Interview Questions Essay Example | Topics and Well Written Essays - 1000 words

Inquiries Questions - Essay Example The inquiries addresses will be partitioned into five gatherings focusing on various informational index and they will include: 4. Do you believe that strict researchers and liberal situated society individuals can get together for a typical reason? What might be the shared opinion that could bring these two distinctive situated social orders together? In what manner will this cooperation be useful in the improvement of the general public and what might be the conceivable result? Will this result be useful? 12. Do you think your association is among the associations that could fill in as an intervention point among society and government? Assuming this is the case, in what way and on what issues would it be able to intervene and the occurrences that it has just interceded. 10. Do you imagine that the jump in innovation and media are helping the Saudi ladies in sharing her inclinations and contemplations to other ladies in the public eye? What different ways do you think exist that may permit Saudi ladies to be all the more effectively successful in

Olive Seniors Decision To Abandon Poetic Conventions English Literature Essay Essay Example

Olive Seniors Decision To Abandon Poetic Conventions English Literature Essay Example Olive Seniors Decision To Abandon Poetic Conventions English Literature Essay Olive Seniors Decision To Abandon Poetic Conventions English Literature Essay Senior presents ways of life of various family units and how a disaster particularly storms can hold changing consequences for each. Senior, in Tropic Love utilizes a straightforward duologue between a grown-up male and a grown-up female to frontal area the highlights of a normal tropical relationship and the issues that grown-up females face in these connections. Man needs sex and friends however delays to offer committedness. In these three refrain structures there is little or no grounds of regular habits, signifiers and components of poesy all things considered, issues and concerns are introduced and the peruser can comprehend and hang on them. In this way, Senior s plan is accomplished thus unmistakably questions the debatable. Olive Senior does non pass additional clasp guaranting that the lines in her stanza structures follow a particular rime system or contains a set figure of lines. Nor is her poesy burdened by pictures, nonliteral gadgets or unpredictable or expand developments. I can consider, had Senior made these shows her priority the central reason for her work would hold passed on. Subsequently it must be re-underscored that her assurance to be unexpected created all the more great in comparison to injury. Senior s purpose is to ensure that when people read her stanza structures they can partner to the condition of affairss and have the option to get them. In what capacity would that be able to be conceivable in the event that one has no idea with respect to what the subject of the refrain structure is? Senior uses certain qualities which a few artists would sneer at, for example, narrating story, tattle Creole slang. Nonetheless, these qualities make her section structures relatable, checking on and they pull perusers. These are the qualities which are basic to her perusers rendering her stanza structures understandable. One could express that Olive Senior difference from lovely shows attempts to demo handle to life and that there is a whole other world to verse than only giving rime, however to concede the of import things and fights in existence with each line or refrain. The way wherein Senior composes the refrains in her section structure is other than a difference from graceful show however it helps in accomplishing her work increasingly originative as in the section structure Yemoja where the verses are made as such where it looks like the dorsum and forward movement of the sea moving edges. The refrain structure traces how nature is firmly connected and the expire or end of the H2O mood would result in the perish of life itself as delineated in her stanza structure. The stanza structure Yemoja shows how nature ( the H2O ) sustains the land as a female parent would encourage her child and can be connected to the way that the life of a child relies upon the female parent and the life of the land relies completely upon H2O. Senior decides to redirect from the regular way of making poesy with an infiltration of phantasy as she sees verse more than just a look of oneself yet alongside to pass on obvious radiation to the skirmishes of life as showed in another of her stanza structures Hurricane Narrative 1903 where the help of the individuals relied upon their livestock and is a thought of the lives of most Caribbean individuals and how they make due off their livestock and if suck a calamity like the tropical storm. Senior other than goes amiss to draw the male and female relationship in the stanza structure as it show how the capacity of the grandmother was to encourage while the gramps took on endeavors which requested musculus which could be noted other than as a quality of families in the Caribbean. Through her uniqueness she other than depicts how universes and nature are firmly connected and on occasion sends an admonition as appeared in Hurricane account 1903 . Be that as it may, he was the seventh kid of a seventh kid and could understand checks and decipher admirations so when the sups flew underneath the rooftop line, when the sky took on a specific Prunus persica newness, when runs f winged creatures cruised west past that certain point. At the point when mists banked at the far side and the air was still, he realized it was clasp to make sure about down. In this manner she shows that nature and fills in as a traitor to grown-up male and a turn of events or the constant utilization of designing redirects our going to from nature. Olive Senior is a station pilgrim creator and it is run of the mill of her to occupy from lovely shows. By making so Senior is recommending that poesy can in any case be as strong or significantly progressively viable regardless of whether one does non comply with graceful shows. Senior may hold considered shows to be a cutting edge twenty-four hours signifier of subjugation and in this manner was unrealistic of interfering with liberated from all the components that attempted to stifle her. Through creation so she other than features or brings to the head the privilege of opportunity of look, a privilege to which the subjugated had been denied. Senior s poesy praises her uniqueness and heredity ; it furnishes her and her peruser with a reestablished feeling of pride. So as to achieve this senior needed to snatch the ordinary methods of forming poesy. Along these lines she delivered a workmanship extraordinarily Caribbean, a craftsmanship which mirrors her assurance to hinder away. Olive Senior s assurance to occupy has in no way negatively affected the reaction of her work. Without her challenge to be distinctive at that spot would non hold been the acknowledgment that being various does non mean losing.

Kohlbergs Theory of Moral Development

Kohlberg's Theory of Moral Development Theories Developmental Psychology Print Kohlbergs Theory of Moral Development By Kendra Cherry facebook twitter Kendra Cherry, MS, is an author, educational consultant, and speaker focused on helping students learn about psychology. Learn about our editorial policy Kendra Cherry Reviewed by Reviewed by Amy Morin, LCSW on September 28, 2019 facebook twitter instagram Amy Morin, LCSW, is a psychotherapist, author of the bestselling book 13 Things Mentally Strong People Dont Do, and a highly sought-after speaker. Learn about our Wellness Board Amy Morin, LCSW on September 28, 2019 More in Theories Developmental Psychology Behavioral Psychology Cognitive Psychology Personality Psychology Social Psychology Biological Psychology Psychosocial Psychology In This Article Table of Contents Expand Overview Preconventional Morality Conventional Morality Postconventional Morality Criticism View All Back To Top How do people develop morality? This question has fascinated parents, religious leaders, and philosophers for ages, but moral development has also become a hot-button issue in both psychology and education.?? Do parental or societal influences play a greater role in moral development? Do all kids develop morality in similar ways? One of the best-known theories exploring some of these basic questions was developed by a psychologist named Lawrence Kohlberg.?? His work modified and expanded upon Jean Piagets previous work to form a theory that explained how children develop moral reasoning. Piaget described a two-stage process of moral development  while Kohlbergs theory of moral development outlined six stages within three different levels.?? Kohlberg extended Piagets theory, proposing that moral development is a continual process that occurs throughout the lifespan. In recent years, Kohlbergs theory has been criticized as being Western-centric with a bias toward men (he primarily used male research subjects) and with having a narrow worldview based on upper-middle-class value systems and perspectives. The Heinz Dilemma: Kohlbergs Approach to the Study of Moral Reasoning Kohlberg based his theory on a  series of moral dilemmas were presented to these participants and they were also interviewed to determine the reasoning behind their judgments of each scenario.?? One example was Heinz Steals the Drug. In this scenario, a woman has cancer and her doctors believe only one drug might save her. This drug had been discovered by a local pharmacist and he was able to make it for $200 per dose and sell it for $2,000 per dose. The womans husband, Heinz, could only raise $1,000 to buy the drug. He tried to negotiate with the pharmacist for a lower price or to be extended credit to pay for it over time. But the pharmacist refused to sell it for any less or to accept partial payments. Rebuffed, Heinz instead broke into the pharmacy and stole the drug to save his wife. Kohlberg asked, Should the husband have done that? Kohlberg was not interested so much in the answer to questioning whether Heinz was wrong or right  but in the reasoning for each participants decision. The responses were then classified into various stages of reasoning in his theory of moral development.?? Level 1. Preconventional Morality The earliest stage of moral development, obedience, and punishment are especially common in young children, but adults are also capable of expressing this type of reasoning. At this stage, Kohlberg says, children see rules as fixed and absolute.?? Obeying the rules is important because it is a means to avoid punishment. At the individualism and exchange  stage of moral development, children account for individual points of view and judge actions based on how they serve individual needs. In the Heinz dilemma, children argued that the best course of action was the choice that best-served Heinz’s needs. Reciprocity is possible at this point in moral development, but only if it serves ones own interests. Level 2. Conventional Morality Often referred to as the good boy-good girl orientation, the stage of the interpersonal relationship of moral development is focused on living up to social expectations and roles.?? There is an emphasis on conformity, being nice, and consideration of how choices influence relationships. This stage is focused on maintaining social order. At this stage of moral development, people begin to consider society as a whole when making judgments. The focus is on maintaining law and order by following the rules, doing one’s duty and respecting authority. Level 3. Postconventional Morality The ideas of a social contract and individual rights cause people in the next stage to  begin to account for the differing values, opinions, and beliefs of other people.?? Rules of law are important for maintaining a society, but members of the society should agree upon these standards. Kohlberg’s final level of moral reasoning is based on universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules. Criticisms Kohlbergs theory is concerned with moral thinking, but there is a big difference between knowing what we ought to do versus our actual actions. Moral reasoning, therefore,  may not lead to moral behavior. This is just one of the many of the criticisms of Kohlbergs theory. Critics have pointed out that Kohlbergs theory of moral development overemphasizes the concept of justice when making moral choices. Factors such as compassion, caring, and other interpersonal feelings may play an important part in moral reasoning.?? Does Kohlbergs theory overemphasize Western philosophy? Individualist cultures emphasize personal rights while collectivist cultures stress the importance of society and community. Eastern, collectivist cultures may have different moral outlooks that Kohlbergs theory does not take into account. Were Kohlbergs dilemmas applicable? Most of his subjects were children under the age of 16 who obviously had no experience with marriage. The Heinz dilemma may have been too abstract for these children to understand, and a scenario  more applicable to their everyday concerns might have led to different results. Kohlbergs critics, including Carol Gilligan, have suggested that Kohlbergs theory was gender-biased since all of the subjects in his sample were male.?? Kohlberg believed that women tended to remain at the third level of moral development because they place a stronger emphasis on things such as social relationships and the welfare of others. Gilligan instead suggested that Kohlbergs theory overemphasizes concepts such as justice and does not adequately address moral reasoning founded on the principles and ethics of caring and concern for others.

The Role of Women in Heart of Darkness - Free Essay Example

Sample details Pages: 4 Words: 1334 Downloads: 5 Date added: 2019/06/24 Category Literature Essay Level High school Tags: Heart of Darkness Essay Did you like this example? In Joseph Conradrs Heart of Darkness, despite the disparaging comments made about women, numerous feminine figures in the story display or exercise a more notable amount of power than the male characters. Joseph Conradrs, Heart of Darkness, discusses social issues such as racism, sexism, and corruption. The power possessed by the female characters closely relates to how paramount these women are in the development of the story and plot. Don’t waste time! Our writers will create an original "The Role of Women in Heart of Darkness" essay for you Create order Initially, Marlow commences by referring to female characters found in the story as girls and does not call them women. Those who oppose could not find any importance behind this. With this in mind, Marlowrs comments demonstrates an automatic response from the male sex to view women as infantile or miniscule. Furthermore, a vast number of females are interchangeable as the female stand- in. Some readers refer to this as Conrad demeaning those women and making them seem as secondary character. Marlow speaks Girl! What! Did I mention a girl? Oh, she is out of it†completely. They†the women I mean†are out of it†should be out of it (Conrad 108). Those women are being diminished and their role of power is being stripped from them, not only in Joseph Conradrs Heart of Darkness, but the world in which they lived in at the time. During the Victorian Period, women did not live as well as their male counterparts. Women during this time lived in the shadow of their men. I n most cases, they were thought of as weaker, fragile, or slower. Furthermore, the Victorian Period was vastly what would be referred to as a patriarchal society. Patri- derives from the Latin word pater-, meaning father. Patriarchy is a social system in which a male-dominated power structure takes place. For instance, women did not obtain the right to vote, that not happening until years later. Women were not allowed to own property, but men could possess as much as he longed for. To sum up, it is a system in which men have more power than women, men have some level of privilege to which women are not entitled. Ironically, power never works in a way we think it does. For example, The Victorian Period was a social culture. People relied extravagant parties, wealth, and social status. Men were mainly responsible for getting things done and lots of women married to high-ranking, influential men. Therefore, these doing demonstrated that although women were seen as minute, they had held most power. As previously stated, women are portrayed as secondary characters in Heart of Darkness. However, those women who seemed to at first have little to no power, represent more than initially thought when further analyzing the female character. To begin, Marlowrs aunt is introduced. Marlow begins to speak and displays sentiment about women through his attitude toward his aunt by saying Itrs queer how out of touch with truth women are. They live in a world of their own. (Conrad ) the aunt holds a significant amount of power. It is because of that women that Marlow is headed towards Africa. With that being said, Marlow later reveals how he obtained his employment as a steamboat pilot. He reveals that he tried the women and set the women to work to get a job (Conrad). Marlowrs aunt shows much enthusiasm towards her nephew and would love to give him a hand. Marlow is indifferent and would only respect his aunt if she can obtain employment for him. Therefore, with her power, his aunt was able to successfully get him a job. Not Marlow, but his aunt, a female, pulled it off better than he could ever and she is the only reason he had a job in the first place. To continue, the knitting women that appear in Heart of Darkness also are imperative to the plot. Marlow arrives at the Companyrs office where he comes face to face with two other women, who knitted black wool feverishly (Conrad). Additionally, Marlow describes the old women,She seemed to know all about them and about me, too. An eerie feeling came over me. She seemed uncanny and fateful (Conrad). The women only appear briefly but hold a symbolic meaning. The knitting women correspond to the Moirae the ancient Greek personifications of fate. These powerful women spin, measure, and cut the thread of life. The Fates, who were in the Companyrs office, were measuring Marlowrs life as he embarked on the journey. The Fates are immortal beings who have the ability to see every manrs fate, thus making them very powerful. Moreover, Kurtzrs African mistress plays a vital role in Heart of Darkness. Marlow beautifully described the women, She walked with measured steps, draped in striped and fringed cloths, treading the earth proudly, with a slight jingle and flash of barbarous ornaments.She carried her head high; her hair was done in the shape of a helmet; she had brass leggings to the knee, brass wire gauntlets to the elbow, a crimson spot on her tawny cheek, innumerable necklaces of glass beads on her neck (Conrad). From Marlowrs description of his African mistress, anyone can point out the powerful presences that she holds. She seems to have influence on Kurtz and has him hooked. Itrs ironic to think of the menrs way of thinking during this time, when they would refer to women as less. Men would never admit it, but men need women in more ways than one, and that could also work the other way around and women could need men. Nevertheless, from the detailed description given about the Kurtz mistress, a reader can easily point how much of a trance he is in while admiring her beauty. More often than not, that is all it takes to lure in men, is beauty and they will be in a trance and infatuated. That is where women hold power over the man and could get him to do anything. Notably, the Russian sailor recounts to Marlow how she got in one day and kicked up a row about I wasnt decent I fancy Kurtz felt too ill that day to care, or there would have been mischief (Conrad). From this textual evidence, it can be inferred that the mistress has power over her man and gets things done her way. Moreover, the final notable female character in Heart of Darkness is the Intended. The Intended was Kurtzrs fiance. Kurtzrs fiance waited for Kurtz in Belgium while Kurtz was in the Congo gathering ivory. Marlow later visits her more than a year after Kurtzrs death. Marlow describes their encounter by stating that She had a mature capacity for fidelity, for belief, for suffering (Conrad). His fiance seems to still be in mourning. Additionally, the Intended represents a symbol for colonialism. For example, she is utterly infatuated with Kurtz and only remembers the Kurtz that she knew not the one who did tasteless things. She recalls, I am proud to know I understood him better than any one on earth (93). This textual evidence shows how the Intended is the Europeans; they believe in the greatness of men like Kurtz without knowing the dark and hidden parts of their characters much as the mistress did when remembering Kurtz. To conclude, Heart of Darkness is a densely male dominated story which undermines women, yet women are paramount to the development of the plot. Marlowrs aunt, the knitting women, and Kurtzrs mistress all hold a grip and power of the men in Heart of Darkness. The protagonist, Marlow, often encounters these women at landmarks of his life. Marlow continous to believe women should stay in their own world and stay out of the manrs world. Even if this new lense of viewing the roles of the women in Heart of Darkness is not convincing enough it is intriguing to ponder and relate to this in this century and in real life. With this in mind, after further analyzing Heart of Darkness, the female character are far from powerless in this Conrad classic.

Music of the Civil War - 751 Words

The War Between the States was complex. If you wish to understand the events, you should refer to a textbook. Music of the time, however, helps us delve into peoples thoughts and opinions on the war, slavery, and many other important issues in our countrys history. Prior to the civil war, American music followed its European roots. During the civil war, American music began to develop in its own way, largely influenced by the music of the African-Americans. The war produced many well-known songs. These songs were important in their time and they are still known to many people today. Music was important to the Union and also to the Confederacy. The troops sang on battlefields, around campfires and while marching. They sang to†¦show more content†¦I chose John Browns Body because it expresses the abolitionist point of view. Dixies Land is an example of a song that, while written by a northerner, became extremely popular in the South. Music is an important aspect of life. It is used to express thoughts, opinions and feelings. During a time of war it can unite and incite. The music can commemorate important people and events. In times of sorrow it can comfort. Despite the differences between the North and the South, people shared a love of music, as well as a common musical culture. The music of the Civil War period illustrates the many uses of music during times ofShow MoreRelatedMusic in the Civil War600 Words   |  3 PagesMusic in the Civil War The North and the South both used music extensively during the Civil War. They used it to rally troops, to march by, as recreation, and many more reasons. When the soldiers would march off to war, they took a love of song that was divided among them. General Robert E. Lee once said, â€Å"Without music, there would have been no army, music is as indispensable to warfare as money.† Alot of the time the North and the South would borrow each others tunes and lyrics. Often times theRead MoreCivil War Music505 Words   |  2 PagesCivil War Music Music was a vital part of the war. The Civil War had also been referred to Americas â€Å"great musical war.† There was a rank for musicians. They played at recruitment rallies and kept up the troops morale. Their main job was to relay orders from higher ranking officers. The branches of the military determined which instrument made the calls. The drummer boys, fife players, buglers and the songs that they performed played a significant part in the war. Drummer boys enlistedRead MoreImportance of Music During the Civil War892 Words   |  4 Pages1861, the civil war began. It was a war between the north, or the Union, and the south, or the Confederacy over slavery. The Union had an army of nearly two million soldiers, while the south had approximately half because of their population differences. About 620,000 total soldiers died from combat, starvation, disease, or even accident. The civil war was the bloodiest battle in the history of our country and resulted in the greatest number of casualties compared to any of American war. SoldiersRead MoreRole Of Music During The Civil War1489 Words   |  6 PagesUS History I Honors 27 February 2015 Did music play a significant role in motivating soldiers to overcome their hardships in both the Union and Confederate armies during the Civil War? General Lee once remarked, â€Å"Without music, there would have been no army† (Kehoe). The New York Herald concurred with Lee in 1862 when a reporter wrote, â€Å"All history proves that music is as indispensable to warfare as money; and money has been called the sinews of war. Music is the soul of Mars...† (Bowman). It is evidentRead MoreEssay about Music of The Civil War735 Words   |  3 Pages The War Between the States was complex. If you wish to understand the events, you should refer to a textbook. Music of the time, however, helps us delve into people’s thoughts and opinions on the war, slavery, and many other important issues in our country’s history. Prior to the civil war, American music followed its European roots. During the civil war, American music began to develop in its own way, largely influenced by the music of the African-Americans. The war produced many well-known songsRead MoreMusic ´s Role in the Civil War501 Words   |  2 Pa gesI dont believe we can have an army without music. said Confederate General Robert E. Lee. Many think that the Civil War was a time of fighting and do not recognize that music played a key role in the war. Americans used music to try and explain more of what happened instead of pictures. Whether it was used to bring back memories of loved ones and home, boost the morale of the soldiers, or state political standpoints; music was very common to both the Union and the Confederate states. DifferentRead MoreCivil War And The 1960s1631 Words   |  7 PagesA History of Protest Music – Revolutionary War to the 1960s Protest music in the United States dates back to the 19th century. This protest music focused around subjects that were topical for the time period. Among these topics were the Civil War. Another topic was slavery, and its abolition. A final topic was women’s suffrage. A famous group of protest singers was the Hutchinson Family Singers. Their notoriety, which spanned the mid-19th century, began in 1839. Their songs about abolition wereRead MoreThe ‘60s: Culture and Music Essay1478 Words   |  6 PagesThroughout history, music have defined or depicted the culture and social events in America. Music has constantly played an important role in constituting American culture, where people have expressed themselves through music during flourishing and turbulent times. In the 1930’s, Swing music created a platform for audiences to vent their emotions in the midst of Great Depression and political unrest. Such strong relationship between music and culture can be seen throughout history, especially inRead MoreIn the 1960s, People Turned to Music for Hope, Peace, and Happiness1215 Words   |  5 PagesDuring the 1960s and the early 1970s, music reflected the political and social changes that America was undergoing at the time. Some of these ma jor changes included the African-American civil rights movement and the conflict over America’s role in the Vietnam War. During these hard times, people turned to music for hope, peace, happiness and answers. The African-American civil rights movement was a cruel time for the African American race to endure due to the harsh discrimination and segregationRead MoreHistory of the Blues Essay1018 Words   |  5 Pages In one way shape or form Blues music has influenced almost every music artist and their work. Jazz and Blues gave way to such artists as Elvis Presley and Chuck Barry. The history and origins of Blues traces back many generations. Many articles have been written over the years helping readers better understand the history and importance of Blues music. All the articles have a similar attitude toward The Blues. Each article makes Blues Musics social and musical importance and impact blaringly

The Sunflower Free Essays

Melissa Torres Period: 2 2/9/13 The Sunflower Dear Simon Wiesenthal, After reading The Sunflower and having mixed emotions during this book I made my decision. â€Å"What would I have done? † I would have done the same thing you did. Just walk away from all of it. We will write a custom essay sample on The Sunflower or any similar topic only for you Order Now I believe it would be a tough situation to think about and have a response to right then and there. Like Deborah says in her essay, â€Å"The question to be asked is not should the prisoner have forgiven the SS man but could the prisoner have forgiven him? This is obviously saying that no one has the right to forgive anyone on behalf of another. This request brings up several moral questions like, Is it alright to forgive someone who has done no harm to you? Can a person forgive someone on behalf of others? Can anyone really forgive anyone else, or is forgiveness in the hands of a higher power? The soldier asked you for his forgiveness just because you are a Jew, and in the soldiers mind, all Jews are equal. Even though you weren’t burned alive, shot dead, or in any other heinous acts in the concentration camps. How could his forgiveness, had he granted it, put the soldier at rest about the hundreds of Jews he has been a party to the murder of? I think you had no right to forgive the soldier. The soldier didn’t commit a crime against you personally, and for you to forgive him would have been an empty phrase with no meaning. The soldier should have asked for forgiveness between himself and all the Jews he murdered. Sven Alkalaj I like that Sven included in his essay what he went through in Bosnia. I agree with Sven that Simon made a good decision not forgiving the soldier. Just as Sven asks in his essay, â€Å"Who is entitled to speak on behalf of the victims? † Simon didn’t have much of a say just because they didn’t torture him. Just like Sven says, Simon was unsure if his response to the dying soldier was okay. It was hard for Simon to get over his response and wanted other peoples opinions on his decision. When the nurse attempts to give Simon some of the soldiers possessions. Simon refuses the package. It obviously shows that he didn’t want to do much with the soldiers. The holocaust was a horrible thing, and the killing of thousands of Jews was not okay. Forgetting the crimes would be worse than forgiving the criminal who seeks forgiveness† It is such a atrocious thing, its hard to forget and Sven said it would be bad to forget everything that happened. The Dalai Lama I don’t agree with Lama. He says â€Å"one should forgive the person or persons who have committed atrocities against oneself and mankind. † I am totally against what he says because forgiving the soldier would mean that Simon is okay with what he did. The soldier didn’t really care if the Jew was tortured or not because he just asked the nurse to find a random Jew. I felt like the soldiers apology was a lie and he just wanted to die in peace. But he doesn’t really deserve it after everything he did. Lama also says â€Å"but that is not the Buddhist way,† Lama’s culture is different and believes that forgiveness is okay. But if Simon was to forgive the soldier, it wouldn’t bring back any of the people he killed. The Jews he killed are piled up dead and accepting his apology isn’t going to change a thing. All the awful things that happened will always be in Simon’s mind. Melissa Torres Period: 6 The Sunflower In The Sunflower, by Simon Wiesenthal the main character, Simon is put in an awkward situation and doesn’t really know how to deal with it. His development from the beginning of the book to the end of the book is kind of crazy. Towards the end of this book he realizes he made the right decision. Simon just needed a little bit of extra help to decipher if what he did was right. With condoning factors supporting the Nazi in The Sunflower is asking for forgiveness both out of guilt and amends, there is no possible way to decipher if he should or should not be forgiven. Simon was asked to go clean at a hospital. When he arrived at the hospital the nurse asked him if he was a Jew. Simon said yes and the nurse took him to the bedside of Karl, a 21-year old dying Nazi soldier. Karl was covered in bandages with openings only for his mouth, nose and ears. Karl wanted to tell Simon his story. Karl talked about his childhood and then the conversation came up to him being a Nazi. Karl admitted to shooting a mother, father and their two kids. Karl felt guilty about the hundred of Jews he killed and he didn’t want to die without coming clean to a Jew. Karl asked for forgiveness, he knew he was asking for too much from Simon but without his answer Karl couldn’t die in peace. Simon left the room without a word. When he returned to the hospital the next day, the same nurse came to Simon and told him that Karl had died. Over the next years of the war, time and time again, through all his suffering, Simon thought of Karl and wondered if he should have forgiven him. Over the years, every time Simon would enter a hospital, see a nurse, or a man covered with his head bandaged, he recalls Karl. Many years later Simon questioned whether he had done the right thing. He asked many people about his actions. A few of these people included Jews, Rabbis, a Catholic Cardinal, Christians and even an ex-Nazi. They all had different opinions and different reason of forgiveness. Faced with the choice between compassion and justice, silence and truth, Simon said nothing. Simon always wondered if he had done the right thing. As the book was coming to an end, Simon started noticing that he did the right think not forgiving Karl. Forgiving him wouldn’t bring back any of the people he killed. The Jews he killed are piled up dead and accepting his apology isn’t going to change a thing. Karl didn’t commit a crime against Simon personally, and for Simon to forgive Karl would have been an empty phrase with no meaning. Karl should have asked for forgiveness between himself and all the Jews he murdered. The main character’s development throughout the book showed that at first Simon wasn’t confident with his decision and always had the situation on the back of his mind. But towards the end of the book, Simon notices he did make the right decision to just get up, walk away without saying a word. Simon basically needed other peoples opinions to see that he had done the right thing. How to cite The Sunflower, Essay examples

Michael Pollan Behind the Organic-Industrial Complex free essay sample

My reasons for doing this are as follows: I want to eat locally grown produce; I want to reduce the use of chemicals in the food I eat; I want to reduce my carbon footprint by buying local, non-corporate food; I prefer to support local farmers, especially in a down economy; by subscribing rather than just buying at a farmer’s market, I’m showing my commitment to organic farming; and I will eat a broader range of vegetables as a result. By doing this, I am hoping to improve my own health while also, I hope, reducing the environmental costs of corporate farming. Michael Pollan’s â€Å"Behind the Organic-Industrial Complex,† Rachel Carson’s â€Å"The Human Cost,† and Peter Huber’s â€Å"How Cities Green the Planet† each provide insight into the way the organic farming practices are influencing the health of people and the planet. However, there are overlooked human costs to buying organic food: not everyone can afford it, and on organic farms, farmworkers may be more at risk for Valley fever and mosquito-borne illnesses. We will write a custom essay sample on Michael Pollan Behind the Organic-Industrial Complex or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Nevertheless, organic farming practices have the best interests of the environment and of the humans living on the planet in mind. Paragraph #2 Lately we have been hearing a lot about buying local food, but many wonder whether it is healthier and better tasting than food that has come from longer distances. One benefit of local food is that the consumer knows exactly where it is coming from, and that may make the consumer feel better about eating it. A common definition of local food is food that comes from a single bioregion, which is a rather flexible term. For the purposes of this essay, food will be considered local if it comes from within a one-hundred mile radius. Why is eating and supporting locally grown food beneficial? Michael Pollan’s â€Å"Behind the Organic-Industrial Complex,† Rachel Carson’s â€Å"The Human Cost,† and Peter Huber’s â€Å"How Cities Green the Planet† each provide insight into the way locally sourced food is influencing the health of people and the planet. If you buy food grown by a giant corporation, you are likely harming the planet and possibly yourself because of the large carbon footprint and chemical residue of â€Å"corporatized† food. However, if you buy locally grown food, you support renewable farming practices and this leads to a healthier planet, a healthier you, and a healthier local economy.   Ã¢â‚¬Å"Think globally, eat locally. † We have been hearing this slogan a lot lately, but many of us do not yet know what it means to eat locally. We can often eat locally by buying from farmers markets, supporting small farms, and shopping at the local food co-op. Sometimes, however, the food in these places might come from too far away to be considered local. For the purposes of this essay, food will be considered local if it comes from within a one-hundred mile radius. Is eating and supporting locally grown food beneficial? Michael Pollan’s â€Å"Behind the Organic-Industrial Complex,† Rachel Carson’s â€Å"The Human Cost,† and Peter Huber’s â€Å"How Cities Green the Planet† each provide insight into the way locally sourced food is influencing the health of people and the planet. Locally sourced food is picked ripe, thereby having a better flavor and more nutrients; the carbon footprint may be lower because it is not transported so far; and buying local food stimulates your local economy. All this is well and good, but there is not enough locally sourced food available to feed everyone in a particular region, and locally sourced food may not be grown or transported as efficiently as food grown elsewhere. While many are concerned that there is not enough locally sourced food available to feed everyone in a particular region, and locally sourced food may not be grown or transported as efficiently as food grown elsewhere, it is still in our best interests to consume locally sourced food whenever possible. Locally sourced food is picked ripe, thereby having a better flavor and more nutrients; the carbon footprint may be lower because it is not transported so far; and buying local food stimulates your local economy.

Mill Workers free essay sample

The women and young girls had to work on the large machines and had to go fast. There was a lot of dangers for them, young factory girls didn’t save money for themselves and gave it to their families. Japans workers rarely got to see their families. Women played a big part in the revolution because they replaced many men therefore the women were paid less. They jump started the industrial revolution. Woman in both England and Japan had to work long and hard hours in assembly lines. The long hours and low wages made Japans textile industry successful. How similar were their experiences? In England the percent of females in Norfolk, Suffolk, and Essex in 1833 was at 96%. 53% of that 96% is females under the age of 16 years old. The percent of men there is 4. The English textile industries in 1841 had about 48,000 female workers under 20, and 65,000 20 and older working in cotton manufacturing. We will write a custom essay sample on Mill Workers or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page That wasn’t all the jobs there was. There was Silk Manufacturing, Lace Manufacturing, and Woolen Manufacturing. The total of all those jobs out of all those women working were 171,000. The Gender and Ages in the Silk Factories in Japan in 1901 were high too. The percentage of female workers was at 92. The percentages of men were at 8. The ages, 14 and under were at 2,184 workers in 205 mills. The total amounts of female workers in the 205 mills were at 12,519. In 1902 there were 25 million people gainfully employed in Japan, mostly farming. 499,000 of that 25 million worked in industry, while 269,000 worked in the textile industry. The silk mill workers constituted a majority of the textile workers. The factory girls in Japan were in neat assembly lines, working nonstop. For example, In Wigan, England, the year 1840, a nine year old is working, earnings were potentially high, the working hours were horrendous. The weekdays some started work at 5:30 a. m. and finished the day at 8 p. m. Included into this working hours were a thirty-five minute break for breakfast and a fifty-five minute break for dinner. On the Saturday, they worked another whole nine hours. Sundays were their day off. These hours working were straining of these women and children especially the children. The children worked the same hours as an adult. A study by the government in Japan of 1900 showed us that a normal working day in Okaya was thirteen to fourteen hours. During their busy season, these workers were thrown from their beds at 4:05 a. m. , sent to go to work at 4:30 to 6, given 15 minutes for breakfast, and then sent back to work by 6:15. They were all allowed to 15 minutes for lunch, had a break between 10:30 and 10:45, also a 10 minute break from 3:30 to 3:40. If they weren’t doing that they were kept busy at all times and were kept until 10 p. m. In the 1800’s a Japanese worker averaged one holiday every two weeks off.

Relation between Amnesia and Consciousness

Relation between Amnesia and Consciousness Abstract Psychology is the scientific study of human behavior. Human beings exhibit different behaviors. The behavior that an individual portrays is controlled by the mind because people act as per their thoughts. People have different personalities whereby another dislikes a behavior, which one cherishes.Advertising We will write a custom research paper sample on Relation between Amnesia and Consciousness specifically for you for only $16.05 $11/page Learn More The term consciousness is defined as the state of mind in which one is aware of what he/she is doing. Conscious persons control his mind in determining what to do and what not to do and the time. Since the person acts in his right senses, he is accountable for results of his actions. There are some instances in which people act out of consciousness. An individual can get involved in a very bad act but he does not know whether he has committed any sin. Consciousness involves prior plans because people act according to their plans. The state of mind determines the condition in which one performs his actions. Amnesia is a condition in which memory is lost totally or partially. The term memory is used to refer to the remembrance of things, which happened sometimes back as well as keeping in mind events taking place presently. The Limbic system is a region in the brain whose function is to retrieve memories already stored in the brain. The limbic system is composed of hippocampus, amygdale and the cortex. The lymphatic system enables the functioning of the endocrine system as well as the feelings and emotions (Holland, 2003). If the lymphatic system is interfered with, amnesia is likely to occur. Since Amnesia deals with mind, it is important in the scientific study of consciousness. Literature Review Chapter Overview The scientific study of human and animal behavior is referred to as psychology. Psychology is also concerned with the methods that affect and change the behavior of pe ople. The study of behavior and processes of mind is collectively referred to as psychology. Psychologists are mainly interested in the study of behavior and characteristics of people. A study of psychology includes issues that take place from individual’s day of birth to death. Psychology became a discipline on its own in the 17th century during Greeks time. During this time, Rene Descartes a French philosopher introduced the idea of dualisms, which asserted that human body is made up of two different parts, the body and the mind.Advertising Looking for research paper on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More The study of mind was supposed to be independent. Nature versus nurture theories of human behavior also explain the role played by psychology. According to the nature theory, human behavior is genetic. During the process of mutation, character traits are passed from the parents to the child so that the child behaves much more like the parents. The nurture theory is based on the assumption that human behavior depends on the environment in which an individual is brought up. Background Modern psychologists use scientific methods to study human behavior as well as his thoughts. Physiology has contributed a lot towards the emergence of psychology as a discipline. In the study of brain and behavior, physiologists applied scientific methods in an attempt to understand human behavior and thoughts. Wilhelm Wundt founded psychology in 1979. He started the first Experimental psychology lab at Leipzig. In his book, â€Å"Principles of Physiological Psychology†, he defined psychology as the study of human consciousness. He aimed at carrying out research to understand internal processes of mind .He used a method he referred to as introspection. Introspection is the process through which an individual examines and reports his/her thoughts, feeling and impressions for a period. It invo lves observing the functioning of the brain to understand the laws that govern the mind. The process occurs consciously in mind. The behavior that individuals display is based on the thoughts. Behaviorists who suggest that psychology should base on objectives and ways, which can be measured, have criticized the method. Psychologists shifted their attention from consciousness and sensation to measurable behavior. There are two major schools of thought in psychology. Structuralism was founded by Edward Titchener, a former student of Wundt founded the first major school of thought .Structuralism is the perception that mental experiences is made up of simple events. Structuralists are mainly concerned with the components of mind. Structuralists argue that consciousness of human beings can be divided in to smaller parts. Structural psychology aimed at describing consciousness in its basic elements, putting together these components and determining the relationship to each other as well a s their relationship to the nervous system. Edward classified sensations and thoughts as the major components of mind. The method used in structuralism was unreliable. This is because of the use of subjective methods in the study of the structures of mind. It is also blamed for emphasizing much on the internal behavior, which cannot be observed daily. There is no actual way of measuring internal behavior.Advertising We will write a custom research paper sample on Relation between Amnesia and Consciousness specifically for you for only $16.05 $11/page Learn More Functional psychology is concerned with the process through which the mind acts and functions instead of what it contains. Functionalism was advocated for by William James and Charles Darwin’s theory of evolution. It was a reaction against structuralism. They used systematic and accurate ways of explaining the processes of mind. In addition to elements of consciousness, functionalists were als o interested in studying the purpose of behavior. They also dealt with differences between people, for instance, people have different levels of understanding in schools. Functionalists wanted to know reasons behind this. Amnesia is related to scientific study of consciousness. This is because the behavior that an individual exhibits depends on the state of mind. Amnesia affects the consciousness of an individual because it changes the way in which the brain functions. When people loose memory, they loose the control of their brain and therefore do things unconsciously. For example, mad persons do things unconsciously. They do things, which can never be done by a person in his right senses. Such people walk naked and eat food remainders from garbage. They are not in control of their mind and therefore do not have the knowledge that what they are doing is wrong. Such people have already lost their awareness. Consciousness is therefore influenced by amnesia. Amnesia is related to cons ciousness in the sense that if an individual is amnesiac he is likely act unconsciously (Blackmore, 2005). There are three main categories of human memories. After the creation of a memory, it is stored regardless of the time duration. There are many events, which take place in people’s lives, and if they are accommodated in the brain, it will be overworked. These stages help in sorting the information so that the most important things are permanently stored in the brain. They are sensory, short-term and long-term memory. Sensory memory involves the remembrance caused by stimulus received through the senses. People may remember something after seeing it (iconic memory), hearing a particular sound (echoic memory) or even touching it (haptic memory). Sensory memory is short term as events, which are of importance at that particular time, are stored in the brain. In short- term memory information is stored for a limited time. The capacity of remembrance is low such that only few things are stored. Valuable information is transferred from the short term to long-term memory so that they are retained for remembrance after a long period. This memory stores large volumes of data. For example, the information that students learn in schools is stored permanently in their brains. This helps them later during their exams (Blackmore, 2005).Advertising Looking for research paper on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More In the process of remembering something, information is willingly retrieved from unconscious level to the conscious mind. People are different in remembering where some people remember various things better than others do. Some people are said to have good memories while others poor. People who have problems of remembrance and are physically fit, it is not an implication that the whole memory system is damaged, part of the memory system is not functioning. When an individual keeps books on the drawer before going to sleep, the mind should register where the books were kept. One should pay attention to the storage place or else he will not remember the following day. The information is stored in the mind for future retrieval. If the memory system is working well, the person will find it easy to remember the following day. Difficulties in remembering may be due to lack of proper registration of the storage place, failure to retain what was registered in ones mind or poor memory retrie val. The above stages are very important in ensuring proper remembrance Relation between amnesia and consciousness. Distractions during encoding can make an individual to forget (Blackmore, 2005). Amnesia comes in different forms. The most common form is called anterograde amnesia. It involves the inability to retain and recall events, which happened after the condition. Patients find it hard remember things that have just happened in their lives. If you ask them of their last diet, they will not be in a position to tell. Another characteristic of those patients is their tendency to talk of disorderly things. They may be explaining things, which never happened, in the real sense. In this case, their minds are full of fabricated events. Dementia and Alzheimers diseases have such characteristics. Some Patients forget the events, which took place before the beginning of Amnesia. This is called retrograde amnesia. It mainly occurs because of head injuries. Some patients lose memory of t he events in the previous hours completely. This condition is mostly found among the old people. The conditions disorient the patients so that they keep asking the same questions repeatedly. Those people may not know where they are, what they do and some cannot tell their names. Other mental diseases like madness contribute to memory loss (Elchenbaum Cohen, 1995). Amnesia is also caused by drug abuse. Excessive usage of drugs affects the brain so that the normal functioning of the brain is affected. Most drugs are harmful to human health. Tobacco and alcohol for instance affects the lungs making the breathing system difficult. When persons become addicted, they concentrate much on the drugs. In many cases, drug addicts do not have control on their actions. When they are under the influence of the dugs, they do things, which they cannot remember the following day. They cannot remember the words they utter once they come in their right senses. Stress also contributes to memory loss. When one is stressed, there is low concentration on what is done It is difficult for example for a student to understand what is being taught by their teacher if he is under stress. The student is likely to forget what is taught in class at that particular time (Eichenbaum Cohen, 1995). Critique In future, psychologists should employ accurate measures of explaining the behavior of human beings. This is because functional and structural theories of explaining human behaviors are not accurate. Even though amnesia leads to unconscious actions, some individuals take the advantage and prevent not to be aware of their actions. For example, many drug addicts pretend that they do not know they previously did when drunk. Some are so chaotic when drunk after which they complain not to have any knowledge on their actions. Most of them just prevent not to be aware but in the real sense, they know what they are doing. However, some like mad people do not pretend, as they do not have control ove r their actions. They even do some things, which are harmful to themselves like garbage. According to me, a research topic on the ways of ensuring that people’s actions are really unconscious should be done. This research will differentiate those people who do things out of pretence from those others. This will be of great help because many people do things and pretend not to have done but they are actually aware (Eichenbaum Cohen, 1995). Conclusion Studying the psychology of consciousness is important because it helps in understands the behavior of amnesiacs. Amnesiacs do not have control on the things they do .They do things unconsciously. For instance, mad people usually do abnormal things. They eat dirty foods, dress indecently among other abnormal activities. This is because they have lost their memory of differentiating the right from wrong. For the elderly people, their level of retrieving information is very low. As they grow old, the level of their understanding goe s down. They forget easily, an effect that can lead to wrong steps. In conclusion, amnesia and consciousness are intertwined because they affect each other. Loss of memory leads to unconscious actions so that the person is not conscious about the action he takes. Conscious individuals are accountable for the actions they take while unconscious individuals are not (Parkin, 1997). References Blackmore, S. (2005). Consciousness: A very Short Introduction. New York, NY: Oxford University Press Blackmore, S. (2005). Conversations on consciousness. New York, NY: Oxford University Press Eichenbaum, H. Cohen, N. (1995). Memory, amnesia, and the hippocampus system. New Jersey, NJ: MIT Press Holland, O. (2003). Machine consciousness. Washington, DC: Imprint Academic Parkin, A. (1997). Memory and amnesia: An introduction. London: Psychology Press.

Discussion paper Essay Example | Topics and Well Written Essays - 1000 words

Discussion paper - Essay Example Moderate Thai climate enhances the beauty of tourist resorts and provides ideal pre and post treatment environment. Spas are the main post treatment care places in the Thailand. Body massage and message of any body organ relieves the patients from different worries. Traditional massage, massage for beauty and massage for health are the main categories of massages in spas. Day’s spas help business people to lessen the stress during pause in the business activities. Thailand also provides treatment for cardiac problems in its tourist hospitals. Bumrungrad hospital Bangkok, Bangkok hospital Pattaya, Chaophya hospital and Chiangmai ram hospital are the important cardiac treatment hospitals available across the country. Over 1.2 million local and foreign patients are treated for bypass and heart transplantation. Physician who has treated more than 200 knee patients with a good record are preferred over other doctors in the country. 1.4 million Tourists for knee and hip treatment are expected to visit Thailand this year. This figure is higher than 1.2 million Orthopaedic treatments in 2010. Orthopaedic and other treatments are 20% cheaper than Singapore, India and UK. Cheap treatment encourages the patients to take along blood relatives for personal care as attendants. That is why 6 million US tourists visited Thailand in 2010. Cosmetic surgery is free of insurance policy that helps visitors to explore Thailand in detail. Private hospitals located mainly in the capita Bangkok are leading in surgery with state of the art technology and highly qualified staff. Spas offer post surgery massage for better looks after the surgery. Cosmetic surgery in Thailand ranges from simple face-lifts and tummy tucks to breast growth and sex reassignment surgery. Breast augmentation in Thailand costs about 3000 US$ against 9000 US$ in US. Almost same cost differences exist for face-lifts and tummy tucks. It is the cheapest from Canada, Australia and Germany. Doctor

Ethical issue Essay Example | Topics and Well Written Essays - 750 words

Ethical issue - Essay Example The two sides of the ethical issue facing this accountant are either to report him to the company’s authorities or not report him (Mizzoni 35). The accountant can report the supervisor to the company’s higher authorities, assuming that he has a duty to be honest and accountable to the company. This would mean that the accountant is using deontological ethics in which people act to fulfill a duty, regardless of whether the action pleases or does not please people. Using deontological ethics would influence the accountant’s perception to the effects that the supervisor was not justified in taking the $ 500 but that the money should have been used in developing the company. The ethics of moral duty would make him think that covering up the case would make him an accomplice and that he would be haunted for not reporting the case (Mizzoni 36). However, the decision to report his supervisor to higher authorities in the company would have both positive and negative implications. The company’s higher authorities might investigate the case, find that it is true, and discipline the supervisor. This would justify the accountant’s action, with or without the praise of the higher authorities. Another likely event is that the higher authorities might doubt the accountant, thinking that he is trying to implicate the supervisor and trying to settle a score with him, or that he is trying to report him after their deal to steal the company money went sour. This can cause his dismissal and if he is retained, there will be conflict between him and the supervisor (Mizzoni 36). The accountant could decide not to report the supervisor believing that it would have undesirable outcomes for the supervisor and for him. If he made the decision not to report his supervisor because of its outcomes, he would be led by utilitarian ethics. According to utilitarian ethics, outcomes of an act define its morality. Applying this ethics, the accountant could believe that both

Case Study Of A Patient With Diabetes Mellitus Nursing Essay

Case Study Of A Patient With Diabetes Mellitus Nursing Essay Patient Mr. NCS is a 53 year old Chinese man with the height of 1.72m, and weighs 82kg where his BMI is 27.7kg/m2 (overweight). Patient runs his own business and is currently staying with his wife and 3 children. He claims that he does not smoke and does not drink at all. According to the patient, the paternal side of his family has family history of hypertension and kidney failure where else for the maternal side, hypertension was known to be the family history. Patient has no known drug or food allergy. Patient was known to have had hypertension 15 years ago and also a history of pulmonary tuberculosis 35 years ago. Patient denied of being diagnosed with diabetes mellitus in the past. As for drug history, patient was only on 10mg of lovastatin (tablet) once at night and according to the patient, he was compliant to the medication. 1.2 Clinical Progress Patient was admitted into Accident and Emergency department and complained of shortness of breath (SOB) and mild giddiness. He also complained of having chest pain and a first episode of shortness of breath earlier before he was admitted into the hospital. On examination, he was found to be alert and conscious. Venous blood gas sampling was done and pH was found to be 7.306 (low), pCO2 was 44.2mmHg, pO2 was 45.8mmHg and HCO3 was 24.7mmol/L. Blood pressure was found to be 157/95mmHg, pulse rate was 72bpm, SPO2 was 97%, body temperature was 35.4 °C and respiratory rate was 21 breaths per minute. Reflo value was also obtained and it was found to be 17.1mmol/L and blood ketone was 0.9. Lungs were clear and abdominal was soft and non tender. Cardiovascular testing was done and it showed dual rhythm no murmur. The initial impression of this patient by the general practitioner in the hospital was impending diabetes ketoacidosis. Patient was immediately given 6 units Actrapid subcutaneousl y and the GP also planned to give O2 3L/min and to prescribe GTN 1/1 subcutaneously and Aspirin 1/1. Later on day 1 of admission, patient complained of increased in sweating, shortness of breath, body weakness and vomiting for 3 times in the morning. Patients blood pressure was 123/76, pulse rate was 82bpm, SPO2 was 99% and respiratory rate was 20 breaths per minute. When patient was asked, he mentioned that he has not done body check up and blood pressure measurement for at least 5 years now. Later in the afternoon, patient complained of excessive sweating and lack of appetite for the past 3 days. Patient then denied of having any chest discomfort or shortness of breath, headache and abdominal pain. Besides that, patient also complained of having polyuria and needed to wake up more than 3 times at night for micturation. He also complained of having polydypsia, lethargic and vomiting for 2 times in the morning. Patient was examined and he was found to be alert and conscious where he responded fully to Glasgow Coma Scale (GCS). Patient was also found to have good hydration and his ca pillary refill time (CRT) was less than 2 seconds. Vital signs were obtained and temperature was back to normal, 37 °C, blood pressure was 151/69, SPO2 was 97%, pulse rate was 88bpm and reflo value was 14.6. The management plan by the local GP was to continue monitoring the reflo value, prescribe 10mg lovastatin (tablet) once at night and 10mg amlodipine (tablet) once daily and have the patient to rest in bed. As patient was able to tolerate orally, IV drip was off and patient was allowed to take fluid orally. On day 2, patient was found to be comfortable. However, patient complained of having poor oral intake and that he was sweating profusely. He was still feeling mild giddiness and lethargic but no more chest or abdominal pain. Vital signs were observed and temperature was 37 °C, blood pressure was 128/84, pulse rate was 96bpm and reflo was 14.9mmol/L. Fundoscopy was also done and patient was found to not have any signs of retinopathy and chest X-ray was found to be clear. The management plan for day 2 was to continue 10mg amlodipine once daily, allow fluid intake orally, continue reflo monitoring 4 hourly and to trace and review the fasting blood sugar (FBS). On examination, patient was found to be alert and responded well to the GCS with the score of 15/15. Blood pressure was taken and it was 145/100 when patient was lying down and 130/90 when patient was standing. Renal profile was normal except for low potassium level of 3.0mmol/L. Impression for this patient was newly diagnosed d iabetes mellitus. Further management plan for this patient was to conduct a stress test on patient after discussing with the specialists and to monitor patients blood pressure for both lying down and standing up position 4 hourly for a day. Further plan was to start 500mg metformin (tablet) twice daily, 150mg aspirin (tablet) once daily, 20mg lovastatin (tablet) once at night, trace urine full examination microscopic examination and to refer the patient for diabetic counseling. Besides that, local GP also decided to off amlodipine and to change it to 4mg perindopril (tablet) once daily. Table 1 : Patients laboratory findings on Day 2. Sodium 129 mmol/L à ¢Ã¢â‚¬  Ã¢â‚¬Å" [135 145mmol/L] Potassium 3.0 mmol/L [ 3.5 5.0mmol/L] Creatinine 83  µmol/L [27 62  µmol/L] Glucose fasting 14.1 mmol/L [3.9-5.0mmol/L] Total Cholesterol 5.7 HDL 0.82 Triglycerides 6.7 AST 24 IU/I [10-37IU/I] ALT 45 IU/I [10-65IU/I] Bilirubin 11  µmol/L [2-24  µmol/L] INR 1.03 Trop I 0.02 CKMB 0.5 Disease Overview and Pharmacological Basis of Drug Therapy. Disease Background The prevalence of diabetes mellitus (DM) varies vastly from population to population and throughout the whole wide world. In United Kingdom (UK) itself, diabetes prevalence increased from 2.8% in the year of 1996 to 4.3% in the year of 2005. The incidence of type 2 DM showed an increase from 2.60/1000 person-years in 1996 to 4.31/1000 person-years in 20059. As much as the incidence of DM is increasing, it was estimated that up to half a million more have not had their condition diagnosed and treated10. Diabetes mellitus (DM) is a disorder in which blood glucose level is persistently above the normal range. This hyperglycaemia is thought to be due to either deficiency of insulin secretion or resistance to the action of insulin, or it could also be a combination of these6,7. DM is classified into four different types which include Type 1 DM, Type 2 DM, DM due to specific mechanisms and diseases and lastly, gestational DM8. Only type 2 DM will be discussed further here. Type 2 DM is normally caused by a combination of insulin resistance and decreased insulin secretion to overcome the resistance. It is the more common form of DM and it comprises of approximately 90-95% of the total DM cases8. The common risk factors associated with type 2 DM include increasing age, high caloric intake, overweight, central adiposity and sedentary lifestyle8. In type 2 DM patients, insulin secretory peaks every 5-10 minutes seen in normal subjects are hardly or absolutely not seen. In normal cases, when intravenous glucose is administered into a humans body, this will stimulate normal insulin secretion and is illustrated by a biphasic pattern, with an initial peak rising immediately 3-5 minutes after the administration, and lasted for 10 minutes, then followed by a deliberat e and more progressive phase, which lasts throughout the glucose infusion period. In type 2 DM, initial phase insulin secretion is not seen and the late phase occurs later and to a lesser extent11. For the diagnosis of DM, hyperglycaemia must be established before confirming that the patient has DM. Persistent hyperglycaemia needs to be confirmed and in order to do so, at least two plasma glucose measurements must be taken on separate days. There are three different types of plasma glucose test that can be used which include casual plasma glucose, fasting plasma glucose and oral glucose tolerance test (OGTT). According to WHO, there are three main criteria to be met to confirm diabetes in patients. The first would be symptoms of diabetes which include thirst, polydipsia, loss of weight and polyuria are seen in patients and their casual plasma glucose à ¢Ã¢â‚¬ °Ã‚ ¥ 11mmol/L. The other two would be if patients fasting plasma glucose à ¢Ã¢â‚¬ °Ã‚ ¥ 7.0mmol/L and patients 2-hours plasma glucose à ¢Ã¢â‚¬ °Ã‚ ¥ 11.1mmol/L during OGTT being conducted by giving the patient 75g of glucose load6. OGTT is the most effective test to detect glucose metabolism disorder where it assesses the rate of glucose excretion after administration of glucose. OGTT is strongly recommended when fasting blood glucose is within 7.0-7.8 mmol/L in the diabetic range where OGTT is practical to clarify the diagnosis6,8. Summary of Drugs Pharmacology Aspirin Aspirin with the dose of 150mg is used as an anti-platelet agent or as prophylaxis to cardiovascular events. The mechanism of action of aspirin as an anti-platelet agent is strongly associated with the permanent inactivation of prostaglandin synthase and cyclooxygenase12. It also inhibits the formation of thromboxane in the platelet concurrently. The common side effects of aspirin include bronchospasm, gastrointestinal haemorrhage and also other forms of haemorrhage13. Lovastatin Statin reduces the risk of cardiovascular disease events without taking into account of the serum cholesterol concentration and is often used as the drug of first choice in the primary and secondary prevention of cardiovascular disease. The mechanism of action of statins involves competitive inhibition of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, which is the enzyme involved in the synthesis of cholesterol13. As liver is the major site of cholesterol biosynthesis, it appears to be the main target organ for the statins14. Statins can cause several muscular adverse effects which include myositis and other side effects include gastrointestinal disturbances, sleep disturbances, dizziness, paraesthesia, fatigue, sexual dysfunction and alopecia13. Metformin Metformin is so far the only biguanide available in the market now. It is an antihyperglycemic agent that improves glucose tolerance in patients with type 2 DM by decreasing both the intestinal absorption of glucose and the hepatic glucose production, and improves insulin sensitivity in the tissues. Metformin was also found to have potentially favourable effects on decreasing serum lipid levels and fibrinolytic activity15. Gastrointestinal side effects such as nausea, abdominal pain and diarrhoea are common with metformin and may persist in some patients13. Lactic acidosis due to metformin is rare, and the risk of this complication is higher in patients with renal impairment13,15. Amlodipine Amlodipine falls in the calcium channel blockers group which act by interfering with the inward entrance of calcium ions via slow channels present in the active cell membranes. They act mainly on the myocardial cells and the vascular smooth muscle cells which then lead to reduction of myocardial contractility. It affects both the electrical impulses and vascular tone within the heart where they may be depressed or diminished13. 2.2.5 Perindopril Perindopril is an angiotensin converting enzyme (ACE) inhibitor where it acts by inhibiting the conversion of angiotensin I to angiotensin II. ACE inhibitors are the preferred initial drug to be used for hypertension13. ACE is the enzyme that converts angiotensin I to angiotensin II where angiotensin II causes increase blood pressure, systemic vasoconstriction, Na2+ and fluid retention and etc16. Thus, ACE inhibitors act by directly blocking the formation of angiotensin II and also increase the bradykinin level at the same time. This results in reduced vasoconstriction and increased vasodilation through the release of bradykinin. The common side effects of perindopril include profound hypotension, dry cough, angioedema, rash and gastrointestinal disturbances13. Actrapid (Soluble Insulin) Insulin plays an important role in the regulation of carbohydrate, protein and fat metabolism where it helps to increase the glucose utilization in human body. Actrapid, soluble insulin, is a short acting form of insulin where it is normally injected into patients 15 to 30 minutes pre-meal. Actrapid is normally given in emergency cases especially in patients suspected with diabetic ketoacidosis4. It is normally administered subcutaneously as it gives a rapid onset of action (30 to 60 minutes) and a longer duration of action of up to 8 hours. One of the potential problems of insulin is hypoglycaemia where patients can be advised on how to avoid it13. 2.2.7 Glyceryl Trinitrate (GTN) Nitrate plays a key role in the prophylaxis and treatment of angina. It causes direct relaxation on vascular smooth muscles and also dilation of the coronary vessels which improves oxygen supply to the heart. Dilation of the blood vessels results in reduction of preload and afterload and thus, myocardial oxygen consumption is reduced17. Sublingual form of GTN is one of the most effective drugs to provide a fast symptomatic relief of chest pain but it is of short duration of action. Dose of 300mcg is appropriate as the starting dose for patients who have not used GTN before previously. Side effects of nitrates include postural hypotension, tachycardia, dizziness, throbbing headache and possible nausea, vomiting, flushing and heartburn13. 2.2.8 Oxygen Oxygen is normally prescribed for patients experiencing hypoxia to raise the alveolar oxygen tension and to lessen the workload of breathing in patients. There are generally four types of oxygen therapy which include long term oxygen therapy, short burst oxygen therapy, emergency oxygen and ambulatory oxygen. It is commonly given in emergency cases to achieve oxygen saturation within the normal range, just like in this case. The administration of the correct oxygen concentration is important as inappropriate concentration of oxygen may result in serious or fatal outcomes13. Evidence for Treatment of The Condition. Metformin Metformin is one of the main therapeutic drugs used in managing Type 2 DM and many clinical studies have been conducted to support the clinical use of metformin in the management of type 2 DM. In one of the Cochrane Review, it confirms that metformin as a single agent is one of the key therapeutic options for type 2 DM in patients with overweight or obesity problems, as it may prevent some cardiovascular complications events and mortality as well. Just as mentioned in this patient, he is a newly diagnosed diabetes patient who is overweight and he was given metformin 500 mg twice daily. In the study, 29 trials with 5259 participants were included in the analysis, comparing metformin (2007 participants) with sulphonylureas (1167), placebo (702), diet (493), thiazolidinediones (132), insulin (439), meglitinides (208), and glucosidase inhibitors (111). Obese patients who are given metformin as blood glucose control agent showed a superior benefit than glibenclamide, chlorpropamide, or insulin for any diabetes-related consequences (P = 0.009), and for mortality (P = 0.03). Besides that, patients assigned to metformin as a single therapy showed a significant greater benefit for blood glucose control, weight, dyslipidaemia, and blood pressure18. Besides that, the Comparative Outcomes Study of Metformin Intervention versus Conventional (COSMIC) study was done to compare the incidence of serious adverse effects, mortality and hospitalization in patients receiving metformin and also those who are on other usual care treatments. Among the patients, 7,227 of them received metformin and another 1,505 of the patients received usual care. To the end of the study, there were only 89.7% of the metformin group and 76.9% of the usual care group remained receiving their initial intended treatment. Serious adverse events were reported in 10.3% of the metformin group and in 11.0% of the usual care group, where both the groups reported similar adverse events. Cardiovascular events were found to be the most ordinary cause of death in DM patients where 0.7% occurred in metformin group while 0.9% in usual care group19. A population-based cohort study was also done to study on the mortality rates with the use of sulphonylureas compared to metformin. The mean age of the patients was 66.3 ±13.4 years old where 43.4% were female and their mean length of follow-up was 4.6 ±2.1 years. A greater risk of mortality was observed with higher daily doses of the first-generation sulfonylureas and glyburide but not metformin20. 3.2 Insulin secretagogues (Sulphonylureas and Meglitinides) Sulphonylureas is another group of antidiabetic treatment used after metformin in Type 2 DM. Patients blood glucose level remained high on day 2 and thus should be monitored closely after administering metformin. If blood glucose level has not been brought down, addition of sulphonylureas or meglitinides should be considered. The sulphonylureas act by enhancing insulin secretion. The sulphonylureas act at the pancreatic ÃŽÂ ²-cell membrane by causing closing of ATP-sensitive potassium (K+) channels. Closure of the channels occurred when sulphonylurea binds to the sulphonylurea receptor (SUR) subunit of the K+ channel. Meglitinides, which is not a sulphonylurea, act through the same mechanism where it also binds at the sulphonylurea binding site. Examples of sulphonylureas include tolbutamide, gliclazide, glibenclamide and glimepiride. Meglitinides is referred as an alternative to sulphonylureas as it does not cause additional stimulation of insulin excretion when patient failed to respond to maximal dosage of sulphonylureas. Examples of meglitinides include repaglinide and nateglinide21. Adding on a sulphonylurea or meglitinide to metformin as a therapy to type 2 DM was found to have a better control of blood glucose level. 318 patients (61 from metformin group, 126 from glimepiride group and 131 from glimepiride + metformin group) completed the study to compare the effectiveness of metformin monotherapy, glimepiride monotherapy and the combination treatment in controlling blood glucose level. It was found that the greater efficacy of combination treatment in reducing HbA1c levels than either glimepiride alone (p Comparison was conducted in a study where 124 patients were randomly given either repaglinide 1 mg daily or glimepiride 1 mg daily. The dose of study drug was given over an 8 week titration duration, which then followed by a 12 months treatment length. FPG levels, HbAlc values and PPG levels significantly fall from baseline in both groups after 6 and 12 months of treatment. However, after 12 months, fasting plasma insulin (FPI) levels on the other hand were significantly increased in the repaglinide group (p So far, the most commonly reported adverse event in sulphonylureas was hypoglycaemia. 605 people over 34,052 person-years were diagnosed with hypoglycemia during sulphonylurea therapy, which equals to an annual risk of 1.8%24. There is also high risk of hypoglycaemia in diabetic patients who are taking ACE inhibitors at the same time. Therefore, the use of sulphonylureas in this patient should be used in caution as he is currently taking perindopril as his anti-hypertensive drug. Several studies suggested that there is an increase in mortality due to cardiac events in patients treated with sulphonylureas. In one of the studies, 120, 4138 and 1537 patients were given a first-generation sulfonylurea, glyburide monotherapy and metformin monotherapy respectively. 24.8% of the total deaths were found to be due to an acute ischaemic event. Those given first-generation sulfonylurea monotherapy had the highest mortality (67.6 deaths per 1000 person-years), compared with metformin monotherapy users (39.6 deaths per 1000 person-years). As higher doses are used, higher rates of death are observed as compared to those who are on lower doses20. Other less common side effects of sulphonylureas include weight gain, nausea, diarrhoea, gastrointestinal pain and cutaneous reactions such as rashes, urticaria and pruritus21. Further Management Thiazolidinediones, gliptins (GLP-1) mimetic, also known as exenatide and insulin administrations are the further management in type 2 DM if the above oral anti-diabetic agents are not able to control the high blood glucose level. Pioglitazone and rosiglitazone are examples of thiazolidinediones where they are the newer oral anti-diabetic agents which are more expensive but present better adverse effects profiles. A thiazolidinedione can be added on instead of a sulfonylurea as second-line therapy if sulphonylurea is contraindicated or not well tolerated or it can be added on to the sulphonylurea therapy if metformin is contraindicated. Another recommendation is to add on a thiazolidinedione to metformin plus sulphonylurea when the blood glucose is not well controlled and the use of insulin therapy is not suitable25. Two randomised trials were conducted and in the first study, 317 patients who are already on metformin received an add-on therapy of pioglitazone at the dose 15-45 mg/day and another 313 patients received gliclazide at the dose 80-320 mg/day instead. In the second study, 319 patients who are already on sulphonylurea therapy were randomly assigned to receive add-on therapy of pioglitazone at the do se 15-45 mg/day and another 320 with metformin at the dose of 850-2,550 mg/day. After 2 years, the mean reduction in HbA1c from baseline was found to be 0.89% for pioglitazone and 0.77% for gliclazide addition to metformin. The reduction in mean FBG after 2 years was statistically significant between the two add-on therapies where a decrease of 1.8 mmol/L for pioglitazone and a decrease of 1.1 mmol/L for gliclazide was seen (p Another option is adding on a GLP-1 mimetic agent as third-line therapy to first-line metformin and a second-line sulfonylurea25. Effectiveness of exenatides in bringing down the blood glucose level in type 2 DM patients was extensively studied. One of the studies includes patients at the age of 22-76 years old and had type 2 DM treated with at least the maximally effective dose of a sulfonylurea as monotherapy for at least 3 months. After a 4 weeks single-blind, placebo period, 377 patients were randomized (60% men, age 55 ±11 years, BMI 33 ±6 kg/m2, HbA1c 8.6 ±1.2%) and began either at 5  µg subcutaneous exenatide twice daily(before breakfast and dinner; arms A and B) or placebo for 4 weeks. Patients in arm B were then increased to 10  µg bd of exenatide. At week 30, HbA1c changes from baseline were -0.86 ±0.11, -0.46 ±0.12, and 0.12 ±0.09% ( ±SE) in the 10- µg, 5- µg, and placebo arms respectively (p à ¢Ã¢â‚¬ °Ã‚ ¤ 0.001). FPG values also showed a significan t reduction in the 10- µg arm compared to the placebo arm (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.05) 28. If all else fails to control blood glucose, insulin therapy should be introduced in patients with poorly controlled type 2 DM. It was believed that there is possibility that the oral anti-diabetic agents mentioned above might be useful in combination with insulin therapy in enhancing better blood glucose control, reducing insulin dose requirement, or minimizing side effects of insulin therapy. A study was conducted to compare the efficacy of adding once-daily basal insulin with switching to twice-daily premixed insulin in type 2 DM patients uncontrolled by oral anti-diabetic agents (OADs). It was a 24 weeks period clinical trial where 371 patients with poor glycaemic control (FBG à ¢Ã¢â‚¬ °Ã‚ ¥120 mg/dl, HbA1c 7.5-10.5%) were randomized to once-daily morning insulin glargine plus glimepiride and metformin or to only 30% regular/70% human NPH insulin (70/30) twice daily without any OADs. It was found that mean HbA1c decrease from baseline was significantly better in the presence of O ADs than the one without OADs (p = 0.0003). More patients reached HbA1c à ¢Ã¢â‚¬ °Ã‚ ¤7.0% without confirmed nocturnal hypoglycemia (45.5 vs. 28.6%, p = 0.0013) with glargine plus OAD than with only 70/30 NPH insulin. In addition, decrease in FPG was greater with glargine plus OAD (p Conclusion In this patient, he was newly diagnosed with type 2 DM and was given metformin 500mg twice daily initially to control his high blood glucose level, which was appropriate according to the guideline. If blood glucose is still not well controlled, changing of medication or further management as above should be considered. As hypertension and overweight are risk factors of DM, hypertension should be well managed in this patient and the patient should be advised on complying with his medication. Besides that, patient should also be advised on healthy diet and lifestyle to control his weight.

Advancements in Medical Research Due to Hela Cells

Katrina Samborski Honors English 1100 Dr. Nicole Caswell November 10, 2012 Advancement of Medical Research from HeLa Cells HeLa simply stands for Henrietta Lacks, a young mother in the 1951 who went to the doctor complaining of vaginal bleeding and discovered she had cervical cancer. Henrietta’s cells were taken for a biopsy and were found to be like nothing ever seen before; her cells were immortal. Her cancer cells double every 20 to 24 hours and have lived on for the past 60 years. Since HeLa cells were created, our world of modern medicine has been completely changed.We now vaccines for once incurable diseases and have used the cells for cloning and other biomedical research. Although the cells have done a great deal of good, they have also caused substantial harm to Henrietta Lacks, her family, and potential trial research participants. Therefore, though some may think it was ethically wrong of Henrietta Lacks’ doctors to not inform her that they were using her cel ls, she is the reason we have been able to save thousands of lives. It was at Johns Hopkins Hospital when Dr.Gey, a prominent cancer and virus researcher, discovered Henrietta’s cells were immortal. Since cancer cells will die outside the body without the right mix of chemicals, Dr. Gey created the roller tube. This contraption held glass tubes containing samples in nutrient-rich fluids, turned slowly – sometimes just two revolutions an hour, exposing the cells to just the right mix of air and nutrients. When Henrietta’s cells were placed in this device, they never stopped dividing. While their research value is unquestioned, the tumor cells had created havoc in Henrietta Lacks' body.Skloot recounts the lab technician Mary Kubicek who was present at the autopsy. â€Å"The tumors had completely blocked her urethra, leaving doctors unable to pass a catheter into her bladder to empty it. Tumors the size of baseballs had nearly replaced her kidneys, bladder, ovarie s and uterus. And her other organs were so covered in small white tumors it looked as if someone had filled her with pearls† (Williams). Although her cells are cancerous, HeLa cells share many traits with normal cells, making them useful in studying protein synthesis, the human genome and how viruses work. Dr.Gey sold the cells to researchers around the world, who used them to develop a variety of medicines. HeLa cells were the first to travel into space in an unmanned satellite to see if humans could survive zero gravity. â€Å"This cell line is used all around the world and revolutionized cell biology because they grew so well in culture, said William Earnshaw, principal research fellow at the University of Edinburgh's Centre for Cell Biology. â€Å"They yielded a huge amount of information,† Earnshaw said (Sharp). In the early 1950s, the world experienced the biggest polio pandemic in history.Jonas Salk devised the world's first polio vaccine, but testing it would r equire huge supplies of live cells that, at the time, would have involved the sacrifice of thousands of monkeys. HeLa cells proved to be technically more suitable for testing, and much less expensive and messy, than using monkeys. Moreover, HeLa cells grew virtually anywhere and on any surface, including while floating on liquid. A HeLa mass production and distribution center was therefore established at the Tuskegee Institute, ironically at exactly the same time that the infamous Tuskegee syphilis study on black subjects was being carried out.Soon HeLa cells were to enable the first disaggregation of chromosomes, numerous discoveries from genetic and viral studies, and the first-ever cloning of a cell, gene mapping, in vitro fertilization and much, much more. (Ncayiyana) HeLa cells have had a positive influence on medicine in many ways including with giving us knowledge about the human papillomavirus (HPV) DNA and HPV18-positive. HeLa cells have been linked to changes in microRNA e xpression. Since HPV18 has been associated with very aggressive adenocarcinomas, this finding may explain why Dr.Gey was surprised by the prolific growth of HeLa cells in culture. Routine Papanicolaou smear screening may not detect rapidly progressive cervical carcinomas; the new HPV vaccine holds the promise of preventing these tumors. (Hutchins). The problem of possible contamination of other long-term cultured tumor cell lines with HeLa cells not only caused an international embarrassment, but also raised the concern of misattributing a specific property so another cell line, for example, a virus or a tumor-specific marker, which actually belongs to HeLa.With the continued and growing use of tissue culture in biochemist research, intra- and interspecific contamination becomes a significant risk. The determination of stable genetic markers on cultured cells is a powerful tool for monitoring such contamination. Recent experiments in which cultured cells and innumerable clones of so matic cell hybrids have been used for genetic analysis have shown that, with the proper use of polymorphic markers to characterize the cells, the possibility of undetected cross contamination of cultures is no longer the problem it once may have been.Therefore, in an effort to clarify the characteristics of the HeLa cell and establish its probable genotype for better-known polymorphisms, we studied HLA and other markers, in the surviving husband and children of Henrietta Lacks. (Hsu) Not only were there several negative effects for Henrietta Lacks, but the general public has found flaws with HeLa cells as well. The Drug Information Association sponsored a workshop that brought together people who deal with facilitating or regulating the collection of clinical specimens for genetic analyses to complement drug trials.Genetic studies of clinical samples have for years had to negotiate a tricky path through informed consent, confidentiality, and regulatory-oversight, but according to a couple of speakers who noted the Henrietta Lacks story, the 19 months since the book's publication have made some people even more wary of this research. â€Å"I think it was disconcerting to people who are not used to thinking about how specimens are handled, that their specimens could outlive them,† said the meeting's main organizer and chair, Amelia Wall Warner, Ph. D. who heads clinical pharmacogenomics and clinical specimen management for the drug company Merck. The Skloot book seems to be creating a lot of conversation, with patients often asking for a menu of consent that large-scale trials with many thousands of patients can't accommodate, she noted. (Zoler) Although there are accusations against doctors and corporations that bought these cells stating they did so without Henrietta Lacks’ consent, we owe our world of modern medicine to her. Her cells allowed us to research and experiment countless diseases and opened the door to learn about the human enome and cancer cells. Dr. Gey said, â€Å"It was the best of times, it was the worst of times. † It was the best of times for science in that this very peculiar tumor gave rise to the HeLa cell line, which has been available for the various studies referred to by others. For Mrs. Lacks and the family she left behind, it was the worst of times. Scientific progress and indeed progress of all kinds is often made at great cost, such as the sacrifice made by Henrietta Lacks† (Jones). While her family has yet to be compensated, HeLa cells continue to be used everyday in the medical field.Works Cited: Ncayiyana, Daniel J. â€Å"The extraordinary story of the life after death of Henrietta Lacks. †Ã‚  South African Medical Journal  101. 3 (2011): 141. Health Reference Center Academic. Web. 12 Nov. 2012. Grover M. Hutchins, Brendan P. Lucey, and Walter A. Nelson-Rees. Archives of Pathology & Laboratory Medicine. 133. 9  (Sept. 2009)  p1463. Word Count: 4083. Jones HW Jr â₠¬â€œÃ‚  Am J Obstet Gynecol  Ã¢â‚¬â€œ 01-JUN-1997; 176(6): S227-8 MEDLINE ® is the source for the citation and abstract of this record   Susan H.Hsu, Bernice Z. Schacter, Nancy L. Delaney, Thomas B. Miller, Victor A. McKusick, R. H. Kennett, J. G. Bodmer, D. Young and W. F. Bodmer Science  , New Series, Vol. 191, No. 4225 (Jan. 30, 1976), pp. 392-394 Published by:  American Association for the Advancement of Science Article Stable URL: http://www. jstor. org/stable/1741942 Mitchel Zoler. Internal Medicine News. 44. 17  (Oct. 15, 2011)  p63. Word Count: 433. Williams, Nigel. â€Å"Prize For the HeLa Cell Story. †Ã‚  Current Biology  20. 23 (2010): n. ag. Sciverse. com. Web. 11 Nov. 2012. Manfuso, Jamie, and Stephanie Desmon. â€Å"Honoring the Henrietta Lacks Legacy at Hopkins. †Ã‚  Hopkins Medicine Magazine. Johns Hopkins, 20 May 2011. Web. 11 Nov. 2012. Hepworth, Jeri, PhD. â€Å"Advocacy for Henrietta Lacks and Family Medicine. † Editorial. Fam ily Medicine  Sept. 2011: 595-96. Society of Teachers of Family Medicine. Web. 11 Nov. 2012. Sharp, Rob. Life and afterlife of a women who will live for ever. The Independent. November 10 2010. Web. Nov 12 2012.

An Analysis of the Social Gradient of Health Essay

â€Å"The demonstration of a social gradient of health predicts that reducing inequality itself has health benefits for all, not simply for the impoverished or deprived minorities within populations. † (Devitt, Hall & Tsey 2001) The above quote from Devitt, Hall and Tsey’s paper is a relatively well grounded and well researched statement which draws on contemporary theoretical sociological concepts to support the assertion that reducing inequality is the key to improving health for all. However the assertion that the demonstration of a social gradient of health predicts that a reduction in inequality will lead to health benefits for all is a rather broad statement and requires closer examination. The intention of this essay is to examine the social gradient of health, whose existence has been well established by the Whitehall Studies (Marmot 1991), and, by focusing on those groups at the lower end of the social gradient, determine whether initiatives to address inequalities between social classes will lead to health benefits for those classes at the lower end of the social scale. The effectiveness of past initiatives to address these social and health inequalities will be examined and recommendations made as to how these initiatives might be more effective. The social gradient described by Marmot and others is interrelated with a variety of environmental, sociopolitical and socioeconomic factors which have been identified as key determinants of health. These determinants interact with each other at a very complex level to impact directly and indirectly on the health status of individuals and groups at all levels of society; â€Å"Poor social and economic circumstances affect health throughout life. People further down the social ladder usually run at least twice the risk of serious illness and premature death of those near the top. Between the top and bottom health standards show a continual social gradient. † (Wilkinson & Marmot 1998) In Australian society it is readily apparent that the lower social classes are at greater disadvantage than those in the upper echelons of society; this has been discussed at length in several separate papers on the social gradient of health and its effects on disadvantaged Australian groups (Devitt, Hall & Tsey 2001, Robinson 2002, Caldwell & Caldwell 1995). Within the context of the social gradient of health it can be inferred that Indigenous groups, for example, are particularly susceptible to ill health and poor health outcomes as they suffer inordinately from the negative effects of the key determinants of health. A simple example of this is the inequality in distribution of economic resources: â€Å"Average Indigenous household income is 38% less than that of non-Indigenous households. † (AHREOC 2004). The stress and anxiety caused by insufficient economic resources leads to increased risk of depression, hypertension and heart disease (Brunner 1997 cited in Henry 2001). Higher social status and greater access to economic resources is concomitant with a reduction in stress and anxiety levels, as individuals in these groups have more control over economic pressures which create this stress. This simple comparison proves that the social gradient of health accurately reflects how socioeconomic determinants affect the health of specific social classes at the physiological level. An extension of the research into the social gradient and the determinants of health is the examination of the pathways through which specific social groups experience and respond to these determinants. These ‘psychosocial pathways’ incorporate psychological, behavioural and environmental constraints and are closely linked to the determinants of health; â€Å"Many of the socio-economic determinants of health have their effects through psychosocial pathways. † (Wilkinson 2001 cited in Robinson 2002). These pathways have been demonstrated by Henry (2001) in the conceptual model of resource influences (Appendix A), a model which illustrates the interaction between the constraints mentioned above and their impact on health outcomes. Henry states that a central differentiator between classes is the amount of control an individual feels they have over their environment. Whereas an individual from a lower class group holds a limited sense of control over their well being and consequently adopts a fatalistic approach to health, those in higher classes with a stronger sense of control over their health are more likely to take proactive steps in ensuring their future wellbeing. This means that both individuals will cope differently with the same health problem. This is partly as a result of socioeconomic or environmental determinants relative to their situation, but it is also a result of behavioural/physical constraints and, most importantly, the modes of thought employed in rationalising their situation and actions. In essence these psychosocial pathways occupy an intermediate role between the social determinants of health and class related health behaviours. This suggests that, while the social gradient of health is a good predictor of predisposition to ill health among specific classes, it cannot predict how reducing inequality in itself will affect health outcomes or how a specific social class will respond to these changes. An examination of some initiatives aimed at reducing inequality in the indicators of health outcomes reveals this problem; â€Å"In 1996 only between 5% and 6% of NT Aboriginal adults had any kind of post secondary school qualification compared with 40% of non-Aboriginal Territorians. † (ABS 1998). Within the context of the social gradient of health, education is an important indicator of health outcomes. It is evident from the quote above that there exists huge inequality within the Northern Territory education system; this suggests an increased likelihood of ill health for Aboriginal people in later life. Even though there have been initiatives to address this inequality in one of the indicators of health outcomes (Colman 1997, Lawnham 2001, Colman & Colman 2003), they have had only a minimal impact on Indigenous second level education rates (ABS 2003). This is partly due to the inappropriateness of these initiatives (Valadian 1999), but it is also due to the disempowerment and psychosocial malaise (Flick & Nelson 1994 cited in Devitt, Hall & Tsey 2001) which are a feature of Indigenous interaction and responses to the social determinants of health. Research has also been carried out into how effecting change in the inequalities in other indicators of health might affect health outcomes. Mayer (1997) cited in Henry (2001) examined the effects of doubling the income of low income families and concluded it would produce only modest effects. Henry believes that this points to the strong influence of the psychological domain in influencing health behaviours. This suggests that the key to better health for all lies not just in reducing inequality between the classes but also in changing those elements of the psychological domain which influence health behaviour. Another example of the gap between initiatives to reduce inequality and their impact on those inequalities is evident in an examination of economic constraints experienced by Indigenous Australians on social welfare. Price and McComb (1998) found that those in Indigenous communities would spend 35% of their weekly income on a basket of food, compared to just 23% of weekly income for those living in a capital city for the same basket of food. To combat this inequality it would seem logical to reduce the price of food in Indigenous communities or else increase the amount of money available to those living in remote communities, i. e. a socioeconomic approach. It has already been established that increasing income has only modest effects and in combination with the fact that smoking, gambling and alcohol account for up to 25% of expenditure in remote communities (Robinson 2002), how can it be guaranteed that the extra funds made available through either of the two suggestions above would be employed in achieving a desirable level of health? One possible suggestion is that a socioeconomic approach must be complemented by a psychosocial approach which addresses those abstract modes of thought, cultural norms and habits and health related behavioural intentions which dictate healthful behaviours. â€Å"Culture and culture conflict are factors in Aboriginal health. But instead of the emphasis being placed on Aboriginal failure to assimilate to our norms, it should rather be put on our failure to devise strategies that accommodate to their folkways. † (Tatz 1972 cited in Humphrey & Japanangka 1998) Any initiative which hopes to resolve inequality in health must incorporate a sound understanding of the influence of the psychosocial pathways relative to the class level and cultural orientation of that group, otherwise its success will be modest at best. Using Henry’s model of resource influences provides a framework for understanding how addressing these psychosocial pathways can lead to greater uptake of initiatives designed to address these inequalities. An analysis of the National Tobacco Campaign (NTC 1999) reveals how this initiative failed to impact significantly on Indigenous smoking rates. This was a purely educational initiative which aimed to raise awareness of the effects of smoking on health. One of the primary flaws of its design was its failure to even acknowledge those Indigenous groups at the lower end of the social scale; it also failed to communicate the relevance of its message to Indigenous people; â€Å"The only thing is that when it comes to Aboriginal people, they will not relate to Quit television advertisements because they don’t see a black face†¦. I’ve heard the kids say ‘Oh yeah, but that’s only white fellas’. They do. † (NTC 1999) Not only did this initiative fail to connect with Indigenous people, it also failed to influence the elements of the psychological domain which legitimate such high rates of smoking. Within Indigenous culture smoking has become somewhat of a social practice, with the emphasis on sharing and borrowing of cigarettes (Gilchrist 1998). It is ineffectual to put across messages about the ill effects of smoking if the underlying motivation of relating to others is not addressed. In a report conducted on Indigenous smoking (AMA & APMA 2000 cited in Ivers 2001), it was suggested that one of the key themes of an initiative aimed at reducing indigenous smoking rates should be that smoking is not a part of Indigenous culture. The ‘Jabby Don’t Smoke’ (Dale 1999) is an example of an initiative whose design attempted to influence accepted social norms. Its focus was primarily on children, thereby acknowledging the importance of socialization and the instillation of cultural norms at an early age. Unfortunately no data is available detailing its impact on smoking rates. As mentioned earlier in this essay, another feature of the psychological domain which has an effect through the psychosocial pathways is the modes of thought employed in rationalising actions and responses to various determinants and constraints. Self efficacy or the amount of perceived control over one’s situation is an important contributor to health status; â€Å"Empowered individuals are more likely to take proactive steps in terms of personal health, whilst disempowered individuals are more likely to take a fatalistic approach† (Henry 2001) Examples of initiatives which have strived to empower Indigenous people in being responsible for their own health include ‘The Lung Story’ (Gill 1999) and various health promotion messages conveyed through song in traditional language ( Castro 2000 cited in Ivers 2001, Nganampa Health Council 2005). By encouraging Indigenous people to address these issues in their own way, the amount of perceived control over their own health is increased thereby facilitating a greater degree of self efficacy. The intention of this essay has not been to deny that the social gradient of health does not exist or that it is not an effective tool in creating understanding of where social and health inequalities lie. Unfortunately programs and initiatives which have been guided by the social gradient of health and have been purely socioeconomic in their approach have failed to have a significant, sustainable effect on health inequalities. In the US, despite socioeconomic initiatives to resolve inequality, the gap between upper and lower class groups has actually widened in recent times (Pamuk et al 1998 cited in Henry 2001). The scale of the intervention required to ensure a sustained impact on health inequalities has been discussed by Henry (2001), he also highlights the need to garner substantial political will in order for these changes to happen and makes the point that those in the upper classes are relatively content with the present status quo. This essay has attempted to demonstrate that in an environment where well grounded, evidence based socioeconomic initiatives are failing to have the desired out comes, it is perhaps time to focus more on altering those strongly held health beliefs which not only dictate responses to social determinants of health but also dictate responses to initiatives designed to address these inequalities; â€Å"Healthful behaviours are due to more than just an inability to pay. A mix of psychological characteristics combines to form distinctive behavioural intentions†. (Henry 2001) In the current environment of insufficient political will and finite resources it would be prudent to use every tool available to ensure initiatives aimed at reducing inequality between the classes will have the maximum amount of benefit. This approach is not a long term solution, but until it is possible to achieve the large scale social remodelling necessary to truly remove social inequality, and consequently health inequality, it is the most viable solution available. REFERENCES. ABS, 2003. ‘Indigenous Education and Training’, Version 1301. 0, A Statistical Overview, Australian Bureau of Statistics, Canberra, viewed 22nd August 2005, http://www. abs. gov. au/Ausstats/abs@. nsf/Lookup/FC7C3062F9C55495CA256CAE000FF0D6 A statistical overview of Aboriginal and Torres Strait Islander peoples in Australia 2004, Australian Human Rights and Equal Opportunities Commission (AHREOC), Sydney, viewed 20th August 2005, http://www. hreoc. gov. au/social_justice/statistics/. Brunner, E. 1997. ‘Stress and the Biology of Inequality’. British Medical Journal. No. 314, pp 1472-1476. Castro, A. 2000. ‘Personal Communication’. No other details available. Caldwell, J. & Caldwell, P. 1995. ‘The cultural, social and behavioural component of health improvement: the evidence from health transition studies’, Aboriginal Health: Social and Cultural transitions: Proceedings of a Conference at the Northern Territory University, Darwin 28-30th September. Colman, A. 1997. ‘Anti-racism Course’, Youth Studies Australia, Vol. 16, Issue 3, p. 9, viewed 22nd August 2005, EBSCOhost Database Academic Search Premier, item: AN 12878155. Colman, A. & Colman, R. 2003. ‘Education Agreement’, Youth Studies Australia, Vol. 22, Issue 1, p. 9, viewed 22nd August 2005, EBSCOhost Database Academic Search Premier, item: AN 9398334. Dale, G. 1999. ‘Jabby Don’t Smoke, Developing Resources to Address Tobacco Consumption in Remote Aboriginal Communities’, Paper presented to the Eleventh National Health Promotion Conference, Perth. 23-26th May. Devitt, J. , Hall, G. , Tsey, K. 2001. ‘An Introduction to the Social Determinants of Health in Relation to the Northern Territory Indigenous Population’, Occasional Paper. Co-operative Research Centre for Aboriginal and Tropical Health. Darwin. Flick, B. , Nelson, B. 1994. ‘Land and Indigenous Health’, Paper No. 3, Native Titles Research Unit, Australian Institute of Aboriginal and Torres Strait Islander Studies, Canberra. Gilchrist, D. 1998. ‘Smoking Prevalence among Aboriginal Women’, Aboriginal and Islander Health Worker Journal, Vol. 22, No. 4, pp. 4-6. Henry, P. 2001. ‘An Examination of the Pathways through Which Social Class Impacts Health Outcomes’. Academy of Marketing Science Review, vol. 3, pp 1-26. Humphery, K. , Japanangka, M. D. , Marrawal, J. 1998. â€Å"From the Bush to the Store: Diabetes, Everyday Life and the Critique of Health Service in Two Remote Northern Territory Aboriginal Communities. † Diabetes Australia Research Trust and Territory Health Services, Darwin. Ivers, R. 2001. ‘Indigenous Australians and Tobacco; A Literature Review’, Menzies School of Health Research and the Cooperative Research Centre for Aboriginal and Tropical Health, Darwin. pp. 67-80, 93-107. Lawnham, P. 2001. ‘Indigenous Push at UWS’, The Australian, 27th June, 2001. p. 34, viewed 22nd August 2005, EBSCOhost Database Academic Search Premier, item: AN 200106061025662941. Marmot, M. G. , Davey Smith, G. , Stansfield, S. , Patel, C. , North, F. , Head, J. , White, I. , Brunner, E. and Feeney, A. 1991. ‘Health Inequalities among British Civil Servants: the Whitehall II Study’, Lancet, 337, 1387. reading 1. 5. Mayer, S. 2001. What Money Can’t Buy: Family Income and Children’s Life Chances. Harvard University Press, Cambridge, Massachusetts. National Tobacco Campaign. 1999. ‘Australia’s National Tobacco Campaign: Evaluation report Volume 1’. Commonwealth Department of Health and Aged Care, Canberra. Nganampa Health Council. 2005. Nganampa Health Council, Alice Springs. Viewed 23rd August 2005, http://www. nganampahealth. com. au/products. php Pamuk, E. , Makuc, D. , Heck, K. , Reubin, C. , Lochner, K. 1998. ‘Socioeconomic Status and Health Chartbook’. Health, United States. National Centre for Health Statistics, Maryland. Price, R. , & McComb, J. 1998. ‘NT and Australian Capital Cities Market Basket Survey 1998’. Food and Nutrition Update, THS, Vol. 6, pp. 4-5. Robinson, G. 2002. ‘Social Determinants of Indigenous Health’, Seminar Series, Menzies School of Health Research. Co-operative Centre for Aboriginal Health. Valadian, M. 1999. ‘Distance Education for Indigenous Minorities in Developing Communities’, Higher Education in Europe, Vol. 24, Issue 2, p. 233, viewed 22nd August 2005, EBSCOhost Database Academic Search Premier, item: AN 6693114. APPENDIX A. CCONCEPTUAL MODEL OF RESOURCE INFLUENCES. [pic] Henry, 2001. .