Essay on American History To 1700 - 942 Words

The writings of Columbus, Castillo, and de la Casas represented vastly different points of view of the Spanish conquests of the Americas. In his first letter, Christopher Columbus mostly focused on the political victory of the voyage and arriving in the Indies (p. 32), and the splendor of the landscape including palm trees, mountains, and beautiful birds (p. 33). In the subsequent letter to King Ferdinand of Spain, Columbus seems selfish and one-sided (somewhat understandable considering that he was begging Ferdinand for forgiveness of his crimes (p. 35). Bernal Diaz del Castillos account, however, was not clouded by much bias or opinions at all. Because Castillo was just a simple foot soldier (Castillo p. 42) and was left to follow†¦show more content†¦33). After having been plotting against by his own men (p. 34), and being unsuccessful in governing, the weary explorer pleads with the King to let him leave the lands in America and perform a pilgrimage to Rome to convey his forgiveness (p. 35). Christopher Columbus once a confident man ready to take up the task and explore the New World, became downtrodden with the inability govern and carry out his personal wishes and those of the country he was serving. Cortes and Montezuma experienced moments of tension in their interactions with each other. Before they even met, Cortes was sent many gifts of gold and silver by one of Montezumas men, Quintalbor (Castillo p. 43). Montezuma specifically chose to send Quintalbar because his body and facial features closely resembled those of Cortes (Castillo p. 43). Both of these actions show that Montezuma was all ready becoming fearful that these strange men were going to threaten his land. Unfortunately, his gift-giving was counterproductive because it made Cortes and his men excited that the land was plentiful with gold. This ultimately became the reason that they attacked Tenochtitlan (Castillo pp. 43-44). The first time Cortes and Montezuma met face to face, Montezuma made a grand entrance, most likely to show Cortes how powerful he was. He wasShow MoreRelatedThe New World s Was Anything But Fair And Equal Between Men And Women1259 Words   |  6 Pagesnew world in the 1700’s was anything but fair and equal between men and women. The utopist idea of the hundred pilgrims signing the First American governing document, Mayflower Compact (Plymouth, MA-1620) was about to be rocked by centuries of racial discriminations. The Stono rebellion will trig various changes in the Colonies, this event will reshaped the 1700s’ racial status, and provide Southern states with a great opportunity to capitalize on its outcome. North America in 1700s was engaged inRead MoreWhat I Learned From Taking American Civilization 1700905 Words   |  4 PagesAt the beginning of the semester I wrote an assignment addressing what I wanted to learn from taking American Civilization 1700. I went through the course syllabus and I chose skills that I thought were important for me to know better as well as important to my future career as a teacher. Two skills that I did not list that I wanted to work on were comparing and contrasting. Comparing and contrasting are two skills that I thought I was quite good at and had no problems with. When it came to do theRead MoreThe Evolution Of The Education1566 Words   |  7 Pagesestablished as one of the first forms of Colonial education (The History of Education in America.). Grammar-Latin schools were founded as an educational institution for the children of the upper class, where boys could prepare for a role in the Church or State. 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The AutobiographyRead MoreThe American Revolution : A Historiographical Introduction846 Words   |  4 PagesThe American Revolution, also known as the U.S. War of Independence, started in the early 1700s and ended in the late 1700s. This war was started in an attempt to end the tension between the American colonies and the British government. After reading the article, â€Å"The American Revolution: A Historiographical Introduction,† provided by The British Library, and â€Å"The Historiography of the American Rev olution† by Michael Hattem, I have a better overall understanding of how the history of the AmericanRead MoreFrance - Change over Time Essay (French Revolution)1156 Words   |  5 Pages*As the title indicates, this is a change/continuity AP essay written for World History class. 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Research from the National Coalition for Women and Girls in Education (NCWGE) has shown that when Title IX was introduced in 1972, girls were able to participate in any state-funded activity, resultingRead MoreCongressional Acts that Helps Uplift African Americans1041 Words   |  5 PagesThe Search For Throughout history, there has been a struggle for equality and justice. The oppression that African Americans have received throughout the generational period in which they first arrived in America has continued to be a raging war. Article I, Section 8 of the American Constitution enabled Congress to have certain rights and authorities over the laws. In the evaluation of the 1700s, 1800s, 1950s, and 1990s, the prolific effects can be seen through specific Congressional Acts. BetweenRead MoreAmerica Needs Gun Control Laws Essay903 Words   |  4 Pages Guns have been the weapon of choice for some of the most brutal massacres on America soil. Since early history guns have been used mainly for militia and defense purposes. But, the development of new gun technology has made firearms more accessible and deadly. Although the second amendment gives the right to bear arms, guns should be controlled and monitored by the government because guns have contributed to a lot of killings in America and will increase crime rates. Gun control can be definedRead MoreBrief Overview of American Literature From Plymouth to the 1800s657 Words   |  3 PagesThe trace in literature and history from Plymouth and Virginia colonies through the Jeffersonian Enlightenment to the transcendentalists represented by Emerson and Hawthorne all begins with John Smith, whom had been granted by a charter from King James I reached Virginia in 1607. The settlers landed in what was Jamestown ready to begin the dangerous undertaking of surviving in a new environment. Dealing with harsh winters, lack of drinking water, and the spread of disease made life in Jamestown difficult

Argumentative Essay On Euthanasia - 1302 Words

Bryan Euyoque 4/24/17 Economics behind Euthanasia In an ethics class I took in high school, I have learned about many controversial topics. One that caught my attention specifically was euthanasia or the â€Å"right to die† as some call it. There are many types of Euthanasia, including active and passive. In class we debated the difference between the two and why passive euthanasia is legal and active is not. Active euthanasia is defined as â€Å"a person directly and deliberately causing the patient s death.† (Forms of euthanasia) Passive euthanasia is when â€Å"death is brought about by an omission of a certain thing required for life to continue.† (Forms of euthanasia) Examples of passive euthanasia would†¦show more content†¦If the point of euthanasia is to end suffering, then passive euthanasia does not seem like a good option. (The conventional Doctrine) When it comes to passive euthanasia the disease is what kills the individual. Those who qualify for passive euthanasia are mostly suffering from excruciatingly painful diseases. Passive euthanasia does not seem like the way to go if minimizing pain is the goal. As a result, â€Å"in many cases where it is right to let a patient die, it is also right to practice active euthanasia† (The conventional Doctrine) Those not in favor of euthanasia believe it is wrong to kill another human being even if it means saving them a lot of pain. An argument those who oppose euthanasia use is that â€Å"euthanasia weakens society’s respect for the sanctity of life† (Anti-euthanasia arguments) Sanctity of life means â€Å"Human life must be respected regardless of age, gender, race, religion, social status or potential for success. Life is good in and of itself, not just as a means to achieve an end.† (Arguments against euthanasia). In other words, no one has the power to end another person’s life regardless if their intentions are good or bad. Laws like â€Å"The Universal Declaration of Human Rights† were created to legally enforce the sanctity of life. Euthanasia would be a violation to this law thus should not be legal. Subsequently the argument from nature by J. Gay-Williams is also used inShow MoreRelatedEuthanasia Essay - Pro Euthanasia Argumentative Essay1148 Wo rds   |  5 PagesImani Henry Mr. Dowie Honors English 9 1/13/17 Pro Euthanasia Argumentative Essay Euthanasia is the act of intentionally killing someone to end suffering, with and without their consent. This practice has been around since the beginning of time and has been practiced by different cultures all over the world. In the United States currently, only 5 states allow the option of euthanasia. All states throughout the USA should allow the act of euthanasia. Considering it is within the 1st amendment due toRead MoreArgumentative Essay On Euthanasia754 Words   |  4 PagesEuthanasia In 1478-1535 euthanasia was first mentioned in the book â€Å"utopia† by sir Thomas More. The utopian priests encouraged euthanasia when a patient is terminally ill or dying. The earliest American statute explicitly to outlaw assisted suicide was enacted in NewYork 1828. Until the end of the nineteenth century euthanasia was regarded as a peaceful death and art of accomplishment, it was often referred to as â€Å"de euthanasia medica prolusion†. (life.org) When a person commits an act of euthanasiaRead MoreArgumentative Essay On Euthanasia1195 Words   |  5 Pagesaided death (PAD) is a problem that should be decided on once and for all. Euthanasia, similar to physician aided death, has a history dating back to the ancient Greeks and Romans (Haerens 1). In their culture, human life was not valued as it is now. While in extreme pain or suffering, they would take a shot of lethal poison. In the ancient times, 19th century, and now, there are doctors that oppose the practice of euthanasia because of the Hippocratic Oath- an ancient Greek oath that doctors takeRead MoreArgumentative Essay On Euthanasia839 Words   |  4 Pages Euthanasia is a very controversial and sensitive topic because of the ethical, legal, and moral issues of it. In the United States alone, it is illegal almost everywhere, however; it’s legal in Colorado, Vermont, Montana, Washington D.C., Oregon, Washington, and California. But, what exactly is euthanasia? Euthanasia can be categorized in three different ways; voluntary euthanasia, non-voluntary euthanasia, and involuntary euthanasia. Voluntary euthanasia is when a patient agrees to receive assistanceRead MoreArgumentative Essay On Euthanasia1828 Words   |  8 PagesEuthanasia Is your life really yours? Can a person decide on his or her death? If ‘yes’, what circumstances we would consider and what is a boundary between calling it â€Å"help† or ‘killing†? These questions point to euthanasia, a highly debatable issue. As described by Hermsen (520) euthanasia or mercy killing involves painlessly ending a life of an individual suffering from chronic and incurable illnesses or a permanent coma. It gives individuals authority over their lives where it allows them aRead MoreArgumentative Essay On Euthanasia715 Words   |  3 PagesEuthanasia (Physician-Assisted Suicide) Euthanasia has been around for a long time. In 1990 every state had laws that made assisting suicide a felony. Assisted suicide been in the news since the 1990s. A supporter of euthanasia Dr. Jack Kevorkian played an important role in more than 100 suicides before he was charged with murder. In Oregon voters passed the death with dignity act in 1994, but a lawsuit blocked its enforcement until 1997, when it went into effect. The consideration of potentialRead MoreArgumentative Essay On Euthanasia752 Words   |  4 PagesEuthanasia is the termination of a very sick person’s life in order to relieve them of their pain and suffering. Euthanasia is from a Greek word meaning easy death. The person who undergoes euthanasia usually has an incurable condition and in some cases wants their life to be ended. Euthanasia can be done at the request of a person which is voluntary but at the same time if a per is too sick and is unable to make the decision the family/next of kin inline , do chose or the court makes the decisionRead MoreArgumentative Essay On Euthanasia943 Words   |  4 Pagesthrough passive suicide. euâ€Å"Passive euthanasia occurs when a person is allowed to die due to the deliberate withdrawal of treatment that might keep them alive† (Pg.124)and prolong their life. It is a legal way of hastening death in a calm manner. Its methods are not the same as active suicide. The main difference is that it simply consists of removing treatments that would prolong life, instead of prescribing lethal doses of medicine to kill someone. Passive euthanasia is not as controversial for theRead MoreArgumentative Essay On Euthanasia994 Words   |  4 PagesThe term Euthanasia is quite a hot debate these days, even back in last century. People consider this as a process where people choose to end their lives with no physical pain by ingesting a pill, which also known mercy killing and assisted suicide. Due to the effect, many comments are about whether this way of killing should be legal or forbidden. Jack Kevorkian, an euthanasia proponent, was well known as â€Å"Doctor Death† who was a physician give patients the choice of mercy killing. Yet, he was arrestedRead MoreArgumentative Essay On Human Euthanasia1433 Words   |  6 PagesHuman Euthanasia It is a shared understanding that human life must be valued under any circumstance, and it should not be terminated for whatever reasons unless it is a natural occurrence. The value and respect for human life were behind the debate against â€Å"the death row† in many states and countries around the world. In addition, religion places high value in human life, basing on the claim that it is a sin to end one’s life. However, there have been instances where ending the life of another person

Critial Investigation of the etiology of juvenile idiopathic arthritis Free Essays

Introduction Juvenile idiopathic arthritis is an umbrella term which includes all forms of arthritis that begin before the age of sixteen, of over six week’s duration, and of unknown cause. (Petty el al 2004) With various contributing environmental and genetic factors, arthritis is an autoimmune disease. Ongoing research, into the etiology of juvenile idiopathic arthritis, has identified the most common risk factor as infection in combination with genetic susceptibility. We will write a custom essay sample on Critial Investigation of the etiology of juvenile idiopathic arthritis or any similar topic only for you Order Now An autoimmune reaction occurs as a result of an infection or trauma, this causes synovial hypertrophy and chronic joint inflammation in genetically susceptible individuals. (Rabinovich 2010). Juvenile idiopathic arthritis is a genetically complicated characteristic in which many genes are important as indications at the onset of the disease. Both the IL2RA/CD25 and the VTCN1 genes have recently been identified as juvenile idiopathic arthritis susceptibility loci (Hinks et al 2009) .Pathogenesis has many other contributing factors such as stress and maternal smoking. (Prince et al 2010) The International League of Associations for Rheumatology (2004) classification of Juvenile idiopathic arthritis, JIA, includes seven subtypes: Systemic onset JIA, oligoarticular, polyarticular RF-positive and RF-negative, Enthesitis-related arthritis, Juvenile ankylosing spondylitis, and ‘‘other.’’ The most common type of JIA is Oligoarticular.60% of children, mainly girls under 5, with JIA have this type. During the first 6 months Oligoarticular affects between one and four joints. The knees, ankles and wrists are the most affected. After 6 months it can spread to more than four joints and is known as ‘Extended oligoarthritis’ affecting 2 in 5 children. Affected children are moody and difficult as a result of their symptoms, which include joint stiffness in the morning and joint pain. Walking may be delayed in very young children. 1 in 5 children also have inflammation of the eye, Uveitis. Children who carry antinuclear antibodies in their blood are most at risk of uveitis. (Arthristis Research UK, 2010) Polyarticular arthritis, which again is more common in girls, affects 20% of children with JIA. (Arthristis Research UK, 2010) Polyarthritis mainly affects the joints of the hands and feet, which become painful, swollen and stiff. This type can often affect more than one joint, usually over 4, at a time. The child can often become unwell and pain may be accompanied by a fever. About 10% of children will have the rheumatoid factor (RF), meaning that their blood contains an antibody similar to that often found in adult rheumatoid arthritis. Most RF-positive children are girls, typically aged 10 or over. RF-positive children can have a more severe form of the disease which, without early intervention, can result in long-term joint damage. It is unlikely that RF-positive children will be free from Polyarthritis with symptoms continuing into adult life. Permanent remission is more often seen in children who are RF-negative. (David and Lloyd 1999, pg 207) About 10% of cases of arthritis in children are systemic. This type of arthritis affects girls and boys equally but is more often seen in under fives. (Arthritis Research UK, 2010). This severe and potentially fatal form of JIA includes children who have arthritis associated with marked systemic features. Systemic arthritis can be identified by a fever which persists daily for at least two weeks either at the onset or prior to the arthritis. One or more of the subsequent systemic features must also occur, these are a rash, generalised lymphadenopathy, liver or spleen enlargement and serositis (inflammation of the serous tissue, which lines the major organs including the heart and lungs.) Every child is different. Some children will fully recover after one bout of systemic arthritis. Others could have symptoms that come and go for several years and a number of children go on to develop polyarthritis but have no further fever attacks. (Arthritis Research UK, 2010) Psoriatic arthritis affects less than 10% and is most commonly found in girls aged 8 to 9 years. Psoriasis, a skin condition causing a widespread flaky skin rash is prevalent.The rarer form, Enthesitis-related arthritis usually affects boys aged eight and over. The main symptoms are arthritis in several joints at once, often located at the sacroiliac joint. Enthesitis-related arthritis has a genetic risk factor with children carrying, the HLA-B27 gene. This gene is an indicator common with some adult forms of arthritis. However affected children don’t always go on to suffer in adult hood. (Arthritis Research UK 2010) Although Munro et al (2009) reported that there are no specific tests for the diagnosis of JIA. Diagnosis is made on both clinical findings and investigations. A literature review, by Munro et al (2009), reports that past research recommends documenting the range of motion in all joints, the extent of joint swelling, the presence of bony overgrowth and whether affected joints are affected by muscle atrophy and weakness. Significant trauma, fever, in particular if it is persistent for 10 days or without clear cause or coupled with a rash also need to be evident.. Rheumatoid factor and antinuclear antigen screening tests should be conducted although children with an infection or current pathology may have positive findings, and the tests should not be used as a definite diagnosis of JIA. Inflammation, identified with a raised white cell or platelet count,may also be identified by during a full blood screening. T-lymphocytes play an essential role in the pathophysiology of JIA. They release pro-inflammatory cytokines and favour a type-1 helper T-lymphocyte response. An abnormal interaction between type 1 and type 2 T-helper cells has been hypothesized. Research into T-cell receptor expression; confirm recruitment of T-lymphocytes specific for synovial antigens. Evidence of a disorder in the humoral immune system is identified by the increased presence of autoantibodies, increased serum immunoglobulins, existence of circulating immune complexes or complement activation. Chronic inflammation of the synovium is characterized by B-lymphocyte infiltration and expansion. Macrophages and T-cell invasion are linked with the release of cytokines, which induce synoviocyte proliferation. (Rabinovich 2010) JIA, if badly managed, can have a number of consequences such as growth failure, leg length discrepancy, contractures, scoliosis, blindness (secondary to untreated chronic anterior uveitis), Macrophage activation syndrome, disability and many more. Psychosocial problems are also evident. JIA sufferers are predominantly affected by pain. When treating children in pain, doctors and parents must first understand the physiology of pain and why children have different reactions. The International Association for the Study of Pain (2007) defines pain as â€Å"An unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of such damage, or both.† This definition recognises that pain is a perception and not a sensation as many believe. Pain can be categorised into nociceptive, or neuropathic. Sustained activation of the nociceptive system caused by tissue injury results in pain described as nociceptive . While neuroplastic changes are evidently involved, nociceptive pain is alleged to arise as a result of the normal activation of the sensory system by noxious stimuli, a process that utilises transduction, transmission, modulation and perception. Direct injury or dysfunction of the peripheral or central nervous system results in Neuropathic pain. The injury could be to either neural or non-neural tissues. (American Medical Association, 2010) There has been several pain mechanism theories proposed over the last 50 years. The specificity theory, described in 1664 by Rene Descartes, proposes that pain impulses travelled along a dedicated pathway from receptors in the periphery to a specialised pain centre in the brain, resulting in a mechanical behavioural response. Descartes described each nerve as having a specific function, with free nerve endings being called pain receptors. (Thomas 1998, pg 6) It suggests that the greater the damage or injury then the more sever the pain. (Brannon and Feist , 2000) This theory can be supported to the extent that there are some specialised nerves in the human body however others can have numerous functions or detect several types of stimuli. On the other hand this theory does not explain the variable nature of pain. Furthermore no pain centre has ever been identified; current research suggest multiple areas of the brain detect and respond to the pain stimuli. (David and Waterfield 199 9) In 1962, Weddel (cited by Thomas 1998) states that there is no separate system for perceiving pain, rather that pain is due to intense peripheral stimulation of non-specific receptors. This in turn produces a pattern of nerve impulses, which is interpreted centrally as pain. The pattern theory proposed that strong and mild stimuli produced different patterns of impulses. (Thomas 1998, pg 6) This theory ignores the specialism of some receptors and does not account for conditions in which a gentle touch can trigger episodes of neuralgia (David and Waterfeild 1999) The best explanation to date is the pain gate theory, proposed by Mezack and Wall in 1965. (David and Lloyd 1999, pg28) The theory suggests that stimulation of nerve endings evokes nervous impulses that are transmitted by three systems located in the spinal cord. The substania gelatinosa in the dorsal horn of the spinal cord, the dorsal column fibres and the central transmission cells act to stimulate or inhibit nocioceptive impulses. The transmission of impulses from the afferent fibres to the spinal cord transmission cells is modulated by the spinal gating mechanism in the dorsal horn. The gating mechanism is influenced by the amount of activity in the larger-diameter fibres. Larger diameter fibres are thought to be inhibiter, thus closing the pain gate, the opposite occurs when smaller fibres are stimulated: pain is transmitted and the gate opens.(Melzack and Wall, 1996) In addition descending control from various structures in the brain can also inhibit the relay and close the g ate. On reaching the brain, the impulses are further modified and integrated with other sensory input. On arrival at the brain the impulses are felt as pain. It is important to understand that those afferent fibres do not have a fixed response but are subject to modification even before they reach the pain gate and after they reach the brain. (David and Lloyd 1999, pg 28) The pain gate theory was the first to appreciate that pain can be affected bypsychological factors. A person may be able to control pain be altering their state of mind. For example if a person is able to distract themselves from the pain then less impulses are sent to the brain therefore not enough stimuli are present to open the gate. (Salvano and Willems 1996, pg 15) In summary experiences of pain are influenced by many physical and psychological factors such as beliefs, prior experience, motivation, emotional aspects, anxiety and depression can increase pain by affecting the central control system in the brain. The specificity theory and the pattern theory suggests that pain occurs only due to damage to body tissue while the gate control theory claims that pain may be experienced without any physical injury and individuals interpret pain differently even though the extent of injury is the same. The gate control theory also suggests that pain can be controlled by the mind. The author’s understanding is that Juvenile idiopathic arthritis produces nociceptive pain, through recurrent inflammation of the joints. Inflammation releases chemicals such as histamine and bradykanin, which are detected by nociceptors which then activate noxious impulses to the dorsal horn. Once enough impulses are generated to â€Å"open the gate† neural areas responsible for perception and response activate. The perception and level of response is influenced by the state of mind. Pain impacts on the lives of children, with arthritis, by limiting activities, disrupting school attendance, and contributing to psychosocial distress (Kimura and Walco 2006). A study by Schanberg et al (2003) investigated levels of pain in 41 children with arthritis by the daily completion of pain diaries. They found that 70% of the children had significant amounts of pain, on 60% of the days, with 38% having pain daily. Children often describe the pain associated with JIA as â€Å"aching,† â€Å"sharp,† â€Å"burning,† and â€Å"uncomfortable† (Antony and Schanberg 2003). Research also suggests that children with JIA have a lower pain threshold than their healthy counterparts. (Hogeweg et al 1995) This could be due to the children’s brains, were pain is processed, changing due to long exposure to noxious impulses. The perception of pain in children with JIA could also be influence by the cognitive capabilities and age. Beales et al (1987, cited i n Antony and Schanberg 2003) suggest that cognitive development impacts pain perception due to the association and understanding of the child’s condition. For example all the children , despite their age, described the pain as â€Å"aching† but younger children did not associate it with anything unpleasant , older children, however,are more likely to relate their joint feeling to their arthritis-related disability. Therefore with cognitive maturation, children become capable of connecting internal sensations with internal pathology and the potentially serious consequences. Hence, older children with arthritis may become more distressed by the sensation, resulting in increased reported pain intensities as the child’s age increases. (Antony and Schanberg 2003). There is a mounting body of research indicating to the importance of psychosocial variables in the pain incidence of children with JIA, consisting of emotional distress, stress, and mood. Also significant is the child’s perception and coping strategy with their pain. Moreover, a number of studies have described the role of parental and familial factors in child pain, specifically parental psychological health, parental pain history, and the nature of the way in which family members interact with one another. Addressing these issues while managing the condition may help to reduce pain, elevate mood, and improve overall quality of life for children with arthritis. (Antony and Schanberg 2003). A child’s pain needs to be assessed at each appointment, whether by a doctor or physiotherapist. Pain can be assessed both subjectively and objectively. It is important to gain a good description of areas affected, the intensity, type and severity of the pain. A more objective measurement is a Visual analogue scale, completed by the child and a VAS global assessment of disease and function completed by the parents. (Pounty 2007) A multidisciplinary approach, to the management of Juvenile idiopathic arthritis, is considered best practice. Treatment is aimed at controlling inflammation and minimising its effects on the joints. For the best outcome, awareness of complications of both disease and therapy and the psychosocial effects of the illness on both the child and family is essential. (Davidson 2000) Treating the pain can sometimes be the only intervention during a physiotherapy session. Both pharmalogical and non-pharmalogical methods are used to treat pain in JIA.Guidelines for the management of childhood arthritis,The British Paediatric Rheumatology Group (2001), are available and new research is continuing to improve treatments. Most JIA children are Initial treatments include intra-articular long-acting corticosteroid injections and NSAIDs. NSAIDs control pain and inflammation and are usually given for 4 to 8 weeks before starting treatment with a second-line agent. Naproxen, tolmentin, diclofenac, and ibuprofen are commonly used and are usually well tolerated with little gastrointestinal discomfort. The choice of NSAID may be based on the taste of the medication and the convenience of the dosing regimen. Naproxen is prescribed most frequently. Indomethacin is a potent anti-inflammatory medication commonly used to treat ERA and SOJIA, however side effects include headaches, difficulty in concentrating, and gastrointestinal upset. These can be counter acted with other medications. (Weiss and Ilowite 2005) A literature review (Hashkes and Laxer 2005, Cited by Munro et al 2009) looked at the affects of NSAIDS on JIA. These were inconclusive as the participants receiving all forms and doses of NSAIDs achieved significant improvements in the outcome measures and no individual NSAID was shown to have a clear advantage over others. The immune system can be suppressed and the progress of arthritis slowed down, as well reducing the inflammation, by the use of diseases modifying anti-rheumatic drugs (DMARDs) (National Rheumatology Society 2008) Methotrexate is most commonly used for JIA. Random controlled placebo trials and dose finding trials have shown that DMARDs can be effective in polyarticular and oligoarticular arthritis although not in systemic arthritis. (Prince et al 2010) Both physiotherapy and occupational therapy can reduce the impact of JIA, on the daily lives of children. Physiotherapy has a number of treatments that can be utilised to reduce pain. Physical therapy and exercise programs have been shown to be helpful in reducing pain in children with arthritis and should therefore be encouraged, especially since children with arthritis tend to be less physically active and may have become de-conditioned (Kimuru and Walco 2006). Exercise can have an analgesic effect. If using the Pain gate theory, movement can help to close the gate by providing a distraction. Exercise is also good for the healing process. Satallite cells, which can only be activated through exercise, are important for muscle growth and repair. They can be stimulared to either replace damaged muscle cells or add muscle cells. (Poutney 2007, pg 234) A literature review, by Long and Rouster-Stevens (2010), highlighted the importance of exercise in the treatment of JIA. Current studies show that inactivity can lead to deconditioning, disability, decreased bone mass, and reduced quality of life. While progress in pharmacology has improved the lives of patients with JIA, management should also consist of a moderate, regular exercise program or more active lifestyle. The literature suggests physical activity may improve exercise capacity, reduce disability in adulthood, improve quality of life and, in some patients, lessen disease restrictions. . There is however limited evidence of the effect of strength training in children with JIA. Fisher et al (2001) monitored the effects of resistance exercise, via isokinetic equipment, in 19 children with JIA. Children were given an 8 week, personalised progressive programme.Participants demonstrated significant improvement in quadriceps and hamstring strength and endurance, contraction speed of the hamstrings, functional status, disability and performance of timed tasks. Despite the limited evidence, it is recommended that a programme of strength training may be beneficial with JIA. Recommendations for healthy children can be used as a guide. The American Academy of Paediatrics (2001, cited by Maillard 2010) recommends that to increase strength and fitness, low resistance for 15 repetitions is ideal for children. They suggest twenty to thirty minute sessions, two to three times weekly. There is evidence that there is no benefit to increasing the amount of sessions. (Maillard 2010) Hydrotherapy is also advocated for JIA. The effects of hydrotherapy are gained with the combined effect of the warmth, the buoyancy and the fun element of the treatment. Hydrotherapy aims to reduce pain and muscle spasms, increase joint range of movement, and increase muscle strength. Epps et al (2005) found that following two months of hydrotherapy combined with land based exercise there was an increased quality of life and reductions in the impact of the disease in 47% of children with active juvenile arthritis. Pain relief from the heat generated from the pool could be replicated using heat pads or a hot bath. Heat relaxes your muscles and stimulates blood circulation. In relation to the pain gate theory thermal receptors may detect a raise in temperature, impulses are generated which help to close the gate in the dorsal horn, reducing the amount of noxious impulse to the perception area therefore providing relief Conversely cold packs could be used to reduce inflammation and therefore reduce the amount of impulses generated by chemorecepters. (Arthritis Foundation 2011) Alternative therapies are often used to aid pain relief (Feldman et al 2004). Massage is found to be effective on depression, anxiety, mood, and pain (Walach et al 2003). Field et al (1997) investigated the use of massage on children with JIA. Parents massaged their child for 15 minutes per day, for 30 days. They found that the self assessed pain scales decreased as well as cortisol levels lowering, reducing their stress and anxiety. It is possible that the touch from massage helps to reduce pain by closing the gate in the dorsal horn. In conclusion, juvenile arthritis is a painful condition that affects a child’s social, educational and physical life. Pain is a major contributor to the lowered quality of life experienced by these children. Relief can be found in many interventions. A multidisciplinary approach is best practice. The evidence suggests that a combined programme of physiotherapy and medication can help to reduce pain and improve function in these children References American Medical Association.(2010) ‘Pathophysiology of Pain and Pain Assessment.’ Chicago [online]. Available at:http://jhuleah.files.wordpress.com/2010/08/dr-moore-reading-1-ama_painmgmt.pdf (Accessed on 10th March 2011) Anthony.K, Schanberg. L, (2003) ‘Pain in children with arthritis: A review of the current literature’ Arthritis Care Research, 49(2), pages 272–279[online] available at: http://onlinelibrary.wiley.com(Accessed on 14th March 2011) Arthritis Foundation (2011) ‘using heat and cold’ [online] Available at: http://www.arthritis.org/use-heat-cold.php (Accessed on 14th March 2011) Arthritis Research UK (2010) ‘Juvenile idiopathic arthritis (JIA, arthritis in childhood)’ . Available at: http://www.arthritisresearchuk.org(Accessed on 14th March 2011) British Paediatric Rheumatology Group (2001) ‘Guidelines for the Management of Childhood Arthritis’. Rheumatology, 40(11), pp1309-1312, [Online]. Available at: http://rheumatology.oxfordjournals.org (accessed on: 16th March 2011) Brannon, L. Feist, J.(2000), Health Psychology: An Introduction to Behaviour and Health ,4th ed , USA: Brooks/Cole, David.C, Lloyd.J (1999) ‘Rheumatology Physiotherapy’. London: Mosby International limited Davidson.J.(2000) ’Juvenile Idiopathic Arthritis: a clinical overview European Journal of Radiology, 33( 2), pp 128-134,[Online]. Available at: www. Sciencedirect.com (Accessed on 12th March 2011) Epps.H, Ginnelly.L, Utley.M, Southwood.T, Gallivan.S, Sculpher.M, Woo P.(2005) ‘Is hydrotherapy cost-effectiveA randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis.’ Health Technol Assess. 9(39), pp1-59, [Online]. Available at: http://www.ncbi.nlm.nih.gov (Accessed on 12th March 2011) Feldman.D, Duffy.C, De Civita.M, Malleson.P, Philibert.L, Gibbon.M, Ortiz-Alvarez.O, Dobkin.P (2004) ‘factors associated with the use of complementary and alternative medicine in juvenile idiopathic arthritis’ Arthritis Care Research, 51(4), pages 527–532,[online]. Available at: (Accessed on 10th March 2011) Fisher NM, Venkatraman JT, O’Neil KM, (2001) ‘The effects of resistance exercises on muscle and immune function in juvenile arthritis.’ Arthritis Rheum, 44(9), pp276, [Online]. Available at:www.medscape.com(Accessed on 12th March 2011) Hinks A, Ke X, Barton A, et al. (2009) ‘Association of the IL2RA/CD25 gene with juvenile idiopathic arthritis’. Arthritis Rheum, 60(1), pp251-7, [Online]. Available at: http://onlinelibrary.wiley.com(Accessed on 10th March 2011) Hogeweg.J, Kuis.W, Oostendorp.A, Helder.R, (1995) ‘General and segmental reduced pain thresholds in juvenile chronic arthritis’ Pain, 62(1), pp11-17, [Online]. Available at: www.sciencedirect.com (accessed on 10th March 2011) Hull.RG, (2001). ‘Management guidelines for arthritis in children.’ Rheumatology, 40, pg1308, [online]. Available at: http://rheumatology.oxfordjournals.org (Accessed on 12th March 2011) International Association for the Study of Pain (2007) ‘IASP Pain Terminology’[Online]. Available at: http://www.iasp-pain.org(Accessed on 12th March 2011) International League of Associations for Rheumatology, Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P. (2004) ‘International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001.’Rheumatology,31(2), pp390-2, [Online]. Available at: http://www.jrheum.org (Accessed on 12th March 2011) Kimura.Y, Walco.G, (2006) ‘Pain in children with rheumatic diseases’ Current Rheumatology Reports , 8(6), pg480-488, [online] Available at: www.springerlink.com. (Accessed on 11th march 2011). Long,.A, Rouster-Stevens.R, Kelly. A (2010) ‘The role of exercise therapy in the management of juvenile idiopathic arthritis’ Current Opinion in Rheumatology , 22( 2), p 213–217, [Online]. Available at: http://journals.lww.com/co-rheumatology (Accessed on 12th March 2011) Maillard.S(2010) ‘Physiotherapy for Juvenile Idiopathic Arthritis’ [lecture] Great Ormond Street Hospital, London [online] available at:www.vadlo.com (accessed on: 12th March 2011) Melzack.R, Wall.D (1996) ‘The challenge of pain’ 2nd ed.London: Penguin, Munro.J, Haesler.K, Rada.J, Jasper.A, (2009) ‘Juvenile idiopathic arthritis: a literature review of recent evidence’ NHMRC,[online] available at: http://www.racgp.org.au (Accessed on 10th March 2011) National Rheumatology Society (2008) ‘Methotrexate in Rheumatoid Arthritis’ [Online] available at:http://www.nras.org.uk (Accessed on 10th March 2011) Petty.R, Cheang.M, Malleson.P, Oen.K, Cabrel..N, Rosenberg.A (2004) ‘Predictors of pain in children with established juvenile rheumatoid’. Arthritis Care Research, 51(2), pp222-227, [Online]. Available at: : http://onlinelibrary.wiley.com (Accessed on 14th March 2011) Poutney.T (2007) ’Physiotherapy for Children’. Philadelphia: Elvieser Prince.F, Otten.M, van Suijlekom-Smit.L, (2010) ‘Diagnosis and management of juvenile idiopathic arthritis.’ BMJ,341,c6434, [Online]. Availbel at: www.bmj.com (accessed on: 16th march 2011) Rabinovich (2010) ‘Juvenile Rheumatoid Arthritis’ Available at: http://emedicine.medscape.com/article/1007276-overview(Accessed on 14th March 2011) Schanberg L, Anthony KK, Gil KM, Maurin EC(2003) ‘Daily pain and symptoms in children with polyarticular arthritis.’ Arthritis Rheum, 48, pp1390–1397, [Online]. Available at: http://onlinelibrary.wiley.com( Accessed on 14th March 2011) Thomas.V, (1998) ‘Pain : its nature and management ‘ London : Bailliere Tindall Walach H, Guthlin C, Konig M. (2003) Efficacy of massage therapy in chronic pain: a pragmatic randomized trial. J Altern Complement Med.; Vol 9: pg 837-846. [online] available at: http://www.ncbi.nlm.nih.gov (accessed on 16th March 2010) Weiss.JE, Ilowite.(2005) ‘Juvenile Idiopathic Arthritis’ Paediatric.clin north america52,pp413-442,[online] available at: http://www.ncbi.nlm.nih.gov (Accessed on 10th March 2011) How to cite Critial Investigation of the etiology of juvenile idiopathic arthritis, Essay examples

Social Context Assessment and Case Formulation Solution

Question: Describe the client's family and social context. Assessment and case Formulation including psychosocial needs (supported by references). Describe the substance abuse model- Abstinence and rationale. Outline of counselling and treatment process--- residential detox then residential rehabilitation with partner. Client outcomes- challenges and supports such as cultural programs, religious organisation- pastor support for education, sporting organisations, recreational PCYC........ Identify ethical issues likely to arise. Answer: As Ruby seems to be neglected by her parents and feels that they have no time for her, it seems that this is the main cause of her alcohol addiction. Hence, the cognitive behavioral model will be involved in the treatment of Ruby, as this method is focused on making individuals learn that how their personal feelings, thoughts, and behaviors, like alcohol drinking, in this case, are connected and various methods to break this kind of connections. The treatment plan will include helping the client analyze and recognize her environment, as well as, analysis of the methods of responding to the various cues to utilize alcohol, as well as, to develop new ways and methods of response to these different cues. Further, this treatment plan will involve the cognitive therapy and will attempt in reducing excessive and rapid emotional reactions, as well as, the self-defeating attitude of the client by modifying her faulty thinking, as well as, maladaptive beliefs which are responsible for these k ind of reactions (Kumpfer, 2002). Moreover, this treatment plan will involve strategies that will focus on the various behavioral aspects and ways of coping instead of thinking or running away from the situation. Hence, it will involve the participation of the client in relapse prevention programs and other training programs for the development of the cognitive, behavioral, as well as, abstinence skills. This treatment method will include 12-16 sessions, usually for more than 12 weeks and will focus on developing interpersonal skills, as well as, strategies to help client expand her social support connections and other coping skills. The physical and psychological aspects that may occur in this case are changes in the behavior of the client as she is asked to refrain herself from the alcohol use. It may lead to the aggressive or angry behavior. Moreover, the difficulty faced by the client during the early stages of the plan to refrain herself from the alcohol can lead to the event o f relapse. Hence, proper monitoring and participation in the relapse prevention events and various other supporting programs are highly recommended (Worley, Tate, McQuaid, Granholm, Brown, 2013). As Sammy is highly addicted to alcohol with the habit of drinking alcohol as soon as he wakes up and due to the deterioration of his health status caused by alcohol drinking, the use of abstinence model or 12-step model will be used in the treatment of Sammy. As this method involves the multi-disciplinary and is abstinence-oriented, hence, it will help Sammy to stop consuming alcohol and abstain himself from drinking. Firstly, this treatment plan will involve the teaching and educate the client about the use of alcohol as a major problem and its extent. Secondly, this method will involve the motivational interviewing process while counseling with the client for a better understanding of his alcohol addiction and resolving the problem (Winters, Stinchfield, Latimer, Lee, 2007). Thirdly, this method will involve different individual and group therapies, the collaboration of the method with other supporting teams like PCYC and religious organizations for physical and recreational activ ities, as well as, will involve inpatient detoxification, various rehabilitation services, as well as, other outpatient services. This method will also involve the spiritual orientation and will include other symptomatic treatments for the upliftment of the clients health status. This plan will be followed for at least 28 days with participation in the twelve step programs and meetings (Lammertink, Lhrer, Kaiser, Hambrecht, Pukrop, 2008). Moreover, it will also include aftercare plan for supporting ongoing recovery of the client after the completion of the treatment plan as it is the life-long process. The physical and psychological challenges that may occur in this case is the occurrence of the serious symptoms that may occur when there is no alcohol consumption all of a sudden. Hence, it requires close medical monitoring of the patient due to his deteriorated health condition and alcohol addiction. Moreover, the chances of relapse are also there even if abstinence is achieved dur ing the treatment process, thus, requiring the after care plan utilization (Khalsa, Treisman, McCance-Katz, Tedaldi, 2008).As Amira is a heroin addict and has been arrested for soliciting, the use of a cognitive behavioral model, as well as, pharmacological treatments will be the preferred method of treating Amira. The foremost step in the treatment plan will be the detoxification or chemical withdrawal of the client from heroin. The second step to be followed after detoxification of the client will be the use of various classes, as well as, therapy sessions that will help the client in coping the situation and overcoming the desire of using of heroin again ("Maintenance Treatment of Heroin Addiction. Evidence at the Crossroads", 2004). The next step of this treatment plan will be the maintenance after the completion of the treatment program. It involves follow-up care by participation in the 12-step programs like Narcotics Anonymous and other supporting groups besides the individu al therapy (Connell, 2006). Residential training for the period of about 30-90 days will be undertaken depending upon the addiction of the client and her improvement. The physical and psychological challenges that can be experienced by the patient may involve various withdrawal symptoms experienced by the patient on stopping heroin use like vomiting, bone pain, restlessness, insomnia, cold flashes (Blanken, Hendriks, van Ree, van den Brink, 2010). Moreover, there can be extreme cravings for the heroin experienced by the patient in association with the withdrawal symptoms, which can lead to the relapse of the heroin addiction. Hence, the use of medical treatment during the process of detoxification is very important to minimize these withdrawal symptoms, as well as, the extreme cravings for the heroin use. Hence, the treatment plan will include the medically assisted detoxification process, cognitive-behavioral therapy, various educational and motivational lectures, individual, as w ell as, group counseling programs, family therapy, and the incorporation of the 12-step program as a after care plan (Future Challenges For Heroin And Other Opioid Substitution Treatment", 2008). Introduction Drugs, as well as, substance abuse are found to be the major contributing problem worldwide and has become the major problem observed among teenagers. It has been observed that several youngsters do drugs to show they are cool or because they are pressured by the peers into doing drugs. It has been found that the peer pressure has been the concerned problem regarding the drug abuse. People who are a substance or drug addict have no control over their lives and lacks the understanding regarding their surroundings. Risk factors like lack of emotional or mental resources to cope up with the stress, requiring sudden relief from distress, or having a low tolerance to handle the stress and frustration are commonly found to be the reasons for drug addiction (Shepard, 2002). In this article, I will seek to review the case of the Australian movie character, Samson in the movie titled Samson and Delilah, who is involved in the substance abuse and is a petrol sniffer. Case study Description of the character: Samson is a teenager who lives in the remote Aboriginal area of the Central Australia. He used to live with his brother and shares the battered cinder-block apartment with his elder brother. The apartment is dirty and, besides having the refrigerator, which has no eatables or food inside it, the house does not have any other kind of the real furniture. The community where he lives is surrounded by empty beer cans, milk crates, as well as, abandoned cars and litters the poor, as well as, an oppressed community where he survives. The life of Samson is miserable, and he used to live in the extreme conditions. Due to the poverty and poor conditions of his family, he has become addicted to substance abuse and sniffs petrol to alleviate his boredom and physical hunger. He wants to learn guitar and his brother has the reggae band. However, his brother does not allow him to play his instrument. Hence, to amuse himself besides beating his physical hunger, Samson has become a substance addict and used to sniff petrol for his personal amusement and to overcome his miserable life due to the poverty and isolation. He finds petrol sniffing to be the way of coping his loneliness and boredom he has in his life. Samsons petrol sniffing addiction increases and worsens day by day due to which he is losing the touch with the real world (Gorman, 2009). Evaluation of the case: Samson is a petrol sniffer, and his addiction is increasing day by day as he wishes to overcome the harsh cruelty of his life. His psychosocial needs indicate that Samsons addiction to the petrol sniffing is to overcome his physical hunger and boredom as he belongs to the poor family and lives in an isolated community with his brother. His brother is not supporting in nature and devoid of having family relations due to the absence of family, Samson is found to be involved in the addiction. Moreover, the use of illicit substances, alcohol, as well as, tobacco is found to be the cau se, as well as, effect of the great suffering seen among the Indigenous people. The statistics have shown that about 28 % of the Indigenous people are found to be more involved in the substance and drug abuse as compared to the other Non-Indigenous people. The isolation of the Indigenous people from the white community and the sufferings they have faced has led to the use of illicit drugs. The inequality and the lower standards of living of the Indigenous people like lack of education, healthy housing, proper sanitation, food resources, as well as, unemployment are the factors that have inclined the client to the addiction (Gorman, 2009). Substance abuse model for the client: Depending upon the condition and level of addiction in Samson, the abstinence-based addiction counseling is chosen to treat the addiction of the client. Through counseling, as well as, through continued support, the client will be recovered from the addiction as long as the client maintains the abstinence from the petrol sniffing for a lifelong term (Laudet Stanick, 2010). The main and foremost goal of this substance abuse model is to help Samson achieve, as well as, to maintain the abstinence from the petrol sniffing and other addictive behaviors and chemicals. The secondary goal of this treatment model is to help him recover all the damage and negative impacts the client had faced due to the addiction (Dawson, 2000). Rationale: The abstinence-based addiction counseling will work initially by making the client understand the problem and by motivating him to recognize the occurrence of his problem, as well as, the related irrational thinking with this problem. Next, the patient will be encouraged and motivated to achieve, as well as, maintain the abstinence from the petrol sniffing. Moreover, through this counseling model of substance abuse, we will develop the required and important psychosocial skills, as well as, the spiritual development that will be helpful to the client to continue his abstinence from the substance in the lifelong process of recovery. This approach will actively lead to the formation of the strong and healthy therapeutic alliance among the client (Dodge, Sindelar, Sinha, 2005). Interventions: As Samsons addiction is worsening day by day, therefore, I will follow the Abstinence-focused addiction counseling method for treating his addiction problem. The abstinence treatment model of substance abuse will initially be focused on the diagnosis mainly on the comprehensive evaluation of the client, which recognizes and determines that addiction is the biological, social, as well as, a psychological disease. Hence, the initial and foremost phase of this model of treatment of substance abuse will require the process of detoxification that will be medically supervised. Moreover, the comorbid diseases and health issues that can be associated with the petrol sniffing, as well as, dual diagnosis of the diseases like bipolar disorder, depression, hyperactivity disorder, or attention deficit disorder will also be diagnosed, as well as, treated whatever the case may be (Chi, Sterling, Campbell, Weisner, 2013). The treatment for the substance abuse will involve the use of cultural interventions, individual cognitive based behavioral therapies, group therapies, partner therapy, as well as, the relapse prevention measures and therapy. The use of cultural interventions has found to offer the promise and hope of recovery from various kinds of addictions and substance abuse for Indigenous people. From the use of various sweat lodges to the implementation of traditional teachings, the regionally based interventions will be practiced. The use of cultural elders that will help the client to assume their traditional role and will be a constant reminder to him about his native cultural and traditional norms will be followed. Art therapy that will include traditional teachings and social culture programs will also be followed. Psycho-therapeutic practices involving spiritual and cultural domains will help the client to identify his tradition and culture (Rowan et al., 2014). Besides giving traditional teachings, will work in collaboration with the supporting te ams like Uniting Church that works for the upliftment of indigenous people and acknowledges their rights. Uniting Church is the community service provider and provide various scholarships for training and education, employments, and work for the benefit of Indigenous People (Cardelus, Lowman, Eshete, 2012). Hence, this will help the client to overcome the social determinants of his life that have forced him towards addiction. Moreover, the client will be enrolled in the petrol sniffing prevention program where the client will participate in the volatile substance rehabilitation program, will be re-engaged in various cultural activities like hunting, visit to sacred places, fishing, as well as, learning the stories. Moreover, there will be implementation of various education and communication strategies, activities for strengthening and supporting the Indegenous people community, and evaluation of the progress of the client (Bryce, Rowse, Scrimgeour, 2010). Moreover, the use of cog nitive behavioral therapy, acceptance and commitment therapy, and narrative therapy. Client Outcomes: The outcome of this treatment model will be positive for the client as it focuses on the underlying reasons responsible for the addiction of the client to the substance abuse. Moreover, this model helps in overcoming and dealing with the medical, religious, as well as, the psychological components. This treatment plan also includes the after treatment programs that motivate and encourages the patient to continue his abstinence to the substance abuse. The total abstinence is the main motto of this program. The use of the cognitive behavioral therapy will help the client to understand the link between his addictive behavior and his surroundings and environment. Moreover, this therapy will help him to analyze his feelings that insist him to petrol sniffing and will provide ways to overcome these kind of feelings and situation (Moyers Houck, 2011). The use of the acceptance and commitm ent therapy will help the client overcome psychological disorders. It is a mindfulness therapy and will aim to help the client learn, as well as, grow as a result of his sufferings. Moreover, this therapy will help the client to develop the detached relationship to his thoughts and feelings. While, the narrative therapy will help the client to re-map his future by heading in a positive and a sober direction. This therapy will highlight the positive past experiences of the client that will motivate him and will become the building blocks for his successful future (Marsh, Dale, Willis, 2007). However, during the process of this treatment of substance abuse, the client will face various difficulties and challenges as it will be very difficult for him to refrain himself from petrol sniffing suddenly. Due to this, the client may be unwilling or unable to remain adhered to the treatment program. Frequent dropouts, as well as, withdrawal symptoms can also occur as a result of this. Moreov er, lapses can often occur during the early period of this treatment plan. Hence, motivational, as well as, supporting services are very much required and important for the clients adherence to the treatment program (Galanter, 2007).Ethical issues likely to arise in this case: The ethical issues related to the clients confidentiality, cultural background, and societal status are likely to arise in this case. Respect of the client in respect of his cultural background and social status is very important. As the client belongs to the poor economical status and to the Aboriginal community, it is likely that his counseling process is being affected by these parameters. However, this behavior is beyond the ethical norms and is the breach of the code of ethics, which states that the person should be treated and counseled irrespective of his caste, creed, color, and background (Scott, 2000). Moreover, as this treatment and counseling process is solely focused on abstinence process, it may work against the will of the client at certain times due to the clients desire of drug addiction and in the case of relapse. Other ethical issues that may arise in this case can be negligence or improper counseling and treatment method for the substance abuse of the client due to the inability of his to pay for the process. As the client is poor and inefficient in paying for the counseling process and providing any other kind of financial support, it is likely to happen that these parameters might affect the whole counseling process (Bretteville-Jensen, 2006). The confidentiality, equality, and autonomy are the few ethical concerns likely to arise in this case. Conclusion The abstinence model involves the comprehensive, as well as, the multi-disciplinary approach focusing on the treatment of various kind of addictions that is abstinence-related. Various kinds of elements, as well as, methods that are widely related with the foremost treatment method while following this model involves individual therapies, group therapies, motivational and encouraging lectures, multi-disciplinary staff, recovering individuals as counselors, a therapeutic milieu, family counseling, various therapeutic oriented work assignments, utilization of the Twelve Step program, family counseling, daily evaluation of the clients progress, attendance of the client at AA meetings, as well as, provision of various opportunities to the client for recreational and physical activity (Notley, Blyth, Maskrey, Pinto, Holland, 2014). Even after the completion of the treatment plan, the clients are encouraged to participate and involve in the meetings and after care programs. This model has the main focus on identifying the chemical dependency to be the main problem. This model is neither punitive nor blaming, and it emphasizes on seeking the treatment to be the best and appropriate response to the chemical dependency problem. Hence, this method besides helping in achieving the abstinence from the substance abuse also provides the measures favoring the continuity of this abstinence for a life long term (Reichel Bevins, 2009). References Future challenges for heroin and other opioid substitution treatment. (2008). Addiction, 103(6), 967-968. Blanken, P., Hendriks, V., van Ree, J., van den Brink, W. (2010). Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands.Addiction, 105(2), 300-308. Bretteville-Jensen, A. (2006). Unresolved Issues Associated With Current Economic Models of Substance Abuse. Substance Use Misuse, 41(4), 605-606. Bryce, S., Rowse, T., Scrimgeour, D. (2010). Evaluating the petrol-sniffing prevention programs of the Healthy Aboriginal Life Team (HALT). Australian Journal Of Public Health, 16(4), 387-396. Cardelus, C., Lowman, M., Eshete, A. (2012). Uniting Church and Science for Conservation.Science, 335(6071), 915-917. Chi, F., Sterling, S., Campbell, C., Weisner, C. (2013). 12-Step Participation and Outcomes Over 7 Years Among Adolescent Substance Use Patients With and Without Psychiatric Comorbidity.Substance Abuse, 34(1), 33-4 2. CONNELL, P. (2006). Organization of the treatment and supervision of heroin addiction. Addiction,90(6), 843-845. Dawson, D. (2000). Alternative measures and models of hazardous consumption. Journal Of Substance Abuse, 12(1-2), 79-91. Dodge, R., Sindelar, J., Sinha, R. (2005). The role of depression symptoms in predicting drug abstinence in outpatient substance abuse treatment. Journal Of Substance Abuse Treatment, 28(2), 189-196. Galanter, M. (2007). Spirituality and recovery in 12-step programs: An empirical model. Journal Of Substance Abuse Treatment, 33(3), 265-272. Gorman, S. (2009). Review of Samson and Delilah. History Australia, 6(3), 81.1-81.2. Khalsa, J., Treisman, G., McCance-Katz, E., Tedaldi, E. (2008). Medical Consequences of Drug Abuse and Co-Occurring Infections: Research at the National Institute on Drug Abuse. Substance Abuse, 29(3), 5-16. Kumpfer, K. (2002). Prevention of alcohol and drug abuse: What works?. Substance Abuse, 23(sup1), 23-45. Lammertink, M., Lh rer, F., Kaiser, R., Hambrecht, M., Pukrop, R. (2008). Differences in substance abuse patterns: multiple drug abuse alone versus schizophrenia with multiple drug abuse. Acta Psychiatrica Scandinavica, 104(5), 361-366. Laudet, A. Stanick, V. (2010). Predictors of motivation for abstinence at the end of outpatient substance abuse treatment. Journal Of Substance Abuse Treatment, 38(4), 317-327. Maintenance Treatment of Heroin Addiction. Evidence at the Crossroads. (2004). Addiction, 99(10), 1360-1360. Marsh, A., Dale, A., Willis, L. (2007). A counsellor's guide to working with alcohol and drug users. Perth, W.A: Drug and Alcohol Office.Moyers, T. Houck, J. (2011). Combining Motivational Interviewing With Cognitive-Behavioral Treatments for Substance Abuse: Lessons From the COMBINE Research Project. Cognitive And Behavioral Practice, 18(1), 38-45. Notley, C., Blyth, A., Maskrey, V., Pinto, H., Holland, R. (2014). Exploring the Concepts of Abstinence and Recovery Through the Experie nces of Long-Term Opiate Substitution Clients.Substance Abuse, 36(2), 232-239. Reichel, C. Bevins, R. (2009). Forced Abstinence Model of Relapse to Study Pharmacological Treatments of Substance Use Disorder. Current Drug Abuse Reviewse, 2(2), 184-194. Rowan, M., Poole, N., Shea, B., Gone, J., Mykota, D., Farag, M. et al. (2014). Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study. Subst Abuse Treat Prev Policy, 9(1), 34. Scott, C. (2000). Ethical Issues in Addiction Counseling. Rehabilitation Counseling Bulletin, 43(4), 209-214. Shepard, P. (2002). Integrated medical and substance abuse treatment increases abstinence rates for people with substance abuse-related medical conditions. Evidence-Based Healthcare, 6(2), 51-52. Winters, K., Stinchfield, R., Latimer, W., Lee, S. (2007). Long-term outcome of substance-dependent youth following 12-step treatment. Journal Of Substance Abuse Treatment, 33(1), 61-69. Worley, M., Tate, S., McQuai d, J., Granholm, E., Brown, S. (2013). 12-Step Affiliation and Attendance Following Treatment for Comorbid Substance Dependence and Depression: A Latent Growth Curve Mediation Model. Substance Abuse, 34(1), 43-50.

Water Consumption Essays - Meat, Cleaning, Dishwasher,

List of actions you can take to reduce your water consumption: Home: 1. Take 7-minute showers 2. 2 laundry loads each week 3. 2 dishwasher loads per week 4. Transportation and Energy: 5. Turn off lights while not in a room 6. Unplug electronics while not in use Diet: 1. Eat 2 servings of beef per week 2. Eat 1 serving or less of pork each week 3. 1 cup of milk per day Stuff: 1. Purchase less clothing each year 2. Buy half the home supplies purchased each year 3. Re-use paper (use the back of paper)

Women in Ancient Greek Marriages

Women in Ancient Greek Marriages The Greeks thought that Cecrops- one of the early kings of Athens who wasnt entirely human- was responsible for civilizing mankind and establishing monogamous marriage. Men were still free to establish relationships with courtesans and prostitutes, but with the institution of matrimony, lines of heredity could be traced, and marriage established who was in charge of the woman. Marriage Partners Since citizenship was passed through to ones offspring, there were limits on whom a citizen might marry. With the enactment of Pericles citizenship laws, resident aliens- or metics- were suddenly taboo. As in the Oedipus story, mothers were taboo, as were full sisters, but uncles might marry nieces and brothers could mary their half-sisters primarily in order to keep property in the family. Types of Marriage There were two basic types of marriage that provided legitimate offspring. In one, the male legal guardian (kurios) who had charge of the woman arranged her marriage partner. This type of marriage is called enguesis betrothal. If a woman was an heiress without a kurios, she was called an epikleros and might be (re-)married by the marriage form known as epidikasia. Marital Obligations of the Greek Heiress It was unusual for a woman to own property, so the marriage of an epikleros was to the next closest available male in the family, who thereby gained control of the property. If the woman were not an heiress, the archon would find a close male relative to marry her and become her kurios. Women married in this way produced sons who were legal heirs to their fathers property. The dowry was an important provision for the woman since she would not inherit her husbands property. It was established at the enguesis. The dowry would have to provide for the woman in case of either death or divorce, but it would be managed by her kurios. The Month for Marriage One of the months of the Athenian calendar was called Gamelion for the Greek word for wedding. It was in this winter month that most Athenian weddings took place. The ceremony was a complicated ceremony involving sacrifice and other rituals, including registration of the wife in the phratry of the husband. Greek Women's Living Quarters The wife lived in the gynaikonitis womens quarters where she overlooked the management of the home, tended to the educational needs of the young children, and of any daughters until marriage, cared for the sick, and made clothing.

Build and sustain an innovative work environment Assignment - 2

Build and sustain an innovative work environment - Assignment Example It offers a wide selection of cutting-edge technology tablet pc’s, smartphones and related services such as application configuration, networking, software updates and training on the best use of the devices. Located in Serres Macedonia, the business strives to meet the global challenge posed by stiff competition and attain its goal of serving over 20 million clients annually through effective marketing by 2016. Smart Spot is well acquainted with the sheer fact that it operates in a market characterized by hasty change and an incessant quest for effective and efficient services and perceives innovation as the only way of meeting the customers demand and maintain its market share. In its innovation process, the organization embraces the broadmindedness and creates a space where trust can happen and risks taken in the innovation process. In generation of ideas, the owner, George Papadopoulos and the shareholders ensure that all parties are comprehensively involved thus helping the business to develop best services and products that meet customer needs, tastes and preferences (Innovation and Business Industry Skills Council, 2010). Through daily interaction with George Papadopoulos, it was evident that customers experienced delays when they made orders. The stakeholder ostensibly blamed it on the inefficient operation of the attendants and kept on complaining about a practice that was costly both in terms of time and money. After the realization of this major setback, we resulted to introduce vending machines in some sections of the stall. Apparently, the lead time was maintained but the waiting time was reduced by 50% and 87% of clients expressed satisfaction with the new service delivery method. My intention to reduce the wait time by 60% was already surpassed and now just needed to make thorough and methodical consultation with George Papadopoulos and systems engineers within the research and

Advaced Business Structures Essay Example | Topics and Well Written Essays - 2000 words

Advaced Business Structures - Essay Example Most cities and many countries require businesses - even tiny home-based sole proprietorships to register with them and pay at least a minimum tax. And if you do business under a name different from your own, such as a custom coding, you usually must register that name - known as a "fictitious business name" with your country.1. Cheap Setup Cost - There are no legal complications in setting up a sole proprietorship. There are no minimum or maximum limits for capital thus even qualifying small business units with less capital as a Sole Proprietorship. The business is flexible in its operations as it can engage in any other operations without any restrictions as it may be in the case of Limited Companies.2. Reduced Operating Costs - Sole proprietorships are easy to setup and to maintain. Much of the running of the business is done by the owner, saving on labour costs as there is no requirement to hire professional help.3. Avoidance of Corporation Tax - At the time of paying income tax, a sole proprietor simply reports all business income or losses on his or her individual income tax return. The business itself is not taxed. Sole proprietor is not required to pay Corporation Tax because it is not a separate legal entity from its owner, so the business will not be taxed separately.... For instance, if you're engaged in a low-risk enterprise such as freelance editing, landscaping or running a small band that plays weddings and social evens, your risks of facing massive debt or a huge lawsuit is pretty small. 5. Subject to Governmental Regulations - As stated above, there is no regulation on minimum or maximum capital, the sole proprietorship is not required to file its accounts with the registrar of companies, there is no need to produce memorandum or article of association. There is also no compulsary audit as it is the case with Limited Companies. Disadvantages of Sole Proprietorship 1. Failure to raise funds - Many financial institutions consider sole proprietorship as risky ventures and are not willing to extend finance to these entities. Sole proprietor may not be able to raise capital on his own unlike in partnership where they are able to share the financial burden of raising funds. 2. The Proprietor has unlimited liability - The liability of the sole proprietorship is bound to the proprietor since this type of business is one with its owner. Therefore the liability of the business is ultimately the liability of the proprietor. Since there is no law binding the owner regarding limited liability, this can prove to be fateful if the owner takes a huge loan and cannot repay. 3. Lack of Business Skills - The proprietor does not avail the services of any professional, hence conducting the day-to-day business on his own. In many businesses, the lack of the proprietor's experience would be detrimental to the health of the business unlike a Public Limited Company, where professionals are hired to conduct the day-to-day business. Partnerships

A job application letter, a resume,a cover letter Assignment

A job application letter, a resume,a cover letter - Assignment Example nal potentials; housing facility is not available, the duty hours are 40 hours of work per week, and possible overtime may be required depending upon need basis and there is no drug test required for the job; however the government would have a background check. Occasional travel may be required for training purposes. According to the job description the candidate has to perform several duties; these duties include to asses patient care need and to adjust the staff appointments accordingly, to assess the opportunities of improvement, serves on committee and to review and revise nursing policies, must participate in problem solving, develop plans for the care of patients, formulate nursing intervention based on their identification of the diagnosis, consult with healthcare professional on patients to coordinate the diagnosis, must be able to promote harmonious environment, initiates treatments and mediations based on appropriate utilization of standing orders, must be able to operate specialized equipments, maintains professional knowledge through continuing education and must be able to perform other related duties assigned. I believe learning and expanding my learning to the world around. I believe in helping humans and ensuring that I do something creative with my life so that I can be able to serve mankind and the environment around. Life is about giving and I want to get so that I can give. I am writing to you with respect to your job announcement titled â€Å"Clinical Nurse† at PHS Indian Health Hospital in Pipe Ridge, South Dakota, USA. I have been working as a Nurse with USA Memorial Hospital for the past 8 years and over the 8 years I have been awarded 3 times as the best nurse award. I believe in providing the best of services, I am very caring towards human nature and the only reason I opted for a nursing degree and occupation is I want to serve the mankind; I want to give them a source of comfort and a piece of mind. In order to achieve my goal I have

Effect of Social Media on Political Participation

Effect of Social Media on Political Participation Has social media led to substantial changes in citizens’ repertoires of political participation? In the past few decades, an upsurge in the use of social networking sites (SNS) has been witnessed (Bode et al., 2014). Ever since the emergence of social media, the deliberation of how and to what extent they altered the way people engaged in politics has been ardently discussed. To understand this question, one should first examine it in two directions, the definition of social media and political participation, before moving on to the discussion of whether or not there are changes over time. Undoubtedly, any authority would be ill-advised to underestimate the power of the internet. If using the internet and sending text messages can modify the foreground of a nation and overturn ingrained authoritarianisms; if they have the ability to change the fortune of an unknown man into an overnight star; if they have magic for fixing the ‘illness’ of the society by pressuring governments, is it possible for anyone to resist using these types of media to achieve their goals? It is an undeniable fact that the current society is a world where all kinds of social media are almost inevitable. Since the launch of social media over 10 years ago, one can fairly address that there have been some enormous changes in people’s everyday lives. According to Jeroen Van Laer and Peter Van Aelst, â€Å"A notable feature of recent public engagements with the internet is its use by a wide range of activists and groups engaging in social and political protest† (Aelst et al., 2010). Tufekci and Wilson (2012) provided an example of this statement. They noted that, â€Å"Since the ‘‘Arab Spring’’ burst forth in uprisings in Tunisia and in Egypt in early 2011, scholars have sought to understand how the Internet and social media contribute to political change in authoritarian regimes† (Tufekci et al, 2012). The two mentioned assertions of each scholar have shed some light on the influence of the internet. This essay will deal with the following aspects of the question of whether or not social media reforms the means of civic participation in politics, a) what is political participation; b) what is the role of social media in the sense of taking part in the policy-making procedure. Finally, the essay will be concluded by the outcome of the discussion in question. To begin with, the definition that was given by Boyle and other scholars in ‘Expressive responses to news stories about extremist groups: A framing experiment’, they proposed that the term ‘‘expressive action’’ included talking to friends and family about politics, sending letters to the editor, contacting public officials and attending rallies (Boyle et al., 2006). However, as Rojas, H. and Puigà ¢Ã¢â€š ¬Ã‚ ià ¢Ã¢â€š ¬Ã‚ Abril, E mentioned in their journal (2009), â€Å"Verba et al. (1995) narrowly define political participation as ‘an activity that has the intent or effect of influencing government action–either directly by affecting the making or implementation of public policy or indirectly by influencing the selection of people who make those policies’ (Rojas et al., 2009). Either way, one thing is clear, political participation is a set of activities to affect who decides or decision itself in any possible way. In ‘Mobilizers mobilized: Information, expression, mobilization and participation in the digital age’, a number of hypotheses were suggested by Rojas, H., and Puig-Abril. These hypotheses embodied a model explaining the cycle of the interactions between Information and Communication Technologies (ICTs) as Figure 1 they proposed below. As the result of their study, assumptions of informational uses of ICT resulting expending expressive behaviours in the online sphere are sturdily supported. Furthermore, the relative significance of blogs as a source of information that accelerates such expressive behaviours is also suggested in this study. Nevertheless, one interesting result was noted that there is no support for a direct relationship between online expressive behaviours and offline participatory behaviours. This implies that online political activists may not be as enthusiastic as they are online when it comes to taking part in the policy-making procedure offline (Rojas et al., 2009). Political participation on social media is referred to as ‘political SNS use’ by Bode (2014). The definition of ‘political SNS use’ is using SNS for political intentions, for example, displaying a political preference on one’s profile page or becoming a ‘fan’ of a politician (Bode et al, 2014). However, another argument suggested that while one is studying ‘political SNS use’, the disadvantages that it presented should not be overlooked. One example of this is addressed in one of Clair Cain Miller’s articles of The New York Times. Miller stated that due to the convenience that the internet provides, it is useful for promoting events, such as the Arab Spring to the Ice Bucket Challenge. However, people might be reluctant to express themselves because of the urge for obtaining recognition (Miller, 2014). With the exact reason, people tend to interpret the various signals in social media, as liked or hated. As these signa ls become clearer, the reluctance of people to express their views online increases; hence, the differentiation between the different positions will turn into a more serious situation and those who share the same or similar points of view will be even more unified (Miller, 2014). Citing from Bode’s journal, â€Å"although social networking sites were not originally conceived of as political tools, politicians have quickly adapted to use them as such (Bode et al, 2014). The internet has given civil society new tools to support their claims. In the recent years catchphrases, such as, ‘‘Twitter Revolution’’ or ‘‘Facebook Revolution’’ have been high-lighted (Tufekci et al, 2012). However, one should keep in mind that social media alone did not cause the revolutions and demonstrations (Joseph, 2012). In the case study of the Arab Spring, it was the urgent need of four things; namely, justice(Adala), freedom (Hurriya), dignity (Karama), and respect (Ihtiram) which pushed the citizens participating in those protests, and social media merely played the role of supporting the combustion by providing the platform for exchanging and spreading the information. Due to the falling costs and expanding capabilities of mobile phones, the traditional communications have been enriched with capacities of taking pictures and videos. Within the past decade, communities in which it had long been difficult to access information were converted into massive social experiments fuelled by an explosion in channels of information (Aelst et al., 2010). The evolution of new communication technologies brought new forms of political communications. In Jeroen Van Laer and Peter Van Aelst’s journal, they categorised 4 new forms of political communication; namely, a) Internet-supported action with low thresholds. In this category, donation of money, consumer behaviours, and legal protests and demonstrations are involved. It is believed that donating money is the most primary way to engage in a social movement that involves almost no risks or commitments (Aelst et al., 2010). b) Internet-supported action with high threshold, which means transnational demonstrations, transnational meetings, and Sit-in / occupations and more radical forms of protest. One case study of this section is the Harvard Progressive Student Labour Movement at Harvard College. The incident was for demanding higher living wages for the institution’s security guards, janitors and dining-room workers. This movement was initiated with the occupation of several university administrative offices in 2001. Eventually, the ‘real-life ’sit-in at Harvard College was accompanied with a ‘virtual sit-in’ in order to increase media attention and to broaden the pressure on administration officials (Constanza-Chock 2003;Biddix Park 2008). c) Internet-based action with low threshold. This includes actions that are solely performed online: online petitions, email bombs and virtual sit-ins. Any Face book user can generate a group to protest or support a specific cause and invite other members to ‘sign’ this cause by taking part in this group. d) Internet-based action with high threshold. This involves Protest websites, Alternative media sites, Culture jamming, and Hacktivism. The definition of culture jamming was coined by Stolle and other researchers, â€Å"changes the meaning of corporate advertising through artistic techniques that alter corporate logos visually and by giving marketing slogans new meaning (Stolle et al., 2005). These ‘attacks’ are all blurring the line between what is legal and what is not. These tactics are then labelled as ‘electronic civil disobedience’, ‘hacktivism’ or as ‘cyber terrorism’, and depends on the point of view (Denning 2001; Vegh 2003). Using and managing social media as a participatory tool is not the same thing. The real challenge is how to utilize social media to properly take part in the decision-making process. It is indeed that the world needs diverse voices and with the help of social media, everyone is granted the power to ‘have a say.’ Social media did not merely become a tool in hands for those who actively want to have a say, they also bind the communities which were not asked to take actions previously. However, one should bear in mind that ‘saying what’ is the most crucial part of participating in politics. The results from Bode’s study are compelling,†-political SNS use is not a dead-end, but instead provides an impetus for greater political participation (Bode et al, 2014). Perhaps it is worth acknowledging here that social media have indeed changed the citizens’ repertoires of political participation. The evidence is compelling, although there are some op posed arguments. The development of ‘political SNS use’ is promising and is a study worthy for future research. Bibliography Biddix, J. P. Park, H. W. (2008) ‘Online networks of student protest: the case of the living wage campaign’, New Media Society, vol. 10, no. 6, pp. 871–891. Bode, L., Vraga, E. K., Borah, P., Shah, D. V. (2014). A New Space for Political Behavior: Political Social Networking and its Democratic Consequences.Journal of Computer-Mediated Communication, 19(3), 414-429. doi: 10.1111/jcc4.12048 Boyle, M. P., Schmierbach, M., Armstrong, C. L., Cho, J., McCluskey, M. R., McLeod, D. M., et al. (2006). Expressive responses to news stories about extremist groups: A framing experiment. Journal of Communication, 56, 271–288. Constanza-Chock, S. (2003) ‘Mapping the repertoire of electronic contention’, in Representing Resistance: Media, Civil Disobedience and the Global Justice Movement, eds A. Opel Pompper D. Praeger, London, pp. 173–191. Denning, D. E. (2001) ‘Activism, hacktivism, and cyberterrorism: the internet as a tool for influencing foreign policy’, in Networks and Netwars: The Future of Terror, Crime, and Militancy, eds J. Arquilla D. Ronfeldt, RAND Corporation, Santa Monica, CA, pp. 239–288. Joseph, S. 2012. ‘Social Media, Political Change and Human Right’, Boston College International Comparative Law Review. Laer, J. V. Aelst, P. V., (2009) INTERNET AND SOCIAL MOVEMENTACTION REPERTOIRES.Information, Communication Society,13(8). Available at: http://www.academia.edu/262038/Internet_and_Social_Movement_Action_Repertoires_Opportunities_and_Limitations> [Accessed: February 19, 2015]. Miller, C. C., 2014. How Social Media Silences Debate.The New York Times, [Online]. 0, 0. Available at: http://www.nytimes.com/2014/08/27/upshot/how-social-media-silences-debate.html?abt=0002abg=1 Rojas, H., Puigà ¢Ã¢â€š ¬Ã‚ ià ¢Ã¢â€š ¬Ã‚ Abril, E. (2009).Mobilizers mobilized: Information, expression, mobilization and participation in the digital age.Journal of Computerà ¢Ã¢â€š ¬Ã‚ Mediated Communication, 14(4), 902-927. doi: 10.1111/j.1083-6101.2009.01475.x Stolle, D., Hooghe, M. Micheletti, M. (2005) ‘Politics in the supermarket: political consumerism as a form of political participation’, International PoliticalScience Review, vol. 26, no. 3, pp. 245–269. Tufekci, Z. Wilson, C., 2012. Social Media and the Decision to Participate in Political Protest: Observations From Tahrir Square. Journal of Communication. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1460-2466.2012.01629.x/pdf> [Accessed: February 19, 2015]. Vegh, S. (2003) ‘Classifying forms of online activism: the case of cyberprotests against the World Bank’, in Cyberactivism. Online Activism in Theory and Practice, eds M. McCaughey M. D. Ayers, Routledge, New York, London, pp. 71–95. Verba, S., Schlozman, K. L., Brady, H. E. (1995). Voice and equality: Civic volunteerism in American politics. Cambridge: Harvard University Press

The Christain Theme of Tolstoys The Death of Ivan Ilyich Essay

The Christain Theme of  Tolstoy's The Death of Ivan Ilyich   Ã‚  Ã‚  Ã‚  Ã‚   Tolstoy's The Death of Ivan Ilyich attacks the pursuit of material possessions.   The Ilyich family bases itself upon the unsure foundation of wealth.   As Ivan ascends the rungs of the corporate ladder, he acquires new possessions and articles.   After joining the Civil Service, Ivan buys "new fashionable belongings" at the "very best shops" to keep up appearances (100).   For his wedding to Fiorodovna, Ivan buys "new furniture, new crockery, new linen[s]" to be proper or comme il faut.   He tries in vain to keep up "appearances as ordained by public opinion" (116).   None of these niceties are needed: Ivan buys them purely for the pleasure of owning them and in attempt to fit in with those of his class.   He succeeds instead... ...erings" that Ivan's illness put her through.   In the end, Ivan has nothing to solace him during his slow expiration.   What Tolstoy points out in The Death of Ivan Ilyich is a purely Christain theme:   do not place your foundation upon material things, but upon those things which transcend all time. Work Cited Tolstoy, Leo. The Death of Ivan Ilyich. Bantam Classic ed. New York: Bantam, 1991.

Animal Farm Essay

Animal Farm by George Orwell is an allegory written in 1943. It was also made into a TV film version in 1999 directed by John Stephenson, produced by Greg Smith and Robert Halmi and distributed by Hallmark Films. Animal Farm is a deceitfully simple story about a group of farm animals who are tired of living in a dystopia caused by humans. They rebel and create their own way of life, only to find themselves back in a dystopia caused by animals. The film follows the plot line of the novel closely but changes some major details. While the film and the novel Animal Farm are basically one in the same and have similar plot lines, the film had less detail, while the novel was thoroughly detailed. The differences between the film and the novel were points of view, exposition and major plots. Orwell tells the story of Animal Farm through a third person, omniscient point of view. The narrator is never involved in the action of the story, but knows everything. This point of view allows readers to see into the minds of the characters and understand their motivations. The film is told by a narrator, a character in the novel, Jessie. It explains the film in a way that she sees everything occurring. It also stops most of the dialogue between the animals and they don’t really talk like they do in the novel. Another difference between the novel and film is the exposition, which gives background information on the plot. In the novel, some of the events that occur in Animal Farm’s exposition play important roles later on in the novel. In the novels exposition, Orwell describes many of the animals that are important to the novel. In the films exposition, very little time is spent on developing the characters of the important animals. Also, the song Beasts of England is not sung in the exposition, unlike the novel, this song plays a very pivotal role later on in the novel. In the film, they don’t know the characters very well and the animals don’t really sing it, they hum it. This takes away from the mood of the song. The movie is merely an adaptation of the novel into film, so almost all the events that take place in the novel will take place in the film. Another difference between the novel and film is the major plot differences. The novel and film follow the same plot line but there are some major differences. In the novel, Old Major died about 3 days after his speech from natural causes. While in the film, Mr. Jones shoots Old Major minutes after his speech, while they’re reciting the Beasts of England song. In the novel, all of the animals could speak while in the film it was arrated by Jessie which cut the dialogue of most of the animals. The end of the film and novel differ greatly. In the novel, the animals are sadly dominated by Napolean. But in the film they somehow overthrow his power and finally bond together for another attempt at a utopia. The film covered major ideas but missed some details, characters, and small stuff that made the novel so interesting. It’s quite apparent that there are many significant differences between Animal Farm the novel and the film. There are a number of differences between the use of point of view, the exposition, and the major plots. Animal Farm is a simple story about a group of farm animals who overthrew their human dictators and their animal counterpart who dictated them also. The novel was very detailed and had many characters which made it very interesting. While the film had less details, and characters which made it a little dull, and boring. These are my comparisons of the film and novel called Animal Farm.

Summarise discussions on the main challenges and consequent changes in policy and ideology over 60 years of the NHS. The WritePass Journal

Summarise discussions on the main challenges and consequent changes in policy and ideology over 60 years of the NHS. Introduction Summarise discussions on the main challenges and consequent changes in policy and ideology over 60 years of the NHS. IntroductionScenario 4: Health Trainers.Scenario 5: Sure Start. ReferencesRelated Introduction In the 1940s new legislation aimed to remove Beveridge’s five ‘giant evils’ of Want, Disease, Idleness, Ignorance and Squalor (NICE 2010). This was due to a shift in political ideology from the individualistic to the collective because the Labour government at this time believed in ‘democratic socialism’ partly as a result of societal change due to the Second World War. Another key example of this shift was the NHS which was established by Aneurin Bevan in 1948. The NHS had three key principles of the service being free at the point of delivery, being comprehensive in covering all individuals in Britain and that access would be based on need (NHS 2009). In 1951 Labour pioneered the dental and eye service charge and prescription charges were only just avoided. However the Conservatives increased dental and eye charges and also introduced the prescription charge in 1952 which had two increases in 1956 and in 1961 which was the biggest policy change in the financing of the NHS (Webster, 1998:39). This shifted the political ideology away from collectivism because prescription charges meant that health care was no longer free for all. Thatcherism was another shift away from collectivism as the government needed to meet the challenge of saving money due to a global recession and the NHS’s budget was a major use of resources. According to Taylor-Gooby (1988:2), In the early and mid-1980s existing social divisions deepened: provision aimed specifically at poor minorities was tightly constrained, whereas services used by the mass of the population were little affected by spending cut-backs. This was linked to the new policy where managers of NHS Trusts were given limited budgets and had to ensure that they remained within them which meant that some services had to be cut in order to ensure that they could balance the books at the end of the financial year (Walsh et al., 2000). This was a clear of example of health and social care managers needing to interpret government legislation and policies in order to ensure that they could meet targets needed to gain funding for the next financial year. This was carried out through the use of internal markets which were created by Thatcher’s government in order to streamline the NHS’s use of services and ensure that prices were competitive. The next challenge to the NHS was New Labour’s election in 1997. According to Driver and Martell (1998) this led to a post-Thatcherite shift in political and social ideology where collectivism and the Welfare State began to be rebuilt. Their approach was to offer a diverse range of services, because of the wide diversity in individuals living in modern Britain. Who now had a longer life expectancy and to promote freedom of choice, with an emphasis placed on meeting the needs of their service users which was similar to the original NHS mandate (Driver and Martell, 1998). For example, in 2002, Primary Care Trusts (PCTs) were created to improve administration and delivery of healthcare services at the local level (NHS Choices, 2008). According to NHS Choices (2008), PCTs control over eighty percent of the budget and contract out services but that because they are local they can best understand the needs of their community. PCTs moved away from Thatcherite management which had led to too many priorities being set, challenging the NHS’s ability to provide a healthcare service (West, 1997). PCTS were created with a â€Å"single management structure†, which meant that budgets and equipment was shared to provide an integrated service without wasting money, for the reason being that management was no longer spread among multiple people (Clouston, 2005:9). Social policy and political ideology is once again challenging the NHS from 2010, as another global recession has led to the need to cut public services. This also shows a shift back towards the individualistic ideology of Thatcher. The White Paper Liberating the NHS (2011:3) aims to â€Å"putting patients at the heart of the NHS, focusing on improving outcomes† and â€Å"empowering local organisations and professionals†. This will be done by giving managerial power to GPs and those who are in direct contact with patients on a local level, which is similar to Blair’s plans although there will be a Central Commissioning Board in charge of ensuring financial targets are met. However, health inequalities revealed in the Black Report (1980), the Acheson Report (1998) and the Marmot Report (2010) show that the NHS is still being challenged by Beveridge’s giants today. Scenario 4: Health Trainers. Choosing Health (2004) was put in place to help tackle health inequalities and to improve health by providing a new service that could help individuals to achieve a healthier lifestyle. The latest Department of Health (DoH) White Paper, Our Health, Our Care, Our Say (2006) mentioned the health trainers in the latest NHS ‘Life Checks’ and that the service’s ethos was to provide ‘support from next door’ (DoH, 2006:236). This new service brought in individuals who had experience in health inequalities and were from the local community (DoH, 2006).   However Marmot (2009) states that inequalities exist because of â€Å"social inequalities in society, not simply because of inequalities in healthcare†, and that the solutions to those inequalities should reflect their causes and covers the â€Å"social, economic, cultural and political† (DoH, 2009:2).    A General Practitioner (GP) can encourage individuals that would seem unlikely to take part in any other health support schemes, to engage in this service as health trainers support individuals in Healthy Eating and Physical Activity, Diet Weight Loss, Drugs Alcohol, Sexual Health, Smoking Cessation, Smoking during pregnancy, Mental Health, Depression and Anxiety, Cancer Screening and Health Checks (DoH, 2004). Health trainers aim to inspire individuals in the community to change their lives which in return would help the individuals to have higher self-esteem, help them to become fitter and fulfil the primary objective- to lower costs for the NHS by reducing their burden on services due to an unhealthy lifestyle. The Yorkshire and the Humber Primary Care Trust (YHPCT) (2009) suggested that clients that used this service, 99% changed their lifestyle and improved their health by effectively helping them to control their existing conditions. This was mainly because they felt that the health trainers were local individuals, and could communicate with the community on their level, by empowering clients to think of solutions and helping them to maintain their choices (YHPCT, 2009). However in some cases individuals would be signposted to other organisations to help them with their lifestyle choices like Slimming World, where they would receive free vouchers every week, explaining how to access services where they would get extra help. This is just one of many ideas, which would also help with the equal allocation of health care equity. However the NHS geographical plan for health equity resource allocation is being denied with a wide range of variables in socio-demographic and socio-economic health care utilisation known as the postcode lottery (DoH, 2005b). Policies need to evolve each year for the health trainers otherwise this could have an impact on the programmes. Health trainers should also be put into place in all health centres at a national level, which would support all individuals with inequality in their communities. According to the DoH (2011), their vision is for the financial strain on the NHS to be significantly reduced by the distribution of health promotion funds. In 2005 there were twelve sites for health trainers with each allocated  £200,000 to empower clients to transform their health and the DoH suggested there will be funding nationally until 2011 (NHS 2009). This is a significant shift in direction of public health policy from treating ill-health towards prevention by reducing inequalities as focused on by The Black Report (1980), the Acheson Report (1998), the Darzi Review (2008) and the Marmot Report (2010). Prime Minister Tony Blair stated that individuals who want to improve their lifestyle have to make the decision themselves and that the government â€Å"cannot and should not pretend it can make the population healthy† but instead offer them the support necessary for them to do so (DoH, 2004:207). The health trainers program was a key tool for this strategy, although it took five years to put into practice and is still not present in all areas. As a result, Tony Blair said small changes can make a big difference to people’s lives this service is not yet available as â€Å"support from next door† to all individuals (DoH, 2004). Scenario 5: Sure Start. The Government has introduced detailed policies to tackle social determinants of health inequalities; which included the ten-year health inequalities targets and community-based initiatives including Health Action Zones, Sure Start and Healthy Towns. Health Action Zones (HAZs) were the New Labour government’s first important policy, using a multi-agency group to try to diminish health inequalities. Acheson stressed how important the quality of life is in a child’s early years. (Acheson et al 1998). The New Labour government suggested that they want to radically reduce child poverty by 2010 and eliminate it by 2020. However these targets were missed in 2004-5, furthermore they are not on target for 2010-2011(Parliamentary Business, 2009). The New Labour Government poured three billion pounds into Sure Start when it was introduced in 1998, to try to provide help to disadvantaged families in the fundamental early years of a childs life (Wilce, 2008). This would be done by trying to attain enhanced results for families and the community by increasing childcare, improving a childs health and emotional growth and also supporting the child’s parents and encouraging them to strive towards employment (ET, 2007). However this vision for helping deprived families was an optimistic one as the government said that out of the 14 outcomes measured that related to health and chil d development, Sure Start only impacted on five; there was no positive impact taking place within language development, accidents, father’s involvement, maternal Body Mass Index, maternal smoking or childrens immunisations (Parliament UK, 2009). In 2007 Education Today (ET) reported that Hull University conducted research about Sure Start which suggested that even though Sure Start was aimed at underprivileged areas, underprivileged and marginalised people were not gaining any benefits. The report also argued that Sure Start were generally taken up by middle-class families, and was not creating contact with minority groups such as travellers, vagrant workers and families of Bangladeshi origin and Sure Start was criticised for not employing any translators or staff from ethnic and minority communities (Bagley and Ackerley, 2006). There was also some apprehension over the deliverance and performance of a Third Way multi-agency programme (ET, 2007). It has been suggested that Sure Start has moved away from its first focal point on disadvantaged children and become a universal choice. Burkard (2010) argues that the government should fund disadvantaged children instead of the Sure Start centres, and that any nursery involvement that has money thrown into it, is more than unlikely to improve the life chances of children from deprived areas. The centres could be beneficial in other areas for mothers and children because children could have early gains in acquiring knowledge and social development, but they seem to almost immediately fade when children enter into full- time education (Burkard, 2010). New Labour tried to implement strategies to prevent health inequalities through the early years of a childs life with Sure Start, and national assessments have shown that Sure Start has been successful in some parts of eradicating health inequalities but only achieving five out of the fourteen assessments (Education Today, 2007). There needs to be a considerable amount of improvement when it comes to reaching minority groups and getting better health results for parents and their children. Furthermore, there are some fears that broadening this policy through children’s centres nationally would divert their main goal of helping reduce inequalities for the underprivileged families that need the support most. 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