gives him an almost sinister look. The body then ascends the wall of the laboratory, the camera placed about halfway up the wall and follows it all the way till it passes by and reaches the top. After seeing part of the contraption disappear through the roof, we cut to a extremely long shot of the whole tower with the machine rising above the roof, after which the camera cuts to a full shot of the body being hooked up to various wires by Dr. Pretorius’ workers. The most critical arrangement of shots then occurs the moment before life is given to the body. The camera cuts back to the lab with an aerial close-up of Dr. Frankenstein who has shadows cast across his face from underlighhting. The same for Dr. Pretorius as we cut back and forth between the two. As the shots go back and forth, the lighting on their faces gets gradually brighter making their eyes seem to sink back into their heads and disappear, leaving only empty sockets. This plays into the theme that they are no longer controlled by God or nature, but by evil. The section ends with Frankenstein appearing on the roof after awakening from his slumber.

Responsible Social Networking on Campus

Responsible Social Networking Campus gossip websites were ideally intended to be used as a way to communicate with students and engage with peers in useful ways. I feel that campus gossip websites are being used unethically. Currently, Campus gossip websites are just now being utilized to start rumors and anonymously publicly bash fellow students without ramifications from school and related officials. In turn, the students have gone to new extremes with malicious comments towards fellow peers and in some cases, causing physical and emotional damage with no clarity on who all should be held liable.A waste of time and energy is spent by students anonymously involving themselves in these gossip websites who knowingly hold such power to destroy a fellow peer and yet people still use them in all the wrong ways. It is completely unethical to post a rumor about another individual on a campus gossip website. There are standards that every person should hold themselves to and in return be ab le to treat one another as you would like to be treated. College should not be a place where students are more concerned about social statuses and stressed about being publicly humiliated by peers because of one person’s post on a campus gossip website.Cruel, hurtful comments tend to follow, making campus life for the targeted individual agonizing. Ethical conduct should be carried out day to day, through out every aspect, even when socially it can be easy to stray if you are constantly subjected or surrounded around peers who chose not to. It still gives no excuse to contribute to gossips websites. It’s simple, know right from wrong and conduct yourself in that manner, posting rumors on gossip websites results in nothing but unethical. If I were to read about myself in a posting on a gossip site of course, I would first feel the need to defend myself.Depending on the severity of the information that was posted, I know my first thought would be who did this and what th is person’s intent behind doing so. The thought of having someone have such a negative opinion about you is very depressing. Everyone always wants nothing but positive things to be said when your name is mentioned. My train of thought would be to fight back, say something in response to let this person and everyone else know that what’s being said is nothing but someone’s personal attack for some unknown reason to publicly degrade me.My actions, on the other hand, would not reflect any of that. I have been in situations where I have read some harsh critics opinions and peers personal thoughts of what they thought of me and/or current status socially and acted on my first defensive thought strategy. The result never ended where my first intentions wanted to. Looking back after taking the time to calm down, reading both of our comments, I realized that I made myself look just as unethical as the person posting about me. I was getting drawn in, feeling like I had t o respond back by using personal attacks to feel justified.Not responding and by not contributing in any form is what needed to be done. Of course, my feelings would be dishearten but overall I would know what I did was right by not having to be unethical as a form to feeling justified to prove them wrong. As of right now, schools administrators and even federal law cannot fully regulate or hold certain parties responsible who are at fault for these campus gossip websites. Ethically, of course this is not right. We are taught as children, that there are consequences for our bad choices.There are laws that we are to follow and if we do not, you will be held accountable and punished. So how is it that so many people have been hurt and suffered some mental distress and in some cases unfortunately, physical harm and damage? As discussed in* a case raised question whether colleges should be obligated to intervene when one of their students are targeted on a gossip website. A very concern ed mother addressed an issue with the Dean at the University where her daughter attended because some explicit names where posted on a campus gossip website under her name.After the Mother was told nothing could be done by the University to block or remove the comments, she then decided to file a complaint with the U. S Department of Education’s Office for Civil Rights stating the University was required to take action under Title IX, Federal Gender-Equity Law arguing that it interfered with her daughter’s ability to learn. After they reviewed the case, they ruled that because the comments were posted anonymously and not able to be proved students, and because the Mother did not identify her daughter by name to the University so they could properly investigate further, nothing was done.Certain steps needed to be followed like the daughter reporting the conduct to the campus police. Her representation stated it was not all a loss. The Department’s willingness to consider the complaint means that gossip websites fall under Title IX guidelines meaning in turn, more questions would have to be answered and hopefully, long term, Law and Regulations can be better stated and put into place. * Something needs to be done to hold certain parties responsible. So it is unethical that nothing is being done to stop this ongoing issue that has hindered many students.Sadly enough, cyber bullying and gossip websites has become severe enough to be lead to rape, murder and suicides. As talked about in*(http://topics. nytimes. com/top/reference/timestopics/people/c/tyler_clementi/index. html) a Rutgers University freshman Tyler Clementi committed suicide after his roommate decided to live stream his intimate encounter broadcasting on twitter encouraging to watch and revealing to everyone that he was gay. He then was ridiculed as he turned into the dorm’s gossip.Tyler, a very quiet, reserved young man never spoke of his sexual orientation so you can imag ine the extreme distress and humiliation that followed and unfortunately, 3 days later he decided to jump off the George Washington Bridge into the Hudson River in an apparent suicide. There were 2 people charged in this case and in my own personal opinion, lightly and not even in relation to the suicide but more along the lines invasion of privacy. The case questioned Hate crime due to the sexual orientation and his roommate exploiting Tyler, prosecutors stating that his roommate was homophobic.There are many more cases like this maybe some not as extreme but how is it that people are getting no ramifications, no punishment what so ever for their mean attempt to harass, mortify and viciously attack peers leading to crimes in due result of anonymously posting on a gossip website. In this case Tyler’s was documented and more publicly noted by his roommate making charges easier but still not enough in regards to cyber bullying and being held accountable and who all should be pu nished.Responsibility to crimes in due result of a posting on a gossip website first and foremost the person responsible doing the act needs to be held accountable, the victims school if proper steps were not taken by the victim to notify proper officials to try to prevent the crime, and the website host should also be held accountable for letting people post such things that could in turn, lead to something as severe as a crime as a result of. Postings should be monitored and everyone should be under certain guidelines for this reason of crimes taking place.As Technology advances, we have to be constantly changing, learning and adapting to be able to communicate anywhere we go. To be able to attend College, it is almost impossible to be able to be successful without a computer, cell phone and internet. Having such access to information, constantly online talking with peers and other social outlets has become the majority of communication. In today’s culture, people spend mor e time on a computer than anything else and as technology advances, everyone feels urged to keep up with it due to its improvements to make day to day tasks as simple as possible, instant gratification to any task at hand.This influences our culture in many ways but in the case of how it affects the overall scheme of campus gossip websites, you can only imagine how easy it is to access this information and how easy it is instantly post. I think technology advances are meant for much more then to able to get on Facebook and post what you had for lunch but having such easy access to this gives campus peers way to gossip more freely. Word of mouth takes much longer as to posting online where you know it’s going to be seen in a matter of seconds. In conclusion, campus gossip websites are unethical.Posting rumors, spreading lies regardless of your personal opinion about someone, in no way shape or form, is going to accomplish anything positive for either person involved. Having to find any information about yourself is upsetting enough but to have to deal with it on a daily basis where more concern should be about education, not about being ridiculed or embarrassed by what someone post stated. Standards and laws need to be put in place to better protect students from being put in the situation where cyber bullying and posting anonymously goes unpunished by holding schools, the posting party and web host.

Campbells IQ Meals essays

Campbell's IQ Meals essays Founded in 1869 by Joseph Campbell, a fruit merchant, and Abraham Anderson, an icebox manufacturer, the Campbell Soup Company has since evolved into an internationally renowned enterprise, mostly recognized for its leadership in the soup market . In the early 1990s, despite their powerful leadership, the company realized the soup market had become mature and offered little growth opportunity. As a result, Campbell considered an entry in an emerging market mostly focusing on diet and disease prevention: the nutraceutical market. Stephen DeFelice, coiner of the term nutraceutical, defines the latter term as a food or part of a food that provides medical or health benefits, including the prevention and/or treatment of a disease. Based on the growing interest in health and disease prevention from the American population, the entry in the nutraceutical market was perceived to have an explosive potential by David W. Johnson, CEO of Campbell at the time. Campbell Soup then engaged in a five years development of mail-delivered clinically-proven meals, designed for people with cardiovascular problem, Type II diabetes and other health concerns. About $30 millions were invested in research and development (R as the meals were named just before the market test . Although product trials and taste tests yield positive and optimistic results, Campbell was forced to withdraw the product line from the market after 15 months of market testing in Ohio . Many unconstructive aspects of the IQ meals outweighed their apparent benefits, thus conducing to sales results discouragingly lower than the 200-million-a-year expectations. David W. Johnsons prediction of the products explosive potential could have originally turned out to be accurate since numerous product benefits could be highlighted. In fact, IQ meals were found to be the first and ...

Literary Analysis Frankenstein Essays

Literary Analysis Frankenstein Essays Literary Analysis Frankenstein Essay Literary Analysis Frankenstein Essay Essay Topic: Frankenstein Foreshadowing is great literary device that catches, hooks, and captures the reader’s attention. In a novel using foreshadowing leaves the reader captivated about what series of events will occur next. Also, it allows the reader to formulate a conclusion about what will happen with the characters at the end of the novel. In Mary Shelley’s, Frankenstein, Victor Frankenstein was determined, curious, and extremely innovative. In the novel, Victor was very determined to put forth his scientific skills in order to make a creation. Victor is a mad scientist that dedicates the majority of his day on pure science and different projects. When you are very passionate about something you tend to make that your main concentration. Being determined means that you do not give up very easily and you preserve through whatever you are struggling with. Also, you continue to strive to achieve that goal or dream, set the bar high, and push the envelope. Sometimes things don’t always happen exactly the way you planned and it is the opposite of what you expected. After the monster came to life, Victor wasn’t exactly thrilled about its appearance. According to â€Å"Frankenstein† Victor was not pleasantly surprise with the outcome of the monster.† I had gazed on him while unfinished; he was ugly then; but when those muscles and joints were rendered capable of motion, it became a thing such as even Dante could not have conceived.† (Shelly 45). After realizes what he had created wasn’t what he hoped for, Victor decides to abandon the monster because of its monstrous appearance. Another characteristic Victor displays in the novel is curiosity. Curiosity causes Victor to devote his life to science. He works sleepless nights on different project hoping something great will come out of it. Curiosity can really drive a person insane because it leaves you wanting to know more and more. Sometimes curiosity can be detrimental because you may learn somethi

American History In Literature Annotated Bibliography

American History In Literature - Annotated Bibliography Example Berkin, Carol. Making America: A History of the United States. Brief Sixth ed. Boston, MA: WADSWORTH CENGAGE Learning, 2014 This bibliography demonstrates history as a vibrant process twisted by human expectations, tricky choices, and frequently the startling consequences. The book encourages readers to reason historically and to grow into citizens who value their past. The straightforward narrative and clear chronology emphasize communication over intimidation making if very interesting to read. Berkin, Carol. Making America: A History of the United States. Brief Sixth ed. Boston, MA: WADSWORTH CENGAGE Learning, 2014 This book acknowledges President Abraham Lincoln consideration of other approaches to remedying the menace of slavery during his reign. The book uses various artistic devices to present a bigoted and flawed notion of colonization as a temporary fixture of U.S. As such, the historical book remembers Lincoln as having discarded his backup of colonization when he signed the declaration.

The American History in the Roaring 1920s Essay

The American History in the Roaring 1920s - Essay Example These consolidations led to more growth which benefitted most Americans including women. The American younger generation influenced the growing middle class to discard traditional values, especially those that discriminated against women. College students adopted a drinking habit and attended wild parties. Women enjoyed more freedom and would take part in advancing the national course. Sources of prosperity The sources of the 1920s prosperity consisted of four main factors which were: consolidation mergers; second industrial revolution; assembly line mass production, other growth areas and income misdistribution-sick industries. To begin with, the first consolidation merger had happened during 1895-1904 and the second occurred during the 1920s. In the era of the 1920s people were becoming used to big business and they were no longer a threat to them. Big businesses offered their employees benefits which helped them with health insurance. One struggle that starter businesses faced is the problem of Oligopoly, which one industry controlled three businesses. These practices made the business world less competitive. Second Industrial Revolution involved mainly the Henry Ford Company (1903) which produced their most famous model which was called â€Å"Model T.† The company made this model for over twenty years. Cars during this time were expensive to make and very little people could afford them. Car prices were about $850 during 1908, because Henry Ford wanted cars to be available for people. Through this mass production of cars there were three innovations: Assembly Line, raised wages, and credit. The assembly line for workers was a complete change in their work force it speeded up the process of making cars. Before the assembly line, it took twelve hours to build a â€Å"model T† but after the assembly line, it took one and a half hours to make a car. By 1927 the price of a car dropped to $290, which was two months of your work wage if you were a wo rker at Ford. Secondly Henry Ford raised his workers wages to five dollars a day to keep his workers in the job. Credit, was the last innovation: people were buying everything with credit by the 1920 credit left everyone in debt. The credit allowed people to get what they want on loan. By 1929 in the United States 80% of all American families owned a car which was 1 in 4 people. With the General Motors Company also growing in size, people were able to purchase cars in different colors, which led to some social consequences. Automobiles helped the rural people by breaking down rural isolation, gave country people access to towns and cities and even doctors. The coming of trackers helped increase food production. The consequences of automobiles is it made Americans mobile; it allowed people to find jobs that were further from their homes and people could go wherever they wanted to. Cars were a form of entertainment: they helped to change daily habits of most Americans, premarital preg nancies increased, and cars were being used by criminals. Additionally, other growth areas consisted prosperity: It consisted of ancillary industries such as steel, oil and rubber, which were industries that were dependent on car industries. The multiplier effect was one job in the car industry would be equal to more jobs in steel, oil and rubber companies. Federal government invested in roads and highways and the second growth area was electricity which was first used

The Political Classification of France Essay Example | Topics and Well Written Essays - 1750 words

The Political Classification of France - Essay Example For instance, it recently contributed to the fall of dictatorial leadership of Libya in Africa. The country has experienced many rulers under a monarchy and even empire1. The political institutions in the Country have undergone several changes since the 1789 revolution. This paper brings to attention the study of France as a country and its classification in terms of politics. Regime European countries have for a long time employed communism. Liberalization in the region introduced the issue of totalitarianism2. In the period between 1922 and 1989, there were waves of democratization which were reversed by authoritarian and totalitarian systems of governance which believed in the ideologies of National Socialism and communism. This was also the case in France which is among the European countries. The regime that is in use today in the country is totalitarianism. System of governance of the French Republic Most countries have their system of governance which may differ or be the same as of the other countries. They chose between presidential system of governance where power is not confined to one person and parliamentary system of government where executive power is rested upon collective executives. Adoption of any system under which power is shared is intensely critical in the political economy of a particular nation. France has been under a hybrid system since it was made to be a fifth republic. The system of the government is based on characteristics of both the presidential and parliamentary systems3. This means that, the country partially separates the powers and partially fuses them. The hybrid form of the republican government was created by the constitution of the fifth republic which was fully in use, in the year 1958. The authority that the parliament had been cut down, and the president was embrowned with a lot of powers such as the power to dissolve the National assembly and power to appoint the prime Minister. This was rhetoric since the prime min ister had authority as the heads the council of ministers and he was also the leader of the party that had the majority seats in the National Assembly. France was termed as a sovereign country, according to this constitution. It stated that the national sovereignty belongs to the citizens of France. The constitution further gives people the right to practice their political desire in elections and referenda which took place after some specified period. Legislature of France The legislative France is entailed in the parliament. The parliament is composed of two chambers namely the National Assembly and the Senate. The two are referred to as â€Å"Assemblee Nationale† and â€Å"Senat† in French. The senate has approximately 318 members who are elected indirectly by an institution set for the purpose. The upper chamber, which is the National Assembly, is more powerful than the Senate, although both chambers share legislative authority. Members of the national assembly are about 577 in number and are elected directly by the citizens of France. The members of the senate serve a term of nine years in which a third of the seats fall for elections after every three years4. The national assembly serves for a period of five years. The charter, which is in use now, was adopted in 1958 and revised in 1962, established the Fifth Republic and provided for a powerful president, and a bicameral legislature with less power than it had in the past. The Constitution of France France has had

Research proposal nursing Example | Topics and Well Written Essays - 1750 words

Nursing - Research Proposal Example For ischemia of soft tissue to come about, the pressure in the external part of the body must exceed the pressure in the capillaries so as to obstruct the flow of blood. The minimum pressure for which the capillaries would close is about 32mmHg. Despite the fact, that high pressure interface is a factor that is pertinent; the duration of time that is on promoting skin integrity would also play a significant part. In most cases, duration of monetary awards is by the period of time taken to promote skin integrity. A study that was done by Bain and Ferguson-Pell in 2002 explained that high pressure for a short length of time and low pressure for a longer length of time would lead to damage of the pressure. A number of studies advanced in this field have attempted to explain whether the duration of skin integrity could be a possible risk factor for a monetary award to CNAs/GNAs. Some studies like those for Guy 2004, Nasolpel 2004, Schoonhaven and Defloor 2002, Lewicki 2007, Morrison 2001 , Amonovitch 2006, Stevens 2004, and Schoonhaven 2002 studied the duration of skin integrity and concluded that it was not an exclusive factor for a monetary award to CNAs/GNAs (Guy, 2004). Vanderwee and Gunningberg in 2007, involved 500 Participants in a study. The study assessed variables like duration of surgery and co morbidities. This author utilized an analysis tool which identified the likelihood of various variables, which may affect the monetary award to CNAs/GNAs development. ... 2004, Schoonhaven and Defloor 2002, Lewicki 2007, Morrison 2001, Amonovitch 2006, Stevens 2004, and Schoonhaven 2002 studied the duration of skin integrity and concluded that it was not an exclusive factor for a monetary award to CNAs/GNAs (Guy, 2004). Vanderwee and Gunningberg in 2007, involved 500 Participants in a study. The study assessed variables like duration of surgery and co morbidities. This author utilized an analysis tool which identified the likelihood of various variables, which may affect the monetary award to CNAs/GNAs development. The Participants' mean age was forty seven years, with the age range of the Participants being 13- 86 years. The recorded duration of skin integrity promotion was lower by 228.7% of the subjects, 29.9% of the Participants, 26% of the sample. The author performed a postoperative assessment and the other performed a preoperative assessment. Of all the cases that were assessed the only predictor of monetary award to CNAs/GNAs was the skin inte grity promoter. The author concluded that skin integrity is with a monetary award to CNAs/GNAs development. However, other studies in this topic do not confirm the association of skin integrity and monetary award to CNAs/GNAs. For instance a study made by Vanderwee and Gunningberg in 2007on 100 Participants, where by a number of pressures ulcer risk factors were assessed. The average age of the participants was 50 years and the age range of the Participants was between 30- 80. After strict assessment of the Participants, the author did not discover any cases of monetary award to CNAs/GNAs action. The author, therefore, concluded that the skin integrity is not an exclusive risk factor for a monetary award to CNAs/GNAs development (Guy, 2004). Description of design Research Approach My study

Under what circumstances might short term interest rates lose their Essay

Under what circumstances might short term interest rates lose their potency as an instrument of policy control by central bank..........FULL TITLE BELOW - Essay Example One such inherent problem which dilutes the effectiveness of interest rates as a viable monetary policy instrument is a liquidity trap situation. Liquidity trap is a situation when the rate of interest falls too low to be used as a monetary policy tool. It is a situation when the nominal rate of interest becomes so close to zero so that the real rate of interest could almost be considered as negligible. The lower the rate of interest is higher is the amount of aggregate investment expected to be; but the problem in this instance is that commercial banks do not have ample funds to lend out to the investors. Hence, there are little chances of any stimulation in the aggregate level of investment and so of that of the aggregate output in the economy. Usually, the need for lowering the rate of interest arises when the nation in question is in an urgent need of financial stimulation. However, if the nominal rate of interest is already bound to zero and there is practically no room left for further depreciation, the multiplicative impact of an expansionary monetary policy goes in vain (Rabin, 2004). The LM curve diagram being depicted here shows that till the point when the rate of interest lingers above Rt, there are possibilities of the rate of interest being used as an effective expansionary monetary policy measure. However, at Rt, when the shape of the LM curve becomes almost horizontal, changes in aggregate demand for money from Ma to Mb and vice-versa, has no mushrooming impact at all. Hence, in such a situation, the stimulating power of rate of interest becomes almost zero. Quite obviously, the economy has to rely upon other measures to invigorate the financial condition in the economy and also initiate some steps to reinstate the corrective power of the rate of interest. Hence, unless there is a fall in the rate of interest there are little chances of an appreciation in the aggregate output level in the current period and

American Constitution Law 3 J Essay Example | Topics and Well Written Essays - 500 words

American Constitution Law 3 J - Essay Example The clause is there to protect accused persons or alleged perpetrators from abuse in a number of ways, namely; from a second trial for the same offence after prosecution, acquittal, and against multiple punishments (Stephens & Scheb, 2008). In Johnson’s case, he was already tried and found innocent of the purported crime. The clause also dictates that defendants cannot be tried for a lesser crime within the original crime (Stephens & Scheb, 2008). This means that any crime that is seen to be lesser in nature to the original crime, but is merged within the murder, cannot be used to try and convict Johnson in a court of law. Johnson has a right to cite the Double Jeopardy Article in the event you decide to take him to court over the same crime. I think it may be worthwhile mentioning that there are some instances where the rule may not apply, for instance; if multiple offenses were carried out by Johnson, the clause does not apply to him. He could be tried for the other offenses he committed that may carry the same sentence or conviction as the murder of your family member. Unfortunately, this case may not be used to talk of the defendant’s conduct. There is also a reason why this testimony may not be enough to let Johnson go to court. The court would want to maintain the integrity and finality of all criminal proceedings. If the court were to summarily ignore the unsatisfactory outcomes of your case against Johnson, then its integrity would be called to question. This Clause is considered as one of the oldest concepts, and cannot easily be altered as people have tried over the years (Stephens & Scheb, 2008). In spite of the testimony provided by Johnson’s brother on his deathbed, it may not be sufficient to ask for a retrial of Johnson’s case. His Miranda rights did not apply at the time of the confession because it is a belief that anything said at that time is acceptable in court. He can be tried and found guilty of the

Research proposal nursing Example | Topics and Well Written Essays - 1750 words

Nursing - Research Proposal Example For ischemia of soft tissue to come about, the pressure in the external part of the body must exceed the pressure in the capillaries so as to obstruct the flow of blood. The minimum pressure for which the capillaries would close is about 32mmHg. Despite the fact, that high pressure interface is a factor that is pertinent; the duration of time that is on promoting skin integrity would also play a significant part. In most cases, duration of monetary awards is by the period of time taken to promote skin integrity. A study that was done by Bain and Ferguson-Pell in 2002 explained that high pressure for a short length of time and low pressure for a longer length of time would lead to damage of the pressure. A number of studies advanced in this field have attempted to explain whether the duration of skin integrity could be a possible risk factor for a monetary award to CNAs/GNAs. Some studies like those for Guy 2004, Nasolpel 2004, Schoonhaven and Defloor 2002, Lewicki 2007, Morrison 2001 , Amonovitch 2006, Stevens 2004, and Schoonhaven 2002 studied the duration of skin integrity and concluded that it was not an exclusive factor for a monetary award to CNAs/GNAs (Guy, 2004). Vanderwee and Gunningberg in 2007, involved 500 Participants in a study. The study assessed variables like duration of surgery and co morbidities. This author utilized an analysis tool which identified the likelihood of various variables, which may affect the monetary award to CNAs/GNAs development. ... 2004, Schoonhaven and Defloor 2002, Lewicki 2007, Morrison 2001, Amonovitch 2006, Stevens 2004, and Schoonhaven 2002 studied the duration of skin integrity and concluded that it was not an exclusive factor for a monetary award to CNAs/GNAs (Guy, 2004). Vanderwee and Gunningberg in 2007, involved 500 Participants in a study. The study assessed variables like duration of surgery and co morbidities. This author utilized an analysis tool which identified the likelihood of various variables, which may affect the monetary award to CNAs/GNAs development. The Participants' mean age was forty seven years, with the age range of the Participants being 13- 86 years. The recorded duration of skin integrity promotion was lower by 228.7% of the subjects, 29.9% of the Participants, 26% of the sample. The author performed a postoperative assessment and the other performed a preoperative assessment. Of all the cases that were assessed the only predictor of monetary award to CNAs/GNAs was the skin inte grity promoter. The author concluded that skin integrity is with a monetary award to CNAs/GNAs development. However, other studies in this topic do not confirm the association of skin integrity and monetary award to CNAs/GNAs. For instance a study made by Vanderwee and Gunningberg in 2007on 100 Participants, where by a number of pressures ulcer risk factors were assessed. The average age of the participants was 50 years and the age range of the Participants was between 30- 80. After strict assessment of the Participants, the author did not discover any cases of monetary award to CNAs/GNAs action. The author, therefore, concluded that the skin integrity is not an exclusive risk factor for a monetary award to CNAs/GNAs development (Guy, 2004). Description of design Research Approach My study

American Constitution Law 3 J Essay Example | Topics and Well Written Essays - 500 words

American Constitution Law 3 J - Essay Example The clause is there to protect accused persons or alleged perpetrators from abuse in a number of ways, namely; from a second trial for the same offence after prosecution, acquittal, and against multiple punishments (Stephens & Scheb, 2008). In Johnson’s case, he was already tried and found innocent of the purported crime. The clause also dictates that defendants cannot be tried for a lesser crime within the original crime (Stephens & Scheb, 2008). This means that any crime that is seen to be lesser in nature to the original crime, but is merged within the murder, cannot be used to try and convict Johnson in a court of law. Johnson has a right to cite the Double Jeopardy Article in the event you decide to take him to court over the same crime. I think it may be worthwhile mentioning that there are some instances where the rule may not apply, for instance; if multiple offenses were carried out by Johnson, the clause does not apply to him. He could be tried for the other offenses he committed that may carry the same sentence or conviction as the murder of your family member. Unfortunately, this case may not be used to talk of the defendant’s conduct. There is also a reason why this testimony may not be enough to let Johnson go to court. The court would want to maintain the integrity and finality of all criminal proceedings. If the court were to summarily ignore the unsatisfactory outcomes of your case against Johnson, then its integrity would be called to question. This Clause is considered as one of the oldest concepts, and cannot easily be altered as people have tried over the years (Stephens & Scheb, 2008). In spite of the testimony provided by Johnson’s brother on his deathbed, it may not be sufficient to ask for a retrial of Johnson’s case. His Miranda rights did not apply at the time of the confession because it is a belief that anything said at that time is acceptable in court. He can be tried and found guilty of the

Different types of farming Essay Example for Free

Different types of farming Essay Farming has contributed to communities by being a source of income and food. As stated in the Oxford Dictionary â€Å"farming is the activity or business of growing crops and raising livestock.† Different communities use different types of farming to suit their way of living. They either use commercial or subsistence farming. Commercial farming is farming that is done by companies and raising of crops and livestock for sale in outside markets. Subsistence farming is self-sufficiency farming which means farmers focus on growing enough food to feed their families. Farming has been depended on to sustain a good economy in many societies. The term economy is defined as â€Å"the wealth and resources of a country or region, especially in terms of the production and consumption of goods and services,† in the Oxford Dictionary. There are three types of economies planned economy, mixed economy and free economy, and in The Bahamas the mixed economy is practiced. A mixed economy is an economic system that includes a mixture of capitalism and socialism. This type of economic system that includes a combination of private economic freedom and centralized economic planning and government regulation. The Bahamas is heavily dependent on the tourism, banking and construction industries. The Bahamas is mainly dependent on tourism but the tourism rates have and are declining. Tourism is the practice of traveling for recreation for business and leisure purposes. There are many different jobs that are in the tourism industry. Some are construction workers, hotel managers and other positions that are available and taxi drivers. Since the recession is global less people have travelled and visitor arrivals have fallen. This has forced businesses to close and as a result people have lost their jobs. The tourism industry has provided work for half of the Bahamian workforce. With contributions from other industries such as farming the effects of this recession can be minimized. Contribution means the act of giving in common with others for a common purpose. If the farming industry is used then less jobs will be lost and more jobs will be provided, and decrease our dependence on imported foods. One contribution that farming can make is creating jabs. Jobs in the country are important because it provides the necessary items for families. A Job is â€Å"to carry on public business for private gain,† according to the Webster dictionary. Jobs provide money to circulate around the country to improve the country and to help with the welfare of families in the country.

Nurse-led Clinics in Respiratory Care: a Literature Review

Nurse-led Clinics in Respiratory Care: a Literature Review INTRODUCTION 1. What is a nurse-led clinic? As the coined term suggests, a nurse-led clinic is a health care centre in which nurses are involved in high level specialist procedures and assessments. In such centres, nurses are the critical decision makers, being involved in patient care at the micro-, meso-, and macro-levels. While the role of the physician in the provision of health care is undisputable, the deity-like status that medical practitioners typically have in the mind of patients, coupled with the limited time available for individual patient consultations, make it hard for these group of health care professionals to tackle the ‘softer’ side of patient care. Nurses, on the other hand, defined by the Oxford Medical Dictionary as health care professionals that are trained and experienced in nursing matters and entrusted with the care of the sick and the carrying out of medical and surgical routines, are better placed to provide this essential follow-up, especially in the care of patients with chronic dise ases. According to Hatchett (2003), a nurse-led clinic is a clinic in which nurses have their own patient case loads of whom they take complete charge. Hatchett broadly describes the components of such a clinic. There would be an increase in autonomy associated with the nursing role in the nurse-led clinic, with the power to admit, discharge or refer patients, as appropriate. In Hatchett’s own words, the roles which nurses adopt in these revolutionary settings can be broadly classified as follows (Hatchett, 2003): Education Psychological support Patient monitoring The initiation of nurse-led initiatives probably owes its origins to the rise in nursing specialties in the United Kingdom. Throughout primary and secondary care, nurses are taking senior positions in health care institutions, such as nurse specialists, nurse practitioners, nurse consultants, nurse prescribers, etc, leading to a marked change in service delivery and the profile of the nursing profession. In addition to the usual registered nurse training, nurses working at higher levels of practice receive training to acquire a range of other medical skills such as physical examination and medical history taking in order to recognise abnormal clinical findings. In a two-phase exploratory study to evaluate the domains of structure, process and outcome of nurse-led clinics in supporting intermediate care after the acute phase of disease, Wong et al (2006) interviewed nurses from 34 clinics and 16 physicians and observed 162 nurse-led clinic sessions. Their findings demonstrated the high level of skill and experience of the nurses who ran the clinics. Their work involved skills such as adjusting medications and initiating therapies, and diagnostic tests according to protocols. Interventions included assessments and evaluations, and health counselling. All patients studied showed improvement after the nurse clinic consultation, with the best rates reported in wound and continence clinics; satisfaction scores for both nurses and clients were high. However, although physicians valued their partnership in care with the nurses, they were concerned about possible legal liability resulting from the advanced roles assumed by these nurses. Ultimately, nurse-led clinics provide an integral and invaluable patient-centred approach to the management of chronic disease which build upon skills such as counselling, teaching and health promotion which are key to contemporary nursing practice, as well as newly acquired medical skills. The advent if nurse-led clinics provides an opportunity for nurses to develop enhanced roles in which they can achieve more autonomy in their practice. This can be made a reality if adequate training and education, as well as effective leadership are in place (Wiles et al, 2001). 2. The general roles of nurses in chronic care management The chief nursing officer, Sarah Mullally has proposed ten key roles for nurses in autonomous patient care. These are outlined below as cited by Hatchett (2003): Order diagnostic interventions: just like a medical practitioner would, the present-day nurse is able to ask for laboratory or clinical diagnostic tests to aid the process of diagnosis. Furthermore, a well-trained nurse will also be able to read and interpret laboratory results effectively Make and receive referrals directly: while the all-important roles of nurses are recognised, the need for a multidisciplinary approach to patient care remains key in order to optimise patient outcomes. Accordingly, nurses should be able to recognise the patients’ needs and refer them to the appropriate health care service as required. Similarly, nurses should be ready to accept referrals from other health care disciplines as necessary. Admit and discharge patients for specified conditions, within agreed protocols: in order to make the best use of the often limited hospital resources, a nurse should have the power to recommend patients for hospital admission and subsequent discharge Manage patient case loads: in nurse-led clinics, nurses are also responsible for managing their individual case loads. It is important to delegate patient cases to other members of the team, when necessary to ensure that patients receive the best care possible. Run clinics: the autonomous role of the nurse in a nurse-led clinic includes all aspects of the management and day-to-day running of the clinic. Prescribe medications and treatments: nurse prescribers are able to advise patients on appropriate treatment, based on diagnosis of ailment and individual characteristics and laboratory findings. Carry out a wide range of resuscitation procedures, including defribillation Perform minor surgery and outpatient procedures: especially in injury clinics. While nurses are probably not equipped to carry out full-fledged surgical operations alone, they are trained to conduct emergency processes as appropriate. Triage patients, using the latest information technology, to the most appropriate health care professional Take a lead in the way local health services are organised and in the way they are run Nurses have always been considered as a supplement to the fundamental care provided by medical doctors. In fact, in some geographical regions, nursing roles are limited to menial tasks such as changing bedpans etc. In the new age, the nursing role as we know it is becoming increasingly important with nurses taking on infinitely more clinical roles. This has led to controversial debates with critics arguing that nurses cannot replace doctors in the provision of health care services. As Richard Hatchett very astutely pointed out (2003), the increased autonomy being acquired by nurses is not a bid to compete with medical doctors. Instead, â€Å"it is a case of considering who can provide the most appropriate service to the patient† (Hatchett, 2003). Thus, it is clear that the roles of nurses in chronic care management is very diverse and can be integrated into any nurse-led clinic intervention to the utmost benefit of the patient and all stakeholders. There have been numerous studies on the role of nurses in the care of patients with chronic diseases. In addition, and more specifically, the feasibility and benefits of implementing nurse-led clinics in practice have also been investigated to some extent. In the subsequent sections, we will review the evidence to support these innovative nursing interventions in an attempt to make the best use of health care resources. 3. Nurse-led clinics in the management of chronic care diseases: the evidence The World Health Organization (2002) defines chronic diseases as health care problems that require ongoing management over a period of years or decades. The nature of these disease conditions make it necessary to provide long term care and follow-up for the afflicted patients. Nurse-led interventions have been investigated a wide range of chronic diseases. It could be a logical, user-friendly, cost-effective and practical approach to improving long-term patient outcomes and should be explored fully to maximise the contributions of nurses to the chronic care management. Although this review aims to analyse the effectiveness of nurse-led clinics in the treatment of respiratory diseases, a prior look at the role of these interventions in the management of other chronic care diseases will provide an insight to the general contributory roles of nurses and will serve as a foundation for complete understanding of this state of the art intervention. 3.1 Nurse-led interventions in the management of diabetes Numerous studies have evaluated the benefits and practicalities of nurse-led clinics in the long-term management of diabetes. The renal diabetic nurse specialist is described as an â€Å"essential player† in organising the management of, and to meet, all aspects of need of this group of patients (Marchant, 2002). An unintended benefit of a nurse-led clinic to reduce cardiovascular risk is improved glycaemic control, HbA1c (Woodward et al, 2005). In particular, nurse-led diabetic clinics have been shown to benefit specific ethnic groups. Matthias et al (1998) identified the needs of diabetic patients from minority ethnic groups, such as blacks and Asians and postulated that nurse-led clinics were of particular benefit in this patient group. As epidemiological data show that diabetes is most common in minority ethnic groups (Carter et al, 1996), the importance of these innovative interventions is further emphasised. 3.2 Nurse-led interventions in the management of cardiovascular disease Care of patients with cardiovascular diseases is broad and involves many aspects, from risk factor management (non pharmacological interventions), primary and secondary prevention of clinical events, pharmacological therapy, surgical procedures, etc. Through a large well-designed randomised controlled trial in Scotland, Campbell et al (1998) showed that nurse-led clinics were practical to implement general practice and led to an significant increase in various aspects of the secondary prevention of coronary heart disease. Significant improvements were noted in aspirin management, blood pressure management, lipid profile management, diet and physical activity, regardless of the individual patient’s baseline cardio performance or status. However, surprisingly, there was no recorded improvement on smoking cessation, which would have been a beneficial intervention in most acute and chronic disease states, including respiratory diseases. In addition to the apparent effectiveness of the nurse-led clinics in the long-term primary and secondary prevention of coronary heart disease, the optimal use of nurses in the care of these patients has been shown to be cost-effective in terms of quality adjusted life years (QALYs) (Raftery et al, 2005). In this large cost-effectiveness analysis, although the cost of the nurse-led clinic intervention was  £136 higher per patient, the differences in other National Health Service (NHS) costs was not statistically significant. Furthermore, there were 28 more deaths in the non-intervention group leading to a gain, in the intervention group, in mean life-years per patient of 0.110 and of 0.124 QALYs. 3.3 Nurse-led interventions in rheumatology The role of clinical specialist medical doctors in the care of their patients is unquestionable; however, the role of nurses in the therapy area of rheumatology (i.e. in patients with rheumatoid arthritis) is also well documented. Hill and colleagues (1994) clearly demonstrated the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic. Although this was a small study with a sample size that only included 70 patients, the statistical significance of the findings of this randomised controlled trial cannot be ignored. In patients managed in the Rheumatology Nurse Practitioner clinic, pain, morning stiffness, psychological status, patient management and satisfaction all improved significantly (p = 0.001; p = 0.028; p = 0.0005; p In addition, patient satisfaction is frequently higher in patients who are allocated to nurse care than those allocated to standard medical care (Hill, 1997). In yet another study by Dr Jackie Hill, a registered nurse at the Academic and Clinical Unit for Musculoskeletal Nursing in the Chapel Allerton Hospital in Leeds, the researchers concluded that a nurse-led clinic is effective and safe and is associated with additional benefits, such as greater symptom control and enhanced patient self-care, compared with standard outpatient care. 3.4 Nurse-led interventions in cancer care The effectiveness of nurse-led care in different common cancer afflictions has been researched variously. An extensive review article by Loftus and Weston (2001) discussed the patient needs that could be met by nurses working in nurse-led clinics and highlighted the experience and skills of advanced nursing practice that make such innovative care a reality. The types of nurse-led interventions are as varied as the different types of cancers for which they are used. These range from nurse-led telephone clinics in patients with malignant glioma (Sardell et al, 2001); nurse-led follow up in patients receiving therapy for breast cancer (Koinberg et al, 2004); and nurse-led screening programmes in Hong Kong Chinese women with cervical cancer (Twinn and Cheung, 1999). In a randomised controlled trial in a specialist cancer hospital and three cancer units in southeastern England, Moore et al (2002) assessed the effectiveness of nurse-led follow-up in the management of patients with lung cancer. The findings of the study showed high levels (75%) of patient acceptability. This negates the possibility of patients’ reduced confidence in nurses’ ability and preference for standard medical doctor care. Clinical outcomes were also greatly improved as shown by less severe dyspnoea at three months (p=0.03), better scores for emotional functioning (p=0.03), and less peripheral neuropathy at 12 months (p=0.05). 3.5 Nurse-led interventions in the management of HIV infection Using a rigorous model of comprehensive care nurse-led clinic in genitourinary medicine to compare nurse-led and doctor-led clinics at a central London medicine clinic, Miles and colleagues (2003) reported reliable and valid results to support the use of the nurse-led variety as an acceptable alternative to the existing doctor-led clinics. More specifically, the British HIV Association (BHIVA)/British Association for Sexual Health and HIV (BASHH) advocate the benefits that can be accrued from a nurse-led educational intervention in the care of patients with HIV infection (Poppa et al, 2003). A small pilot study that investigated the effects of a 6-month nurse-led educational programme reported that improved virological responses were seen in treatment-experienced patients (Alexander et al, 2001). While a majority of the studies on nurse-led clinics in other chronic diseases can be broadly applied to nurse-led care in patients with respiratory diseases, differences in the nature of these diseases and the necessary care pathways mean that the extent to which these tested interventions can be applied to other therapy areas is, in actual fact, limited. Government policies that advocate the clinical and economic effectiveness of nurse-led interventions frequently pool together evidence from all therapeutic areas. Indeed, it can be hypothesised that, if nursing interventions are shown be practical alternatives for medical care in complex diseases with poor prognoses, such as cancer, HIV and coronary heart diseases, care of patients with respiratory diseases which generally have better prognoses should be easily, effectively and safely undertaken by qualified and well-trained nurses. Nevertheless, these findings of the effectiveness of nurse-led interventions in the numerous chronic diseases explored in previous sections, should be applied to the different patient population with respiratory diseases. As much as possible, research findings from similar patient groups should be applied in clinical practice in order to ensure that evidence-based practice in this case is relevant. 4. Government policies influencing the establishment of nurse-led clinics Government health policies in the United Kingdom actively support the extension of nurses’ skills into areas such as nurse prescribing and the development of nurse practitioner posts (NHS Plan 2000; Department of Health). Government initiatives that that strive to reduce consultation waiting times and optimise the use of medical practitioners indirectly support the establishment of nurse-led clinics. The Government has endorsed the implementation of nurse-led clinics as a means of increasing access to specialist health care and treatment more quickly and also as an effective way to manage chronic conditions (Hatchett, 2003). In the Department of Health (1999) document, ‘Making a difference’, government plans for strengthening nursing contribution to health care is presented. The Government has launched an ambitious programme of measures to improve the National Health Service and the health of the public, and the role of the nursing profession in this initiative cannot be overemphasised. The key nurse-related points of the document are outlined below: To extend the roles of nurses, midwives and health visitors to make better use of their knowledge an skills – including making it easier for them to prescribe To modernise the roles of school nurses and health visitors in supporting the new health strategy and other policies To see more nurse-led primary care services to improve accessibility and responsiveness The document highlights numerous nurse-led initiatives that have been effectively implemented all around the United Kingdom. A nurse-led minor injury service in rural Cornwall has provided patients with a number of benefits: easier accessibility, reduced waiting times, reduced need for on-site medical; attendance, increased patient satisfaction and reduced need for transfers to local Accident and Emergency departments. Similarly, a nurse-led rapid response team in Peterborough responds to acute crisis cases and allows patients to be nursed at home. Evaluation has shown that 71% of patients referred to this ‘hospital at home’ service would have been admitted to hospital if the service did not exist. Other effective live nurse-led services include a nurse-led rheumatology service in Merseyside and a nurse-led intermediate care unit in Liverpool. Furthermore, several nurse interventions are advocated in the document for contributing to the management of cardiovascular disease. Several of these are also applicable to respiratory diseases; these include: Smoking cessation clinics using national smoking cessation guidelines Healthy lifestyle clinics in collaboration with other health professionals to address factors such as diet, nutrition and exercise, thus improving overall health Care for patients with congestive cardiac failure under ‘home-based’ initiatives Nurse-led chest pain clinics or risk factor screening and reduction clinics Nurse-led blood pressure clinics to identify and help manage blood pressure disorders and medication adherence 5. Review objectives The objectives of this review are: To briefly summarise various studies on effectiveness and cost-effectiveness of nurse-led interventions in common respiratory diseases To critically appraise the methods employed by these studies To evaluate, interpret, and where possible, compare the findings of the various studies To explore the applicability and generalisability of the results to practice in the appropriate patient population To make suggestions for future studies in this area. METHODS Literature search A search of two major databases, MEDLINE and EMBASE, was conducted to identify articles published from 1990 through 2008. Search terms that were used include nurse, nurse-led clinic, nurse-led interventions, respiratory diseases, asthma, chronic obstructive pulmonary disease, bronchiectasis, tuberculosis, cystic fibrosis, cost-effectiveness analysis, cost-benefit analysis, and economics. A secondary search of the reference lists was then conducted to identify relevant articles, editorials, and other unoriginal reports that may have been missed in the primary search. Some studies were excluded based on the following criteria: They were not conducted in patient populations with respiratory diseases Independent nurse-led interventions were not investigated The study populations being investigated were mixed in terms of diagnosis, which would affect the integrity of the study findings for respiratory diseases The methodology and/ or statistical analysis methods were not clearly elucidated 6. Nurse-led clinics in the management of respiratory diseases: a review of the evidence The role of the specialist respiratory nurse has evolved since the early 1980’s with the support of the Royal College of Physicians (RCP 1981). The possible complexity of respiratory patients’ regimens necessitates support with various aspects of their care plans, such as: Supervising nebuliser and inhaler techniques Monitoring progress, i.e. by periodical assessment of lung function and exercise capacity Education on the specific disorder, medications, potential adverse events, etc Counselling and education on positive lifestyle, or non-pharmacological, changes Adherence support and monitoring The role has developed further with nurses providing nurse-led clinics in chronic obstructive pulmonary disease (COPD) and asthma along with nurses providing early supportive discharge and ’hospital at home’ for patients with COPD (French et al, 2003). Some schools of thought argue that nurse-led clinics would culminate in the neglect of the more traditional nursing roles, as nurses focus on a more medical-focused aspect of patient care. However, research in other therapy areas, such as rheumatology (Hill et al, 1994) and mental health (Reynolds et al, 2000) shows that nurses can effectively combine the medical role with the traditional nursing approach. Nursing care strives to provide a holistic approach to care through practical management of disability, education and counselling and referral to other health care services as required (Rafferty and Elborn 2002). 6.1 Bronchiectasis Nurse-led clinics have been evaluated, compared with regular doctor-led clinics, in a single randomised controlled trial in patients with bronchiectasis, a respiratory condition in which there is widening of the bronchi or their branches (Sharples et al, 2002). The study was a randomised controlled crossover trial including 80 patients in a bronchiectasis outpatient clinic. Patients received 1 year of nurse led care and 1 year of doctor led care in random order, and were followed up for 2 years. Various outcome indicators were used in the comparison, including lung function and exercise capacity, infective exacerbations, hospital admissions, quality of life and cost-effectiveness of the intervention. The results of this study are illustrated in Table 1 below. Table 1: Nurse-led and doctor-led care in care of patients with bronchiectasis (Sharples et al, 2002) Measurement outcome Nurse-led Doctor-led Mean difference (95% CI) p-value Forced expiratory volume in one second (FEV1) (%) 1.87 1.86 0.01 (-0.04 to 0.06) Forced expiratory volume in one second (FEV1) (L) 69.7 69.5 0.2 (-1.6 to 2.0) Forced vital capacity (FVC) (%) 87.6 87.6 -0.02 (-1.5 to 1.4) 12 minute walk distance (m) 765 746 18 (-13 to 48) Infective exacerbations (patient years of follow up) 262 (79.4) 238 (77.8) 0.34 Hospital admissions attributable to patient’s bronchiectasis 43 23 0.22 As the table above clearly shows, there was no statistical difference in FEV1/FVC percent predicted or distance walked between nurse led and doctor led care in the two treatment periods. Furthermore, 262 episodes of infective exacerbations were recorded by patients in the nurse practitioner-led care group in 79.4 patient years of follow up, compared with 238 in 77.8 years in the doctor-led care group. Thus, nurse practitioner-led care is associated with a relative rate of exacerbations of 1.09 (95% CI 0.91 to 1.30), p=0.34. Using the St Georges Respiratory Disease questionnaire to assess differences in health-related quality of life between the two groups, there was no statistically significant differences in each of the scores for Symptoms, Control, Impact or total score. Also, the study showed that nurse-led care resulted in significantly higher costs per patient compared with doctor-led care; this was largely due to the difference in the number of hospital admissions and intravenous and nebulised antibiotic costs. The authors concluded that nurse practitioner-led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources. This study has several potential limitations which could invalidate the findings. As the study relied on patient report to record the prescriptions issued by general practitioners, these may have been underestimated and could grossly affect the cost analysis. Conversely, the nurse practitioner was required to record prescriptions and tests issued at the clinic, and thus these records are probably more reliable and she would be more likely to have ensured that patients left with supplies of routine treatment. Another possible drawback of this study is the use of a crossover design in the methodology. Unless a wash-out period is incorporated in the study design, there is the possibility of a carryover effect with crossover study designs, with the danger that the effects of the earlier treatment is falsely attributed to the final experimental treatment. In this study, there was no allowance for a washout period and thus this could affect the reliability and validity of the study results. This order and time effect needs to be checked for within the analyses but it can rarely be excluded as potential biasing factors (Pocock 1983). However, as recruited patients received the interventions in random order, this may negate the carryover effect. Despite the possible limitations of the study that could potentially hinder its applicability in practice, the findings support the implementation of a nurse-led clinic in patients with chronic cases of bronchiectasis as an alternative to the standard rigid medical care. 6.2 Asthma Similar to the findings in the study by Sharples and colleagues (2002) in patients with bronchiectasis, Nathan et al (2006) more recently compared the effect of follow-up by a nurse specialist with follow-up by a respiratory doctor following an acute asthma admission. In a single centre prospective randomised controlled trial, 154 patients admitted with acute asthma were randomly assigned to receive an initial 30-min follow-up clinic appointment within 2 weeks of hospital discharge with either a specialist nurse or respiratory doctor. The intervention comprised a medical review, patient education, and a self-management asthma plan. Further follow-up was then arranged as was deemed appropriate by the corresponding doctor or nurse, and all patients were asked to attend a 6-month appointment. Despite hospital outpatient follow-up, there was a significant proportion of patients in both groups who had exacerbations. However, there was no statistically significant difference between the two groups (Table 2). In the same manner, there was no statistically significant difference in quality of life assessed with two different validated questionnaires, the Asthma Questionnaire and the St George Respiratory Questionnaire. Mean change in peak flow at 6 months was similar between the two groups, probably indicating equivalence of the two tested interventions. Nathan et al (2006) concluded that follow-up care by a nurse specialist for patients admitted with acute asthma can be delivered equivocally with comparable safety and effectiveness to that traditionally provided by a doctor practitioner. Table 2: Nurse-led and doctor-led care in follow-up care of patients admitted with acute asthma (Nathan et al, 2006) Measurement outcome Nurse-led Doctor-led Odds ratio (95% CI) Mean difference (95% CI) p-value Change in peak flow 1.39 (-3.84 to 6.63) 0.122 Infective exacerbations (%) 45.6 49.2 0.86 (0.44 to 1.71) 0.674 Quality of life 87.6 87.6 -0.02 (-1.5 to 1.4) Asthma Questionnaire 0.78 (-0.64 to 2.19) 0.285 St George Respiratory Questionnaire 1.08 (5.05 to 7.21) 0.891 The possible limitations associated with this study is the large amount of missing data for some outcomes, especially peak flow and quality of life

The Use of Electroconvulsive Therapy in Patients with Severe Depression

The Use of Electroconvulsive Therapy in Patients with Severe Depression or Schizophrenia â€Å"In surveys, individuals with both a history of severe depression and a history of physical trauma due to an accident ranked the pain of mental illness as much worse than that of physical trauma† (Isaac 5). Mental illnesses cause immense suffering and potentially even death; in the year 2000, the suicide rate of patients suffering from depression was estimated at fifteen percent. This is a testament to the fact that mental illnesses such as depression and schizophrenia are serious issues, and those suffering from them deserve the most effective treatment available. Many psychiatrists turn to anti-depressants and â€Å"talk-therapy† in attempts to heal their patients; however, there are other options. Electroconvulsive therapy (ECT), also known as electroshock, or simply electrotherapy, is a controversial treatment of numerous mental illnesses, including depression, schizophrenia, bipolar disorder, and other mood disorders. The procedure consists of sending an elect ric current through the brain, essentially shocking it and inducing a seizure. There are many known side-effects, including memory loss; however, their prevalence and magnitude are much debated and far over-dramatized, creating a negative reputation. The origin of this reputation lies in electroconvulsive therapy’s questionable history. Many people look at the use of electroshock in the past, rather than the current advancements that have been made, providing an unfair prejudice regarding the procedure’s use today and causing the population to associate electroconvulsive therapy with images of torture. Despite the preconceived notions that the procedure is cruel and often unsuccess... ...lectroconvulsive Therapy is an Effective Treatment for Schizophrenia and Depression.† Mental Illness. Ed. Tamara L. Roleff and Laura K. Egendorf. San Diego: Greenhaven Press, 2000. Opposing Viewpoints Resource Center. Thomson Gale. George Mason University. 28 Sep. 2012.. Kneeland, Timothy W., and Carol A.B. Warren. Pushbutton Psychiatry: A History of Electroshock in America. Westport, Conn.: Praeger, 2002. Sherer, Richard A.  "Kitty Dukakis Book: In Praise of ECT- Despite the Memory Issue.(electroconvulsive therapy)(Shock: The Healing Power of Electroconvulsive Therapy)."  Psychiatric Times  23.13  (Nov 1, 2006):  1.  Expanded Academic ASAP.  Thomson Gale.  George Mason University.  7 Dec. 2012.   . Thackery, Ellen, and Madeline Harris. The Gale Encyclopedia of Mental Disorders. Detroit, Mich.: Gale Group, 2003. The Use of Electroconvulsive Therapy in Patients with Severe Depression The Use of Electroconvulsive Therapy in Patients with Severe Depression or Schizophrenia â€Å"In surveys, individuals with both a history of severe depression and a history of physical trauma due to an accident ranked the pain of mental illness as much worse than that of physical trauma† (Isaac 5). Mental illnesses cause immense suffering and potentially even death; in the year 2000, the suicide rate of patients suffering from depression was estimated at fifteen percent. This is a testament to the fact that mental illnesses such as depression and schizophrenia are serious issues, and those suffering from them deserve the most effective treatment available. Many psychiatrists turn to anti-depressants and â€Å"talk-therapy† in attempts to heal their patients; however, there are other options. Electroconvulsive therapy (ECT), also known as electroshock, or simply electrotherapy, is a controversial treatment of numerous mental illnesses, including depression, schizophrenia, bipolar disorder, and other mood disorders. The procedure consists of sending an elect ric current through the brain, essentially shocking it and inducing a seizure. There are many known side-effects, including memory loss; however, their prevalence and magnitude are much debated and far over-dramatized, creating a negative reputation. The origin of this reputation lies in electroconvulsive therapy’s questionable history. Many people look at the use of electroshock in the past, rather than the current advancements that have been made, providing an unfair prejudice regarding the procedure’s use today and causing the population to associate electroconvulsive therapy with images of torture. Despite the preconceived notions that the procedure is cruel and often unsuccess... ...lectroconvulsive Therapy is an Effective Treatment for Schizophrenia and Depression.† Mental Illness. Ed. Tamara L. Roleff and Laura K. Egendorf. San Diego: Greenhaven Press, 2000. Opposing Viewpoints Resource Center. Thomson Gale. George Mason University. 28 Sep. 2012.. Kneeland, Timothy W., and Carol A.B. Warren. Pushbutton Psychiatry: A History of Electroshock in America. Westport, Conn.: Praeger, 2002. Sherer, Richard A.  "Kitty Dukakis Book: In Praise of ECT- Despite the Memory Issue.(electroconvulsive therapy)(Shock: The Healing Power of Electroconvulsive Therapy)."  Psychiatric Times  23.13  (Nov 1, 2006):  1.  Expanded Academic ASAP.  Thomson Gale.  George Mason University.  7 Dec. 2012.   . Thackery, Ellen, and Madeline Harris. The Gale Encyclopedia of Mental Disorders. Detroit, Mich.: Gale Group, 2003.

Ghost Sightings in Monroe, New Jersey :: Ghost Stories Urban Legends

Ghost Sightings in Monroe, New Jersey The following story was told to me by a nineteen year old man in his dorm room at College on a Saturday afternoon in March. He is from Monroe, New Jersey, and lives with his two parents, his younger brother, his dog Cougar, and his cat affectionately known as Hellspawn. His father works as a contractor, a security guard, and a fire extinguisher inspector, and his mother works at a local garden center. The story was told to him by the main subject, his gym teacher. His teacher told the story to his health class one day as a firsthand account, although he never specified when it occurred. This is the version told to me: Alright. So I was telling you about that gym teacher I had who was a substitute teacher, and he always claimed that he†¦ would get in the â€Å"zone† and be able to, like, see ghosts and stuff and communicate with them. He was at a Wawa one time, and he stepped outside and there was an old man out there, and he was like, â€Å"Excuse me, sir. . . I just need your help for a second.† He was like, â€Å"Yea, sure†¦ whatta ya need?† And the old man was like, â€Å"Could you go into this store†¦ and ya see that lady over there?† She’s like an elderly lady. â€Å"So could you like go over there and tell her that I love her?† And then he told him his name, ya know, whatever it was, and my gym teacher was like, â€Å"Yea, sure.†Ã¢â‚¬ ¦ So he went in there, and†¦ he went up to the lady and he was like, â€Å"Hey, I had a message from John,† whatever the hell his name was, â€Å"And he wanted me to tell you t hat he loves you.† And she told him that John had been dead for a couple of years†¦ He described what he looked like to her, and she was like, â€Å"Yea, that’s definitely John, and he’d definitely do something like that.† Umm, yea. So, I mean, I don’t know if it’s true or not, but, he told stories like that all the time. When asked, the storyteller elaborated that the old man was no longer outside the Wawa when his gym teacher went back outside. The teller had slight pauses in several places in his story, most notably before explaining that his gym teacher could see ghosts and after the elderly woman confirming it was her late husband.