My favourite book «Pride and prejudice» Jane Austen Essay

I like reading very much. Books are the history and tastes of each era. Some of them hopelessly lost its charm, others – are relevant and are read with interest today. Every writer wanted to write for ages, but could he or no; it turns out in subsequent generations. I can say that I love all kinds of books. I have a lot of them, they are different, some imaginative, other fantastic.  «Pride of woman, beggar and completely free – in its poverty, in its irony, in the strength of her character †¦ Is there something equal to such pride? Prejudice of woman, almost incapable to kick, to believe in the sincerity of men’s feel and stop thinking about it. This novel â€Å"Pride and Prejudice† by Jane Austen. Book, without which there wouldn’t be â€Å"psychological† novel or â€Å"feminist† literature or – simply – â€Å"elite† prose as such!  »  «Pride and Prejudice » is a novel of manners by Jane Austen, firs t published in 1813. The story follows the main character Elizabeth Bennet as she deals with issues of manners, upbringing, morality, education, and marriage in the society of the landed gentry of early 19th-century England. Elizabeth is the second of five daughters of a country gentleman. In the small town of Meryton that in the county of Hertfordshire, comes the sensational news: one of the richest estates in the county Netherfield Park will not be empty : it was rented by rich young man , aristocrat Mr. Bingley . To all of his accomplishments was adding another one, the most significant , truly priceless : Mr. Bingley was a bachelor . And minds of young ladies were darkened and confused by this news for a long time, Mrs. Bennet (mother) in particular. However, Mr. Bingley arrives not alone; he is accompanied by sisters and inseparable friend Mr. Darcy. Bingley is naive, trusting, opened for communication, without snobbery and ready to love everyone. Darcy – completely opposite of him: proud, arrogant, closed, full of exclusiveness of belonging to a select society. Relationship developing between Bingley – Jane and Darcy – Elizabeth is quite appropriate to their nature. Bingley and Jane. They are riddled with clarity and directness, and both are guileless and trustful (which will be the basis on which arises a mutual feeling , then the cause of their separation , and then it will  bring them together again .) Elizabeth and Darcy would be quite different: the attraction – repulsion, sympathy and equally obvious mutual dislike, those  «Pride and Prejudice » that will bring them a lot of suffering and mental anguish, through which they will painfully seek each other approval. Their first meetings immediately designated mutual interest, curiosity. Both are equally outstanding: Elizabeth is very different from other ladies – the acuity of mind, independence and judgments, and Darcy – education, manners, restrained arrogance. Originally, the arrogance of Darcy, his snobbery that underlines his behavior, which are Elizabeth and dislikes, and even reave. Their pride draws them together, but the prejudice of Darcy can only repel Elizabeth. Their rare meetings on the balls and in the living rooms – it’s always a verbal duel. Duel of equal opponents – always courteous, never going beyond the bounds of decency and social conventions. Darcy’s soul encompasses the feeling of love, with which he opposes. But unable to resist, he declared his love Elizabeth. The scene of his explanation is one of the strongest scenes in the novel. His confession mixed with bitterness, declaring love, he says, that he was not supposed to love. Surprising that Darcy gets refusal, moreover, Elizabeth accuses him of wrongful deeds. Reading this book, I wondered what attracted proud aristocrat a country girl? Naturalness, harmony of her soul. Maybe he hasn’t met such good ladies. And Elizabeth overcome her prejudice, when she met Darcy in his estate of Pemberley . There she found a new Darcy, about whom servants spoke like he is the best man in the world. Because of the society, he put on a mask of a proud aristocrat, and only the love to Elizabeth helped him to take it off. This novel belongs to my favorite works. For me, it became a kind of standard. Purity and elegance of style, brightness and liveliness features, understanding of psychic life, personality, clarity of composition, especially the language of each character, all this combination creates an unusually coherent harmonious picture. Reading this amazing novel, I look inside myself and learn  «to read the hearts » and check the sense by mind.

Jenny: A Character Analysis Essay

INTRODUCTION This paper is a two-part personality analysis of Jenny’s character in the movie Forrest Gump. Jenny is the lead character’s childhood friend who, as a child, is sexually and physically abused by her own father and, as a young adult, gets into drug addiction and attempts suicide, and eventually succumbs to an early death, leaving behind Forrest and their only son. Section I looks at Jenny from the points of view of Social Cognitive and Psychodynamic theories. Section II is an in-depth analysis of Jenny’s personality using Social Cognitive Theory.    Section I:  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Character Personality Matrix Theory Major Components Structure Process Growth and Development Psychopathology Change    Social Cognitive Theory    Jenny has a talent in singing but has poor self-perception, low self-efficacy and does not have goals.    Jenny lacks self-regulation.       Jenny has a mal-adaptive personality which is a result of her low self-efficacy. She could have learned her anti-social or maladaptive behavior (drug use, being associated with anti-social peers, and suicidal tendencies, among others) through observation from models as well as through direct experience. She was brought up by an abusive father, she has witnessed aggression (she was present when Forrest was bullied by the kids at school) and, as a grown-up, been a direct recipient of an aggressive behavior (she was hit in the face by her boyfriend in the Blank Panther party).       Jenny’s maladaptive behavior is a result of dysfunctional learning — she has observed and directly experienced inadequate or sick models (his father and his peers) — and maintained this kind of learning through reinforcement. She seems to have a phobia in relationship, that’s why she keeps running from Forrest who loves her and whom she professes to love.    Jenny shows a remarkably altered behavior toward the end of the movie — the result of her acquiring new thought patterns and behavior, and improved self-efficacy. Psychodynamic Theory Jenny has a weakened ego caused by an internal conflict. Jenny is suffering from anxiety caused by earlier trauma (her traumatic experience with her father, and even her experience of witnessing traumatic events happen to Forrest). Jenny is living in a distorted reality. She has learned to repress her emotions. She may also be living in denial of her traumatic past. Jenny’s maladaptive behavior from young adulthood and into adulthood are mainly caused by her traumatic experiences when she was a young girl (that is, the physical and sexual abuse she received from her father). Jenny exhibits a conflict of wishes and fears. She has carried over into adulthood her childhood wishes and dreams. Jenny’s altered behavior toward the end of the movie may be the result of undergoing cathartic hypnosis or free-association method.    Section II:  Ã‚  Ã‚  Ã‚  Ã‚   Application of Personality Theory    Theory Description and Rationale Social cognitive theory is a personality theory proposed by Albert Bandura and Richard Walters in 1963. Taking its roots from the social learning theory proposed by Neal Miller and John Dollard in 1941, it views people as â€Å"neither driven by inner forces nor automatically shaped and controlled by external stimuli†¦ [but are] active agents who exercise some influence over their own motivation and actions,† (Bandura, 1986, p. 18, 225). It views people as â€Å"self-organizing, proactive, self-reflecting and self-regulating rather than as reactive organisms shaped and shepherded by environmental forces or driven by concealed inner impulses,† and human processes as â€Å"the product of a dynamic interplay of personal, behavioral, and environmental influences,† (Fajares, 2002). What’s good about the theory is that it takes into account the individual’s beliefs and expectations. It emphasizes that although reinforcement and punishment affect motivation, they do not directly cause behavior. According to the theory, the beliefs that people have about themselves are critical in their response to situations. People are both products and producers of their own environments and of their social systems, and, though they are influenced by their environment, their interpretations of their situations greatly shape their behavior. Humans, in the view of the theory, posses intricate capabilities that define what it is to be human. They can symbolize and deduct meanings from symbols, learn, self-regulate, and self-reflect, among other things, and these capabilities help them define their own personality (Fajares, 2002). According to the theory, modeling, which can be direct (from live models), symbolic (from books, movies, and television), or synthesized (combining the acts of different models), lies at the core of social cognitive theory. Modeling can cause new behaviors, facilitate existing behaviors, change inhibitions, and arouse emotions (Pervin, 1989). The choice of the social cognitive theory to analyze the character of Jenny in the movie, Forrest Gump is mainly due to the author’s perception of the theory as the most comprehensive of all the personality theories, and hence, the most fitting to analyze the character in question. The theory takes into consideration factors that behavioral and cognitive theories dismiss. It can also clearly explain things that the other theories cannot explain, as it does not have as many limitations as the other personality theories. Character Description From the view of the social cognitive theory, Jenny is a talented woman, but has poor self-perception and low self-efficacy. This means that she most likely thinks of herself as incapable of coping with situations. Likewise, Jenny has poor self-regulation and is without goals. This means that she does not have a guide that will help her to establish her priorities, and is more likely incapable of regulating her own behavior. Having directly experienced physical and sexual abuse from her father as a child, and having lived in an environment that tolerates maladaptive behavior as a young adult, Jenny eventually exhibited maladaptive behavior herself as a result of the interplay of her environment and her poor self-perception, self-efficacy and self-regulation. It is also a result of her dysfunctional self-conception and expectations. Towards the end of the movie, we see an altered Jenny. She is more mature in appearance and in the way she carries herself. She is shown performing a normal job (a waitress) and finds it easier to talk to Forrest about why she keeps running away from him. From the point of view of the social cognitive theory, this improvement in her behavior is a result of an improved self-efficacy and the acquisition of new thought pattern and behavior. From the point of view of the psychodynamic theory, Jenny may be described as one who has a weakened ego due to her internal conflicts, which is brought about by her traumatic experiences in the hands of her father when she was a child. She has carried into adulthood the memories of the traumatic experiences of her childhood, albeit in a repressed manner. She may not be conscious of the underlying problems in her personality, but it is shown in the way she keeps running away from Forrest whom she says she loves, and as manifested by her involvements with drugs and her having suicidal tendencies, among others. The altered Jenny that we see in the movie may have been the result of undergoing cathartic hypnosis or free-association method. She could have finally discovered and resolved her inner conflicts and set free her repressed memories. Character analysis Structure    The character of Jenny in the movie has a talent in singing. In fact, her dream is to become a professional singer. As a young kid, Jenny showed ability to relate with another person on a personal level; she and Forrest taught each other some tricks. She also showed the ability to encourage others to overcome their fears; she urged Forrest to climb tree, shouting, â€Å"Come on Forrest, you can do it!† from the tree top. However, even as a kid, she already seemed to have escapist tendencies: she is seen running away from her father, and praying to God: â€Å"Dear God, make me a bird, so I can run far, far away from here† (Tishe, Finerman, & Zemeckis, 1994). She also urges Forrest to run away and to run fast whenever she sees her friend being bullied. She shouts: â€Å"Run Forrest, run!† Many years later, when Forrest was assigned to Vietnam, she would advise him not to try to be brave but to run away from trouble, fast. But while her friend’s Forrest’s runs are in the literal sense, Jenny’s is both in the literal and in the figurative senses. She did a lot of running, but not away from trouble, but towards it, and away from the person she loves — Forrest. Viewed from the structure of her personality through the lens of social cognitive theory, Jenny appears to have poor self-perception, as manifested when, as an answer to Forrest’s question as to why she wouldn’tt marry him, she says it is Forrest who would not want to marry her (implying that Forrest deserves someone better than her) and, again, when she gives Forrest her being screwed up as the reason for her running away from him. She tells him when she explained for the first time why she kept going out of his sight: â€Å"I was just messed up† (Tishe, Finerman, & Zemeckis, 1994). Jenny likewise has a poor self-efficacy. According to Bandura (1986) in Pajares (2002), self efficacy is the perceived ability to cope with specific situations. It is the people’s â€Å"judgments of their capabilities to organize and execute courses of action required to attain designated types of performances.† Having a poor self-efficacy hindered Jenny from achieving her dream of becoming a famous singer because self-efficacy is the very basis of motivation. People with poor efficacy tend to avoid activities that they perceive to be beyond their capabilities, may not put much effort to achieve their dreams, may not persist when there are obstacles, may have negative thought patterns while performing the tasks needed to be done to achieve their dreams and may have negative emotional reactions while anticipating an event, or in the middle performing a task. Hence, she always finds herself wanting to fly but couldn’t. Finally, though Jenny had dreams of a good future, she did not have goals. According to the social cognitive theory, goals are those that â€Å"guide us in establishing priorities among rewards and in selecting among situations that enable us to go beyond momentary influences and to organize our behavior over extended period of time,† (Pervin, 1989, p.338). Jenny failed to establish her priorities and overcome the bad influences in her life and to have an organized behavior over a period of time. Hence, since attending an all-girl school, she has been involved in maladaptive behavior, such as getting into drugs, being with bad crowds, having suicidal tendencies, as well as having relationship phobia, among others. Process As a young kid, Jenny had been exposed to and directly experienced aggressive behavior from his father, and from the bullies who mistreated Forrest in her presence. And while attending an all-girl school, she might have had negative influences from peers, and these negative influences may have been accepted in her new environment. Having been introduced to an environment that gave positive rewards to bad behavior by means of acceptance, Jenny eventually turned out doing the modeled behavior. But more than just having been thrown in an environment that accepts negative behavior, the more important thing that could have contributed to Jenny’s maladaptive behavior is her lack of the ability to self-regulate. Self-regulation involves an individual’s ability to control their behavior rather than mechanically reacting to external influences (Pervin, 1989). If Jenny was able to self-regulate, meaning, she was able to process the influences modeled to her such that she was able to assign which behavior was socially acceptable, and which behavior was not, she could have prevented herself from succumbing to the negative influences modeled to her. According to the social cognitive theory, behavior is maintained by expectancies or anticipated consequences. Individuals learn to set appropriate goals for themselves, and reward themselves with self-praise, when they are able to model the behavior and with guilt when they fail to. Moreover, behavior is not exclusively regulated by external forces; there is a process of self-reinforcement through which individuals reward themselves for attaining the standards they set for themselves (Pervin, 1989). Jenny, who does not have goals in the first place, as mentioned in the structure section of this paper, also does not seem capable of self-regulating. Growth and Development As a result of her low self-efficacy, Jenny has developed a maladaptive personality which she learned through observation from models as well as through direct experience, having been brought up by a physically and sexually abusive father, and having witnessed and directly experienced aggression outside of the home; she was present when Forrest was bullied by the kids at school and, as a grown-up, been hit in the face by her boyfriend during an argument in a Blank Panther party. Jenny seems not to have become an aggressive person, but she developed maladaptive behavior. Her aversive experiences drove her to use drugs, develop phobia of relationship, and to attempt or contemplate suicide. Psychopathology Jenny’s maladaptive behavior is a result of dysfunctional learning —she has observed and directly experienced inadequate or sick models (his father and his peers) and maintained this kind of learning through reinforcement. Her exposure to and direct experience of inadequate models may have resulted in dysfunctional expectancies and self-perceptions. Her running away from Forrest who loves her and whom she professes to love may be indicative of a relationship phobia. It may be possible that she is reminded of her painful past which she might be trying to run away from whenever she is with Forrest. Or maybe she has developed fear of pain — fear of being ridiculed when with Forrest perhaps, or fear of the ghost of her painful past. According to the social cognitive theory, dysfunctional expectations and self conceptions have a great role in the learning of overt behavior, such that people learn, erroneously, to expect painful things to follow some events or to associate pain with an event (Pervin, 1986). In Jenny’s case, her developing a relationship phobia (with Forrest) may be caused by associating pain with being with Forrest, or expecting pain to happen by being with Forrest for a long period of time. Her incessant impulse to stay away from Forrest after brief encounters with him may be a defensive behavior to escape the pain she expects to experience or painful events she expects to happen when she is with Forrest. Change Toward the end of the movie, we see a new Jenny. She no longer exhibits maladaptive behavior, no longer runs away from Forrest, and is now able to confess her feelings. In the view of social cognitive theory, change in behavior happens when there is alteration in the level of and strength in self-efficacy. As the level of self-efficacy increases, a person’s behavior tends to change toward positive behavior (Pervin, 1989). At some point in her life (while Forrest was running across America), Jenny must have had acquired new thought patterns and behavior, and improved self-efficacy. This change in Jenny might have been brought about in part by maturation and her becoming a mother, but mostly by having new influences to model from. During that time in her life when change started to develop, she could have met new friends who modeled to her good behavior, in an environment that accepts that kind of behavior. She might have had systematic desensitization of her phobia; thus, in the end she is not only able to go back to the man she loves and with whom she has a child, but also ask him to marry her. Internal and External Factors Jenny’s personality is both a product of internal and external factors. Among the external factors that greatly influenced her personality include her father and the abuses he inflicted upon her; her aunt who took care of her when she was taken from her father; her peers in school and the people she came in contact with throughout her life; Forrest himself and the friendship they shared together since they were young children; and the events in the society they were born into. Compared with Forrest, Jenny is more involved with the events that shaped their country. The internal factors, on the other hand, include her thoughts about, feelings toward and perceptions of the people that she came in contact with and of the events that took place around her. Together, the external and internal factors have defined the person that is Jenny. Conclusion   Ã‚   Overall, when seen from the perspective of the social learning theory, Jenny comes out as a person who was not only screwed up by the environment but also by her inability to process her circumstances in a manner that could have enabled her to prevail over the sad events in her life.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Jenny’s greatest achievement is that she eventually prevailed over her maladaptive behavior toward the end of the movie. This change, from the point of view of social cognitive theory, is not impossible. All she needed is someone to model from — someone who has had similar circumstances like hers, but is behaving differently. She must have had at least one such model.    References Albert Bandura biographical sketch. (n.d.) Retrieved January 26, 2008 from Emory University, Division of Educational Studies Website: http://www.des.emory.edu/mfp/bandurabio.html Bandura, Albert. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, N.J.: New Prentice Hall. Boeree, George C. (2006). Albert Bandura. Retrieved January 28, 2008 from http://webspace.ship.edu/cgboer/bandura.html    Pajares, Frank. (2002). Overview of social cognitive theory and of self-efficacy. Retrieved January 25, 2008 from http://www.emory.edu/EDUCATION/mfp/eff.html Pervin, Lawrence A. (1989). Personality theory and research. US: John Wiley & Sons, Inc. Social cognitive approach to personality: Albert Bandura. (2001, February 26). Retrieved, January 26, 2008 from http://condor.admin.ccny.cuny.edu/~hhartman/SOCIAL%20COGNITIVE%20APPROACH%20TO%20PERSONALITY%20ALBERT%20BANDURA%20 (1925).htm Social cognitive theory. (n.d.) Retrieved January 26, 2008 from http://www.infosihat.gov.my/Artikel%20HP/Social%20Cognitive%20Theory.doc Social cognitive theory. (2004). Retrieved January 26, 2008 from the University of Twente Website: http://www.tcw.utwente.nl/theorieenoverzicht/Theory%20clusters/Health%20Communication/Social_cognitive_theory.doc/ Social Cognitive Theory. (n.d.) Retrieved January 26, 2008 from University of Wisconsin-Milwauke Website: http://www.uwm.edu/~vince/psy407/wwwcourse.407.lec20.soccog.handout.htm    The psychodynamic theory. (n.d.) Retried January 26, 2008 from Ryerson University Website: http://www.ryerson.ca/~glassman/psychdyn.html Tishe, S. & Finerman W. (Producer) & Zemeckis, R. (Director). (1994). Forrest Gump [Motion picture]. United States: Paramount Pictures.   

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- AMAZON - Case Study Example The featured organization remained engaged in selling DVDs, CDs, VHS cassettes and a lot of electronics before it can actually became capable of developing and commercializing Kindle Fire tablet. The introduction of Kindle acted like a lucky charm for the retailer and things initiated to look improved ever since the product was launched in the year of 2011 whereas, its predecessor Kindle e-book Reader was launched in 2007. The improved version of the formerly mentioned product was released in 2012 (History & Timeline, 2014). The company produces products by outsourcing their manufacturing to countries that can produce them cheaply. The apparels are made in Sri Lanka and Bangladesh. The technological products are either made in China or US. The products are distributed through chain of warehouses, fulfillment centers and third party distributors (Kucera, 2014). Jeff Bezos had incorporated Amazon.com as an organization in July 1994 and the website was made available for customer use in 1995 after intensive tests and beta version releases. However, the concept worked and worked great indeed. The initial name of the company was Cadabra and it was replaced with Amazon after getting inspired with the title of Amazon River which is one of the most spacious water masses located on the face of the Earth. The Amazons is a term that was used to refer to great nation of female warriors known to exist in the traditional Greek mythology. Amazon managed to vend its subsidiary websites to England, America, France, Canada, Italy, Germany, Spain, Australia, Brazil, Japan, China, India and last but not the least Mexico. In 2011, the company was in plans to launch its websites in Poland, Netherlands and Sweden. Jeff Bezos did not engage in internet business in the period of early development of the industry but he made up for his misgivings in this regard an d introduced Amazon in 1994. Amazon as a

Death Of A Salesman by Arthur Miller Essay Example | Topics and Well Written Essays - 750 words

Death Of A Salesman by Arthur Miller - Essay Example Broken and delusional, he goes home to his family, trying to make sense out of his life (Whitalec 144). The challenge for Willy is that he does not know how to do anything else but sales. Although he attempts to find a job with his neighbor Charlie, he is unsuccessful. Eventually, he decides that the best thing for him to do is commit suicide; at least his family will have the insurance money when he is gone. 2 Symbolism There are a variety of symbols that Miller uses to advance the story. The title itself is a symbol of the dying breed of traveling salesman, as well as a foreshadowing that Willy will eventually take his life. In the beginning of the story, Willy likes to do gardening at night and there is a great emphasis on planting seeds. Seeds are a symbol of growth and these are also the seeds of the many pleasant memories that Willy has about Ben and about his â€Å"past and barren present condition† (Ali 1). The seeds are also a symbol for the wealth that Willy wants an d his need to put food on the table for his family. Planting seeds can also be about telling someone bits of wisdom. Willy felt that he was not able to help his son Biff in a way that would have helped him become someone in the world. From Willy’s perspective, Biff is not doing enough with his life and this is because Willy was not able to â€Å"cultivate and nurture† (Sparknotes 3) his son. Willy feels that if he could have planted the seeds of ambition within his son, that he would have done more with his life. The American Dream is a symbol that runs consistently through the story and it is a symbol of what Willy feels he cannot have, no matter what he does. Part of the American Dream is to have money and for Willy, the diamond mine that his brother was working with was about wealth. Diamonds present a symbol of wealth that is tangible to Willy and he sees diamonds as a way to validate his labor. Diamonds are also a symbol of a legacy that he could pass down to his sons (Sparknotes). Unfortunately, the American Dream has not meant wealth for Willy and at the end of the story he kills himself so that his family can receive the insurance money for his death. Stockings are often sold by salesman and Willy seems to be obsessed with making sure that his wife has new stockings all the time. These stockings are also a symbol of infidelity when Biff finds out that his father is having an affair and has given a pair of new stockings to his mistress. Also, new stockings for his wife provide Willy with the idea that he has taken care of at least one of his wife’s needs (Sparknotes). Willy lives in New York hoping that he will one day be able to move ahead in life. He yearns to leave the city and go to Africa with Ben (though Ben is now dead) or he would like to go to the American West. These symbols show Willy as someone who really wants more out of life but he does not know how to do this for himself; instead, he lives his dreams of wealth throug h hallucinations of his brother Ben. He had the change to go with Ben at one point in his life, but he did not do it because he was afraid. He allowed his home to restrict his movement. His home is actually another symbol of his restricted living. He does not have a space at home that is totally his and it is met with many financial problems that continue to keep him restricted (Witelec 1). The issue of acceptance is another theme that also acts

Magical Healthy Goodies Essay Example | Topics and Well Written Essays - 1250 words

Magical Healthy Goodies - Essay Example She plans to receive orders and preferences regarding goods through wall postings and messages. The products will be delivered two days after the order is posted on Facebook. The proposed business is in its start up phase. At this stage the aim of the business is to earn as much profits as possible to finance the initial set up of the business. Another objective of the business is to create awareness about its existence and get many customers. She cannot afford to use expensive methods of advertising her products. The business also aims to establish a reputation of always delivering goods on time and a reputation of selling good quality and healthy goods. The business cannot afford to pay the salary of too many employees. Ms Fatmah Hemdan has decided to appoint Ms. Alyaa Mohamed as her personal assistant and she would look after the entire business management. The business activity is a home-based business, named as Magical Healthy Goddies. Products offered are healthy and low calorie products like Cookies, Pastries and cakes. Customization of products is also intended to be available according to the needs and demands of the customers. Ms Fatmah Hemdan has decided to use the social networking site, Facebook for marketing her goods. This hardly involves any expenditure and will help her to get her initial set of customers. After her goods become popular she can expect to get more customers through ‘word of mouth’ publicity. This company is a sole proprietorship. The main stakeholder in this company is the owner herself. Ms Fatmaha has to be careful to avoid undercapitalization and has to ensure that the business has sufficient working capital. Ms Fatmah may take a loan from the bank to meet the initial start up and operating expenses. Banks may not lend seed capital and she might have to borrow from her close relatives. Therefore the stakeholders in the company would be

National Brands vs. Private Labels Term Paper Example | Topics and Well Written Essays - 250 words

National Brands vs. Private Labels - Term Paper Example Private brands, however, have a great economic value for both the retailer and the customer. They do create customer loyalty that eventually contributes to referrals and effective word of mouth to other customers and thus higher sales for the retailer. In addition, private labels give retailers sole ownership of the product. The retailer will come up with innovative ideas related to pricing and quantity and thus suiting the preferences of the customer (Horowitz, 2000). The main disadvantage of nation-manufacturer brand emanates from the high cost that may discourage some consumers and limit profitability while low unit profit margin that may compromise quality to consumers and motivation among retailers is the major disadvantage of private-label brands. It is quite difficult to determine whether the own-labeled brands are equal in pricing and quantity to national labeled brands. Hence, the customers may be exploited without their knowledge. Unlike the store brands, national brands spend exorbitant amounts of resources in advertising across a wider region and the burden of the cost falls on the customer because of the expenses incurred (Aaker, 1991; Horowitz,

The Power of Words Essay Example for Free

The Power of Words Essay For those of you who like to create, you know that you are never fully satisfied with what you produce. Sure it may get the grade or suffice for what you planned to accomplish, but the thoughts circling what you could have done differently or ways you could improve can grow in the back of your mind. Maybe after investing great measures of effort and time, you are Done  by the time you’re done; don’t want to think about it, just want to move on. But maybe you go back, and go back, and go back, and can’t stop dwelling on things you could do or change to make whatever you made/produced/created manifest the ideas in your mind in a more accurate way. Well, that is how I feel about what I write. Since coming home for the summer, I’ve revisited old papers and essays for further refinement and fine tweaking just because I think it’s fun (and because I’m a perfectionist, whoops). So some of the essays I post are more loved and tended to than others, but today I am posting the first essay I wrote for the Nonfiction Writing class I took this past spring at KU. It’s come a long way since then, and I’m certain I will pay it a visit again in a few weeks or months and mix things around yet again. One day I love it and am happy with the progress I’ve made, and another day I am frustrated by my inability to express exactly what I want how I want. But that’s just the way it is, I suppose! so all that to say, here are some thoughts on the power of words, which just so happens to be the clever title of my essay. Boom. Feedback welcome! The Power of Words The tongue has the power of life and death, and those who love it will eat its fruit. -Proverbs 18:21 Long before I began, words existed. Even in my infancy, I babbled indistinct jargon to empty air. As a toddler, my parents spoke to me and urged me onward as I struggled to coerce meaning into form. With great exertion, I studied the shape of their mouths and attempted to recreate the sounds myself. Through practice, frustration, and failure, I learned words. But after nearly two decades of befriending new words, there are still words left unlearnt. Each new introduction excites, confounds, and embarrasses me all in one breath. When I shy away, they beckon me to understand. Thankfully, the words are gracious to those who delight in their discovery. I live to encounter them; to be empowered by them. However, I have failed to remember this until just now, and this fresh remembrance peels the scab of a wound I’ve left untreated for far too long. No amount of stitches could seal up this wound. My hands wrung together, willing the searing fire to subside, willing to forget the sting of the blade. But the penetration of a double-edged sword permits no man to walk away unscathed. I am no exception. The memory of my injury echoed and swelled in my mind, piercing me deeper and fiercer with each remembrance. Any compliment offered to me was like putting a cold compress on the head of a patient in need of heart surgery: a kind gesture, but naive at best. No earthly remedy can heal the wound caused by a rash remark, a reckless word, a biting tongue. The words reverberated, transcending both time and space, tossing a pinch of salt into the festering puss with each visit. In one blazing breath, the levee was breached. Insecurities gushed forth from moments past to moments present. The words washed over me again and again and again, throbbing to the rhythm of a familiar pulse. Worthless. Ugly. Insufficient. Outcast. The faces of the ones who introduced me to these words flooded my mind. The playground bully, the jealous friend, the past love interest, the inconsiderate classmate – one by one, their faces appeared and circled around me, each breathing their own kind of fire. They etched their scorching words onto my memory and my heart. Each recollection brought a new wave of hurt. Their flames engulfed me and I stood defenseless. Perhaps these dragons were right about me. Perhaps I was what they said. My knees began to buckle beneath the weight of some sort of self-hatred or bitterness. But just before I collapsed to the cold kitchen tile, my mother’s arms encircled me from behind and secured me in an embrace. Her hushed whispers traveled through my ear into my aching sides, tenderly dressing my wounds with honey. Gentle reassurances momentarily cooled the scorching fire which ravaged my thoughts. My mother’s sweet lips massaged my burns as nourishing balm. Maybe I wasn’t as worthless as they said. Though words have destroyed me, they have also restored me. But sometimes my scars whisper to me in the middle of the night, reminding me, ushering me into the dragons’ lair where I am taunted by each rash remark, reckless word, or biting tongue that has ever wounded me. Even as a child, I understood the weight of words and the value in speaking responsibly. I remember shutting the door of my fourth-grade classroom, double-taking to ensure no one was watching, and skipping along the empty hallway in search of the nearest drinking fountain. My eyes danced until they rested upon the rusted spigot. Suddenly, my innocent skip-to-my-lou developed into a nutcracker’s march. I swung my arms and stomped my feet to the beat of a distant war drum, stifling giggles at my own theatrical display. I was hilarious, giddy, free. At last I lowered my lips, gently twisted the nozzle, and felt the cool water trickle down the back of my throat. After several gulps, I straightened my back and my eyes zeroed in on a laminated poster taped to the wall. It portrayed a crying girl with her back turned from a group of laughing schoolchildren. My heart sunk as I read, â€Å"Sticks and stones may break my bones but words can never hurt me.† What a lie, I thought. Why else would the girl be crying if she was not hurt? Who wrote this? Though I stomped back to my classroom, it was not a giddy stomp as before. I felt indignant at the injustice done to the crying girl in the poster. Even as a fourth grader, I knew words were far more powerful weapons than measly sticks and pebbles. I suddenly wished I was Mary Poppins and could leap inside the poster and watch the clip-art scene come to life. I would parade right towards the menacing pack of bullying children, stand on my tippiest-toes, and wag my finger in their mocking face. How could they not see the hurt they caused, the damage they’d done? The artist of this poster flippantly dismissed the girl’s hurt – dismissed my hurt. Obviously, he has never entered the dragon’s lair; or perhaps, he has but is simply trying to forget. Perhaps he hopes that denying his injuries will ease the pain they bring. The very thought caused my own scars to burn. Rage pulsed through my body as I thought of the daggers digging deeper into the crying girl’s subconscious – into my subconscious. Feeble. Pathetic. Weak. I could see the fire on the bullying children’s breath as their words melted into her ears. Though pressed down upon on all sides, her dragons bid her to stand strong as they prodded her with white-hot prongs and secured their perpetual mark. I’ll bet her scars whisper to her at night, too. To dismiss a reckless remark is to remove responsibility. This flippancy severs the cord of accountability between speaker and speech. As the mediums of our messages transitioned from slabs of stone to paper to screen, the weight of a word lost its wonder. Consider the scribe. He pauses – an ancient practice – before dipping his pen into his jar of thick, black ink. Fully aware of the repercussions of an error, he painstakingly paints each stroke with precision. He lives in an age unacquainted with a backspace key and where few can afford the price of an error. But today, a text message mindlessly tapped out is just as soon deleted. Even this sentence was reconsidered, revisited, and revised. Our ability to communicate no longer springs from our dexterity of thought but the agility of our thumbs. Our words are no longer preserved in a weighty stone tablet. Instead, they are typed, deleted, and retyped – in a two pound, portable tablet – then launched into cyberspace to be received and deleted from an already cluttered inbox. But why not? We are entitled. We have rights. Does not every tweeted and retweeted thought deserve merit merely in its right to be said? Is it politically correct to correct a politically incorrect statement? I never can tell. Our cry for the freedom of speech made passage for the freedom from speech and the careful tending that should accompany it. Our tongues run rampant – never checked nor balanced. We demand our right to speak, but our flapping mouths pay no heed to how we speak. Because an error or offensive slip of the tongue incurs only minimal – if any – cost, our words are many and close between. I fear I also am the rambling type. The filter between my head and my mouth is shorter than I’d like to admit. Sometimes I wonder if I even have a filter or if it got lost somewhere long ago in some prattling speech. Maybe I forgot I have one and, thus, never use it. In any case, I discover amusement in meandering the trail of my own thoughts and relaying my journey to others. I have never suffered from a scarcity of words. On the contrary, I am their abuser. I am apt to respond when spoken to and likely to speak until stopped. But the scribe towers over me, soliciting silence. â€Å"If you love the words, you will treasure them,† he cries. When words are many, error is not absent. Even a fool who holds his tongue seems wise for he at least holds the appearance of revering the sanctity of a word well said. Sticks and stones may break your bones, but words wield the power of life and death. One flippant remark on how one should eat cake turned nation against queen and then off came her head. By the power invested in one man’s announcement, two lives are joined and beget more life still. On the twenty-second day of September, in the year of our Lord one thousand eight hundred and sixty-two, a bearded, honest man issued a proclamation declaring that all persons held as slaves would be then, thenceforward, and forever free. A deceitful dictator once told a big enough lie so frequently that his followers ran camps where with the aim of teaching the world to decipher beauty in piles of misshapen bodies. When Sophie Scholl spoke out against that lie and called German youth to cast off their cloaks of indifference, the dictator silenced her once and for all. By the word of a King, a dream stretched over the expanse of history and cried for the equality of the emancipated. By the word of the King, dry bones rose from the grave and walked out of their tombs. The Word from the very beginning sighed that it was finished and up from the deep the dragon prince relinquished his keys. With reverence comes escape. At some point or another, I began to regard the words as my slaves. I made them toil on my behalf. Beneath my whip, they labored without rest. Though they were exhausted, I trafficked them through the night and forgot to feed them breakfast in the morning. I believed their usefulness to me fulfilled their purpose. I considered them as nothing more than a spoken sound, a written conglomeration of lines and curves and dots, existing only to serve me – the â€Å"autonomous† man, the benefactor – and my appetites. But today I realized I will soon be dead – be it in sixty years or in the morning – and the words will live on without me just as they did before me for the word and the Word cannot die.

Case Study Of Unstable Angina

Case Study Of Unstable Angina The patient in context is a 61 year old male, Mr. X, admitted to hospital in the late evening for a case of unstable angina. Presenting complaints include left-sided chest pain which was less severe than that of his previous admission and localized pain during rest. Absent symptoms are profuse sweating as well as nausea and vomiting, orthopnea and paroxysmal nocturnal dypsnoea, cough and fever. Patients past medical history includes diabetes mellitus and hypertension diagnosed 6 years ago, ischaemic heart disease (IHD) since 3 years ago, for which the last hospital admission was 11 months ago. In the previous admission for IHD, Mr. X also suffered from pneumonia and ventricular failure, his electrocardiogram (ECG) indicated right bundle branch block, his serum troponin I levels were 0.3 ng/mL (normal levels 0-0.1 ng/mL), and his creatinine levels were 5.0 mg/dL (normal for males 0.2-0.6 mg/dL). Mr. X is also afflicted with chronic kidney disease, for which his baseline creatinine dur ing his last admission was 208 ÃŽÂ ¼mol//L. Mr. X has retired from the military and is living with his wife, who monitors his medications and compliance. He used to be a chronic smoker but has stopped smoking 15 years ago. His previous medication history is as below: Drug and Form Strength Frequency Furosemide tabs 40 mg BD Omeprazole tabs 20 mg PRN Amlodipine tabs 10 mg OD Simvastatin tabs 20 mg ON Perindopril tabs 4 mg OD Table 1: Table showing past medications of Mr. X. Mr. X takes no non-prescription medications and has no known drug allergies. On examination he appears to be alert and comfortable on his nasal cannula for delivery of oxygen 3L/min. His blood pressure is 134/81 mmHg, pulse rate is 76 bpm, body temperature 37oC, SpO2 of 99%, abdomen feels soft and non-tender, and no pedal oedema was observed. A blood glucose strip test reveals that Mr. Xs glucose levels were 10.3 mmol/L. Emergency ECG shows right bundle branch block and no ischaemic changes. The tentative diagnosis was unstable angina and further tests were scheduled, including a full blood count (FBC), renal profile (RP), liver function test (LFT), troponin and creatinine (CKMB) investigations, as well as a urine full examination and microscopy (UFEME). The immediate plan was to give Mr. X subcutaneous enoxaparin 60 mg stat and twice daily thereafter, aspirin 75 mg tablets once daily, lovastatin 20 mg tablets once daily, sublingual glyceryl trinitrate when required, and to continue the 3L/min oxygen cannula. Clinical Progress Day 1 Morning Patient was well, free from chest pain, tolerating orally and suffering from no nausea or vomiting. He had minimal shortness of breath (SOB). Troponin I levels were at 0.15 ng/mL and ECG showed no acute or evolving changes. Fasting plasma glucose was at 4.8 mmol/L (within normal range). Secondary dehydration was observed using the skin pinch test, so patient was started on intravenous normal saline drip (3 x 500 mL bag per 24 hours). Patient was found to be anaemic due to pre-existing chronic renal failure. Evening Patient reported mild chest pain and SOB. His troponin I levels were 0.15 ng/mL and other vitals were normal. His creatinine levels were 423 ÃŽÂ ¼mol/L. Day 2 Patient felt comfortable and his vitals were normal. His creatinine levels decreased to 345 ÃŽÂ ¼mol/L. Day 3 Patients condition was well, no chest pain was reported but he was still experiencing some SOB in the morning, which subsided in the afternoon. Patient was put on continuous peritoneal dialysis in the late morning. Patients vitals were normal, and he was taken off enoxaparin in the evening. Day 4 Patient complained of chest pain in the morning, with minimal SOB. His vitals were normal. Subcutaneous enoxaparin 60 mg was given and the IV saline was continued. Lab Findings Urine Biochemical Analysis (Day 1) Investigation values Normal values Protein ++100 mg/dL Glucose negative negative Blood negative Leucocytes +-10 WBC/ÃŽÂ ¼L Ketone negative negative Bile negative negative Urobillinogen normal Specific gravity 1.025 1.003 1.040 pH 5.5 4.6 8.0 Nitrite negative negative Table 2: Results of urine biochemical analysis on Day 1 Lipid Panel Fasting Serum Lipid Plasma total cholesterol / mmol/L 4.5 Desirable Borderline 5.17-6.19 High risk >6.20 Plasma triglyceride / mmol/L 1.27 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Desirable Borderline 1.7-5.64 High risk >5.65 Plasma LDL-cholesterol / mmol/L 2.91 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Desirable Borderline 3.36-4.12 High risk >4.13 Plasma HDL-cholesterol / mmol/L 1.01 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Desirable >1.03 High risk Total cholesterol / HDL-cholesterol 4.5 Desirable Borderline 3.8-5.8 High risk >5.9 Table 3: Results of lipid panel (fasting serum lipid levels). Renal Profile Electrolytes Measured levels on Day 1-1.14am Measured levels on Day 1-12.54am Measured levels on Day 2-10.47am Normal range Urea / mmol/L 22.8 22.4 21.1 2.8-7.2 Sodium / mmol/L 129 128 129 136-146 Potassium / mmol/L 5.3 4.8 4.7 3.5-5.1 Chloride / mmol/L 98 94 101 98-107 Creatinine / ÃŽÂ ¼mol/L 423 398 345 58-96 Table 4: Renal profile of Mr. X showing levels of electrolytes and creatinine. Plasma troponin I 0.15 ng/mL Liver Function Test Measured level Normal range Plasma total protein 81 g/L 66-83 g/L Plasma albumin 34 g/L 35-52 g/L Plasma globulin 47g/L 25-44 g/L A/G ratio 0.7 0.9-1.8 Plasma alkaline phosphatase 119 u/L 30-120 u/L Plasma aspartate transaminase 19 u/L Plasma alanine transaminase 43 u/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Plasma total bilirubin 6 ÃŽÂ ¼mol/L 5-21 ÃŽÂ ¼mol/L ESR 47mm/hour à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ 0-20 mm/hour Table 5: Results of liver function test showing protein and liver enzyme levels in plasma. Full Blood Count (FBC) (Beckman Coulter) Cell type Measured level Normal range WBC 9.9109/L 4-10109/L RBC 3.341012/L 3.8-4.81012/L Haemoglobin 95g/L 120-150g/L Haematocrit 0.273L/L 0.36-0.46L/L Mean cell volume 81.8fl. 83-101fl. Mean cell haemoglobin 28.4pg. 27-32pg MCH concentration 347g/L 315-345g/L Platelets 353109/L 150-400109/L RDW 19.4% Neutrophils 3.3 2-7 x109/L Lymphocytes 1.74 1-3 x109/L Monocytes 0.55 0.2-1.0 x109/L Eosinophils 0.21 0.02-0.5 x109/L Basophils 0.03 0.02-0.1 x109/L Table 6: Full blood count of Mr. X. Vital Stats Chart Date Time Blood Pressure/ mmHg Temperature / oC Pulse Rate/ bpm SpO2/ % Blood Glucose levels/ mmol/L Day 0 11.05 pm 140/80 37 91 100 13.9 11.30 pm 137/84 37 80 100 Day 1 8.30 am 130/80 37 70 4.8 (fasting) 3.55 pm 130/70 37 90 10.30 pm 108/64 37 81 Day 2 8.20 am 119/69 37 78 4.50 pm 130/90 37 82 9.6 9.45 pm 140/90 37 80 6.7 Day 3 8.50 am 114/77 37 72 98 6.6 Table 7: Records of vital stats of Mr. X from Day 0 3. Disease Overview Pharmacological Basis of Drug Therapy Acute coronary syndrome (ACS) is a broad term used to classify a continuum of symptoms and events stemming from acute ischaemic episodes affecting the cardiac muscle.1 This includes unstable angina, non-ST segment elevation myocardial infarction (NTEMI), and ST segment elevation infarction. It is usually characterised by chest pain which increases in its severity at rest or with physical exertion. The ischaemic events usually arise from the development of unstable atheromatous plaques,2 which explains the fact that stable angina (due to a stable coronary atheromatous plaque) is not included under this umbrella term. Rupture, ulceration or fissures of the atherosclerotic plaque often leads to formation of a thrombus, causing occlusion of coronary arteries and inadequate blood flow and, subsequently, inadequate supply of oxygen and nutrients to the cardiac muscle. This can be precipitated by acute stress factors on the sclerotic cap usually consisting of fibrous material, which is caus ed by local blood flow disturbances or vasospasms3. Unstable angina usually occurs without cardiac muscle damage while myocardial infarction (MI) may occur with or without myocardium damage. The thrombus formed in unstable angina is labile and obstruction is transient, and not a full-on occlusion as would occur in MI.4 Unstable angina occurs at rest and is almost indistinguishable from a non-ST segment elevated myocardial infarction except in the severity of cardiac muscle ischaemia. Theoretical definitions of unstable angina would include changes in usual patterns of stable angina after a stable pain-free period, or severe acute anginal pain causing almost total incapacity5, though it is difficult to define it exactly as the term is often used by medical professionals to describe a range of different conditions intermediate between stable angina and MI. The primary clinical symptoms of unstable angina are: sudden occurrence of chest pain that persists for more than 20 minutes which may be felt in other areas such as the jaw, arm, shoulder, neck or back; without cause (as opposed to stable angina which stems from physical exercise); shortness of breath, rapid pulse rate, and sometimes a rapid drop in blood pressure. Patients suffering from an ACS have a high risk of MI and possible even death; immediate hospitalization is often required1 and treatment is of a more urgent nature compared to that of stable angina. It has been suggested by the National Health Service (NHS) Hospital Episode Statistics in 1998 that 1000 out of every million per population is affected with unstable angina, or 10 acute hospital admissions per week.6 On a more recent note, NHS has reported in 2009 that angina affects between 10-15% of women and 10-20% of men aged 65 and above in England.7 Due to the close relationship between unstable angina and coronary events, it is worth noting that the highest averaged rates of cardiovascular events were observed in Glasgow and Belfast (UK), North Karelia and Kuopio (Finland), Newcastle (Australia), and Warsaw (Poland).8 Diagnosis of an unstable angina episode, or any ACS in that matter, is based on several aspects9. Physical symptoms include anginal pain at rest that lasts for 20 minutes or more; new onset angina severely limiting ability of physical activity; or changes in existing angina intensity, frequency or length of attack. One or more of these symptoms are an urgent indication that the patient is suffering from an ACS attack. Upon admission to hospital, ECG and blood tests should be performed to confirm the type of ACS in order to initiate treatment. In unstable angina, the ST segment is not elevated and levels of cardiac enzymes are normal (especially troponin T and I). If the onset of symptoms is unclear as to indicate ACS, a measurement of serum troponin concentration should be carried out 12 hours from presentation to establish the diagnosis.10 Treatment of unstable angina and NSTEMI are similar in terms of pharmacological management; indeed they are at presentation indistinguishable exc ept in terms of the severity and extent of cardiac muscle ischaemia, in which the ischaemia is less severe in unstable angina and less troponin T and I are released into the bloodstream. Antiplatelet agents. Aspirin and clopidogrel are the immediate emergency drugs used in the ambulance, both being antiplatelet drugs. Aspirin is an irreversible inhibitor of arachidonate cyclooxygenase (COX) enzyme, in which covalent acetylation of the serine moiety in a hydrophobic channel in the enzyme11 reduces synthesis of thromboxane A2 in platelets and prostaglandins in the endothelium. This prevents platelet aggregation and further enlargement of the thrombus formed in the coronary artery. Clopidogrel is an inhibitor of the ADP-dependent activation of the GPIIb/IIIa receptor and prevents the formation of fibrinogen bridges between glycoprotein IIb/IIIa receptors on the surfaces of platelets11, subsequently preventing platelet activation. Glycoprotein IIB/IIIA receptor antagonists, eg, abxicimab, have the advantage of inhibiting all pathways in the platelet activation process by inhibiting the glycoprotein IIB/IIIA receptor. Anticoagulants. Unfractionated heparin is an activator of antithrombin III, which inhibits the action of thrombin and serine proteases. The heparin also binds to thrombin; the combined effect of this and the heparin-antithrombin complex formed inhibits thrombin, which decreases the conversion of fibrinogen to fibrin and reduces platelet aggregation. In contrast, low molecular weight heparins (LMWH) have molecular sizes that are too small to bind to thrombin but still bind to antithrombin III, which inactivates all serine proteases including Factors XIIa, IXa, and Xa11, preventing the coagulation process. Direct thrombin inhibitors such as hirudin and bivalirudin inhibit thrombin reversibly. These agents can bind to free and bound thrombin, thus have the ability to prevent and dissolve preformed clots. Synthetic pentasaccharides (fondaparinux) is a selective indirect inhibitor of Factor Xa. It binds to antithrombin III reversibly, catalyzing the inactivation of Factor Xa12 and inhibit ing the coagulation cascade. Beta blockers. All beta blockers bind to beta-adrenoceptors, competitively antagonizing the action of catecholamines. These drugs block the beta-1 adrenoceptors at the heart, achieving a decreased heart rate and force of cardiac contractions, as well as lowering blood pressure. Atenolol is relatively specific for cardiac beta-1 adrenoceptors and exerts fewer side effects associated with beta-2 adrenoceptor blockade, for example bronchospasm in asthmatics. Nitrates. Organic nitrates mimic the actions of endogenous nitric oxide to relax vascular smooth muscle by increasing the synthesis of cGMP, leading to the dephosphorylation of myosin light chains.11 Vasodilatation of coronary arteries causes increased coronary blood flow and coupled with its effects of decreasing arterial pressure and also cardiac output, the myocardial oxygen consumption is largely reduced. Statins. Also termed HMG-CoA reductase inhibitors, these medicines inhibit the rate-limiting enzyme in the synthesis of cholesterol, in which this enzyme converts HMG-CoA to mevalonic acid. ACE inhibitors are diuretics acting on the rennin-angiotensin system which inhibit the angiotensin-converting enzyme (ACE) and block the production of angiotensin II from angiotensin I. This reduces vascular resistance, increases tissue perfusion, and reduces cardiac afterload. Angiotensin II receptor inhibitors also act on the same system as the ACE inhibitors, except that they block the angiotensin II receptors directly instead of inhibiting their formation. The outcome is the same as above. Evidence for Treatment of the Condition Antiplatelet Agents The SIGN guidelines advocate that aspirin and clopidogrel be given to patients with ECG ischaemic changes or increased levels of cardiac markers; and aspirin is advocated for all patients suffering from ACS. A meta-analysis of 287 randomised trials proves the protective effect of aspirin on patients with unstable angina, halving the rate of cardiovascular events, including death, non-fatal MI and strokes, or also termed the first primary outcome; while in those with an acute MI, it reduces the rate of coronary events by almost a third13. Long-term use of aspirin for these patients was also shown to be a beneficial antiplatelet therapy. According to the same study, reduction of serious vascular events by clopidogrel was 10% compared to aspirin. The combined use of clopidogrel and aspirin as compared with a placebo and aspirin showed significantly higher success rates in reducing occurrences of first primary outcomes (9.3% compared to 11.4%, P On the flipside, although short term studies have shown that antiplatelet medications are effective for patients with renal failure in the prevention of serious vascular events13, the risks of bleeding is increased by renal disease15, posing a possible contraindication for antiplatelets to Mr. X. A clinical study found that treatment for NSTEMI ACS in patients with chronic renal disease (mild to moderate stages) was less aggressive than those with normal renal function, despite the risk that these patients with renal disease would experience greater adverse outcomes from insufficient treatment for ACS compared to the other patient group16. However the available information on adverse effects of antiplatelets on patients with varying degrees of renal disease is limited and it would appear that this would result in the reluctance of medical professionals in using this class of drugs for patients with chronic renal disease as well as ACS. It can be inferred that Mr. X would gain the maximum benefits if his medications were changed to aspirin 300 mg and clopidogrel 300 mg stat and aspirin 75 mg and clopidogrel 75 mg thereafter, in which the patient should be closely monitored for signs of bleeding. Heparins LMWHs A 2003 review of 7 studies involving 11,092 patients with non-ST elevation ACS found that low molecular weight heparins (LMWH) were more effective than unfractionated heparins in reducing MI events, requirement for revascularization procedures, and thrombocytopenia17. No difference in the mortality, recurrent angina, major and minor bleeds were observed in the two types of drugs. A meta-analysis of 12 randomised trials with 17,157 patients involved found that patients who have had a non-ST elevation ACS who were put on aspirin experienced no significant difference in benefits in efficacy (preventing MI or death) or safety (major and minor bleeding complications) when they were put on unfractionated heparin or LMWH17, implicating no difference in the thrombolytic effect in both classes of drugs. These results are partially similar to those of the first review. Another meta-analysis of 2 phase-3 trials comparing enoxaparin and unfractionated heparin, on the other hand, showed a signifi cant (20%) difference in reducing death or severe cardiac ischaemic events18. From an economic point of view, authors of yet another meta-analysis on the subject stated that the cost of LMWH is 3-5 times higher than unfractionated heparin19. From these data it can be concluded that LMWHs does indeed have additional positive treatment outcomes compared to unfractionated heparins22; it does not show significantly decreased side effects (bleeding). Enoxaparin has, though, an increased bleeding effect on patients with renal disease as reported by an investigation of 106 patients, in which total bleeding complications occurred in 22% of normal patients and 51% of patients with impaired renal function (p It is still the drug of choice for patients present with non-ST elevated ACS, and this is applicable to Mr. X with unstable angina. Beta-Blockers Beta-blockers were not prescribed for Mr. X. The SIGN guidelines states that beta-blockers should be the drug of choice for first line treatment of anginal pain in patients with non-ST elevated ACS. A meta-analysis of 5 trials consisting of 4700 patients in all showed a 13% reduction in anginal pain with the use of beta blockers (initially IV then oral for a week) in patients with non-ST elevated, MI-characterised chest pain23. It was stated in the clinical progress Mr. X had chest pain on Day 1 and 4, thus the addition of a beta blocker to his medications would be useful in alleviating his pain. Despite the popular belief that beta-blockers are contraindicated in patients with diabetes mellitus, it is possible to treat these patients using beta-blockers as long as good glycaemic control is achieved and the patient is monitored regularly24. This would further support its use in Mr. X; furthermore, several studies have shown that diabetic patients derive a significant benefit from the use of beta-blockers after an MI, in which diabetic patients had a significantly lower mortality 1 year post-discharge25, total mortality after 3 years, and deaths from cardiac events26. A multicentre randomized trial, the HINT trial, on patients with unstable angina found that metoprolol, a relatively cardioselective beta blocker, reduced occurrence of myocardial ischaemia or progress to MI within 48 hours, indicating that metoprolol has a short term beneficial effect on patients not already taking beta blockers prior to the unstable angina episode27. It has been suggested that beta-blockers be the first line treatment for unstable angina and if patients remain unstable, a calcium channel blocker should be added28. Statins The beneficial effects of statins in reducing mortality and cardiovascular events have been proven by a meta-analysis of large, randomized controlled trials (n=90,056) where coronary artery disease was present or absent29. The positive results were also proven spanning a large range of serum cholesterol levels. Investigations comparing the use of intensive versus moderate doses of statins in the early stages and post-ACS showed positive results: a meta-analysis of 4 large trials (n=27,548) shows a 16% reduction in cardiovascular deaths or MI, as well as a 16% reduction in cardiovascular deaths or coronary events30. This view is shared by another meta-analysis of the same subject of 13 randomised controlled trials which found a decrease in mortality and coronary events after 4 months of treatment31. These data support the use of statins by Mr. X. Nitrates Nitrates have been widely used in relieving pain from unstable angina, despite its lack of clinical evidence in supporting its role in improving survival and reducing the rate of MI and cardiovascular events32. ISIS-433 and GISSI-334 reports no significant difference of the use of glyceryl trinitrate post-MI in reducing the overall mortality; however this may be explained by the fact that more than 50% of patients in the controlled group are also on other forms of nitrate therapy, such as intravenous glyceryl trinitrate. Despite this, nitrates will still be of use for reducing the pain in post-MI patients and those with unstable angina. The BNF advises against the use of nitrates in patients with serious anaemia (Hb Glycaemic control Mr. Xs plasma glucose levels were elevated on the day he was admitted to hospital (13.9 mmol/L). Diabetes mellitus has been proven to be a strong independent risk marker for coronary heart disease: patients with poorly controlled diabetes at hospital admission have a worse outlook on prognosis and future development of cardiovascular events35. The DIGAMI investigation reports that the use of intensive insulin therapy increased long-term prognosis (P=0.011) of patients presenting with hyperglycemia (>11mmol/L) at admission compared with those on standard antidiabetic therapy36. These data support the use of insulin to control the blood glucose levels of Mr. X which were highly increased upon admission. This is also supported by the SIGN guidelines which advocate immediate control of blood glucose is carried out for MI patients with glucose levels of more than 11.0 mmol/L for at least 24 hours. ACE Inhibitors The SIGN guidelines recommend that patients with unstable angina should be given ACE inhibitors as long-term therapy. In patients at high risk of cardiovascular events, ACE inhibitors (ramipril was investigated in a report37) have been proven to reduce overall mortality, MI, and stroke, particularly in patients with diabetes mellitus. Perindopril was found to reduce cardiovascular risk (relative risk reduction =20%, P=0.0003) in a population with stable coronary heart disease in absence of heart failure38 in a double-blinded, randomized multicentre trial involving 13,655 patients. A meta-analysis of the 2 above trials and a third one (PEACE) showed a reduction in overall mortality, cardiovascular death, non-fatal myocardial infarction, stroke, heart failure, and coronary artery bypass surgery by ACE inhibitors39. This demonstrates the benefits of ACE inhibitors in patients with atherosclerosis: as patients who had an ACS event would have a higher rate of cardiovascular events, the po sitive outcomes of ACE inhibitors can perhaps be extrapolated to this population in order to decrease coronary events and improve prognosis. However, the BNF advises caution and close clinical monitoring if ACE inhibitors are to be used in patients with hyponatremia ( Oxygen therapy On admission, Mr. Xs SpO2 was 99% and remained high throughout his stay in the hospital. The use of oxygen therapy is significantly beneficial only in hypoxic patients (with SpO2 Anaemia and Unstable Angina Anaemia can disturb the balance between myocardial oxygen supply and demand: a decrease in the number of red blood cells can lead to a reduction in the supply of oxygen to the myocardium. Thus correction of the causative factor would be sensible in the treatment of unstable angina for the patient in context. Mr. X was given a combination of ferrous fumarate, vitamin B complex, and folic acid for treatment of his anaemia. From the data in Table 6, it can be seen that Mr. X has low haemoglobin concentrations (95 g/L) and a low mean cell volume (81.8 fl.). To confirm that Mr. X is indeed suffering from iron-deficiency anaemia (as suggested by his treatment medication), three parameters must be established namely the plasma iron, the plasma ferritin, and total iron binding capacity. However, as very few conditions can cause abnormalities in the mean cell volume, and a decreased value is due to iron-deficiency anaemia or thalassemia42, it is safe to assume that Mr. Xs anaemic condition is due to an insufficiency of iron. Iron supplements are given to correct the iron status of the patient, in which the ferrous form given orally is found to be cheap, safe and effective in the majority of patients with iron-deficiency anaemia2. Vitamin B complex and folic acid are only indicated in patients with the respective deficiencies2; there is little evidence that they would be of any significant benefit in patients with iron-deficiency anaemia. Summary Based on the evidence given, Mr. Xs aspirin dose should be changed to 300 mg stat and 75 mg thereafter, and clopidogrel should be added into his medication profile in the same doses. These changes ensure that Mr. X is obtaining sufficient antiplatelet effects from his medications to prevent another attack of unstable angina or even a myocardial infarction. Present drugs that were given for his condition that are suitable and supported by evidences include enoxaparin, lovastatin, insulin, and GTN: these can be safely continued without problems. A beta-blocker (metoprolol tablets) may be given additionally in doses of 50-100 mg as evidences described above have shown that they can be safely used in diabetic patients contrary to popular belief; an ACE inhibitor (perindopril as previously used by Mr. X) may be initiated coupled with regular electrolyte

Film Review King Arthur

Film Review King Arthur Film Review King Arthur The film I will be reviewing is called King Arthur. King Arthur is from the action epic genre and is a brilliant well put together film which will help many audiences in many ways and would be bound to sell. I will also include a historical context showing how King Arthur was related to the Roman invasion of Britain and how it also affected the characters involved. The maker of the film is Jerry Bruckheimer. The actors that star in the film are Clive Owen as king Arthur, Keira Knightley as Guinevere, Ray Winstone as Bors, Ioan Gruffudd as Lancelot Stellan Skarsgà ¥rd, Stephen Dillane. Clive Owen has a reputation for providing top class films. Back in 1990, he performed as the wisecracking, sharp-suited wheeler-dealer Stephen Crane in the hit show Chancer; he was described as â€Å"the hottest thing on TV†. Keira Knightley also has a reputation for providing top films such as her earliest Bend It like Beckham to in 2003 Pirates of the Caribbean. After performing in those still only 18 she also preformed in Love Actually and then continued Pirates of the Caribbean. From this we can see that all the actors and actresses are excellent and great performers so therefore my expectations only followed by their reputation. The film is all about King Arthur and the Knights of the Round Table. It came out in 2004 and lasts for 140 minutes. There is a lot of history of this film as King Arthur is a legend. Similar to Robin Hood King Arthur has many different versions such as an older version and this newer version. In my opinion the film is a great one attracting a wide audience of historians, people with an interest in King Arthur and action packed viewers. King Arthur is believed by some as a myth but most believe he was a real king and that he really did make England proud. This film is set around 409 A.D. This time was when the Roman Empire controlled most of Britain. King Arthur, who is partly Roman and an ally to Rome, was mainly British and loved his country that every battle in this film he would fight would be for him and his knights of the round tables freedom. As an agreement all these British villages had to send their children and some adults to fight for Rome. Similar to subscription and they had to serve a certain amount of time where they would earn their freedom. Later on after a few years in around 410 A.D the Roman invasion had ended because Rome had redrawn from Britain due to other opposing enemies and also due to the attack of the Saxons and Scots. The film begins with a well worded description of the legend of King Arthur which reads â€Å"Historians agree that the classical 15th Century King Arthur and his knight’s rose from a similar individual who lived in a period often called the Dark Ages†. The picture comes awake with a Roman army on horseback often called the â€Å"Praetorian† an elite roman horseback army. The beginning of the film is very important because it sets the scene to what the whole film is about which in this case is about the Roman Britain Empire and its connection with King Arthur. We see at the start a map which shows how far the Roman Empire extended which was from Saudi Arabia to Britain and this is a key point in understanding why Rome called for King Arthur and his knights to carry out so many missions. The reason being that Rome was not satisfied with their land they kept on wanting more and more so leaders like King Arthur were sent on missions to keep the Empire strong. This s hows the outline of the film and the reason as to what the film is about. One key point that we notice in the film is that Lancelot who is one of Arthur’s knights is the narrator and speaks in 1st person â€Å"I was such a son† he said when at the start the roman army came to recruit him on the grounds similar to conscription. So he was off to fight for Rome. Then the scene changes and we see King Arthur as a young boy who is presented as a bright future leader both wealthy and important as we can tell by his freedom of movement. Arthur sees the young knights including Lancelot on horseback and asks who they are and he is told they may someday be his knights little does he know that one day they will. This is a use of dramatic irony as we know it is to happen by the role of Lancelot as one of his knights but the character himself is unaware. After this scene there is a gap which says â€Å"15 years later† then they are all shown as grown men and we notice that there conscription was supposed to be for 15 years therefore the director lives the audience to find this out for themselves. Then we see the characters for the first time as men and their first mission is to protect the bishop from the forest Woads who Merlin (an old friend of Arthur’s) leads. The Woads attack some Roman troops so Arthur and his knights pace to the scene and upon arrival witness the deaths of these Roman soldiers. The Knights take up their swords and fight off the Woads for now as Merlin looks on from the forest. After the attack the Bishop appears dead with an arrow straight through his head however Arthur spots it is not the bishop but a fake. The real Bishop appears and they talk about the great Samaritan Knights that Arthur leads. After they arrive at the castle where all the knights expect their freedom from the subscription that they are bound to. However the Bishop revels that the pope has one more mission for them and all of the knights including King Arthur disapprove after 15 long years of fighting however the mission is to rescue the pope’s favourite godchild and pupil so therefore on their last day of subscription they must go on this mission. As to be expected all the Knights don’t want to go but after a talk from King Arthur unwillingly for Arthur they approve. So after the disapproval of the mission the scene changes and we see who the knights will come up against. Saxons from the north. They were very strong at the time and the opposition to the Romans. When Rome left in 410 A.D it was the Saxons that took over England. We then see the Saxons killing innocent women. This demonstrates the brutality of the Saxons. Then the Knights get on their horseback and ride off towards their mission. They cut through the forest where they are being tracked by Merlin’s knights. Aware of the movement of the Saxons Merlin traps Arthur and the Knights in the forest and they agree to fight the Saxons together. After reaching their mission point they find Alecto the godchild of the pope. Arthur finds a secret door blocked up and his Knight uses his axe to break it down. Inside they find injured Woad. The Woad is called Guinevere who by legend is the eventually the wife of King Arthur therefore this is an important step because this is the entrance of a main character played by Keira Knightley. After a disagreement with the townsman leader the father of Alecto the knights take off away from the Saxons. The Saxons continue to get closer and closer. Then they reach the ice and they finally intercept with the Saxons. Ready and prepared to fight the main scene unfolds. The odds start at 7 Samaritan knights against 200 Saxons. The fight starts with the 7 using their long bows to cut off the wings of the 200 it forces them to stay together putting more weight on the ice eventually the ice begins to break however their out of range and the ice hasn’t broken. Dagenot one of the knights runs forward with his axe and breaks the ice covered by the other 6 with their longbows. Unfortunately he is shot with arrows 3 times and dies however their mission is a success in one way but a loss in another. The next scene begins back at the castle where they are greeted by the Bishop who is happy to see Alecto. They are given their freedom but Bors and all the others are unhappy due to the loss of Daganot. They buried Daganot and looked on in a sad manner. Then we see the final scene which is where the Saxons have risen to Hadrian’s Wall and are ready to attack the Emperor and the knights. However the Romans are leaving and the knights are free but King Arthur says he must stay and fight. None of the knights stay but when they see the bravery of Arthur on his own they race to back up. Then the first Saxon army attack behind the castle gates therefore the Saxon leader can’t see who is winning and only a few of his army come out and they believe there was only six knights however the Woads have joined and they all worked together and Arthur was there leader. The final Saxon army attacked and lost to King Arthur in a great battle and casualties were lost such as Bors and Lancelot which who were two of Arthur’s Samaritan knights. Also the narrator was Lancelot so we notice it is told by a character that later dies this is a technique to have a greater influence of understanding the times of King Arthur and the Knights of the Round Table. The battle ends and Arthur wins and they bury the dead and Lancelot’s request to be cremated takes place. The film ends as Guinevere and Arthur get married and Britain is in safe hands. My opinions of the movie are that it is a good exciting film. The film is entertaining and the storyline keeps the audience in suspense. Another good opinion of the film is that the historical context makes the audience want to see the film because they want to know more about Roman British Empire so they are more likely to see the film. One part I like is where at the start the knights defeat the Woads even though there are only a few knights. I like this part because it makes the knights look strong and therefore impresses me as the audience. Another part I liked is when Daganot takes his axe and destroys the ice so that the Saxons can’t cross the line. However I found this sad because Daganot gets killed in this part of the film. Another action packed part is the last scene where there is a big battle. This scene is action packed and therefore entertaining in the film. Compared to films like Gladiator this film is better because it gives a more historical outlook on the fil m. Therefore I think it is more successful and more entertaining. I think in the film that when the character of Lancelot died it was disappointing because historians know that he was a great warrior therefore the way he died was unexpected and I believe it was better to keep him alive. Therefore if I was directing the film I would have not killed off Lancelot however I like the way that the character of Daganot was killed because he was made to look like a hero. The character I am critical of is Guinevere because in the story of King Arthur she was supposed to be a high class lady from a good family however in this story she is presented as Woad like a rebel whom I think is unrealistic and completely changes the character. Therefore I dislike the character. The parts which are successful are the opening scene where the few knights fight many Woads. This is successful because it sets the tone of the film and lets the audience know how skilled the knights are and how they grew up to become knights. Another part which is successful is where Daganot smashes open the door with an axe. This is successful because it allows the audience to see how strong the knights are again and also get the audience more involved to see what is inside because the breaking down of the door is like footsteps of a massive army because the audience wants to see what will happen next. Therefore in both ways it is successful. In conclusion I recommend the film and would give it 8 out of 10. The reasons for this are because it is a successful film in the way it attracts and entertains the audience such as the start where the knights fight many Woads. It is an interesting film where there is a great historical context such as the history and leadership of King Arthur himself and Roman Britain. The reason I would only give the film an 8 out of 10 is because there were parts I disliked such as that Lancelot got killed and that Guinevere was made to look different then the real story. Therefore in conclusion I would give the film an 8 out of 10 and recommend it to people as a good film because it has many good features and covers the historical part of King Arthur as well as the entertaining action packed fighting in the film therefore I recommend it.

A Review of the Beck Youth Inventories for Children and Adolescents Es

The Beck Youth Inventory Test was developed in 2001 by Judith Beck, Aaron Beck, John Jolly, and Robert Steer. The purpose of this psychological testing tool is a brief self-report to measure the distress in children and adolescents (Flanagan & Henington, 2005). The Beck Youth Inventory includes using five self-administered scales. The five tests include the Beck Depression Inventory, Beck Anxiety Inventory, Beck Anger Inventory, Beck Disruptive Inventory, and the Beck Self-Concept Inventory. These tests can be administered individually or in combination to the youth. The intended population for this test is ages 7-14 years (Flanagan & Henington, 2005). This test is used to assess symptoms of depression, anxiety, anger, disruptive behavior, and self esteem (Beck, 2001). The Beck Depression Inventory measures depression criteria as evidenced in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (Flanagan & Henington, 2005). The Beck Anxiety Inventory assesses childhood fears related to health and school (Flanagan & Henington, 2005). The Beck Anger Inventory appraises the individual’s opinion of mistreatment, negative thoughts, and physiological arousal (Flanagan & Henington, 2005). The Beck Disruptive Behavior Inventory measures behaviors and attitudes related to oppositional and defiant behavior (Flanagan & Henington, 2005). This is consistently seen in youth diagnosed with Oppositional Defiant Disorder and Conduct Disorder. Lastly, the Beck Self-Concept Inventory assesses feelings of self-worth and competence (Flanagan & Henington, 2005). The theory of the Beck Youth Inventory Test was derived from the adult Beck Scales (Beck, 2001). The authors of this testing instrument saw a need for this... ...ne only individually in order to encourage honest responses and not have any peer influences (Flanagan & Henington, 2005). Overall, the Beck Youth Inventory is a useful tool, but should be used in conjunction with other assessment instruments. References Beck, J. (2001, November). New Scales for Children: The Beck Youth Inventory. The Beck Institute, 1-5. Copyright 1999-2007. www.beckinstitute.org Beck, J. (2001). Beck Youth Inventories for Children and Adolescents (2nd ed.). PsychCorp: Harcourt Assessment, Inc. Flanagan, R., & Henington, C. (2005). Review of the Beck Youth Inventories for Children and Adolescents: Second Edition. Mental Measurements Yearbook, 18, 18123501 Trochim, W. (2006). Reliability and Validity: What’s the Difference?. Retrieved February 8, 2010, from http://socialresearch methods.net/tutorial/Colosi/lcolosi2.htm

The Kohen Gene :: Biology Essays Research Papers

The Kohen Gene In a world where Jews have assimilated so much into other cultures, is it possible to trace the lineage of an elite group of Jewish men all the way back to a man who lived three-thousand and five-hundred years ago? According to Karl Skorecki, a scientist at the Israel Institute of Technology in Haifa, and Michael Hammer, a geneticist from the University of Arizona at Tuscan, the possibility is alive (1). In Jewish tradition, as written in the Hebrew Bible, the Children of Israel were split into three groups. The Kohanim (the singular is simply Kohen) were the priests. The first Kohen was Moses' brother, Aaron, and all Kohanim since then are said to be descendants of Aaron. The second group was the Levis, of which Moses himself was a part of, and the third group was compiled of the remaining eleven tribes (of which ten have said to be "lost"), simply called the Israelites. Since the Kohanim were the priests among the Jewish people, their duties were the holiest and most important. They were in charge of the sacrifices brought to the Temple, and thus had the most intimate relationship with God, aside from the prophets such as Moses. After the destruction of the Second Temple in 70 C.E., and thus the secession of sacrificial offerings, the role of the priests became ceremonial. However, despite the fact that their strict duties do not apply today, all Kohanim, according to Jewish tradition, must still obey many commandments that pertain directly to them. The hope is that one day, a new Temple will be built, and their service will be required once again (1). According to Jewish tradition, the role of each individual (Kohen, Levi, or Israelite) is passed down patrilineally from father to son. In traditional and orthodox Judaism, a woman is known as "the daughter of a Levi" (if her father is a Levi) until she marries, and then she is "the wife of a Levi." So, the concept of a "kohen gene" can only pertain to Jewish men who have not converted into the faith (1). A gene is a sequence of DNA that is used by cells to create protein. It has all of the information needed to make a protein. It knows when to make these protein and where to begin and end. The functions of a cell are then carried out by the proteins.

The Handicapped Poor in America Essay -- Disabled Poverty

In The Working Poor, David Shipler relates the plight of the invisible poor in America, sharing the stories of laborers across the nation who work but cannot get a firm grip on the slippery surface of the American dream. Shipler also touches on, but does not fully explore, the even thornier path of the disabled, impoverished individual in America. Although a relatively large segment of the population (10-20 percent of the United States population is disabled), the disabled poor encounter setbacks in their struggle to succeed in a world where one’s worth is often judged by one’s economic and educational attainment. A blind and impoverished woman from Eastern Europe directly states that the disabled poor "depend on everyone; no one wants us. We are like garbage that everyone wants to get rid of" (Wolfensohn 1). Far from the thoughts of many in the social hierarchy, including the healthy working poor, the disabled poor face numerous obstacles in their path towards a stable income above the poverty line. Addressing the problem of helping disabled individuals through legislation becomes difficult because definitions of disability differ. Some may argue that depression is not a disability because not only is it difficult to prove that an individual is afflicted with it, but it is also questionable whether it is the cause of their unemployment. Asthma may not be considered a disability for a child in the suburbs, who, with the help of an inhaler, may play soccer without suffering, but chronic, untreated asthma can be debilitating for a child living in poverty and, according to the American Lung Association, â€Å"can be a life-threatening disease if not properly managed.† The government defines disability as having a â€Å"physical or m... ... > U.S. Census Bureau: American Fact Finder. â€Å"Sex by Age by Disability by Employment Status for the Civilian Noninstitutionalized Population 5 Years and Over.† ds_name=ACS_2003_EST_G00_&-redoLog=false&- mt_name=ACS_2003_EST_G2000_P059>. U.S. Department of Health and Human Services. â€Å"Child Health USA 2003†. . U.S. Department of Health and Human Services. â€Å"Disability Among Women on AFDC: An Issue Revisited.† 1993. . U.S. Department of Labor. â€Å"The United States Department of Labor Homepage, Secretary of State Elaine L. Chao.† . The University of New Mexico Center for Development and Disability. .