Older parents and younger parents Essay Example | Topics and Well Written Essays - 1000 words - 1

Older parents and younger parents - Essay Example Arguments for younger parents focus mostly on the biological aspect of motherhood and the aspect of the biological clock is often invoked. A middle path is often more suitable with no norm being set that would miss the whole point of individual freedom. One of the main points that are used against older parents is their inability to handle the cognitive aspects of mental illness when it happens in children. This severely limits their ability to handle instances where their children are affected by mental ailments (Cook, et al.). There are however, advantages of being an older parent. In many cases, older parents have resources of financial and mental kinds that are useful and sometimes even essential for the purpose of parenthood. The stress that one goes through during parenthood can thus be eased to a great extent if one is independent and able to manage one’s finances on one’s own. Older parents are also considered to be more comfortable with each other and hence able to offer a better environment for the child. Older parents would thus not need to compromise on their marital quality so as to have a child (Needham and Umberson 439). This argument is similar to the feminist argument that an older woman would be emot ionally and financially readier for a child. This would also reduce the chances that a parent would suffer of regret that a parent may suffer in relation to his or her career. The feminist argument in this case is stretched to include fathers who are then seen to play an equal part in parenthood and in the development of the child. Older fathers and mothers are then seen to be more mature and hence better for the future of the child. The child is then seen as not a product of merely those factors that are hereditary but also those of nurture. In such a framework, nurture is what is considered, according to this view, more important. Younger parents are sometimes not considered to

Article Review of Organizational Culture Essay Example for Free

Article Review of Organizational Culture Essay It was not expected that the hierarchical model would be dominant given the previous attempt to change the culture. The altruistic values of those surveyed indicated they are committed to social development and public interests and are most comfortable with a hierarchical dominate culture. The sample size of 530 participants obtained from the Public Sector Directory was an adequate size. All of the executives in the directory were included in the survey, which suggests a less than random selection process for the final candidates. However, the six varied departments selected represented central coordination, infrastructure provision and social services. Although an almost two to one ratio of male to female employee responses were utilized, none of the demographic variables collected in section C of the three part survey affected the perceptions of the current culture. Sections A and B of the survey gathered information on character, managers, cohesion, emphases and rewards. Results indicated that Departments A – D preferred the internal process or group culture. Department E preferred the internal process model, but it was equally comfortable with rational goal model indicating goal fulfillment was a requirement. Department F results indicated a comfort level with the rational goal model most likely due to their interactive responsibilities with other departments. Forcing change from a formalized, rules and rewards based culture to a more flexible, decentralized culture could create individual-organization value conflict resulting in stress. Of the population surveyed only 191, 36%, was usable and the male respondents outnumbered the female respondents nearly 3 to 1. The survey, divided into three sections dealing with perceptions of the current culture, respondent ideal culture, and demographic information. The survey reviled 4 out of 6 public sector departments in the study held to the traditional model. The findings also suggest organizational culture is driven at the non-managerial employee level and the deeply embedded cultural values can’t be forced any form of management. The article mentions the constant state of transition is the Queensland government over a twenty year period; employees may value the stability and predictability of the traditional bureaucratic model. Base on the research and finding in the article, culture change must target the organization at the non-managerial level in order for the culture change to be effective. In order for Queensland traditionally bureaucratic organizations to embrace high performing teams, the change must address the needs of the driving force of the traditional model culture; the non-managerial employees. In forming high performing teams for the Queensland public sector, it is important to investigate the factors/components of those teams. Also, because most teams are unique in their goals and focus, there is no off the shelf solution for all teams (Davenport, 2001) and that there is no singular, uniform measure of performance effectiveness for groups (Guzzo and Dickson, 1996. p. 309). By creating a customized plan for transitioning, Queensland public sector can move from a control hierarchical organizational culture to a culture of change, flexibility, and productivity. The Queensland public sector was managed for so many decades using the top down management that the culture of the organizations productivity depended on it. The results of the study can be supported by the need for stability which can only be changed by small adjustment to small changes (Bhide 2010). The culture of the organization is controlled by political authority, so it was not surprising that a hierarchical process model was so deeply rooted in to the essence of the government employees who understood the leadership values (Goodwin and Neck, 1998). Organizations lack of understanding of their members caused employees to be less adaptable to change, and with that less productive. Employees will move to do only their specific functions and only respond to the tasks directed by their manager, which is contradicting to the desired results of flexibility, and supports the article results (Miller S 2009). â€Å"Beyond top-down and bottom-up work redesign†, explains â€Å"Authority is traditionally conceptualized as hierarchical†, but the informal authority operates day to day work of organizations. This proved to be true for the Queensland public sector with few exceptions such as a high commitment to the rules and the attention to details. These changes have also been achieved on a federal level with similar setbacks who still managed to overcome the existing dominant culture (189). Just because the organization is not dominated by the â€Å"new managerialist thinking† as stated in â€Å"Organisational culture in the public sector† article, Sting and Loch explain that this does not mean that there is not a need for a â€Å"bottom-up participation† which was part of the work environment before the values of the employees were, in a way, forced to be changed for unexplained reasons to them. As a result of such, this did cause setbacks in the cultural change that was attempted. Changing the value of a large group of people within the company is next to impossible when it’s so closely tied to their private beliefs such as the members of the Queensland public sector. In order to move from a hierarchical process model of an organization to a more flexible and change oriented one, organizations must first understand their employees preferred organizational structure, and then create a corporate culture which employees can slowly get accustom to. In the case of six organizations in the Queensland public sector, the transformation required a culture change from the â€Å"Mechanistic† to ‘Organic† organizational structure and this should have been done very slowly only after understanding the values of those involved. One easy way to get this information is to have employees perform a self-assessment. Because â€Å"a corporate culture is influenced by the industry in which the organization operates†, outside factors such as political control have to be considered in a path taken to change employees assumptions, values, and artifacts (McGraw-Hill Companies, 2002-2009). Before an organization can move from a hierarchical process to a more flexible one employees must understand the benefits of shifting their culture from â€Å"control† to â€Å"performance†, where their input is valued. Through our research and critical analysis of the six organizations in the Queensland public sector, it is evident to us that the paradigm public organizations are functioning in will not change easily. Though the employees have to be able to accept change and shift, employers must understand that the need to create an environment that fosters a corporate cultural environment is vital. Change is inevitable but a positive response to the change is not. Without the strategic planning of organizational leaders, we will continue to see results like we saw with the six organizations in Queensland; the entire organization has to be a part of the implementation, intimately, in order for it to be effective. Unfortunately, when employees of any organization settle for the â€Å"norm,† they will not only resist change but they will fear it.

What Technology Brings To Us :: Television TV Essays

What Technology Brings To Us I have selected television as my technology subject because, on a global level, television has the greatest impact on the largest number of people of all the technologies available to us today. I have found that television has become widely distributed for many reasons, the most important being the fact that television sets have become more affordable over the years. There is also a desire by poor people in poor countries to have the same gadgets that are owned by the people in rich countries and only television can satisfy that need. Television can also be the means by which all levels of government can communicate with their populations. Thanks to satellites, television signals can be received just about everywhere on the planet. In the Third World, a single television can bring people together in order to watch a program on the community-owned set. In less educated cultures, television must seem like magic and its magic can draw those people closer together for the common experience of seeing a TV program. However, that same technology in the hands of advantaged societies tends to drive people apart. In America, you can often find a TV in every room (and sometimes in the bathroom), and various family members can spend hours and hours watching their own programming preferences on their own TV sets and not interacting with each other at all except during meals. Even the dinner hour cannot guarantee family communication. Too often, after-school activities such as sports and other outside interests draw people away from a shared meal. Those who eat alone often do so with a television for company, thereby replacing two-way conversations with the toxins of modern television programming. Television unifies the poor and separates the rich. It is both an anesthetic and a pacifier but it is never a reliable source for the truth. Thanks to the wealth of this nation, American television has always had the resources needed to do very great things for the citizens of this country. It could bring profoundly important documentaries to the attention of those who are removed from those stories, it could teach children who have outgrown Sesame Street foreign languages and critical thinking skills plus it could easily spread the truth with each news broadcast. A higher level of entertainment could encourage more sophisticated tastes and cultural expectations. Instead, American television offers a disgusting collection of trash at all levels and that trash makes Americans a very proud but ignorant people.

Aspects of Poetry

To be able to explain the aspects of poetry to you all, I thought I would break the mini lesson down into two parts. It will help you understand the differences between a poem and a sonnet, and will make it easier to absorb all of the components involved. First we will start with a sonnet. Let’s start by talking about just what a sonnet is. â€Å"Before Shakespeare’s day, the word â€Å"sonnet† meant simply â€Å"little song,† i. e. , a short lyric poem† (poetry. about. com, 2010). By the 1200’s, the sonnet had come to be known as a form of poetry that is comprised of 14 lines.The first type of sonnet was the Italian version, also known as the Petrarchan sonnet. The Italian sonnet is separated into two segments by two different clusters of rhyming sounds. The first 8 lines are called the octave and it serves as the question. The remaining 6 lines are called the sestet. The sestet serves as the answer to the octave, or the question. Later we c ame to know the English version, or the Shakespearean version. The English sonnet differs from the Italian sonnet in the way is broken down. The English sonnet has four divisions, not two.You will notice the breaks between the divisions. The first three parts are called the quatrain, and the last part is called the couplet. The couplet is an observation of the first three parts, or quatrains. I will be breaking down the aspects of a sonnet. We will discuss the theme, the language usage, and the metaphorical references that are found within the sonnet that I have chosen. It was a tough decision, but the sonnet I chose to discuss is â€Å"How do I love thee? Let me count the ways† by Elizabeth Barrett Browning [1806 – 1861] Here is the sonnet:The first aspect we will tackle is the theme. Common themes can be related to love, death, war, and others. The obvious theme in the chosen sonnet is love and the sonneteer’s feelings towards her husband to be, Robert Brownin g. It is a beautiful sonnet and shows just how intense her love is for her partner. The second aspect we will discuss is the use of language in the sonnet, or figures of speech. You will regularly see the use of metaphors, similes, personifications and irony in sonnets.An example of a metaphor in this sonnet is when the author states â€Å"I love thee freely, as men strive for Right† she is comparing the depth of her love with the passion a man can feel when he is defending his rights and beliefs. On the very next line, the author uses simile by stating that â€Å"I love thee purely, as they turn from Praise†. She is sizing up her love with her faith, or religion. Lastly, I believe that the author displays personification when she writes that â€Å"the ends of Being and ideal Grace† she is personifying her love with life and religion.It is the main theme that pops from the sonnet. By and large, the sonnet is just a beautiful work that expresses extremely deep an d intense feelings about love for another person. I will be discussing the importance of word usage in poem. The poem I chose to discuss is â€Å"To My Dear and Loving Husband† by Anne Bradstreet [c. 1612 – 1672]. Word choice in a poem is the one key aspect to get the message across in a poem. I admit that there are some poems that you have to read over and over again to begin to get an idea of what the author is talking about.Anne Bradstreet created a lovely tribute to the husband and she is expressing just how deep and intense her love is for her partner. By using words that really bring home the powerful sentiments, the reader can comprehend almost immediately what the author is expressing. Bradstreet writes â€Å"I prize thy love more than whole mines of gold†Ã¢â‚¬ ¦. she is helping the reader understand how big her love is by making a comparison to a monetary concept. She also writes â€Å"My love is such that rivers cannot quench†Ã¢â‚¬ ¦. here she i s making a comparison of the extreme love she feels for her husband with a physical thirst that not even a river can satisfy.That statement is intense! Lastly, Bradstreet writes â€Å"Then while we live, in love let's so persevere†¦That when we live no more, we may live ever†Ã¢â‚¬ ¦. Such is the adoration for her husband that she is expressing that their love will continue even in death. Using an effective word choice in a poem will make or break a poem. It is the wording that will help get the author’s point across to the reader. â€Å"Words are capable of creating beauty or ugliness, creating mood, creating imagery, sounds, and smells† (Taylor, M, 2006). After reading this poem over and over again, I can say that I feel the love that Bradstreet is expressing.This is a great example of using the right words to get a point across. Whether you’re reading a poem or an epic novel, if you are not choosing the right words, you will not grab your readers.R eferences: Holman, B. Snyder, M. (2010). Sonnet. Retrieved from http://poetry. about. com/od/poeticforms/g/sonnet. htm Taylor, Marilyn. â€Å"Tips For Finding the Right Words. † Writer 119. 12 (2006) Warn, E. (2010). Anne Bradstreet: â€Å"to my dear and loving husband†. Retrieved from http://www. poetryfoundation. org/learning/poem-guide. html? guide_id=238168

Shadow Kiss Chapter 14

Fourteen ABOUT A HALF HOUR before my alarm was scheduled to go off the next morning, I heard a knock at my door. I expected it to be Lissa, but a sleepy check of our bond showed that she was still fast asleep. Puzzled, I staggered out of the bed and opened the door. A Moroi girl I didn't recognize handed me some folded clothes with a note attached. I wondered if I should tip her or something, but she left too quickly for me to react. I sat back on my bed and unfolded the clothing. Black slacks, white blouse, and a black jacket. It was the same ensemble that the other guardians wore around here, and it was in my size. Wow. I was about to become part of the team. A slow grin spread over my face, and I opened the note. It was in Dimitri's writing: Wear your hair up. The grin stayed on my face. A lot of female guardians cut their hair to show off their molnija marks. I'd reluctantly considered it once, and Dimitri had told me not to. He loved my hair and had told me to wear it up. The way he'd said it back then had given me chills, just like now. An hour later, I was on my way to the trial with Lissa, Christian, and Eddie. Someone had rustled up a black-and-white outfit for Eddie too, and I think we both kind of felt like kids playing dress-up with their parents' clothing. My cropped jacket and stretchy blouse were actually pretty cute, and I wondered if I'd be able to bring these back with me. The courtroom was over in the large, ornate building we'd passed upon arrival. Walking through its halls, I saw a mix of the old and the new. Outside, it was all arched windows and stone spires. Inside, it was a hub of modern activity. People worked in offices with flat-screen monitors. Elevators led to upper floors. Yet, despite that, a few antique touches could still be found. Sculptures on pedestals. Chandeliers in the halls. The courtroom itself had beautiful murals that stretched from floor to ceiling, and in the front of the room, seals from all the royal families hung on the walls. Lissa stopped as we walked in, her eyes falling on the Dragomir dragon. King of the beasts. A sea of conflicting emotions swirled within her as she stared at the seal and felt the full weight of being the only one left to carry on her name. Pride to be part of that family. Fear that she wouldn't be good enough to live up to the name. Giving her a gentle nudge, I urged her on toward our seats. The seating was split by an aisle down the middle of the room. We sat at the front of the right-hand section. There were still several minutes to go before proceedings began, but the room wasn't very full yet. I suspected that wouldn't change, due to the secrecy surrounding what had happened with Victor. A judge sat at the front, but there was no jury. An elevated seat on one side of the room marked where the queen would sit when she arrived. She would be the one who made the ultimate decision. That was how it worked with royal criminal cases. I pointed it out to Lissa. â€Å"Let's hope that she's against him. Looks like she'll be the only one making the decision.† Lissa frowned. â€Å"Not having a jury feels kind of weird.† â€Å"That's because we spent so much time around humans.† She smiled. â€Å"Maybe. I don't know. Just seems like there's a lot of room for corruption.† â€Å"Well, yeah. But this is Victor we're talking about.† Moments later, Prince Victor Dashkov himself entered the courtroom. Or, rather, just Victor Dashkov did. He'd been stripped of his title when he'd been imprisoned. It had gone to the next oldest person in the Dashkov family. Fear shot through Lissa, and the little color that was in her cheeks completely disappeared. Mingled with that fear was an emotion I hadn't expected: regret. Before he'd kidnapped her, Victor had been like an uncle to her – that was even how she'd referred to him. She'd loved him, and he'd betrayed her. I put my hand over hers. â€Å"Easy,† I murmured. â€Å"It's going to be okay.† His eyes, narrowed and cunning, looked around the courtroom as though it were a party. He had that same unconcerned look he'd had while talking to Dimitri and me. I felt my lips curl into a sneer. A red haze tinged my vision, and I worked hard to be as serene as the other guardians in the room. He finally focused on Lissa, and she flinched at seeing the same eye color she and others of her family had. When he nodded a sort of greeting to her, I felt my control snap. Before I could actually do anything, I felt new words in my mind – Lissa's. Breathe, Rose. Just breathe. It looked like we were going to have to rely on each other to get through this. A heartbeat later, Victor was walking again, off to take his seat on the left side of the room. â€Å"Thanks,† I said to her, once he was gone. â€Å"It's like you can read my mind.† â€Å"No,† she said gently. â€Å"I could just feel your hand.† I looked down at where I'd put my hand over hers. I'd done it to comfort her and had ended up clenching her fingers in my own agitation. â€Å"Yikes,† I said, jerking away and hoping I hadn't broken her bones. â€Å"Sorry.† Queen Tatiana's entrance followed his, which distracted me and helped calm my dark feelings. We all stood when she appeared and then knelt. It was all kind of archaic, but it was a custom the Moroi had held onto over the years. We didn't rise until she took her seat, and then the rest of us were able to sit too. The trial started. One by one, those who had witnessed the events with Victor gave their account of what they'd seen. Largely, this involved the guardians who had pursued Lissa when Victor had taken her away and who had subsequently been part of the raid on Victor's hideout. Dimitri was the last of the guardians to go. On the surface, his testimony wasn't much different than theirs. They'd all been part of the rescue squad, but his part in the story had begun a little earlier. â€Å"I was with my student, Rose Hathaway,† he said. â€Å"She shares a bond with the princess and was the first to sense what had happened.† Victor's lawyer – I couldn't even imagine how they'd gotten anyone to represent him – glanced at some papers and then looked back up at Dimitri. â€Å"Based on the events, it sounds like there was a delay between when she discovered that and when you alerted the others.† Dimitri nodded, his mask of composure never slipping. â€Å"She couldn't act on it because Mr. Dashkov had inflicted a charm on her, one that caused her to attack me.† He spoke the words so levelly, it amazed me. Not even the lawyer seemed to notice anything. Only I could see – or maybe it was just because I knew him – how much it hurt for Dimitri to lie. Oh, he wanted to protect us – wanted to protect me in particular – which was why he was doing this. But it killed a piece of him to stand up there, under oath, and lie. Dimitri was not perfect, no matter how much I thought he was some days, but he always tried to be truthful. Today he couldn't be. â€Å"Mr. Dashkov works with earth magic, and some who use that power and are strong in compulsion can influence our base instincts,† continued Dimitri. â€Å"In this case, he affected her anger and violence through an object.† Off to my left, I heard a sound – like someone choking on their own laughter. The judge, an elderly but fierce Moroi woman, glared. â€Å"Mr. Dashkov, please respect the decorum of this courtroom.† Victor, still smiling, waved his hands in apology. â€Å"I'm terribly sorry, Your Honor and Your Majesty. Something in Guardian Belikov's testimony just tickled my fancy, that's all. It won't happen again.† I held my breath, waiting for the blow to fall. It didn't. Dimitri finished his statement, and then Christian was called up. His part was short. He'd been with Lissa when she'd been taken and had been knocked out. His contribution was being able to ID some of Victor's guardians as the kidnappers. Once Christian sat down, it was my turn. I walked up, hoping I looked calm in front of all those eyes – and in front of Victor. In fact, I went out of my way to not look at him at all. As I said my name and gave my oath to tell the truth, I suddenly felt the full force of what Dimitri must have experienced. I was standing before all these people, swearing I'd be honest, but I would lie in an instant if the lust charm came up. My version was pretty straightforward. I had details to offer from before the night of the kidnapping, like about when Victor had laid his sick traps to test Lissa's power. Otherwise, my story lined up with Dimitri's and the other guardians'. I'd said before that I could lie well, and I brushed over the â€Å"attack† charm part with such ease that no one paid any attention. Except Victor. Despite my refusal to look at him, I inadvertently glanced in his direction when I mentioned the charm. His eyes bored into me, and a small smirk sat on his lips. His smugness, I realized, was more than just because he knew I was lying. It was also because he actually knew the precise truth – and the look he gave me told me that he had that power over me and Dimitri, the power to ruin everything for us in front of all these people – no matter what Dimitri had threatened. All the while, I kept my face calm enough to make Dimitri proud, but inside my chest, my heart thudded loudly. It seemed to last forever, but I knew I was only on the stand for a few minutes. I finished, sagging with relief that Victor hadn't called me out, and then it was Lissa's turn. As the victim, she offered the first new perspective thus far, and everyone there grew caught up in her story. It was compelling; no one had ever heard anything like it. I also realized that, without even trying, Lissa was using her spirit-induced charisma. I think it came from the same place compulsion did. People were enraptured and sympathetic. When Lissa described the torture Victor had put her through to force her to heal him, I saw faces go pale with shock. Even Tatiana's stern mask faltered a little, though whether she felt pity or just simple surprise, I couldn't say. The most amazing thing, though, was how calmly Lissa managed to deliver the story. On the outside, she was steady and beautiful. But as she spoke the words, describing exactly how Victor's henchman had tortured her, she relived the pain and terror of that night. The guy had been an air user, and he'd toyed with that element, sometimes taking it away so she couldn't breathe and at other times smothering her with it. It had been horrible, and I'd experienced it right along with her. In fact, I experienced it with her again now as she spoke about the events on the stand. Each painful detail was still etched in her mind, the pain echoing back to both of us. We were both relieved when her testimony finished. Finally, it was Victor's turn. From the look on his face, you never would have guessed he was on trial. He wasn't angry or outraged. He wasn't contrite. He didn't plead. He looked like we were all hanging out somewhere, like he had nothing in the world to worry about. Somehow, that made me that much angrier. Even when answering, he spoke as though he made perfect sense. When the prosecuting lawyer asked why he'd done what he had, he looked at her as though she were crazy. â€Å"Why, I had no choice,† he said pleasantly. â€Å"I was dying. No one was going to condone me openly experimenting with the princess's powers. What would you have done in my place?† The lawyer ignored that. She was having a hard time keeping the disgust off of her face. â€Å"And you found coaxing your own daughter into turning Strigoi also necessary?† Everyone in the courtroom shifted uncomfortably. One of the most awful things about Strigoi was that they were made, not born. A Strigoi could force a human, a dhampir, or a Moroi into becoming Strigoi if the Strigoi drank the victim's blood and then fed Strigoi blood back to the victim. It didn't matter if the victim wanted it or not, and once she became Strigoi, she lost all sense of her old, moral self. She embraced becoming a monster and killing others to survive. Strigoi converted others if they found someone they thought would strengthen their ranks. Sometimes they did it just out of cruelty. The other way a Strigoi could be made was if a Moroi willingly chose to kill another person during feeding, destroying all the magic and life within themselves. Christian's parents had done that because they'd wanted to be immortal, no matter the cost. Victor's daughter Natalie had done it because he had talked her into it. The extra strength and speed she'd gotten from being a Strigoi had helped her free him, and he'd felt his goals were worth the sacrifice. Again, Victor showed no remorse. His answer was simple. â€Å"Natalie made that decision.† â€Å"Can you say that about everyone you used to meet your ends? Guardian Belikov and Miss Hathaway had no say in what you made them do.† Victor chuckled. â€Å"Well, that's a matter of opinion. I honestly don't think they minded. But if you have time after this case, Your Honor, you might want to consider trying a statutory rape case.† I froze. He'd done it. He'd really done it. I expected everyone in the room to turn and point at Dimitri and me. No one even looked in our direction, though. Most people were giving Victor appalled looks. I realized that was exactly what Victor had known would happen. He just wanted to tease us; he didn't actually expect anyone to take him seriously. Lissa's feelings through the bond confirmed as much. She felt like Victor was trying to shift attention off of himself by making up stories about Dimitri and me. She was horrified that Victor would stoop so low. The judge was too, and she chastised Victor for getting off topic. By that point, most of the questioning was done. The lawyers wrapped up, and it was time for the queen to deliver her verdict. I held my breath again, wondering what she would do. He hadn't denied any of the charges. The evidence was overwhelming, thanks to my friends' testimonies, but as even Victor had pointed out, there was a lot of corruption among royals. The queen could very well decide that she didn't want the scandal involved with imprisoning someone so well known. Even if no one knew the details, his imprisonment would start a buzz. Maybe she didn't want to deal with that. Maybe Victor had bought her off too. But in the end, she found Victor guilty and sentenced him to life in prison – a different prison, not the one at Court. I'd heard stories about Moroi prisons, and they were terrible places. I suspected his new home would be very different from the cell we'd found him in. Victor remained calm and amused throughout it all, just as he had yesterday. I didn't like that. The conversation I'd had with him made me think he wasn't going to accept this as serenely as he pretended. I hoped they'd watch him closely. A gesture from the queen ended formalities. The rest of us stood up and began talking while she surveyed the room with a sharp eye, probably taking notes. Victor's escort started to lead him out. He passed by us again. This time, he stopped and spoke. â€Å"Vasilisa, I trust you've been well.† She didn't answer. She still hated and feared him, but with this verdict, she finally believed he could no longer hurt her. It was like the end of a chapter she'd been stuck in for months. She could finally move on and hopefully let those horrible memories fade. â€Å"I'm sorry we didn't get a chance to talk, but I'm sure we will next time,† he added. â€Å"Come on,† said one of the guardians with him. They led him away. â€Å"He's crazy,† muttered Lissa once he was gone. â€Å"I can't believe he said that stuff about you and Dimitri.† Dimitri was standing behind her. I looked up and met his eyes as he moved past us. His relief mirrored my own. We'd danced with danger today – and we'd won. Christian came up to her and hugged her, holding her for a long time. I watched them fondly, surprised at my own kind feelings for them. When a hand touched my arm, I jumped. It was Adrian. â€Å"You okay, little dhampir?† he asked softly. â€Å"Dashkov said a few †¦ uh †¦ suggestive things.† I stepped closer, keeping my voice low as well. â€Å"No one believed him. I think it's okay. Thanks for asking, though.† He smiled and tapped my nose. â€Å"Two thank-yous in as many days. I don't suppose I'll get to see any, uh, special gratitude?† I scoffed. â€Å"Nope. You'll just have to imagine it.† He gave me a half-hug and released me. â€Å"Fair enough. But I have a good imagination.† We started to leave, and then Priscilla Voda hurried over to Lissa. â€Å"The queen would like to meet with you before you leave. In private.† I glanced over to the raised chair where the queen sat. Her gaze was fixed on us, and I wondered what this could be about. â€Å"Sure,† said Lissa, as confused as I was. To me, she sent through the bond: Will you listen again? I gave her a quick nod before Priscilla spirited her off. I returned to my room, tuning in to Lissa while I packed my things up. It took a little while because Tatiana had to finish a few courtroom formalities, but she finally arrived in the same room as yesterday. Lissa and Priscilla bowed as she entered and waited for the queen to sit. Tatiana made herself comfortable. â€Å"Vasilisa, you need to be in the air soon, so I'll make this brief. I would like to make an offer to you.† â€Å"What kind of an offer, Your Majesty?† â€Å"You'll need to go to college soon.† She spoke like it was a done deal. And yeah, Lissa did plan on going to college, but I didn't like the presumption. â€Å"I understand you're dissatisfied with your choices.† â€Å"Well†¦it's not that I'm dissatisfied, exactly. It's just, all the places Moroi are supposed to go are small. I mean, I understand it's for safety, but I don't know. I'd like to go somewhere bigger. Somewhere prestigious.† Guardians monitored a handful of select colleges in the country so that Moroi could safely attend them. As Lissa had noted, though, they tended to be smaller schools. Tatiana nodded impatiently, like she already knew this. â€Å"I'm going to give you an opportunity that no one else has ever been given, to my knowledge. After graduation, I would like you to come live here, at the Royal Court. You have no family, and I think you'd benefit from learning politics right in the heart of our government. Along with this, we would make arrangements for you to attend Lehigh University. It's less than an hour from here. Have you heard of it?† Lissa nodded. I'd never heard of it, but she was enough of a nerd to have researched every college in the U.S. â€Å"It's a good school, Your Majesty. But†¦ still small.† â€Å"It's bigger than the ones Moroi usually attend,† she pointed out. â€Å"True.† In her mind, Lissa was trying to puzzle out what was going on here. Why was Tatiana making this offer? Especially considering how she'd seemed to disagree with Lissa earlier. There was something weird going on here, and she decided to see how far she could push it. â€Å"The University of Pennsylvania isn't that far either, Your Majesty.† â€Å"That school is enormous, Vasilisa. We couldn't ensure your safety there.† Lissa shrugged. â€Å"Well, then it probably doesn't matter if I go to Lehigh or one of the others.† The queen looked shocked. So did Priscilla. They couldn't believe Lissa seemed indifferent to the offer. Truthfully, Lissa wasn't indifferent. Lehigh was a step up from what she'd expected, and she wanted to go. But she also wanted to see how badly the queen wanted her to go. Tatiana frowned and appeared to be weighing matters. â€Å"Depending on your grades and experiences at Lehigh, we could possibly arrange for you to transfer in a couple years. Again, the safety logistics would be very difficult.† Wow. The queen did want her around. But why? Lissa decided to simply ask. â€Å"I'm very flattered, Your Majesty. And grateful. But why are you offering me this?† â€Å"As the last Dragomir, you're a precious commodity. I'd like to make sure your future is secure. And I do so hate to see bright minds wasted. Besides†¦Ã¢â‚¬  She paused, hesitant to speak her next words. â€Å"You were right to a certain extent. The Moroi do have trouble changing. It could be useful to have a dissenting voice around here.† Lissa didn't answer right away. She was still analyzing this offer from every possible angle. She wished I was there to advise her, but I wasn't sure I'd have much of an opinion. Splitting my guardian duty between the Court and a cool university could be pretty neat. On the other hand, we'd have more freedom elsewhere. In the end, Lissa decided in favor of higher education. â€Å"All right,† she said at last. â€Å"I accept. Thank you, Your Majesty.† â€Å"Excellent,† said Tatiana. â€Å"We'll see that the arrangements are made. You may go now.† The queen made no signs of moving, so Lissa bowed again and scurried to the door, still reeling with this news. Tatiana suddenly called out to her. â€Å"Vasilisa? Will you send your friend here to talk to me? The Hathaway girl?† â€Å"Rose?† she asked in astonishment. â€Å"Why do you – ? Yes, of course. I'll get her.† Lissa hurried toward guest housing, but I met her halfway. â€Å"What's going on?† I asked. â€Å"I have no idea,† said Lissa. â€Å"Did you hear what she said?† â€Å"Yup. Maybe she wants to tell me how I have to be extra careful with you going to that school.† â€Å"Maybe. I don't know.† Lissa gave me a quick hug. â€Å"Good luck. I'll see you soon.† I went to the same room and found Tatiana standing with her hands clasped, posture stiff and impatient. She was dressed like a corporate businesswoman again, with a sleek brown blazer and skirt set. That color wouldn't have been my first choice to go with her dark gray hair, but that was her style adviser's problem, not mine. I bowed just as Lissa had and glanced around the room. Priscilla was gone; only a couple guardians remained. I expected Tatiana to tell me to sit, but instead, she stood up and walked right over to me. Her face did not look happy. â€Å"Miss Hathaway,† she said sharply, â€Å"I'm going to keep this brief. You are going to stop this atrocious affair you're having with my great-nephew. Immediately.†

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101 Intro to Literary Analysis and Woman Hollering Creek Professor Ramos Blog

101 Intro to Literary Analysis and Woman Hollering Creek Analysis vs Summary Quick Write A theme is a central idea in a piece of writing or other work of art. What theme or themes did you notice in â€Å"Woman Hollering Creek?† Analysis vs Summary Summary versus Analysis. What is the difference? What does it mean to analyze literature? Analysis : detailed examination of the elements or structure of something. â€Å"Woman Hollering Creek† La Llorona Prezi What are some themes, recurring topics or ideas, that you have noticed? Lets come up with a list of characters. Arguable Thesis Start with what interests you, to develop a point of analysis. You can choose a character, theme, issue, context, patterns, metaphors, authors style or language, etc. What is standing out to you and then you can develop that into a thesis. You will be arguing that your analysis of the work is valid. Developing Strong Thesis Statements In Woman Hollering Creek, Sandra Cisneros is recasting traditional negative Mexican female archetypes in a positive light. Focus on Thesis and Structure One way to organize your analysis essay: Introduce the text and state your  arguable thesis. Body paragraphs 1-3,4,5,6 cite passages and explain how each supports your thesis and interpretation. Conclusion, sum up your interpretation in light of your analysis Document Sources, works cited. You can choose other ways of organizing, as long as it is clear and   makes sense. Student Video What is a Literary Analysis? Writing a Literary Analysis Presentation Literary Analysis The Art of Quoting According to the book, what is the purpose of a citation? When is the use of a citation appropriate? Claims China  is the largest nation in the world. A McDonald’s  Big Mac ®Ã‚  has 550 calories. Why do these need support? Where can you find it? Quote Sandwich Introduce the quotation p. 46 Quote, relevant Explain Quotation p. 47 Quick Write Why are citations important? How did you find support for the claims? Is it wrong to not cite sources?   Why or Why not? How would you feel if your ideas or work were used without giving you credit? Alternate Interpretation

Reflections, Translations, and Rotations on SAT Math Coordinate Geometry Guide

Reflections, Translations, and Rotations on SAT Math Coordinate Geometry Guide SAT / ACT Prep Online Guides and Tips If it's always been a dream of yours to shift around graphs and points on the $x$ and $y$ axes (and why not?), then you are in luck! Points, graphs, and shapes can be manipulated in the coordinate plane to your heart's content. Want to scoot that triangle a little to the left? Flip it? Spin it? With reflections, rotations, and translations, a lot is possible. This will be your complete guide to rotations, reflections, and translations of points, shapes, and graphs on the SAT- what these terms mean, the types of questions you'll see on the test, and the tips and formulas you'll need to solve these questions in no time. Before You Continue Reflection, rotation, and translation problems are extremely rare on the SAT. If you're aiming for a perfect score (or nearly) and want to grab every last point you can, then this is the guide for you. But if you still need to brush up on your fundamentals, then your time and energy is better spent studying the more common types of math problems you'll see on the test. Remember, each question is worth the same amount of points, so it is better that you can answer two or three questions on integers, triangles, or slopes than to answer one question on rotations. So if you've got everything else nailed down tight (or you just really, really like coordinate geometry), then lets talk reflections, rotations, and translations! What is a Reflection? Just like how your image is reflected in a mirror, a graph or a flat (planar) object can be reflected in the coordinate plane. It can be reflected across the x-axis, the y-axis, or any other line, invisible or otherwise. This line, about which the object is reflected, is called the "line of symmetry." Most SAT reflection questions will ask you to identify a shape that is symmetrical about a line that you must imagine or draw yourself. These questions should be simple enough so long as you pay attention to the details. For example, The diagram below shows the Greek letter pi. Each side of the figure is reflected identically about a vertical line of symmetry. Of the letters shows bellow, which has both a vertical and a horizontal line of symmetry? A. B. C. D. E. Now, we are being asked for a letter that has BOTH a vertical AND a horizontal line of symmetry (even though the example, pi, only has a vertical line of symmetry). If you are going too quickly through the test, you might be tempted to find the letter with only a vertical line of symmetry like the example picture. Doing this, however, would lead you to select the wrong answer choice. So, now that we know that we must find a letter that is symmetrical both vertically and horizontally, let us examine our options. You can either draw lines of reflection in your mind or on the page, but we will draw it out here. Let us test our options by first giving them a vertical line of symmetry. If they fail the vertical test, then they will automatically be eliminated, with no need to test if they have a horizontal line of symmetry. (Remember, we are looking for a letter that has both.) So let us draw a potential vertical line of symmetry through each of our answer choices, starting with answer choice A. We can see that rho does not have a vertical line of symmetry, as each half is not a perfect reflection of one another. We can eliminate answer choice A. Each half of gamma is also not symmetrical with the other half. We can eliminate answer choice B. Mu is symmetrical about itself vertically and if you were going quickly through the test, you may be tempted to stop here. But we know we must also find a horizontal line of symmetry. Mu does not have a horizontal line of symmetry, so we can now eliminate answer choice C. Eta, as well, has a vertical line of symmetry. Let us see if it also has a horizontal one as well. Success! Eta is symmetrical, whether the line of symmetry is vertical or horizontal. We can stop here, as we have found our correct answer choice. Our final answer is D. Nature showing off its coordinate geometry skills. Clearly. What is a Rotation? Objects in the coordinate plane can also be rotated (turned) clockwise or counterclockwise. Imagine that we can adjust the object with our hands- it will spin, while still lying flat, like a piece of paper on a tabletop. To rotate an object, we must pick a point to act as the center point for our rotation. This center point of our rotation does NOT have to be the center of the shape, however; there must always be a center to our rotation, but we can pick any point to act as this center. Let us look at a visual demonstration of this. First, let's look at a shape that has a center of rotation at the center of the shape itself. Now we can see how the movement of the object changes as the center of rotation shifts. Here, we have a center of rotation as a point on the outline of the shape. But though any point can act as a center of rotation, you will almost always be asked to rotate an object "about the origin." This means that the origin (coordinates $(0,0)$) will act as your center of rotation. The angle about which the object moves is called the angle of rotation. As we rotate an object, the angle of rotation will be: Positive when we move the object counterclockwise Negative when the object is rotating clockwise. A positive angle of rotation. A negative angle of rotation. Through both objects ended up in the same place, one was rotated +180Â ° and the other was rotated -180Â °. If you are asked to rotate an object on the SAT, it will be at an angle of 90 degrees or 180 degrees (or, more rarely, 270 degrees). These are nice numbers that evenly divide the coordinate plane into 4 parts, and each of these degree measures has a standard rule of rotation. Let us look at these rotation rules. Note: if you're a little shaky on the different quadrants of the $xy$-coordinate plane and where $x$ and $y$ are positive and negative, you should take a couple of minutes to read through our article on the four graph quadrants before going to the next section of this guide. Put your cudgels away and we'll prove we're not fakirs. Rotation Rules and Formulas You can determine the new coordinates of your point if you rotate your object by a certain angle about the origin. [Note: these formulas only work when rotating a point or a series of points about the origin- they will not work if rotating the object about any other center of rotation.] Each of the three degree measures- 90, 180, or 270- will shift the coordinates of your original point to a different, calculable, position on the graph. If rotating counterclockwise (a positive angle of rotation), you can use these rules to find your new coordinate points. For example, let us start with a set of coordinates at $(4, 6)$ and rotate the point. Here we have our original coordinates of $(4, 6)$ For 90 degree rotations: $(a, b)$ = $(-b, a)$ If our original coordinates of (4, 6) are rotated 90Â °, the new coordinates will be (-6, 4). For 180 degree rotations: $(a, b)$ = $(-a, -b)$ If our original coordinates of $(4, 6)$ are rotated 180Â °, the new coordinates will be $(-4, -6)$. For 270 degree rotations: $(a, b)$ = $(b, -a)$ If our original coordinates of $(4, 6)$ are rotated 270Â °, the new coordinates will be $(6, -4)$. (And, of course, a 360 degree rotation will bring you right back to the beginning at $(a, b)$ again!) If our original coordinates of $(4, 6)$ are rotated 360Â °, the new coordinates will be the same, $(4, 6)$. â™ ª You spin me right round, baby, right round â™ ª What is a Translation? If we continue to think of the shape as a piece of paper lying flat on a table (on the coordinate plane), a translation is the act of sliding it along the coordinate plane in a particular direction. The shape can be translated up or down (or both!) any amount of distance along the plane. It maintains its shape and bearing, but is simply located elsewhere in the plane. The way to notate that a translation is to occur is by saying: $T_{a,b}(x,y)$ This means that your final coordinates for this point will be: $(x + a, y + b)$ For example, What is the new point for $T_{-3, 4}(2, -6)$? A. $(-5, 10)$B. $(-1, 2)$C. $(1, -2)$D. $(-5, -10)$E. $(-1, -2)$ We know that we must add together our translated points to the corresponding $x$ and $y$ values of our original coordinates. So: $T_{-3, 4}(2, -6)$ $(2 + -3, -6 +4)$ $(-1, -2)$ Our new coordinates for this point are at $(-1, -2)$. You can see why this is true if we look at it on a graph. We are starting at the coordinates $(2, -6)$. Now, we are traveling -3 spaces along the $x$-axis and +4 spaces along the $y$-axis. By tracing this, we can find our new coordinates. Our final answer is E, $(-1, -2)$. Typical Reflection, Rotation, and Translation Problems Again, these types of questions are extremely rare on the SAT, and the odds likely that you will not see any reflection, rotation, or translation problems at all on your test. That said, there are three different types of reflection/rotation/translation problems that will show up, when they appear at all. These questions will be either a reflection, rotation, or translation questions about: #1: Points#2: Shapes in the coordinate plane#3: Function graphs Let's look at all three. Points Points are the simplest objects to be rotated, reflected, or translated, because there is only one component- the single point. Any point on the coordinate plane will have an $x$-coordinate and a $y$-coordinate, but you will still have far fewer moving parts when dealing with a point rotation than with any other kind of rotation, reflection, or translation. Shapes Shapes are slightly more complicated to reflect or rotate than points are for the sheer reason that shapes are made up of several points (and the lines connecting those points). This means that any shape rotation/reflection/translation will require more consideration and care, in order to make sure all your pieces are properly aligned. It is often much easier, when working with modified shapes, to map out the positions of the points alone. Don't worry about the lines- mark the proper position of the new coordinates for the points and the lines will sort themselves out. For instance, let us say that we must rotate a trapezoid +90 degrees. The particular question may ask you to find the slope of one of the new lines of the rotated shape, identify a new coordinate point, or anything else. But first, we must rotate our figure. The easiest way to do this is to simply map the new coordinate points according to our rotating rules. We know that a 90 degree rotation will transform all of our coordinates from $(a, b)$ to $(-b, a)$, so let's find them. Each given coordinate point will transform like so: $(1, 1)$ = $(-1, 1)$ $(3, 4)$ = $(-4, 3)$ $(7, 4)$ = $(-4, 7)$ $(9, 1)$ = $(-1, 9)$ Now we can simply connect the lines and find our new trapezoid, allowing us to answer any question we need to about it. Function Graphs Finally, function graphs can be reflected or translated just like shapes and points, though NOT rotated. (Why can't functions be rotated? If a function were rotated, it would fail the vertical line test and no longer be a function.) A reflected function. A translated function. Functions cannot be rotated! This fails the vertical line test and so is no longer a function. Function Translations We can either translate our function vertically (up and down) or horizontally (left and right), or a combination of the two. The way we do this is by modifying our inputs and outputs (for more on how functions work, including inputs and outputs, check out our guide to SAT functions.) We can translate our function up or down by adding or subtracting from our output. Adding to output translates the graph up. Subtracting from the output moves the graph down. On the other hand: Adding to the input will shift the graph left Subtracting from the input will shift the graph to the right Function Reflections We can also reflect our function about a line of symmetry along the $x$ or $y$-axis. Making the output negative makes the function reflect across the $\bi x$-axis (inverts it about the $x$-axis). Making the input negative makes the function reflect across the $\bi y$-axis. If this is a lot of new information for you, don't stress. These types of questions are, again, so rare that the odds are you won't see them on your test. Only try to memorize these rules if you feel comfortable doing so. Strategies for Reflection and Translation Problems Though no two reflection/translation/rotation problems are exactly alike, there are a few tips and tricks to follow for any kind you may come across. #1: Draw Your Own Graphs Especially when dealing with a problem that requires a reflection or a translation, it is always a good idea to take a moment to sketch out a graph of the object's old and new positions in space. This allows you to work with the problem on the page instead of in your head, which is especially useful if you are asked to find information other than simply identifying a new coordinate point (a feat in and of itself!). For instance, you might be asked to find the slope of a reflected line, or the product of two translated $x$-coordinates, or anything else the SAT might think of. Without making your own drawings and diagrams, it can be easy to become confused, fall for bait answers, and lose precious points. #2: Drill Your Rotation Formulas When working with translations or reflections, it is simple enough to draw your own picture and line up your corresponding points, but when it comes to rotations, it can be much harder to visualize the movement of the point or the object. Even when you've mapped out the original point, rotations are often much trickier than they appear. Unless you have a paper cut-out of your point, shape, or function and want to spend your time spinning your scratch paper around in circles, it's better to simply memorize your rotation rules for 90, 180, and 270 degrees. #3: Double-check, double-check, (triple-check) Rotations, reflections, and translations may seem simple (and, indeed, the underlying principles are not overly complex), but the difficulty in solving these kinds of problems is in just how easy it is to mis-map a coordinate point or two. Nothing is more frustrating than when you know how to solve a problem, but go too quickly or too carelessly and so get the question wrong. So make sure you double-check that you've properly shifted your coordinates before you bubble in that final answer. Test Your Knowledge 1. 2. The graph $y = f(x)$ is shown below. What could be the graph of $y = f(x + 3)$? A. B. C. D. E. Answers: E, A Answer Explanations: 1. If we draw an imaginary vertical line through every letter in the answer options, we can see that all but one are symmetrical about that vertical line. Only the letter E has a different shape to it on each side of the vertical line. Our final answer is E. 2. We know that adding to the input or output will shift our graph and translate it somewhere else. In this case, we are adding to the input, which, you'll recall, translates our graph to the left. We are making no additional changes, so its vertical position will remain unchanged. The only answer choice that shows us a graph that maintains the vertical position and is shifted to the left is answer choice A. Here is the starting position of the function. And here it is shifted to the left in answer choice A. Our final answer is A. Yay! You did it! The Take-Aways Though quite rare to see, the surprise rotation or reflection question can throw a wrench in the works if you are unprepared for it. But nothing the SAT can put on the test is insurmountable (and, indeed, the test is designed to give you opportunities to succeed). Once you've got your understandings down tight and know not only the difference between all your terms, but how to properly take down any kind of coordinate geometry question the SAT can throw at you, you will be well on your way to earning that perfect score. What's Next? You've taken on one of the more obscure SAT math topics, but have you made sure that you have a solid understanding of all the rest of the math topics the SAT will test you on? As always, it is better to get as many points as possible (as accurately as possible), so now might be a good time to catch up on your understanding of circles, triangles, and integers, both basic and advanced. Want to know two of the most invaluable math strategies? Check out our guides on how to use plugging in numbers and plugging in answers to make sense of some of the trickiest SAT problems out there. Looking to get that perfect score? Our team has your back with our guide to getting a perfect 800 on the SAT math, written by a perfect-scorer. Want to learn more about the SAT but tired of reading blog articles? Then you'll love our free, SAT prep livestreams. Designed and led by PrepScholar SAT experts, these live video events are a great resource for students and parents looking to learn more about the SAT and SAT prep. Click on the button below to register for one of our livestreams today!

Virtual Classroom Essay Example | Topics and Well Written Essays - 1500 words

Virtual Classroom - Essay Example dvisory Group behind the Crick Report was originally formed in 1997: â€Å"To provide advice on effective education for citizenship in schools – to include the nature and practices of participation in democracy; the duties, responsibilities and rights of individuals as citizens; and the value to individuals and society of community activity† (Crick Report, 1998: 4). As these observations and examinations into the National Curriculum were being made, advances in technology were also having an effect on the means by which this type of instruction, as with many other topics, could be transmitted. Technology is having an electric effect upon the way in which pupils learn and the ways in which teachers instruct, reducing the time teachers spend on mundane paperwork tasks and bringing students experiences in ways that have never before been possible while also attempting to bridge, to some extent, the so-called digital divide. Whether this is ultimately more or less effective than traditional methods of instruction alone will depend to a large degree on the way in which lessons are approached and how technology is used to enhance education rather than simply providing entertainment. To understand the ways in which Information and Communication Technology (ICT) can be used to enhance inclusion and citizenship instruction to students, this paper will examine current practices by examining the ways in which ICT has been used thus far and discussing whether these uses have been effective educational tools. In making their recommendations for the revision of the National Curriculum, the National Union of Teachers (2005) cited the National Foundation for Educational Research: â€Å"from the pupil’s point of view, the curriculum should be ‘fun’ and ‘interesting’ †¦ it should be kept practical and challenging †¦ pupils should be given responsibility for their own work and a chance to work independently †¦ above all, pupils want greater connection of the

Language analysis Essay Example | Topics and Well Written Essays - 500 words - 1

Language analysis - Essay Example 25).The reversed event sequences make it interesting, the beginning marking Sal’s present-day account of spending Christmas with his relatives in Virginia, the middle part showing Dean’s surprise and unannounced visit to Sal in Virginia, and the final part describing the events leading to Dean’s unannounced visit to Sal, bridging the beginning with the end. Kerouac focused the addressee’s attention using sequence markers depicting what came first and last. For example the phrase â€Å"It was over a year before I saw Dean again† (Kerouac, 1999, p.101) implies the present setting, continuing until Sal learned that â€Å"Dean had lived happily with Camille in San Francisco ever since that fall of 1947†¦Ã¢â‚¬  (Kerouac, 1999, p.104).The phrase â€Å"I learned that (Dean had lived†¦)† prompts a flashback in the story’s timeline on how Dean ended up in Virginia in a car with two other people. Even in the narrative’s reversed sequence of events, subtle context clues and prompts show what happened, what happened next, and what happened after that (Hooey, 2000, p. 25). Contextually this is the narrative’s sequence: Dean compulsively bought a car using Sal as scapegoat to leave her and be on the road. Meanwhile, within the year that these events happened, Sal spent time writing his book at ho me and going to school. Sometime between Christmas and New Year Sal visited his relatives and brother in Virginia, but was surprised on Christmas Day when Dean and company appeared at his brother’s doorstep. After settling down, Dean told Sal why he visited unannounced (Kerouac, 1999. Kerouac moderates narrative timeline jumps by prompts connecting indirectly-related events. Since people take contexts and subtle links using their own experiences and views, the narrative makes sense even when sequences are reversed (Underhill, 2013, pp 20-22),

Jill Duerr Berrick(2010)Assessing Quality of Care in Kinship and Assignment - 1

Jill Duerr Berrick(2010)Assessing Quality of Care in Kinship and Foster Family Care - Assignment Example The attention has been captivated by the large numbers of children being served in foster care by kin and the scarcity of information available about the rapidly growing arrangement for care† (Berrick, 1997, p.273). According to Mokgosi (1997, p.7), â€Å"placement with extended family or kinship is becoming widely used as an alternative placement. Many child welfare experts believe that children will be better served if their care is provided by family members within the community of origin rather than by strangers.† For, separation from distant family members may lead to the child’s disruption, if unattended. On the other hand, Berrick claims, â€Å"on a number of measures relating to the home environment, non-kin homes were rated as more safe† (1997, p.273). The author describes kin caregivers as â€Å"older than foster family parents and a group heavily represented by single women of color who are struggling themselves with limited incomes† (Berrick, 1997, p.273). Whilst foster family providers generally prepare for their new role as parents, kinship foster parents more often fall into older parenthood in response to a pressing family emergency. Trends in this data point to the need for further research in the field, that is, â€Å"the need for changes in policy and practice that might strengthen the kin and non-kin resources currently available to dependent children are also suggested† (Berrick, 1997, p.279). Although the study done by Berrick was designed to assess the quality in kin and non-kin homes, focus herein will be given on its quantitative aspect, that is to say, in terms of the empirical patterns found in the data collected, so as to explain the research phenomena with regards to its numerical data. The primary method used was survey research, which included interviews. The county staff drew a random sample of 123 kinship and 97 non-kin homes from their foster care databases. Herein, a simple random sampling method of analysis was

Critically evaluate Susan Brownmillers (1975) assertion that ' war Essay

Critically evaluate Susan Brownmillers (1975) assertion that ' war provides men with a tacit license to rape - Essay Example Brownmiller feels that rape perseveres as a way for men to perpetuate their historic societal dominance over women on the whole. Assault laws have evolved over recent decades with respect to different classes of rape; harsher sentencing for wartime rapists has also been achieved where once it was nearly impossible to convict a man. Wartime continues to be the most difficult scenario for the control and subsequent punishment of rape. Brownmiller and her colleagues agree that because of the relaxed morality of a battlefield or a war-torn country, men feel free to not only take advantage of their baser instincts to fight and kill, but also to rape. Brownmiller explains rape as a purely human issue; she notes how zoologists will not address rape since it is believed to be nonexistent in the animal kingdom. To Brownmiller and many other researchers, â€Å"human beings are different† (1975, 1) in that their males are capable of rape and their females are capable of succumbing to violent sexual acts. In nature, the sexual act of animals is governed by the female’s fertility cycle: in essence, animals will not have sex unless the female is fertile and the male senses this. With humans, however, the female fertility cycle does not govern sexual acts nor does it have any effect on the sex drive of males; this is the fundamental difference between people and animals on which Brownmiller bases her distinctions of rape. Instead of being based on the fertility cycle, people copulate based on their individual urges. As Brownmiller says, â€Å"our call to sex occurs in our head† (ibid.). With animals, the male of the species will not attempt to copulate with a female unless she is clearly fertile; therefore the fertility cycle governs not only sexual urge but the act itself. Since humans do not behave based on this fundamental principle, women are always able to be viewed in a sexual way, men are always able to become aroused

Quality Data Collection Essay Example | Topics and Well Written Essays - 1250 words

Quality Data Collection - Essay Example Lack of proper data collection strategies results in wastage of hospital and patients resources since some results done are insignificant while others are annihilated. This paper focuses on data collection tools in emergency departments for blood culturing and the tools used in critical value reporting. The paper also elucidates on how the tools operate and compares how the tools operate. Improvement in data collection is vital for apposite analysis, diagnosis, treatment, and running of health amenities. Patience in the emergency department is often febrile and thus blood cultures are often obtained devoid of following the guidelines. However, most blood cultures ordered from the emergency departments are rarely utilized in management of the patient’s health. They thus end up being a source of unnecessary costs to the patients as well as the hospital. Another factor that declines the services of most community hospitals is excessive delays in defining and reporting of critical value results. Critical laboratory values have imperative significance on determining prompt treatment or actions that health provider ought to undertake. Most decisions and patient diagnosis depend on analysis of laboratory reports thus improvement in organization of laboratory services can improve on service provision. It is therefore vital to improve on timelines of reporting critical values (Tintinalli, et al, 2004). Blood Culture Contamination Rate in the Emergency Department Blood cultures are crucial in detecting conditions such as sepsis in the emergency departments. However, various researches show that most hospitals do not use blood culture results efficiently in clinical management of patients. The main problem in blood culturing is the inability to differentiate between contaminated cultures with true bacteraemia (Hall, & Lyman, 2006). To reduce errors and increase utilization of blood culture results, it is important to improve on tools used in monitoring performance information. It is recommendable that culture be collected only when clinically required. It is also important to use proper sampling techniques to prevent contamination. Tools used in blood culturing in the emergency department include culture bottle and needles. Enhanced collection of uncontaminated blood cultures is vital and can be done by proper disinfection of surfaces before drawing blood samples as well as using sterilized culture bottles. Use of surgical needles for blood sampling leads to contamination especially if proper sterilization is not done on the patients skin (Tintinalli, et al, 2004). Proper management of the data obtained after blood culturing is fundamental in improving the significance of the samples in management of emergencies. Another tool used to collect blood culture in the emergency department is automated blood culture technology that is capable of differentiating between positive and negative culture (Tintinalli, et al, 2004; Hall & Lyman, 2006). Crit ical Value Reporting Clinical value reporting provides mechanism for determining and reporting critical laboratory reports requiring urgent response. Critical values are determined differently by different hospitals with most choosing to use published values. Others make use of non-laboratory medical staff advice while others use inter-laboratory comparison, manufacturer proposals, or conduct internal studies to come up with their own

Critically evaluate Susan Brownmillers (1975) assertion that ' war Essay

Critically evaluate Susan Brownmillers (1975) assertion that ' war provides men with a tacit license to rape - Essay Example Brownmiller feels that rape perseveres as a way for men to perpetuate their historic societal dominance over women on the whole. Assault laws have evolved over recent decades with respect to different classes of rape; harsher sentencing for wartime rapists has also been achieved where once it was nearly impossible to convict a man. Wartime continues to be the most difficult scenario for the control and subsequent punishment of rape. Brownmiller and her colleagues agree that because of the relaxed morality of a battlefield or a war-torn country, men feel free to not only take advantage of their baser instincts to fight and kill, but also to rape. Brownmiller explains rape as a purely human issue; she notes how zoologists will not address rape since it is believed to be nonexistent in the animal kingdom. To Brownmiller and many other researchers, â€Å"human beings are different† (1975, 1) in that their males are capable of rape and their females are capable of succumbing to violent sexual acts. In nature, the sexual act of animals is governed by the female’s fertility cycle: in essence, animals will not have sex unless the female is fertile and the male senses this. With humans, however, the female fertility cycle does not govern sexual acts nor does it have any effect on the sex drive of males; this is the fundamental difference between people and animals on which Brownmiller bases her distinctions of rape. Instead of being based on the fertility cycle, people copulate based on their individual urges. As Brownmiller says, â€Å"our call to sex occurs in our head† (ibid.). With animals, the male of the species will not attempt to copulate with a female unless she is clearly fertile; therefore the fertility cycle governs not only sexual urge but the act itself. Since humans do not behave based on this fundamental principle, women are always able to be viewed in a sexual way, men are always able to become aroused

Causes of the Civil War Essay Example | Topics and Well Written Essays - 2000 words

Causes of the Civil War - Essay Example As an overview, the American Civil War lasted from 1861 to 1865 where 11 states from the South of the country secede. With this secession, the 11 states established the Confederate States of America, which was primarily done in order to legislate the presence of slavery in these states. In line with this, the American Civil War must be understood beyond the context of death, but it must be taken into account that the civil war had bore many positive changes and perspective, not only to the American society and political system, but also in the worldwide perspective. To name a few, it had caused the Constitutional amendments, which allowed a stronger relationship between citizens with citizens and citizens with the government. Essentially, the most crucial result of the American Civil War was the abolition of slavery across the country. Nonetheless, it must be noted that prior to the emergence of the American Civil War, there have been cited causes of its coming into existence (The Am erican Red Cross 3; West 2).   The cotton gin was invented by Eli Whitney, who graduated from Yale University, and was able to go to South Carolina to tutor the children of wealthy farmers. As a graduate from Yale University, the people in South Carolina were aware of the intelligence of Whitney. One of the individuals who used this information critically was Catherine Greene, who owns a large cotton plantation in Savannah Georgia. Greene invited Whitney to her farm as a guest, and there she encouraged Whitney. to invent a machine that will allow workers to remove seen from the cotton. Whitney accepted the proposal, and after 10 days, he was able to come up with the cotton gin. With the invention of Whitney, the South was able to experience a growth in the production of its cotton. In particular, it was able to produce 8 million pounds of cotton in the span of two years after the invention of the cotton gin broke out. However, his contribution did not end here because after 12 yea rs of using the cotton gin, the American South was able to produce 80 million pounds of cotton. It was inevitable that the region was already economically up scaling due to the invention of the cotton gin (Hazen 4). The demand of cotton in the international market grew high; the American South producers considered this as an opportunity. However, the American South considered this success to be dependable on the slave labor. With this in hand, the agricultural and the societal system in the American South had greatly depended in the presence of slaves and the aspect of slavery. During the year 1860, it was recorded within the slave states that there were already 3.5 million slaves. In average, there was a minimum of five slaves and a maximum of 20 for every slave owner (Griess 7). The slaveholders of the South found that the slaves were true to their work and were more efficient. However, even with these positive working attitudes of the

Analytical Description of Players in Hamlet Essay Example for Free

Analytical Description of Players in Hamlet Essay The significance of the players exceeds the sole purpose of entertainment, as each possesses the power to unveil the occulted guilt (3.2.75) and conscience of the King. Hamlet assumes the responsibility to advise these players with precise and adequate direction so that a whirlwind of passion (6) may not effectively separate Claudius from personally identifying with the play. Hamlets enthusiastic approach toward direction may be so that he encourages the players to suit the action to the word, the word to the/ action, with this special observance, that you oerstep not/ the modesty of nature (16-18). However, this exercise of caution may justify Hamlets too often delayed attempt toward the action of avenging his fathers murder. His direction confines him to the overflow of words as he experiences imprisonment within the truth of his own identity. Hamlet grants himself the opportunity to momentarily direct himself, yet it remains unknown as to whether he directs a representation of truth or a falsity. He exemplifies madness so well, as the sight of a damned ghost (77) insanely induces his imagination and comfortably transforms his identity to one of lunacy. This role he acquires is one he portrays so explicitly well as an actor that he easily utilizes it as the foundation for his players. He instructs the players: Nor do not saw the air too much with your hand, Thus, but use all gently, for in the very torrent, tempest, And, as I may say, whirlwind of passion, you must acquire And beget a temperance that may give it smoothness. (4-7) Abstinence from overly dramatizing the actions of the play may be reflective of Hamlets character prior to his escape from true self: a once-lived life of normalcy focused more wholly on smoothness (7) rather than an uncontrolled torrent, tempest, / whirlwind of passion (5-6). Hamlets direction of the players claims victory as Claudius abruptly arises and exclaims, Give me some light. Away (254)! Horatios observation of the Kings reaction confirms his guilt-inflamed conscience as he was forced to witness the reenactment of his brothers murder. Hamlet, relieved, reveals, Ill take the ghosts word for a thousand/ pound (271-272). The ghost is officially trustworthy as the Kings reaction encourages Hamlet to journey further toward his mission of avenging the death of his father. Any form of immediate action is ignored when Hamlet wrestles Polonius with false visions of psychosis as he inquires, Do you see yonder cloud thats almost in shape of a / camel (355-356)? Hamlets separation from action invites a sense of fear that intensifies his madness and entangles his entire self in nothing more than the mere use of words. It is his words that camouflage the notion that his own conscience may be afflicted with an overpowering sense of guilt. Even though Hamlets accurate direction of the players did celebrate success as it illustrated the guilt of the Kings conscience, Hamlets identity remains in crisis as he continues to revel in his words. His speech reveals his craving for action: Tis now the very witching time of night, When churchyards yawn and hell itself (breathes) out Contagion to this world. Now could I drink hot blood, And do such (bitter business as the) day Would quake to look on. (367-371) The claim that he is prepared to engage in necessary action remains solely a claim as Hamlets burden of self-loathing dominates his internal struggle. He may fear the truth of his identity, as he is horrified by the realism included in the players precise portrayal of his own life in actuality.

Electroconvulsive Therapy for Severe Depression: Evaluation

Electroconvulsive Therapy for Severe Depression: Evaluation Can electroconvulsive therapy make a meaningful contribution in the treatment of Severe depressive illness? The work of mental health nurses. Contents Abstract Introduction Methodology of the review Critical Review of the literature The place of electroconvulsive therapy in the therapeutic armamentarium The place of electroconvulsive therapy in relapse prevention Mechanism of action Preference of site of stimulation Side effects of treatment Discussion Conclusions Appendix References Abstract This dissertation seeks to explore the evidence base for electroconvulsive therapy. It does so by considering the historical background to the procedure and its evolution to the present. It considers the professional and legislative guidelines which govern its use and contrasts the regulations in the UK with those in other cultures, notably the USA. In order to assist the exploration, the literature review is subdivided into five sections, each exploring a different area of interest. Electroconvulsive therapy is placed within a therapeutic spectrum of treatment for patients with major depressive illness and psychosis and is compared with other modalities of treatment. Its use in both acute treatment and its role in disease prevention and relapse is discussed. Current hypotheses of its possible mode of action are explored, and conclusions drawn about the strength of the evidence base in this area. There appears to be considerable discussion about the site of optimal stimulation for electroconvulsive therapy. This area is discussed in depth with a critical analysis of the studies which inform the evidence base in this area. The literature review concludes with an examination of the various side effects of the treatment. There is an element of discussion of the evidence and conclusions are drawn from the evidence extrapolated and presented. The whole dissertation is fully referenced. Introduction Electroconvulsive therapy was introduced into clinical practice in the late 1930s and rapidly gained a place in the standard treatment of major depressive illness. It was originated by the Hungarian, Dr Meduna, who mistakenly believed that schizophrenia and epilepsy were mutually exclusive conditions. He argued that epilepsy was never seen in schitzophrenic patients and therefore artificially inducing fits (epilepsy) in patients would cure schizophrenia. (Mowbray R M 1959). The effects on schitzophrenia were soon recognised to be minor and the most marked effect appeared to be in the patients with major depressive illness. The advent of effective classes of antidepressant, antipsychotic and mood stabilising drugs has seen a marked decline in the use of electroconvulsive therapy, but recent figures suggest that it is still used in over 10,000 cases per year in the UK (ECT Survey 2003). Currently the main use of electroconvulsive therapy is in major depressive illness although it also is considered still to have a place in the treatment of schizophrenia and some other mood disorders (UK ECT 2003), psychosis (Corrible E et al. 2004), and overt suicidal intent (Kellner C H et al. 2005). The Mental Health Act of 1983 allowed Psychiatrists to give electroconvulsive therapy to inpatients without consent if they were sectioned. This should be contrasted to the situation after the 1959 Mental Health Act, where psychiatrists had no clear guidance and a number of litigation cases forced a change in legislation. (Duffett R et al. 1998) The procedure itself involves anaesthetising the patient with a general anaesthetic and a muscle relaxant and the a small, brief pulse current (typically about 800 milliamperes) is passed between two electrodes applied directly to the scalp. This generates a seizure and there are a number of demonstrable biochemical changes in the brain after the event. (Nobler M S et al. 2001) Electroconvulsive therapy is usually given as a course over several weeks. The evidence base for length of time of treatment is not strong and appears to vary considerably between authorities. (Lisanby S H 2007) In 2003 NICE investigated the evidence base for electroconvulsive therapy and issued guidelines which suggested that it should only be used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening in individuals with severe depressive illness, catatonia or a prolonged manic episode. (NICE 2003) One of the most extensive recent reviews on electroconvulsive therapy concluded that it had been demonstrated to be effective short term treatment for depressive illness in otherwise healthy adults. Many studies were cited and had shown it to have a greater effect than drug treatment. The authors noted shortcomings in many of the trials cited, especially in areas such as drug resistant depressive illness where electroconvulsive therapy is believed to be particularly helpful. (UK ECT Review Group 2003) One of the major side effects of electroconvulsive therapy is short and long term memory loss cited in many trials and studies (viz Gupta N 2001) Methodology of the review Cormack suggests that â€Å"Ultimately all good research is guided by and founded on a critical review of all of the relevant literature published on the subject.† (Cormack, D. 2000). It is therefore important not only to define what is currently believed about a subject, but also to place this in a historical context. This is particularly important in the field of electroconvulsive therapy, as the introduction to this dissertation has suggested, with great fluctuations in both understanding and application of this type of therapy over the years. One of the prime reasons for conducting a literature review is to establish the current evidence base for a particular subject. A critical review of the literature must be preceded by a careful literature search. It is often believed that searching the literature is a linear or â€Å"single episode† process. Current thinking suggests that this is seldom an optimal strategy. Bowling advises that a good literature review is â€Å"primarily a cyclical recursive process that mirrors the thinking and research process, where the discovery of new information results in new ideas, new knowledge and possibly new understanding. Once an overview, or initial opinion has been formed, it then becomes possible to revisit the initial reviews from a more informed perspective which, in turn, allows for a more perceptive interpretation of the data. (Bowling A 2002). The methodology used in this particular review was to allow for an initial period of reflection on the subject matter and to consult a small number of reference books to achieve an overview of the area. (Taylor, E. 2000). References were noted and some followed up in order to ascertain the main themes of the review. Once these were established, then methodical searches of a number of databases were carried out utilising the facilities of the local University library, the Post-graduate library (Client to personalise here) and a number of on-line search engines and literary sources including Cochrane, Cinhal, Ovid, BMJ and Lancet archives, Royal College of Psychiatrists archive and various NICE publications. Papers were accessed in both hard back and electronic forms. (Fink A 1998) Search terms included electroconvulsive therapy; evidence base; evolution; history; schizophrenia; psychosis; major depressive illness; mental health nurse; antidepressant drugs; Mental Health Act; psychiatrist. These terms were used in various combinations to sift papers with varying degrees of relevance to the topic under consideration. (Carr LT 1994) Inclusion criteria were papers less than 10 years old (unless there were specific reasons for older paper inclusion). UK sources were preferred to other ones. It should be noted that a substantial proportion of the body of literature on the subject of electroconvulsive therapy is American based. A number of authorities have suggested that this may be because the USA currently uses electroconvulsive therapy more frequently than the UK and therefore has a greater experience with it. Papers were only considered from peer reviewed sources unless making a historical point. (Bell J 1999). Each paper considered was then ranked according to its evidential value (See Appendix 1) and the highest value paper was presented for each point to be made. Critical Review of the literature The place of electroconvulsive therapy in the therapeutic armamentarium A good place to start this literature review is with the Olfsen paper. (Olfson M et al. 1998). This is an authoritative overview of the place of electroconvulsive therapy in the treatment spectrum. It has to be noted that this paper is already 10 years old and reflects clinical patterns of usage in the USA. The reason that this paper is selected for discussion is primarily on the vast size of its study cohort, which is 6.5 million patient contacts (249,600 with a diagnosis of depressive illness) spread over mainland USA. Critical analysis of the paper suggests that the authors reveal their viewpoint in the first few sentences of the paper and therefore the opinion part of the review must be understood on the basis that the authors consider electroconvulsive therapy a â€Å"safe and effective treatment for patients with all subtypes of major depression† citing the authority of the APA for this statement (APA 1997) The paper suggests that there is a strong evidence base to confirm that electroconvulsive therapy is at least as effective as antidepressant drugs pharmaceuticals for the treatment of major depressive illness. (Weiner R D 2004) The authors make the point that despite this general belief, electroconvulsive therapy is not as widely used as it should be due to three major misconceptions namely public concern about the safety of the procedure, reactive regulations and guidelines and the belief that it is not cost-effective. They then set about addressing each of these concerns Rather worryingly, the authors cite evidence of safety with the unqualified comment that â€Å"None of the depressed patients who received ECT died during the hospitalisation. In contrast, 30 (0.14%) of the depressed patients who did not receive ECT died in the hospital. (Schulz K F et al. 1995) Although this may well be the case, it is entirely possible that patients who were ill with other comorbidities (and therefore at greater risk of death) were not offered electroconvulsive therapy, as it required a general anaesthetic. One cannot jump to the implied conclusion that these figures suggest that electroconvulsive therapy is therefore intrinsically safe. (Mohammed, D et al. 2003) The authors draw a number of conclusions, perhaps the most significant of which is that current practice tends to reserve electroconvulsive therapy for the elderly, and those with comorbidities such as schizophrenia, dementia, and general medical (nonpsychiatric) disorders. They also comment that prompt use of electroconvulsive therapy is associated with shorter in patient stays and, by definition, more rapid resolution of the depressive state. Despite these findings, there is a large body of literature documenting the fact that many patients with major depressive illness remain largely unresponsive to therapeutic intervention. With this in mind one should consider the contribution of the Spanish research group under Gonzalez-Pinto who published a trial of a small group of patients (13) who had proved resistant to both venlafaxine and electroconvulsive therapy separately but who responded to both measures when used in a combined fashion. (Gonzalez-Pinto A et al. 2002). This was a non-randomised non-controlled trial and therefore constitutes evidence value at level III. Curiously the response was not proportional to the dose of venlafaxine used. The authors however, report the rather worrying side effect of asystole in 3 of the 13 patients immediately after the electroconvulsive therapy. A number of authorities suggest that there is a definite place for electroconvulsive therapy in the severely depressed patient who is a suicidal risk. The Kellner paper addresses this suggestion directly. (Kellner C H et al. 2005). Suicide remains one of the major associations of major depressive illness and carries a 15% lifetime risk for any patient who has been hospitalised with the same. (Bostwick J M et al. 2000) with symptoms such as profound hopelessness, hypochondriacal ruminations or delusions, and thoughts of suicide or self-harm during depression predict future suicide. (Schneider B et al. 2001). The Kellner study was a randomised crossover comparative follow-up trial making it evidence value of level 1b. There are a great many result strands from this study, but if one specifically considers the suicidal elements, then one can state that the study showed that of the 444 patients enrolled in the trial as having major depressive illness, 26% had suicidal ideation at a level of 3 or greater on the Hamilton rating scale (the measurement tool used in the trial) and 3% achieving a score of 4 (actual suicidal attempt). This group had a reduction of their scores to 0 in over 80% within the two week course of the electroconvulsive therapy. It was also reported that in the group who scored 4, 100% dropped to 0 by the end of the treatment. Despite there impressive figures for short term remission, one would have to note that the trial did not have any significant long term follow-up and there is no information on the rate of relapse after the initial treatment. (Rosenthal R. 1994). The authors state that they were aware of two successful suicide attempts which occurred whilst the trial was running (but after these patients had completed their treatment. The authors suggest that electroconvulsive therapy should be used early in the treatment regime once a diagnosis of suicidal risk has been made. To provide a balanced argument on the place of electroconvulsive therapy in the spectrum of treatment, one can consider the recent paper by Eranti (Eranti S et al. 2007) who tested out the hypothesis that has recently been published, that Repetitive transcranial magnetic stimulation (rTMS) is as effective as electroconvulsive therapy but does not have the same side effect profile that restricts the use of electroconvulsive therapy in some patients. (viz. Gershon A A et al. 2003 and Loo C K et al. 2005) This trial was a randomised, blinded comparative trial with a substantial entry cohort (260 patients) being followed up for 6 months after treatment giving it a level 1b significance. (Clifford C 1997). There were a number of possible outcome measures studied but, of relevance to our considerations in this dissertation, one can state that the authors found that Repetitive transcranial magnetic stimulation (rTMS) was not as effective as electroconvulsive therapy in the treatment of depressive illness both at the end of the treatment period and at the end of the 6 month study. The authors were able to comment however, that the rTMS was virtually free of demonstrable side effects. The place of electroconvulsive therapy in relapse prevention It is fair to comment that a brief examination of the literature shows virtually no good quality published material on this topic with the studies that have been done comprising individual case reports (viz Kramer B A 1990), naturalistic studies and small studies of retrospective cases (viz. Schwarz T et al. 1995), none of which have any control element and all of which are evidence level IV at best. A notable exception is Keller et al. who made a large UK based study of relapse prevention in major depressive illness with a randomised controlled trial over a seven year period involving over 500 patients. (Kellner C H et al. 2006). The trial is a level 1b evidence level trial and is of a particularly robust structure with great efforts made to achieve standardisation. (Denscombe, M 2002). The structure is a direct comparison between electroconvulsive therapy and a standard pharmacological regime (lithium carbonate plus nortriptyline hydrochloride). Both were given as a therapeutic course (the medication over a six month period) and the patients were followed up with DSM-IV assessments to determine their degree of relapse The analysis is long and complex but, in essence, the study clearly demonstrated that both groups had better results than a placebo control with similar percentages (about 33%) suffering a relapse and about 46% remaining disease free. The trial suffered from having a large group (about 20%) failing to complete the trial protocol. (Rosenthal R. 1994). This study does however, provide firm evidence that electroconvulsive therapy is at least as effective as pharmacological measures in reducing the likelihood of clinical relapse. Further evidence for longer term efficacy comes from the Gagnà © study (Gagnà © G G et al. 2000), which starts by acknowledging the fact that depressive illness tends to be a long term disability with long term pharmacological intervention a comparatively normal treatment strategy. The authors make a subtle distinction between continuance therapy (which is starting a new course of treatment after initial resolution and then relapse) and maintenance therapy which extends beyond the continuation therapy stage and is aimed at preventing relapse. This paper is noteworthy because, as the authors point out, there is general acceptance by healthcare professionals that long term maintenance therapy with pharmaceuticals is both rational and indicated in patients with a high likelihood of relapse of depressive illness. Treatment with continuation electroconvulsive therapy has failed to gain general acceptance. The authors argue that such an approach is particularly rational, at least in a group of patients who have demonstrated their ability to respond to electroconvulsive therapy in the past, are at high risk of relapse and who may be refractory to pharmacological intervention. The Gagnà © study is a retrospective case-controlled comparative study comparing the long term course of electroconvulsive therapy plus pharmacological maintenance therapy with long-term antidepressant treatment alone in a demographically matched group. The two groups comprised 60 patients. The maintainence electroconvulsive therapy group received the electroconvulsive therapy as a single treatment monthly after the normal intensive treatment course for the acute episode. It has to be noted that this regime is comparatively arbitrary as there appears to be no preceding published evidence base to support it. The results from this study are nonetheless quite impressive. Both groups are reported to have responded to treatment, but the group who were also maintained with follow up electroconvulsive therapy did markedly better in terms of resistance to relapse being almost doubled at two years (93% vs. 52%), and quadrupled at five years (73% vs. 18%). This result could also be expressed as a doubling of the mean time to relapse in the electroconvulsive therapy group (6.9 years versus 2.7 years for the antidepressant-alone group). A major criticism of this study would have to be a lack of standardisation of treatment in the electroconvulsive therapy group with some patients receiving univocal and others bipolar electroconvulsive therapy. The number and duration of each was left â€Å"to the clinical judgement† of the responsible clinician. This does not reduce the impact of the overall finding, but does make for difficulties in comparison with any other trials which might follow. (Berlin J A et al. 1999) A critical analysis of the study would also have to conclude that the study suffered from a comparatively small number of patients with assignments to the comparison groups not being random. More importantly, the trial assessor was not blinded to the patients group assignment. These factors make it difficult to confidently assign an evidence level to this trial. (Denzin, N K et al. 2000) The authors conclude their study with the comment that a larger, prospective study on the subject is currently underway. One should perhaps regard the results of this study as interesting, but not proven. In assessing the validity of this paper, one should note comments that it has generated in the peer reviewed press. Gupta makes a number of valid points of criticism (Gupta N. 2001), arguably the most important of which is that the study did not make any measurement of the well recognised effect on memory function that short term electroconvulsive therapy is known to have. (Isenberg K E et al. 2001). Gupta suggests that clinical effectiveness must be assessed only after a risk-benefit ratio has been properly determined. Certainly a valid point and one that was not addressed in the original paper. Mechanism of action A number of papers have been published reporting biochemical changes after electroconvulsive therapy. There seems to be a general agreement that depressive illness is associated with a disturbance in the monoaminergic-cholinergic balance within the cerebral cortex. (Schatzberg A F et al. 2005). A novel and significant advance was published in 1998 by Avissar (Avissar S et al. 1998) when a correlation with G-protein levels in leucocytes was found and was discovered to be significantly reduced in depressive illness. The significance of this paper was that the authors found that electroconvulsive therapy resulted in a normalisation of the G-proteins level which preceded (by about a week), and thus predicted, clinical improvement. Patients who did not respond to electroconvulsive therapy did not show a change in G-protein levels. The significance of this finding is enhanced with the knowledge that lithium is also known to alter G-protein levels (Schreiber G et al. 2000), as are some other treatments for bipolar disorder. (Young L T et al. 2003). It is also known the G-protein levels are raised in manic states thereby suggesting that it is a marker for affective mood states. (Schreiber G et al. 2001) Further evidence of altered metabolism comes from the Nobler study (Nobler M S et al. 2001). This study used Positron emission tomography (PET) to study glucose metabolism in different brain areas. It has to be noted that this was a small study of 10 patients who were assessed before and after a course of electroconvulsive therapy. This study involved highly sophisticated measurements and concluded that certain areas of the brain showed marked reduction in metabolic rate after electroconvulsive therapy and these changes were most significant in the frontal, prefrontal, and parietal cortices. The authors suggest that their results support the hypothesis that electroconvulsive therapy works by suppression of functional (non trophic) brain activity, most prominently in the prefrontal cortex. The authors comment that their findings are consistent with the earlier Drevets study which demonstrated a reduction in brain metabolism after successful treatment with antidepressant drugs. (Drevet s W C 1998) A more modern paper by Sanacora reported alterations in the GABA concentrations in plasma, and cortex after electroconvulsive therapy. (Sanacora G et al. 2003). It is known that patients with depressive illness have reduced levels of the neurotransmitter GABA. This study, again with a small entry cohort of 10 patients, assessed patients before and after electroconvulsive therapy. It was found that the levels of GABA increased with successive treatments. It was also found that the length of duration of the convulsions was proportional to the concentrations of GABA found in the cortex supporting the view that GABA decreases cortical excitability. It may also be significant that GABA concentrations have been found to increase after the use of selective serotonin reuptake inhibitor (SSRI) treatment. (Sanacora G et al. 2002). These findings suggest that enhanced GABA activity may be central to any antidepressant activity Takano et al. have recently produced a yet more sophisticated study along the lines of the Nobler investigation. (Takano H et al. 2007). This study also uses positron emission tomography (PET) and it studied patients before, during and after the application of electroconvulsive therapy. This is essentially a technical rather than a clinical study. It also has to be noted that all the data was derived from only six patients. The majority of the results are therefore not relevant to this consideration other than the fact that the authors concluded that electroconvulsive therapy exerts its effect by increasing the post treatment blood supply to the anterior cingulate and medial frontal cortex and thalamus. They refine this comment by acknowledging that it cannot be stated that this observed phenomenon is cause or effect, but simply an association with the mechanism of treatment and is associated with a resolution of symptoms. Preference of site and nature of stimulation There is a great deal of discussion in the peer reviewed literature about the optimal sites for electroconvulsive therapy application and whether univocal or bipolar stimulation gives better results. Unfortunately the vast majority of it is anecdotal and of poor evidential value. The Bailine study is a notable exception providing a randomised comparative trial with a moderate size of entry cohort (60) making it a level 1b trial. (Bailine S H et al. 2000). The authors compared the efficacy of bitemporal stimulation with bifrontal stimulation over a treatment period of 12 treatments. The study was assessor blinded. The rationale behind the trial was that bifrontal stimulation avoids direct stimulation of the temporal areas which are directly involved with cognition and memory functions. The authors reported that they found both placements to be equally effective in their ability to relieve depressive illness, but the bifrontal positioning achieved statistical significance in reducing cognitive and memory effects. Although not directly tested, the authors comment that right sided unilateral frontal placement has fewer cognitive side effects than bilateral stimulation but needs 2 5 times the current to achieve its therapeutic effect. (citing Letemendia F J J et al. 1993) One area of difficulty which, even a brief overview of the subject illuminates, is the level of stimulus that is required to achieve therapeutic results. Some studies do not specify the level of stimulus, others simply refer to a supra-threshold stimulus, a third group refer to a â€Å"titration of stimulusâ€Å". This makes direct comparison of results difficult. Some authorities have made the comment that not standardising the level of stimulus applied is similar to conducting a comparative trial of antidepressant drugs to placebo when the drugs are given at a sub-optimal dosage and therefore not achieving their maximal therapeutic effect. Krystal has attempted to tackle this problem by reviewing the regulations governing the administration of electroconvulsive therapy and also trying to achieve a generally acceptable standard of treatment. (Krystal A D et al. 2000) The USA limits (by statute) the maximum output charge for clinical applications of electroconvulsive therapy to 576 millicoulombs. The equivalent restriction in the UK is 1,200 millicoulombs for electroconvulsive therapy devices and this has been determined by the Royal College of Psychiatrists, and this limit is more than double the limit allowed in the USA. As far as the USA is concerned there is no evidence base to ensure that this limit will allow for consistently effective electroconvulsive therapy, which is something of a paradox considering that the USA considers electroconvulsive therapy more mainstream than does the UK. Krystal published a retrospective study of nearly 500 patients who had received electroconvulsive therapy. Although most of the patients reviewed had a clinically successful treatment, the authors noted that 15% of patients required the maximum stimulus intensity to trigger a seizure and 5% of the total did not have a seizure at all. The authors comment that the clinicians responsible for the patient had to use enhancing strategies to boost the therapeutic response with caffeine, ketamine, or hyperventilation. This still left a residual 5% of patients with a sub-therapeutic response at the maximum permitted output charge. Further problems can be encountered as not only can patients vary with regard to the amount of charge that they need to trigger tonic-clonic seizures, but the amount of charge can vary as the course of treatment progresses in each individual patient. (Coffey C E et al. 2005) The difficulty that therefore arises in these non-responders, is that there is no greater therapeutic response than placebo if a tonic-clonic seizure is not triggered, but the effects on cognition and memory impairment are still present. (PECT 2000). If this is added to the clinical and economic costs, it is clear that a case can be made for higher limits of initial triggering charge, at least in the USA. The other factor which may also be relevant and can be a major cause of inconsistency between studies is the pulse width with some electroconvulsive therapy machines delivering a shorter pulse width and longer stimulus duration than others. The majority deliver a pulse width between 0.5–0.75 msec. but other machines are capable of delivering pulse widths considerably beyond these limits. There has been no definitive study which has considered the possible effect of pulse width on either the therapeutic response or the likelihood of triggering a tonic-clonic seizure. The final point made in the Krystal paper is the fact that one of the reasons that the charge limit was set at the level that it is was the fact that the authorities wanted to minimise the theoretical risk of neuropathological damage. There is now evidence that the levels of stimulus charge necessary to cause such damage is far in excess of the imposed limits. (viz. Weiner R D 1994 and Devanand D P et al. 2004) The concept of stimulus titration is referred to in many of the clinically based papers reviewed. If this concept is considered in parallel with the comments by Krystal relating to the variation of charge required to produce the seizure, the situation can be clarified in an monograph by MacEwan who advises that it is an important feature of the treatment to allow sufficient time between the initial unsuccessful shock and the attempt at restimulation as the effect of the comparative refractivity after the first shock takes a little time to wear off. (MacEwan T 2002) Side effects of treatment Considering the rather gross and intrusive physical nature of the treatment, it is quite remarkable that the literature shows very few studies which have specifically explor