Problem of the Drug Abuse Essay

The problem of teenagers drug abuse is not something that has sprung up in recent times. It has been one of the unsolved issues since many decades now. And with modernization, the problem seems as if it is never going to leave. There could be a myriad of causes of this problem, and there are also several types of complications associated with it. As you read further, you would realize the potency of the causes of drug abuse among teenagers. Causes of Drug Abuse Among Teenagers Prescription Drug Abuse Among Teenagers This has been found to be one of the most common causes of drug addiction, especially in the teens. The term ‘prescription drug abuse’, is plainly defined as a condition wherein, the prescribed medicine is not used in a way the doctor recommends the patient to. Meaning, the person takes higher doses of the drugs and even if his/her illness is cured. The drugs which are common in this cases include all types of pain killers, drugs for anxiety or sleep disorders, and drugs for triggering stimulant activities. It has been found that most teenagers use these prescription drugs with a thought that these are safer than using illicit drugs. Absence of Communication One of the potent causes of alcohol and drug abuse among teenagers is a space that creeps in communication, probably from the parents’ side. Most teens may have this notion that their parents might not care about them abusing the drugs. So this stresses on the importance of communication between parents and children. It is most likely that, knowing about the specific dangers and health concerns of drug abuse, would help teenagers to avoid the habit. So, work with your kids and look for some real information in the form of statistics and medical explanation about the side effects of drug abuse. Supervision Continuing this data on drug abuse among teenagers, it comes to parental supervision which can either save teenagers from getting into the grips of drug abuse or saving them from it. Parents must give importance to the fact that their children are still in their teens. This happens to be an age, where they stay the most vulnerable to get involved in all the undesirable things in their lives. Get involved in your kids’ life and let them know that you are interested in what they do and when they do. If you are one of those parents who just let their kids do whatever they please, then you may be providing your children with a fine opportunity to get exposed to drugs. It is most likely that your kids might not appreciate the fact that you are trying to interfere too much in their lives. However, it is also true that, if you do so, your kids would be the ones to thank you later in their lives, when they achieve a matured level of understanding about all the repercussion s of drug abuse. So don’t be too stringent about nor too aloof from your kids’ life. Easily Available The fact remains that teenagers get to learn most of the things from their parents. As a parent, if you are throwing a party where alcohol is served, then your kids would take it as a clear cue or message, that you have no objection to drinking alcohol. This is where, you stand to be the main offender for encouraging your kids to get vulnerable for drug abuse. Also, most parents unknowingly let their kids have access to alcohol, cigarettes, and even prescription medications, when they are not at home. Even in this way, teenagers may used this carelessness of their parents as an opportunity to at least try using all such stuffs. Stress Causing Factors Broken relationships, issues in the family, stress caused due to peer pressure, studies load, etc., are some of the common factors which trigger stress in teenagers’ life. These may also be the causes which drive them to resort to the use of drugs. So, these were some of the potent causes of drug abuse among teenagers. As far as the treatment is considered, if measures are taken at an early stage, then the condition may be well curbed before it gets worse any further. Otherwise, drug abuse rehabilitation is known to be an effective tool for the treatment. And talking about the drug abuse prevention, the most important job lies in the interest of parents. If they can reduce the opportunities their kids get themselves into, then there is no other better way to keep the condition at bay.

Blood Brothers Essay

â€Å"Blood Brothers† is a play about two twins who are separated at birth, they do not only have different parents but have a whole different lifestyle. Eddie lives in a world of luxury and has opportunities to go to university and eventually owning his own business which is more than Mickey could have ever dreamed of. On the other hand Mickey is brought up in a working class family with no qualifications whatsoever, as soon as Mickey thinks he has finally settled down with a job he then finds himself fired and starts turning to crime. Towards the end of the play the differences between Eddie and Mickey begin to show as friction is caused between them. They begin to turn against each other and Linda is stuck in the middle as she has feelings for both Eddie and Mickey, this is when the question is raised asking whether Linda and Eddie have been having an affair. This is then what sends Mickey off the rails and ends up being the cause of the Johnstone twin’s death as Mickey shot Eddie in a rage of anger over Linda. Tension is caused at the end of the play when Mrs Johnstone tells Mickey and Eddie that they are brothers as the audience already knew this they just wanted to know when and how this would be revealed to the twins. Willy Russell wrote Blood Brothers to show how life was in Liverpool in 1980s and how being in a different class separated people. He also refers to the recession and how so many people lost their jobs and the only way for them to earn a living was to turn to crime like Mickey did as he needed money to support Linda and his child, Sammy did not help the situation as he was the one who had persuaded Mickey to earn money in that way. The end of the story is revealed to the audience by the narrator at the very beginning of the play. This builds up tension because people know what is going to happen so they are waiting to find out how it happened and what led up to that scene. Another thing that adds tension to the play is how the narrator keeps on referring back to the devil â€Å"the devils got your number, y’know he’s gonna find y’. Y’know he’s right behind y.† Towards the end of the play the narrator says how close the devil is getting, the devil being the devil inside Mickey when he shoots Eddie down. Mrs Johnstone sings a song about the price that she has to pay â€Å"Living on the never, never, constant as the changing weather never sure who’s at the door or the price I’ll have to pay† This song says that Mrs Johnstone has a price to pay, this could mean that she has to give up her baby in return for the money that Mrs Lyons gave her but the audience know that the price that she will have to pay is the guilt that she will suffer and that both her twins die. The constant weather indicates her life has been up and down like it’s raining when she is sad and sunny when she is happy and that everything changes as fast as the weather. Secondly when she says that she is â€Å"living on the never, never, Constant as the changing weather never sure who’s at the door† this could refer to the people who came to knock on her door to take away her possessions and that living on the never, never could mean that she knows that nothing that she has will stay with her forever. Another thing that indicates this is that when she says â€Å"It’s alright lad †¦ we’re used to it we were in the middle id our tea one night when they came for that table.† This means that she has had her belonging possessed before and because of this she doesn’t really mind when it happens again because it has happened so many times before. Willy Russell has made the audience sympathize with Mrs Johnstone because she has been through a lot in her life. At the beginning of the play she tells us how she got to be in that position in that moment in time. Mrs Johnstone describes her marriage and says â€Å"that I was six weeks overdue† which makes the audience feel sorry for her. It also describes the place of marriage which was at the registry office. â€Å"We got married at the registry and had a do†. This suggests to us the audience that the wedding was nothing too fancy, not too expensive and that the marriage was sudden and unexpected. She got married because she was expecting a baby, in difficult, circumstances to get married in. Soon after the wedding Mrs Johnstone wanted to go out and enjoy herself like she had done before but her husband wouldn’t take her anywhere because he became very conscious of her appearance and felt embarrassed to be seen with her. This is evident due to the fact that sh e gained weight and now perceived herself to be â€Å"twice the size of Marilyn Monroe†. The audience feels sympathetic towards her because she has seven children and low self esteem. This is shown by the fact that she describes herself to look like she is forty two instead of twenty five. This shows the physical strain that Mrs. Johnston has gone through. I understand why she gave her baby away to Mrs Lyons because Mrs Lyons emotionally manipulated Mrs Johnston in this terrible time she is going through. Mrs Lyons attempts to make Mrs Johnstone think positively by saying that â€Å"if he’s with me you’ll still be able to see him each day as you come to work† Mrs Lyons presents Mrs Johnstone with the idea that her son would have a much better life with herself â€Å"if he grew up here as our son†¦ he could have everything†. However this is why she may have done this for the benefit of the baby because she felt that Mrs Lyons could provide for him much better than she ever could and she just wanted him to have a better life. The purpose of the narrator is to explain some of the key action on stage. The narrator also involves the audience by asking them directly, to judge what they see. He reveals that the brothers die at the very start of the play and from then on he constantly reminds the audience of the twin’s fate. He presents the themes of fate, destiny and superstition throughout the play, but at the end he asks the audience to consider if it was social class rather than fate that caused the tragedy. In the play the narrator constantly reminds Mrs Johnstone and Mrs Lyons about the devil â€Å"Y’know the devils got your number, y’know he’s gonna find y’, y’know he’s right behind y’, he’s starin through your windows and he’s creeping down the hall.† This makes the audience realise that when the narrator refers to the devil he means the devil that is going to cause the death of the twins at the end of the play this makes the audience anxious as to when this is all going to happen. In this play Mickey, Eddie, Linda, and Sammy play all sorts of games, I think that the games that they play influence them when they are older for example they play with pretend guns and Sammy says â€Å"It only fires caps. I’m gonna get a real gun soon, I’m gonna get an air gun† This later becomes true as Sammy does get a real gun which is then used to kill someone; both Mickey and Sammy were arrested for this. The arrest is also relevant as the children used to play cops and robbers. â€Å"Come on Eddie, you can have a shot at our target in the park.†This is relevant because Mickey and Eddie practised shooting and in the end Mickey shoots Eddie so the shooting practise came in handy. I think the strongest child was Linda because she stuck up for Mickey no matter what; she stuck up for him when he was getting told of by the teachers and she was able to have the courage to lie to a police officer. Superstition is a big theme in the play and Mrs Johnstone is shown to be superstitious right at the beginning of the play. â€Å"New shoes on the table. Take them off†¦Ã¢â‚¬ .The new shoes on the table could result in the birth of the twins. â€Å"Plural, Mrs Johnstone, mouths to feed, you’re expecting twins.† The narrator uses superstition during the play to imply the loss of money or precious things. â€Å"An’ a spider’s been killed.† A main part in the play is when Mrs Lyons uses Mrs Johnston’s superstitions to stop her from telling Eddie and Mickey that they actually brothers â€Å"They say that if either twin learns that he once was a pair, they shall both immediately die.† As Mrs Johnstone is very superstitious she believed every word Mrs Lyons says to her. This superstition later becomes true, as at the end of the play the only reason why the gun got fired was because Mrs Johnstone told the boys that they were actually br others as she thought that it would stop Mickey from shooing Eddie but in the end although it may have been an accident Mickey still fired the gun either over anger or rage over Linda or pure shock to find out that he was a twin. The narrator finishes his speech with the idea of superstitions and whether they are the cause of the traumatic story line and ending. â€Å"And do we blame superstition for what came to pass.† The first sign of tension is when he kids grow up and Sammy causes trouble on the bus as he gets a knife out and starts threatening the conductor to give the bag with all of the fair money in just because he wouldn’t give Sammy a ticket â€Å"Fuck off, now move, you move! Give me the bag† This creates tension because nobody has ever seen that side of Sammy before and even Mickey gets scared and tries to stop him from getting into to deeper trouble â€Å"Sammy, Sammy!† The repetition means that Mickey is really worried and wants to get Sammy’s attention. When both Sammy and Mickey are both fired tension is created when Sammy asks Mickey to help him out with a job, Sammy then produces a gun and says they will go and hold someone up for some money. Mickey is reluctant at first, but wants to be able to buy Linda something nice, and agrees to stand guard. The audience want Mickey to be able to say no to Sammy because they know that it probably won’t end well, because they know that Mickey wants to be able to provide for Linda and his child but he won’t be able to do that behind bars. Meanwhile all this is happening at exactly the same time Edward meets up with Linda, proclaiming his love for her. She explains she has always loved him in a way, but she is now married to Mickey, and very much in love. Willy Russell shows them talking at the same time so the audience can compare what both Linda and Mickey are saying, Mickey gave into temptation and was willing to help Sammy with a job for money whilst Linda had Eddie declaring his love for her but Linda was strong enough to say no because she couldn’t do that to Mickey. At the beginning of the play Mickey and Eddie had a very strong friendship and cared and looked out for each other, when one was sad the other asked why and wanted to help â€Å"Mickey what’s wrong?† Eddie saw that Mickey was upset so he wanted to know if there was anything he could do to help. â€Å"I Thought we were blood brothers† this shows that they were once very close and being blood brothers meant that they always stuck together. As the play went on and the kids grew up into adults the relationship between Mickey and Eddie had changed. Before they were best friends, which had then changed into a university kid and an unemployed man who had nothing to say to each other. When Eddie announced that he had everything he had ever wanted and offered to give Mickey money, Mickey’s jealousy got the better of him â€Å"You, you’re a dickhead†. This indicates that Mickey is angry at Eddie because he has everything including all the money in the world whilst Mickey had no job, no money and hated the thought that his old best friend had everything he didn’t have. Right at the start of the play everyone saw how close Mickey and Linda were but when Mickey was in jail it not only changed him, but it changed his mental health as he became attached to drugs and became insane and mad. â€Å"He said about, about me nerves, an how I get depresses an, I need to take these cos they make me better.† But when Mickey did use these drugs it might have made him feel better but it put a strain on his and Linda’s relationship as they argued all the time which then resulted to Linda turning to Eddie for comfort and supposedly romance. Willy Russell uses ellipses to show pauses or that t he character is being hesitant in sentences to create tension and also to make the reader hang on to the speakers words and waiting for the next instalment. In the final moments of the feel tense as Mickey is running round the town with a gun searching for Eddie and everyone is wondering if he actually will shoot his brother or if he will just threaten him. The confrontation between Eddie and Mickey is very dramatic as Mickey is shouting out the odds and Eddie is denying everything. Then the police come in demanding that Mickey puts down the gun down then when he starts to realise what he is doing he begins to lower the gun, then when Mrs Johnstone comes and announces that they are twin brothers â€Å"Mickey don’t shoot Eddie, he’s your brother, I couldn’t afford to keep both of you. His mother couldn’t have kids so I agreed to give one of you away.† Mickey despairs that he was not the one given away, because then he could have had the life given to Eddie. Mickey, distraught, gestures carelessly with the gun towards Eddie. This sad story ends when the police misinterpret this action and gun Mickey down as he accidentally shoots Eddie, killing him. I think Blood Brothers the musical is a fantastic play, I especially love the way that each song has a meaning and the emotions of the characters in the lyrics. But I thought the end was good as you would have never thought that Mickey would kill Eddie. How the play was set for the narrator to have told the end of the story and the beginning of the play created more and more tension as the play went. I liked the fact that Willy Russell was influenced by Liverpool in 1983, only some of the characters had a Liverpool accent these were Mickey, Sammy, Linda, and Mrs Johnstone these were all the people in lower class and the ones who didn’t have an accent were Eddie, Mrs Lyons and Mr Lyons as they were very well spoken and in upper class. I learnt how social class can get in the way of you want to be friends with because their parents might not approve of you. I think the play might still have a relevance for a modern day audience as some people still rely on their class to get things, for example if Mrs Lyons wasn’t in upper class then Mrs Johnstone would have been able to stand up to her because she wouldn’t have thought that she was so high up. This can make modern day audiences change their mind and know that the times have changed so they can be friends with whoever they want to be. Another thing that the audience would see is how Mrs Lyons gave Mrs Johnstone money for her baby and that still happens today, so they can see that if someone does give their baby away to someone for money then it might not always end in happiness.

Beowulf The Epic Poem English Literature Essay

Beowulf The Epic Poem English Literature Essay Treasures often go for centuries without being found. And the best ones often come from unknown origins. Beowulf, the epic poem about a heroic Geat had gone untold and unappreciated for centuries until it was finally recognized in the early 1800’s. Known as one of the greatest and most important Anglo-Saxon Literatures and written by an unknown Anglo-Saxon poet, Beowulf proceeds to bring about many allusions and themes which are of great literary value. In particular however, the poet of Beowulf employs an array of Christian themes mixed in with some Germanic paganism in his epic poem. In order to completely understand Beowulf, critics often look into the mysterious poet himself. The fact that the Beowulf poet was a Christian is a recurring theme for many critics. For example, â€Å"..the Christian author who was responsible for giving the poem the general shape and tone..†(Rogers 233). Rogers goes on to talk about the attitude of the poet towards the poem and the mate rial which he used. It is safe to assume that the poet didn’t invent anything in the poem but instead, used the material in â€Å"†¦his own purpose, placing his personal emphasis upon it†(Rogers 233). Rogers feels that the poet is clearly biased pro Christianity. â€Å"The poet saw the heroic past of the Danes and the Geats through the eyes of a Christian Anglo-Saxon.† The critic then goes on to give examples of the various methods of the poet which suggest his Christian influence on the poem. The poet is portrayed as being a complacent Christian, one who believes in all things good, and is disgusted by the paganism of his time. The poet uses motives such as weapons, treasure, and society to his advantage in an entirely Christian method. Unlike in other works of literature, similar motives in Beowulf are used in a completely different method. Such as the sword, in Beowulf is melted away after performing just one great deed, when in other literature the hero would treasure it and do many great deeds. Treasure is also portrayed in a Christian way, instead of showing both sides of treasure, which most other literature would have done, the poet only emphasizes the evils of treasure (Rogers 234-235). Although the poet of Beowulf uses many Christian doctrines carefully and mostly successfully, it’s his use of paganism, and the knowledge or to some, the lack of, that intrigues many critics. â€Å"No one now doubts that it was composed by a poet thoroughly versed in Christian and biblical traditions, but whether its author had the same degree of knowledge of the background to his chosen subject matter–specifically, Scandinavian paganism–has been fiercely debated† (O’donoghue). In questioning the poet’s knowledge and views on paganism, whether Germanic or Anglo-Saxon, many critics peruse the poet’s sources, most of which include older literature available to the poet at the time. O’donogh ue goes on to analyze and compare different sources such as Old Norse-Icelandic literature and how the poet distorts and kilts it with ancient Germanic past.

Why are there so many different theories of international politics Essay

Why are there so many different theories of international politics - Essay Example Nevertheless, no one theory can adequately capture all the aspects of these complex relations. It is, therefore, only fair that different theories be used to explicate international politics (Prithi, 2005). This way, one theory adds on to the ideas of another, while at the same time criticizing the other theory. This competition helps us to see the weaknesses and strengths of each theory and its applicability to international politics. In this essay, we take a look at different theories of international politics and applicability to the complexities of world politics. Proponents of the realism theory of international politics hold that states are always struggling to gain power over other states. The sole and most important purpose of a state is to amass as much power as possible, decreasing the power of their enemies in the process. Such states place their self interests above those of other states, thereby creating supremacy battles, with each state endeavoring to be the most prominent (Walt, 2000). This competition often leads to conflicts over which state is superior to the other. However, even among realists, there are differences in thoughts and opinions. For example, classical realists believe that that states are like human beings and that they have an innate need to control other states. This uncontrollable desire for domination often leads to conflicts and wars among the involved states. On the other hand, the neorealist theory which is more modern holds that the international system is to blame for states wanting to control others. Proponents of this new theory argue that each state seeks the best ways to survive in global politics. If the survival of the state depends on its domination of another, then the former is forced to do exactly that. Since there are no international rules that refrain rivalries between states, it becomes easy for states to attack each other for the sake of power. A powerful state is a

Reflection Essay Example | Topics and Well Written Essays - 500 words - 76

Reflection - Essay Example It is vital to acknowledge that the elements of nature have a significant influence in stimulating an individual or a designer into accomplishing a given design task in a way that suits the demands of the respective environment. A substantial example that illustrates this fact is Thomas’ Seed Cathedrals located at the Expo Shanghai that is built to survive the forces of Mother Nature (Wujec et al. 91). As a recommended pillar in design, clarity of vision certainly helps in the creation of the world’s most spectacular designs that end up solving some of the oldest world’s snags in a postmodern way. Therefore, through â€Å"abductive reasoning† that Roger talks about, fresh and valuable ideas derived from experience laced with keen observation can ultimately solve the expected future complicated problems of the world. Even as some stakeholders in the design industry brag of the availability of a defined process of design, it is apparent that the steps taken by individual designers in coming up with their designs are exceptionally unique. If the story behind the artists of the Shanghai Tower, who emphasized on the efficiency and later delivered a spectacular structure is anything to go by, then there are many aspects beyond processes that come to play. Indeed, making such a remarkable design and implementing it fruitfully does not only demand a defined design process, but a combination of collaborative, fiscal and technical acrobatics (Wujec et al. 133). The fact that individual designers differ significantly in various aspects evidence that their personal talents and unique vision could be the two elements that dictate how far they excel in design. The postulation does not, however, disallow the use of defined processes in undertaking design work. Designers must acknowledge certain standard processes in design. As evidenced by the contemporary developments in the field of design. They should embrace the precedence set by Zaha Hadid

Nursing Care and Rationale Essay Example | Topics and Well Written Essays - 1750 words

Nursing Care and Rationale - Essay Example As the discussion declares ischemia has four different stokes. In ischemia, blood fails to reach some parts of the brain. In hemorrhagic, bleeding or hemorrhage occurs into the brain or in the fluid near the brain. As explained by Dawes, et at. in brain ischemia, the flow of blood to some part of the brain stops, thus denying cells in this area adequate oxygen and energy they require. This results in the failure of neurons, which dies when blood flow is not restored soon enough. The brain damage resulting from the deprivation of blood to brain is referred to as ischemic stoke, while the area damaged is known as a brain infarct. Brain ischemia normally develops suddenly, and in many cases it occurs in the morning. Ischemia symptoms varies depending on the part of the brain that affected by not receiving blood. At times, an individual will suffer from vision loss either in both eyes or in one eye. A person could as well feel weakness or reduced senses in the leg, hard, arm and face on one side or on both sides, or the person could have difficulties in walking. Other symptoms include dementia, amnesias, and difficulties in speaking, reading or writing. These symptoms can as well differ in severity and duration. Mrs. Hive, who has an ischemic stroke, will have to undergo through three types of therapy that aim at restoring her normal heath conditions. The first one is physical therapy that has a great concern on regaining gross motor deficits.

Parents or Prisons Essay Example | Topics and Well Written Essays - 500 words

Parents or Prisons - Essay Example This paper would be dealing with. Morse’s arguments in three points. First, the article stated some news reporting the dumping of a dismembered body by two boys. Such news is common even before because the crime appeals to sensationalism that makes the reading public buy newspapers. Grisly accounts of murders, whether or not involving parents is common since ancient times. Then, the news article was linked by Ms. Morse to the budget cuts imposed by city Mayors except for the Department of Corrections. Apparently, the article missed to establish the main reasons why budget spending for prisons were not part of said budget cuts. The Department of Corrections spending needs to be increased simply because the increasing rate of population also produces a higher incidence of criminality. This doesn’t mean that majority of the crimes can be attributed to juvenile delinquency as caused by children from single-parent homes. There are many factors why the Bureau of Corrections h as to increase spending which the author failed to explain. Instead, the news reports were directly correlated to incidence of juvenile delinquency which lacked substantial evidence. Second, the article cited some studies that link mental illness and single parents.

DO WE NEED AND, IF SO, WHAT ARE THE PRINCIPLES FOR A CURRICULUM AND Essay

DO WE NEED AND, IF SO, WHAT ARE THE PRINCIPLES FOR A CURRICULUM AND PEDAGOGY FOR LIFELONG LEARNING - Essay Example ive advantage over their competitors, just as it means that national economies must spur lifelong learning if they are to become, or remain, competitive; as regards the sociological front, greater social diversity and changing demographics, as in increasingly older and more ethnically and racially diverse populations, has determined the imperatives of lifelong learning as a strategy for older adults to acquire the knowledge deemed requisite for working and competing within the said environment. In other words, the importance of lifelong learning emanates from both the aforementioned changes and the mercurial, ever-changing, nature of global and national economies. There is no doubt that lifelong learning, due to the reasons mentioned in the preceding, is a critical imperative. The question is whether this means that the development of a curriculum for lifelong learning is necessary. As this research will argue, traditional curricular models cannot be applied to lifelong learning as these only embrace formal learning which usually unfolds within a classroom setting. In direct comparison, lifelong learning embraces all of formal and informal types of learning and may be defined as a continuous process of learning, autonomous and directed, formal and informal, theoretical and practical. Following a review of the implications of lifelong learning and a clarification of the meaning and structure of curriculum, this research will argue that while lifelong learning does not need a curriculum, it does need a model. As broadly defined by Knowles (1980, p.25), adult education is â€Å"a set of organized activities carried on by a wide variety of institutions for the accomplishment of specific educational objectives,† and Rachal (as cited in Merriam & Brockett, 1997) described the workplace as â€Å"a major force in the changing nature of adult education† (p. 151). Darkenwald and Merriam (1982, p. 9) defined adult education as â€Å"systematic and sustained learning

Essay (Visual Text of the girl) Example | Topics and Well Written Essays - 500 words

(Visual Text of the girl) - Essay Example The image of her on a greenish background draped in a tattered red scarf or burqa with her iconic green eyes directly starring at the camera became the symbol of the Afghan conflict and sufferings of the refugees. So, a visual analysis of the photograph will done focusing on how the colors and framing was effectively composed, and how it reflects her tough life but at the same time her strong resolve. It seems that McCurry has set up the shot of the girl with apt coloring and framing, starting with a green building in the background. This green building coincidently yet perfectly matches the green eyes of the girl. The tattered and soiled red scarf contrasts with that background thereby not only complimenting the girl’s green eyes but also making those eyes stand out, which entices viewers to the girl’s striking and piercing stare. In addition, McCurry uses the girl’s own torn out red scarf to frame her face, which provides more focus to her face and eyes. As McCurry has chosen to shoot the photograph in a low light area with soft overtones, it makes the girl’s eyes even more vibrant and brighter. At the same time, the burned and ragged scarf and importantly her dirty and slightly wrinkled face reflect her difficult life. Although, some form of pre-print photo retouching was done, extensive work was not possible because of the lack of advanced technolo gies at that time. So, it is obvious that photo was effectively composed, both in terms of color and framing, through natural means and mainly because of the skills of the photographer. Although the contrasting colors and framing has created a sort of illusion, when viewed deeply it provides disturbing but at the same time stunning perspectives about her emotional side. That is, when her dilapidated clothes and her haunting eyes are deeply focused, it seems her emotion at that time was a mixture of sullenness and courage. Although, the

Managerial Accounting Case Analysis Essay Example for Free

Managerial Accounting Case Analysis Essay Compare assigned costs per product under both methods. Why has Activity-based costing changed the total costs assigned to each product? By comparing the two cost assigned methods, there are some differences existed: Unit Product Cost:| Gadgets| Smidgets| Smadgets| Smadgets| Traditional Costing Method| 400| 1,000| 1,350| 850| Activity-Based Costing Method| 590| 1,100| 760| 1,250| Overhead Cost| Widgets| Gadgets| Smidgets| Smadgets| Traditional Costing Method| 200,000| 600,000| 800,000| 400,000| Activity-Based Costing Method| 390,000| 600,000| 210,000| 800,000| I deduct the main reason for that are: Traditional Costing Method use the Overhead Rate (200% of direct labor) and the Activity-Base Costing Method just use the Overhead Cost Drives. As for Traditional Costing Method, the company just accumulate costs into a cost center (Three kinds of costs: director material, director labor, Manufacturing Overhead) , and the Manufacturing overhead just equals the director labor multiply by 200% , the Overhead Rate. These three kind of costs added together we got the total cost, and the total cost divided by the each unit built, we get the final unit product cost, I think it is a rough calculating process. The result depends on the direct labor hours and regardless of any other elements, if direct labor dose not account for a larger portion of the product, the result will not be accurate. In terms of Activity-based costing method, the company use Overhead Cost Drives (There are three allocation bases in the ABC method: depreciation, machine set-up and rent). The Overhead expense just use cost drivers (Such as Machine hours, Set-up hours and Rent) to apply the costs on the products. On the basis of these three, we can get the Overhead cost drive’s Pool Rate, and we also get the actual Cost Driver Quantity for Product Line, and finally we can know what is the exact Activity Cost for Product Line with respect products, finally, we got the total ABC Overhead cost for the three products. So I think this allocating process is more accurate, because it use the Cost drives into different part in detail.

The Death of Ivan Ilych and The Sun Also Rises Analysis

The Death of Ivan Ilych and The Sun Also Rises Analysis Lie The short story The Death of Ivan Ilych and the novel The Sun Also Rises have different from each other structure, scenery, and protagonists. The Death of Ivan Ilych is told by the author, omniscient. Per Kelly If there is no limit to what the narrator knows, if he can eavesdrop on the minds of characters and reveal their unspoken thoughts, we call him omniscient (xiv). In difference The Sun Also Rises is told by the protagonist. The narrator, limited omniscient, is the character of the novel and everything was shown based on his thoughts and views. The underline of each story is the lie and how it leads characters lives. In the story The Death of Ivan Ilych many lies have been accepted by characters as a truth. The lie starts from the begging of the story when Ivan Ilychs coworkers learned about his death. Their thoughts and actually pronounced words were complete opposites. Tolstoy states, receiving the news of Ivan Ilychs death the first thought of each of the gentlemen in the privet room was of changes and promotions (15). Tolstoy also exposes that the coworkers were acquaintances and so-called friends, but not true friends. Even the persons, who Ivan Ilych considered friends, had one thing in their mind how to benefit from his death. [T]he more intimate Ivan Ilychs acquaintances could not help thinking that they have to fulfill the very tiresome demands of propriety by attending the funeral service (Tolstoy 16). They were so fake friends that, the attending to the funeral had only far-sighted reasons. Ivan Ilychs life was full of lies and dishonesty. Everything started from his work and society that he was in. Throughout the story, Tolstoy shows how power and good connection help to get things that people are not qualified. [Ivan Ilych] set off for one of the provinces where, through his fathers influence, he had been attached to the Governor as an official for special services (Tolstoy 23). He started to act and do things that bring him good reputation and respect. Tolstoy affirms that [he] picked out the best circle of legal gentlemen and wealthy gentry living in the town (25). His life started to be just show off and every action was done for societies reaction, even getting married and having a family. To say that Ivan Ilych married because his social he fell in love with Praskovya Fedorovna would be as incorrect as to say that he married because his social circle approved of the match (Tolstoy 26). These all made the accepted lies bigger and bigger. The realization about lies came to Ivan Ilych when he got sick. The fist realization accrued to him in a visit to a doctor. He was accepting that doctor was avoiding his questions and overlook something like he used to do on the court. The doctor put on just the same air towards him as himself put on towards an accused person (Tolstoy 35). When Ilychs condition became worst many more thoughts came to his mind. He had additional time to think and realize that his life was filled with many lies. Every small thing was irritating and inflaming to him. He could find any relief in his relatives. The only pleasant person for him was his butlers young assistant, Gerasim. In the story, Tolstoy represented Gerasim as a person who lived good and clean life. Grasim was in Ilychs side most of the times and Gerasims sleepy, good-natured face made him think that he lived his whole life wrong. He realized that everything in his life was false and there was nothing real to him. It occurred to him tha t . his professional duties and the whole arrangement of his life and of his family, and all his social and official interests, might all have been false (Tolstoy 60). At the end of his life, Ivan Ilych understood that his life was not what he would want it to be. He was feeling sorry for his wife and kids, especially for his son. The novel The Sun Also Rises is told by the main character, Jake. In this novel, all the characters are living in the lies. Even though the whole time in the story Jake talks about other people, he describes him and his fillings. Robert Cohn was once middleweight boxing champion of Princeton. He cared nothing for boxing, in fact, he disliked it, but he learned it painfully and thoroughly to counteract the feeling of inferiority and shyness (Hemingway 11). Jake hade some insecurities which he was showing by describing Cohn. Jake is slightly concerned about the violence and fighting happened with Cohn, and it feels that Jake have feelings of inferiority too. Later in the novel, we find that Jake was in a war. Youre not a bad type, she said. Its a shame youre sick. We get on well. Whats the matter with you, anyway? I got hurt in the war, I said. (Hemingway 23). A conversation between Jake and Georgette brings in Jakes injury and how the war has influenced his life but keeps some things uncovered and shaded. The barrier between Jake and Brett gets quite clear at the end of the novel. Oh, Jake, Brett said, we could have had such a damned good time together. Ahead was a mounted policeman in khaki directing traffic. He raised his baton. The car slowed suddenly pressing Brett against me. Yes, I said. Isnt it pretty to think so?' (Hemingway 250). The policeman, cars being slow downed and stopped symbolically represent that their relationship is not going anywhere and they are not going to be together. Furthermore, Jakes somewhat skeptical and unpleasant response demonstrates that he has no impressions about their relationship. It looks as if he respected the circumstance that a relationship between himself and Brett would have been improbable to end otherwise than any of her other unsuccessful relationships.

Kurt Cobain was Murdered Essay -- essays research papers

Kurt Donald Cobain was found dead in the green house of his mansion on March 1994, cause of death â€Å"suicide by self inflicted gunshot wound† or at least what was pronounced and believed by many to this day. It is plain and simple he was murdered.   Ã‚  Ã‚  Ã‚  Ã‚  Kurt Cobain the singer and guitarist of the 90s band Nirvana which was an alternative rock band from 1988 to 1994. Cobain was born in the town of Aberdeen Washington. Aberdeen is a rural white trash town that borders Seattle the birth place of â€Å"Grunge†. Before them at record stores there were special sections for alternative music, they popularized it. However many grunge bands were around such as Mud Honey and The Melvins. Kurt had three times the lethal 225 mgs dose of heroin in his blood system with puncture marks in both arms (Grant). Medical experts and doctors will tell you that with that much heroin in your blood stream if you don’t instantly die you would fall into a coma in a few seconds. Kurt supposedly shot up that insane dosage of heroin, pulled out the needle, put the syringe neatly into a cigar box feet away, then picking up a Remington 20-gauge shotgun he placed it in his mouth and fired. According to Tom Grant and other researchers it is an impossible feat even for a hardcore abuser such as Cobain. Not only did he have heroin in his system he also had valium in his blood. Valium doesn’t mix well with heroin making a small overdose bad; Kurt’s overdose wasn’t a small one. It’s not possible that he shot himself with a shotgun or any gun and if so why? Why would someone shoot themselves when they were on so much junk they would just die in their sleep? He had a daughter Frances Bean that makes it hard enough to believe he did it with out the scientific impossibility. â€Å"Dead Men Don’t Pull Triggers† (Roger Lewis). â€Å"Drug related suicides are often a staged cover up for murder† (RL).   Ã‚  Ã‚  Ã‚  Ã‚  The police report of the suicide read, there were no legible finger prints on the shot gun, the pen which was used for the suicide note, or on the bow of shot gun shells. Kurt Cobain had finger prints, and it’s not as if he were wearing gloves. If one thinks that’s amazing for supposedly committing suicide, Sergeant Cameron admitted two years later that there wasn’t any sign of Kurt firing a gun there wasn’t any marks on his hands such as Gunshot residue. Why was eve... ...life towards the end of it all he got diagnosed and had surgery many said he was a new man. â€Å"He seemed really clean when we were on tour. In some ways it was really awkward he wasn’t joining in the very mild debauchery that went on† (shelley). Rosemary Carroll, long time friend and lawyer of the Cobains told investigator Tom Grant in April1994 that Kurt wasn’t suicidal over and over when asked. Courtney’s own father has a book in which he expresses how he thinks Courtney knows who killed Kurt or was in on it herself. That is just wrong to accuse your daughter of that. Yes he could be a heartless whacko trying to cash in on his story or he really knows what he is talking about because he can’t let the truth go unknown.   Ã‚  Ã‚  Ã‚  Ã‚   Kurt Cobain's death labeled a suicide by most media and police could not have been not only did people who knew Kurt discredit the suicide lie. There is concrete evidence he didn’t do it and the case should be reopened. I think why the Seattle Police department doesn’t reopen the case is it is a huge embarrassment to the force. A blunder of that size would make them look very badly. Kurt is innocent of Suicide and murderer is out there.

Preparing For Our Deaths :: essays research papers

Preparing for Death   Ã‚  Ã‚  Ã‚  Ã‚  A lack of preparation for our deaths is a serious problem whether it is because we don’t know the exact time or just don’t want to face death. In a article in time magazine by John Cloud he writes â€Å"We will spend more time getting ready for two weeks away from work than we will for our last two weeks on earth† (Cloud,2000,p.60). We should prepare for our deaths to show our wishes concerning treatment and life support as well as other aspects. We should make choices while we are still well, so that we are treated properly before we die. Frank Ostaceski said â€Å"we have more preparation for how to operate our VCRs than we do for how we die†(Cloud,2000,p.60).   Ã‚  Ã‚  Ã‚  Ã‚  In today’s society we all try to prolong life as long as possible. Technology is finding new ways that we can stay healthier and lead productive lives longer. Governor Lamm said â€Å"we should be careful in terms of our technological miracles that we don’t impose life on people who, in fact, are suffering beyond our ability to help†(Collins,1991,p.540). That is the real issue at hand; are we in fact over stepping our boundaries by keeping people alive who are maybe beyond our help. â€Å"Machines can extend the length but not always the quality of life† (Cloud,2000,p.62). As doctors, they need to think about the well being of the patient and if any methods could really help the situation.   Ã‚  Ã‚  Ã‚  Ã‚  It is hard to let someone that is close to us die, but we need to look beyond the fact that you will miss them. You need to think about what is best for the patient and if they are terminal; prolonging their life is not the best thing. It is important to prepare for our own death and make our wishes known. A living will is one way of doing that. A living will is a document explains to your doctor what types of treatment you want if you become terminally ill. A living will only works when you are terminal, it does not come into effect if you are in an accident and need emergency treatment. Some people may feel that a living will is not for them, when in fact everyone should have a living will. Most people assume that a living will means that they are refusing treatment, which is not true. A living will just explains your wishes.

Cell Phone Use Should be Prohibited While Driving :: Argumentative Persuasive Argument Essays

Cell Phone Use Should be Prohibited While Driving A small sedan is crawling through an evening of rush hour traffic on I-65. Aware of the huge SUV attempting to merge into the lane, the driver slows in an effort to allow the vehicle to claim a space in the horde of eager business men and women fleeing from offices and pushing towards typical Friday night destinations. The driver of the SUV is unaware of the tiny car beside her and smashes into the automobile and curses into her cell phone. A witness a few cars behind quickly dials 911 on his cell phone. Unable to pay attention to traffic and dial the phone at the same time, he crashes into the truck in front of him causing a pile up of several cars. Because of the distraction they provide to motorists, cell phones should be banned from use by drivers of moving vehicles. According to the Cellular Telecommunications & Internet Association (CTIA), nearly 168 million U.S. citizens used cell phones in August 2004 (Cell Phones and Driving). Without a doubt the number increases daily. Cell phones are becoming as American as baseball and apple pie. The insane amount of cell phones in the hands of distracted drivers can only mean one thing: a higher chance for an accident and that is exactly what is happening. ?A 1997 article published in the New England Journal of Medicine [stated]?the use of cell phones in motor vehicles?quadrupled risk of collision? (Cell Phones?on Highways?). This is a large increase considering accidents are being cause by a wireless device being used for meaningless phone conversations while sharing an interstate with other distracted drivers. Removing cell phones, an obvious distraction, is one way to reduce the number of traffic accidents. Simply not answering the persistent ring or allowing a passenger to dial and make the p hone conversation could save many lives. Life in America has become so fast paced that the separation between work and home is not apparent?especially when major business deals are being made by business men and women who are making left turns and sitting at four-way stops. As stated in the Electronic Engineering Times, ?Harvard?s Center for Risk Analysis?[shows]?2,600 people a year are killed and 330,000 are injured in car crashes involving cell phones? (1). With these statistics it would be expect that police officers responding to car accidents would document the proper information and ask if a cell phone was involved in a car accident.

Factors and Hazards of Infant Development Essay

Author’s note: This essay is a summary of my beliefs of the three most hazards factors in the early stages of Infant Development. This essay is for Mrs. Hacker’s EC100/EEC1700 Section 07 Foundations of Child Development Course. Factors and Hazards of Infant Development There is nothing more precious in life, than hearing your baby heartbeat or feeling it kick for the first time. Mothers and fathers to be should be aware of various hazards that can play a major factor in the development of their infant. The three factors that I feel are the most hazardous are alcohol, smoking, and drugs of any kind. In this essay, I will try to explain to you why these factors are very important to be avoided before and during pregnancy. Alcohol consumption during pregnancy can have serious consequences for mother and the developing fetus (O’ Leary et al., 2010). If a mother is consuming alcohol during pregnancy she can have a miscarriage, stillbirth, low-birth weight, or a premature infant (ACP CS-EBK for Developmental Profiles, pg. 58). A developing fetus consumes whatever the mother puts into her mouth and body. Alcohol is a teratogen that has irreversible effects on infant development. There are several birth defects that a mother who drinks should be aware of; they are fetal alcohol spectrum disorder (FASDs) fetal alcohol syndrome, hyperactivity, heart defects, facial deformities, and speech impairment (Ismail et al., 2010). A mother who drinks mild alcohol during pregnancy could cause their infant to suffer from fetal alcohol effect. Infants with this effect suffer from learning and behavior disorders. It is very important that a mother to be does not consume alcohol. If you care about your baby well-being do not drink during pregnancy. Smoking is a bad habit that’s hard to kick once started. Smoking is dangerous for pregnant women, kids, men, and women. Smoking can damage the lungs of the smoker, and also cause lung cancer to those who smoke for long periods of time. Many pregnant women continue to smoke despite the warning on the U.S. Surgeon General label. Maternal smoking has been linked to many fetal malformations and birth complications (Ashford et al., 2010). Cigarette smoke contains harmful substances, which can harm a person body. These harmful substances are nicotine, tar, and carbon monoxide. All the substances can harm an undeveloped fetus if consumed throughout pregnancy. Mothers who smoke during birth are at risk for having infants who suffer from asthma, allergies, and it can cause SIDS. Prescription and nonprescription medications, pesticides, fertilizer, and street drugs are very dangerous during pregnancy (Mattison, 2010). These drugs and chemicals can have many adverse effects on developing fetuses. It can cause SIDS, miscarriages, stillbirth, and numerous birth deformities to the undeveloped fetus. Drugs of any kind should be avoided during pregnancy, to ensure a better chance of having a healthy fetus. There are many reasons a mother to be should be cautious about the environment and the things she consumes during pregnancy. The best care a mother to be can give to her undeveloped fetus is to eat right, get adequate rest, and regular check-ups, which can better ensure the birth of a beautiful, healthy baby. References Ashford, K., Hahn, E., Hall, L., Rayens, M., Noland, M., & Ferguson, J. (2010).The Effects of prenatal secondhand smoke exposure on preterm birth and neonatal outcomes, Journal of Obstetric, Gynecologic, and Neonatal Nursing, 39(5), 525–535. Mattison, D. (2010). Environmental exposures and development, Current Opinion in Pediatrics, 22(2), 208–218. O’Leary, C., Nassar, N., Kurinczuk, J., de Klerk, N., Geelhoed, E., Elliott, E., & Bower, C (2010). Prenatal alcohol exposure and risk of birth defects, Pediatrics, 1 26(4), E843– E850.

Chinese and Greek Mythology

The Diverging Commonalities of Creation Myth’s Long ago, people wanted to acquire a better understanding of the beginning of the universe which ultimately resulted in the establishment of religions, beliefs and most pertinent, creation myths. Mythology provides explanations for the worlds mysteries especially in regards to the creation of Earth, Humans and the environment.This comparative paragraph analyzes the similarities and differences between a Greek myth entitled, The Beginning of Things, and a Chinese myth named, Heaven and Earth and Man, contrasted in the aspects of conflict, solutions, heroic action, and the education of the first humans. Conflicts arise for different concerns but after the battles cease, peace is restored because of supernatural intervention, the world advances and progresses to prevent future misfortune. Firstly, if peace is kept in the heavens of Greece then there will be less despair on Earth.The battle of authority results in a punishment system being enforced to confine cruel people and prevent rebellions. In ancient Greece there was a constant power struggle for the gods because of the underlying fear that their children would replace them in the chain of command. The text supports the argument of development and enhancement after unreasonable decisions are made by the deities; If any of them breaks the oath, for one year he lies breathless, and cannot partake of sweet nectar and ambrosia; after that year he is cut off from the meeting of the gods for nine years more, and then only may he come back and join their company. Rouse, 3) During the destruction of the battles, evil is unleashed and causes chaos in the land. The justice system, which is created in response to Cronuses’ rebellion, is essential for any society to continue successfully. There is heroic involvement in both myths, with Zeus in particular in Ancient Greece. Zeus defeated his father and saved his brothers and sisters after being swallowed and tra pped in his stomach. Cronuses’ awful deed deserves punishment which results in Zeus creating the Underworld and a standard of the amount of time spent punished.In fact, the Chinese story also includes a quarrel, different in rationale but improvement after the disagreement is a prevalent theme in both. Subsequently, in respect to the Chinese myth, after the war between fire and water, the pillar was destroyed; Nu-Kua repaired the gaps in the sky by supporting the sky with additional blocks. The literature provides evidence to confirm this line of reasoning; Block by block, she patched the holes in the sky. Lastly, she killed a giant turtle, and cut off its powerful legs to make pillars between which the sky is firmly held over the Earth, never again to fall. Birch, 7) After chaos returns for the second time, when the elements fight against each other, involvement from spirits resolves the crisis and mitigates harm from humans. The irrational and aggressive clash between fire and water causes destruction but also provides reasoning for the position of the oceans and world geography. Apart from the similarities, there are many discrepancies circulating around the topic of conflict. In the Greek myth, conflicts originate from the desire to establish power and authority by rebelling. First, Cronus rebelled against his father Uranus and Zeus against Cronus followed.The competition is caused because children inherit their parents’ position and both gods prevent this from happening by swallowing or imprisoning them. On the contrary, the Chinese dispute is against the elements fire and water. In Chinese mythology, fire is masculine and symbolizes strength, aggression, impulsiveness. Water is considered feminine and symbolizes fluidity, downward energy but has the potential to be noisy. The conflict is probably caused because the elements are opposites and naturally enemies. This clash of the elements is a result of senseless hostility and not a fight for control.The difference in culture is what causes the significant differences in myths. Evidently, in Greek mythology acquiring status and supremacy is valued whereas there isn’t a sense of hierarchy but instead teamwork in China. According to the Asian myth, the spirits all work together towards a common goal which is to enhance and protect the Earth. Another obvious commonality in relation to either conflict is the presence of a supreme being which triggers and assists the chain of events which form the World. The Greek mythology had many different supreme beings which were responsible for various forces on Earth.The Chinese version, only included two main beings, one which was the result of the environment and the other was the creator of the human race. Comparative mythology also requires examining the distinction between the ideas of how both cultures though the Earth was created. An indication of how diverse the culture and beliefs of people is demonstrated in the topic of the formation of Human beings and the surrounding eco-system. The creation of humans, wildlife and geographic landscapes varies with the idea of the Greek Gods sculpting most organisms hemselves whereas the Chinese believe Pan’Ku’s body transforms into the environment. The aspect of creation and the environment is portrayed very differently in both legends. The number of dissimilarities outweighs the number corresponding ideas surrounding the mystery of the beginning of the Universe and our existence. In ancient Greece, after a period of chaos and disagreement between the deities a clever titian named Prometheus establishes the first human and provides luminosity and warmth in a world, swallowed by darkness after the sun sets.Prometheus sculpts animals and accidentally, the first human out of clay and began to teach them how to survive including hunting and making fire; Prometheus was very much pleased with his new pet. He used to watch men hunting for food and liv ing in caves and holes, like ants or badgers. He determined to educate men as well as he could. (Rouse, 2) After rebelling by taking responsibility for the Earth underneath the heavens, Prometheus entertains himself by making models out of clay. Accidently, he creates humans and spent most of his time teaching humans how to continue to exist.Prometheus sculpts humans by accident whereas Nu’Kua from the Chinese myth wants to produce beings that will aid to cure her solitary state. To contrast, in the Chinese myth, the weather conditions, mountains, rivers and vegetation are all created by Pan’Ku’s body. Additionally, after humans are created by Nu’Kua, they are taught many vital skills in addition to simply the ability to survive; â€Å"Who in his life [Pan’Ku] had brought shape to the universe, by his death gave his body to make it rich and beautiful†¦ to the Earth he gave his body† (Birch, 6).In the Chinese story, the environment is no t created by a specific spirit but instead transforms from a god into the surrounding nature and landscape. A further comparison against the Greek tale is the little explanation about how the land and plants are created except for the separation of sky and ground which reveals an already existing ecosystem. Moreover, the humans in the Chinese myth are taught how to communicate, reproduce and to live in peace. The humans in ancient Greece are never taught skills beyond survival. Finally, there is an evident variation for the reasons to assemble humans.Nu’Kua intends to create a creature that will provide her relief from isolation meanwhile Prometheus is only amusing himself and the first human emerges entirely unintentionally. Nevertheless, both fairy-tales have a couple of resembling principles. To begin with, humans are formed and educated by the deities. The first humans were taught to hunt, gather food, and construct shelter to avoid perishing as a species. The principal o bjective is to aid humans to continue to populate and the justification in both fables was that supernatural intervention maintained the evolution of such a powerful species.Magical clay was used in both myths as the main material in the production of creatures and human beings. The motive for why these two parables are so similar is to emphasize how there is an external influence which assisted the formation of humans because it is difficult to believe that simple resources could have conceived such complex living, breathing creatures. Additionally, as a society in the present day, education is a requirement and essential for the genetic continuity of the human race, peace and maintenance of the Earth’s resources.By the means of education can one’s potential be used to maximum extent. It is natural for the authors of these short fictitious stories to assume the hero’s and goddesses teach humans because then there will be no foundation to carry on the sharing of lessons and information. In conclusion, it is in the nature of humans to wonder about the unknown and search for answers. At the foundation of nearly every culture is a creation myth which explains how the wonderful mysteries of the Earth came to be.Despite geographical barriers, many cultures have developed creation myths with the same basic elements and structure. However, there are many cultural and societal influences which cause variations in the beliefs and alter the overall creation myth from region to region. Apart from the fundamental similarities, the Greek and Chinese ideologies deviated in certain aspects of the myth because their values and morals as separate countries have impacted, adapted and evolved differently in response to world events.

Milk Powder in China Essay

Firstly, the customers of Milk powder market in China can be devided in to three parts.Which are high income, working-class,and low income. In China now, most of young parents pay most of their attention to children’s health. They often look foreign goods like food and clothes for children. but not everyone has ablity As mentioned above, our milk powder will be easily accepted by the young parents who are highly educated, and have high income due to its high quanlity and the suitble for asian babies in demographics. In psychographics, as we know, resently, most of Chinese milk powder has been checked out Melamine that can lead to kidney stones. Young parents have lost confidence in the manufacturing of milk powder. More and more people try to purchase foreign milk powder for baby no matter how expensive it is. But most of them buy it from internet by someone who can buy the powder derectly in the country of origin, it will pay lots attention and more money. This is a reminder that we can use this mind to develop our Chinese market. In the past , most Chinese parents buy milk powder which was advertised well, they thought the products that film star recommended would be high quantity. Facts had proved that it would not work. People have lost their confidence on advertisment. It is a problem for us how to promote our milk powder. If we over- used advertisement, it may cause resentment from parents. Some other people will buy milk powder which is recommended by friends or experts from China and other countries. According to the above analysis. We can use concentrated global marketing srtategy. As have related we must use single marketing mix to suit the customer Our milk powder is expensive, not everyone has ability r to bear the expense. So our customer groups is who have high income and highly educated and think baby’s health is the most important thing they have concerned. This part will have little family of hostility, at least they will firstly consider the needs of their baby.

Oedipus Rex – Entrapment of Mankind Through Reasoning

For example, when Alias and Oedipus Rexes were reveled with their prophecies, they tried to divert themselves away from it. As a result, they reverted themselves into the prophecy, therefore fulfilling it. Although man tries to control their own fate, in reality, such control is impossible and cannot be possessed. Through the use of Oedipus' life decisions, diction, and connotation of words to display the idea that man's most powerful attribute fails mankind. In other words, through Oedipus Rexes, Sophocles shows that reasoning cannot give mankind the power and control they sire. Therefore, such control and power for mankind does not exist.Oedipus Rexes proves that man's most powerful attribute Is reasoning. Sophocles gives his readers the idea that mankind is trapped through their most powerful attribute. Oedipus Rexes believed that he could escape the reality of his prophecy through his attempts to reason throughout it. However, his aim to avoid the prophecy using reason failed him . As the prophecy was revealed to Oedipus, he believed he could avoid it by leaving Corinth and the family whom he believed was his own blood. However, this thought of his is what failed him and lead to Oedipus actually fulfilling the prophecy.This decision leads mankind to believe that they can control their life through reasoning. As Oedipus moves onto Thebes, he crosses through the road where three roads meet. At this exact road, he meets Alias, his father, whom he does not know. Alias and Oedipus begin a feud start brawling with one another. Thus, completed. Although Oedipus continues onto Thebes and solves the sphinx's riddle, his success leads him into the second part of his prophecy being fulfilled as he meets Coast, marries her, bears children with her, and birth children of incest.In spite of the fact that Oedipus' best characteristic is his constant attempt to reason, it's his exact reasoning and questioning that lead him to the â€Å"truth† of the prophecy. Despite Oedipus' failed attempts to control the prophecy, Alias is also another culprit of failed attempts to reason. Alias, King of Thebes, birth a child with Coast and believed that he could become the next ruler of Thebes. However, a prophecy was told to Alias that his own son would soon murder him and take over. At this very moment, he decides It's best to bind Oedipus' feet and send him away to die.He does not realize, however, that this decision leads him Into the entrapment of his own life. He fulfills the actual prophecy when he tries to take Oedipus out of his life. This Is another failed attempt of reason. Therefore, man's most powerful attribute of proves that reasoning brings mankind doom. As Alias did not want his baby to kill him, he sends the baby away. The Old man sees the baby and picks it up because no mortal being would see a baby hurt and abandoned without having to pick it up. He gives the baby to his King of Thebes because he knows they cannot bare a child, feeling pi ty for them all.Oedipus himself hears about the prophecy and runs away from it. All these people, all these steps were made from attempts to reason and control the world, when in reality, it ultimately failed. Mankind cannot use their so- called â€Å"most powerful attribute of reasoning† to control their lives. If reasoning brings doom to mankind, what is the purpose of reasoning itself? Sophocles answers this question by proving through Oedipus Rexes that reasoning traps mankind, making mankind limited. The Chorus, whom supports Oedipus the most out of all characters of the play, reveal their thoughts and true emotion towards the doom of Oedipus.Through their character, Sophocles conveys the pity one may feel towards Oedipus whom was a great man dealt with UN inevitable doom. In a passage by the Chorus on pig. 18, they stated, â€Å"A prince of men/ Whose loot what citizen/ Did not with Emmy see,] How Deep the billows of calamity/Above him roll/Watch therefore and regard t hat supreme day;/And of no mortal say/That man is happy,† datelined by no grievous ill/He pass Life's goal In this passage, the Chorus shows how great of a man Oedipus was, nonetheless, how great of a King he was.He was not only great because of his role as King, he was great because he reasons. However, this characteristic of constant reasoning, to pursue and search for the truth leads to the fulfillment of the prophecy. When the Chorus says, â€Å"billows of calamity', they talk about the mass destruction Oedipus was placed in. On that day, he was realized he entrapped himself into the prophecy. Therefore, Oedipus acts as a representation of mankind, conveying the idea that seasoning dooms us all and traps mankind. Mankind is under the illusion that control exists and reason works.Through the first half of the stanza, the Chorus exemplifies their support for Oedipus. He was a Prince out of all the men, who gained respect and order from his people. After Oedipus discovered h is tragic state in the prophecy, such a situation could not be explained. It was disastrous, catastrophic, devastating, but all these words do not show how grievous this day was for Oedipus. He believed he escaped the prophecy and lead to be a King, a King of whom many honored. He set out to believe that he must save his city from disaster, from the plague, when he was the plague himself.The Chorus tells the readers to watch the day Oedipus fell into the prophecy and learn that no human being is lucky. No man has a goal, for their most powerful attribute fails them ultimately. Therefore, no man is lucky until they are dead. Sophocles shows through Oedipus Rexes that reasoning cannot give mankind the power and control that they desire. Through the understanding of the way Alias and Oedipus both failed at their attempts to reason and the Journey Oedipus invests myself into throughout the play, readers are able to see how Oedipus portrays a representation of mankind.Through his represe ntation, one may find that although doom upon him. This leads to the idea that reasoning fails mankind and the purpose of reasoning is invalid. Sophocles uses Oedipus life decisions, diction, and connotation of words to display the idea that man's most powerful attribute fails mankind. Although man tries to control their own fate, in reality, such control is impossible and cannot be be possessed.

The United States as an Empire Research Paper Example | Topics and Well Written Essays - 2500 words

The United States as an Empire - Research Paper Example An empire is defined as an extensive group of countries under the umbrella of a single supreme authority and mainly controlled by an emperor or an empress. An empire exercises control and influence over an expanded territory beyond its original boundaries while maintaining military posts or bases throughout the world. To maintain the control, an empire conducts wars of aggression on foreign lands and goes to an extent of offering protection to other countries as well. As a way of serving the less fortunate people from other countries, an empire accepts them into its realm as unskilled laborers. The United States is well endowed with powers that do not match any other nation. The absence of serious threats to the American security that gives the United States control over foreign policy choices. Lack of military threat gives the U.S opportunities for global outreach. The military capabilities enable the U.S to support its outreach ends. The U.S military has never been challenged by an y country. For instance, in the year 2012, the U.S military spending was bigger than any other spending of other influential military powers like China, Russia, the United Kingdom, Japan, France, Saudi Arabia, India, Germany, Italy, and Brazil all combined. This is why the U.S dominates military globally, keeping international deployment at the present level, and tackling international missions successfully (Buzan 2004, p.9). Even before the Americans were free, they already had intimations of greatness. The French and the Indian War demonstrated that the U.S forces were of significant size as per the eighteenth century standards, especially their armies on the North American continent. The Anglo-American victory determined their western boundaries and further gave them the confidence of rendering superpowers over other governments.

Cultural anthropology and food Research Paper Example | Topics and Well Written Essays - 250 words

Cultural anthropology and food - Research Paper Example Food has become extremely instrumental in clearly defining the differences among the diversified cultural groupings. Like all the other known culturally defined symbols and materials, food has also served in both solidifying group membership and setting groups apart (John 2001, 161). It strengthens the cultural groupings or national identity. Food clearly distinguishes people from different cultural backgrounds. John (2001, 243) argues that the correlation of one’s consumption, belonging and identity of feeds gives one imaginations of the person he or she is. The food consumed has been used in the western and African countries to identifying the cultural backgrounds of an individual. Although in the past language has widely been perceived as a marker of culture, food has always endured where the language is lost, or its use is limited. According to the cultural anthropologists, food has been used in observing prestigious festivals and rites. According to John (2001, 128), Korean and Americans have varied preferred food. For instance, Koreans culture can easily be associated with the inclination for moon cakes. While that of people from America is associated with pizza and hamburger eating behaviors. Conclusively, observing the kinds of foods consumed by one, can easily tell their culture. Therefore, according to the anthropologists food and culture are

Health People of 2020 Essay Example | Topics and Well Written Essays - 750 words

Health People of 2020 - Essay Example This group also shared four of its greatest disparities with the Hispanic population; drug-induced deaths, cirrhosis deaths, new tuberculosis cases, and deaths from poisoning (Chu, 2004). Potential causes of these health disparities The health disparities are unbalanced and have direct links to the history and current unequal distribution of political, economic, social and the environmental resources. Historically, the acceptance of different groupings in the United States population has frequently been marked by discrimination, disparate treatment, and hostility, providing a solid cause for concern on the health of minorities. The earliest racial and ethnic disparities developed between the original American Indian inhabitants of the continent and the then European colonists. Although the natives split into several racial and ethnic groups for many reasons, the colonialists and their governments employed a logical difference between them and the natives, lumping together of the Alas ka Native and American Indian populations that still finds its value used in government statistics (Koh, 2010). According to Thomas, the requisite importation of slaves from the American colonies of Africa led to a third racial or ethnic group. The definition of this group has changed with time as it is also in other countries, like Brazil and South Africa. The United States detained for several centuries later to a rule of hypodescent, making any African or African American genealogy identifiable as a black.

IBM Essay Example | Topics and Well Written Essays - 1000 words

IBM - Essay Example The company and employees welcome change as the main driver of success and profitability. IBM has 32 leaders responsible for certain organizational activities and performance. Customers and technology are the primary driving factors in this arena. Customers want products that satisfy their needs or improve their productivity. IBM looks for ways to deliver these benefits at a lower cost, smaller size, and higher speed. Operating within an industry with this kind of rapid change presents several challenges for personal computer and notebooks, namely production costs, intellectual property owners, and monopolies. In general, IBM is one of the profitable Corporations today and, as predicted, in future (Bellis, 2001). Strengths of IBM Corporation include knowledge, relationships, selling and history. The challenges of the company are based on high quality of products and services. Direct sales force maintains a relationship. Among the weaknesses are high competition and rapidly changing technology market. The innovative PC technology is not cheap and that is why not all the potential customers can afford it today. IBM, in contrast to Dell Corporation, tries to maintain high standards of service proposing and selling (the most important) to its customers high quality products. Taking into account his vision of the company, it is possible to say that central planning and negotiating inputs from might have gone, but there remained the assumption that some other agency would solve the problems: an assumption the CEO himself appeared to share. All of this was taking place within a structure which remained hierarchical, with little involvement of junior management or the workforce, who believed that their product could only sell locally and clung to the assumption that they could sell everything they could produce. All of the IBM leaders participate in the change

The Marketing Plan (optional company your pick) Research Paper

The Marketing Plan (optional company your pick) - Research Paper Example 1- 6). McDonalds primarily targets children and young adults for its products. This as a result identifies three major categories of the company’s audience. The first category is parents who take their children to restaurants. Another category consists of grown up children and youths who visit the stores on their own. Adults on tight work arrangements also form part of the company’s target population (McDonalds, p. 3). McDonalds’ pricing strategy is based on continuous research that identifies customers’ perceived value of its products. The company, as a result, builds its image and develops loyalty and utility among its customers. This is then used to determine prices at which customers are willing to pay for the products. Though the food industry is competitive, the company does not adopt pure price reduction because of it has marketing disadvantages (McDonalds, p. 5). The company is majorly a retail enterprise and focuses its distribution channels to its outlets. Strategic location of its outlets is therefore the main element of its product distribution (McDonalds, p. 1). McDonalds adopts a diversified approach to promoting its products. Its promotional initiatives include advertisements, â€Å"sales promotions, point of sales display, merchandising, direct mail, telemarketing and loyalty schemes† among others (McDonalds, p. 5). Advertising also employs different media forms that include print media in posters and magazines, audio media such as radio stations, and audiovisual media (McDonalds, p. 5). McDonalds major marketing strengths include its brand imaging and research based marketing strategies. Its major weakness is lack of innovation that leads to monotony in its product mix (McDonalds, p. 3). Wallace and Forte explains that a good market plan is economical, precise, â€Å"simple and easily understood, informative and customer oriented†

Reflection papers Essay Example | Topics and Well Written Essays - 250 words

Reflection papers - Essay Example Many local musicians continually win international fame in the music arena owing to their sensational music that hits the global audience. For instance, the up-tempo Arabic tune of Princess Diana remains acclaimed piece of art that has influenced the nature of the Western music especially in San Francisco (Tomasino 2005). Music pervades the limits of the artistes region and receives global attention depending on the ability of the singer to coin the message of the songs in a manner that suits the diverse audience. Recent progress in the music industry however gives the impression that music artistry has become more audience-demand motivated than self-manipulative. Despite the remarkable progress made in the music industry, music piracy remains a public concern for the American music (Tomasino, 2005). Piracy takes the form of sales of illegally recorded music and general illegal acquisition of music segments without the consent of the songwriter. Furthermore, reception of global music threatens to scuttle the dominance of local music in various regions, though music domination has to be responsive to the changing audience base that has the access to a variety of international music. It is undeniable that piracy threatens the progress in the music industry yet its progress is dependent on the rewards that the artistes gain from their music. The music industry is obliged to remain manipulative and more responsive to changes in the global audience expectations in order to retain

Controversy Japanese Internment Camps Research Paper

Controversy Japanese Internment Camps - Research Paper Example were not included in these camps (Joy, p104). The President of United Stated Franklin D. Roosevelt declared war with Japan on December 7, 1941 after the Japan’s attack on the Pearl Harbour. After this declaration situation became worst for the Japanese living in the United Stated and most of them had to go through extremely tough time that they had never thought about. The President allowed the removal of all the Japanese from their homes to the guarded camps established in the interior part of the country. In this way the Japanese living in United States had to pay very heavy cost of Japanese attack on Pearl Harbour and getting United States involved in the war (Karen, p183). During this process, over 120,000 Japanese were taken out from their homes in United States and they were forces to leave their houses, work places, businesses and lives they were living in US. They were moved to the camps that were mostly set up in the desert areas with little facilities of life. There was no running water around the camps and the imprisoners were all time surrounded by barbed wires and guards. The establishment of these camps and moving the Japanese descents in these camps was a highly controversial step taken by the government of United States and the action started up heated and prolonged debate about the justification of the action taken by the U.S government. The government of United States put forward their stance that they had the fear of further attacks from Japan on their territory and they see the danger of presence of Japanese descent spying for Japan. They justified the establishment of camps that the step was taken to avoid the possible support provided by the Japanese American to their homeland by providing information to the Japanese or though different assets and cooperation (Nash et al, p92). Despite this justification the experts and people widely opposed the act of United Stated to detain the Japanese American in these camps and the justificatio n given by the U.S. government was also rejected. It was argues from the other side that almost two third of the interned were American citizens and half of the people kept in the camps were children. There were no evidences to prove the involvement of these people in the spying activity neither there were sign of disloyalty for America shown by these people. These camps were also criticised for providing poor living conditions to the detainees. It was reported that the people had problems in getting access to fresh water. The weather was extremely harsh and the environment of the camps was also very hostile and antagonistic. The members of the families were separated from each other and they were kept in different camps from where they found it impossible to contact their family members and reunite with them. Throughout the war there were just ten people found accused to spying for Japan and over 120,000 people were kept in the camps just because of doubt of spying and disloyalty ( Daniels et al, p54). The government of United States clarified that the step was necessary to strengthen the position of America in the war by eliminating the possibilities of spying and internal support to Japan from America but it is widely believe that it was just a cover used to justify the action and in real the step was led by racism and biasness for the Japanese Americans. The detention of Japanese Americans also became matter of

Questions to answer on Management Essay Example | Topics and Well Written Essays - 3250 words

Questions to answer on Management - Essay Example The patent right enables an individual to own the idea or invention for substantial period of time so that it can be developed sufficiently into a real invention or business. Patent rights provide protection for the idea or invention from being copied or reproduced by others. Firstly, the idea or invention has to be explained in brief through an application made to the Government Patent Office by an agent or lawyer. This will be reviewed and approved if original and new. Once the first application is approved, a date will be given to the application during which he/she can work on the idea; this date is referred to as the ‘priority date.’ Once approved, a plan for its development must be prepared and produced to the patent office for further approval within 12 months. During this period, the inventor can advertise or publish the idea. After one year, the inventor needs to produce a detailed plan for its development, which is referred to as the ‘Final Specification. ’ If this idea is completely new and does not match with any of the other patents, then it is approved. If it finds any similarities with others, it is rejected. Rejection is accompanied with sufficient explanation. The applicant can also modify it in case it resembles any other idea. If the inventor fails to abide by the confidentiality of the idea or leaks the idea in some way, the patent will be subject to cancellation. Hence, confidentiality is very important during the period when first application is sent for approval. Secondly, if the idea or invention resembles or already exists in the market, then patent rights may be rejected. Patents applied in the United Kingdom are valid only within that country. To obtain patent protection in different countries, separate patents must be filed according to the respective country’s regulations. Obtaining international patents are very expensive. However, the International Convention on Patents provides a common priority da te for all patents during which ideation and development in different countries can be prepared. One common committee governing European patents is the European Patent Office (EPO), which provides patent protection in all European countries at the same time. Hence, patents issued by the EPO are enforceable by individual nations within the European Union and few other countries that come in the purview of EPO. Moreover, the patents issued by the EPO are governed by laws related to various international committees. Patents are divided mainly into 3 categories namely utility patents, design patents, and plant patents depending upon the idea or invention. In the engineering sector, utility and design patents are more common ones. National patents issued within European countries are governed by national legislation and could include aspects related to filing the patents, examination, scope of grants, invalidation, breach and revocation. Patents obtained on methods or ideas related to pr ocedures and certain products are not same in all countries. For instance, patents approved in the United States for certain products or procedures may not be approved in the United Kingdom and other countries. Under an employment agreement, ideally all inventions that are made during the employment and related to the job during working hours and with the use of official resources are owned by the employer. Therefore, if an employee invents something related to his/her job, then the rights to that invention are with the

Private School vs Public School Essay Example for Free

Private School vs Public School Essay Many public school facilities are impressive others are mediocre. The same is true of private schools. In the public school system, the twin engines of political support and economic revenue base are critical. In private schools the ability to attract endowments and other forms of financial support are just as critical. Private school facilities reflect the success of the schools development team and that of the school to continue to generate alumni support. Some private K-12 schools have facilities and amenities which surpass those found at many colleges and universities. Hotchkiss and Andover, for example, have libraries and athletic facilities on a par with those at Brown and Cornell. They also offer academic and sports programs which make full use of all those resources. It is hard to find comparable facilities in the public sector. They are few and far between. Public schools also reflect the economic realities of their location. Wealthy suburban schools will have more amenities than inner city schools as a rule. Think Greenwich, Connecticut versus Detroit, Michigan, for example. So, who has the edge? Lets call it a draw, all things considered. Class Size: According to the NCES report Private Schools: A Brief Portrait private schools win out on this issue. Why? Most private schools have small class sizes. One of the key points of private education is individual attention. You need student to teacher ratios of 15:1 or better to achieve that goal of individual attention. On the other hand a public system has to take almost anyone who lives within its boundaries. In public schools you will generally find much larger class sizes, sometimes exceeding 35-40 students in some inner city schools. At that point teaching rapidly degenerates into babysitting. Teaching: Public sector teachers are generally better paid. Naturally compensation varies widely depending on the local economic situation. Put another way, its cheaper living in Duluth, Minnesota than it is in San Francisco. Unfortunately low starting salaries and small annual salary increases result in low teacher retention in many public school districts. Public sector benefits have historically been excellent; however, health and pension costs have risen so dramatically since 2000 that public educators will be forced to pay or pay more for their benefits. Private school compensation tends to be somewhat lower than public. Again, much depends on the school and its financial resources. One private school benefit found especially in boarding schools is housing and meals. Private school pension schemes vary widely. Many schools use major pension providers such as TIAA-CREF Both public and private schools require their teachers to be credentialed. This usually means a degree and a teaching certificate. Private schools tend to hire teachers with advanced degrees in their subject over teachers who have an education degree. Put another way, a private school hiring a Spanish teacher will want that teacher to have a degree in Spanish language and literature as opposed to an education degree with a minor in Spanish. Budgets: Since local property taxes support the bulk of public education, the annual school budget exercise is a serious fiscal and political business. In poor communities or communities which have many voters living on fixed incomes, there is precious little room to respond to budget requests within the framework of projected tax revenue. Grants from foundations and the business community are essential to creative funding. Private schools on the other hand can raise tuition, and they also can raise significant amounts of money from a variety of development activities, including annual appeals, cultivation of alumni and alumnae, and solicitation of grants from foundations and corporations. The strong allegiance to private schools by their alumni makes the chances of fund-raising success a real possibility in most cases. Administrative Support: The bigger the bureaucracy, the harder it is to get decisions made at all, much less get them made quickly. The public education system is notorious for having antiquated work rules and bloated bureaucracies. This is as a result of union contracts and host of political considerations. Private schools on the other hand generally have a lean management structure. Every dollar spent has to come from operating income and endowment income. Those resources are finite. The other difference is that private schools rarely have teacher unions to deal with. Advantages and disadvantages: There are many advantages and disadvantages to both public and private schools. As a parent, both options must be explored and the choice must be based on what is right for each particular child. Public schools often have a larger variety of subjects available, especially when it comes to electives. However, what is learned is somewhat decided by the state because public schools need to do well on standardized testing. Private schools, on the other hand, whether parochial or private have much more freedom of choice in curriculum and can choose to make their own assessments. Because of the individualized instruction, private schools tend to do generally better on standardized testing, that is, if they choose to use it. Private schools, many times, have more demanding curricula and have a higher rate of students who go on to attend college. Public schools are larger and also have larger class sizes. Public schools also have larger student-teacher ratios. According to a web site called Public School Review, Private schools average 13 students per teacher, compared with an average of 16 students per teacher in public schools (public school review). However, public schools have certified teachers. Private schools typically have teachers who are not state-certified and who may not have expertise in their subject matter. The biggest difference between public and private schools probably is that public schools are required to educate all students. They cannot deny any student admission. On the other hand, private schools have complete control about which they accept and can kick students out much more easily. Public schools are funded by tax revenue whereas private schools are funded privately. That means private schools cost money to attend called tuition. Taxpayers pay for public schools so the payment is included in what people pay. However in private schools, the payment is upfront for students to attend. Overall, there is no one right answer for which kind of school a student attends-public or private. The decision must be made for each individual student as there are advantages and disadvantages of both. Comparisons: Private school can be more beneficial than going to a public school. Private schools focus on preparing students for the next level of education; public schools are focused on test preparations sessions. Choosing the right school system for your child has a repercussion towards their future education. In the public school system the classrooms are overcrowded with students. Each class has an average of 27 to 30 students to it, which can limit the ability of one on one interaction with the teacher. A lot of the bullying issues come from the unstructured dress codes. This can create social divide to the less fortunate kids that can’t afford all the name brand items. In public school teachers are quick to say your child needs to be on medication if they are high strung, without knowing what other forms of issues might be occurring in the home. When parents try to discipline their child at home the school seems to always try to step in. Some things should be up to the parents to handle without haven to worry about the school stepping in. In the private school system when a child enters the school for the first time he or she will start out with a minimal class size with no more than 20 students. This allows more one on one time with the teacher, it also opens up more time for activities. The private school has a very strictly enforced dress code to eliminate animosity between the students. The schools are very family oriented with parents and students being involved with school activities. Teachers and parents are held to higher standards from the private schools. Teachers are expected to continue to grow and parents are obligated to maintain discipline of their children even in their absence. The testing that takes place at private schools is called Terra Nova, and kids are tested two or three times a year. Conclusion So, who comes out on top? Public schools or private schools As you can see, there are no clear-cut answers or conclusions. Public schools have their advantages and disadvantages. Private schools offer an alternative. Which works best for you? Thats the real question which you have to answer.

Rebound Tenderness in Diagnosis of Appendicitis in Children

Rebound Tenderness in Diagnosis of Appendicitis in Children Abdominal pain is a common presentation within the accident and emergency department [A+E] and specialist nurses working in this environment need to be familiar and confident in dealing with this presentation (Hibberts and Bushell 2007, Pines, Pines, Hall, Hunter, Srinivasan and Ghaemmaghami 2005). Abdominal pain can be associated with a wide variety of surgical and nonsurgical conditions, with the most prevalent cause being acute appendicitis (Lin, Chen, Chung, Ho, and Lin, 2009). The diagnosis of appendicitis is formulated from subjective and objective data including a patients history, abdominal examination, laboratory investigations and signs and symptoms. This assignment will critically analyse the clinical skill of testing for rebound tenderness and its relevance to diagnosing appendicitis in children. The clinical diagnosis of acute appendicitis in children is difficult for many practitioners (Broek, Ende, Bijnen, Breslau and Alkmaar, 2004). Between the years 2008 and 2009 the number of patients presenting to A+E within the UK who were diagnosed with appendicitis was 44,244 (NHS Information Centre, 2009). This equates to almost 0.3% of all presentations in A+E over one year. Approximately 9,300 of this population were between the ages of 0 and 14 years old (NHS Information Centre, 2009). However up to 25% of these 9,300 children with suspected appendicitis have a normal appendix at operation (Smink, Finkelstein, Garcia-Pena, Shannon, Taylor, and Fishman, 2004). Furthermore, the 25% of paediatric negative appendectomies now result in considerable clinical and economic costs to the NHS (Koepsell, 2002). These substantial figures are one of the primary reasons for specifying this assignment on children. In addition, the scope of practice within A+E covers paediatrics for many adult q ualified nurses and adult trained nurse practitioners. It is therefore imperative that the knowledge base for all A+E staff encompasses paediatrics at an advanced level as well (Cleaver, 2003). The overall accuracy for the clinical examination in diagnosing acute appendicitis has been reported to be between 54% and 70% in children (Birkhahn, Briggs, Datillo, Van Deusen and Gaeta, 2006). In addition Whisker, Luke, Hendrickse, Bowley and Lander (2009) suggest that only 4% of children have a miss-diagnosis of appendicitis in specialist paediatric centres, compared to 20% in district general hospitals. Despite the uncertainty of the diagnosis and the cost of miss-diagnosis to the NHS, appendicitis requires urgent treatment (Williams, et al., 2009). This is due to the risk of perforation, which occurs in approximately one third of cases in children (Neilson, et al., 1990). Therefore the need for a good clinical assessment at first contact in A+E is needed to provide a correct management plan and reduce on costs for the NHS. An abdominal examination should be performed where possible in a warm, well lit room with the patient well-draped and relaxed (Bickley, 2009). Initially the practitioner should undertake inspection, auscultation and percussion of the whole nine sections of the abdomen (Lippincott Williams and Wilkins, 2008). The final aspect of the abdominal examination should be palpation as this has the potential to be the most painful (Allan, 2008). Palpation is a process which should always be commenced away from the site of pain, as this will allow the patient to gain some reassurance from the practitioner and help them to relax (Bickley, 2009, Hibberts and Bushell, 2007). The practitioner should utilise the palmer surfaces of the fingers to identify any abnormal signs (Bickley, 2009). More specific palpation techniques can help to diagnose appendicitis, such as rebound tenderness (Bickley, 2009). This is performed by pressing slowly and firmly to a specific area and then withdrawing them quickly (Bickley, 2009). Practitioners should observe the patient and ask if pain was worse on pressing or letting go (Hibberts and Bushell, 2007). However, Bickley (2009) suggests that if any of the previous examinations such as light or deep palpation are positive then this should not be undertaken as it will cause undue pain for the patient. The whole process of abdominal examination in children follows the same system as in adults. However, the causes of abdominal pain in children are often different, encompassing a broad range of acute and chronic diseases (Bickley, 2009). Therefore it maybe pertinent to suggest that more emphasis should be placed special techniques such as checking for rebound tenderness rather than abdominal palpation and testing for rebound. The initial discovery and accreditation of rebound tenderness (also known as Blumbergs sign) is credited to a German surgeon called Jacob Moritz Blumberg (1873 1955). Many articles make reference to Blumbergs sign; however there appears to be no relevant literature, research or evidence base to support this surgeon was the gentleman who discovered this sign (Mantzaris, Anastassopoulos, Adamopoulos and Gardikis, 2008). A study undertaken by (Williams, et al., 2009) showed that out of 98 children who had acute appendicitis 91% had right lower quadrant tenderness on palpation however only 30% had rebound tenderness. Another study by Lin, Chen, Chung, Ho, and Lin (2009) also suggested that 43.4% of the 53 children examined with appendicitis had rebound tenderness. So both these studies suggest that positive rebound tenderness is an indication of an acute appendicitis in children and therefore cannot be ruled out of an initial differential diagnosis. Golledge, Toms, Franklin, Scriven and Galland (1996) specifically evaluated the â€Å"cats eye symptom† (pain going over a bump in the road), the cough sign, right lower quadrant pain to percussion, rebound tenderness and guarding. The data from this evaluation suggested that rebound tenderness had a likelihood ratio of 7.4 compared to the other signs which had likelihood ratios of between 1.1 and 4.1. This data therefore suggests that rebound tenderness is a very useful sign in the diagnosis of acute appendicitis, but that the other signs and symptoms are not (Moyer, et al., 2001). Overall rebound tenderness is useful sign for diagnosing appendicitis when there is a high suspicion of appendicitis and is accompanied with other diagnostic indicators (Moyer, et al., 2001). Another presentation to be considered in relation to abdominal pain and rebound tenderness is the duration of the pain experienced by the child. A study undertaken by Oshea, Bishop, Alario and Cooper (1988) involved 246 children from 13 to 18 years old who presented to the emergency department with a history of less than one week of abdominal pain. Results showed that the likelihood ratio of pain was greater when the child had the pain for more than 12 hours (Likelihood ratio: 1.3) compared to less than 12 hours (Likelihood ratio: 0.64). Later in the study pain duration was evaluated at less than 24 hours and more than 24 hours, with their likelihood ratios being 0.83 and 1.2 respectively. When compared to Andersson, et al. (1999) study of 502 patients aged 10 to 86 the greatest likelihood ratio was 1.7 at 7-12 hours after onset of pain. Based on both studies it is very difficult to see how duration of pain can lead to the diagnosis of appendicitis. Therefore, practitioners must not allow the duration of pain to prevent any further investigation into the diagnosis (Moyer, et al., 2001). Another symptom which could possibly indicate the diagnosis of appendicitis is fever (Gwynn, 2001). Cardall, Glasser and Gusss (2004) study evaluated two hundred and ninety three people aged between 7 and 75 who presented to the emergency department with suspected appendicitis. Temperatures were classed at greater than 99oF or less than 99oF. The study showed that 27% of patients whos temperature was 99oF. When the results were analysed in terms of specific temperature intervals, the highest likelihood ratio (3.18) was found in patients with temperatures greater than 102  °F. However, Bergerons (2006) study on clinical judgement suggests there is no clinical value with temperature as there is minimal sensitivity and specificity in the diagnosis of appendicitis. Therefore, as with duration of pain duration and levels of WBCC, temperature as a single entity has little diagnostic utility in the diagnosis of appendicitis unless it is combined with other signs and symptoms such as rebou nd tenderness (Cardall, Glasser and Guss, 2004). For many years laboratory tests such as white blood cell count (WBCC) leukocytes and C-reactive protein (CRP) have been used to support a diagnosis, but the considerable overlap with other inflammatory conditions accounts for the low specificity and positive predictive value of these tests (Stefanutti, Ghirardo and Gamba, 2007). Recent studies on adult patients who present with clinical signs and symptoms indicating acute appendicitis, show that appendicitis can be excluded if both leukocyte count and C-reactive protein value are normal (Gronroos, 2001). However, Stefanutti, Ghirardo and Gamba, (2007) suggest that only a few studies have been reported in paediatric patients and the role of WBCC and CRP in excluding acute appendicitis in children has not been confirmed. According to Andersson et al. (1999) children who present with signs and symptoms of appendicitis such as rebound tenderness and have a WBCC of 15000 only moderately increases the estimated risk of appendicitis. This t herefore shows that only at the extremes of the WBCC does this diagnostic indicator appear useful (Moyer, et al., 2001). Therefore, contrary to adult patients, normal leukocyte count, WBCC and CRP value cannot effectively exclude acute appendicitis in children. Another usual predictor of appendicitis is vomiting (Bergeron, Richer, Gharib and Giard, 1999). The study by Andersson et al. (1999) calculated the likelihood ratio for appendicitis in a patient with vomiting compared to one with no vomiting to be 1.8. In addition Reynolds and Jaffe (1992) study suggests that a combination of four predictors including; vomiting right lower quadrant pain, abdominal tenderness, and abdominal guarding. More specifically 97% of the 377 children studied who were diagnosed with appendicitis had two or more of these predictors. Therefore, a patient who presents to A+E with less than two of the above predictors is quite unlikely to have appendicitis. Alvarado (1986) conducted a retrospective study of 305 patients hospitalised with abdominal pain suggestive of acute appendicitis. Signs, symptoms, and laboratory findings were analysed for specificity, sensitivity, predictive value, and joint probability.Their importance, according to their diagnostic weight, was determined as follows: localized tenderness in the right lower quadrant, leukocytosis, migration of pain, shift to the left, temperature elevation, nausea-vomiting, anorexia-acetone, and direct rebound pain (Alvarado, 1986). This scoring system shown below is deemed by many surgeons as an easy aid for supporting the diagnosis of acute appendicitis (Khan and Rehman, 2005). A study undertaken by Baidya, Rodrigues, Rao and Khan (2007) investigated the diagnostic accuracy of Alvarado scoring system. The results showed that a score of >7 for an appendicitis was 88.2% correct in diagnosis. However, the diagnostic accuracy of an Alvarado score Despite recent advances in knowledge and diagnostic investigations, a population-based analysis in the United States found that the incidence of unnecessary appendectomy has not changed (Flum, Morris and Koepsell, 2001). Therefore to increase diagnostic accuracy, new modalities such as ultrasound scans have been introduced (Broek, Ende, Bijnen, Breslau and Alkmaar, 2004). Kaneko and Tsuda (2004) conducted a 10-year study using ultrasound scans to diagnose appendicitis in children and are convinced that ultrasound scans can identify inflamed appendices with 100% sensitivity and can also determine the severity as well. However Smink, Finkelstein, Garcia-Pena, Shannon, Taylor and Fishman (2004) suggest that the use of ultrasound has not decreased negative appendectomies as similar negative rates were present over a decade ago. Therefore on the basis of the available evidence, patients presenting to A+E with a strong clinical case of appendicitis should be referred direct to the surgeon without an ultrasound. In addition to the use of ultrasound scanning the use of computed tomography (CT) has been recently studied and evaluated. There are currently two perspectives in the literature regarding the use of CT scan for the diagnosis of acute appendicitis: one supporting its routine use due to the decreased incidence of negative appendectomies, and the other one against its routine use due to the increased cost and delay in surgical management (Ceydel, Lavotshkin, Yu and Wise, 2006). In addition the benefits of imaging eliminating inpatient observation and unnecessary surgery must be weighed against the malignancy risk from radiation, as well as discomfort of rectal contrast administration (Smink, Finkelstein, Garcia-Pena, Shannon, Taylor and Fishman, 2004). Ceydel, Lavotshkin, Yu and Wises (2006) retrospective study showed that the negative appendectomy rate was much less in patients who had CT scans (7.6%) compared to the non CT scan group (24%). Therefore clinicians within A+E use their cl inical judgement and place emphasis on the importance of routine history and an accurate physical examination utilising CT scans for atypical cases of acute appendicitis (Gwynn, 2001). Currently within the A+E department there is no specific pathway or tool for ruling in acute appendicitis in paediatrics. In addition Birkhahn, Briggs, Datillo, Van Deusen and Gaeta (2006) suggest that no major medical association or professional organisation currently endorses a standardised pathway for the evaluation of patients with suspected appendicitis. With up to 25 % of children having negative appendectomies it is therefore of clinical and financial value to consider the use of a scoring system to admit or discharge children who present with a possible acute appendicitis. Current systems are in place for other potential conditions such as myocardial infarctions, pancreatitis and pneumonia. These other systems have been audited locally and nationally and are currently working well within the trust, therefore the plans to introduce the Alvarado scoring system will be put forward in the next review of clinical practice meeting between nursing and medical staff. To conclude, this assignment demonstrates that for an emergency department practitioner in a fast paced A+E setting, the accurate diagnosis of acute appendicitis remains a challenge for the paediatric age group. An accurate history and physical examination, which as highlighted can be challenge in younger patients plays an important role in the diagnosis of early acute appendicitis (Mallick, 2008). Physical clinical signs elicited upon examination provide the practitioner with a good insight to expected diagnosis. However, the usefulness of rebound tenderness as a single examination has minimal clinical value. The whole patient picture which encompasses an accurate history, clinical examination, laboratory investigations and possible diagnostic imaging is therefore vital to providing a correct diagnosis. The use of clinical scoring systems like the Alvarado score can be a cheap and quick tool to apply in emergency departments to rule in acute appendicitis. This scoring system includes many aspects such as clinical history, rebound tenderness and laboratory investigations. This allows for observation and critical re-evaluation of the evolving clinical picture. Its application improves the overall diagnostic accuracy and consequently reduces negative appendectomies (Khan and Rehman, 2005). In clinical cases where the practitioner is unsure if the actual diagnosis is acute appendicitis other diagnostic imaging studies such as ultrasound and CT may be undertaken. 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