Saturday, August 31, 2019
Poor decision making Essay
Poor decision making problem is not confined at the individual level alone but is manifesting itself more and more in organizations. Employees have become more vociferous in their demands for a better deal. Various departments in an organization face a situation full of problems due to a number of reasons like goal diversity, scarcity of resources or task interdependence etc. Management today is faced with the awesome responsibility of ensuring optimum levels of growth and productivity in an environment that is full of conflicting situations. Modern manager spends over 20% of his time handling one form of problem or the other. DIFFERENT FACTORS It is not at all good to have any conflict and the role of a manager starts once it arises. These are very important points which one tend to answer in one way or the other depending upon the views he  hold about problems. Environment Factor The behaviouralists maintained that since an organization was composed of individual- and they had different perceptions of goals and differing values, problem was bound to arise in the organization. Managers of various departments had separate priorities and conflicting ideas about resource allocation. Hence conflict was the unavoidable outcome. Subordinates may clash with the manager over whether the work can be accomplished in the given period of time or not. Social Factor The thinking currently prevalent about conflict has been labelled as the interactionist view. In contrast to the behaviouralist view which merely accepts conflict as inevitable, the integrationists not only accept conflict but also encourage it. However, they maintain that conflict must he regulated so that it does not get out of control producing dysfunctional consequences. ECONOMIC FACTOR  A large number of potential sources of conflict exist in organizational life as antecedent conditions and realistic basis for some conflicts. Any group exists for the purpose of attaining some goals with the help of available resources. These resources may be tangible like men, materials, and money or intangible like power, status or the manager’s time. No organization is capable of providing all the resources demanded by various units. Resources are limited and different groups have to compete for these scarce resources and many conflicts arise from this source. TECHNICAL FACTOR Groups in organization have different functions to perform and as such they develop their own norms and goals. Theoretically the achievement of these goals should achieve overall organizational goals but, often, in real life the reverse is true. Goals of one group are incompatible to the goals of another group. For example, a company which manufactures electric fans has a seasonal demand. Three departments marketing, production and financeâ€â€are involved. Since the demand for the product is seasonal, the marketing manager would like to have sufficient stock during the season. References Beaumont,P.B., Applied Microeconomics for Decision Making, Sage Publications, London,1993 Kaplan , P.L., Human Resources and Personnel Management, McGraw-Hill, New York,1997 Feldman, D.C., 1985 A taxonomy of intergroup conflict-resolution strategies University Associates:San Diego Taylor Sims, J. Robert Foster, ArchG. Woodside,(1997) Marketing Channels: Systems and Strategies Harper and Row: New York.
Friday, August 30, 2019
Psychodynamic Theory Essay
What Psychodynamic Theory Has to Contribute to Our Understanding of  Counselling in a Multicultural Society? If counsellors are to discern very well their clients of diverse backgrounds or culture and their place in a multicultural society, psychodynamic theory may be particularly helpful in this respect. Theories and techniques used in counselling are diverse and it is imperative for counsellors to know how to use their knowledge of psychodynamic theory in conceptualising systems for both counselling and therapy. In psychodynamic therapy, which is an approach in counselling based on psychoanalytic theories, it is postulated that conscious and unconscious influences mold human behavior and social relationships. This concept of the unconscious is often associated with Sigmund Freud whose contribution in psychoanalysis can not be discounted. Psychoanalytic theory though, is not exclusively Freudian. Freud’s brilliant ideas and theories, were controversial. His theories were under attack from many directions and it was a good thing though that from his perspectives, many other psychoanalytic theories emerged as well. Carl Jung was famous for his collective unconscious and his oriental approach was unorthodox for Western psychoanalytic theorists. D.D. Winnicott’s transitional objects and good- enough mothering for instance, are interesting contributions to psychoanalysis as well. It should be fascinating to explore these theorists’ contribution to systems and approaches of multicultural counselling. In as much as these theorists’ perspectives seem to have distinct or even conflicting orientations, we may have the chance to look upon their theories, in many ways, complementary in the practice of counselling in a multicultural society. Their theories can prove to be useful at any point in counselling (or therapy) sessions in understanding clients, their unique history, individual concerns, and understanding their behavior, the impact of their past experiences to their present condition in life, and some of their underlying motives and beliefs. Sigmund Freud            Psychoanalytic approaches to therapy and counselling originated from the works of Sigmund Freud. He viewed that people are driven by unconscious influences, a part of their inner world of which they are not aware of. He theorised that repressed unconscious thoughts and feelings could manifest through dreams, fantasies and odd behavior. Until after these repressed forbidden desires, hurtful memories and experiences are brought to conscious awareness, these were presumed to lead to irrational and maladaptive behavior. Based on this concept, effective counsellors can effectively draw upon these repressed thoughts and emotions through psychotherapy to ease their client’s depression or anxiety and to rebuild their client’s self-esteem.            Freud’s concept of eros (sexual and life instincts) and thanatos (aggressive and death instincts) are considered motivating factors of personality, with the term libido referring to basic energy of life associated with Eros. Troubled individuals may manifest death instincts through destructive behavior such as, alcoholism, substance abuse, aggression (towards self or others), and even suicide.            Freud theorised that the individual’s behavior is assumed to result from the interaction of three components of the personality: id, ego, and superego. The id is said to be the source of instinctual drives and operate in terms of the pleasure principle. It is capable of eliciting mental images and wish-fulfilling fantasies (Coleman, 1980).            The second personality component is the ego, which intercedes between the demands of the id and the external world, and operates in terms of the reality principle. For instance, Freud believed that sexual or aggressive tendencies are in conflict with society’s rules and prohibitions.            It was clever of Freud to introduce the third personality component, which is the superego, or commonly known as conscience. If one has learned and adapted to the moral demands of society, the individual would have a better grasp of what is right from wrong. The superego serves as personality’s system of control to inhibit immoral desires.            Freud believed in the interplay between the id, ego and superego, and how it becomes crucial to behavior. Inner conflicts may arise because the id, ego and superego are striving for different goals. Inner conflicts could manifest as a mental disorder if not resolved. Another important psychoanalytic concept of Freud is defense mechanisms. For him, whatever pains or anxieties are eased by distorting reality, if one can not deal with it rationally (Coleman, et.al., p. 54). Therefore, an individual’s distorted perception of reality poses behavior problems. This only happens though when the ego can no longer cope with the pain or anxiety by rational measures. Freud’s contribution to developmental psychology is his theory on five Psychosexual stages: the oral, anal, phallic, latency, and genital stages. He believed that these stages of development could determine one’s defenses, anxieties, and impulses. A child who has been deprived of fully experiencing any of these stages may suffer fixation at that stage of development. The first three stages of development, the oral, anal, and phallic stages, are the most crucial, as one’s personality is molded at this time. If fixation happens at any point during this period, then the child would likely develop distinct personality type. From birth to 1 year (oral stage), the mouth is the principal erogenous zone and it is assumed that an infant’s greatest source of gratification is sucking. If the caregiver is overindulgent or depriving, then the child is likely to develop fixation at this stage. Some traits associated with overindulgence are optimism, manipulativeness, boldness and admiration. On the other hand, deprivation would lead to traits such as pessimism, suspiciousness, self-belittlement, passivity, and jealousy. Further, as Freud theorised, fixation at this stage, or when the individual did not receive adequate oral gratification during infancy, the individual is predisposed to excessive drinking or eating in adult life. When the child is about 18 months to 3 years (anal stage), the anus and rectum are considered to be the primary sources of pleasure. Either an excessive demand or permissiveness from a child’s caregiver, will lead to the development of anal personality. Other psychological problems that are thought to arise from this stage are obsessive-compulsivity and paranoia. During the phallic stage, or when the child is about 3 to 6 years old, the penis or clitoris is assumed to be the major source of pleasurable sensation. At this stage, the child learns to manipulate the genitals and becomes curious about the opposite sex. Curiously enough, Freud also believed that it is at this stage when the child develops intense sexual feelings for the parent of the opposite sex, or otherwise known as Oedipus and Electra complex. The Oedipal complex is the perception that boys desire to possess their mother. Freud thought that boys have incestuous cravings for their mother, even sees their father as rival, but they have fear that the father will harm them (castration anxiety). Likewise, the Electra complex is the assumption that girls desire their father, and want to replace their mother. The fear of the same-sex parent leads to sublimation of their sexual attraction for the opposite sex parent into non-sexual love, and they learn to identity instead to their same-sex parent. For either sex, it imperative for them to resolve the conflict, such that when they enter young adulthood stage, they are likely to have a satisfactory heterosexual relationship. In the years from 6 to 12 (latency stage), sexual motivations are put aside and the child channels his energy into school, play, shared activities with friends, and sports. Finally, the genital stage, which is from puberty onwards, the deepest feelings of pleasure come from heterosexual relations. At this stage, the individual channels his energy into socially acceptable ventures such as entering into romantic relationships, establishing friendships, career planning and also some recreational activities.  Freud’s cathartic hypnosis was popular during his time, but more than the technique of hypnosis as a therapeutic cure to psychological illnesses, was his concept that feelings were drawn from the unconscious. His contribution stands out in the sense that he was the one who developed techniques such as free association and dream analysis in dealing with both the conscious and unconscious aspects of mental health. Freud emphasized the role of the unconscious motives and ego-defense systems, and the importance of early childhood experiences in the personality adjustment and maladjustment of adults, as well as the relevance of sexual factors in human behavior and mental disorders (Coleman, et.al., p. 57). Freud’s techniques now used in contemporary psychodynamic counselling provide much deeper understanding of the (client’s) self, and can prove to be helpful in emotional, spiritual development and self-awareness. Carl Jung            One of the most original and controversial features of Jung’s theory on personality was the concept of collective unconscious. He theorised the existence of universally shared motives, drives, potentials, fears and symbols – that human beings have more or less the same collective unconscious. Collective unconscious is defined as the â€Å"storehouse of latent memory traces inherited from one’s ancestral past†(Hall & Lindzey, 1978, p. 119). Simply put, with this theory, there is probability of reviving experiences of past generations. â€Å"Humans are born with many predisposition for thinking, feeling, and perceiving according to definite patterns and contents that become actualized through individualized experiences†(Hall & Lindzey).            If Freud’s â€Å"unconscious mind†is often associated with repressed forbidden desires, hurtful memories and experiences, Jung’s collective unconscious is a vast resource of subliminal contents and potential, which includes the â€Å"wisdom and experience of uncounted centuries, and laid down in its archetypal organs†(Jung, cited in Hall & Lindzey, p.120). The collective unconscious can then serve a very good purpose to the individual. But, if this ignored by the ego, â€Å"the unconscious may disrupt the conscious rational processes by seizing hold of them and twisting them into distorted forms (Hall & Lindzey, p.120). Instances of irrational behavior could arise such as phobias and delusions.            Jung believed that the individual achieves completeness or wholeness only as fantasies, images and dreams from the personal and collective unconscious become accessible to the conscious self (Coleman, et.al., p.58).            Jung’s concept of archetypes refers to patterns of behavior within the unconscious mind. The most common of these archetypes are the persona, shadow, self, and anima and animus. The persona is tantamount to the social personality – the â€Å"face†an individual has in his social relationships. A healthy persona could then mean good adaptation to the demands of society or the environment where one belongs. In some respects, Jung’s concept of the persona is similar to Freud’s superego. The shadow has some resemblance to Freud’s concept of the id. It is considered the hidden or dark side of personality that sometimes the individual is not even aware of. This part of the psyche would be difficult to accept. If a certain trait of another distress an individual, then this could be a reflection of his shadow. Traits such as laziness, attention-seeking, anger expression, etc., are usually kept from consciousness and is often projected to others. The self can be considered the sum total of one’s personality, the motivating factor of human behavior that causes one to constantly strive and attain wholeness. It was Jung’s view that the self can only emerge only if various aspects of the personality have fully developed (known as individuation) (Hall & Lindzey, p. 124). Thus, this does not happen until one has reached middle age when one â€Å"begins to make a serious effort to change the center of personality from the conscious ego to one that is midway between consciousness and unconsciousness†(Hall & Lindzey). Jung believed that one takes the journey toward individuation, spending almost half of his life individuating, and the second integrating. This concept has direct application and relevance to career counselling. Notice that most individuals who reach middle age begin to have more focus and sense of purpose, not wasting their time and energy where they do not fit or are not welcome, and extending effort only in activities that will lead them to their true calling. Somewhat parallel to Freud’s Oedipus and Electra complex which prove relevant to understanding one’s heterosexual adjustment is Jung’s anima and animus. This is much like the â€Å"yin and yang†of the Chinese, the masculine and feminine side of human personality. The role of biological hormones cannot be discounted, but from a Jungian perspective, this is more considered to be a product of racial experiences of man with woman and vice versa. Jung’s anima and animus may be of relevance in understanding man-woman relationships in a counselling setting. Man is supposed to â€Å"apprehend the nature of woman by virtue of his anima, and woman apprehends the nature of man by virtue of her animus†(Hall & Lindzey, p. 123), and without regard to the real character of the other, their relationship will most likely lead to discord. Donald Winnicott            The influential concepts of transitional objects, the good-enough mother and the true and false self are attributed to Winnicott. A transitional object is some sort of a security blanket for a child. It could be a favorite stuffed toy, baby blanket, pillow or any symbolic object that a child finds comfort in having. A transitional object helps a child cope with fear while their principal caregiver is away. The most influential person (object) during a child’s development would be the principal caregiver. In a counselling setting, the counselor serves as the transitional object, who gradually helps his client overcome frustrations and develop greater independence over time. The good-enough mother pertains to the principal caregiver whose parenting style fit the child’s developmental needs. Winnicott believed that caregivers have to be good-enough in providing the child’s needs, but not too much. They have to teach children as well to tolerate frustrations, and teach them the lesson of independence and self-sufficiency. Winnicott theorized that children’s needs, if not adequately met, could help develop a false self (this is somehow identical to Freud’s concept of fixation). On the other hand, when children’s needs are adequately provided, then, they are likely to develop a true self. A relationship based on trust, a relationship that is more real, will grow between the caregiver and the child. This concept may apply to counselor (or therapist)-client relationship. An effective counselor knows how to provide a safe â€Å"holding environment†for his client, and is adaptive to his client’s needs. The counselor knows how to respond to his client’s emotions with warmth and empathy, thus helping his client reveal his true self. References Coleman, James C., James N. Butcher and Robert C. Carson. Abnormal Psychology and Modern Life (6th ed.). Illinois: Scott, Foresman and Company. Dakai, S.H. (2003). â€Å"Addiction Counseling: Examination of Various Addiction Counseling and Therapy Approaches.†Journal of Addictive Disorders. Breining Institute. Hall, Calvin S. and Lindzey Gardner (1980). Theories of Personality (3rd ed.). New York: John Wiley & Sons. McGinnis, James D. and Kenneth R.Thomas (1991). The Psychoanalytic Theories of D.W. Winnicott as Applied to Rehabilitation. The Journal of Rehabilitation. 1 July 1991 Â
Wassily Kandinsky
Wassily Kandinsky could have been the premier abstract artist of the 20th century is a world at war had no twice interfered with his artistic career and destroyed three of his early works. Kandinsky was born in Russia in 1866 and soon moved to Germany where he worked with the Bauhaus School of expressionist painters integrating art in architecture and design (â€Å"Artcyclopedia†). He also founded the Der Blaue Reiter, a group of artists attempting to express and define spirituality through art (â€Å"Artcyclopedia†) Kandinsky believed that music and art should be integrated as a well as a means of defining the influence of the soul on the outer world. To that end, he began his series called Composition and had completed 7 of them before the beginning of World War II. Tragically, the first three canvases in the series were destroyed during the war. While Kandinsky could not have planned for the destruction of his work, the loss of the first three Composition pieces helps complete the series as an allegory for his life, the ultimate tribute to a man who believe art should be spiritual.At the only time in recent history when the entire collection, with full-size black and white photos of the lost three holding their place, was displayed, reviewer Mark harden called Kandinsky one of he most original and influential artists of the 20th century. â€Å"His â€Å"inner necessity†to express his emotional perceptions led to the development of an abstract style of painting that was based on the non-representational properties of color and form. Kandinsky's compositions were the culmination of his efforts to create a â€Å"pure painting†that would provide the same emotional power as a musical composition.The exhibition â€Å"Kandinsky: Compositions†, organized by Magdalena Dabrowski and on display at the Los Angeles County Art Museum until September 3, 1995, presents these monumental works together for the first and possib ly last time and provides an opportunity to witness the creative process of Kandinsky†(Harden, 1995). The loss of the first three works and the attempt at representing them in the show left the viewer with a great sense of loss, Harden wrote, but perhaps more interesting is the fact they were lost at sometime near the artist’s death in 1944. That they were destroyed in Germany during the war as some much of his life had been as well simply adds an ironic twist to the entire project.The other twist on the Composition series is that the final painting is the only one of the series done on a black background. In 1911, when he was working on Composition IV and V, Kandinsky is quoted as saying, â€Å"(Black) is like the silence of the body after death, the close of life.† (Harden, 1995) He painted Composition X on a black background just five years before his death, when Germany was once again disrupting the world and taking the world back to war.By 1911, Kandinsky was already a world-renowned painter and known for his desire to incorporate spirituality into his art but as tension rose in Europe, he returned to his native Moscow where he remained until 1921. Compositions VI and VII would be completed in 1913 and then he did not return to the series until a decade late.  (Geggenheim, 2007). â€Å"Composition VII is the pinnacle of Kandinsky's pre-World War One artistic achievement. The creation of this work involved over thirty preparatory drawings, watercolors and oil studies. Each of these is included in the exhibition, documenting the deliberate creative process used by Kandinsky in his compositions. Amazingly, once he had completed the preparatory work, Kandinsky executed the actual painting of Composition VII in less than four days.†(Harden, 1995).Composition VII may have also been intended to be his finale in the series as art scholars â€Å"through Kandinsky's writings and study of the less abstract preparatory wor ks, have determined that Composition VII combines the themes of The Resurrection, The Last Judgment, The Deluge and The Garden of Love in an operatic outburst of pure painting†(Harden, 1995). Because Kandinsky had such a strong belief in the use of abstraction to present underlying themes with symbols and it is likely that he had intended this wrapping up of religious themes to be his final work in the series (Long, 1975). Then, he began his self-imposed exile to his native land and stayed there until it appeared Germany was a haven again for thought and progress.In 1922, he joined Bauhaus and in 1923, painted Compositions VIII, like all the works in the series it was highly representational of his emotions and mental state at the time of its painting. â€Å"Composition VIII reflects the influence of Suprematism and Constructivism absorbed by Kandinsky while in Russia prior to his return to Germany to teach at the Bauhaus. Here, Kandinsky has moved from color to form as the dominating compositional element. Contrasting forms now provide the dynamic balance of the work; the large circle in the upper left plays against the network of precise lines in the right portion of the canvas.†(Harden, 1975) This work also is more bright and less chaotic than his final pre-war effort, possible indicative of a more upbeat and spiritual peaceful time. Kandinsky was making progress in his work, developing with the group at Bauhaus and gaining additional international acclaim. His first solo show in New York coincided with this work (Guggenheim, 2007).Perhaps this perceived happiness and his involvement in other pursuits is why it would be another 10 years before Kandinsky added another painting to the Compositions series. He gained citizenship in Germany in 1928 and seemed contented in his new homeland until 1933 when Bauhaus was one of the early casualties of the Nazi government. He then moved to France where his Composition IX was definitely influence d by the surrealists gaining popularity there (Harden, 1995). After Composition IX was completed in 1936, Europe once again became an ugly place to live and in 1937, 57 of Kandinsky’s works were seized by the Nazi government.(Guggenheim, 2007). Some, like the first three Composition pieces, were destroyed.Two years later, in 1939, Kandinsky completed the series, breaking from all the previous works and creating his work on a field of black. Given his earlier statements about the color and the loss of his other works, it is no doubt a reflection of the very pain in Kandinsky’s soul brought on by the second World War. â€Å"The outstanding characteristic of Composition X is obviously the stark, black ground. The colors and forms appear particularly sharp against the black background. The brilliance of the colored shapes brings to mind the cutouts done by Matisse over a decade later.The movement of the forms is distinctly upward and outward from both sides of a central a xis running through the book-like form near the top of the canvas. This movement enhances the evocation of hot-air balloon forms rising into an infinite space. The round form between the book shape and the brown balloon shape has a lunar feel to it that even conveys a feeling of literal â€Å"outer space†. Kandinsky had always expressed a strong dislike for the color black and it is significant that he chose it as the dominating color of his last major artistic statement.†(Harden, 1995).Ultimately, the reviewer is right and the final Composition is kandinsky’s statement about his loss and the world at war. â€Å"For Kandinsky, if that objective element of a painting were taken away, the building blocks of the composition would reveal themselves to cause a feeling of repose and tranquil repetition, of well-balanced parts.†(Dabrowski, 1995).  The artist spent a lifetime telling the world that he disliked the color black and that his work was all abo ut the symbolism and the meaning behind the painting itself. It makes perfect sense then that his final major work would be about death itself and the life that has been interposed over it. Whether Kandinsky knew that Compositions X would be among his final works is not clear.What is clear is that death too is symbolic of loss and pain, emotions that the highly spiritual Kadinsky could not help but feel when his work was captured by the Nazi regime. Perhaps more so than even the usual artist, Kandinsky was tied to his art, deeply and emotional. That they were an expression of his belief system and his very soul make the loss of the first three Compositions even more tragic.Sadly, World War II was a horrible time for the great works, with many works of art lost forever to the savages of war. The difference in Kandinsky’s work, as opposed to other great masters, is that the artist was still alive and he was able to present one last finale, to express the pain and rage and t he destruction and to show that life, even without art, must sometimes go on.WORKS CITEDDabrowski, Magdelena. â€Å"Kandinsky:Compositions†Museum of Modern art: New York, 1995.â€Å"Geggenheim Museum†, http://www.guggenheimcollection.org/site/artist_bio_71.html, November 14, 2007Harden, Mark. â€Å"Kandinsky: Compositions†http://www.glyphs.com/art/kandinsky/, November 14, 2007.Long, Rose-Carol Washton. â€Å"Kandinsky's Abstract Style: The Veiling of Apocalyptic Folk Imagery†,Art Journal > Vol. 34, No. 3 (Spring, 1975), pp. 217-228 Stable URL: http://links.jstor.org/sici?sici=0004-3249%28197521%2934%3A3%3C217%3AKASTVO%3E2.0.CO%3B2-4 , November 14, 2007.â€Å"Wassily Kandinsky†November 14, 2007.
Thursday, August 29, 2019
Discuss some of the benefits and drawbacks of studying for a Essay - 2
Discuss some of the benefits and drawbacks of studying for a university degree, Which appear to be more persuasive Refer to the text and other sources - Essay Example Not only does a degree from a university improve a person’s career prospects but it also helps him socially. His societal status improves and he is respected more. Saying that, however, does not mean that attaining a university degree is a sure shot at landing at your dream job. It is very commonly seen that graduates are jobless or working at a lowly position which is not what they had in mind when pursuing their degree. The value of a university degree should not be gauged monetarily only although that is what most people do and high paying jobs are why people pursue a degree. A university degree gives other possible benefits as well that will be detailed in the rest of this paper. Nevertheless, a degree is never a waste of investment and even if a person does not end up getting a job right away he will find that later on, when he has some experience in lowly jobs, his degree is what will set him out from non-graduates and help him get a good job. I am a single mother of four, having lost my husband a year back. I have a background in nursing and 15 years of experience in the same field. Now I have decided to move into Public Health. I am currently enrolled in the program and also working a part time job side by side. The reason I decided to pursue this degree is that I have a passion for academics and I believe that it will help me a lot in climbing up my career ladder. Yes, it is a pretty hard task managing studies, work and a family and yes, it is extremely difficult to give equal time to all, not to mention it becomes very tiring and stressful too. But then, if you want to achieve something you have to sacrifice and work hard for it. I have also planned to complete my university training as that will be counted a lot. Training and experience is always a bonus in professional life. I believe that once I have this degree I can apply for a better position and be able to earn and support my family better. Even if the results
Wednesday, August 28, 2019
Questions unit 5 Assignment Example | Topics and Well Written Essays - 750 words
Questions unit 5 - Assignment Example By doing so, he had expressed his right to be bound by the contract. The fact that the agreement was not in writing is irrelevant as a consensus ad idem can be established (Elliott, p 21). 5. The requirement of payment of deceased debts by virtue of being an administrator does not have to be expressly provided. It is an implied term under which a party is required to carry on with the legal obligations touching on the estate of the deceased. 8. Generally, personal service contract cannot be delegated. An exception may exist, however with consent of the obligee on condition that they remain liable until the assignee has performed the contract to the satisfaction of the obligor. 9. a).In case the original contract is still in term, the minimum period remains unaltered, b).It poses a suitable break compared with assignment since with an assignment it is less clear as to who is liable for charges around the time of an assignment. 10. It is not ethical. The law sets out what must not be retained by such a person. The rationale being that they should have the property only sufficient for survival and ought not to be a
Tuesday, August 27, 2019
The reflective letter Essay Example | Topics and Well Written Essays - 500 words
The reflective letter - Essay Example The assignments you provided were a great basis of information which has enabled me to refer to when drafting my papers. By reading my peer’s papers I gained a lot of knowledge because of the many different topics under discussion. I realized that I am good peer responder than I thought. I am now able to find errors in the writings of other people. The peer responses I received enabled me to correct my papers as I took all the advice and used it to improve my paper. I get the feeling that my peers are my audience and their responses are helpful to me as I understand my paper. When I chose to write about breaking up with my childhood girlfriend it was difficult for me, but it also helped me psychologically as sharing of feelings reduces the emotional hurt. I have learnt to accept the break up and move on. I overcame a lot of emotional feelings to be able to write a paper that enabled me to understand the situation and also help my audience to understand. I used my personal information and researched information. I used my personal experience to break up the information. It was not easy to come up with a final draft paper as I had to write many drafts. Every draft had a new concept to my paper. Even my classmates wrote different drafts to come up with a final draft. This enabled us to combine our ideas and put them together. My research on the internet, library, and personal interview enabled me to understand what I really wanted for my paper.my focus was clear as I worked on every draft. My research was an eye opener to new information. The research helped me understand my break up and be able to integrate it to my audience. I realized that this class helped me to improve my writing skills. These skills will be of great help at present and in future. Although I am not a perfect writer I believe I am a descent writer. I am now able to approach any writing assignments with an open mind. Computer classes were very helpful to me. The chat room
Monday, August 26, 2019
Labor Turnover in HK's Hospitality Industry Essay
Labor Turnover in HK's Hospitality Industry - Essay Example There is no denying that each manager in the hospitality industry wants to control the rate of employee turnover in order to ensure the stability of their organization. Managers have also found that hiring and training new employees cost more than retaining and promoting current employees. Employee turnover can cause bad effects, not only the cost of training and be hiring but in other areas as well. The hidden costs to the company are even greater due to bad customer service, poor brand projection, lower morale in the organization, loss of experience and lack of building a corporate legacy (Branham, 2000: 93). The hospitality industry depends on the relationship between customers and employees, because the employee is on the front line serving the customer directly. One expert points out: ‘the hospitality industry is one in which there is a high need to ensure customer loyalty as when a customer experiences good quality service, he tends to visit the same hotel again. However, if the employee turn over is fast, there is difficulty in building the customer loyalty as well as the quality of service.’ (Marder, 2006) Sometimes even some loyal customers can be swayed to switch to a competitor’s business because a senior employee quit. In fact, this is especially true for the banquet and event services. Another problem is when senior employees, like managers or supervisors, jump to other organizations they might be disclosing some confidential information to their competitors. These techniques can range from training to recipes. The conclusion about the control the rate of employee turnover is very important due to the high rate of employee turnover impacting the delivery of efficient services in hotels and restaurants. The trend of employee turnover should be investigated to enlighten managers about the value of retaining employees.Â
Sunday, August 25, 2019
Capital Investment Appraisal Essay Example | Topics and Well Written Essays - 750 words
Capital Investment Appraisal - Essay Example In applied capital budgeting, however, the fundamental concept of managerial flexibility, or active project management, has been well accepted and long practiced. In the past, one way decision-makers have attempted to supplement a traditional analysis is with "what if" analyses, such as sensitivity analyses, scenario analyses, and simulation. However, richer and more efficient capital budgeting decision-making frameworks are needed; and they should directly translate into increased corporate effectiveness, profitability, and long-term survival in today's globally competitive marketplace. (Black 637-354) The primary enhanced decision-making framework is a "real option" analysis. During the last fifteen years, increasing attention has been given to the "real option" approach to capital investment decision-making. "Real options ... allow managers to add value to their firm, by acting to amplify good fortune or to mitigate loss". When real options are present, the traditional DCF methodology may fail to provide an adequate decision-making framework because it does not properly value management's ability to wait, to revise the initial operating strategy if future events turn out to be different from originally predicted, or to account for future (dis)investment. (Trigeorgis 202-224; Fabozzi 7-9; Grinblatt 9-15) Thus, calculating the value of the decision rights of managers to actively manage investment opportunities is not simply a matter of discounting. In addition, since management is not committed to revising the firm's investment strategy or undertaking these future discretionary op portunities, the right to do so is truly an option. That is, managers undertake these opportunities only if and when they chose to do so. In practice, capital investments are determined by managerial discretion where the available options to invest in real assets is evaluated on an on-going basis and either exercised, deferred, or allowed to expire. An option-based approach is, therefore, an excellent representation of the managerial decision-making process. To be simple the internal capabilities of a firm must be matched to its external opportunities in order for managers to maximize shareholders' wealth. The real options are characterized by the flexibility they offer in timing of decisions involving the capabilities and opportunities of the firm (Walters and Giles 1-7; Ross 96-102; Chung 1215-1221; Copeland 15-22). The true NPV of a project can be viewed as the sum of the traditional NPV and the values of inherent real options: True NPV = Traditional NPV + NPV of Real Options. To clarify the value of options from active management, suppose that a firm considers producing a new product, which requires an initial outlay of $1 million. The capacity of the production facility over one period would be 40,000 units. The variable cost of producing one unit of this product is $390. The price of the product in one period from now would be either $300 or $500 with an estimated probability of 50 percent for each state of the nature. The appropriate discount rate for the project is 15 percent. The expected cash flow from the project after one period woul
Saturday, August 24, 2019
Abstract Assignment Example | Topics and Well Written Essays - 250 words - 2
Abstract - Assignment Example This wall provided a platform in which most artists created their art with the main aim of communicating. The street art in Germany, Berlin to be precise, went on after the wall was pulled down in the year 1989 when Germany was reunited again (Visconti et al., 520). Street art has been seen to have a large influence on both political and social cultures of people all over. For instance, artwork in San Francisco, worked a lot for the people by communicating with both leaders and society. It was used by people in San Francisco to struggle of peace movements, gay rights, and the horrors of capitalism. At the same time, the artwork in both the middle class, underprivileged and wealthy neighbourhoods, which always acts as a reminder for equality throughout social classes (Dickens, 70). Art work in Berlin, paid a lot more over the time when there was oppressive and the country was separated into two, street art, worked as the voice of the people without much rebellion and did not all go in vain, it led to Germany being reunified. At the same time, these artworks serves as the best custodian of the historical revolutions Germany has gone through (Riggle,
Friday, August 23, 2019
Changing Minds Case Study Example | Topics and Well Written Essays - 1000 words
Changing Minds - Case Study Example How can you approach such a person or group and attempt to change their minds? Being a fundamentalist, one adheres to a strict doctrine of thought. Basically, it is similar to a computer in that it already has programmed responses; fundamentalist already have responses in which they are going to act in certain parameters. It makes it extremely difficult to sway the minds of those that are fundamentalist in that they are dedicated to a certain pattern of thought and straying from this thinking pattern can cause them anxiety. In order to convert fundamentalist, you must be able to reconstruct the view so that a person can easily integrate into the mindset. 2.       In Changing Minds Gardner talks of an ‘Integrated viable identity.’ How can the work of a site such as ours impact and attempt to create change in a way that supports the development and enhancement of any existing ‘integrated viable identity’ in any of our readers? (Hint – this is hard to find yet findable – look at references provided in the back of the book to help you find it if needed). This involves the conversion of the fundamentalist to what could be considered the radical and changing point of view. In order for the variable to become viable, he idea that is radical must be integrated into the cognition and memory of the fundamentalist. The final step is taking this integrated thought and moving it into behavior. In terms of the project, you had to not only convince them that the idea of ecologically sound cars is good, but in order to make it integrated and viable, they must move the belief into actions. 3.       In Changing Minds Gardner speaks of ‘Representational Redescription.’  Explain what this is, and whether we have it in our site. If we do, describe where it is and how it works in the site.  Also, explain how you might effectively use it in the future. Representational Redescription is wher e a reformist must radically change the ideas of the group by reversing traditional roles and values. We did this by showing how traditional technologies are not beneficial. The function of compressed gas does not mean that it is compressed as in explosive like when we think of compressed gas in a can, however the explosion itself can help power as an alternative resource. 4.       In Changing Minds Gardner describes how ‘Designated Driver’ became a household word internationally. Using this model, what could be done on this project or others in the future to successfully establish a similar acceptance of an idea in the average public person? What would you do differently on the project knowing this? This shows that society is actually the driver in change, whether it is locally or universally, such as in reforms for drunk driving and texting while driving. We want the community to push for change in the electric vs CNG debate. In order to get public s upport, you have to show that not only is it economically feasible, but also that it will make a difference. 5. In Changing Minds, Gardner talks about Wetware, Dryware and Goodware. Explain these terms and how you either used them in our project or how you might use them effectively in the future. Be sure to integrate and compare all three in your response. Gardner used his creative writing techniques to compare our psychological reasoning and aspects in comparison to a computer. Dryware is the basic components in processing and traditional data processing techniques. Goodware is the natural altruistic behavior, which guides people to do
Thursday, August 22, 2019
JPMorgan Chase Essay Example | Topics and Well Written Essays - 1250 words - 6
JPMorgan Chase - Essay Example In the last section the essay will shed light on software automation in online banking transaction. According to Securities and Exchange Commission (2013), its purpose of existence is to protect the interest of investors, facilitate capital formation and maintain a transparent and fare market. Research scholars such as Kamin and DeMarco (2010) and Hill (2010) have pointed out that SEC plays much larger role in comparison to CFTC when it comes to saving the interest of investors. Hence in this essay, the researcher will only focus on control mechanism of SEC in order to discourage banks and financial institutions from involving in high risk gambles in primary market and securities. SEC has created two divisions such as Division of Trading and Markets and Division of Investment Management in order to create a fair a transparent market and protect interest of investors (Securities and Exchange Commission, 2013). ... mechanisms of Trading and Market Division and Investment Management Division of SEC to protect interest of investors can be summarized as, 1- incorporating financial integrity program to mitigate conflict of interest between broker-dealers, 2- reviewing policies to identify and punish fraudulent activities of banks and other companies, 3- assisting the Commission to establish a fair security market and 4- monitoring the actions in commodity market, 5- reviewing the investment adviser filings and 6- assisting Commission to go for law enforcement against companies and banks falsifying the financial results (Securities and Exchange Commission, 2013). SEC has also investigative arm which conduct investigation on following charges; Omission or misrepresentation financial results or crucial security information Manipulation of market prices of securities Defrauding customer’s fund  Insider trading of market information On the basis of above mentioned guidelines, control measures and legal enforcement actions, SEC take actions in order to prevent high-risk gambles in securities in the field of banking operation and security exchange. Elements of contracts include various items such as, 1- An Offer- willingness of parities to enter into bargain, 2- An Acceptance- acceptance of condition mentioned in by both parties, Purpose- purpose of the contract must be legal, 4- Mutuality of Obligation- mutual understanding of the condition and obligation between parties, 5- Consideration- there must consideration of benefits among both promisor and promise and 6- Certainty of Subject Matter- all the conditions must be clearly defined in the contract so that everyone involved in the contract can understand it. However, the nature of contract between banks and customers is purely based
Sex, Vampires and the Fascination with Bloodsucking Essay Example for Free
Sex, Vampires and the Fascination with Bloodsucking Essay Vampires have long fascinated the world, from their ability to change forms often times transforming into a bat, fog, or other creatures, and their charismatic and sexual nature which has not only seduced literature in Bram Stocker’s Dracula but has also been the outlet of the movie going audience in such films as the adaptation of Dracula in movies such as Blade, Monster Squad, Interview with a Vampire, and the series of Dracula films. The following paper will explore this fascination with Dracula, and vampires in general, paying attention to not only the novel Dracula but the mainstream movie going audience as well as the subculture that exists of vampires. Two main themes of the vampire will be explored in this paper: that of immortality, and of seduction. In the idea of forgetting one’s identity the concept of a vampire is a great iconic figure by which to catalyst the role of the double identity. It is with these two things that the vampire, as a literary character, a movie icon, and a subculture holds the interest of the general population. Body In Bram Stocker’s rendition of vampires in the character of Count Dracula there are certain elements which have become part of the increasing myth and fascination of vampires. Stocker’s character was very enigmatic, however, this did not mean that John was not attracted to this mystery. The idea of stealing someone’s life force, and of the willingness at times that Dracula achieved this feat is part of the lure of the vampire, â€Å"The lust that they portray on the movie screen, the woman gladly greeting the vampires lips with her own, then bending her head to the side so he can bite the tender flesh of her neck. What a marvelous image that seems, enticing us, and repelling us at the same time. Who among us can say for a moment that we did not find that fascination in the mystery of the vampires arms? †(Gottberg 2006). It is with Count Dracula’s charm that the readers become intrigued by the vampire, and his ability to beckon his victim while at the same time having to hold up to a code of ethics. These ethics are also part of the fascination and they are usually including the following characteristics and elements of a vampire: only permitted to come into a house or dwelling after being requested to do so by the owner, only sucking blood that is still warm from the blood pumping through the heart, having an allergic reaction to garlic, sunlight and anything holy, ability to shape shift, extreme sexuality. It is with this last part that the true fascination with vampires hinges. The sexuality of the vampire is accustomed to a smooth tongue, charming people into getting what they, a type of bending of the will of the victim, and their immortality. Especially with this element of immortality, there seems to be a certain gift and curse involved with it because the vampire trades so much in order to gain immortality which is never being able to see sunlight again, and having to feed on human or animal blood to survive. However, despite these gifts and/or curses, the in the original legend of Count Dracula as perceived by Bram Stocker, the Count is able to at once almost haunt the conscious mind of his victim John while at the same time enticing him to become part of the vampiric world. The ability of a vampire to bend a victim’s will, so much so that the victim becomes a willing participant in the bloodlust is how the mainstream media or movies, are focusing their plot outlines. Vampires are becoming a subculture which allows a person to be completely sexual, willing, and to crave blood while at the same time embracing their ‘curse’, as the fascination with vampires persist the question becomes not why does a vampire need blood to stay alive, but there is a more interesting equation involving sucking someone’s life force which in turn gives one the ability to live forever (excluding certain circumstances involving exposure to UV rays, black lights, garlic, holy relics, and a stake through the heart). Thus, the fascination of mainstream movie going audience and the more intellectual reading of a book becomes not an intrigue into an occult but rather that more alluring of attributes of the vampire: immortality. It seems that John in Dracula was not so much duped into becoming an occupant of the Count’s castle, his slave, his blood supply, as he was wanting to learn the Count’s trick of living past the status quo dying age. Thus, John realized that the Count needed blood in order to maintain his life, his charm, his intrigue, his health, and his strength, â€Å"The blood is the life, or so it is said in the vampire culture. Many cultures have included sacrifice, blood letting, and drinking of blood in their worship, so it is really no surprise that our fascination would continue. Even in biblical times blood was important for sealing covenants and sacrifice. So impotent was the blood that God forbade it to be drunk. †(Gottberg 2006). Not only in the aspect of immortality, of man’s desire to cheat death at any cost, especially as the legend goes, to give his soul as a vampire is said to do (hence the aversion to anything holy) but there is a definite sexual drive in vampires that is further seen in Stocker’s Dracula. The view of the Count as he seduces Mary is one in which a man/vampire becomes a part of his victim, sucking her blood, allowing one of the most intimate parts of her to become a part of him, to in fact sustain his life. Thus, it is not sex alone that entices her to allow the Count to ‘enter’ her through the neck, but it is the need, the primal need for life, that makes their relationship one of complete engrossment for her as well as the audience/reader, It is so many things. For many it is the ability to be so fully known by another, to be enraptured inside and out by one who could know every ounce of our being, know all we have ever done, and all we have ever thought, and still desire us more then anything. That was the mystery of Bram Stokers Dracula, a man who could listen to her deepest thoughts and travel the length of not only the world, but time itself to win her back. A woman who would stand by him, even against God himself. This is the true romance of the legend, the image that entices us beyond understanding. †(Gottberg 2006). Conclusion It seems then that this paper has explored two main points of the fascination with vampires, or Count Dracula, that is: immortality, and seduction. In these two elements the main stream culture of the movie going audience is enthralled as well as readers of Stocker’s work. These two main themes or characteristics of the vampire are what continually entice a person to read up on vampires, to watch movies, to delve into the darker realms of the subculture and to explore the idea of immortality, of sucking the life blood from a willing or even unwilling victim and to become so intrinsically a part of someone to know their thoughts, to know their heart beat, to depend on them for true sustenance, that it is no wonder that there remains, after hundreds of years, this verdant image of a charming man or woman in a cloak, knocking on one’s door asking permission to come in and to suck their blood. The idea of possession is a turn on for the subculture of vampires just as it was for Count Dracula; the kind of dependence on someone for a life force as well as the control the vampire has over their victim is what makes this subculture so fascinating and how it can attract the type of crowd that it attracts. Thus, the subculture of the vampire is not merely about bloodsucking but involves something quite animal and quite human about it; it involves allowing someone to take control of one as well as force control on another person, the turn on then becomes power through possession. Although critics might argue that the vampire is a lonesome creature, cursed to walk the earth for eternity, living without a soul, but with the rise of this as a subculture and the popularity it has attracted over the years, it seems that vampirism is becoming more mainstream as more movies are made glamorizing the sex appeal of vampires and the fact that eternity is the natural attraction of this subculture and the young are always attracted to maintaining their youth.The vampire victim is almost always willing. Work Cited Gottberg, C. Why a Fascination with Vampires. 2006. Online. Retrieved 5 November 2007. http://www. associatedcontent. com/article/110969/why_a_fascination_of_vampires. html? page=3
Wednesday, August 21, 2019
Complaint letter
Complaint letter I wish to present complaints that your business has presented to Yoga Center which have continually worked to strain our relationship as business neighbors. Your employees have always been leaving the garbage carts outside our Day-care premises making it a huge distraction to our clients as well. This is against the accepted code of behavior since the carts should be kept at the appropriate storage areas at all times. We have also noted with concern that your businesses have been dumping wastes and other inappropriate items close to our premises. This is an eyesore to our business and has adversely affected the business. This illegal dumping has made us land into problems with the local authorities as dumping is against the local regulations (Joshi, 2006). Recently Yoga Center was even required to pay a hefty fine. Another complaint which we wish to raise is the noted unfair competition which you have subjected to our business. The billboards which have been erected around our business have largely confused our clients and made the business to not pick-up fast as anticipated. The storage and parking of vehicles has also been a case of distress. Noise has been on increase in the recent past. This being a yoga centre we require total silence in order for the people to effectively reflect and offer adequate care to babies. The increased noise levels work as a distraction and the clients do not achieve the necessary results. This has made our clients not to be satisfied with the results and they have left the yoga classes thus making us to lose profits. Kindly consider these complaints for mutual relations between us, thanks. References Joshi, G. (2006). Writing Skills for Technical Purposes. New York, U.S.A: Gyan Publishing House
Tuesday, August 20, 2019
Biography of Karl Marx Essay -- Karl Marx Communism Biographies essays
Biography of Karl Marx Karl Marx, the author of the Communist Manifesto, is viewed to be one of the greatest social thinkers of his time. His social, political and economical thoughts are still highly regarded today. The life of this man is stamped with many accomplishments and ideas that have been adopted by many prominent figures. As a historian, philosopher, and revolutionary, Karl Marx has helped shaped the society of the past, present and future. Karl Marx was born in Trier, Germany on May 5, 1818. He was born to Heinrich Marx and his wife, Henrietta who had a total of seven children. They were a middle class family who came from a long lineage of rabbis. However, his family was baptized Protestant in order for his dad to keep his job as a practicing lawyer.[1] At an early age, Marx’s next-door neighbor became an influential model for Marx and eventually a future father-in-law.[2] Marx’s intellectual career began in 1835 at the age of seventeen at the University of Boon where he was to study law. Not more than a year after his arrival at Boon he was arrested for drunkenness and was injured in a brawl.[3] Also at this time he became secretly engaged to his childhood sweetheart, Jenny Von Westphalen. Outraged by his actions, his father forced him to transfer and begin a more serious academic career at the University of Berlin. His father voiced his opinion in a letter to Marx â€Å" degeneration in a learned dressing-gown with uncombed hair has replaced degeneration with a drinking glass.[4] On October 22, 1837, he became officially engaged to Jenny and would ritually write her a letter telling about his life at school.[5] Shortly after his arrival at Berlin he... ...ree in the afternoon, the greatest living thinker ceased to think†¦Just as Darwin discovered the law of development or organic nature, so Marx discovered the law of development of human history.†[17] Notes [1] Peter Singer, Marx (New York: Hill and Wang, 1980), 2. [2] Allen W. Wood, Karl Marx (London: Routledge & Kegan Ltd, 1981), xii. [3] Singer,2 [4] Singer,2 [5] â€Å"A Revolutionary Thinker,†(12 March 2002). [6] â€Å"A Revolutionary Thinker†[7] Wood, xii [8] Steven Kreis, â€Å"Karl Marx,†The History Guide: Lectures On Modern Intellectual History, 10 February 2002, [9] Singer, 3 [10] Singer, 3 [11] Singer, 3 [12] Kreis [13] Wood, xiii [14] Singer, 4,5 [15] Wood, xiii [16] Wood, xiii, xiv [17] Kreis
Monday, August 19, 2019
islam in the united states Essay -- essays research papers
The biased and discrimination in United States have always been done with the minority. Muslims have always been a minority in this country throughout time. They have faced discrimination in society and especially from the government and media. I believe that people running this country are Anti Islamic due to there view on things. Also this is a Zionist country, which is another reason that makes the media discriminate against the Muslim’s, due to the conflict with Palestine and other Muslim countries. The media has always portrayed Islam in a negative way. The reason the media is biased when it comes to Islam because they hate the Islamic structure and the beliefs. The majority of media conglomerate ownership is of people who consider themselves as Zionists. They are the big owners and of course will want to get their views across in any way possible, even if that means to discriminate a certain group of people. One of the biggest reason this country is against Islam, is because of the Islam’s Social System. It is very different then how this country wants you to live your life. Another reason which this conflict occurs is because due to the fact that you cant find further truth the n the Quran compared to Bible or Torah or any other books. All three of them are books of GOD, and his message. Torah is known as the old testament, then cam e the Bible, new testament, and Quran is the final testament and has the final message which is a lot easier to follow, making Islam the fastest growing religion of United States and also the world. That is why Islam is hated by the western world and is always portrayed as a killer disease. Promoting Islam is all for violence and kill people and how the term â€Å"JIHAD†is so misused in today’s western society. Without knowing or having two bits of knowledge of Islam, that this religious revolves around PEACE. The social system in Islam is geared towards the preservation of the human race. It is uniquely built around the concepts of responsibility. Unlike the capitalistic concept of 50% shared activity, Islam defines the specific duties of each person and holds him or her equally important in the progress of society. Social disease such as crime and violence, drugs and alcoholism, rape and sexual harassment, teenage pregnancy and homosexuality are the norms of the Western life. Islam provides a strong foundation for a high... ...e help of United States. Saddam Hussein was helped put in power by United States. Mohammad Karzi the president of Afghanistan was put in power by United States. These people who are putting leaders in Islamic countires are against Islam and it’s belief that is why the media portrays Islam in the most negative way possible, because the government pretty much runs the Media. 1. Nizam al-Din al-Naysaburi, Ghara'ib al-Qur'an wa Ragha'ib al-Furqan, Cairo, 1962; Ibn Abi Dawud, Kitab al-Masaahif, p.12, in Arthur Jeffery, Materials for the History of the Text of the Qur'an, Leiden: Brill, 1937; and Badr al-Din al-Zarkashi, Al-Burhan fi Ulum al-Qur'an, Cairo, 1957, Vol.1, p.240 respectively 2. ISLAMIC SOCIAL SYSTEM. 20 August 1997. IBN MUHAMMAD. 30 Nov. 2004 3. Nonviolent Action and Third Party Role in Islamic World. 20 October 2000. Sezai Ozcelik. George Mason University/Institute for Conflict Analysis and Resolution.. 30 Nov. 2004. http://www.geocities.com/tatarkirim/islam5.html 4. Material on the Authenticity of the Qur'an. 1998, 1999, 2000 Muslim Answers. Abdur-Raheem Green. 30 Nov 2004. http://www.muslim-answers.org/proofs10.htm 5. The Holy Book of Quran. The citations are given.
Sunday, August 18, 2019
Fitzgeralds The Great Gatsby and the Tragic Hero Essay -- Great Gats
Fitzgerald's The Great Gatsby and the Tragic Hero     Aristotle invented a list of criteria in an attempt to determine the exact definition of a tragic hero. The list states the following - the tragic hero must cause his own down fall; the tragic hero's fate is undeserved; the tragic hero's punishment exceeds his crime; the tragic hero must be a great and noble person according to the standards of the current society. In Fitzgerald's The Great Gatsby, Jay Gatsby can be defined as a tragic hero who possesses all of the aforementioned traits.  Jay Gatsby's main desire in life is to become a member of high society, respected more than anyone else. Gatsby has taken steps to ensure that this desire becomes a reality. He has accumulated wealth, power, and influence, all in an attempt to create the sparkling image of a successful man. Although Gatsby's friend Nick is "inclined to reserve all judgements" (1), Gatsby is a strong, unselfish idealist. Gatsby is a romantic dreamer who wishes to fulfill his ideal by gaining wealth in hopes of impressing and eventually winning the heart of the mat... ...his vision, until his death. Daisy indirectly causes Gatsby's death, making her more than ever, unworthy of Gatsby's affections. Ironically, Gatsby lived for Daisy and up to his death, believed and had faith in her and his vision.  Works Cited Dillon, Andrew. "The Great Gatsby: The Vitality of Illusion." The Arizona Quarterly 44 Spr. 1988: 49-61. Fitzgerald, F. Scott. The Great Gatsby. New York: Macmillan Publishing Company, 1992. Irwin, John T. "Compensating Visions: The Great Gatsby." Southwest Review 77 Autumn 1992: 536-545.
Saturday, August 17, 2019
Nursing: Epidemiology and Health
U N I T Concepts of Health and Disease arly peoples were considered long-lived if they reached 30 years of ageâ€â€that is, if they survived infancy. For many centuries, infant mortality was so great that large families became the tradition; many children in a family ensured that at least some would survive. Life expectancy has increased over the centuries, and today an individual in a developed country can expect to live about 71 to 79 years. Although life expectancy has increased radically since ancient times, human longevity has remained fundamentally unchanged.The quest to solve the mystery of human longevity, which appears to be genetically programmed, began with Gregor Mendel (1822–1884), an Augustinian monk. Mendel laid the foundation of modern genetics with the pea experiments he performed in a monastery garden. Today, geneticists search for the determinant, or determinants, of the human life span. Up to this time, scientists have failed to identify an aging gene th at would account for a limited life span. However, they have found that cells have a ? nite reproductive capacity. As they age, genes are increasingly unable to perform their functions.The cells become poorer and poorer at making the substances they need for their own special tasks or even for their own maintenance. Free radicals, mutation in a cell’s DNA, and the process of programmed cell death are some of the factors that work together to affect a cell’s functioning. I E CHAPTER Concepts of Health and Disease Georgianne H. Heymann Carol M. Porth 1 ogy. There has been an increased knowledge of immune mechanisms; the discovery of antibiotics to cure infections; and the development of vaccines to prevent disease, chemotherapy to attack cancers, and drugs to control the manifestations of mental illness.The introduction of the birth control pill and improved prenatal care have led to decreased birth rates and declines in infant and child mortality. The bene? ts of scienc e and technology also have increased the survival of infants born prematurely and of children with previously untreatable illnesses, such as immunode? ciency states and leukemia. There also has been an increase in the survival of very seriously ill and critically injured persons of all age groups.Consequently, there has been an increase in longevity, a shift in the age distribution of the population, and an increase in age-related diseases. Coronary heart disease, stroke, and cancer have now replaced pneumonia, tuberculosis, and diarrhea and enteritisâ€â€the leading causes of death in the 1900s. This chapter, which is intended to serve as an introduction to the book, is organized into four sections: health and society, historical perspectives on health and disease, perspectives on health and disease in individuals, and perspectives on health and disease in populations.The chapter is intended to provide the reader with the ability to view within a larger framework the historical aspects of health and disease and the relationship of health and disease to individuals and populations, and to introduce the reader to terms, such as etiology and pathogenesis, that are used throughout this text. HEALTH AND SOCIETY HEALTH AND DISEASE: A HISTORICAL PERSPECTIVE The In? ence of Early Scholars The Nineteenth Century The Twentieth Century The Twenty-First Century PERSPECTIVES ON HEALTH AND DISEASE IN INDIVIDUALS Health Health and Disease as States of Adaptation Disease Etiology Pathogenesis Morphology Clinical Manifestations Diagnosis Clinical Course PERSPECTIVES ON HEALTH AND DISEASE IN POPULATIONS Epidemiology and Patterns of Disease Prevalence and Incidence Morbidity and Mortality Determination of Risk Factors The Framingham Study The Nurses’ Health Study Natural History Levels of Prevention Evidence-Based Practice and Practice Guidelines e concepts of what constituted health and disease at the beginning of the last century were far different from those of thi s century. In most of the industrialized nations of the world, people now are living longer and enjoying a healthier lifestyle. Much of this has been made possible by recent advances in science and technol- T Health and Society Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obligated, at least for a spell, to identify ourselves as citizens of that other place. 3 4 UNIT I Concepts of Health and Disease After completing this section of the chapter, you should be able to meet the following objectives: ? Describe the concepts used to establish belief systems within a community and the effects on its health care practices ? Identify a disease believed to be generated by speci? c emotions and the characteristics ascribed to it ? Explain how mythologizing disease can be detrimental to individuals in a society There is a long history that documents the concern of humans for their own health and well-being and that of their community.It is not always evident what particular beliefs were held by early humans concerning health and disease. Still, there is evidence that whenever humans have formed social groups, some individuals have taken the role of the healer, responsible for the health of the community by preventing disease and curing the sick. In prehistoric times, people believed that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be paci? ed or the evil spirits driven from the body. In time, this task became the job of the ealers, or tribal priests. They tried to pacify the gods or drive out the evil spirits using magic charms, spells, and incantations. There also is evidence of surgical treatment. Trephining involved the use of a stone instrument to cut a hole in the skull of the sick person. It is believed that this was done to release spirits responsible for illness. Prehistoric h ealers probably also discovered that many plants can be used as drugs. The community as a whole also was involved in securing the health of its members.It was the community that often functioned to take care of those considered ill or disabled. The earliest evidence of this comes from an Old Stone Age cave site, Riparo del Romio, in southern Italy. There the remains of an adolescent dwarf were found. Despite his severe condition, which must have greatly limited his ability to contribute to either hunting or gathering, the young man survived to the age of 17 years. He must have been supported throughout his life by the rest of the community, which had incorporated compassion for its members into its belief system. Communities such as this probably existed throughout prehistory; separated from each other and without any formal routes of communication, they relied on herbal medicines and group activity to maintain health. Throughout history, peoples and cultures have developed their he alth practices based on their belief systems. Many traditions construed sickness and health primarily in the context of an understanding of the relations of human beings to the planets, stars, mountains, rivers, spirits, and ancestors, gods and demons, the heavens and underworld.Some traditions, such as those re? ected in Chinese and Indian cultures, although concerned with a cosmic scope, do not pay great attention to the supernatural. Over time, modern Western thinking has shed its adherence to all such elements. Originating with the Greek traditionâ€â€which dismissed supernatural powers, although not environmental in? uencesâ€â€and further shaped by the In? uences of zodiac signs on the human body. (Courtesy of the National Library of Medicine) ourishing anatomic and physiologic programs of the Renaissance, the Western tradition was created based on the belief that everything that needed to be known essentially could be discovered by probing more deeply and ever more minu tely into the ? esh, its systems, tissues, cells, and DNA. 3 Through Western political and economic domination, these health beliefs now have powerful in? uence worldwide. Every society has its own ideas and beliefs about life, death, and disease. It is these perceptions that shape the concept of health in a society.Although some customs and beliefs tend to safeguard human communities from disease, others invite and provoke disease outbreaks. The beliefs that people have concerning health and disease can change the destiny of nations. The conquering of the Aztec empire may be one example. Historians have speculated how Hernando Cortez, starting off with fewer than 600 men, could conquer the Aztec empire, whose subjects numbered millions. Historian William H. McNeill suggests a sequence of events that may explain how a tiny handful of men could subjugate a nation of millions.Although the Aztecs ? rst thought the mounted, gunpowered Spaniards were gods, experience soon showed CHAPTER 1 Concepts of Health and Disease 5 otherwise. Armed clashes revealed the limitations of horse? esh and of primitive guns, and the Aztecs were able to drive Cortez and his men from their city. Unbeknownst to the Aztecs, the Spaniards had a more devastating weapon than any ? rearm: smallpox. An epidemic of smallpox broke out among the Aztecs after their skirmishes with the Spaniards.Because the population lacked inherited or acquired immunity, the results were catastrophic. It is presumed that a quarter to a third of the population died from the initial onslaught. Even more devastating were the psychological implications of the disease: it killed only American Indians and left Spaniards unharmed. A way of life built around the old Indian gods could not survive such a demonstration of the superior power of the God the Spaniards worshipped. It is not hard to imagine then that the Indians accepted Christianity and submitted meekly to Spanish control. Although we live in an age of science , science has not eliminated fantasies about health; the stigmas of sickness and the moral meanings that they carry continue. Whereas people in previous centuries wove stories around leprosy, plague, and tuberculosis to create fear and guilt, the modern age has created similar taboos and mythologies about cancer and acquired immunode? ciency syndrome (AIDS). The myth of tuberculosis (TB) was that a person who suffered from it was of a melancholy, superior character sensitive, creative, a being apart.Melancholy, or sadness, made one â€Å"interesting†or romantic. The general perception of TB as â€Å"romantic†was not just a literary device. It was a way of thinking that insinuated itself into the sensibilities and made it possible to ignore the social conditions, such as overcrowding and poor sanitation and nutrition, that helped breed tuberculosis. The infusion of beliefs into public awareness often is surreptitious. Just as tuberculosis often had been regard ed sentimentally, as an enhancement of identity, cancer was regarded with irrational revulsion, as a diminution of the self. Current accounts of the psychological aspects of cancer often cite old authorities, starting with the Greek physician Galen, who observed that â€Å"melancholy women†are more likely to get breast cancer than â€Å"sanguine women. †Grief and anxiety were cited as causes of cancer, as well as personal losses. Public ? gures such as Napoleon, Ulysses S. Grant, Robert A. Taft, and Hubert Humphrey have all had their cancers diagnosed as the reaction to political defeat and the end to their political ambitions. Although distress can affect immunologic responsiveness, there is no scienti? evidence to support the view that speci? c emotions, or emotions in general, can produce speci? c diseasesâ€â€or that cancer is the result of a â€Å"cancer personality,†described as emotionally withdrawn, lacking self-con? dence, and depressive. These di sease mythologies contribute to the stigmatizing of certain illnesses and, by extension, of those who are ill. The beliefs about health and disease have the power to trap or empower people. They may inhibit people from seeking early treatment, diminish personal responsibility for practicing healthful behaviors, or encourage fear and social isolation.Conversely, they also can be the impetus for compassion to those who are ill, for commitment to improving one’s own health, and for support of efforts to improve the health status of others. In summary, what constitutes health and disease changes over time. Prehistoric times were marked by beliefs that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be paci? ed or the evil spirits driven from the body. Tribal healers, or priests, emerged to accomplish this task. Prehistoric healers used a myriad of treatments, including magic charms, spells, and incantations; surgical treatment; and plan t medicines.Throughout history, the concept of health in a society has been shaped by its beliefs about life, death, and disease. Some beliefs and customs, such as exhibiting compassion for disabled community members, tend to safeguard human communities and increase the quality of life for all community members. Others invite and provoke disease outbreaks, such as myths about the causes of disease. Even though science and technology have advanced the understanding and treatment of disease, misconceptions and fantasies about disease still arise.In previous centuries, diseases such as leprosy, plague, and tuberculosis were fodder for taboos and mythologies; today, it is cancer and AIDS. The psychological effects of disease mythologies can be positive or negative. At their worst, they can stigmatize and isolate those who are ill; at their best, they can educate the community and improve the health of its members. Health and Disease: A Historical Perspective After completing this sectio n of the chapter, you should be able to meet the following objectives: Describe the contributions of the early Greek, Italian, and English scholars to the understanding of anatomy, physiology, and pathology ? State two important advances of the nineteenth century that helped to pave the way for prevention of disease ? State three signi? cant advances of the twentieth century that have revolutionized diagnosis and treatment of disease ? Propose developments that will both hamper and contribute to the promotion of health and the elimination of disease in the twenty-? rst century It has been said that those who do not know history are condemned to repeat it.There are many contributors to the understanding of how the body is constructed and how it works, and what disease is and how it can be treated, which in turn leads to an understanding of what health is and how can it be maintained. Much of what we take for granted in terms of treating the diseases that af? ict humankind has had its origin in the past. Although they are seemingly small contributions in terms of today’s scienti? c advances, it is the knowledge 6 UNIT I Concepts of Health and Disease produced by the great thinkers of the past that has made possible the many things we now take for granted.THE INFLUENCE OF EARLY SCHOLARS Knowledge of anatomy, physiology, and pathology as we now know it began to emerge with the ancient Greeks. They were the ? rst to recognize the distinction between internal and external causes of illness. To Hippocrates and his followers, we owe the foundations of the clinical principles and the ethics that grew into modern medical science. Hippocrates (460–377 BC) was a blend of scientist and artist. He believed that disease occurred when the four humorsâ€â€blood from the heart, yellow bile from the liver, black bile from the spleen, and phlegm from the brainâ€â€became out of balance.These humors were said to govern character as well as health, producing phl egmatic, sanguine, choleric, and melancholic personalities. This belief paralleled the even older Chinese tradition, which was founded on the complementary principles of yin (female principle) and yang (male), whose correct proportions were essential for health. Hippocrates is identi? ed with an approach to health that dictated plenty of healthy exercise, rest in illness, and a moderate, sober diet. It was Aristotle (384–322 BC) who, through his dissection of small animals and description of their internal Hippocrates: A blend of scientist and scholar. Courtesy of the National Library of Medicine) anatomy, laid the foundations for the later scrutiny of the human body. For Aristotle, the heart was the most important organ. He believed it to be the center of the blood system as well as the center of the emotions. However, Aristotle’s main contributions were made to science in general. The person who took the next major step was Galen (AD 129–199), a physician to t he emperors and gladiators of ancient Rome. Galen expanded on the Hippocratic doctrines and introduced experimentation into the study of healing. His work came to be regarded as the encyclopedia of anatomy and physiology.He demoted the heartâ€â€in his view, the liver was primary for venous blood, whereas the seat of all thought was the brain. He described the arteries and veins and even revealed the working of the nervous system by severing a pig’s spinal cord at different points and demonstrating that corresponding parts of the body became paralyzed. According to Galen, the body carried three kinds of blood that contained spirits charged by various organs: the veins carried â€Å"natural spirit†from the liver; the arteries, â€Å"vital spirit†from the lungs; the nerves, â€Å"animal spirit†from the brain. The heart merely warmed the blood.After Galen’s death, however, anatomic research ceased, and his work was considered infallible for almo st 1400 years. As the great medical schools of universities reformed the teaching of anatomy in the early 1500s and integrated it into medical studies, it became apparent to anatomists that Galen’s dataâ€â€taken from dogs, pigs, and apesâ€â€often were riddled with error. It was only with the work of Andreas Vesalius (1514–1564) that Galen’s ideas truly were challenged. Vesalius, professor of anatomy and surgery at Padua, Italy, dedicated a lifetime to the study of the human body.Vesalius carried out some unprecedentedly scrupulous dissections and used the latest in artistic techniques and printing for the more than 200 woodcuts in his De Humani Corporis Fabrica (â€Å"On the Fabric [Structure] of the Human Body†). He showed not only what bodily parts looked like but also how they worked. The book, published in 1543, set a new standard for the understanding of human anatomy. With this work, Vesalius became a leading ? gure in the revolt against Gal en’s teachings. One of the most historically significant discoveries was made by William Harvey (1578–1657), an English physician and physiologist.He established that the blood circulates in a closed system impelled mechanically by a â€Å"pumplike†heart. He also measured the amount of blood in the circulatory system in any given unit of timeâ€â€one of the ? rst applications of quantitative methods in biology. Harvey’s work, published in On the Motion of the Heart and Blood in Animals (1628), provided a foundation of physiologic principles that led to an understanding of blood pressure and set the stage for innovative techniques such as cardiac catheterization. With the re? ement of the microscope by the Dutch lens maker Anton van Leeuwenhoek (1632–1723), the stage was set for the era of cellular biology. Another early user of the microscope, English scientist Robert Hooke (1635–1703), published his Micrographia in 1665 in which CHAPTER 1 Concepts of Health and Disease 7 William Harvey’s most eminent patient, King Charles I, and the future King Charles II look on as Harvey displays a dissected deer heart. (Courtesy of the National Library of Medicine) he formally described the plant cells in cork and presented his theories of light and combustion and his studies of insect anatomy.His book presented the great potential of the microscope for biologic investigation. In it, he inaugurated the modern biologic usage of the word cell. A century later, German-born botanist Mathias Schleiden (1804–1881) and physiologist Theodor Schwann (1810–1882) observed that animal tissues also were composed of cells. Although Harvey contributed greatly to the understanding of anatomy and physiology, he was not interested in the chemistry of life. It was not until French chemist Antoine Lavoisier (1743–1794), who was schooled as a lawyer but devoted to scienti? pursuits, overturned 100year-old theories of che mistry and established the basis of modern chemistry that new paths to examine body processes, such as metabolism, opened up. His restructured chemistry also gave scientists, including Louis Pasteur, the tools to develop organic chemistry. In 1796, Edward Jenner (1749–1823) conducted the ? rst vaccination by injecting the ? uid from a dairymaid’s cowpox lesion into a young boy’s arm. The vaccination by this English country doctor successfully protected the child from smallpox. Jenner’s discovery led to the development of vaccines to prevent many other diseases as well.Jenner’s classic experiment was the ? rst of? cially recorded vaccination. Painting by Georges-Gaston Melingue (1894). The ? rst vaccination. Here Dr. Jenner introduces cowpox taken from dairymaid Sarah Nelmes (right) and introduces it into two incisions on the arm of James Phipps, a healthy 8-year-old boy. The boy developed cowpox, but not smallpox, when Jenner introduced the organis m into his arm 48 days later. (Courtesy of the National Library of Medicine) THE NINETEENTH CENTURY The nineteenth century was a time of spectacular leaps forward in the understanding of infectious diseases.For many centuries, rival epidemiologic theories associated disease and epidemics like cholera with poisonous fumes given off from dung heaps and decaying matter (poisons in the air, exuded from rotting animal and vegetable material, the soil, and standing water) or with contagion (person-to-person contact). In 1865, English surgeon Joseph Lister (1827–1912) concluded that microbes caused wound infections. He began to use carbolic acid on wounds to kill microbes and reduce infection after surgery. However, Lister was not alone in identifying hazards in the immediate environment as detrimental to health.English nurse Florence Nightingale (1820–1910) was a leading proponent of sanitation and hygiene as weapons against disease. It was at the English base at Scutari dur ing the Crimean War (1854–1856) that Nightingale waged her battle. Arriving at the army hospital with a party of 38 nurses, Nightingale found nearly 2000 wounded and sick inhabiting foul, rat-infested wards. The war raged on, deluging the hospital with wounded as Nightingale not only organized the nursing care of the wounded but also provided meals, supplied bedding, and saw to the laundry.Within 6 months, she had brought about a transformation and slashed the death rate from approximately 40% to 2%. 3 8 UNIT I Concepts of Health and Disease Florence Nightingale caring for wounded at Scutari, Turkey, during the Crimean War. (Courtesy of the National Library of Medicine) From the 1860s, the rise of bacteriology, associated especially with chemist and microbiologist Louis Pasteur in France and bacteriologist Robert Koch in Germany, established the role of microorganismal pathogens. Almost for the ? rst time in medicine, bacteriology led directly to dramatic new cures.The techni que of pasteurization is named after Louis Pasteur (1822–1895). He introduced the method in 1865 to prevent the souring of wine. Pasteur’s studies of fermentation convinced him that it depended on the presence of microscopic forms of life, with each fermenting medium serving as a unique food for a speci? c microorganism. He developed techniques for culturing microbes in liquid broths. Through his work, he was able to dispel the disease theory that predominated in the mid-nineteenth century, attributing fevers to â€Å"miasmas,†or fumes, and laid the foundation for the germ theory of disease.The anthrax bacillus, discovered by Robert Koch (1843–1910), was the ? rst microorganism identi? ed as a cause of illness. Koch’s trailblazing work also included identifying the organism responsible for tuberculosis and the discovery of a tuberculosis skin-testing material. In 1895, German physicist Wilhelm Rontgen (1845– 1923) discovered X rays. For the ? rst time without a catastrophic event, the most hidden parts of a human body were revealed. Even though he understood that it was a signi? cant discovery, Rontgen did not initially recognize the amazing diagnostic potential of the process he had discovered.THE TWENTIETH CENTURY The twentieth century was a period of revolutionary industry in the science and politics of health. Concerns about the care of infants and children and the spread of infectious disease became prevailing themes in public and political arenas alike. It was during this time that private duty and public health nursing emerged as the means of delivering health care to people in their homes and in their communities. Social service agencies like the Henry Street Settlement in New York, founded by Lillian Wald, sent nurses into tenements to care for the sick. The placement of nurses in schools began in New York City in 1902 at the urging of Wald, who offered to supply a Henry Street nurse for 1 month without charg e. 5 Efforts to broaden the delivery of health care from the city to rural areas also were initiated during the early 1900s. The American Red Cross, which was reorganized and granted a new charter by Congress in 1905, established a nursing service for the rural poor that eventually expanded to serve the small town poor as well. 5 Scienti? c discoveries and innovations abounded in the twentieth century.In the early 1900s, German bacteriologist Paul Ehrlich (1854–1915) theorized that certain substances could act as â€Å"magic bullets,†attacking disease-causing microbes but leaving the rest of the body undamaged. In 1910, he introduced his discovery: using the arsenic compound Salvarsan, he had found an effective weapon against syphilis. Through his work, Ehrlich launched the science of chemotherapy. CHAPTER 1 Concepts of Health and Disease 9 The operating room. With the advent of anesthesia, knowledge of how microbes cause disease, and availability of incandescent ligh ting in the operating room, surgery became an option for treating disease.Rubber gloves had not yet been invented and the surgical team worked with bare hands to perform surgery. (Hahnemann Hospital, Chicago, IL. Courtesy Bette Clemons, Phoenix, AZ) The ? rst antibiotic was discovered in 1928 by English bacteriologist Sir Alexander Fleming (1881–1955). As he studied the relationship between bacteria and the mold Penicillium, he discovered its ability to kill staphylococci. However, it was not until the 1940s that later researchers, who were searching for substances produced by one microorganism that might kill other microorganisms, produced penicillin as a clinically useful antibiotic.By the 1930s, innovative researchers had produced a cornucopia of new drugs that could be used to treat many of the most common illnesses that left their victims either severely disabled or dead. The medical community now had at its disposal medications such as digoxin to treat heart failure; su lfa drugs, which produced near-miraculous cures for infections such as scarlet fever; and insulin to treat diabetes. At the turn of the century, social service agencies like Henry Street Settlement in New York sent nurses into tenements to care for the sick. (Schorr T. M. , Kennedy S.M. [1999]. 100 years of American nursing [p. 12]. Philadelphia: Lippincott Williams & Wilkins) 10 UNIT I Concepts of Health and Disease With the discovery of insulin, a once-fatal disease known from antiquity no longer carried a death sentence. Working together, Canadian physician Sir Frederick Banting (1891–1941) and physiologist Charles Best (1899–1978) isolated insulin from the pancreas of a dog in 1921. The extract, when given to diabetic dogs, restored their health. In January 1922, they successfully treated a young boy dying of diabetes with their pancreatic extracts.Although still incurable, it became possible to live with diabetes. One disease that remained not only incurable but u ntreatable through much of the twentieth century was tuberculosis. With no cure or preventive vaccine forthcoming, efforts at the turn of the century were dedicated to controlling the spread of tuberculosis. It was then that an alliance between organized medicine and the public resulted in the formation of voluntary local organizations to battle the disease. These organizations focused on education to counteract the fear of tuberculosis; at the same time, they warned against the disease.In 1904, the local organizations joined together to form a national organization, the National Association for the Study and Prevention of Tuberculosis. In 1918, the name was changed to the National Tuberculosis Association, which was renamed the American Lung Association in 1973. 6 The national and local tuberculosis associations played a vital role in educating the public by running campaigns urging people to have skin tests and chest x-rays as a means of diagnosing tuberculosis. Once tuberculosis was diagnosed, an individual was likely to be sent to a sanatorium or tuberculosis hospital.There, good nourishment, fresh air, and bed rest were prescribed in the belief that if the body’s natural defenses were strengthened, they would be able to overcome the tuberculosis bacillus. For almost half a century, this would be the prevailing treatment. It was not until 1945, with the introduction of chemotherapy, that streptomycin was used to treat tuberculosis. Outbreaks of poliomyelitis, which had increased in the early decades of the 1900s, served as the impetus for the work of American microbiologist Jonas Salk (1914–1995).At its peak, the virus was claiming 50,000 victims annually in the United States. 3 Test trials of Salk’s vaccine with inactivated virus began in 1953, and it proved to prevent the development of polio. By 1955, the massive testing was complete, and the vaccine was quickly put into wide use. Surgical techniques also flourished during this time . A single technical innovation was responsible for opening up the last surgical frontierâ€â€the heart. Up to this time, the heart had been out of bounds; surgeons did not have the means to take over the function of the heart for long enough to get inside and operate. American surgeon John Gibbon (1903–1973) addressed this problem when he developed the heart-lung machine. Dramatic advances followed its successful use in 1953â€â€probably none more so than the ? rst successful heart transplantation performed in 1967 by South African surgeon Christiaan Barnard (1922–2001). For centuries, the inheritance of traits had been explained in religious or philosophical terms. Although English naturalist Charles Darwin’s (1809–1882) work dispelled long-held beliefs about inherited traits, it was Austrian bo-A tuberculosis skin testing clinic. (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 49]. Philadelphia: Lippincott Williams & Wilki ns) CHAPTER 1 Concepts of Health and Disease 11 The â€Å"iron lung,†which used negative pressure to draw air into the lungs, was used to provide ventilatory support for persons with â€Å"bulbar polio. †(Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 91]. Philadelphia: Lippincott Williams & Wilkins) anist Gregor Mendel’s (1822–1884) revolutionary theories on the segregation of traits, largely ignored until 1902, that laid the groundwork for establishing the chromosome as the structural unit of heredity. Many other scientists and researchers contributed to the storehouse of genetic knowledge. With the work by American geneticist James Watson (1928–) and British biophysicists Francis Crick (1916–) and Maurice Wilkins (1916–) in the early 1950s, which established the double-helical structure of DNA, the way to investigating and understanding our genetic heritage was opened.It is dif? cult, if not impossible, to single out all the landmark events of the twentieth century that contributed to the health of humankind. Among the other notable achievements are the development of kidney dialysis, oral contraceptives, transplant surgery, the computed axial tomography (CAT) scanner, and coronary angioplasty. Not all of the important advances in modern medicine are as dramatic as open-heart surgery. Often, they are the result of dogged work by many people and yield results only after a number of years, and then they frequently go unheralded.For example, vaccination programs, control of infectious diseases through improvements in sanitation of water and waste disposal, safer and healthier foods free from microbial contamination, identi? cation of health risks from behaviors such as smoking, and improved prenatal care all have saved many lives in the twentieth century. THE TWENTY-FIRST CENTURY The twenty-? rst century reveals new horizons, but also new problems. In greater numbers than ever, goods an d people travel the world. There is unprecedented physical mobilityâ€â€travel and migration from villages to cities and country to countryâ€â€and interconnectedness.However, the bene? ts of physical mobility and interconnectedness are accompanied by risks. Diseases such as AIDS remind us that nothing is regional, local, or limited in its reach: contagious illness has a worldwide arena. The challenges of maintaining health and well-being in this global community are increasingly apparent. The inadvertent introduction of pathogens poses an unrelenting threat to public health, as does the deliberate use of microorganisms as weapons (see Chapter 18 for a discussion of bioterrorism and emerging global infectious diseases).In February 2003, the viral respiratory illness named severe acute respiratory syndrome (SARS) by the World Health Organization was ? rst recognized in China. 8 In the next few months, the illness swept through parts of Asia and spread to more than two dozen cou ntries in North America, South America, and Europe. The disease was characterized by rapid onset and variable severity, ranging from mild illness to death. The prevention of SARS was a particular challenge because preventive interventions (e. g. , vaccines and antibiotics) were unavailable.Containment became a global collaboration, with public health authorities utilizing isolation and quarantine to focus delivery of health care to people who were ill and to protect healthy people from getting sick. During the February to July outbreak, more than 8000 people worldwide became infected, and more than 900 died. Commerce also is an integral part of the growing world community, bringing goods and services once unobtainable into the global marketplace. Expanded international trade also provides the vehicle for the unwitting introduction or transmission of disease. One such instance occurred in the spring of 2003 in the United States. A multistate outbreak of human monkeypox, ? rst identi? ed in the Democratic Republic of the Congo in 1970, was traced by investigators to pet prairie dogs. The prairie dogs became infected when they were housed or transported along with infected Gambian giant rats, dormice, and rope squirrels that were part of a shipment of small mammals from Ghana. Spread of nonindigenous zoonotic pathogens to indigenous susceptible animal populations can be rapid and deadly. With such outbreaks lurks an additional dangerâ€â€the potential for interspecies exchange, including between humans and animals such as pets.The widespread distribution of infected and potentially infected animals allowed epizootic spread of monkeypox through several states before effective interventions could be put into place. One of the challenges to the world health community will be to study the role of international travel and commerce in the emergence of infectious diseases through the dissemination of pathogens and their vectors throughout the world and then to develo p long-term strategies of surveillance and intervention with the ultimate goal of curtailing their occurrence.In 1976, the World Health Organization (WHO) actually succeeded in eliminating smallpox from the face of the earth. 10 This triumph gave substance to the idea that other infections, like measles, also might disappear if suf? cient efforts were directed at worldwide campaigns to isolate and cure them. However, new infectious diseases, such as Lyme disease and Legionnaire’s disease, and new forms of old diseases, such as resistant strains of tuberculosis and malaria, have emerged and are readily spread 12 UNIT I Concepts of Health and Disease ing on Hippocratic doctrines and introducing experimentation into the study of healing.His work, gleaned through his role as physician to the emperors and gladiators of Rome and animal dissections, came to be regarded as the encyclopedia of anatomy and physiology and was considered infallible for almost 1400 years. Signi? cant chal lenges to long-held beliefs began with the work of Andreas Vesalius (1514–1564), professor of anatomy and surgery at Padua, Italy. His published work, On the Fabric [Structure] of the Human Body, showing how the parts of the body looked and worked, set a new standard for the understanding of human anatomy.Other significant early contributions were made by scholars such as William Harvey (1578–1657), the English physician and physiologist, who in his book, On the Motion of the Heart and Blood in Animals, provided a physiologic framework for the circulation of blood; Anton van Leeuwenhoek (1632–1723), the Dutch lens maker who refined the microscope and set the stage for the era of cellular biology; and Edward Jenner (1749–1823), the English country physician who conducted the first successful vaccination. The nineteenth century was a time of major discoveries that paved the way for understanding infectious diseases.Signi? cant contributions were made by suc h scientists as Joseph Lister, the English surgeon who concluded that microbes caused wound infections; German bacteriologist Robert Koch, who discovered the anthrax bacillus, thus identifying for the ? rst time a microorganism and the illness it caused; and French chemist and microbiologist Louis Pasteur, who developed the technique of pasteurization. Perhaps the most notable technical innovation of the century was the discovery of X rays by German physicist Wilhelm Rontgen. The scienti? undertakings and discoveries of the twentieth century were revolutionary. In 1910, Paul Ehrlich introduced chemotherapy, and in 1928, Sir Alexander Fleming discovered the ? rst antibiotic as he studied the relationship between bacteria and the mold Penicillium. Diseases that had once been fatal or crippling were managed or prevented by new advances, such as the discovery of insulin by Sir Frederick Banting and Charles Best in 1922 and the development of the polio vaccine by Jonas Salk in 1953. Tech nical innovations set the stage for new surgical techniques.The creation of the heartlung machine by American surgeon John Gibbon paved the way for coronary bypass surgery and the ? rst successful heart transplantation in 1967, which was performed by Christiaan Barnard, a South African surgeon. Other important advances included kidney dialysis, oral contraceptives, the CAT scanner, and coronary angioplasty. Public health programs also were responsible for greatly affecting the health of populations, such as those dedicated to increasing vaccination, improving sanitation of water and waste disposal, and identifying health risks.Knowledge about the in? uence of heredity on health and disease originated with Charles Darwin’s (1809–1882) evolutionary theories about inherited traits and with Gregor Mendel’s (1822–1884) theories on the segregation of traits, which laid the groundwork for establishing the chromosome as the structural unit of heredity. In the ear ly 1950s, geneticist James Watson of the United States and British biophysicists Francis Crick and Maurice Wilkins presented their ? ndings on the double-helical structure of DNA. worldwide.The powerful interventions used to ? ght these infections have had the unexpected effect of accelerating their biologic evolution and making them impervious to one after another form of chemical attack. Pathogens also can be introduced into the food chain and travel worldwide. The discovery that beef from cattle infected with bovine spongiform encephalopathy (BSE) may be the source of Creutzfeldt-Jakob disease led many countries to ban beef products from the United Kingdom when BSE was found to be prevalent in English herds.The introduction of such pathogens can be the result of ignorance, carelessness, or greed. Tobacco is a product that serves as a pathogen. In a quest for ever-increasing pro? ts, the tobacco industry created a demand for its product by arti? cially raising the nicotine content of cigarettes so as to increase their addictive potential. This was done with the knowledge of the health risks of tobacco products, thanks to experiments conducted by the tobacco companies’ own medical scientists, but kept secret.If there is a blueprint for future advances, it is in the genes. The twenty-? rst century is destined to be dominated by advances in genetics. With the mapping of the human genome comes hope of cure for some of the most dreaded crippling and fatal diseases. The mapping of the human genome also has posed new ethical dilemmas, for with it comes the potential to predict the future health of persons based on their genes. It soon may be possible to differentiate between persons who will develop certain debilitating diseases and those who will not.Although advances in science and technology will continue to provide new treatments for many diseases, it has become apparent that there are more impressive rewards to be had by preventing diseases from becomin g established in the ? rst place. Ultimately, maintaining health is more resource conservative and cost effective than relying on the treatment of disease. Many decades ago, we learned that even though the â€Å"magic bullets†such as antibiotics had the ability to cure what was once considered incurable, much of our freedom from communicable disease is due to clean water, ef? ient sanitation, and good nutrition. We have become increasingly aware of the importance of preventive measures against noninfectious conditions, especially cancer and coronary heart disease. There is no better way to prevent disease and maintain health than by leading a healthy life, and increasingly, it will be the individual who is responsible for ensuring a healthy passage through life. In summary, Greek scholars were responsible for establishing the fundamentals of anatomy, physiology, and pathology that served as the earliest knowledge base for understanding health and disease.It was Hippocrates ( 460–377 BC) and his followers who laid the foundations of the clinical principles and ethics that grew into modern science. Although his belief that disease occurred when the four humorsâ€â€blood, yellow and black bile, and phlegmâ€â€became out of balance was disproved, his approach to health that dictated plenty of healthy exercise, rest in illness, and a moderate, sober diet remains valid. Galen (AD 129–199) took the next major step, expand- CHAPTER 1 The twenty-? rst century is predicted to be a time of great advances in the ? ld of genetics, already evidenced by the substantial mapping of the human genome that has taken place. Scientists look to genetic research to provide advances that not only will predict who may develop disease but also will provide new treatments for those diseases. However promising future advances may appear, it is readily apparent that prevention is an equally important tool in maintaining health. Concepts of Health and Disease 13 P erspectives on Health and Disease in IndividualsAfter completing this section of the chapter, you should be able to meet the following objectives: ? State the World Health Organization de? nition of health ? Describe the function of adaptation as it relates to health and disease ? State a de? nition of pathophysiology ? Characterize the disease process in terms of etiology, pathogenesis, morphology, clinical manifestations, and prognosis ? Explain the meanings of reliability, validity, sensitivity, speci? city, and predictive value as they relate to observations and tests used in the diagnosis of diseaseWhat constitutes health and disease often is dif? cult to determine because of the way different people view the topic. What is de? ned as health is determined by many factors, including heredity, age and sex, cultural and ethnic differences, as well as individual, group, and governmental expectations. HEALTH The World Health Organization (WHO) in 1948 de? ned health as a â€Å"stat e of complete physical, mental, and social well-being and not merely the absence of disease and in? rmity. †10 Although ideal for many people, this was an unrealistic goal.At the World Health Assembly in 1977, representatives of the member governments of WHO agreed that their goal was to have all citizens of the world reach a level of health by the year 2000 that allows them to live a socially and economically productive life. 10 The U. S. Department of Health and Human Services in Healthy People 2010 described the determinants of health as an interaction between an individual’s biology and behavior, physical and social environments, government policies and interventions, and access to quality health care. 1 with which the need to adapt occurs (see Chapter 9). Generally speaking, adaptation affects the whole person. When adapting to stresses that are threats to health, the body uses those behaviors that are the most ef? cient and effective. It does not use long-term mec hanisms when short-term adaptation is suf? cient. The increase in heart rate that accompanies a febrile illness is a temporary response designed to deliver additional oxygen to tissues during the short period that the elevated temperature increases metabolic needs.On the other hand, hypertrophy of the left ventricle is a long-term adaptive response that occurs in persons with chronic hypertension. Adaptation is further affected by the availability of adaptive responses and the ability of the body to select the most appropriate response. The ability to adapt is dependent on the availability of adaptive responsesâ€â€the greater number of available responses, the more effective the capacity to adapt. Adaptive capacity is decreased with extremes of age and with disease conditions that limit the availability of adaptive responses.The immaturity of the infant impairs the ability to adapt, as does the decline in functional reserve that occurs in the elderly. For example, infants have d if? culty concentrating urine because of the immaturity of their renal tubular structures and therefore are less able than an older child or adult to cope with decreased water intake or exaggerated water losses. Similarly, persons with preexisting heart disease are less able to adapt to health problems that require recruitment of cardiovascular responses. Adaptation also is less effective when changes in health status occur suddenly rather than gradually.For instance, it is possible to lose a liter of blood through chronic gastrointestinal bleeding without developing signs of shock. On the other hand, a sudden hemorrhage that causes the loss of an equal amount of blood is apt to produce hypotension and circulatory shock. Even in advanced disease states, the body retains much of its adaptive capacity and is able to maintain the internal environment within relatively normal limits. DISEASE The term pathophysiology, which is the focus of this book, may be de? ned as the physiology of a ltered health. The term combines the words pathology and physiology.Pathology (from the Greek pathos, meaning â€Å"disease†) deals with the study of the structural and functional changes in cells, tissues, and organs of the body that cause or are caused by disease. Physiology deals with the functions of the human body. Thus, pathophysiology deals not only with the cellular and organ changes that occur with disease but also with the effects that these changes have on total body function. Pathophysiology also focuses on the mechanisms of the underlying disease and provides the background for preventive as well as therapeutic health care measures and practices.A disease has been de? ned as any deviation from or interruption of the normal structure or function of a part, organ, or system of the body that is manifested by a characteristic set of symptoms or signs; the etiology, pathology, and prognosis may be known or unknown. 12 The aspects HEALTH AND DISEASE AS STATES OF ADAPTA TION The ability of the body to adapt both physically and psychologically to the many stresses that occur in both health and disease is affected by a number of factors, including age, health status, psychosocial resources, and the rapidity 14 UNIT I Concepts of Health and Disease f the disease process include the etiology, pathogenesis, morphologic changes, clinical manifestations, diagnosis, and clinical course. ity, the progression from fatty streak to the occlusive vessel lesion seen in persons with coronary heart disease represents the pathogenesis of the disorder. The true etiology of atherosclerosis remains largely uncertain. Etiology The causes of disease are known as etiologic factors. Among the recognized etiologic agents are biologic agents (e. g. , bacteria, viruses), physical forces (e. g. , trauma, burns, radiation), chemical agents (e. g. , poisons, alcohol), and nutritional excesses or de? its. At the molecular level, it is important to distinguish between sick molecu les and molecules that cause disease. 13 This is true of diseases such as cystic ? brosis, sickle cell anemia, and familial hypercholesterolemia, in which genetic abnormality of a single amino acid, transporter molecule, or receptor protein produces widespread effects on health. Most disease-causing agents are nonspeci? c, and many different agents can cause disease of a single organ. For example, lung disease can result from trauma, infection, exposure to physical and chemical agents, or neoplasia.With severe lung involvement, each of these agents has the potential to cause respiratory failure. On the other hand, a single agent or traumatic event can lead to disease of a number of organs or systems. For example, severe circulatory shock can cause multiorgan failure. Although a disease agent can affect more than a single organ, and a number of disease agents can affect the same organ, most disease states do not have a single cause. Instead, most diseases are multifactorial in origin . This is particularly true of diseases such as cancer, heart disease, and diabetes.The multiple factors that predispose to a particular disease often are referred to as risk factors. One way to view the factors that cause disease is to group them into categories according to whether they were present at birth or acquired later in life. Congenital conditions are defects that are present at birth, although they may not be evident until later in life. Congenital malformation may be caused by genetic in? uences, environmental factors (e. g. , viral infections in the mother, maternal drug use, irradiation, or intrauterine crowding), or a combination of genetic and environmental factors.Not all genetic disorders are evident at birth. Many genetic disorders, such as familial hypercholesterolemia and polycystic kidney disease, take years to develop. Acquired defects are those that are caused by events that occur after birth. These include injury, exposure to infectious agents, inadequate n utrition, lack of oxygen, inappropriate immune responses, and neoplasia. Many diseases are thought to be the result of a genetic predisposition and an environmental event or events that serve as a trigger to initiate disease development. MorphologyMorphology refers to the fundamental structure or form of cells or tissues. Morphologic changes are concerned with both the gross anatomic and microscopic changes that are characteristic of a disease. Histology deals with the study of the cells and extracellular matrix of body tissues. The most common method used in the study of tissues is the preparation of histologic sections that can be studied with the aid of a microscope. Because tissues and organs usually are too thick to be examined under a microscope, they must be sectioned to obtain thin, translucent sections.Histologic sections play an important role in the diagnosis of many types of cancer. A lesion represents a pathologic or traumatic discontinuity of a body organ or tissue. De scriptions of lesion size and characteristics often can be obtained through the use of radiographs, ultrasonography, and other imaging methods. Lesions also may be sampled by biopsy and the tissue samples subjected to histologic study. Clinical Manifestations Disease can be manifest in a number of ways. Sometimes, the condition produces manifestations, such as fever, that make it evident that the person is sick.Other diseases are silent at the onset and are detected during examination for other purposes or after the disease is far advanced. Signs and symptoms are terms used to describe the structural and functional changes that accompany a disease. A symptom is a subjective complaint that is noted by the person with a disorder, whereas a sign is a manifestation that is noted by an observer. Pain, dif? culty in breathing, and dizziness are symptoms of a disease. An elevated temperature, a swollen extremity, and changes in pupil size are objective signs that can be observed by someone other than the person with the disease.Signs and symptoms may be related to the primary disorder, or they may represent the body’s attempt to compensate for the altered function caused by the pathologic condition. Many pathologic states are not observed directlyâ€â€one cannot see a sick heart or a failing kidney. Instead, what can be observed is the body’s attempt to compensate for changes in function brought about by the disease, such as the tachycardia that accompanies blood loss or the increased respiratory rate that occurs with pneumonia. It is important to recognize that a single sign or symptom may be associated with a number of different disease states.For example, an elevated temperature can indicate the presence of an infection, heat stroke, brain tumor, or any number of other disorders. A differential diagnosis that describes the origin of a disorder usually requires information regarding a number of signs and symptoms. For example, the presence of fever , a reddened sore throat, and positive throat culture describe a â€Å"strep throat†infection. A syndrome is a compilation of signs and symptoms (e. g. , chronic fatigue syndrome) that are characteristic of a speci? c disease state. Complications are possible adverse ex-Pathogenesis Pathogenesis is the sequence of cellular and tissue events that take place from the time of initial contact with an etiologic agent until the ultimate expression of a disease. Etiology describes what sets the disease process in motion, and pathogenesis, how the disease process evolves. Although the two terms often are used interchangeably, their meanings are quite different. For example, atherosclerosis often is cited as the cause or etiology of coronary heart disease. In real- CHAPTER 1 Concepts of Health and Disease 15 ensions of a disease or outcomes from treatment. Sequelae are lesions or impairments that follow or are caused by a disease. Diagnosis A diagnosis is the designation as to the na ture or cause of a health problem (e. g. , bacterial pneumonia or hemorrhagic stroke). The diagnostic process usually requires a careful history and physical examination. The history is used to obtain a person’s account of his or her symptoms, their progression, and the factors that contribute to a diagnosis. The physical examination is done to observe for signs of altered body structure or function.The development of a diagnosis involves weighing competing possibilities and selecting the most likely one from among the conditions that might be responsible for the person’s clinical presentation. The clinical probability of a given disease in a person of a given age, sex, race, lifestyle, and locality often is in? uential in arriving at a presumptive diagnosis. Laboratory tests, radiologic studies, CT scans, and other tests often are used to con? rm a diagnosis. Normality. An important factor when interpreting diagnostic test results is the determination of whether they are normal or abnormal.Is a blood count above normal, within the normal range, or below normal? Normality usually determines whether further tests are needed or if interventions are necessary. What is termed a normal value for a laboratory test is established statistically from test results obtained from a selected sample of people. The normal values refer to the 95% distribution (mean plus or minus two standard deviations [mean  ± 2 SD]) of test results for the reference population. 14 Thus, the normal levels for serum sodium (135 to 145 mEq/L) represent the mean serum level for the reference population  ± 2 SD.The normal values for some laboratory tests are adjusted for sex or age. For example, the normal hemoglobin range for women is 12. 0 to 16. 0 g/dL and for men, 14. 0 to 17. 4 g/dL. 15 Serum creatinine level often is adjusted for age in the elderly (see Chapter 36), and normal values for serum phosphate differ between adults and children. Reliability, Validity, Sensitivit y, Speci? city, and Predictive Value. The quality of data on which a diagnosis is based may be judged for its reliability, validity, sensitivity, speci? city, and predictive value. 6,17 Reliability refers to the extent to which an observation, if repeated, gives the same result. A poorly calibrated blood pressure machine may give inconsistent measurements of blood pressure, particularly of pressures in either the high or low range. Reliability also depends on the persons making the measurements. For example, blood pressure measurements may vary from one observer to another because of the technique that is used (e. g. , different observers may de? ate the cuff at a different rate, thus obtaining different values), the way the numbers on the manometer are read, or differences in hearing acuity.Validity refers to the extent to which a measurement tool measures what it is intended to measure. This often is assessed by comparing a measurement method with the best possible method of measu re that is available. For example, the validity of blood pressure measurements ob- tained by a sphygmomanometer might be compared with those obtained by intraarterial measurements. Measures of sensitivity and speci? city are concerned with determining how well the test or observation identi? es people with the disease and people without the disease.Sensitivity refers to the proportion of people with a disease who are positive for that disease on a given test or observation (called a true-positive result). Speci? city refers to the proportion of people without the disease who are negative on a given test or observation (called a true-negative result). A test that is 95% speci? c correctly identi? es 95 of 100 normal people. The other 5% are false-positive results. A false-positive test result, particularly for conditions such as human immunodeficiency virus (HIV) infection, can be unduly stressful for the person being tested (see Chapter 22).In the case of HIV testing, a positive res ult on the initial antibody test is followed up with a more sensitive test. On the other hand, false-negative test results in conditions such as cancer can delay diagnosis and jeopardize the outcome of treatment. Predictive value is the extent to which an observation or test result is able to predict the presence of a given disease or condition. A positive predictive value refers to the proportion of true-positive results that occurs in a given population.In a group of women found to have â€Å"suspect breast nodules†in a cancer-screening program, the proportion later determined to have breast cancer would constitute the positive predictive value. A negative predictive value refers to the true-negative observations in a population. In a screening test for breast cancer, the negative predictive value represents the proportion of women without suspect nodules who do not have breast cancer. Although predictive values rely in part on sensitivity and speci? city, they depend more heavily on the prevalence of the condition in the population. Despite unchanging sensitivity and speci? ity, the positive predictive value of an observation rises with prevalence, whereas the negative predictive value falls. Clinical Course The clinical course describes the evolution of a disease. A disease can have an acute, subacute, or chronic course. An acute disorder is one that is relatively severe, but selflimiting. Chronic disease implies a continuous, long-term process. A chronic disease can run a continuous course, or it can present with exacerbations (aggravation of symptoms and severity of the disease) and remissions (a period during which there is a lessening of severity and a decrease in symptoms).Subacute disease is intermediate or between acute and chronic: it is not as severe as an acute disease and not as prolonged as a chronic disease. The spectrum of disease severity for infectious diseases such as hepatitis B can range from preclinical to persistent chronic inf ection. During the preclinical stage, the disease is not clinically evident but is destined to progress to clinical disease. As with hepatitis B, it is possible to
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