Quality Nursing Care Essay Example | Topics and Well Written Essays - 2000 words

Quality Nursing Care - Essay Example She was Madeleine Leininger who was among the first graduate to gain doctorate degree in anthropology and she thought to add new dimension to nursing by introducing culture relevant caring technique which was introduced as a concept and later mature into a specialized domain in nursing and known to be as transcultural nursing. "A substantive area of study and practice focused on comparative cultural care (caring) values, beliefs and practices of individuals or groups of similar or different cultures. Transcultural nursling's goal is to provide culture specific and universal nursing care practices for the health and well-being of people or to help them face unfavorable human conditions, illness or death in culturally meaningful ways" Culture and care has been associated in nursing in transcultural setting where care is provided with accordance to person's culture. Care according to Leininger is termed as a powerful and dynamic force to understand the totality of human behavior in health and sickness (p 2). According to Leininger "Caring is also attributed to actions, attitudes and practices to assist or help others toward healing and wellbeing" (p 5) Culture on the other hand is the "broadest, most comprehensive, holistic and universal feature of human being which comprises of the learned, shared, and transmitted values, beliefs, norms, and life ways of a particular culture that guides thinking, decisions, and actions in patterned ways and often intergenerationally" (Leininger, p 6). Leininger thought that having no cultural knowledge was affecting the quality of nursing actions and decisions. So nursing in transcultural setting is reliant on the knowledge about the patient's culture and cultural attributes. Transcultural nurses are train to work in diverse culture and to identify unknown or misunderstood cultures factors and influencers which affect caring actions and decisions. Sharon Murphy quotes that transcultural studies comprises of care symbol, expressions and meanings and their research is basically studying cultural care and health concern. Leininger also presented a theory called as "The Culture Care Theory". This theory presented the interdependency between culture and care and emphasized that culture relevant care helps to improve the helping technique use to facilitate patient in the course of their recovery. Some major construct of Leininger's theory are firstly the interdependency between culture and care, secondly the theories and models are unknown blurred truth and expressions in a culture and are pictorial diagram showing some concept but lack the relationship among them respectively. Thirdly the theory is open to discovery of unknown ideas previously unknown or indistinctive related to cultural care experience of human health and welfare. Fourthly the theory encourages ascertaining various aspect of culture and care in naturalistic manner in similar or different environmental context. Fifth is a new technique of discovery such cultural values and expressions which is Ethnonursing method and it is define by Leininger as "an

Time and Happiness Essay Example for Free

Time and Happiness Essay Good morning everyone. The topic I have chosen is WHAT IS HAPPINESS. Nowadays, many people think money can buy happiness so that they will work over ten hours to earn more money. They think that if we are rich then, we can do anything such as buy a fat dog, a big house, a grand car or many luxurious things LV bag, DOIR shoe and so on. It cannot be denied that material life is happiness because you can buy the things you want but I think material life can only give me happiness for a short period of time which is external happiness. I think cultural life can give you a long term happiness and this is happiness from heart. There are three simple ways of gaining happiness that I would like to mention about. First of all, good relationship with friends and family are the main points to become happiness. The reason is I can get more love and sense of care from them . When I feel unhappy or I am in a problem, they are the ones who help me solve the problem and give me support all the time. Although they have never tried to make me happy by buying me some expensive things such as i-phone, i-pad, I can never doubt in their support and love for me†¦and that feeling is what makes me happy. Therefore, I love my family and friends and I am very proud to say that I have a very good relationship with them. The next point that I want to focus on is my dream because self-realization can let me gain pursuit of eternal value. I have some small goals as well as some big, I will never let go of these dreams that I have been dreaming of.. In spite of all the difficulties that I will have to face during this phase, I will try my best to enjoy them and tackle them because these steps can let me know and learn how to be mature and independent. Therefore, the pursuit of eternal value will be eternal happiness. The last thing that gives me happiness is helping the needy people. The reason is I can get more meaningful and wonderful time in my busy life. Undeniably, volunteer can not earn money or waste time but I do not think so. When I help the needy people, I will earn more naive and satisfaction in their possession. And I think, for me this is happiness†¦Getting to help others and doing some good deeds To conclude, good relationship of friendship and family, achieving my dream and helping others are the main three points that gives me the exact meaning of happiness. These things not only give me a long term happiness , but also gives me the satisfaction and the feeling of happiness from heart. You see, these are not the material things. I can say the simple cultural life is happiness in my heart because I know ‘Happy is he who is content’. I hope that you can find the right meaning of happiness in Your Life. Thank You!

A Review Of Literature: Bullying Effects

A Review Of Literature: Bullying Effects In this section of my thesis I reviewed articles thematically. Bond, Carlin, Thomas, Rubin, and Patton (2001) establish a relationship between repeated peer bullying and the indication of anxiety and depression in early teen years. A cohort study over a two-year period was done in Victoria, Australia. The participants were 2,680 students surveyed twice in 8th grade and once in 9th grade. Students completed a survey at school via laptop computers supplied by the researchers. Overall surveys took about 40 minutes to complete (Bond et al., 2001). Reported victimization on the first survey was 49%, 51% on the second, and 42% on the third survey. The respondents reported the following: (a) 33% reported recurrent victimization, (b) 33% indicated being bullied at one time, and (c) 33% reported not ever being bullied. The frequency of stated anxiety and depression at all three survey points were as follows: First point 16%, second point 18%, and third point 15% (Bond et al., 2001). Bond et al. (2001) found evidence that past events of victimization and reduced social interaction foresees the start of emotional problems. Prior recurring emotional problems are not notably related to impending victimization. These results have proposition for how important the occurrence of victimization is cared for and for the motivation of intervention programs focusing on mental health problems and bullying (Bond et al., 2001). Bond et al. (2001) concluded there is a strong connection between victimization and indications of depression and anxiety. Results confirmed the reasons for indication of anxiety or depression is a result of a history of victimization. Therefore, poor social relationships with peers and a history of victimization lead to problems in adolescents (Bond et al., 2001). In a quantitative research study Peterson and Ray (2006), worked together to research if gifted children were especially vulnerable to being bullied. The quantitative analysis was used to find the frequency and influence bullying has on gifted students. There were two surveys done one of which there were 432 participants who were gifted eighth graders in 11 states, these students were given verbal questionnaires inquiring if they had encountered bullying behavior, such as name-calling, pushing, hitting and other physical violence, or teasing about family, grades or appearance (Peterson Ray, 2006, p. 155). The results of the first survey are as follows: The researchers found 67 % of gifted students had encountered bullying by eighth grade, 16 % defined themselves as bullies and 29 % had aggressive ideation. Interviewed participants identified unexpressed violence, depression, and missing days of school as a reaction to bullying. Teasing about appearance, intelligence and grades, name-calling, and pushing and shoving are the most frequent kind of bullying throughout the first nine years of school. Mocking students about appearance had the most damaging outcome psychologically (Peterson Ray, 2006). The second survey was done on 57-bullied students throughout six states who were mailed individual surveys that conducted in-depth follow up questions. The quantitative survey consists of four questions: (a) having been bullied, (b) has been a bully, (c) thinking of being violent, and (d) done any violence. The results of the take home survey found males were most likely to be the bullies, be bullied, think violently, and conduct violence over females (Peterson Ray, 2006). Peterson et al. (2006) concluded by noting bullying appears to be a problem with gifted children and adolescents. Evidence is concerned with the escalation in bullying from middle school going to high school and carrying it on to adolescents. Even though after the sixth grade the name-calling and teasing go away, much stronger and violent bullying accrues (Peterson Ray, 2006). In a quantitative research study, Voss and Mulligan (2000) worked together to find out if short pupils are at risk for being bullied. There were 92 short normal teenagers who were under the 3rd percentile height at school admission. Also, taking part in this study was 117Â  controls equivalent for gender and age that completed the bullying survey. Throughout the bullying survey the study confirmed there was no major gender or social class distinction between the groups. The majority of the ages were around 14 years old and their height was around four to five feet. More short students informed they were bullied at some time in middle school more so than the controls. The study has revealed that shorter boys are more than twice as likely to be victims of bullying then as for the control boys. Bullying also saddens shorter boys much more than control boys. In many of the cases bullying had stopped, but significantly more short pupils than controls, regardless to sex, reported current bullying (Voss Mulligan, 2000, Subjects, Methods, and Results section, Â ¶ 1). Voss and Mulligan (2000) concluded by stating bullying is happening in schools and is harmful to the victims. Generally, victims stated to be more vulnerable than their bullies. This would imply very short students are less likely to be the attacker and more likely to be the victims. The growth study allowed them to observe the occurrence of bullying, as experienced or perpetrated by pupils of different heights (Voss Mulligan, 2000, Comment section, Â ¶ 1). According to Yoneyama Rigby (2006) bullying behavior has an effect on the students perception of the school environment. Research has shown that lesser quantities of bullying behavior are found in schools with a positive school environment. It was hypothesized that judgments of classroom climate would be less positive among students who were identified as (a) bullies, (b) victims, and (c) bully-victims than others who are not involved in bully/victim problems (Yoneyama Rigby, p.36). There was three different questionnaires developed using the following measures: (a) the school climate scale, (b) the victimization scale and (c) the bullying scale. The questionnaires were given to 531 students attending grades eight and nine in Australia. The subjects were taken from five different schools. Average age of the subjects was 14.1 years, for males and 13.9 years for females. In this study, students were only allowed to participate with their parents permission (Yoneyama Rigby, 2006). The average score obtained by Yoneyama Rigby (2006) suggests that the observed school/classroom environment was not negative at the five schools used in the study. The female students rated the classroom climate more positive than the male students. The male students were more likely to be involved in bullying than the females. The male students were also reported to have been involved in more bully/victim problems than the females. Yoneyama Rigby (2006) concluded that students who are involved in some sort of bully/victim problem have a less positive view of the school climate than those students that had no involvement in bullying. The results show that there may be a link between the perception of the classroom climate and student learning. It seems likely that the negative perceptions of school climate that are characteristic of students involved in bully/victim problems may serve to hinder their learning and to disadvantage them academically(Yoneyama Rigby, 2006, p.40). Entenman, Murnen, Hendricks (2005-2006) investigate how bullies and bullying actions are showed in K-3 childrens books published from 1995-2003 and how teachers can utilize these books to inform students about bulling in their classrooms. In the study, 25 books about bullying were selected based upon the criteria set by Jalongo (1983). A subject study was performed on each book to identify the behavior of the bully. The behaviors were broken into different categories: (a) physical intimidation, (b) name-calling, (c) stealing, (d) verbal intimidation, and (e) teasing (Entenamn et al., 2005-2006). The reviewed childrens books showed the roles of the bully, the bystander and the importance of adult involvement when bullying takes place. Entenman, et al. (2005-2006) suggests the teacher can take part in a big job by stopping the actions of the bully early on before the behavior has the opportunity to become part of the childs everyday life. It is significant to communicate that the victim in each of the stories used was capable of rising above the problem and get back their self-confidence by the end of the book, with the help of an adult (Entenman et al., 2005-2006). Research has shown that childrens literature is an effective way to help children resolve problems. Using these books in the classroom is one way teachers can help reduce bullying and discourage bullying behavior. The primary goal of this study has been to give the teachers a list of books that they may be able to use in their classrooms when bullying occurs. Entenman, et al. (2005) inquires about the correlation of labeling a student as a bully at an early age and the ramification of victim blaming and the schools role. The only way to answer these questions is with more research on the subject of bullying and its impact on children (Entenman et al. 2005-2006),. Salmon and James (1998) used a quantitative methodology to examine the psychological health issues of students being bullied. This study assessed: (a) indication of anxiety and depression in bullied students, (b) self esteem in bullied students and students that were not bullied; and (c) self esteem for both bullies and those who were not bullies. Four questionnaires were anonymously completed by the 904 participants aged 12-17. Two secondary schools were used for this study. The first school is in a low income area. The second school is in a high social class area (Salmon James, 1998). Salmon and James (1998) found that boys aged 12-13 with high anxiety and lying scores were most likely to be bullied at the low income school. Boys aged 15-16 with low anxiety and lying scores and high depression scores were most likely to be bullies at the high social class school. Girls ages 13-14 in the advantaged school with low anxiety and lying scores were least likely to be bullied. Girls aged 12-13 with high anxiety and lying scores and low depression were least likely to be bullies (Salmon and James, 1998, Subjects, Methods, and Results section, Â ¶ 2). The study concludes that the low occurrence of bulling may show the value of bullying intervention programs already implemented at the two schools that were assessed. A new finding from this study is the link connecting an excessive depression score and being a bully (Salmon James, 1998). Bishop JH, Bishop M, Bishop M, Gelbwasser, Green, Peterson, Rubinstaj, and Zuckerman (2004) explore the relationship between study behavior and academic engagement of individual students, the norms and attitudes of close friends, and the peer culture of school. The study is particularly interested in how the academic orientation of students and their close friends invites or protects them from harassment (Bishop et al., 2004, p.236). A qualitative research design was used. The participants were from eight New York State suburban high schools. Surveys were done by 35,000 students at 134 schools and information was examined. Interviews and respondents were matched on gender (Bishop et al., 2004). The study found harassment and bullying are directed toward students who are rejected by their classmates. Surveys conducted in 1998 and 1999 found that 13.1% of boys and 6.7% of girls were teased, insulted, or made fun of almost everyday. Another 19.5% of boys and 13.3% of girls were insulted to their face about once a week (Bishop et al., 2004, p. 237). Male outcasts are usually harassed in front of others. Certain types of achievement: (a) athletic, (b) funny, (c) friendly, (d) popular, and (e) attractive are better in the eyes of students classmates. However, for academics, a slightly above average rank of school effort and accomplishment is the norm. One is approved for going beyond it. Students feel that if a peer is smart they are lucky. Students describe nerds as asking a lot of questions and not having fun in their spare time (Bishop et al., 2004). Bishop, et al (2004) found that harassing students poison the school climate teachers attempt to create. To many students at the primary school level, nerds demonstrate that the teacher should be expected to help learn. The secondary school students are saying to them that reliance on teachers is babyish. Schools need to represent the position that school is always about learning and getting an education, and students are suppose to work hard. Schools with the most commanding teachers indicate considerably lower levels of student harassment; students studied together more often, were more occupied in class, and finished homework on a daily bases (Bishop et al., 2004). In an article written by Brown University (2006) it indicates children at elementary school level are involved in bullying either by being the bully or being the victim due to being sad, not belonging, or feeling unsafe. This study was carried out in a West coast urban public school district. There were 3,530 students from grades three through five with an average age of 9.6 years who took part in a thirty-seven questionnaire survey. Survey results showed that 22% stated they took part in bullying as both a victim or as the bully. From the 22% being involved with bullying 6% reported always being bullied, 14% reported bullying others, and 2% reported being the bully as well as being a victim. This study done by Brown University (2006) also indicates 71% of students surveyed state the playground is the most common place where bullying happens (Brown University, 2006, p. 4). Brown, Birch, and Kancherla (2005) wanted to understand the behavior of bullies by searching for the viewpoint of young children, to determine if they thought of bullying as a problem. They wanted to know what the children would do if they were bullied and what they did when they witnessed someone being bullied. One thousand two hundred twenty-nine children between the ages of 9 and 13 were sampled. The students were from seven different states, and 31 different schools. Students could only participate in this study if they got permission from their parents (Brown et al., 2005). Students were given a variety of closed end questions with anonymity being protected. The questions consisted of two demographic questions and eight questions on their individual experiences with bullying. The results of the data collection were compared using a chi-square analysis. One third said they had been bullied once in a while, another 15% admitted to being bullied weekly. Six out of seven said they were never afraid of going back to school as a result of bullying. One half of the students respond to bullying by fighting back and only 8% said they try to talk it out. One fourth of the students believe bullying to be cool. Over 40% of students admitted to bullying at some point in their life with only one in five frequently bullying, more than once a week. The study concludes although boys indicate being victims of more every day bullying, the girls were more likely to inform a teacher (Brown et al., 2005). The student responses seem to be consistent, that is, if the student is bullied and tries to talk to a bully they will usually step in and help another student who is being bullied. The same goes for the opposite, students who fight back when they are bullied tend to be involved during other bullying incidents. In almost every category, according to the student addressing the issue through lesson is the least effective way to stop bullying. This dichotomy of victims may point to the need to customize anti-bullying campaigns. Specifically, victim-bullies need to understand the difference between what they perceive as self-defense and bullying (Brown, Birch, Kancherla, 2005, p.390). Chapell, Hasselman, Kitchin, Lomon, MacIver, and Sarullo (2004) conducted a study of 119 undergraduates from an eastern university and discovered students who were bullies or were a bully-victim in elementary school and/or high school were also bullies or bully-victims in college. This study found there is more bullying in elementary schools than in high schools. At the elementary school level the bullying rate is at 14% and by the end of high school that rate drops down to 2%. According to the study those students who were bullied in elementary and high school experienced more verbal bullying than social bullying or physical bullying (Chapell et al., 2004). A study of 154 5th-grade students in a rural area in Georgia was conducted by Pellegrini, Bartini, and Brooks (1999) to find the factors linking the group connection and victimization in early teenage years. The participants were given a class list and the researchers requested participants to put their classmates in categories of whom they were friends with, who they liked the most, and who they liked the least. This study concluded bullies tend to group with other bullies due to their aggressive behavior toward others. Pellegrini, et al. (1999) also concluded victims of bullying tend to be friends with other victims. Bullies tend to have a positive view on bullying and victims have a negative view on bullying; which allows each group to become friends due to having the same view about bullying (Pellegrini et al., 1999). Pellegrini, et al. (1999) also distributed Olweuss Senior Questionaire to each participant. The questionnaire asked the participants five items about bullying other students, nine items about experience to direct and indirect victimization, and three items about individuals negative attitude toward bullying. Next the students were put into three groups; bullies, victims, and aggressive victims. Out of these participants 14% were put in the bullies group, 18% in the victims group, and 5% were aggressive victims. In this study bully results connected to anger and temperament. It was found that the leaders of the bully groups are those who use anger successfully. They also seem to validate their negative actions by having positive attitudes toward bullying. As for the victims group they do not support the use of anger to get things done. However, they may use proactive anger as a reaction to being bullied. This is an adaptive strategy used commonly among victims. These outcomes are also consistent with intervention work, if students in schools do not accept bullying rates of victimization decline (Pellegrini, et al., 1999). Dake, Price, and Telljohann (2003) explore the occurrence of school bullying actions and examine the connection between bullying and academic problems. The responsibility of school staff in bulling prevention is also explored. A quantitative research design was used in diverse settings, including Norway, Sweden, Denmark, Finland, Germany, Spain, Scotland, Austria, Japan, Canada, and the United States. The participants are all elementary school students in grades one through five. The frequency of victimization varies from a low of 11.3% in a sample of 5,813 students in Finland to a high of 49.8% in a nationwide sample (7,290) of students in Ireland. In the Unites States the estimated amount of students being bullied is 19% (Dake et al., 2003, p. 173). Studies agree a connection between bullying and academic performance exists but studies are not coherent in their results. A British study of children ages 8-13 found a harmful relationship between being bullied and the level of scholastic ability. The same study also showed a harmful relationship between children who bully and the level of scholastic ability. For the British both bullies and their victims demonstrated poorer scholastic ability. A comparable age study of children from the United States found victims and bullies suffered lower academic aptitude. Other school associated issues such as school changes (doing well in class, following school policies, completing homework) and school connection (getting good grades, being content at school, realizing school is serious). Students involved in school bulling had low levels of school adjustment and school bonding. The bullied were affected more than the bullies. Bullies were 2.1 times more likely to feel separated from school t han those not involved with bullying (Dake et al., 2003). In Pattersons (2005) article they define bullying for primary school children as when people are mean to someone or hurt them on purpose (Patterson, 2005, p. 27). This article brings a variety of other studies into his article. Collins et al. (2004) describes different types of bullying such as; physical bullying can be shoving, kicking, or hitting and direct verbal bullying includes spreading rumors, social exclusion, and telling tales (Patterson, 2005, p. 27). Royal College of Psychiatrists suggests 1 in 4 primary students are bullied (Patterson, 2005, p. 27). While Aggelton et al. (2000) says between 5% and 10% of children experience long-term persistent bullying which actively interferes with their mental health (Patterson, 2005, p. 27). Pattersons (2005) article continues on to say in the study done by Karstadt and Woods (1999) they indication a connection between mental health issues and bullying, with children often experience lowered self-esteem and depression. Thompson et al. (2002) suggest bullies experience more negative feelings and thoughts about themselves than their peers (Patterson, 2005, p. 28). For example: The bully may have problems of their own, maybe they will get bullied themselves, they are scared of getting picked on, they want to brag and seem strong, or many do not like themselves and so they pick on others. Kumpulainen and Rasanen (2000) state later in life children who have bullied remain troubled and they may be violent with criminal behaviors and convictions (Patterson, 2005). Greens (2007) research states statistics about students who committed suicide due to being bullied at school. This was from a studied done by Greenbaum (1991). The study states in Norway in 1984 three middle school students committed suicide after being bullied by classmates. In another study done by Barone (1997) the Japanese government reported a 13 year old hung himself after being bullied by classmates and gang members in his school and neighborhood (Green, 2007, p. 333). In Littleton, Colorado in 1999 two students committed suicide after killing 13, because they too had been victims of bullying (also known as the Columbine shooting) (Green, 2007). Dulmus, Sowers, and Theriot (2006) hypothesize a better understanding of the bully-victim, victims, and rural school bullying will be obtained from this study. The knowledge gained from this study will guide future studies as well as school or community based intervention programs to help the victims of bullying. The subjects studied were 192 primary and secondary school students from three different rural areas. The area of this study is severely poverty stricken. Nearly 43-61% of the participants get free or reduced lunch programs and about 12% do not even have a telephone in their homes. The student population is 98% Caucasian. Parent consent forms were signed before the study took place (Dulmus et al., 2006). The students completed an Olweus Bully/Victim Questionnaire was designed for students grade three to ten. The questionnaire consists of 56 questions pertaining to perceptions, observations, and participations about different aspects of bullying in their school. Dulmus, et al. (2006) states for this study any student who reports experiencing any of the bullying behaviors at least two to three times a month is classified as a victim. The results read using chi-square and multivariate analysis of variance (MANOVA) tests. Of 192 children in this study, 82 have experienced some type of bullying at least two to three times a month during the three months prior to data collection, including 60 victims. The other 22 victims meet criteria to be both bullied and a bully, or a bully-victim. This group is 11.5 percent of the total sample or 27% of the victim sub sample (Dulmus et al., 2006, p. 21). School-based intervention programs are an important feature that will be needed to counteract the bullying in the schools. According to Dulmus et al. (2006) participants who are victimized are more terrified of bullying. Forty to fifty percent of the participants state educators do little or nothing at all to offset the bullying in the schools. The study concluded future research needs to be conducted in order for victims needs to be met (Dulmus et al., 2006). Anti-Bullying Programs Dake, Price, and Telljohann (2003) found intervention of school bulling needs to become the number one concern. Peer intervention programs to decrease bulling have had modest results. The best approach to have is for the whole school to participate. The whole school participation would combine multiple activities to decrease bullying. To assist schools in the United States to determine what method of bully prevention works best, more studies need to be completed (Dake et al., 2003). In a study done by Siris and Osterman (2004) a group of elementary school teachers decide to do an action research in their classrooms school wide. These teachers noticed the victims of bullying in their school differed from their peers by looks, culture background, clothing, or actions. These victims tend to be lonely and insecure. The teachers study their classes for three weeks and identified conditions in which students picked for the study that experienced a sense of belonging, capability, and independence. The teachers began to pay more attention to students that were victims and ask the students more personal questions throughout the week for instance: What did you have for dinner last night or what do you do for fun (Siris et al., 2004, p. 290)? This action research concluded once the teachers started to pay more attention to these students and giving positive reinforcement they felt better about themselves, they were happier, enjoyed coming to school, and other students trea ted them better. An anti-bullying program could be as little as paying more attention to victims of bullying and giving them positive feedback by teachers (Siris et al., 2004). According to Whitted and Dupper, (2005), some of the best practices for preventing or reducing the prevalence of bullying within schools are as follows: (a) school-level interventions, (b) classroom-level interventions and (c) student-level interventions. A school-level intervention develops classroom and school wide rules prohibiting bullying and promote modeling of respectful and nonviolent behavior. (Whitted Dupper, p. 169). The message of bullying will be taken seriously is the message that needs to be sent. The bully must know bullying will not be tolerated; this idea must come directly from the principal and be followed through by the administration and teachers. Having a written policy in the school community with a clear definition of what bullying is and the procedures to report incidents is an integral part of the plan. Parents must be encouraged to report if they suspect their child being bullied or being a bully. According to this study (as cited in Rigby, 1995) an evalu ation will increase school staff awareness about the characteristics, popularity, and consequences of bullying. After the needs assessment the coordination of a committee should take place states Whitted and Dupper. The committee should arrange to improve the supervision in the sections of the school that lack it and bullying usually occurs (Whitted Dupper, 2005). Classroom level involvement includes educators integrating bullying prevention materials into the curriculum, and holding classroom meetings to discuss bullying. Involving students in creating and implementing classroom rules against bullying and discussing the importance of bystanders in stopping bullying are two interventions discussed by Whitted and Dupper (2005). This study states (as cited in Rigby, 1995) programs instructing bystanders to notice and report bullying have the biggest influence on reducing bullying (Whitted Dupper, 2005). Garrity, Jens, Porter, Sager, and Short-Camilli (2004) give positive feedback on an anti-bullying program good for schools to use. The program is called Bully Proofing Your School. Throughout the article it does give some interesting statistics about bullies. One statistic is that children who are recognized as a bully by the age of eight are six times more likely than non-bullies to be found guilty of a criminal actions by the age of 24. The second statistic is by age 30 students who were bullies are five times as more probable to have a serious criminal record. It states several times in the article anti-bullying programs are best effective the earlier they are started in childrens education. The study indicates by the time aggressive students reach middle and high school, thought patterns and maladaptive behaviors have solidified into habit, often rendering intervention extremely problematic (Garrity et al., 2004, p. 186). This study also cites another study from Hoover and Oliver (1996) as saying educators need a minimum of 20 hours of instruction to be taught on how to intervene and instruct students with troubled and troubling behaviors (Garrity et al., 2004, p. 186). The article goes further into depth of what comes with the Bully-Proofing Your School program and how each item or manual is effective. Garrity et al. (2004) suggests for this program to work schools should utilize their administrators, teachers, specialists, and behavioral teams to implement the program. The program provides training for schools and parents who choose to utilize it (Garrity et al., 2004). Greens (2007) research discusses a variety of different studies and how important it is to implement an anti-bullying program into schools world wide. Interventions have promising benefits and should be used more often by schools. Some benefits from intervention is students will feel safer at the school they attend, bullies will benefit because several studies show if left alone they show social failure and failure in academics, and if nothing is done to stop bullying it can escalate to more serious violence. According to the article some tips to prevent bullying at schools from another study by Hazler, Hoover, and Oliver (1993) is that bullying does exist and that all school personnel understand this problem. Administrators next step is to train their staff on the steps they must take to handle bullying. Finally, there needs to be a familiar comprehensive plan for the members of the entire staff can follow with ease. Green (2007) quotes, When we listen to our students, we can bring our perception of bullying closer to reality (Green, 2007, p. 336). The Olweus Bullying Prevention Program (1994) is an anti-bullying program intended for ages 6-15 years old. The efforts of this program are aimed at improving peer relationships and making the school environment a safe place to learn. In this intervention all students take part with the students who bully or victims receiving additional help. The program first identifies some of the risk factors of bullying. The Bullying Prevention Program includes the following approaches: information sharing, counseling, behavior modifications, parent training classes, and in school curriculum. Each part is as important as the next in successfully implementing this program (Olweus, 1994). This study goes on to state nine positive remarks about his program; which was evaluated by 2500 students from grades four through seven in Bergen. Here are some of the positive feedbacks from the results of the study: Classes agreed that they show a de

Accounting Essay -- GCSE Business Marketing Coursework

Accounting Accounting is a career that offers many job opportunities and advancements, and a little hard work will inevitably lead to happiness and success. Accountants have different duties depending on the size and nature of the company where they are employed. Usually accountants prepare and analyze financial reports that polish up-to-date information for government agencies, businesses, and other organizations. The data accountants provide information that influences nearly every business and government decision. This is important because a company’s financial condition is the most important thing. Accountants also have many opportunities for part-time work especially with small businesses. There are four major Accounting fields: Management, public, government, and internal auditing. Most accountants are management accountants that are usually employed by a single company to handle their financial records. A few management accountants function as internal auditors, a fast growing field. About 1/3 of all accountants are public accountants. They usually specialize in taxes, and they work for themselves or for an acco unting firm. Government accountants maintain and examine the financial records of government agencies and check the record of businesses and individuals whose financial activities are connected with government agencies. Internal auditors review financial records and reports, to judge their reliability. They also review procedures ...

Education in “The Republic” & “Discourse on the Arts and Sciences”

The role and significance of education with regard to political and social institutions is a subject that has interested political philosophers for millennia. In particular, the views of the ancient Greek philosopher Plato, as evidenced in The Republic, and of the pre-Romantic philosopher Jean Jacques Rousseau in his Discourse on the Arts and Sciences, present a striking juxtaposition of the two extremes of the ongoing philosophical and political debate over the function and value of education. In this paper, I will argue that Rousseau's repudiation of education, while imperfect and offering no remedy to the ills it disparages, is superior inasmuch as it comes closer to the truth of things than does Plato's idealized conceptions. To do so, I will first examine Plato's interpretation of the role of education and its function in shaping the structure of society and government and in producing good citizens. I will then introduce Rousseau's view of education and the negative effects of the civilized culture which it produces, and using this view, will attempt to illustrate the naivete and over-idealization of Plato's notions. Finally, I will attempt to demonstrate that it is Rousseau's view, rather than Plato's, that is ultimately more significant in assessing the actual (vs. idealized) merits (or lack thereof, in Rousseau's case) by which education should be judged with regard to the nurturance of good citizens. For Plato, the question of the role of education arises near the end of Book II (377e), after a discussion of both the necessary and consequent attributes of Socrates' kallipolis or â€Å"Ideal City. Such a city, Socrates argues, will, before long, have need of both a specialization of labor (in order for the greatest level of diversity and luxury of goods to be achieved) and of the establishment of a class of â€Å"Guardians† to protect the city from its envious neighbors and maintain order within its walls (i. e. , to police and govern the city). This, in turn, leads inexorably to the question of what attributes the Ideal City will require of its Guardians, and how best to foster such attributes. The early, childhood education of the Guardians, Socrates argues, is the key. What, then, asks Socrates, should children be taught, and when? This quickly leads to a discussion of censorship. Socrates cites a number of questionable passages from Homer which cannot, he thinks, be allowed in education, since they represent dishonorable behavior and encourage the fear of death. The dramatic form of much of this poetry is also suspect: it puts unworthy words into the mouths of gods & heroes. Socrates suggests that what we would call â€Å"direct quotation† must be strictly limited to morally-elevating speech. Nothing can be permitted that compromises the education of the young Guardians, as it is they who will one day rule and protect the city, and whom the lesser-constituted citizens of the polis will attempt to emulate, assimilating, via the imitative process of mimesis, to the Myth (or â€Å"noble lie†) of the Ideal City in which justice is achieved when everyone assumes their proper role in society. The process of mimesis, is, of course, yet another form of education, in which those of Iron and Bronze natures are â€Å"instructed† and inspired by the superior intelligence and character of the Gold and Silver members of the Guardian class. It is therefore a form of education without which the polis cannot operate. Thus, for Guardian and ordinary citizen alike, the education of the young and the continuing â€Å"instruction† of the citizenry are crucial. In addition to these aspects, Plato also conceives of another function of education, and one which is quite significant in its relation to Rousseau's views. For Plato, education and ethics are interdependent. To be ethical, in turn, requires a twofold movement: movement away from immersion in concrete affairs to thinking and vision of unchanging order and structures (such as justice) and then movement back from dialectic to participation and re-attachment in worldly affairs. It is a temptation to become an abstract scholar. But the vision of the good is the vision of what is good for oneself and the city — of the common good. If one does not return to help his fellow human beings, he becomes selfish and in time will be less able to see what is good, what is best. An unselfish devotion to the good requires an unselfish devotion to the realization of this good in human affairs. Just as the purpose of understanding order and limits in one's own life is to bring about order and restraint in one's own character and desires, the understanding of justice requires application in the public sphere (through education). A man who forgets the polis is like a man who forgets he has a body. Plato thus advocates educating both the body and the city (for one needs both), not turning one's back on them. If education is, for Plato, the means by which man comes to fully realize (through society) his potential as a human being and by which society as a whole is in turn elevated, for Rousseau it is quite the opposite. Education, argues Rousseau, does not elevate the souls of men but rather corrodes them. The noble mimesis which lies at the heart of education in Plato's kallipolis is for Rousseau merely a slavish imitation of the tired ideas of antiquity. The ill effects of this imitation are manifold. Firstly, argues Rousseau, when we devote ourselves to the learning of old ideas, we stifle our own creativity and originality. Where is there room for original thought, when, in our incessant efforts to impress one another with our erudition, we are constantly spouting the ideas of others? In a world devoid of originality, the mark of greatness, intelligence, and virtue is reduced to nothing more than our ability to please others by reciting the wisdom of the past. This emphasis on originality is in marked contrast with Plato, who finds no value in originality, deeming it antithetical to a polis otherwise unified by shared Myths of the Ideal City and of Metals. Rousseau rejects this â€Å"unity†, rightly denouncing it as a form of slavery , in which humanity's inherent capacity for spontaneous, original self-expression is replaced with the yoking. of the mind and the will to the ideas of others, who are often long dead. In addition to suppressing the innate human need for originality, education (and the appetite for â€Å"culture† and â€Å"sophistication† that it engenders) causes us to conceal ourselves, to mask our true natures, desires, and emotions. We become artificial and shallow, using our social amenities and our knowledge of literature, etc. , to present a pleasing but deceptive face to the world, a notion quite at odds with the ideas of Plato. We assume, in Rousseau's words, â€Å"the appearance of all virtues, without being in possession of one of them. Finally, argues Rousseau, rather than strengthening our minds and bodies and (a critical point) moving us towards that which is ethical, as Plato contends, education and civilization effeminate and weaken us physically and (perhaps most significantly) mentally, and cause us, in this weakness, to stoop to every manner of depravity and injustice against one another. â€Å"External ornaments,† writes Rousseau, â€Å"are no less foreign to virtue, which is the strength and activity of the mind. The honest man is an athlete, who loves to wrestle stark naked; he scorns all those vile trappings, which prevent the exertion of his strength, and were, for the most part, invented only to conceal some deformity. † Virtue, as opposed to Plato's conception, is an action, and results not from the imitation inherent in mimesis, but rather in the activity — in the exercise — of the body, mind and soul. Education, however, demands imitation, demands a modeling upon what has been successful. How, then, do we rightly assess the merits of education with regard to its it molding of the public character — in its ability to produce â€Å"good† citizens. The answer to this hinges, I submit, on how we choose to define the â€Å"good† citizen. Clearly, if obedience (or â€Å"assimilation to a political ideology†, or perhaps â€Å"voluntary servitude†) is the hallmark of the good citizen, then we must regard Plato's disposition towards education as the proper one. However, obedience, despite its obvious centrality to the smooth operation of society (as we would have social chaos were it completely absent), has its useful limits. Over-assimilation to a political idea or â€Å"blueprint† is every bit as dangerous — indeed, far more so — as the utter under-assimilation of anarchy. For those inclined to dispute this, I would urge them to review the history of Nazi Germany as perhaps the definitive example of what sad, awful spectacles of injustice we humans are capable of when we trade in our mental and spiritual autonomy for the convenient apathy and faceless anonymity of the political ideal. Furthermore, if , as Rousseau contends, our civilization is such that, â€Å"Sincere friendship, real esteem, and perfect confidence [in each other] are banished from among men,† what is the quality of the society for which education — any modern education — purports to prepares us? When, â€Å"Jealousy, suspicion, fear coldness, reserve, hate, and fraud lie constantly concealed under †¦ [a] uniform and deceitful veil of politeness,† what is left to us to educate citizens for, other than the pleasure we seem to derive in pedantic displays of hoary knowledge? If we remove the civility from â€Å"civilization†, what remains to us that any education will remedy?

Life Without Gravity Essay

In a world without gravity, one would be weightless, but always nauseous. Because of this, it would be very difficult to complete a lot of your daily activities without throwing up. If you tried to eat something while you and your food are floating around, you will probably have a lot of trouble trying to hold your food down. In 0-g, life would be very hard. Roller coasters are a perfect example of this. I do not do well on roller coasters. I get sick when I encounter zero gravity for that split second on rides with loop-dee-loops and the like. This is how I know I would really suck at surviving if there was no gravity. Not only would I be constantly puking, but I wouldn’t be able read or really even enjoy doing anything except floating around trying not to dry heave. So, I wonder how someone, mainly me because I do not have a strong stomach, would merely perform the act of drinking a glass of water and thinking at the same time in a world where everything floats. Without the force of gravity acting on all objects, there is nothing keeping us attached to the earth. We would simply float away from the earth unless we nail out toes to our floorboards, and our entire house to the earth’s crust. So, drinking water†¦this would not go very well for me. Not only would the water not be forced to stay in its proper area of residency, the cup, but it would be poured on my face if ever I tried to drink it, and that is most certainly NOT WHERE IT BELONGS. However, since the only force acting on the cup is the earth’s, pushing everything away from its core, the water probably was already floating around in space somewhere. This would make for a very, VERY thirsty Alex, not to mention the rest of the world. Unless you had stocked up on bottled water prior to the sudden change in the laws of the world, you would be dead. Thinking during splashing water all over yourself, or trying to catch it as it pins itself to your ceiling, just as you are doing because of the lack of gravity, would probably present a slight problem. As if you weren’t already nauseous as could be, suffering from extreme thirst and boredom while you lie in wait on your ceiling for something interesting to happen like being crushed by that bookcase over there that has been slowly creeping closer with each passing second, you would also need to be able to think. While floating around on earth shouldn’t give you any more of a headache than when you lie down, I have a feeling that I would get them anyway. However, in space, 0-g, your blood would be floating free throughout your body, just as you do so, ubject only to those forces placed on it by your own circulatory system. Your blood would have no tendency to pool in any particular part of your body, meaning no headaches. But with everything floating around, I can’t help but think that all that free blood must make you kind of floppy. Without gravity, multitasking would probably be even more difficult than it is in a world with gravitational forces. If I tried drinking my water, while translating our national anthem into Arabic, WHILE I try to bike on one of those stationary exercise bikes, I would be very sad. Not only would I be nauseous and EXTREMELY THIRSTY, causing me to get a headache, but I would be floating away from my excise bike, while trying to stay on it, that giving me exercise within itself. I can’t even imagine how long our species would survive before we either all starved to death or tried to open a window for fresh air and then floated into our atmosphere and died from lack of oxygen. I don’t think that we would live very long at all, and drinking a glass of water would be so terribly difficult that it would make living very complicated.

About Doctor Faustus Essays

About Doctor Faustus Essays About Doctor Faustus Essay About Doctor Faustus Essay ultimately causing the transgressors ruin, all of these feature are shown in Faustus as the play goes on. Faustus curiosity with his power with black magic has transgressed into an obsession. In this scene Faustus reaction to black magic is Oh this feeds my soul! Marlowe has used irony here as Faustus has no longer in possession with his soul due to his contract with the devil. Faustus is continuously showing hamartia in this scene by not repenting as he reassures himself that My heart is hardened, I cannot repent Faustus loss of divinity and despair is causing his downfall in the terms of a tragedy. In this scene Faustus is being persuaded by a performance of the seven deadly sins, which portrays aspect showing the satanic. Faustus overreaches in the scene as he indulges in the performance and says, That sight will be as pleasing unto me as was Adam on the first day of his creation. Marlowe uses ironic inversion to portray Faustus excitement to this performance. It is also ironic as Adam receives something of substance whereas Faustus is just receiving pleasures of the five senses. Faustus asks Tell me who made the world, a question which he know is off limits but yet is attempting to push the boundaries. This is again showing an overreaching characteristic as Faustus is trying to gain access to forbidden knowledge. Jean Calvin believed certain souls preordained by God to salvation some souls condemned to damnation as their lives are predestined. This would mean that Faustus is right to be overreaching and indulging in all he is receiving now as he had been pre destined to be damned. Could it be argued that this characteristic has been put in him by God? David Punter says that one way of looking at the gothic is that it deals with transgression Faustus transgresses to the side of the devil in this scene where he vows never to look to heaven name God or to pray to him to Lucifer. This reaction to Lucifer entering shows how intimidating and overpowering the character is. In some performances the scene has been directed to have Faustus to be seated on a throne next to Lucifer, this interpretation shows Faustus to have fully transgressed to the side of the satanic. Transgression is a key aspect of the Gothic. As the play ends with Faustus dying and been drag down to hell it contrast to the ending with morality plays where the character is resolve at the end. The gothic is all about breaking the boundaries, and Marlowe has done this with this play, as it is not conventional play and it deals with issues and themes of the devil and divinity which were very much controversial themes to explore for a play to be shown the general public. His play is used to explore and transgress the public to talk about these subjects, there for if the play would had to be put in a category I would agree that it would be placed in the Gothic genre.

Platinum essays

Platinum essays Antonio de Ulloa discovered platinum in South America in 1735 and by Wood in 1741. Platinum is a silver-white metal that holds even more value then gold. Its atomic number is 78 and its mass is 195.08. It is also one of the heaviest metals. It is a transition metal and its electron configuration is [Xe ]6s14f145d9. This element has very unique properties, which make it valuable. First of all, it is very easily shaped. It can be shaped and working into almost every possible way, from thin wire too large sheets. Platinum is a solid whos melting point is 2045k and its boiling point is 4100k. The metal was used by pre-Columbian Indians. Platinum occurs native, accompanied by small quantities of iridium, osmium, palladium, ruthenium, and rhodium. These all belong to the same group of metals. The metal does not oxidize in air at any temperature. However, halogens, cyanides, sulfur, and caustic alkalis corrode it. Platinum resistance wires are used for constructing high-temperature elective furnaces. The metal is used for coating missile nose cones, jet engine fuel nossles, jewellry, thermocouple elements, electrical contacts, corrosion-resistant apparatus, in dentistry, sealed electrodes in glass systems, and so on. Platinum is an excellent catalyst, such as in catalytic converters for cars. ...

A Turning Point

Turning Point Singapore is a place full of foreign countries, the fusion of Asian and European culture, scientific growth and opportunities, customs and traditions. When traveling to Singapore for the 2 nd APEC Youth Science Festival, people with diverse backgrounds gathered to meet ideas and insights and gathered artworks filled with cultural colors. After returning to America, I brought stronger cultural awareness, a deeper understanding of the international scientific community, abundant knowledge, and countless lifelong friendships. Perhaps the question you first ask yourself is what is the turning point of history? A dictionary defines a turning point as a point where decisive change occurs. Therefore, the turning point of history is not only important events that occurred long ago. This is a direct (time based) thought, event, or behavior that causes change. This change is social or cultural, and it influences social thinking and behavior. It is political and there is the possi bility of leading to new legislation and new government. It is economical and affects how products are produced, purchased, sold, or how much or how society spends on these items. The turning point may lead to all these changes. Looking back at past events, it is fairly easy to mark various turning points. Individuals may also notice turning points, such as when you meet your best friend, or when you volunteered in India. This symbolic meaning of the turning point was created in the 1640s and there was a more literal meaning less common in about ten years: the point where the opposite direction begins One way to understand how change processes work in the living experience of young carers is to look up turning points (Rutter 1996). Turning point is defined as an important life event or life experience essential for life course. Turning point is an important event of life, they can give front and after structures and can be explained as events of life (Denzin, 1989). The turning poi nt can be understood as plus or minus. They can contain a single episode or cumulative event. They can gradually discover the incident or discover it suddenly. They can be expressed through situational life events such as taking care or through personal subjective experiences such as controlling positive decisions in life. Turning points may also include random events in life (King et al., 2003). What is the difference? Turning point for youth in public care

Foundation degree in public service Essay Example | Topics and Well Written Essays - 1250 words

Foundation degree in public service - Essay Example Social organizations are so set up that crime is not required to obtain the essential necessities of life-food, sex satisfaction, the gratification of primary emotional urges. This is the theoretical assumption of our social philosophy, our constitutions, and criminal codes. But social reality often falls short of these ideal expectations. The most popular theories used to explain crime are Strain Theory and Social Learning Theory. The strain theory was developed by Robert Merton in the 1940s. this theory states that social stress has a dominant impact on behavior of individuals. The loss of social cohesion leads to criminal behavior and isolation form society by an individual. Five reactions to social stress are conformity, ritualism, innovation, ret realism and rebellion. People who experience social stress of this sort must be expected to commit crimes when confronted by an average or even subnormal degree of environmental pressure (Spalek 2005). As long as this disposition has not undergone a change, a sequence of criminal acts must be anticipated. Many of our criminals, endowed by nature with a loosely suspended reactivity, become genuine criminals by recurrence. They acquire abnormal touchiness by the grinding effects of repeated crime and repeated punishment. This theory is important for police and fire service s, emergency etc, to understand human behavior and possible consequences of social stress factors (Hellman and Alper 1997). Social learning theory was developed by Bandura in 1970. This theory is based on psychological concepts and explanations which determine behavior of a person as socially learned. Paramour is learned while overriding actions and communication of other people, their relations and interaction patterns,. According to this theory, criminal behavior is also learned by individuals surrounded by other criminals. Social life

Multiplier-accelerator models Essay Example | Topics and Well Written Essays - 500 words

Multiplier-accelerator models - Essay Example Keynes argued that level of output will increase due to multiplier relationship between output and autonomous consumption. (Hartley, J. et al. 1998). Change in output due to change in investment can be described in following manner: The Accelerator model is based upon the assumption if current economic activity increases, it will allow entrepreneurs to expand productive capacity by investing into additional capital stock . The Acceleration principle also outlines that there will be an increase in the output level with the increase in investment and there will be an additional investment when output increases. The above relationship suggests that consumption comprises of overall autonomous consumption and the propensity to consume with respect to the past income of an individual. Samuelson’s model therefore outlines different parametric conditions under which economy can move and as such economic cycles can occur. Samuelsson’s model is considered as incomplete as a theory of regular cycles because of its inability to predict regular business cycles however, it is still considered as one of the key advances in macroeconomic theory. Lloyd Metzler’s model was based upon his famous Inventory Cycle principle and suggested that the precise inventory policy as chosen by the producers might have an impact on the economic cycles. This model outlines that the change in output is a relationship between the consumption and investment and investment comprises of the investments made in inventory considering capital stock as constant. (SÃ ¸rensen, and Whitta-Jacobsen, 2010). Hicksian Model was also another attempt to understand the business cycles and how consumption and investment actually have an impact on the income level. Hicks assumed that the consumption is the function of past income while investor attempts to maintain a stock of capital in relation with the income. The combination of income and consumption therefore can generate oscillation in income or

Patricia Benner Essay Example | Topics and Well Written Essays - 1250 words

Patricia Benner - Essay Example Benner went on to work as nurse for several years, including a period in an intensive care unit, an emergency room, as a staff nurse, and in home care. She then returned to academia, as a researcher at the University of California. In 1984, she authored the work which set out the basic principles of her influential theories – From novice to expert – Excellence and Power in Clinical Nursing Practice. Benner had become very interested in the Dreyfus model of skills acquisition, and, in this work, adapted this to nursing. Her main intention in doing so was to answer the question ‘how do nurses learn to do nursing?’ (enursescribe.com). This book was based on 21 sets of interviews Benner had conducted with newly-graduated nurses and their preceptors. Additionally, Benner interviewed or observed some 51 experienced clinical nurses, a further 11 newly-graduated nurses, and 5 senior nursing students, hoping ‘to further delineate and describe characteristics of nurse performance at different levels of education and experience’ (Benner, 1996, p.xiv). Among Benner’s many other works are the 1996 book Expertise in Nursing Practice: Caring, Clinical Judgement, and Ethics, with Christine Tanner and Catherine Chesla, and Caregiving, with Suzanne Gordon and Nel Nodding, published in the same year. Her work has had an enormous influence on nursing training and practice, and already in 1985, the year after the publication of From novice to expert, she was elected to the fellowship of the American Academy of Nursing. Benner has also been elected an honorary fellow of the Royal College of Nursing. This influence has also spread well beyond the United States. For example, Benner’s work has provided the basis for a redesigned system of nursing practice and education in three states in Australia (earthlink.net). Benner proposed that a

Reflective letter Assignment Example | Topics and Well Written Essays - 500 words

Reflective letter - Assignment Example As such, I will seek to build on my formatting strengths by referring and practicing the Harvard, Chicago, and MLA writing styles as seen in the Purdue Online Writing Lab. On the other hand, I will seek to overcome my writing weaknesses by proof reading my work before submission. I will also do more research on the best writing skills and sentence construction. Using Microsoft PowerPoint by creating effective slides, APA formatting, critical analysis, and timely completion of assignments are items that represent my best work. This is because these items enabled me to address the writing subject in a detailed, effective, and timely manner in different writing platforms using the required writing style. Notably, the first assignment and the PowerPoint assignment were the most challenging assignments. Indeed, summarizing the most relevant information on the slides and achieving the correct sentence combination were very challenging. Nevertheless, I have begun to solve the problem in achieving correct sentence combination by writing more works, researching the best writing skills, and seeking guidance from my tutor. However, I am proud of my writing skills in assignment 2 because they depict my strength in formatting, great sentence combination, few grammatical errors, and objectivity. Ideally, I adopted efficient revision strategies that included class discussions, detailed research at the library, creating a revision timetable, and seeking professional advice from my tutors. I also addressed my peers, tutor review comments, and sought to perfect my writing skills by doing additional writing assignments. My writing, reading, and critical analysis assignments helped me in my writing since they prepared me to read, analyze the derived information, and present such information in writing using the correct writing style. Notably, the PowerPoint essay was the most informative since it taught me how to summarize, use visual

American history Essay Example | Topics and Well Written Essays - 1000 words - 5

American history - Essay Example The American civil War has also been known to be the earliest industrial battles due to the extensive use of railroads, steamships, mass-produced weapons and the telegraph. The mobilization of mines, food supplies, transportation and shipyards all predicted Word War 1. The civil war is known to be the deadliest battle in the United States’ history (Brinkley). During the civil war, the Northern region had many advantages as compared to the South. They had more people than the South. There were 23 Northern states and, in those states, there were more than 21 million inhabitants. On the other hand, the South only had nine million people and, among those people, there were 3.5 million slaves. However, the size of the Southern army during commence of the war was almost equivalent to that of the Northern army. Another advantage of the North is that it had a large industrial advantage. When the war started, the South was said to have a ninth the industrial capacity of the North. However, the statistics is not true. In 1860, the North went ahead and manufactured 97% of the countries firearms. It also had 96% of railway locomotives, 94% of its pig iron and 94% of its cloth. As a result, the North had two times the density of railroads than the South. The North suppressed the South such that, the entire South did not have even a single rifle works. Therefore, the South had to import all the main ingredients of gunpowder. The North also had another advantage, having control over the navy. This meant that the Northerners had all the control over the seas. As a result of the suppression by the North, the South resulted to creating ammunition by the melting-down of church bells and bells from town squares. On the other hand, the South also had some advantages. The South had food resources and also a large nucleus of trained soldiers. This is because the south had seven among the

Patricia Benner Essay Example | Topics and Well Written Essays - 1250 words

Patricia Benner - Essay Example Benner went on to work as nurse for several years, including a period in an intensive care unit, an emergency room, as a staff nurse, and in home care. She then returned to academia, as a researcher at the University of California. In 1984, she authored the work which set out the basic principles of her influential theories – From novice to expert – Excellence and Power in Clinical Nursing Practice. Benner had become very interested in the Dreyfus model of skills acquisition, and, in this work, adapted this to nursing. Her main intention in doing so was to answer the question ‘how do nurses learn to do nursing?’ (enursescribe.com). This book was based on 21 sets of interviews Benner had conducted with newly-graduated nurses and their preceptors. Additionally, Benner interviewed or observed some 51 experienced clinical nurses, a further 11 newly-graduated nurses, and 5 senior nursing students, hoping ‘to further delineate and describe characteristics of nurse performance at different levels of education and experience’ (Benner, 1996, p.xiv). Among Benner’s many other works are the 1996 book Expertise in Nursing Practice: Caring, Clinical Judgement, and Ethics, with Christine Tanner and Catherine Chesla, and Caregiving, with Suzanne Gordon and Nel Nodding, published in the same year. Her work has had an enormous influence on nursing training and practice, and already in 1985, the year after the publication of From novice to expert, she was elected to the fellowship of the American Academy of Nursing. Benner has also been elected an honorary fellow of the Royal College of Nursing. This influence has also spread well beyond the United States. For example, Benner’s work has provided the basis for a redesigned system of nursing practice and education in three states in Australia (earthlink.net). Benner proposed that a

American history Essay Example | Topics and Well Written Essays - 1000 words - 5

American history - Essay Example The American civil War has also been known to be the earliest industrial battles due to the extensive use of railroads, steamships, mass-produced weapons and the telegraph. The mobilization of mines, food supplies, transportation and shipyards all predicted Word War 1. The civil war is known to be the deadliest battle in the United States’ history (Brinkley). During the civil war, the Northern region had many advantages as compared to the South. They had more people than the South. There were 23 Northern states and, in those states, there were more than 21 million inhabitants. On the other hand, the South only had nine million people and, among those people, there were 3.5 million slaves. However, the size of the Southern army during commence of the war was almost equivalent to that of the Northern army. Another advantage of the North is that it had a large industrial advantage. When the war started, the South was said to have a ninth the industrial capacity of the North. However, the statistics is not true. In 1860, the North went ahead and manufactured 97% of the countries firearms. It also had 96% of railway locomotives, 94% of its pig iron and 94% of its cloth. As a result, the North had two times the density of railroads than the South. The North suppressed the South such that, the entire South did not have even a single rifle works. Therefore, the South had to import all the main ingredients of gunpowder. The North also had another advantage, having control over the navy. This meant that the Northerners had all the control over the seas. As a result of the suppression by the North, the South resulted to creating ammunition by the melting-down of church bells and bells from town squares. On the other hand, the South also had some advantages. The South had food resources and also a large nucleus of trained soldiers. This is because the south had seven among the

Context - historical, cultural or social Essay Example for Free

Context historical, cultural or social Essay The level of efficiency of a literary work does not depend solely on the story, but also on the context of that specific stories. Some stories are only powerful when they are set in a specific context, otherwise they would reach the effect that was wanted. This is exactly the case with Woman at Point Zero by Nawal El Sadaawi, and The Crucible by Arthur Miller. The Crucible is set in a historical time different then that of the author and the reader. In the 17th century people thought in different manners, and believed in different things, in this case witchcraft. If the work wasnt set in this context it could not have been so effective since because witch trials are no longer present, and the whole story would be meaningless. Culturally it is important what people think, what and who people believe in. In the culture of Salem all the citizens were highly religious, and questioned everything not related to religion and beliefs. This is why they believed the girls when they were saying that the good spirits in their souls can detect the evil ones in other people, and never thought, even for a second, to question them. In a social sense this society was ideal, and perfect for the story. Their beliefs and their actions helped the development of the witch trials. In a smaller society the news of witch hunt would not have had been so important for other larger cities, then it was in the case of Salem. Albeit Woman at Point Zero is set in the same time period as the reader is, historically it recalls earlier version of European society, when women were ruled by men, as it is in the Arabian society in the present. This means that although it is hard to understand for someone living in a European society, if it was set in this society and the reappearance of an old historical period. The Egyptian culture is different then almost every outside of the Arab area, but it is necessary to make this work meaningful and powerful. It is clearly started from the beginning of the text that the men are always in charge, and never let the women make their own decisions. This only makes sense in a culture where it is the norm. In other areas it would be meaningless, which is why culture is extremely important. In conclusion it can be seen that story is not the only thing that make a work enjoyable and understandable, but also its context. Without them the whole book would become meaningless and no one would be able to make sense of it.

The bone disorders

The bone disorders Introduction There are many different types of bone disorders and these can have vast implications on a patient suffering from any particular one of these bone disorder. There 7 main categories of bone disorders listed below, each of which will be discussed in detail. Genetic (inherited) disorders, i.e. Achondroplasia, Osteogenesis imperfecta. Nutritional disorders, i.e. Rickets, Osteomalacia. Autoimmune disorders, i.e. Rheumotid Arthritis Degenerative disorders, i.e. Osteoarthritis. Bone tumours, i.e. Primary Bone Cancer, Secondary Bone Cancer. Hormonal disorders, i.e. Osteoporosis. Pagets disease. Genetic (inherited) disorders. Achondroplasia. Achondroplasia is genetic disorder and is the main type of short-limbed dwarfism that takes place in humans, occurring amongst 1 in 15,000 and 40,000 live births. It has been estimated that about 90% of cases of achondroplasia are sporadic, and on average, there is a rise of paternal age at the moment of conception of affected individuals (Vajo et al., 2000). The literal meaning of achondroplasia is without the formation of cartilage, and sufferers have difficulty with bone growth. Achondroplasia affects mainly long bones e.g. legs and arms. It is an Autosomal Dominant Gene Defect (ADGI), and leads to the conversion of cartilage into bone. It occurs when one of the 22 non-sex genes is mutated, and this mutated gene has now been identified to be located on chromosome 4, which is known to be the Fibroblast Growth Factor Receptor 3 (FGFR3). Symptoms; Achondroplasia is typically distinguished by the formation of a long, narrow trunk and short limbs. Some other usual symptoms of achondroplasia include hyperextensibilty of joints in particular at the knees and hands, however the rotation of the elbow is limited as well being unable to fully extend. Sufferers of Achondroplasia normally have a large head, short broad hands, and suffer from hypertonia (poor muscle tone). Spinal cord compression at the cervicalmedullary junction is another typical feature of achondroplasia patients (Horton et al., 2007). The location of the mutated gene associated with achondroplasia was mapped to chromosome 4p16.3 in 1994, and this was followed soon after by the identification of the heterozygous mutations of FGFR3 (Rousseau et al., 1994). It has been further discovered that children that have FGFR3 mutations, they parents generally do not have the FGFR3 mutation, and there has also been a strong association between advanced paternal age, in particular over 35 years of age. Diagnosis; Because the symptoms of achondroplasia are very distinguishable, the diagnosis at birth should not be a problem. However, it has been estimated that about 20% of individuals are not diagnosed with achondroplasia at birth (Trotter et al., 2005). A common method that has been employed and widely used for the diagnosis of achondroplasia is prenatal ultrasound. This method detects effected foetuses in the third trimester of pregnancy. The diagnosis of Achondroplasia can be carried out via CVS (Chronic Villus Sampling), followed by molecular gene tests. CVS is a test that is carried out before birth, in which cells are inspected. Molecular genetic testing is carried out in order to identify possible mutations. Treatment; There is no clear treatment for achondroplasia, and there are many tests that are ongoing in order to do find one. The use of human growth hormone has been proposed as a possible method of treatment. Tests have shown that there was an initial increase in growth rate of subjects with achondroplasia, nevertheless, the long-term benefits of such treatment have not been made clear, and many experts do not recommend it (Horton et al., 1992). In order to increase the stature of achondroplasia patients, surgical limb lengthening is another proposed method to help achondroplasia patients. The typical method compromises of different bones being broken, i.e. femur, tibiae, and humeri, after which orthopaedic appliances are used in order to carry out slow stretching during the healing process. Although this method increases the standing height of the patient, this method is also not recommended due to the many complications arising from it. These complications include, the need of repeated surgeries, wound infections and problems arising from the stretching of skeletal tissue such as blood vessels. Osteogenesis Imperfecta. Osteogenesis imperfecta is a bone disorder causing imperfect bone formation. It effects roughly 1/5,000 to 1/10,000 individuals (Sillence et al., 1979). It occurs as a result of a poor quality of collagen or a lack of collagen production, and can lead to fragile bones that are easily broken and have a low bone mass. Another distinguishable characteristic of osteogenesis imperfecta patients is an s-shaped spine that can eventually break. Osteogenesis imperfecta occurs as a result of mutations in the genes that encode the chains of type I collagen. Type I collagen is the main protein found in bone. Genetically inherited cases of osteogenesis imperfecta normally show very mild symptoms. However, spontaneous cases are often more severe. Symptoms; The symptoms of osteogenesis Imperfecta range in severity, from intrauterine fractures and perinatal lethality, to very mild fractures. Diagnosis; The diagnosis of osteogenesis imperfecta in individuals with a family history of the disease is rather simple, but more difficult in those that do not have a family history. Generally osteogenesis imperfecta is diagnosed clinically, and based on the physical symptoms associated with the disease Osteogenesis imperfecta can be diagnosed via a collagen biopsy test, which is a new method. This test is known to identify 90% of osteogenesis imperfecta cases. Ultrasound is another method that can be used for diagnosis, and can detect more severe types of Osteogenesis imperfecta, even at the foetus phase and also 16 weeks into pregnancy. Test such as those that include culturing cells, and observing the collagen produced can also be carried out, as well as using blood samples to examine mutations of the collagen manufacturing genes. Although these types of tests can be useful in the diagnosis of osteogenesis imperfecta to some extent, they are generally no more than 85% accurate. Treatment; Currently there is no known cure for osteogenesis imperfecta. However particular emphasis has been placed on prevention on injury and maintaining healthy bones particularly in younger children. Supplements of calcium and phosphorus help increase bone density. Also Biophosphates are used, and these are drugs that help decrease the rate of bone resorption. Biophosphates have been clearly shown to prevent bone fractures from occurring and also increasing the bone strength and density. Growth hormones has been previously proposed as a possible treatment for osteogenesis imperfecta (Kruse and Kuhlencordt, 1975). However this has been later dismissed, and although the use of growth hormone in combination with Biophosphates may be a useful treatment, this has not yet been tested. Metal bone plates are also used for patients with more severe fractures, and helps to strengthen and reduce fractures of the affected bones, mainly long bones e.g. arms and legs. Nutritional disorders. Rickets and Osteomalacia. Rickets is a nutritional bone disorder which is found in children. It is known to affect about 1 in 1000 children in the UK alone. A very similar disorder takes place amongst adults and this is known as osteomalacia. Both these disorders occur as a result of abnormal mineralisation (calcification) of bone and cartilage. The body transfers calcium and vitamins from the bone into the blood due to vitamin deficiency i.e. deficiency in Vitamin D and calcium. This demineralisation subsequently leads to bone deformity, and thus the bones become soft and very vulnerable to fractures. There are many reasons that cause vitamin deficiency that subsequently leads to rickets and osteomalacia. Some of which include nutritional deficiency (poor diet), poor lifestyle (lack of exercise), insufficient sunlight exposure (remaining indoors for long periods of time) and abnormal metabolism (liver and kidney disease, chronic renal failure etc) (de Menezes Filho et al., 2006). Another main cause of rickets in children is due to the baby receiving a lack of vitamin D in the womb from the mother who may also be deficient in vitamin D. Symptoms; Symptoms of rickets and osteomalacia include; Growth retardation. Deformities in the upper and lower limbs. Insufficient weight gain in children. High vulnerability to bone fractures. Bone pain. Muscle weakness. Pelvic flattening. Bowing legs. Defects in structure of teeth. Diagnosis; A physical examination will firstly help to identify bone deformities and multiple fractures. A medical history check can also help to identify a possible genetic link. The levels of parathyroid hormone and alkaline phosphate will increase in the blood as a result of deficiency in vitamin D and calcium. These hormones are responsible for the transfer of minerals and vitamins from the blood to the bone. This rise in the bloodstream is a major sign of rickets and osteomalacia, and blood tests carried out to see this elevated rise of these hormones is a good method for diagnosis. X-rays can also show the demineralisation of the bone and reveal any abnormal bone structures. Treatment; Replacing vitamin D, calcium, and other necessary minerals in patients with rickets and osteomalacia is very important, and is the main method of treatment. Babies that received a lack of vitamin D whilst in the womb of their mother, or a shortage from their mothers milk should be given vitamin drops, e.g. Abidec, to help increase their levels of vitamin D. Food rich in Vitamin D and calcium are highly advised, and offer a replacement for their deficiency. These types of food include oily fish (tuna, salmon herrings, mackerels), dairy products (milk, yoghurt), liver, Vitamin supplements can also be prescribed from a doctor. An injection of vitamin D (calciferol) is also available and can last up to a year before another injection is needed. Adequate exposure to sunlight is also highly recommended. Autoimmune disorders. Rheumatoid arthritis (RA). It has been estimated that at least 1 in 100 people suffer from RA, and that in the UK alone there are about 400,000- 500,000 sufferers. It is a chronic inflammatory disease mainly affecting synovial membrane, cartilage and bone. This then can lead to joint destruction, which is typically distinguished by gradual bone erosion, and is the main cause of disability in RA. RA causes the immune system to start producing antibodies, which attack the lining of joints (synovium), and tissues (tendons), and so thus resulting in inflammation and swelling. In response to this, the body releases a special synovium thickening chemical which causes the joint to wear away and loose its shape, and eventually the joint is completely destroyed. RA is also systemic and can spread to other tissues and other parts of the body causing more problems mainly in the hands, feet and spine. In very severe cases the disease can spread to organs and this can be very critical. RA does not occur at a particular age group, and the disorder can develop at any age in sufferers lifetime. However, more commonly RA occurs in patients that are between the ages of 30 to 60 years old. The causes of RA are still relatively unknown, however that have been several theories involving possible genes that can cause RA (Barton and Worthington, 2009). RA may also occur as a result of pollution (bacteria, fungi, viruses). Symptoms; Symptoms of RA include; Swelling of joints. Stiffness, particularly early in the morning. Inflammation. Formation of rheumatoid nodules, which appear on hands, feet and elbows. Flu like symptoms such as fever. Weight loss. Diagnosis; The diagnosis of RA is rather difficult, due to the fact that the main symptoms of RA inflammation and joint stiffness/swelling, and these symptoms can be commonly associated with other diseases/disorders. A full family history is looked at first in order to establish any hereditary traits of RA in the patient. Imaging techniques such as X-rays, CT scans and ultrasound can used to look at rheumatic erosion (the disappearance of bones/joints). However, it can be difficult to diagnose RA in the early stages of the disorder, as there may not be any physical changes during these stages. The cytokines TNF (tumour necrosis factor) and IL-1 (Interlukin-1) are responsible for further inflammation which occurs in people that suffer from RA. Both of these cytokines are present in the joint of people with RA, and checking for the presence of these cytokines at joints is a method used to diagnose RA. ESR (erythrocyte sedimentation rate) is also another blood test that can be used to diagnose RA. It is a measure of the rate in which red blood precipitate in a period of 1 hour, and is a non specific measure of inflammation. The CRP test (C-reactive protein test) is the second most popular diagnosis test for RA. In response to inflammation of tendon/ligaments, the liver produces C-reactive proteins, and this test is used to detect the presence of these proteins in the blood. The antibody RF (Rheumatoid factor) is present in the blood of sufferers of RA. Therefore blood tests to identify the presence of this antibody in the blood, 8 out of 10 times will diagnose a person that is suffering from RA. Treatment; Currently there is no clear treatment for RA, however there a few drugs available that either help relieve some of the symptoms, or to help modify the disorder. Pain killers such as paracetamol and ibuprofen can help relieve some of the symptoms of RA. NSAIDs (non-steroidal anti-inflammatory drugs) are also a set of pain killers e.g. diclofenac, ibuprofen and naproxen, and help to control joint pain and stiffness. Although these drugs help with the symptoms of RA they do not directly impede the development of RA. Furthermore, there are many common side effects associated with NSAIDs including diarrhoea, nausea, increased risk of myocardial infarction etc. Disease modifying anti-arthritic/antirhumatic drugs (DMARDS) are drugs that function by blocking the affect of certain chemicals i.e. TNF following the damage of bone, joints, tendons and ligaments. These drugs not only ease the pain and stiffness related to RA, but also slow the progression of the condition. Maintaining a healthy lifestyle for an individual suffering from RA is also vital as it reduces the chances of further complications arising from the disease. There are also many therapies e.g. acupuncture, hydrotherapy, and also arthroplasty which can significantly help with the pain and joint stiffness linked to the disorder. Degenerative disorders. Osteoarthritis (OA). Osteoarthritis is an age-related disease that ultimately has an effect on each individual, who live onto they senior years (Wong and Carter, 2003). The pain associated with osteoarthritis typically emerges from the degeneration of the cartilage between the joints, as a result of primary osteoarthritis, or from trauma bringing about the loss of cartilage (Temenoff and Mikos, 2000). Given that cartilage demonstrates a poor ability to self-repair, these injuries are sustained for years and can ultimately bring about further degeneration (secondary osteoarthritis) (ODriscoll, 1998). The degeneration of cartilage causes bone ends to become exposed, and the deposition of new osseous tissue on the bone ends. This also reduces the space in the joint cavity and limits movement (Gerard J. Tortora, 2007). The underlying bone also forms osteophytes (spikes) which grow outwards due to the bone compensating for the loss of cartilage, and this hinders joint movement and causes pain. It has been estimated that roughly 36 million Americans are diagnosed with this form of arthritis (Temenoff and Mikos, 2000). Osteoarthritis is also the main reaso n as to why many individuals undergo hip and knee replacement surgery (Wilson et al., 2005), and is also the main cause of mobility impairment in elder individuals (Buckwalter, 1997). Symptoms; Acute pain causing stiffness and lack of joint movement is the main symptom of OA. The capsule surrounding joints become bigger due to inflammation and this reduces mobility, and thus muscles at the joint become weaker. Other symptoms include spasm and contractions in the tendons; accumulation of fluid at joints, muscle weakness, and hardy bone enlargements in small joints i.e. fingers and toes. Diagnosis; There is no single test used to diagnose OA. A physical examination can show a lack of mobility, joint weakness and swelling. X-rays can show the loss of joint space and in extreme cases the presence of osteophytes. Treatment; There is advanced research going into ways to engineer cartilage to help patients suffering from OA, although a major breakthrough has yet been developed. Instead a healthy lifestyle i.e. loss of weight and exercise is highly advised Sufferers are advised to exercise the affected area as this will enable better support for affected joints and strengthen the muscles surrounding the joint. This also helps in increasing the mobility of the joints, balance and posture. Drugs such as NSAIDs (non-steroidal anti-inflammatory drugs) i.e. ibuprofen can help in relieving pain and reducing inflammation. However the long term use of these types of drugs can cause many adverse reactions. Bone tumours. A Bone tumour is the neoplastic growth of tissue in bone i.e. cells in tissue continually dividing resulting in the formation of the tumour, and can be benign or malignant. This tumour can further spread throughout the body via the lymph system. The lymph system contains lymphocytes and phagocytes, and a further function of the lymph system is to remove worn out red blood cells. There are two main categories of bone tumours, primary bone tumours and secondary bone tumours. Primary bone tumours can be localised or can spread (malignant), and these bone tumours derive from within the tissue. Primary tumours can be further divided into benign tumours and cancer. Secondary bone tumours derive from other tumours from a different part of the body and spread to the tissue via the blood. The mutation of the P53 gene which suppresses bone tumour is thought to responsible for the formation of bone tumours; however the exact cause is still not fully known. There are many different types of bone tumours, of which the most common are listed below, including symptoms, diagnosis and treatments. Osteosarcoma- This is the most common type of bone tumour, and as well as Ewings syndrome (see below), is the most aggressive type of bone tumour. It affects people at an early age (5-25years), and is rare in people of above the age of 30. Osteosarcoma is a malignant tumour and eventually will spread throughout the body. It is also known to start in the cavities within the bone, and is it affects long bones mainly the knee. Osteosarcoma is diagnosed via examination and imaging techniques such as MRI or CT scan. Osteosarcoma if usually treated by surgery and chemotherapy before and after the surgery. Ewings Sarcoma- Just like Osteosarcoma, Ewings sarcoma affects people at a young age (5-15 years), and also the survival rate up to 3 years is a 60% chance. Ewings sarcoma in mainly found in the lower extremity, than the upper extremity (Eggli et al., 1993) Some of the symptoms of Ewings disorder include pain and swelling, warmth of the local area, and the appearance of onion skin. Ewings disorder can be diagnosed via MRI and CT scans. Treatments of Ewings disorder include surgery, radiation and multi-drug chemotherapy (Eggli et al., 1993). Chondrosarcoma- This bone tumour affects the chondrocytes of cartilage tissue and subsequently, the tissue eventually becomes cancerous. Chondrosarcoma can occur at any age, and this tumour grows slowly and normally without any pain. Lymphoma- Lymphoma is cancer of lymphatic cells, and usually begins in the lymph node, but can also form in the bones. Multiple Myeloma- This bone tumour occurs as a result of bone marrow cells becoming cancerous and can cause osteolytic bone damage. It usually occurs in people above the age of fifty five, and men are twice more likely to get it than women. The main symptom of multiple myeloma is pain, as well as normochromic anemia, spinal cord compression and renal insufficiency. Multiple myeloma can be diagnosed via MRI and CT scans. Chemotherapy, bone marrow transplant as well as Bisphosphonate drugs are some of the main treatments for multiple myeloma. Osteroid Osteoma- This tumour occurs as a result of the matrix of bone becoming cancerous. It normally occurs twice as often in males than females. It more commonly takes place in the proximal femur, then mainly in the tibia, followed by posterior elements of the spine and the humerus (Bloem and Kroon, 1993). Common symptoms include dull pain which gets worse during the night, an increase in skin temperature, increased sweating and abnormal growth. Radiological scans and CT scans are common methods for diagnosis. Non-steroidal anti-inflammatory drugs are given as part of the treatment for osteroid osteoma as well surgical removal. Osteoblastoma- Osteoblastoma is a benign tumour in bone tissue and occurs when osteoblast cells become cancerous. It is mainly common in children and young adults. Pain and bone mass reduction are the main symptoms of osteoblastoma. Method of diagnosis for osteoblastoma includes x-rays, microscopic examination of osteoblast cells and a biopsy. Surgical removal of the tumour is a common treat for this bone tumour as well as cryosurgery, radiation and chemotherapy. Hormonal disorders. Osteoporosis. Osteoporosis results in bones becoming porous and these pores become bigger (2 times bigger) in cancellous cortical bone. It occurs as a result of a reduction in bone mineral density (bone mineralisation). It is a direct disease of the bone as compared to some of the other bone disorders mentioned above. During osteoporosis the rate of bone renewal is slower than bone breakdown and it commonly affects the hip, wrists and spine. It is estimated that over 3 million people in the UK alone suffer from osteoporosis. There are two main types of osteoporosis (Type I and Type II). Type I osteoporosis occurs mainly in females following menopause. Following menopause there is a deficiency in oestrogen and testosterone and this disorder is known as postmenopausal osteoporosis. Type II is mainly caused by a poor lifestyle i.e. excess smoking and drinking. This leads to a deficiency of calcium and vitamin D as a result of disorders of the intestine. The deficiency may also arise from kidney disorders caused by a poor diet (too much fast foods and fizzy drinks) and excess alcohol consumption. Also people continuously taking drugs mainly corticosteroid drugs will have a loss of bone density. Symptoms; Osteoporosis does not have any specific symptoms; however its main outcome is an increased risk of bone fractures and breaks, and also an increased risk of falling due to fractures of the wrist, spine and hip. Diagnosis Bone mineral density (BMD) test to measure bone mineral density was the first test used to diagnose osteoporosis. There are many different types of BMD tests, the most common being quantitative ultrasound. This is a very good method for diagnosis and is also a much safer approach than x-rays and radiography, which can also be used to diagnose osteoporosis. Blood tests to identify deficiencies in calcium and vitamin D are a further method for diagnosis. Treatments; HRT (Hormone Replacement Therapy) was initially used to treat postmenopausal osteoporosis, however its used was later stopped due to its many side effects e.g. breast cancer, blood clotting, stroke etc. Bisphosphonates can be used to treat osteoporosis and it functions by slowing down the breakdown of bone, in order for the body to cope with bone renewal. Bisphosphonate intolerancy was then later discovered in 20 % of people. Calcitonin drugs are another type of drug used to treat osteoporosis. Calcitonin is produced naturally in the thyroid gland, and calcitonin drugs work by directly inhibiting osteoclast activity. Calcitonin is also found naturally in salmon. Strontium Renelate is another drug that can be used and helps to promote bone renewal. Calcium and vitamin D supplements also help to slow down osteoporosis. Exercise is also highly advised for osteoporosis sufferers and has been shown to maintain or increase bone mineral density especially in postmenopausal women. Pagets disease. Pagets disease is a bone disorder associated with a disorder in bone remodelling, and affects 10% of elderly people (Barker et al., 1980). Furthermore it is more prominent in males than females. In Pagets disease there is an increase in bone remodelling which is also disorganised, and this caused by a primary abnormality of osteoclast cells (Hosking et al., 1996). The bone turnover is increased by 40%, and in addition, bone is grown in areas where bone is not needed and removed from areas where bone is required. Pagets disease is now referred to as osteoclast pagetic disease. In the disorder, the osteoclasts which are bone cells responsible for the removal of bone are targeted. Over a period of time osteoblast activity subsequently increases in response to osteoclast activity, and helps in forming new bone. However, the new bone that is formed is a lot larger and thicker because of the very fast remodelling process, but critically the interior parts of the bone are porous, and a lot more fragile and tender. This therefore makes the bone more venerable to fractures and breaks. Below is an illustration of a particular deformity associated with Pagets disease sufferers (see Figure 2.) Symptoms/complications; Joint pain and bone paint are common symptoms associated with Pagets disease. As the disease progresses the swelling and expansion of the bone leads to the expanding bone becoming weaker. Also the initial symptoms of Pagets disease are not clear but do become clearer over time as the disorder develops. Fractures of long bones e.g. tibia, femur, pelvis, spine, skull are common symptoms of Pagets disease as well as skeletal deformity. Arthritis is a common complication which arises from Pagets disease and occurs mainly in the proximal ends of long bones. A further complication of Pagets disease is Gout. Gout arises from the excessive production of uric acid and salts leading to gouting arthritis, which is a disease of uric acid metabolism. The build up of uric acid and salts in the bloodstream leads to accumulation at the bone joints/cartilage which then causes kidney stones. Bone tumours, and in particular cancellous bone tumour can arise as a result of gout. The dysregulation of bone can also cause an increase in blood circulation and can consequently bring about heart failure. Compression of nerves is also seen in sufferers of Pagets disease and is caused by bone expansion and this brings about complications in movement. Also nerve compression in the skull brings about a loss of hearing and vision. Diagnosis; X-rays is a very clear method to help detect bone expansion, bone loss and bone deformity. Alkaline phosphate which is a by-product of any type of bone disease/disorder is present in the bloodstream, and so blood test can help to identify the presence of these. Treatment; Bisphosphonates and calcitonin are common drugs used to treat Pagets disease. These drugs bind to osteoclast cells and increase their activity, thus reducing their breakdown, and reabsorption of bone into the bloodstream. Pain killers can also be taken to help ease bone pain and neuralgic pain. It is also advised that Pagets disease sufferers should receive adequate sunshine, adequate amounts of vitamin D, and maintain a healthy lifestyle i.e. healthy diet and regular exercise. References Barker, D.J., Chamberlain, A.T., Guyer, P.B., and Gardner, M.J. (1980). Pagets disease of bone: the Lancashire focus. Br Med J 280, 1105-1107. Barton, A., and Worthington, J. (2009). Genetic susceptibility to rheumatoid arthritis: an emerging picture. Arthritis Rheum 61, 1441-1446. Bloem, J.L., and Kroon, H.M. (1993). 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