Cytoskeleton Anatomy, Function, and Structure

The cytoskeleton is a network of fibers forming the infrastructure of eukaryotic cells, prokaryotic cells, and archaeans. In eukaryotic cells, these fibers consist of a complex mesh of protein filaments and motor proteins that aid in cell movement and stabilize the cell. Cytoskeleton Function The cytoskeleton extends throughout the cells cytoplasm and directs a number of important functions. It helps the cell maintain its shape and gives support to the cell.A variety of cellular organelles are held in place by the cytoskeleton.It assists in the formation of vacuoles.The cytoskeleton is not a static structure but is able to disassemble and reassemble its parts in order to enable internal and overall  cell mobility. Types of intracellular movement supported by the cytoskeleton include transportation of vesicles into and out of a cell, chromosome manipulation during mitosis and meiosis, and organelle migration.The cytoskeleton makes cell migration possible as cell motility is needed for tissue construction and repair, cytokinesis (the division of the cytoplasm) in the formation of daughter cells, and in immune cell responses to germs.The cytoskeleton assists in the transportation of communication signals between cells.It forms cellular appendage-like protrusions, such as cilia and flagella,  in some cells. Cytoskeleton Structure The cytoskeleton is composed of at least three different types of fibers: microtubules, microfilaments, and intermediate filaments. These fibers are distinguished by their size with microtubules being the thickest and microfilaments being the thinnest. Protein Fibers Microtubules are hollow rods functioning primarily to help support and shape the cell and as routes along which organelles can move. Microtubules are typically found in all eukaryotic cells. They vary in length and measure about 25 nm (nanometers) in diameter.Microfilaments or actin filaments are thin, solid rods that are active in muscle contraction. Microfilaments are particularly prevalent in muscle cells. Similar to microtubules, they are typically found in all eukaryotic cells. Microfilaments are composed primarily of  the contractile protein actin and measure up to 8 nm in diameter. They also participate in organelle movement.Intermediate filaments can be abundant in many cells and provide support for microfilaments and microtubules by holding them in place. These filaments form keratins found in epithelial cells and  neurofilaments in neurons. They measure 10 nm in diameter. Motor Proteins A number of motor proteins are found in the cytoskeleton. As their name suggests, these proteins actively move cytoskeleton fibers. As a result, molecules and organelles are transported around the cell. Motor proteins are powered by ATP, which is generated through  cellular respiration. There are three types of motor proteins involved in cell movement. Kinesins move along microtubules carrying cellular components along the way. They are typically used to pull organelles toward the cell membrane.Dyneins are similar to kinesins and are used to pull cellular components inward toward the nucleus. Dyneins also work to slide microtubules relative to one another as observed in the movement of cilia and flagella.Myosins interact with actin in order to perform muscle contractions. They are also involved in cytokinesis, endocytosis (endo-cyt-osis), and exocytosis (exo-cyt-osis). Cytoplasmic Streaming The cytoskeleton helps to make cytoplasmic streaming possible. Also known as cyclosis, this process involves the movement of the cytoplasm to circulate nutrients, organelles, and other substances within a cell. Cyclosis also aids in endocytosis and exocytosis, or the transport of substance into and out of a cell. As cytoskeletal microfilaments contract, they help to direct the flow of cytoplasmic particles. When microfilaments attached to organelles contract, the organelles are pulled along and the cytoplasm flows in the same direction. Cytoplasmic streaming occurs in both prokaryotic and eukaryotic cells. In protists, like amoebae, this process produces extensions of the cytoplasm known as pseudopodia. These structures are used for capturing food and for locomotion. More Cell Structures The following organelles and structures can also be found in eukaryotic cells: Centrioles: These specialized groupings of microtubules help to organize the assembly of spindle fibers during mitosis and meiosis.Chromosomes: Cellular DNA is wrapped in thread-like structures called chromosomes.Cell Membrane: This semi-permeable membrane protects the integrity of the cell.Golgi Complex: This organelle manufactures, stores, and ships certain cellular products.Lysosomes: Lysosomes are sacs of enzymes that digest cellular macromolecules.Mitochondria: These organelles provide energy for the cell.Nucleus: Cell growth and reproduction are controlled by the cell nucleus.Peroxisomes: These organelles help to detoxify alcohol, form bile acid, and use oxygen to break down fats.Ribosomes: Ribosomes are RNA and protein complexes that are responsible for protein production via translation.

Of Mice and Men - Critical Evaluation Essay examples

The main theme of ‘Of Mice and Men by John Steinbeck is fate . The techniques he uses such as the title , repetition , echoes and symbolism are very successful in putting across his very pessimistic views on this theme . br brThe two main characters , George and Lennie , share a dream . George dreams of a piece of land of his own . Independence . A couple of acres , a cow and some pigs . Lennie dreams of tending rabbits . With the title ‘Of Mice and Men , Steinbeck is telling you that this dream whilst on the verge of realization , will be destroyed by fate . br brIt relates to Robert Burns poem ‘To a Mouse . Burns and Steinbeck share the same pessimistic views on fate . In ‘To a Mouse Burns shows that he believes that just as†¦show more content†¦br brThe introduction of Curleys wife adds another piece to the puzzle . Her description when she was standing at the doorway with her ‘rouged lips , ‘ hair hung in little rolled clusters and ‘cotton house clusters shows that she will be the one who destroys George and Lennies dream . This technique is simple but very effective . br brGeorge had told Candy of his dream and Candy wanted in on it . Candy had the money to purchase the land required from compensation received after his arm had been cut off by machinery . This moved them to the verge of achieving their dream . br brIn my view the most successful technique in illustrating John Steinbecks view of fate is the symbolism in the last chapter . ‘A watersnake glided smoothly up the pool , twisting its periscope head from side to side , and it swam the length of the pool and came to the legs of a motionless heron that stood in the shallows . A silent head and beak lanced down and plucked it out by the head , and the beak swallowed the little snake while its tail waved frantically ‘. The heron , motionless and waiting , represents fate while the watersnake , helpless and unaware , is its victim . br brSteinbecks view on fate is illustrated again by the word choice . Words like lanced , plucked and waiting suggest that Steinbeck believes that fate striking is almost medical ; sure and precise . br brThe watersnake could represent almost anyone in the novel although it is most likelyShow MoreRelatedThe Endocrinology Of Male And Female Reproduction1447 Words   |  6 PagesReproductive physiology is comprised of many tightly coordinated functions of the endocrine system including the hypothalamus, pituitary and reproductive organs whose dynamic function plays several critical roles in growth and development as well was reproduction. The hypothalamic-pituitary-gonadal axis plays a critical role in the development and regulation of the reproductive system. 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Nike Incorporation Free Essays

Nike is a world class company that manufactures and markets a wide large of sports equipments such as sports, balls, t-shirts, tracks, uniforms for various sporting activities such as football, basketball, athletics, cricket, tennis and golf. The company was in incorporated in the year 1968 in the state of Oregon, it main business being to design and manufacture the best foot wear and other accessory products. But, Nike has grown to be a world class company that sells well branded and expensive products that are well known for their high quality. We will write a custom essay sample on Nike Incorporation or any similar topic only for you Order Now Nike trademark of â€Å"just do it† is well known, and it relates to the sporting spirit. The company has more than 500 plants in more than 45 countries.[1] Nike did not experience much competition until in 1980s and 90s when Reebok and European counterparts Adidas and Puma entered the market. But Reebok was purchased by Adidas in 2006 thus Adidas is the one giving Nike competition. Nike has been the main player on the footwear market until then, the company controlled about 30% of the United States market, Reebok enjoyed about 20% followed by other companies like Adidas and Puma. Nikes abroad sales went up to $2 billion by 1995 and were leading by having 40% of total sales in footwear. [2] The marketing strategy of Nike has been the biggest success of the company. Nike has premium brands, and offers the market high quality and expensive products. The company creates a brand image which is achieved by the unique logo of a (tick) and a slogan of â€Å"just do it† which attracts lots of customers. The company also does promotional activities of its products by entering into sponsorship deals with world class football stars, celebrity athletes, national teams, and also college athletic. Nevertheless Nike has mixed it marketing strategies and has more elements more than promotion.   This other elements are; competitive price, wide range of products, numerous outlets and retailers (more than 20,000), sponsorship and promotion activities. Currently, Nike has a market share of around 37% in the world. The main objective of Nike is to become a leading sport equipment manufacturer in the world and maintain these standards in future. The major client base is the youth and the young adults who mainly buy the sports products from the company. The company has put a lot of attention on products for men, women, and children, and their children’s shoes are now doing very well on the market currently.   The company has created more market by venturing into various market segments and manufacturing more various products. To achieve its objective of being the leader in market business the company is exploiting new markets outside Europe. Nike has also managed to control its market by acquiring other small companies and turning them to manufacture their products. Like in 1998 it’s purchased Cole Hann which was making informal dress and shoes for $180 and cached a base of young people and their sales went up at 23% making a profit of $ 100 millions in 1998. Nike has continued to improve in its brand and marketing and its objective of being â€Å"the greatest sports and fitness company in the world† alongside world class companies like Coca-Cola. Nike gets contracts with individual clients, cooperate clients and even countries and states. The company supplies to them different products, they can be football uniform for a national team, tracksuits for national athletic teams or even tailor made shoes or uniform for specific football stars such as Ranaldhno of Brazil. [3]The market is divided in various segments which can be viewed according to the region There have been many challenges faced by Nike on the marketing side and Nike has done a lot of to recapture the market. These initiatives that Nike undertook was such as creating an ACG (all- conditions gear) unit and Techlab which was meant to market a brand of sports technology products. Such like digital audio player and waist compass these projects were meant to capture sales. In the beginning of 1999 Nike launched its products on the internet and they were directly available to the customers. Nike has continued to expand its market and with a strong marketing team lead by Mr. Perez who has vast experience, the company in 2004, posted profits of more than $1 billion. [4] The company has a high team of human resources managers who are responsible for building a workforce which is effective and efficient. This managers build teams develop the necessary talents that are seriously needed by the organization to perform their duties. The managers also inspire, mentor, set examples, innovate and revolutionize all the employees in order to achieve the best from them. The employees also attend refresher courses seminars and training to keep them in touch with new market trends and technological advancements. In general the public attitude towards the company is good, but the people of Beaverton where the company feel that it should be annexed fro where its headquarters are in Oregon State. But the company feels that the annexing will cost it $700,000 every year in terms of added taxes. The company objective is achieved through proper marketing and advancement in technology by creating high quality products and designing better management approaches to maintain the market. Another aspect the company has done is to create better working conditions and customer relationships as from 2002 Nike addressed the issues of employees exploitations and carried out random company inspections to check the working conditions of its employment. [5] Nike has training programmers to train its employees and advance them with the current market needs. Another thing that the company is involvement in is to improve its company image by getting involved in corporate social responsibilities. The company thus contributions to charities organizations and also organizes social activities for the society, and sponsors individuals and persons. This has greatly improved its image. Nike is also one of the most environmental friendly companies. And this has a very positive image in the eyes of the public which has become much environmental aware. Conclusion Nike is a big organization that commands a large market in the world. It is apparent that to maintains such a market by investing a lot in marketing and research so that it can satisfy its customers and keep up with new trends on the market. Better management skills and quality products are the main ingredient for success for any company. Many obstacles in marketing and management come up to challenge the company including stiff competition. But it is clear that with well and timely adjustments in marketing and advancement in technology and being to be innovative the company has managed to capture and maintain its markets. Therefore for any company to remain profitable and impressive its must embrace prudent management and better technology. References Collingwood, H. (1988): Nike Rushes in Where Reebok Used to Tread; Business Week, October 3, p. 42. Holmes, S. and Christine, T. (2002): How Nike Got Its Game Back; Business Week, November 4, pp. 129-31. Jenkins, H. W. (1998): The Rise and Stumble of Nike; Wall Street Journal, June 3,                [1] Jenkins, H. W. (1998): The Rise and Stumble of Nike;   Wall Street Journal, June 3, [2] Collingwood, H. (1988): Nike Rushes in Where Reebok Used to Tread; Business Week, October 3, p. 42. [3] Collingwood, H. (1988): Nike Rushes in Where Reebok Used to Tread; Business Week, October 3, p. 42. [4] Holmes, S. and Christine, T. (2002): How Nike Got Its Game Back; Business Week, November 4, pp. 129-31. [5] Collingwood, H. (1988): Nike Rushes in Where Reebok Used to Tread; Business Week, October 3, p. 42. How to cite Nike Incorporation, Essay examples

English Summary Thesis Statement

Question: Discuss about theEnglish Summaryfor Thesis Statement. Answer: Introduction The Thesis statement of the article is that while happiness seems to the ulterior goal of life for all the human beings, very few people have comprehensive knowledge about the nature and the actual source of happiness. Usually people tend to think that happiness can be found via the pursuit of materialistic things, and yet true happiness is only realized by creating memorable experiences in life. The central idea of the article is that while most of the people tend to rely on living a secure, safe and prosaic life, they fail to explore what real happiness constitutes. A person, doing a job, travelling back and forth from his office, may earn huge amount of money, but he fails to relish happiness in the true sense. However, a man who is not much interested in leading a secure job, occasionally goes around meeting friends and family, or makes plans for movies, will be far happier. While materialistic things can bring instant happiness, the happiness in itself is much transient as after some time, the man gets habituated with the materialistic objects, and fails to hold on to the same. On the other hand, a man who gains experiences by climbing a mountain, or simply visiting a new place, will undoubtedly create memories to cherish all his life. Since the happiness derived through materialistic objects seems to cease after some time, the article rightly concludes that continuous challenges, interruptions and obstacles are highly important to ensure the long-lasting impact of happiness. Another important supporting idea regarding the nature of happiness introduced here, is that the apprehension of happy moments bring greater satisfaction that the actual pursuit of the same (Dunn et al.). Thus this argument of deferred gratification also goes to prove that happiness is essentially a matter of the mind, which is best achieved when experienced rather than being begotten. Further, the role of experience in the gratification of mind has also been reinforced, as the article rightly states that an individual derives greater pleasure by helping other people, or feeding the, rather than buying food for himself (Sunstein). Now, since the article reinforces the importance of experience in bringing about happiness in life, it also states the importance of giving out money, and helping other people, instead of spending the same for self-gratification. Besides, the article also states that a person can create happiness for himself by doing new things and travelling to new places, rather than buying expensive things. Happiness implies a spiritual awakening of the mind, not a mere pursuit of materialistic objects. However, even though the central argument is indeed true in highlighting the importance of experience, it should also be noted that such arguments are challengeable. Happiness in itself is inherently a subjective concept that varies from one individual to the other, and hence even a shy man can be happy without socializing, or a man who loves to stay at home, may not wish to go out for enjoying adventures, and still stay happy. Reference List: Dunn, Elizabeth W., Lara B. Aknin, and Michael I. Norton. "Spending money on others promotes happiness."Science319.5870 (2008): 1687-1688.. Sunstein, Cass R.What You Can Learn From The New Science Of Smarter Spending. 1st ed. 2013. Print.

The Way To Make The Truly Big Bucks Is On Wall Street. Very Little Has

The way to make the truly big bucks is on Wall Street. Very little has changed on Wall Street since the beginning, everything but a few laws. When those laws are interpreted the wrong way, or when someone breaks a law on Wall Street, the agency respo ible for busting them is the Securities Exchange Commission (SEC). The primary mission of the SEC is to protect investors while maintaining the integrity of the securities market. They want to ensure that the market is fair for all investors, at all t es. How they plan to make the market as secure as it can be is another story- one that includes many specific laws that your average Joe probably doesn't know. Since the beginning of time, man has cheated. Whether it be at sports, on exams, and even on their spouses- man has cheated all. There are several forms of "cheating" on Wall Street. From market manipulation, to trading on inside information, there nothing Wall Street hasn't seen. Bribery, scandals, even murder has made Wall Street what it is today-the financial capital of the world. With the SEC to regulate things, little has changed on Wall Street. The Securities Exchange Commission was created by the Securities Exchange Act of 1934. It acts just like a mini-government in a sense that it includes legislative, executive, and judicial functions. The duty of its legislative branch is to announce les and regulations to the public. The executive branch simply enforces the market rules against anyone who violates the statutes. The main job of the judicial branch is to decide whether or not a person has violated or broken any of those same rules d regulations of the market. While these tasks seem like few, the gray area of the laws make them difficult and confusing, especially for investors. The millions of investors probably doesn't help the SEC out, mainly because they are so largely outnum red. The Securities Act of 1933 was the first federal legislation designed to regulate interstate activities of securities. Basically, it is designed to ensure that investors receive complete, and accurate information. Its aim is to require full and fair blic disclosure of new issues and to prevent fraud. Under the act, all newly issued securities sold through interstate commerce must be registered with the SEC. Registration is completed by filing an "S-1" statement, which gives detailed information t issuing entity and the issue. An interesting fact is that if the S-1 statement proves to be misleading, all those who have signed it can be prosecuted for fraud. The maximum penalty for this crime is 3 years in prison, or a $5000 dollar fine for each ount. The Securities Exchange Act of 1934. The purpose of this act is to bar unfair practices once securities have been issued. It regulates exchanges and is designed to ensure that the market is fair and orderly. The most significant feature of the 1934 t is the creation of the SEC. Its five commissioners are appointed by the president, are approved by the Senate for five-year terms and are barred from any business or stock activity when they are serving. The 1934 Act calls on exchanges to regulate t mselves. All national securities exchanges must first register with the SEC, which at the time they impliedly agree to abide by the law and supply up-to-date information about the organizations rules. Others who must register with the SEC are those in viduals or firms who engage in securities transactions. Also, securities themselves must be registered with the SEC. I have recently heard of internet scams where innocent people have invested in non-existent companies, which isn't regulated by anyone ut one day hopefully will be. Since the beginning of the exchange, there has been manipulation of stock prices which consist of wash sales, matching orders, and false information. A wash sale is when one person simultaneously buys and sells to create the misleading appearance of active trading. Matching orders is when two or more individuals act together and enter identical or almost identical orders simultaneously, so that the transaction appears on the ticker tape although there has been no true change of ownership. False i ormation is when an individual or group urge a transaction in a particular security upon someone else, by saying that some person

Stone Tools Then and Now

Stone Tools Then and Now We all know the cartoon of the cave man bearing his stone axe. How crude life must have been, we may think, when there was no metal. But stone is a worthy servant. In fact, stone tools have been found that are more than 2 million years old. This means that stone technology is not something Homo sapiens invented- we inherited it from earlier hominid species. And stone tools are still around. I dont mean stone used for construction, but things you can hold in your hand and do stuff with. Stone Grinding Tools Start with grinding. One stone tool thats still in common kitchen use is the mortar and pestle, better than anything for turning things to a powder or paste. (Those are made of marble or agate.) And maybe you seek out stoneground flour for your baking needs. (Grindstones are made of quartzite and similar rocks.) Perhaps the highest use of stone today along these lines is in the tough, heavy granite rollers used for grinding and conching chocolate. And lets not forget chalk, the soft stone used for writing on blackboards or sidewalks. Edged Stone Tools But what makes me light up is edged stone tools. If you spend enough time in suitable country, one day youll pick up an ancient arrowhead. The utter coolness of the technology really comes home when you look at one of these stone tools close up, like some of the delicate points at arrowheads.com. The technique of making them is called knapping (with a silent K), and it involves striking stones with harder stones, or highly controlled pressure flaking with pieces of antler and similar materials. It takes years of practice, and you cut your hands a lot until you become an expert. The type of stone used is typically chert. Chert is a form of quartz with an exceedingly fine grain. Different types are called flint, agate, and chalcedony. A similar rock, obsidian, forms from high-silica lava and is the best knapping stone of all. These stone tools- points, blades, scrapers, axes and more- are often the only evidence we have from archaeological sites. They are cultural fossils, and like true fossils, they have been collected and classified for many years around the world. Modern geochemical techniques like neutron activation analysis, coupled with growing databases  of the sources of toolmaking stone, are allowing us to trace the movements of prehistoric peoples and the patterns of trade among them. Stone Tools Today Another thing that makes me light up is knowing that this technology is being revived and preserved by a bunch of fanatic knappers. Theyll show you how at a local knap-in, theyll sell you videotapes and books, and of course theyll put their passion on the web. The best knapping websites, I think, are Knappers Anonymous and flintknapping.com, but if you want to follow the arrowhead trail to the scientific end of things, start with the lithics page from Kris Hirst, the About Archaeology Guide. The knapper/artist Errett Callahan has devoted his career to reproducing all the ancient tools, then moving beyond them. He and other practitioners have brought this technology into what he calls the Post-Neolithic period. His fantasy knives will make your jaws drop. PS: Obsidian scalpels are the sharpest in the world, and plastic surgeons rely on them more and more for operations where scarring must be minimized. Truly, the stone edge is here to stay.

Criticize Elizabeth Anderson's Claim that the Autonomy of Women will Essay

Criticize Elizabeth Anderson's Claim that the Autonomy of Women will be Promoted by Banning Commercial Surrogacy Contracts - Essay Example If the intended mother has the ability to produce eggs that are fertile but is unable to carry the pregnancy then gestational surrogacy can be used. In this process, the egg of the intended mother would be removed and combined with that of the husband or a sperm from another man and finally implanted in the replacement mother. Surrogacy arrangements can be either altruistic or commercial. In altruistic surrogacy, the surrogate mother would be compensated for expenses incurred or sometimes not paid at all. On the other hand, the surrogate would be paid all expenses incurred during the entire period of the pregnancy plus a fee in commercial surrogacy. In this surrogacy, the surrogate mother and the adoptive parents come up with a commercial surrogacy contract that regulates their relationship for the entire period of the pregnancy. Criticism I disagree with Elizabeth Anderson’s claim that the autonomy of women would be promoted by banning commercial surrogacy contracts. As a mat ter of fact, commercial surrogacy has enabled many infertile couples in the entire world to have children. There exist few children for adoption and even the requirements for one to qualify as an adoptive parent are hard to meet. Therefore, commercial surrogacy remains the only hope for some individuals to get children and make up families. It is the only humane answer to the infertility problem. Infertility is extremely common in the world; it affects approximately one out of seven couples. This problem is likely to increase since more women are entering a time consuming workforce, and thus delay the process of giving birth to a later age when fertility challenges are exceedingly rampant (Richards 78). Consequently, adoption does not sufficiently meet the desires of infertile couples wishing to have a baby. There exist no biological link between the couple and the adopted baby; they would be forced to wait between three and seven years to adopt an infant. This has contributed to a call for another reproductive option. Moreover, abortion and the use of contraceptives have led to a serious shortage in the number of adoptable babies. If we follow Elizabeth Anderson’s argument, then we leave many infertile couples without children. Commercial surrogacy is not a practice of baby selling as Anderson argues. It is a contract to bear a child but not to sell the child. The payment to a surrogate is just a fee for the services just similar to the fees paid to doctors and lawyers for their services. The banning of commercial surrogacy will be infringing on ones constitutional right to engage into a contract freely. The society is always at peace when the liberty of its members becomes maximized. Women and the entire society benefit from the freedom of choice that would be offered through surrogacy. Since people would not be forced into the contract, they engage willingly; no one should attempt to stop them. In a rights based culture, commercial surrogacy contract s would be supported since every woman has the right to procreate. She also has the right to demand compensation for expenses incurred during the gestation period. All parties benefit in a surrogacy arrangement that is successful. The intended parents go home with a cherished child while the surrogate mother gets monetary reward for her work (Richards 71). The money the surrogate mot

Instructional presentation Essay Example | Topics and Well Written Essays - 500 words - 1

Instructional presentation - Essay Example Jim Fay’s (1995) discussion of three major teaching styles reminders readers that feedback sends not only the overt message of the words used but the covert messages of tone, actions and general body language. Of the three teaching styles - helicopter, drill sergeants, and consultants – it is the consultant teacher who embodies the overt and covert â€Å"messages of personal worth, dignity, and strength† (Fay & Funk, 1995, p. 197). When looking to the strategies employed by consultant teachers, it becomes obvious that these can be used with all teaching styles to provide corrective feedback in a whole instruction setting. First, educators should make sure the questions being asked are of appropriate difficulty and cognitive levels while being stated as clearly as possible. Schroeder (n.d.) suggests that questions dealing with new material should be such that 80% of the responses given are correct and 90+% for review materials. Educators may find that low-level questions that ask what, where, and who are best for this. Such pedagogical procedures will promote self-esteem as well as momentum needed to progress with instructional activities. Students will then be more willing to work for answers to higher order questions dealing with the why and how. Secondly, teachers should react to responses in such a way as to encourage student answers. Quick, certain responses that are correct need only affirmation that they are indeed correct. Correct but hesitantly given responses need the affirmation of correctness as well as praise and perhaps a short review of why the response is correct. Incorrect responses that are due to a careless error need only a quick reference to the error and time for the student to be allowed to provide the correct answer. Incorrect answers based on a lack of knowledge should be met with prompts and hints that may engage the needed information. Clarifying, rephrasing, or even changing the

T847CA Essay Example | Topics and Well Written Essays - 250 words

T847CA - Essay Example I was lucky to be able to help students whom patient did not show up or did not have a patient because there were two new patients from downstairs. The next most important thing about clinical assistance was listening to detail with different other tasks. I wrote down on the paper each task given, so that I could remember what Irma said. In the meantime, my task was to update appointment on the Axiam. I noticed by adding the code in the treatment plan for group 2 was simple as well as scheduling the patient on Lunex. The students should be able to reschedule their appointment in the Lunex without going through Irma. As a result, Jackson can save her overload work. Because I was cheerful in a calmly manner, everyone we helped went smoothly through the process. For me, this clinical assistant rotation was a great experience as a learner because I realized that Jackson had to work in the office by herself. I was also able to update the entry record in the Lunex which was also a great experience. I would recommend this rotation to everyone especially for this purpose, because one can gain more knowledge and admiration aspect of being in the clinic office. I did not encounter any negative incident and I am happy to conclude that generally, the whole rotation experience was not only wonderful but also

Arguments for and Against Juvenile Courts

Arguments for and Against Juvenile Courts Introduction In the United States we have two parallel systems that deal with individuals that commit crimes and or offenses against society. First we have the criminal justice system, a court which deals with adults who commit various crimes. Secondly, we have the juvenile justice system, a court designed especially for minors and is generally thought to help rehabilitate the offender. The salient difference between these two systems, as Mitcheal Ritter puts it, is the use of distinct terminology to refer to their similar procedures. State and federal legislatures intended this terminological variation to avoid stigmatizing children as criminals and to dissociate the juvenile system from the criminal justice system (Ritter 2010, 222). The major issue I intend to look at it is whether or not we should abolish the juvenile justice system. First, we will look at the position of keeping the current system, why it needs to stay in place, and why in the long run it is the most beneficial to the juvenile. Second, we will examine the research of Barry Feld, one of the most influential advocates on why it needs to be abolished because of the lack of constitutional rights that a juvenile does not receive while being tried under the Juvenile justice system. Thirdly, I will be looking at each partys positions and critiquing it to see it what the strong and weak points are. Finally, I will present my own opinion on whether to keep it, abolish it, or create a whole new system altogether. Presentation of Position A: Do Not Abolish the Juvenile System To try a juvenile in adult court is by no means the right decision. In this section we will look at evidence and arguments on why the juvenile justice system should not be abolished. Juveniles are different from adults and therefore should not be allowed to stand trial in the criminal justice system. Children are not well enough developed mentally, as compared to an adult, to be tried in the adult correctional system. This is why many people take the stance, no way should we get rid of the juvenile justice system. The director of the states (Washington) Bureau of Juvenile Detention Services is seeking to keep 16- and 17-year-old offenders out of the states criminal justice system (McNeil 2008). To lock up a child in an adult correction facility is by no means the right idea even if they are separate from the adults. If a juvenile commits an adult crime like robbery, theft or in most cases drug crimes, a quick fix is to incarcerate that individual in an adult prison to punish him and protect society. While this may work for adults, it is inappropriate for a youth. Advocates argue that we must keep the juvenile justice system because many studies also have found that significantly harsher punishments are meted out to juveniles in adult court when compared with juveniles in juvenile court, particularly for serious or violent offenses (Kurlycheck and Johnson 2010, 727). Sending a juvenile to adult court at such a young age can be problematic for the child, because the court wants to be strict with the child by showing them that their behavior will not be tolerated and because in adult court the child will miss out on educational and rehabilitative programs more readily available in juvenile detention facilities. Kurlycheck and Johnson argue that Juvenile courts are characterized by disposition optio ns that fundamentally differ from adult courts in their symbolic meaning, punitive and treatment alternatives, and punishment goals (2010). In a study in Pennsylvania, Kurlycheck and Johnson compared a sample of juveniles tried in juvenile court with juveniles who were transferred to adult court and showed that the adult courts were harsher on the juvenile: On average, their sentences were 80 percent more severe than for their young adult counterparts (Kurlycheck and Johnson 2010, 729). Juveniles should not be allowed to be tried in adult court because studies have shown that many juveniles function at levels similar to disabled adults who lack competence; not because of diagnosable mental health problems, but because of developmental immaturity (Katner 2006, 507). The theory that sentencing a youth to an adult prison will reduce recidivism and hope that the experience will scare him straight, is invalid. Research shows that experiences with adult jails and prisons show that those facilities may instill fear but are otherwise emotionally-and often physically-dangerous for youth (Butler 2011, 114). Finally, Frank Zimring argued that young law violators are less culpable, and thus deserve less punishment-no matter what kind of court might try and sentence them (Kurlycheck and Johnson 2010, 729). Kurlycheck and Johnson also confirm what Katner is saying by explaining that adolescents are at psychosocial disadvantages in terms of responsibility, peer influence, temperan ce, and perspective; they are less able to foresee future consequences of their actions (Kurlycheck and Johnson 2010, 729). Youths in the detention system have an average IQ of 85, as compared to the national average of 100, and about 60% in detention meet the criteria for at least one mental disorder (Butler 2011, 111). Research by Howard N. Snyder, Ph.D., director of Systems Research at the National Center of Juvenile Justice, shows that 68% of committed males were diagnosed with a mental health disorder, and research indicates that the percentage is greater for females in commitment facilities, 50% of committed males had a substance abuse diagnosis (Katner 2006, 509). If a youth has a mental illness then it is our responsibility to address those needs. A state has no right to refuse adjudicated juveniles. It is the juvenile justice systems legal and ethical responsibility to admit them, and make provisions for their safe and secure care and treatment (Smith 2012). The American Public Health Association found in their Cox proportional hazard study that better mental health services reduced the risk of initial and subsequent juvenile justice involvement by 31% (Foster, Qaseem, and Connor, 2004) and had stronger results with more serious offenders. Their findings said that improved mental health ser vices reduced the risk of juvenile justice involvement (Foster, Qaseem, and Connor, 2004). We must remember that the juvenile justice system is meant to reduce recidivism, help the individual with their struggles, and integrate them back into the community. When a juvenile offender is reintegrated into the community after a year being counseled, treated, and taught, the community is safer than it would be if that same delinquent youth were incarcerated for five years and released with no preparation to respect himself and society and to avoid repeating the same behavior. In Missouri, for example, only 8 percent of juvenile delinquents return to the justice system within three years; the national average is over 50 percent (House 2010). Decreasing recidivism has both immediate and long-term benefits. It has been estimated that juveniles who become adult offenders cost society between $1.5 and $1.8 million each (Macomber, Skiba, Blackmon, Esposito, Hart, Mambrino, Richie, Grigorenko 2010, 224). Therefore, successful education is one of the most important tools that a juvenil e can have while locked up. According to the Journal of Correctional Education, quality education and successful employment is viewed, unequivocally, as the most powerful tool in recidivism reduction, rehabilitation of juvenile delinquent [à ¢Ã¢â€š ¬Ã‚ ¦]into a socially productive, healthy, and happy adult (Macomber, Skiba, Blackmon, Esposito, Hart, Mambrino, Richie, Grigorenko 2010, 225). However, the article does note that the level of education that is delivered to juveniles while incarcerated is nationally recognized as being far from as effective as it should be. Society wants our youths to succeed, be successful, and be normal members of society. That is why many advocates believe in keeping them out of the criminal justice system because they want to help bring these individuals back into society. Advocates for this system believe that juvenile justice systems are the best because once a juvenile is locked up in an adult correctional system, that individual will have a criminal record that follows them for life, which would not be the case if they had been tried in family court (McNeil 2008). Once a child is labeled as a criminal in society (labeling theory,) not only will it be hard for him to apply for a job with his adult criminal record, he will also carry the label of criminal over his head while back in society. Presentation of Position B: Abolish the Juvenile System In this section we will be looking at why it is a good idea to abolish the juvenile justice system. Barry Feld is one of the major advocates for abolishing the juvenile justice system. He believes the system should be thrown out because juveniles are frequently not afforded their constitutional rights in juvenile court. Barry Feld, a law professor from the U of M and an expert on the juvenile justice system, says the juvenile justice system needs to be abolished. He claims that within the past three decades, judicial decisions, legislative amendments, and administrative changes have transformed the juvenile court from a nominally rehabilitative social welfare agency into a scaled-down, second-class criminal court for young people. These reforms have converted the historical ideal of the juvenile court as a social welfare institution into a penal system that provides young offenders with neither therapy nor justice (Feld 1997, 68). In light of these failures, Feld is proposing that the juvenile court be integrated into the traditional criminal court system. Feld talks about how the juvenile justice system lacks constitutional rights for youth offenders. Several important Supreme Court decisions help change and shape the criminalization of the juvenile court. In the case of In Re Winship,the court required states to prove juvenile delinquency by criminal laws standard of proof beyond a reasonable doubt (Feld 1997, 73). In the U.S. Supreme court case of In Re Gault, the court said that juveniles accused of crimes must be afforded many of the same rights that adults get. These rights would be the 5th amendment of right against self-incrimination, the 6th amendment right to confront witnesses, the right to timely notification of the charges and the right to be represented by an attorney. Even though the Supreme Court ruled this way, Feld says that lawyers seldom appeared in juvenile courts and when the juvenile was on trial the judges did not advise juveniles of their rights and did not appoint counsel (Feld and Schaefer 2010, 330). Feld ci tes two associations, the American Bar Association and American Children at risk, that reported that many youths in the juvenile justice system were not represented by counsel and of the lawyers who represented juvenile lacked adequate training and failed to provide competent representation (Feld and Schaefer 2010, 330). If this would happen in the criminal justice system, the case would risk dismissal or being overturned on appeal. Even if a juvenile does have a defense lawyer, many attorneys seldom if ever appeal the decision of the juvenile court judge. Judges are continuing to allow juvenile rights continue to be trampled upon by allowing juveniles to waive their right to an attorney without allowing them to consult with one of their parents or an attorney. Feld and Schaefer say that in most states, judges gauge juveniles waivers of rights by assessing whether they were knowing, intelligent, and voluntary under the totality of the circumstances test. They rejected special procedures for youths and endorsed the adult standard to evaluate juveniles waivers of Miranda rights. When a juvenile is arrested or brought into custody, he should not be allowed to talk to anyone unless his parent or lawyer is present. Feld wants both the criminal and juvenile system to be combined into one in hopes to reduce many constitutional violations, such as a juvenile waving his right to Miranda warnings. He says that many juveniles do not understand a Miranda warning or counsel advisory well enough to make a valid waiver (Feld and Schaefer 2010, 331). This is a major risk for first time offenders because they may not know what they are agreeing to. Juveniles who have gone through the system before may start to get a grasp on the concept of Miranda about as well as adults but substantial minorities of both groups failed to grasp at least some elements of the warning (Feld and Schaefer 2010, 331). To help reduce these constitutional violations, Feld believes that state courts should adopt sentencing guidelines for juveniles, which now exist only in adult courts (Furst 1991). Feld believes that many sentences are based on where the juvenile lived than the crime (Furst, 1991). In Felds study, urban criminals face stiffer penalty, he found that urban juveniles receive harsher sentences for the same crimes than their rural and suburban counterparts (Furst 1991). Felt said that urban courts detained youths that were charged with felonies around the time; rural counties detained them one-tenth of the time and suburban counties one-thirteenth (Furst 1991). Feld says that no reasons exist to believe that rural youths are more competent than urban juveniles to waive legal rights, but rural judges appoint attorneys far less often than do their more formal, urban counterparts (Feld and Schaefer 2010, 332). Feld says that juveniles are very immature and lack a lot of experience. They requ ire the assistance of counsel to understand legal proceedings, to prepare and present a defense, to negotiate guilty pleas, and to ensure fair adjudications (Feld and Schaefer 2010, 350). How is it fair that adults can have lawyers present at their trial and not juveniles? He says that increased efforts to have lawyers present at juveniles trials have remained the same. Feld says that with his data from 1994 and 1999 have predicted the outcome for youths to receive attorneys present at trial. The data is quite surprising that youths convicted of felony and status offenses show a decrease in odds of representation, whereas youths convicted of misdemeanor offenses show an increase in the odds of having an attorney (Feld and Schaefer 2010, 349). One of the most important rights we have in our judicial system is the right to a jury trial. However, Feld argues is that while the right to a jury trial is a crucial procedural safeguard when states punish offenders, the vast majority of jurisdictions uncritically follow McKeivers lead and deny juveniles access to juries (Feld 1997, 87). When judges and juries apply Winship, the reasonable doubt standard, differently, it allows them to convict youths more easily in juvenile court than in adult criminal court with the same evidence. Feld say that the constitution as well as state juvenile statutes allow delinquents to have formal trials with attorneys present. But in reality the actual quality of representation that the juvenile receives is far from optimum. One of his reasons for abolishing the juvenile justice system is because the criminalization of juvenile courts, most states provide neither special procedures to protect youths from their own immaturity nor the full panoply of adult procedural safeguards. Instead, states treat juveniles just like adult criminal defendants when treating them equally places youth at a practical disadvantage (Feld 1997, 87). Feld argues that some scholars believe that rehabilitative juvenile court or a juvenile version of a criminal court simply will not work as their supporters intend (Crawford 2001). Because of this, Felt proposes that an integrated criminal court would be a better solution. He believes this model is the best because society recognizes youths as being less mature and more susceptible to peer influence (Crawford 2001) so the court could offer what he calls youth discounts for sentencing. This would take into consideration the youths age and apply it towards his crime. In his model he is not talking about crime reduction, remove what he considers to be the drama of waivers to adult courts (Crawford 2001). Feld claims it will remove double talk and hypocrisy because justice officials claim rehabilitation as their goal when the reality of their actions is coercion and punishment (Crawford 2001). As long as the youth discount is integrated into the criminal court system, it can provide yout h offenders with better legal protection, ensure they are granted the same constitutional rights that adults get, and most importantly, that juveniles would receive humane consequences from judges. Feld agrees that youths do deserve shorter sentences compared to adults when being tried for comparable crimes. However, there does not need to be separate courts for this. Feld says that the juvenile court system will not survive because it represents a temporary way-station on the road to substantive and procedural convergence with the criminal court (Feld 1997, 132). For both of these court systems to work, Feld says there must be an integrated criminal justice that formally recognizes adolescent as a development continuum may effectively address many of the problems created by our binary conceptions of youth and social control (Feld 1997, 132). Critique of Positions Advocates for the juvenile justice system believe that juveniles should have their own court system. In order for the juveniles to be properly protected, educated and rehabilitated, there cannot be two systems. Many juveniles are not sufficiently mentally developed to stand trial in the adult court system. Recall that The American Public Health Association said that better mental health services reduced the risk of initial and subsequent juvenile justice involvement by 31% (Foster, Qaseem, and Connor, 2004). Once the juvenile entered the detention center and was given appropriate care and treatment, the risk of juvenile justice involvement in the future was reduced. Many advocates argue that we must keep the juvenile justice system because many studies à ¢Ã¢â€š ¬Ã‚ ¦ have found that significantly harsher punishments are meted out to juveniles in adult court when compared with juveniles in juvenile court, particularly for serious or violent offenses (Kurlycheck and Johnson 2010, 727). The study said that of the juveniles tried in adult court, about 80% received harsher punishments compared to their youth counterparts. In order for us to have fair trial systems we cannot try youth with the same standards of adult. Advocates also believe that a juvenile should not be locked up in any adult facility because it would set the child up for more harm from stronger and more powerful adults. Research has shown that experiences with adult jails and prisons show that those facilities may instill fear but are otherwise emotionally-and often physically-dangerous for youth (Butler 2011, 114). I do not see any advantage to put a juvenile in the same cell or facility of another adult. The juvenile justice system is meant to rehabilitate the offender, not make him worse. We want the child to come out better than when he went in. In the adult court the minor would leave with a criminal record which could negatively affect his chances at getting a job once released. In juvenile court their record is usually protected. I do agree with what Feld says about having a juvenile be granted his constitutional right to an attorney, jury trial and correct understanding to Miranda warnings. He makes a big case about how juveniles are rarely granted these rights. I strongly agree with Felds statement regarding this. Many of these youth are waving their right to an attorney without the knowledge of what the consequences might be. Because some judges are allowing this to happen in the juvenile court, Feld make a convincing argument for these youth to be tried in an adult court. This may prevent any further constitutional violations. If an adult was treated this way, the case would have a high probability of being thrown out. If a juvenile is not granted these rights, there is no way he can expect a fair trial. Feld is correct that courts need to follow In Re Winship and In Re Gault. These are the rights granted to the juvenile, for a judge not to follow them would be unprofessional and most of all unconstitutio nal. Feld says that the juvenile court system will not survive because it represents a temporary way-station on the road to substantive and procedural convergence with the criminal court (Feld 1997, 132). I do not agree with this at all. In the juvenile justice system is designed help rehabilitate the offender, if the system is to work correctly; it will not be a temporary way-station. I do recognize that there are some fall backs to the system, but it needs to be run correctly. The idea of youth discounts, if implemented correctly could work. However judges might over abuse their power towards the juvenile. These youth discounts would be totally up to the discretion of the judge. This could pose a problematic issue for the youth if the judge does not follow the guidelines of youth discounts. If judges cannot follow constitutional guidelines of Winship and Gaulti do not believe they would be able to follow a rule of youth discounts. Feld has a good idea behind his youth discounts, however I do not believe judges would follow these rules. His last argument is that youths do deserve shorter sentences compared to adults when being tried for comparable crimes. If the juvenile system is abolished this concept would have to be enforce. I still see it being problematic for the child to serve time in an adult facility. We want to rehabilitate the child, not solely focus on punishing him or her. There is no telling how this system would be implemented. A judge could use this power to unfairly sentence certain youth to longer sentences the he deems necessary. As I have stated earlier, juveniles have different maturity and educational levels compared to adults. That is why many of these youths still need to be tried in a system where a judge is specialized in juvenile crimes. Authors Position Now that we have had a chance to examine the arguments for and against abolishing the juvenile system, our issue is which side should we take and why? It is difficult to pick one side, and therefore I propose a hybrid version. Using strengths from both sides, I believe we can come to a conclusion that will be most beneficial for the juvenile, and our court system, and one that will meet constitutional standards. In order to accomplish all of this we will be looking at concepts, resources, and management. Applying all three of these criteria we will be able to see why the combination of them will result in the best outcome. We will be ending the juvenile system as it currently exists, but instead of getting rid of it all together, there will be some changes to the adult system to help incorporate these new guidelines. As I have stated multiple times above, our concept of the juvenile justice system is to rehabilitate the offender and get the child ready to be brought back into society again. If the juvenile justice is to work correctly it would give the juvenile the necessary skills to be brought back into society. Society accepts this concept because the juvenile is still young, and society is willing to give that individual another chance. Society believes this because the juvenile is put under the obligation to grow himself/herself to be fitted to the perceived values of the society. If this is done successfully, the concept of rehabilitation has worked successfully Currently the juvenile justice system needs to be combined with parts of the adult system to work effectively. Mainly, the concept of having a fair trial is something all adults get in adult court. The juvenile justice system offers the minor educational and mental help through trained and effective services; something that the adult court rarely offers. It has also been stated that the juvenile dentation centers are better at offering rehabilitate skills through classes such as anger management which is essential to any delinquent wanting to enter society again. If the juvenile was just thrown into an adult correction facility, there is a slim chance that he would have access to the proper education that he would need. It is unlikely that the adult system has classes targeted for their needs. As I have stated earlier from the research, juveniles are far less mental and educationally developed compared to adults, that is why a system to house juveniles is still the best system. The a dult system houses individuals from 18 on up. If the delinquent is rehabilitated in a facility with individuals his own age, this might provide a better learning environment. The adult system is more focused on punishing the individual for their crimes and second, to possibly rehabilitated the adult offender. In a juvenile dentation center, their main goal is to rehabilitate the offender, not solely punish them for their crimes. Therefore, the juvenile justice system must take into account the opportunity to grow as a good person without any kind of stigma attached. Part of their rehabilitative process might involve apologizing to the victim. This would result in no father threat to the victim, and help the offender to know the impact of his crime. The last concept is if the juvenile is to be properly rehabilitated he needs to be in a safe environment, one that is targeted for his age group and level of education. While in the detention center, he or she is given the chance to learn and be properly educated, a skill that he or she might not have received while in the outside world. Barry Feld makes a convincing argument for abolishing the juvenile justice system with his argument that it does not afford the juvenile his constitutional rights. He believes that in order to fix this issue, the juvenile justice system need to be abolished and merged with the adult system. We are using Felds idea to merge the system but not abolish the resources and many benefits that come with the juvenile justice system. We will be using not one system but a hybrid of both. We must think of it as a system that only exists on paper not in different court systems. To award trial by jury, Miranda warnings, and the right to counsel only to adults does not represent a fair and balanced justice system. Juveniles must have the same rights that adults are entitled to. If an adult was arrested, questioned by police, brought to court without legal representation and informed the judge of all these violations, the case and evidence would be thrown out. That is why when creating this hybrid system we are using Felds resource of the adult court to create a new justice system for juveniles to ensure they are awarded all the rights adults are. First and foremost, juveniles must be accorded their constitutional rights. Juveniles are by definition young, inexperienced, and not as mentally and emotionally developed as adults. Special protections must be given to them to insure that they are granted their rights. Judges are continuing to allow juveniles to waive their right to Miranda when many are not aware of what they are without a parent or legal advisor. Juveniles who have gone through the system before may start to get a grasp on the concept of Miranda about as well as adults but substantial minorities of both groups failed to grasp at least some elements of the warning (Feld and Schaefer 2010, 331). Even if a lawyer was appointed, they (the lawyer) seldom appeared in juvenile courts and when the juvenile was on trial the judges did not advise juveniles of their rights and did not appoint counsel (Feld and Schaefer 2010, 330). Feld makes a major point of In Re Winship and In Re Gault (discussed above) to prove that even though these are laws exists, many courts overlook or ignore them, ultimately denying juveniles their rights to a fair trial. Constitutional rights cannot be overlooked, which is why I believe Felds argument of abolishing the juvenile justice system as it stands has merit, and the advantages of the adult system must be incorporated, without the negative consequences to juveniles. I propose that no juvenile be allowed to waive his Miranda rights without first consulting with a court appointed attorney. I further propose that no juvenile be allowed to waive his right to attorney, as can be done in adult court. Every juvenile should be represented by an attorney throughout the case. I propose that the juvenile have the right to a trial by jury in all felony offenses. If the offense is a misdemeanor or gross misdemeanor, the juvenile would still be tried before the juvenile court judge. In both misdemeanor/gross misdemeanor and felony level offenses, however, the dispositional alternatives would be within the traditional juvenile court system. There would be no adult sentencing in any misdemeanor/gross misdemeanor offense, and no adult sentencing for felony level offenses without the juvenile being certified to stand trial as an adult. Without good dispositional alternatives, we will not be able to make our hybrid juvenile system work. I am using this hybrid system to represent all non-serious crimes. One of the most important systems that needs to be retained is the educational system. As discussed earlier, successful education is one of the most important tools that a juvenile can have while locked up. If this is eliminated any hope of rehabilitating the juvenile goes out the window. One of the main goals of the juvenile justice system if to reduce the recidivism rate and to rehabilitate the individual with the skills necessary to return them to society. This will require enhanced special education opportunities. Many of the juveniles who are incarcerated have an average IQ of 85, as compared to national average of 100. So, even if they did attend public school, one study put their literacy skills [à ¢Ã¢â€š ¬Ã‚ ¦] at least one standard deviation or two years behind (Macomber, Skiba, Blackmon, Esposito, Hart, Mam brino, Richie, Grigorenko 2010, 225) their school mates in the same grade. To make sure this educational program will work, part of what I am proposing is that the court must require these individuals to participate. Math and reading are generally key important educational programs, but the detention facility also needs to offer other programs such as anger management, developing social skill, and educational classes on a variety of areas that the juvenile might lack. If the juvenile does not agree to these terms and conditions, they will be tried in adult court and sentenced to the adult correctional facility. It is not just education that many of these juveniles lack. Some 68% of committed males were diagnosed with some kind of mental health disorder, along with 50% of committed males having a substance abuse diagnosis. If these juveniles were put into the adult program, these issues might not ever be recognized or if they were, risk a high chance of never being treated. We need to provide adequate psychological support services to those who need them. If a youth has a mental illness then it is our responsibility to address those needs. A state has no right to refuse adjudicated juveniles. It is the juvenile justice systems legal and ethical responsibility to admit them, and make provisions for their safe and secure care and treatment (Smith 2012). If these mental issues are treated right now versus in the future, it very well might drastically reduce the recidivism rate. It has been estimated that juveniles who become adult offenders cost society between $1.5 and $1.8 million each (Macom ber, Skiba, Blackmon, Esposito, Hart, Mambrino, Richie, Grigorenko 2010, 224). This will ultimately be a substantial saving to the taxpayers, free up the jail for serious offenders, and get juveniles the help that many of them desperately need. One of the

Serial Killer :: Serial Killer Essays

Serial killer is a person who kills three or more people with a cooling off period between murders and these murders may go on for a period of months or years. The murders that this person commits may have similar fashion or the victims may have something in common, for example, occupation, race, appearance, sex, or age group. Psychology is the science and study of human behavior and mental processes. Moreover, it is the study of human minds and its function. Krafft-Ebing (1886) found that the serial killer had been through cruelty of animal; enjoy the torture and the pain of their victim during his or her childhood period. Moreover, the mothers of these serial killers were most of time working or doing other things and usually the father were absent. These children experience rejection and lack of attention, therefore, this child grows up having low self-esteem. Research show that adults that gone through abuse and violent behavior during their childhood were three times more likely to become violent as adult more than the non abused adults (Dutton & Hart, 1992). Freud (1940) was the first to do the link between sexual abuses during the childhood and adult abnormal behavior. As a result of that serial killer uses sex as a way to let out his or her anger and aggression. The sexually acts of the serial killer is not only about sex, but it is about revenge, power, and control. â€Å"Serial killers are unconsciously trying to kill off their repressed sexual pain and powerlessness. Every stab into the victim’s flesh is a stab against their own childhood sexual terror and pain, and the rage that accompanies it is a rage against those who tormented and terrorized† (Knight, 2006, p. 1199-1200). To take off the aggression and need to compensate the horrible memories of the childhood explain the reason why serial killers abuse animals during their childhood. When they were children they control pets and they can harm them knowing that the animals can fight back. Therefore, they feel themselves as if they were in absolute power. This animal torture later will turn in to human victim torture. Charister Clause and Lars Lidberg (1999) used five characteristics from Shahriar disorder that are common among serial killers.

American History. The Trans-Atlantic Slave trade

Think piece #1 I choose to answer the second topic. the dehumanizing forces of the transatlantic slave trade The Trans-Atlantic Slave trade was considered the most abominable and cruel force of slavery, during the trade, the way of obtaining the slave is dehumanizing, if we were to conclude the dehumanizing force in only one word, it would be: the minimum food, clothing, and shelter was given to those slaves who survived the Middle-Passage, and the maximum amount of work was expected of them. The first challenge was on their homeland, they were towed into a forest where no one can see them, then people who work for the capitalist beat the person to faint, and then they were chained together and â€Å"escorted† to the small boat which will send them to the slave boat. After that, when they were on boat, they were put on the lower cabin like cargos, there was almost no room to breathe or take a turn. And the food is horrible as well, the slaves can only get food once or at most twice a day, and the food is at most one-spoon full and the taste is awful. Slaves also have no bowls or spoons to eat; they ate with their bare dirty hands. What is more horrible is that ships often run out of food or sometimes there is infectious disease on board, then the slaves who is extra will be thrown into the sea with a bag of heavy rock tied in the beginning. Thus the survival rate during the transportation is extremely low; the number is only 13% or so. The first reason why that method is employed is that slaves were better used to the tropical weather than the capitalist, what is more, their physical building is tough and the number of slaves is much more than the solders on the ship. If they were treated like a human, whom they can get sufficient food and shelter, there might be a rebellion which may put those capitalist into peculiar situation. And at second, the slaves were considered property instead of human in the mind of those capitalists, thus they will not be treated like human. Despite all those horrible conditions and treatments, black people formed a strong culture tie between one and another to keep their rebellion force. The culture they formed is fusion of their own cultures with that of the white colonists, and the culture varies from country to country, region to region across the Americas. Although the slaves were captured from the same kingdoms, for instance, Louisiana is vastly different from that in Haiti or in Brazil. The differences were due to the differing conditions of slavery and the different input from whites in those places.

Fraught Is a Heavy Word

Fraught Is a Heavy Word â€Å"Fraught† Is a Heavy Word â€Å"Fraught† Is a Heavy Word By Mark Nichol Fraught, one of my favorite words, is fraught with meaning. The term, a variant of freight, was originally a noun and an adjective, with a verb form of fraughten. However, the noun, meaning â€Å"cargo,† disappeared from English (though it survives in Scottish), the verb is entirely extinct, and the adjectival form, which means â€Å"laden, full of† has survived only (with the exception, again, of Scottish) in its centuries-old figurative sense. Now, when a situation is fraught, it is accompanied by, or full of, a feeling usually danger, peril, or some synonymous (and usually sinister) quality. There are exceptions: Note the use in the first paragraph of this post, and a place can be said to be fraught with memories, which may be positive, negative, or a combination thereof. However, because of the word’s often negative connotation, fraught has developed an additional sense of â€Å"uneasy,† and when used this way, it requires no object. For example, one might write, â€Å"We found ourselves in a fraught predicament.† In conversation and in writing, use of the word is fraught with consequences: For one thing, it’s a fairly obscure term, though â€Å"fraught with (blank)† constructions are common enough to form a class of clichà ©s. Furthermore, the use of fraught in the sense of a situation involving emotional turmoil may be unfamiliar to your audience. But fraught is loaded with the strength of precision its meanings are sparse and specific, so it packs a punch and you should hesitate to allow a potent word’s relative rarity to disqualify it from your vocabulary. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:Comparative Forms of AdjectivesOne Sheep, Two Sheep, One Fish, Two Fish . . .Artist vs. Artisan

webpage essays

webpage essays We are standing on the precipice of a new culture? Sceptical, questioning connected with the world, thirsting for information and change. Technology is driving society at a pace unparalleled in history creating new attitudes, interrelationships, and global awareness. A new consumer is emerging, suspicious of traditional media sources, incredulous of advertising, and contemptuous of the contrived the hyped, the false. This consumer is not easily persuaded by clever graphics or manipulated by fads in design. In order to integrate all aspects of a brands presentation on a web-site, the designer must move beyond form, colour and type and embrace the comprehensive impact of design. Enhanced awareness of the world; deeper, broader thinking about problems and opportunities; a respect for the historical roots of and formal conventions of design; planning and diligent study are required to create interesting global web-site designs. To identify web-site designs that work, and to identify the reasons to why they work. With the increasing number of web-sites that are coming online daily, in order for them to work, they are more dependent on good design for attracting readership than print is. By examination of the most frequently visited web-sites, and although a historical approach with reference to print in design. Web sites need to be far better designed than anything in the print medium, due to the very interdisciplinary nature of the web-site. Because a magazine with even minimum design gets its information across to the reader. You buy it because you care about the issues in its headlines, if you want more you jump inside, print by its nature is a tactile phenonenom; touch, smell and accessibility, and it is for that reason it will never die. But web-sites are purely visual and aural, one screen at a time. Encouraging the viewer to go beyond the first layer, even learn where to go for wha...

The New Coalition Government in the United Kingdom Assignment

The New Coalition Government in the United Kingdom - Assignment Example These new statutory rules had taken effect last October 1, 2010 and pertain to the gathering of sensitive information and also the handling of confidential correspondence and communications related to child protection and other serious child care incidents.#2 These are all part of social work reforms that are being implemented. However, it must be emphasized that safeguarding is a bit different from child protection in the sense that the former pertains to protecting children from mistreatment, the prevention of impairment in a child’s development and ensuring children grow up in the right environment consistent with their safe and effective care. Child protection is just a part of the overall safeguarding and undertaken to protect vulnerable children who might be suffering.#1 It requires special skill to deal with family situations in which professionals have no other choice but to intervene, or intrude into the family life of a young child. Discussion Parents today are very protective of their children and this is understandable. There are some instances, however, when the children have to be separated from their parents and other adults who might be causing them harm. This is why the English government has taken a right to take care of these vulnerable children as the protector of society.... Although this reaction might be normal for any other person, it must not cloud my judgement on the proper actions to take, such as hesitating to report the matter immediately. For example, I would naturally feel pity for the young Steve and might get into the wrong conclusions about the conditions in the home of Steve and what his parents are doing to him. The appropriate professional response would be to observe Steve objectively, such as how he acts in the classroom or what his reactions are when his stepfather arrives to pick him up. My personal reactions can interfere with my own judgment about what needs to be done in this situation. I need to be quietly inquisitive into the circumstances of Steve’s family life without being obnoxiously intrusive. I have to protect the family’s privacy but not to the extent of possibly neglecting Steve or leaving him at the mercy of his parents. The idea is to correctly identify, understand and deal with possible child abuse. My pe rsonal reactions can lead to an over-reaction, such as reporting Steve’s parents to the authorities when in fact no child abuse has taken place. Steve might just be suffering from some physical ailment. 2. Immediate Concerns – there are some tell-tale signs that all is not well with Steve. The first is his reaction when told about his misbehaviour such as intentionally bumping into other people and his classmates. He was not upset when school staff had told him it is bad for him to keep knocking other people down and even seemed to relish the seemingly violent actions. He is quite aggressive and seems tired just coming into the school in the mornings. It is also noticeable that he is restless and seems always very hungry (which means

MJ refleection week 7 Essay Example | Topics and Well Written Essays - 250 words

MJ refleection week 7 - Essay Example With my positive attitude towards genetics, I have an intrinsic motivation to understand information about Becker muscular dystrophy, its genetic cause, and possible management. I am even motivated to cross reference for clarity of some information in the text that appeared challending (The New York Times 1). Based on my positive attitude towards genetics, seeing the DNA artwork captured my attention and I sought and succeeded in understanding the artist’s motivation and achievement in developing the art. I also understood, based on the artist’s success, that local researchers can used people’s preferences for DNA patterns to understand behavioral orientations, and I plan to implement this in future (The Telegraph 1). The text, ‘a hidden genetic code,’ is however less attractive due to its lack of graphics, but the desire to figure out genetic information and configure involved patterns motivates me to read though it and I have managed to synthesize the contents (Reuell 1). The Telegraph. â€Å"DNA artwork created by German university student.† The Telegraph. September 7, 2008. Web. March 10, 2015.

Cardiovascular Disease Prevention Plan Essay Example | Topics and Well Written Essays - 750 words

Cardiovascular Disease Prevention Plan - Essay Example Although, currently my cholesterol levels and glucose levels are controlled, which also significant risk factors for cardiovascular disease, but my habitual smoking and increased body fat are considerable risk factors for cardiovascular disease. It has been proved through research that smoking doubles the risk for ischemic stroke and smoking acts along with other modifiable and non-modifiable risk factors to increase the risk of cardiovascular disease. Smoking however, is also one of the risk factors which can be easily alterable. Smoking is also associated with premature morbidity and mortality leading to approximately 430,000 deaths per year in United States (Ockene and Miller 3243). A body mass index of 30 or more is considered obese and is a significant modifiable risk factor for cardiovascular disease. Being overweight increases the risk of increased blood cholestrol levels and triglyceride levels and also predisposes the person to diabetes and high blood pressure (National Inst ituite of Health). Cardiovascular diseases such as coronoray heart disease can be prevented by changes in lifestyle and different medicines. Since I am not suffering from high blood pressure and high cholestrol levels, I need to focus on changing my lifestyle in order to attain maximum prevention. Lifestyle changes that I strictly need to follow are following a healthy diet, being physically active, managing my weight and quit smoking. Stress management is also important and should be made a part of normal lifestyle. I should eat healthy diet which includes high fiber, low saturated and trans fat, high in omega-3 fatty acids and reducing daily salt and sugar intake (National Instituite of Health). Low-fat dairy products, fruits and vegetables, fish, legumes, poultry, lean meats, and grains are good sources of energy which also do not increase the risk to cardiovascular disease. According to guidelines I should reduce

Story of Dubliners Essay Example for Free

Story of Dubliners Essay The very first story of Dubliners outlines a large theme that can overlay much of the book and may in part be why James Joyce decided to group all of these short stories into one book. The first short story called â€Å"Two Sisters† focuses on the paralysis of a young boy as the impending death of his mentor Father Flynn draws closer. The boy walks past the priest’s home showing that a part of him cannot let go and that he himself is paralyzed by the loss of his friend and mentor who was prepping him for the priesthood. In the first paragraph of the book the narrator talks of the word paralysis and says â€Å"It filled me with fear, and yet I longed to be nearer to it and to look upon its deadly work† (Joyce, 3). The quote summarizes a recurring theme throughout Dubliners and prepares the reader by showing how paralysis in life is dangerous and leads to unhappiness. The story following â€Å"Two Sisters† is called â€Å"An Encounter† which is about two boys and their adventures while skipping school. Seeking escape from everyday life the boys decide to skip school and have an adventure much like the adventures that Mahoney reads in his books. At the start of their day their original plan is working out for them apart from the fact that Joe Dillon who promised to join them was a no show. However, the title suggests that something would happen to the boys. While they are in a field they see an older man coming right towards them. The old man is particularly creepy towards the boys after asking them about their girlfriends and then leaving walking to another part of the field and then coming back talking of beating Mahoney. Faced by this odd situation the narrator feels paralyzed from taking some sort of action to avoid the old man. Mahoney ran off chasing a cat, but the narrator stayed and instead of leaving as well, the peculiarity of the situation keeps him from acting. The narrator does not respond to the man and sits hoping for the moment to just pass by. Only at the very end of the story is the narrator able to stand up and break free from his paralysis. The next story in Dubliners called â€Å"Araby†, centers around a younger boy who has a crush on his friend’s sister who is likely a few years older. Her presence in the story greatly resembles â€Å"An Encounter† because she is seen as an escape to the narrator. She allows him to break away from the dull dragging on everyday life by giving the boy over romanticized thoughts. He goes to the bazaar to get her a gift, however he arrives late and does not have as much money as wanted to buy her a gift. By the end he gives up his attempts to purchase a gift and has a sort of epiphany; however it is not a positive one. The paralysis in the story centers on this youthful defeat and eludes that life itself will be much the same. The three stories prepare the reader for the paralysis in â€Å"Eveline† because in the stories preceding the paralysis is the same, but slightly different every time. In â€Å"Two Sisters† the narrator is paralyzed from the beginning and thinks heavily on the work itself and how destructive it can be. The narrator foreshadows the theme that continues through the whole novel. In â€Å"An Encounter† the narrator is paralyzed in the field by the old man, but he manages to overcome it after a while and leaves. In â€Å"Araby† the narrator breaks free from paralysis when he has his romanticized feelings for his friend’s sister, but at the end is defeated and thrown back into paralysis after failing to get her a gift. In â€Å"Eveline† the paralysis is so evident that the narrator is described as clinging to the cold iron bars. The theme of paralysis is most evident in this story than it is through the entire novel, however the stories placed before â€Å"Eveline† were needed to help the reader further understand paralysis and how it affects people constantly every day. Short Response 5.In â€Å"Two Gallants† Lenehan receives a great deal of depth even though on the surface he could be seen as a simple con man. Lenehan’s partner, Corely, is fairly one dimensional and is a great contrast from Lenehan. Corley seems content with the life that he lives in that he is described as a â€Å"leech†; however Lenehan is shown in a much different light in that he seems distant when walking with Corely at the beginning of the story, lost in his thoughts. Later when Lenehan is walking on his own he thinks of how he wants to settle down and get a steady job with steady pay and have a good home life possibly with a family. The wishes that he has for a better life shows his depth while his partner has none, but once Lenehan sees the gold chain Corely conned a maid into stealing it seems unlikely Lenehan will change. 2.In â€Å"An Encounter† the narrator and Mahoney skip school in search of adventure, however by the end of the story their relationship has greatly changed. Although the narrator never says anything to Mahoney many of his private thoughts are of him thinking why is Mahoney talking to the old man. He was confused on why Mahoney was egging on the old man by having a conversation while the narrator sat silently. The narrator by the end of the story thinks of Mahoney as dumb for being unable to see the oddness of the situation with the old man as he was able to. 4.In â€Å"Eveline† she is undecided on the notion of leaving with her love, Frank, and abandoning her family, particularly her father. The quote â€Å"It was hard work – a hard life – but now that she was about to leave it she did not find it a wholly undesirable life† plays on the fact that numerous time in the story she changes her mind on whether or not to leave. Certain things make her want to leave such as thinking about how her mother felt stuck, while other things made her want to stay such as the harp playing reminding her of her mother’s death. She constantly is convincing herself to either go or stay even if the reason that she comes up with goes against how she actually feels. Her logic leaves her saying things like the quote in that even though she feels the want to leave she convinces herself it is just as nice to stay home.

Study Of Symptom Management Strategies For Palliative Care Nursing Essay

Study Of Symptom Management Strategies For Palliative Care Nursing Essay This essay revolves around Claire, her symptoms, her ability to cope as well as her husband Andrew. More precisely, it will focus on strategies which can be employed for symptom management. Central to any form of management strategy for Claire is a holistic assessment of her circumstances followed by planning, implementation and evaluation. This can often be accomplished by with the assistance of an assessment model which are all, to a large extent, broadly based on this plan, but each can analyse the problem from a different perspective. (Fawcett J 2005) If one first considers the situation under the aegis of the Roper Logan Tierney model (Roper, Logan Tierney 2000), this model analyses the major issues of patient management in terms of solving the patients difficulties in adapting to and coping with daily living, particularly if such coping is affected by either a physical disability or a disease process. In terms of those with malignant disease, this is clearly one of their major issues. Even a brief overview of the literature demonstrates that this model is extensively utilised and is possibly one of the most widely accepted models of patient management (Holland, Jenkins, Solomon Whittam 2003). One of the major weakness of this model can be seen in the fact that it is not particularly effective in producing management strategies that can be effective in dealing with patients who are frankly manipulative or are presenting with symptoms that are overtly psychological in nature. Whilst there is no suggestion that Claire is overtly manipulative, Johnson points to the fact that the management of psychological issues in palliative care is every bit as central to a successful outcome, as dealing with ostensibly more obvious symptom features such as pain control (Johnson 1999.) Management of such patients can be better if the healthcare professional views such functional behaviour as a adaption process to the illness role as described by the Roy adaption model. (Roy 1991) which seeks to describe patient behaviour in terms of the ability of the patient to adapt to whatever stimulus is generating the behaviour. In the case of the patient with malignant disease, knowledge of a terminal diagnosis is a potent stimulus for behaviour change. Utilisation of this model allows for the nursing management decisions to respond to the evolving trajectory of the illness. This model can prove useful insofar as it determines why the patient tends to exhibit different behaviour patterns or coping strategies in response to their illness trajectory but it is of no real value in circumstances where a patient enters a period of overt denial of their terminal situation. To use Claire as a case in point, it would appear that she is presenting her symptoms individually rather than as part of a spectrum associated with the primary pathophysiological cause. It is not uncommon, in such circumstances, for a person to present with an illness that is obviously terminal, but who insists on trying to continue their daily life pattern as if there was no immediate problem. To a degree, her expression of surprise at the fact that people have come out of the woodwork to visit her is an demonstration of this fact. In contrast to the other two models discussed, the adaption model would describe this as a variety of cognitive distortion rather than overt denial. Clearly the patient cannot adapt to something that they are choosing not to overtly confront. (Steiger Lipson 2005) Claire appears to be somewhere between these two eventualities. Obviously she is aware of her diagnosis, but is expressing surprise that people would suddenly want to visit her. The Johnsons behavioural model would probably be the most appropriate for this scenario as Claires behaviour pattern will almost certainly change as her symptomatology progresses. It follows that one has to take a view on the specific causation of the symptoms before one can take a rational view of the evidence base supporting any management strategies. Prior to the active consideration of the management of the symptoms, in the context of the behavioural model of patient management, one must comment on the huge spectrum of skills and requirements that are currently expected of the modern professional nurse. Yura et al. state, in their authoritative overview paper, that to be functional and effective the nurse must understand the human condition from the viewpoint of the pathophysiology, the psychology, the human dynamic and socio-economic elements of the patients presentation and disease trajectory . (Yura Walsh 2008). In Claires case, this is particularly appropriate. In terms of exploring the evidence base for symptom control. If one uses a biomedical symptom model, then the only significant symptoms are increasing breathlessness, cough and fatigue. There is also an element of insomnia which leads to tiredness during the day. Other, harder to define symptoms, which nevertheless stem from the underlying pathophysiology, but are not generally described in biomedical terms, include her feeling of lack of control of her life, and, by inference there is the issue of her increasing dependence on her husband, Andrew. If one considers the evidence base for symptomatic treatment, one should ideally first consider the four primary dimensions of palliative care as outlined by Cicely Saunders as they are particularly relevant to Claire, namely the physical, social, spiritual and psychological dimensions. (Saunders Regnard 1989). It follows that, although this essay will primarily consider symptomatic treatment of breathlessness, it must be understood that this should be delivered within the context of the holistic assessment of the patient discussed in the early paragraphs of this essay. In the words of Valente et al., The patient, whole and entire, has relatives, friends, beliefs and previous experiences all of which must be integrated into management strategy. (Valente Saunders 2010 Pg 25) Breathlessness, as a specific symptom, is the result of a complex interaction between the physical body and the conscious mind. It is the most commonly reported symptom found in association with lung cancer and one of the most potentially distressing. (Knower, Dunagan, Adair Chin 2007). Breathlessness, unlike the pain commonly associated with malignancies, is difficult to treat with any degree of success. The huge evidence level IIb Higginson trial of lung cancer patients clearly demonstrated that the prevalence of breathlessness rose as death approached and that treatment became progressively more ineffective (Higginson McCarthy 2008). In another large prospective evidence level IIb study by Edmonds et al. it was found that although clinicians and patients both tend to associate lung cancer primarily with pain, breathlessness has a similar incidence to the extent that 85% patients with lung cancer experienced pain and 78% had significant breathlessness in the last year of their li fe. (Edmonds, Karlsen, Khan Addington-Hall 2007) Treatment of breathlessness is particularly problematic. According to Knower et al. this is because the symptomatology is both varied and multifactorial. It is not simply a matter of too little tidal volume in the lungs, it is a multisystem disorder with many possible subtle neurohormonal abnormalities and interactions in skeletal and respiratory muscle structure and function. In addition, the experience is extremely subjective with the feeling of breathlessness being modified by not only previous experience of the symptom but also by pathways from a number of different areas within the central nervous system. Dorman et al. classify malignancy-associated breathlessness into four groups by their different causative mechanisms. An increase in the sense of respiratory drive or effort to overcome an imposed load (e.g. chronic obstructive pulmonary disease, COPD) An increase in the proportion of available respiratory muscle force required for breathing, observed in neuromuscular weakness in which respiratory motor output and the sense of effort increase (e.g. paraneoplastic syndromes) An increase in the patients ventilatory requirements (e.g. anaemia, hypoxaemia) The contribution of higher cortical experience to the sensation. Memory and previous experience as well as fear and anxiety will all modify the sensation of breathlessness. (Dorman, Jolley, Abernethy, Currow et al. 2009) The evidence base for treatment shows that one effective mechanism is to treatment any underlying additive cause, such as anaemia, hypoxia or bronchospasm. (Hatley, Laurence, Scott Thomas 2008) If one considers the physical elements first, a common factor in the experience of breathlessness in all these circumstances is anxiety. One common effective strategy to reduce the subjective sensation is for the patient to learn relaxation and calm breathing techniques and then to consciously use them whenever they feel anxious and breathless. Oxygen therapy is frequently useful in relieving the symptoms of breathlessness and the presence of a nasal catheter or mask is often reassuring for the patient. The main evidence base for symptomatic control however, comes from the use of the opioid and benzodiazepine group of medications. Opiates have by far the strongest evidence base with the evidence level Ib paper by Pharo et al. clearly demonstrating the reduction of both subjective and objective measurements of breathlessness in patients with lung cancer. (Pharo Zhou 2005). The authors point out that the side effects of opiates, as a class, must be carefully weighed against their probable clinical benefits. Careful examination of the evidence base supporting benzodiazepine use shows that it is less secure. Some authors (viz. Wotton 2004) reporting that they have reduced the sensation of dyspnoea in patients, the majority of randomised controlled trials (viz. Maher, Selecky, Harrod Benditt 2010,) have not been able to demonstrate any convincing benefit whilst showing significant side effects. They are also known to decrease respiratory drive and compromise lung function, worsening exercise tolerance. ( Franco-Bronson 2006). On balance, the evidence base does not support the use of the benzodiazepine group for t he relief of breathlessness in malignant disease. Anxiety and depression, both common associations of malignant disease, are commonly associated with increased perceptions of breathlessness. There is a substantial evidence base to show that aggressive treatment of both can produce significant improvement in subjective assessments of the symptom. Treatment of these conditions are complex and specialised and therefore will not be considered in detail. Kunik et al. have demonstrated in an evidence level IIa study that both anxiolytics (buspirone ) and psychological relaxation techniques are capable of producing significant decreases in levels of both anxiety and dyspnoea, as well as improved exercise tolerance among breathless patients. (Kunik, Azzam, Souchek, Cully, Wray, Krishnan, et al. 2007) In the interests of providing a comprehensive and balanced argument, note should be taken of the recent evidence level IIa paper by Lewith et al. which noted the positive, but not statistically significant effect of acupuncture on patients suffering from breathlessness. It should also be noted that these were patients with breathlessness as an all-cause symptom rather than specifically from malignant disease. (Lewith, Prescott Davis 2006) The evidence base relating to treatment of cough, a common symptom in lung cancer. It is generally taken to indicate involvement of the airways rather than the lung parenchyma, primarily because of the location of cough receptors. Kvale published a particularly helpful Medline review in 2008 which explored the evidence base for treatment options. (Kvale 2008). The paper itself is both extensive and comprehensive. Confining the discussion to the relevant portions of the paper shows that both surgery and radiotherapy (where appropriate) are both effective in reducing troublesome cough symptoms. A patient undergoing chemotherapy is less likely to have their cough symptoms reduced. There is a substantial evidence base to support the view that the use of inhaled bronchodilators and corticosteroids can be useful, but not in all cases. Specific antitussive centrally acting drugs that have been subjected to randomised controlled trials include codeine, hydrocodone, and dextromethorphan. Each of these has a strong supporting evidence base and minimum side effects. Dihydrocodeine has been specifically noted as having the dual purpose of both pain relief and cough suppression. (Homsi, Walsh, Nelson 2001). The opiate group in general, in addition to relieving pain and breathlessness are also strongly active in cough suppression. The authors make the point that many trials have noted the cough suppression effect of placebos in randomised controlled trials. This has not only the effect of adding an element of bias into the results, but also offers a line in management of cough in resistant cases. Fatigue is a common symptom associated with malignancies and certainly with lung cancer. This latter association is postulated to be related to the levels of chronic hypoxia in the later stages of the disease. (Higginson, McCarthy 2008) The Dagnelie et al. study is particularly useful in this respect as it considered the effect of fatigue on the quality of life of patients with lung cancer and found that it has clear statistical associations with the stage of the disease process, the degree of support that the patient has and also the mental state of the patient. (Dagnelie, Pijls-Johannesn, Lambin Beijer 2007). They found that those patients who had good support networks, and who were not depressed and who were able to maintain a good level of physical activity were the ones who were least likely to report significant levels of fatigue. A substantive literature search has failed to reveal any good quality trials which support these findings from a therapeutic perspective but intuitively, one might suggest that including the maintenance of a support network and direct assessment for depressive symptoms into a holistic management plan is likely to reduce levels of fatigue experienced by the patient. In passing, one can consider the very recent Breitbart study which looked at the use of psycho stimulants in cases of malignancy-related fatigue and found promising results from Modafinil, which is a new category of psychostimulant commonly referred to as wakefulness-promoting agent in the literature. It appears to be well tolerated and with few side effects. The results are too new to have yet been replicated with a larger randomised controlled trial and the authors also point to a large possible placebo effect in their trial. In these circumstances, the evidence base should perhaps be considered unproven until further evidence emerges. (Breitbart Alici 2010) The case study makes reference to passing reference to Andrew, Claires spouse, who retired two years ago and is clearly the main carer in this scenario. He does the shopping, cooking and various other domestic duties for Clare. Although we are told that this makes him feel useful the experienced and empathetic healthcare professional should be aware that the levels of occult depression in cancer-afflicted patients spouses is extremely high. (Kim, Duberstein, Sorensen Larson 2005) It has commonly been found to be the case that as the focus of care and intervention is generally targeted towards the patient, the carers, and particularly the spouses, do not have their needs either explored, considered or addressed. (Braun, Mikulincer, Rydall, Walsh Rodin 2007) It is part of the holistic assessment of the patients situation that the carers should be actively considered and managed as actively as the patient. This has the direct effect not only of trying to optimise the overall levels of care for the patient, but also promoting the spoken exchange of information, thoughts and feelings which are very likely not to be addressed of recognised, if not explicitly facilitated. (Kim, Schulz Carver 2007) The evidence base for these interventions is not strong. There is a considerable evidence base, from a large number of qualitative studies, which underlines the fact that spouses and carers, if supported, can improve the quality of life for the patient. It also appears to be the case that spiritual well being of the patient is improved if spouses and carers are encouraged and facilitated to talk about the situation, especially impending death, which is often regarded as a taboo subject in a household with a patient with a malignancy. Qualitative studies certainly strengthen the evidence base, but, in terms of guidelines and management strategies, they are generally not seen as being as robust as quantitative studies. (Gomm Davies 2008) In conclusion, the evidence base to devise a management strategy for Claire is dependent primarily on the mechanisms used to define her symptom base as well as her circumstances. It appears likely that Claire is adapting to her illness trajectory with a minimum of cognitive distortion, and is taking a rather fatalistic view of her situation. Management should clearly be primarily supportive, both of her and her spouse. The evidence base for symptom control is fairly strong. Pain is not a feature at the moment. Breathlessness could be tackled, initially by the instigation of anxiety-relieving behaviours and possibly by small doses of opiods. Cough can be helped by the use of dihydrocodeine if it is troublesome and fatigue needs careful evaluation to determine whether there is any depressive or psychological factors which are either primary of additive to the symptomatology. Claire may also need to be given permission to rest during the day and be told to pace herself with physical activity so that her fatigue is not such a problem for her. Healthcare professionals need to consider their interventions with the family very carefully. Claire perceives that they come out of the woodwork, which suggests that they are an unwelcome reminder of the fact that they are only there because she has a serious and ultimately terminal illness. Claire may need to be encouraged to talk and expand on this issue as the family may find it difficult if they are not welcomed, and Claire may need to be helped to confront the reality of her situation more directly. Andrew must not be overlooked when constructing a management strategy for this situation. It is a common finding for healthcare professionals to perceive that the spouse is being strong, but this may be a faà §ade for their partner. It is a useful strategy for the healthcare professional to make time to talk to Andrew on his own so that he can have the opportunity to raise issues that he may be unclear about. It may be that he does not know what to expect and is uncertain of the best way of handling the situation. Although possibly premature at the moment, part of the management plan should be to discuss how Andrew is going to approach a worsening situation. An essay such as this can only realistically consider the situation from a general approach. It is clearly the case that every strategy and intervention should be considered on the basis of a holstic assessment of the individual and the management tailored directly to the specific circumstances of the individual. Appendix I Classification of evidence levels Ia Evidence obtained from meta-analysis of randomised controlled trials. Ib Evidence obtained from at least one randomised controlled trial. IIa Evidence obtained from at least one well-designed controlled study without randomisation. IIb Evidence obtained from at least one other type of well-designed quasi-experimental study. III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies. IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities. (SIGN 2001) Appendix II Case Details Clares general practitioner has just referred her to the community palliative care service. Clare is a 65 year old woman, with lung cancer, an eventually fatal condition. She lives with her husband Andrew in their family home. Her two grown children are married and live interstate. Clare suffers from breathlessness, cough and fatigue. She gets distressed by her inability to catch her breath. Sometimes she has trouble sleeping at night and is frequently sleepy during the day. Clare says she doesnt have many strategies to help her manage her symptoms. She views her illness as a challenge as it impacts on what she can do and she doesnt feel in control of her life. Clare tells you that personal relationships are more meaningful for her now and she misses seeing her children, even though she keeps in frequent phone contact. She is surprised by the number of people who have come out of the woodwork and have come to visit her at home. Andrew retired two years ago so is able to do the shopping, cooking and other domestic duties for him and Clare. He says this makes him feel useful and its easier for him to do things than to talk about things. Andrew asks you if there is anything more he can do to help Clare.