Does Internet Enhance or Reduce Social Interaction Essay Example for Free

Does Internet Enhance or Reduce Social Interaction Essay Papers like HomeNet distributions have been following the impacts, positive or negative of Internet on its clients. The discoveries are intriguing as it reports both positive and negative outcomes. At first the impact was negative on the individuals who depended intensely on web for correspondence. Anyway that situation has changed with time. Current examinations no longer show the general negative impacts of the past. Utilizing web to speak with families and companions just as being engaged with network exercises has been on the ascent. Antagonistic impacts are commonly experienced by individuals with less help financially and loners and beneficial outcomes experienced by individuals with great social assets and extraverts. A few people who have coordinated web into their common lives have for the most part profited, yet they currently experience new social issues. These issues are featured in this conversation top to bottom and an outline made in a table. Those web clients who discover correspondence significant, have valid justification to anticipate that Internet has positive social effect on their lives. For such individuals correspondence, incorporating contact with neighbors, companions, and family, and cooperation in social gatherings, improves their degree of social help. To them communicating with web gives them satisfying individual connections, a feeling of significance throughout everyday life, and duty to normal practices with their networks. Their mental and physical prosperity (Diener et al. 1999; Cohen and Wills 1985; Mirowsky and Ross 1989;). They thoroughly consider the utilization of web for correspondence, they could have significant positive social impacts on people (McKenna and Bargh 2000), gatherings, associations (Sproull and Kiesler 1991), and networks (Hampton and Wellman 2000), including society everywhere (Dertouzos 1997; Hilts). Much the same as the phone did, they figure wide social access could increment people’s social contribution, and encourage development of new connections (Fischer 1992; Wellman 1996). Individuals who are commonly segregated could discover new social personality and duty (Katz and Aspden 1997). Segregated individuals from networks could partake in bunch associations a ways off (Sproull and Kiesler 1991). Web is likewise convenient for political preparation (Bonchek 1997). Regardless of whether Internet has constructive or adverse social effect rely on the nature of the individuals on the web, their exercises and what they offer up to invest energy on the web. More grounded social ties by and large lead to preferred social results over do more fragile ties (Wellman and Wortley 1990). As we experience the conversation we find that the simplicity in correspondence that web offers has supported individuals so much that they currently invest more energy alone, talking on the web with outsiders and almost no time with their networks. Progressively individuals are interfacing with one another through the web, and took a gander at decidedly, one would state web has expanded the recurrence of correspondence among its clients. There are relevant issues to see today in regards to our social communication contrasted and the past: †¢ Has our social connection balanced improved or lessened? †¢ Has it given more proof of the contrast between our virtual self and genuine self? †¢ Has our gathering connection improved or decreased? Clients of web are socially pulled back on the grounds that they are more often than not forlorn and snared onto the net. Examination has discovered that the more individuals are on the web, the more they become socially disengaged ( James E. Katz). The examination further shows that individuals who are continually online the more they become separated from public activity and that there is a connection between discouragement, stress and quality in social ties made by broad utilization of the web. This on the extraordinary can debilitate the social ties that individuals ordinarily have. Robert Kraut who is a scientist in the field and teacher in the Department of Communication at Rutgers University in New Brunswick, N. J. is the main creator of the investigation. Anyway the finding has been genuinely tested as deficient and ailing in thoroughness. The scrutinizes state there expected to have been a benchmark group utilized for examination purposes and that the example size was excessively little. In actuality, PC specialists are cited as saying web has incredibly expanded their human communication. They state that they would now be able to meet more individuals than any other time in recent memory. In any case, human science specialists state this is progressively an appearance of individuals in a condition of refusal than reality. In any case, in all actuality there are two dissimilar perspectives about PCs and its social impact on individuals. Hoffman and accomplice Tom Novak at Vanderbilt Universitys Project 2000 have for instance have directed a team up research with Georgia Institute of Technology in which they find many web clients locate the net perusing enhancing and fulfilling and that they are normally left in a glad perspective a long way from being discouraged. Philip Aspden, official executive of the Center for Research on the Information Society, reviewed 2,500 Internet clients and found no proof of social withdrawal. The examination found that online members are no more averse to join strict, relaxation or any network sorted out exercises than individuals who arent on the web. Virtual association is the standard in web exercises. Individuals utilizing convenient PCs can work in one office, one anticipate without fundamentally being genuinely in a spot. They could be a few kilometers away and do everything together that they could do in one condition, one office, and area. They can talk and have gatherings and conversations together. Web has made the world resemble a one neighborhood town. The issue is what is the social ramifications of this course of action? Is it positive or negative socially? The appropriate response is certain in light of the fact that the physical area can be anyplace generally helpful for the person. It very well may be your home/study room, general store; or inside your vehicle. Individuals work better when they work from premises of their loving. Negative since oversight, control, co-appointment and checking gets troublesome. Individuals find such courses of action new and odd however not really terrible socially. With time we will be utilized to it and our feeling of having a place will change. In this conversation we attempt to bring into center the positive and negative social effect of web. Anyway we appear to concur that web clients have more social issues than expected. They are in addition to other things pulled back from ordinary public activity and in virtual isolation as is generally known. It is intriguing to hear what a portion of these individuals state. It would be ideal if you permit me to cite a few encounters from individuals who use web. â€Å"Every time I experience the procedure it appears to be increasingly more like a strict custom. At the point when I mirror that I am associated with thousands or a huge number of individuals over the world, I overlook that I am situated in a single limit of my PC room. I let it be known is a bizarre inclination, one that I truly prefer to the degree that I overlook the social joy I ordinarily discover associating with individuals outside there. Now and again I likewise get terrified that I am starting to like my PC intervened correspondence (CMC) better than chatting with most genuine individuals with whom I come into day by day contact vis-à-vis. In spite of the fact that I think that its tragic to state, I have never appreciated genuine conversations where individuals state what is in their heart. Social chances and even scholarly open doors for such conversations are lessening. Our way of life has become increasingly unimportant and shallow. † Through CMC individuals can discover scholarly incitement. It is effectively accessible and agreeable. Be that as it may, the human touch is progressively common and additionally fulfilling. We are social creatures and we have to meet and diagram. Intellectualism has its time similarly as public activity additionally has now is the ideal time. The other negative part of web is privatization which was presented by Marshall McLuhan. This hypothesis expresses that as amusement and data turns out to be promptly accessible to individuals, they are more averse to look for them outside their homes. As that occurs, social cooperation is turning out to be less and less continuous. We can choose the individuals to converse with and utilize extraordinary words and method of correspondence. Before long we will be withdrawn from this present reality where we have diverse sort of individuals requiring various kinds of correspondence. My diversion, delight, and even correspondence have become private instead of open. Family individuals possess almost no energy for one another on the grounds that they invest such time in the net. The youthful ones are the most influenced. During the day, they are out in school and their folks are out for work. At the point when they return home they can't meet either, in light of the fact that everyone is occupied with web. When will they talk or gain from the guardians one would inquire? All that they copy are programs from the web, some extremely unusual without a doubt. As guardians we would ignore and loathe the experience we got past social connection with our friend gatherings and networks while we were youthful. It instructed us to find a sense of contentment with our condition. In this condition there is lavishness found in decent variety. The decent variety found in conduct and culture of its kin. We come to be increasingly educated that the world is made of both request and clutter and become prepared to deal with the two events. That is the means by which we have been formed to be solid and strong. The universe of web is denying our youngsters that opportunity and experience. Youngsters never play together at home and almost no in school. PC interceded correspondence CMC is another wonder in the PC world. There are different innovations all the more regularly utilized, for example, email and intuitive visit on the web. These methods of correspondence have both terrible and great sides. They have made correspondence, quick, simple and moderate. The physical area of the individuals we impart to is not, at this point a hindrance. We converse with individuals whenever anyplace

The Enduring Wisdom in Jonathan Swifts Gullivers Travels and Alexande

The Enduring Wisdom in Jonathan Swift's Gulliver's Travels and Alexander Pope's An Essay on Man Whenever learned men of a past period resulted in these present circumstances present time of innovative development, current man may be shocked at the perceptions these people of yesterday would make. More than three centuries back, two such men - Jonathan Swift and Alexander Pope - mentioned objective facts concerning their own time which have fascinating bits of knowledge to the present world. One thing Jonathan Swift may decide to clarify upon is the foundation of political vote based system. In Gulliver's Travels, he remarks, That every obvious adherent will break their eggs at the advantageous end: and which is the helpful end, appears, as I would see it, to be left to each man's soul, or if nothing else in the intensity of the central officer to decide. So in spite of the fact that he accepts that each man has the option to pick his own end - religion - he additionally acknowledges the authority of the boss judge - the ruler - to decide a state-wide religion. This thought is n ot really worthy to vote based system advocates today. Alexander Pope, in his An Essay on Man, propounds the Incomparable Chain of Being hypothesis of presence and request: Immense Chain of Being! which from God started, Natures ethereal, human, heavenly attendant, man, Brute, fledgling, fish, creepy crawly, what no eye can see, No glass can reach! from Infinite to thee, (EM 1102) Know thy own point: this sort, this due degree Of visual deficiency, shortcoming, Heaven gives on thee. (EM 1103) In this Extraordinary Chain of Being, each animal and thing possesses a spot - it appears to be sensible to accept that since there exists more than one interface in the human range, that various people involve distinctive social positions. Lords, for exa... ...e the religion he rehearses in his own home. Pope and Swift may amaze present day society with their perspectives. They would be mindful about tolerating or dismissing anything new - the two men exhibited cautious rationale in their thoughts, and not simply intense conviction. Some cutting edge convictions may require additional time before they would condemn: sci-fi, for instance. Also, some they probably won't concur with however would endure: different religions and political frameworks. Their thoughts regarding other advancements, for example, space investigation, may cause present day society re-to assess its explanations behind investigating the immense obscure. Works Cited Pope, Alexander. ?Article on Man.? Norton Anthology of World Masterpieces sixth ed. Ed. Maynard Mack et.al. New York: Norton, 1992. Quick, Jonathan. Gulliver's Travels. Ed. Louis A. Landa. Boston: Houghton Mifflin, 1990.

DarkMatters, Green and Wild, Chocolate Cake and Raspberries

DarkMatters, Green and Wild, Chocolate Cake and Raspberries A few weeks ago, I started seeing Staceyann Chins face in the Infinite. MIT SAFER^2 was advertising a One Night Stand for Student Rights, a night of spoken word, collective art, and informative camaraderie. I read Chins book about five years ago, and was madly into it at the time. Shes equally (and differently) impressive in person. The whole night was exhilarating. DarkMatter, a queer South Asian performance and literary arts duo, raged onstage against imperialism, white supremacy, and sexism, and when we in the audience (everyone in the audience) clapped and hollered, the response felt more sincere than any applause Ive heard in months. It heartened me to be in that room, with the coolest collection of people and poets and activists, and to see students caring about social justice instead of problem sets for a night. The week continued. I published my first post on CoLab Radio, a planning blog started by the MIT Community Innovators Lab. Im a guest editor this spring. Expect more. Read the first installment in my series on urban wilderness. Ta-Nehisi Coates, my writing professor and mentor, gave a beautiful and devastating* reading of a work in progress. *I choose the word devastating because during the QA following the reading, it was used at least twice in response. Ta-Nehisis writing is light and powerful, (You can tell hes a poet, said a friend afterward) but his subject mattersystemic injustice, white supremacy and imperialism, human lossis heavy. Devastatingly beautiful, someone said, but also just devastating. I read some great things for classes: Fifth Avenue, Uptown, The Greater Common Good. I spent a lot of time in the GIS (Geographic Information Systems) Lab making maps. Somehow, between classes, cooking, and solo field trips to Jamaica Pond, I spent an afternoon in the pottery studio. In other news, one of my favorite people at MIT left this week for a semester away. I made this goodbye cake, a chocolate-raspberry layer cake, as a farewell gesture. I added a tier for grandeur and skipped over some of the steps involving patience. Layers slid and ganache puddled, but a cakeslide is less dangerous than a landslide, and no one minded the pools of chocolate.

Rhetorical Essay Old Spice - 1070 Words

Ashley John Heather Dorn Writing 111 February 20, 2011 Old Spice: The Man You Could Smell Like â€Å" Look at your man, now back to me† is said at the opening of the commercial, as it sets a comical tone for the advertisement and draws the viewers’ interest. The relatively new company, Old Spice, founded in 1990 uses their new commercial series to promote their American brand of male grooming products. Old Spice in the past has focused on targeting middle aged to elderly men in their advertisement campaigns. This new series of advertisements is trying to reach to a new target audience of twenty to forty year old males. This advertisement is attempting to create a memorable impression to the viewer through appealing to pathos,†¦show more content†¦The average man is more likely to use Old Spice since the man in the commercial does so. The credibility of this commercial increase with the use of the male and what he represents as perfect. The setting of the commercial starts off with the shower run ning and the attractive male in a towel and turns into this paradise- like setting. This setting provides an ideal setting to match the character within the commercial. The focus of the commercial comes to be on the male. The background scenery is neutral in both settings. When the male presents the Old Spice bottle, it is a splash of color and the viewers’ eyes tend to be attracted more toward the bottle. The bottle draws attention away from the male and the background setting. This use of product placement and color contrast brought the bottle to be the center of attention of the commercial. The colors in the advertisement tend to be the same, but with the presentation of the bottle, the viewers’ eyes are opened. This draws a parallel to the use of the old Spice and the â€Å"out of the world feeling† it produces. The bottle of Old Spice is shown two times within the commercial. In these two times, it is shown it instills an image of the product inside the vie wers’ mind. The male keeps the viewer engaged in the commercial by constantly drawing comparisons between himself and the audience. Along with this, the scene changes allow the contrast of the bottle to the scene to be made possible. With theShow MoreRelatedMarketing Analysis : Old Spice1186 Words   |  5 Pages Lewsader ENGL 1301 July 1, 2015 Essay 2 It may seem like anything is possible when you smells like Old Spice! When a major company produces an advertisement, they use an array of different strategies and techniques in order to capture the audience into buying their product. Old Spice, a company specialized in producing men’s hygienic products, is well known for its series of funny advertising based off of traditional masculine ideals. The most popular Old Spice commercial, â€Å"The Man Your Man CouldRead MoreOld Spice Ad Analysis1194 Words   |  5 Pagesportraying. In this essay, I will be analyzing these two ads, â€Å"Whale† (Old Spice) and â€Å"Susan Glenn† (Axe). These ads are formulated to get their products noticed, along with sparking the interest of the other goods they may offer. Countless methods are used to convince the audience that’s being targeted to buy the product. Therefore, these ads are similar in its ability to gain the attention of their audiences by appealing to patho s. Through this essay I will analyze the rhetorical effects that helpRead MoreOld Spice Ad Analysis1891 Words   |  8 Pagesthe advertisers study all the ways that they can attract their audience’s attention. The producers of advertisements have many tactics and strategies they use when producing an ad to get consumers to buy their product. These include things such as rhetorical appeals, logical fallacies, and â€Å"the male gaze.† The function of marketing is to either increase the number of customers or increase the rate of use among current customers. The number of customers can be increased by converting customers fromRead MoreThe Woman Who Walked Into Doors5687 Words   |  23 Pagesof colonialism and bourgeois-nationalism but because she is a victim of domestic abuse. Like women who experience sati, like Bhuvaneswari, like all subaltern women, Paula should be silent because she is a subaltern. The last paragraph of Spivak’s essay states this clearly: â€Å"The subaltern cannot speak† (CSS 308). However, as we have noted, for Spivak, impossibility is often (im)possibility, and this deconstructive mode permits contradictions that produce, rather than foreclose, the possibility ofRead MoreQuestions On Writing An Essay Essay9089 Words   |  37 Pageswritten plenty of essays in high school. Yet, for some reason, you still can t see to get an A on an essay. You have the basics of writing down, so what more can you do? Here are some more advanced advice to spice up your essays, and earn you that A! How to Write a College Essay: Address the Opposition Read any book about writing an essay, and you will be told to address the opposition. Acknowledging that your thesis can be argued may seem like it would hinder your essay, but it actua lly makesRead MoreRethinking Mercantalism Essay15042 Words   |  61 Pagesconcepts for these disciplines at the vital moment of their consolidation. From the late 1930s, some thoughtful scholars raised questions about whether mercantilism should be such a hegemonic organizing principle for historians. In a pathbreaking essay published on the eve of the Second World War, A. V. Judges insisted that â€Å"mercantilism never had a creed.†8 Almost two decades later, in 1957, D. C. Coleman took up the cudgel, arguing that mercantilism could not have held the power it supposedly Read MoreNotes18856 Words   |  76 PagesAfrica in the first place? One scholar of Portuguese imperial history has suggested that the Portuguese were moved by â€Å"a crusading zeal, the desire for Guinea gold, the quest for [the mythical Christian kingdom of] Prester John, and the search of spices.†1 Another scholar suggested Prince Henry’s penchant for hazardous travel abroad, real thirst for adventure in the name of acquir- M04_KHAF1713_04_SE_C04.indd 100 1/18/12 10:30 AM  Reasons for Europe’s Interest in Africa 101 ingRead MoreDeveloping Management Skills404131 Words   |  1617 Pagesgreater amount of improvement occurred among students who applied these skills to multiple aspects of their lives outside the classroom, and people who were more competent to begin with made the most progress. In addition, a cohort of 45- to 55year-old executives produced the same results as the MBA students. That is, they also improved dramatically in their management skills even though most were already experienced in senior managerial positions (Boyatzis, 1996, 2000, 2005; Boyatzis, Cowen, Kolb

Can Providers Education about Postpartum Depression...

Can providers’ education about postpartum depression (PPD) increase the acceptance level of pediatrics medical providers to screen mothers for PPD in a primary care setting? Postpartum depression (PPD) is a range of depressive symptoms that women may experience after giving birth. It’s onset within the first month after birth. Many studies define the â€Å"postpartum period† at a minimum of 3 months up to a year after childbirth (Chaudron, Szilagyi, Campbell, Mounts, McInerny, 2007). Symptoms range in severity and the timing post childbirth, peaking at about six weeks after delivery for major depression and two to three months for minor depression. Women can experience another peak of depressive symptoms 6 months after birth (Earls,†¦show more content†¦Infants can ultimately have developmental delay. Postpartum depression has long term effects on children of depressed mothers. The impact can extend up to puberty. Children will experience feelings of i nsecurity, poor social skills, reduce verbal and cognitive skills (Earls, 2010). Children will end up with more behavioral problems, conduct disorders, depression and anxiety. Timely identification and management of maternal depression is important for the child’s early brain development and school readiness. The negative effects of the long term exposure to maternal depressive symptoms in early childhood is concerning. Early intervention will help both the mother and the child (Horwitz, Briggs-Gowan, Storfer-Isser, Carter, 2009). In the United States, women after childbirth will typically have one postpartum visit with their obstetrician at six weeks while new mothers will see the baby’s pediatrician at least 4-6 times during the first year at the well baby visits. These are good opportunities for the detection of PPD. Mothers may be reluctant to share their feeling with family members or the medical providers secondary to fears of being seen as a â€Å"bad† mother, or being labeled as having a psychiatric problem. Pediatricians have a unique potential to intervene (Horwitz et al., 2007). The US

History of the Marine Nco Free Essays

Role of the Marine Non Commissioned Officer After the Vietnam War ended, the Marine Corps’ main focus changed from broad scale operations, to being an Expeditionary Force in Readiness. Although this was no new role for the United States Marine Corps (USMC), there have been many changes in society, technology and tactics that affect how the Corps operates. However, over the last 36 years one thing has remained the same, and that is the role of the Marine Non Commissioned Officer (NCO). We will write a custom essay sample on History of the Marine Nco or any similar topic only for you Order Now With the world changing ever so rapidly, the strong values and responsibilities of the Marine NCO are now, more than ever, necessary to carry out the operations being assigned to United States Marines. The role of the NCO is characterized by their leadership skills, ability to train and care for their subordinates, as well as their responsibility to enforce Marine Corps standards to ensure the proficiency of the Marines in their unit. 1 Strong NCO leadership is extremely crucial on the battlefield, particularly when it comes to small unit combat operations. The Marine NCO must have courage to be able to lead their Marines in the presence of danger. An excellent example of the courage shown by an NCO is portrayed through the actions of Sgt Dakota L. Meyer. On September 8th 2009 (Corporal at the time), Meyer’s unit was ambushed by over 50 Taliban insurgents. This turned into a six-hour fire-fight, in which he risked his life for his fellow service members. Meyer repeatedly exposed himself to enemy fire to rescue the wounded, and bring 13 U. S. Marines and Soldiers, as well as 23 Afghan National Army Soldiers to safety. Along with these actions he also killed over eight enemy combatants. For his actions, Sgt Meyer has been nominated for the Medal of Honor and is scheduled to receive it sometime in September 2011. Sgt Meyer’s outstanding leadership has proven how important the values of courage and selflessness are in the Marine Non Commissioned Officer. Another important responsibility of the NCO is to ensure their Marines ar e knowledgeable. During humanitarian aid missions like Operation Restore Hope (Somalia 1992) and Operation Unified Response (Haiti 2010), troops were deployed on short notice. It was imperative that these Marines understood the mission, and had the proper training before hand to carry out these tasks. The focus that NCOs put on training and preparedness was proven to be successful when it came time for their Marines to assist in expediting the relief efforts. The training Marines are given consists of maintaining annual qualifications, Military Occupational Specialty (MOS), and Professional Military Education. It is the responsibility of the Non Commissioned Officer to ensure that their junior Marines are completing rifle qualifications, physical fitness tests, swimming qualifications as well as any other yearly requirements. Marines should also be seeking knowledge in and outside of their MOS on a regular basis, and are encouraged to do so by their NCOs. The more knowledge Marines possess, the more successful they will be as individuals, as well as the USMC as a whole. The deep sense of professionalism and tradition is influenced heavily by the Marines who enforce the standards of the Corps. It is said that the Marine NCO is the Backbone of the Marine Corps. This can be attributed to the fact that it is the NCO, who enforces the regulations and standards of the Marine Corps. Non Commissioned Officers have a thorough understanding of Marine Corps Orders, and the Uniform Code of Military Justice. They make sure that Marines are conducting themselves professionally, and that they are proficient in their work. NCOs set the example by keeping a good personal appearance, attitude and sense of leadership at all times. These standards and traditions have remained strong until today because of strong NCOs. Throughout the many changes the world has experienced since the end of the Vietnam War, the Roles of the Marine Corps Non Commissioned Officer have remained the same. NCOs continuing to lead, train, set the example, and ensure Marine Corps standards are followed has contributed to the overall success of the Marine Corps. It is clear that one of the most important parts of the USMC is the role of the Marine Non Commissioned Officer. Bibliography History of the Marine NCO Student Guide. Quantico: United States Marine Corps EnlistedProfessional Military Education Curriculum Branch, 2011. The Marine Corps Organizational Structure Student Guide. Quantico: United States MarineCorps Enlisted Professional Military Education Curriculum Branch, 2010. Medal of Honor Sgt. Dakota Meyer Operation Enduring Freedom. Official U. S. Marine Corps Website: USMC Division of Public Affairs Media Team, 2011. http://www. marines. mil/community/Pages/MedalofHonorSgtDakotaMeyer-HeroicActions. aspx (accessedSeptember 7, 2011). Endnotes 1 History of the Marine NCO Student Guide. (Quantico: United States Marine Corps Enlisted Professional Military Education Branch, 2011), 5. 2 Medal of Honor Sgt. Dakota Meyer Operation Enduring Freedom. (Official U. S. Marine Corps Website: USMC Division of Public Affairs Media Team, 2011), http://www. marines. mil/ community/Pages/MedalofHonorSgtDakotaMeyer-HeroicActions. aspx (accessed September 7, 2011). How to cite History of the Marine Nco, Essay examples

Single Importance of Humanity free essay sample

In the website essay, Special Report: Could Wikileaks Cause World War III or the End of the World? David Gewirtz, the author, discusses about the importance of the bond of trust between the people and their government and also between nations internationally. Although the bond of trust may result in betrayal and pain to others, the bond of trust still have to exist between people to improve the society and to prevent careless mistakes. Gewirtz uses rhetorical strategies such as his diction and organization in his argument to effectively convey his perspective on the bond of trust along with his reasoning and analysis. At the start of the essay, Gewirtz dives into the meaning of trust and its possible consequences in a person-to-person manner by saying â€Å"If you think about it, trust is all that stands between us and terrible circumstance† (Gewirtz). As Gewirtz moves on with his arguments, he also states that â€Å"we have to trust some people† because we cannot simply do everything and it’s definitely â€Å"not possible to do everything yourself† (Gewirtz). We will write a custom essay sample on Single Importance of Humanity or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page From these statements, we can all agree on the fact that no one could do everything on earth himself because then, there is no need for the government and various specialties. To convey this idea to his audience effectively, Gewirtz uses diction that sets the atmosphere into more personal and appealing directly to his audience. Contractions like â€Å"it’s† and â€Å"I’m† lightens the serious atmosphere in the discussion about the gravity of trust and allow the readers to easily follow along. Also, the first-person perspective of this essay allows more attention from greater number of readers since the first-person diction is more personal and less formal, which that eliminates the seriousness and provides easy comprehension for people that does not have any knowledge of politics. Similar to how Martin Luther King Jr. appealed to his audience by using the first-person point of view in the famous I Have a Dream speech. The constant repetition of the â€Å"I have a dream†¦Ã¢â‚¬  statements indicates the strong person-to-person appeal to the audience by providing more thinking through the emotion and moral of his audience. Gewirtz also implements his own opinions of the importance of trust by such extreme word choices such as the term, â€Å"nuclear Armageddon. † The organization of the essay is organized in a way that helps emphasize the word â€Å"trust† by making a separate paragraph with only the word â€Å"trust† in it. Gewirtz utilizes this technique to let his audience know the importance of â€Å"trust† since his main point of this entire essay is about trust. Throughout the essay, Gewirtz also implements his own thoughts and words in parenthetical statements along with his argument in the essay. These include, â€Å"or possibly care,† â€Å"unless, of course, it’s not time to be nice,† and â€Å"yes, pressure† which all of these thoughts are implemented in parenthetical statements along with Gewirtz statements. These implements meant to effectively allow Gewirtz and his audience to â€Å"literally† speak to them face-to-face instead of being formal for the selective fewer audience. Through this rhetorical strategy, reader can conclude that Gewirtz wants his essay to be spoken to the general population and not the selected individuals with the knowledge of politics. At the very beginning and the ending, Gewirtz uses the same format of â€Å"trust† in its own separate paragraph and uses a conclusion that is very similar to his introductory paragraph as his final wrap-up. From this strategy, the reader can infer that not only was Gewirtz tried to maximize his emphasis, but to allow his audience to think differently from when they read his introductory paragraph and what they think about the paragraph at the end of the essay after all of Gewirtz arguments has been made. The arguments made by David Gewirtz strongly appeal to his audience through the use of rhetorical strategies like the diction and organization of his essay. Because of the elaborate use of these rhetorical strategies, the reader can incorporate his or her thoughts into the emotional thinking which Gewirtz purposely intended to do so. Although there are some logos appeals in his essay, he mainly focuses on the pathos approach to fully earn all of the agreements of his audience. Overall, I strongly believe that Gewirtz essay made his audience think twice in another perspective as a means of fully understanding the gravity of the dangers of WikiLeaks and the importance of trust.

4 Components to an Award-Winning Resume

4 Components to an Award-Winning Resume Last Monday, Career Directors International (CDI) announced the winners of their 17th annual Toast of the Resume Industry (TORI) award competition. TORI award winners are truly outstanding writers. I am very proud and excited that two members of The Essay Expert’s resume writing team won two awards each! Following the awards announcement, TORI judge Gillian Kelly wrote an article on What the Best Resume Writers Are Doing in 2016. The actual resumes will not be released until next month. In the meantime, Ms. Kelly’s observations serve as valuable advice for resume writers, as well as for job seekers writing their own resumes in 2016-2017. Here are the four main areas where the TORI-award-winning resumes stood out: 1. Storytelling Top-level resumes don’t rattle off boring job duties in long blocky paragraphs. While job duties might be covered in a winning resume, they are connected with a story or accomplishment. Great resumes don’t stop at results. They also explain how that result was achieved, what transformation was necessary to achieve it, and what was unique about the solution. These succinct narratives keep the reader engaged and illustrate the job seeker’s unique brand. Here’s an example from an Essay Expert resume that illustrates story-telling. The following paragraph is the opening paragraph to a position description – a paragraph that often is relegated to a list of job duties: Led largest dollar volume division in country to record sales volume, managing four General Sales Managers and 43 Sales Representatives. Transformed division’s approach to competitive data and market analysis while monitoring lot mix, phasing, new starts, lot premiums, specifications, and promotions. Notice how job duties and scope are covered in this paragraph, but they are made more engaging by wrapping in results and transformative results. 2. Visuals TORI award winners used graphics and other images in their resumes, avoiding the text-heavy look and feel of more traditional resumes. Tools like color, infographics, and text boxes served to accentuate the content of the resume. It’s important to note that if you choose to represent an accomplishment using a graph, you must also write about that accomplishment in a bullet. There are two reasons for this duplicative effort: 1) Since not everyone is visually oriented, they might not even look at the details of the image to understand what it represents, and 2) If the resume gets submitted through an Applicant Tracking System, the data in the graph or image will be lost. Here are just a few examples of graphics used in executive resumes by The Essay Expert: Tools used to create these graphics include basic text boxes, borders, SmartArt, and Excel. You can see how they add pop and interest to what could otherwise be a visually bland resume. 3. Succinct Writing As pointed out by Ms. Kelly, less is more when it comes to resume writing. The best bullets are tightly written, getting each point across in as few words as possible. The fewer words on a resume, the more white space there can be – which is a good thing! White space allows the content to be more easily absorbed. Stay away from densely written, text-heavy resumes, which risk losing the attention of your reader. Here are a couple of examples of tightly written resume bullets: Realized three monthly closing projections in a row, a feat never before achieved in division history. Took one of least profitable divisions and achieved #3 ROI, ranking #2 for lowest overhead and #3 for asset turn. Notice how every word counts! Are your resume bullets this concise, and do they show the true impact you made on your organization? 4. Quantifiable Achievements The best resumes use metrics to nail down achievements, avoiding generalities about a person’s greatness. Buzz words like â€Å"results-oriented† will not fly. And don’t wait to convey your greatest achievements; showcase them in the top 1/3 of the resume! One technique used by TORI award winners was to write â€Å"reverse CAR stories† which state a result, followed by the challenge and action that got the result. Here’s an example of a highlight from the top 1/3 of a resume by The Essay Expert: Built intuitive, interactive user interface for Java web-based delivery system, increasing Java technology downloads by 112% in 3 months. Used Java FX to build Oracles showcase Advanced Results website for 2010 Winter Olympic Games, accessed by 1.2M unique users. Notice there are no generalities in this paragraph; it’s all concrete, factual, quantifiable information. That’s what makes good resume material. Did you learn something from the observations of a TORI judge? How might you change your resume based on her advice and The Essay Expert’s samples? For more examples and tips on how to write a top-notch resume, check out How to Write a WINNING Resume and How to Write a STELLAR Executive Resume, both written by me, Brenda Bernstein. The most current versions of the books are available in PDF through The Essay Expert’s website. Save

Irrealis Were - Definition and Examples

Irrealis 'Were' s Definition In English grammar, irrealis involves the  use of were with a  subject  in the  first-person  singular or third-person singular  to  refer to an unreal or hypothetical condition or eventone thats not true or that hasnt occurred (e.g., If I  were  you, Id go home). In contrast to the more common use of were as a past-tense form (e.g., They were lost), irrealis were is a nontensed mood form, similar to the subjunctive. Irrealis  were  is sometimes called the were-subjunctive or (somewhat misleadingly) the past subjective. As Huddleston and Pullum point out, Irrealis were does not refer to past time, and there is no synchronic reason to analyse it as a past tense form (The Cambridge Grammar Of The English Language, 2002). Defined more broadly, irrealis refers to an event that hasnt occurred (or at least hasnt yet occurred), while realis refers to an event that has occurred. Examples and Observations I was telling Grant that  if I were an  alien and I came down to earth from some far-off planet, there are a few things I would notice about people, and the first thing I would notice is the way they looked, that is, if people looked different on my planet.(Donald Miller, Blue Like Jazz. Thomas Nelson, 2003)Roxanne stood talking to him with one long-nailed hand on his shoulder, the other at her hip as  if she were a  model at a trade show trying to sell him the grill.(Kate Milliken, The Whole World.  If Id Known You Were Coming. The University of Iowa Press, 2013)They took to looking at him as  if he were  on the other side of a dirty window.(Kate Milliken, Inheritance.If Id Known You Were Coming. The University of Iowa Press, 2013) If I werent  so broke and unsettled, Id adopt a dog tomorrow.(Andrea Meyer, Room for Love. St. Martins Griffin, 2007) Moodiness: The Subjunctive and the Irrealis Were Traditional grammarians get tripped up by the verb be because they have to squeeze two different forms, be and were (as in If I were free), into a single slot called subjunctive. Sometimes they call be the present subjunctive and were the past subjunctive, but in reality theres no difference in tense between them. Rather, the two belong to different moods: whether he be rich or poor is subjunctive; If I were a rich man is irrealis (not real). . . . In English [the irrealis] exists only in the form were, where it conveys factual remoteness: an irrealis proposition is not just hypothetical (the speaker does not know whether it is true or false) but counterfactual (the speaker believes its false). Tevye the Milkman [in the musical Fiddler on the Roof] was emphatically not a rich man, nor were Tim Hardin, Bobby Darin, Johnny Cash, or Robert Plant (all of whom sang If I Were a Carpenter) in any doubt as to whether they were carpenters. Counterfactual, by the way, need not mean outlandisho ne can say If she were half an inch taller, that dress would be perfectit just means known to be not the case. (Steven Pinker, The Sense of Style. Viking, 2014) An Exceptional Form This use of were is highly exceptional: there is no other verb in the language where the modal remoteness meaning is expressed by a different inflectional form from the past time meaning. The irrealis mood form is unique to be, and limited to the 1st and 3rd person singular. It is an untidy relic of an earlier system, and some speakers usually, if not always, use preterite was instead. (Rodney Huddleston and Geoffrey K. Pullum,  A Students Introduction to English Grammar. Cambridge University Press, 2005) AlsoSee Past SubjunctiveSubjunctive Mood

Renewable Energy Systems Research Paper Example | Topics and Well Written Essays - 6500 words

Renewable Energy Systems - Research Paper Example astest power manufacturing segments of the world now and there is urgent necessity to minimise the maintenance and operation costs of electricity production. This research essay will make an earnest attempt to elucidate the wind and hydropower generation of manoeuvres of both Australian and Bangladesh government, in particular, to minimise the global warming and of that USA, China, Brazil, Russia and Canadian governments in general by giving unique attention to various empirical studies and eminent authors’ views on the subject. 1-Introduction Both wind energy and hydropower comprises of the renewable energy mix, these bring a lot of economic, technical and environmental advantages both to the developed and developing nations. Energy policy makers all around the world are now paying great attention to harness the renewable energy as they have a duty to safeguard the environment thereby by restricting greenhouse gas emissions into the atmosphere. Both wind energy and hydropower are resources which are abundantly available all around the globe, the technology has been well advanced and proven technology, are having longest plant life and lowest operating cost and the plant life can be extended at minimal costs .This research essay will analyse the hydropower and wind energy capabilities of Australia and Bangladesh in an exhaustive manner and that of USA, China, Russia, Brazil and Venezuela in a crisp. 2-â€Å"What is Hydropower?† As of date, hydropower is the largest renewable-energy source and about 16% of the globe’s electricity needs is catered by the hydropower and hydropower occupies about 80% of the globe’s renewable-energy resource. For 90% of their electricity needs, about 25 countries in the globe are now relying on the hydropower. For example, about 99.3%... This essay stresses that Australian government has set a target of 20% of Australian electricity needs to be catered from the renewable- energy sources by the year 2020. As this is an ambitious target, this can be achieved by developing and harnessing more percentage of energies from hydropower and wind farms. Hydropower is environmental friendly as it creates no pollution and maintains the stream flow of the rivers and the ecological balance. With the help of micro hydropower projects, tiny villages and remote hilly areas can be given electricity through off-grid, which would definitely help to enhance the socioeconomic growth of these remote regions. This paper makes a conclusion that Hydropower as one of the renewable energy helps to avoid about 225 million tons of CO2 emissions in the atmosphere in the USA, and this is equivalent to taking about 42 million cars out of the American roads. According to satellite imagery , the pacific Northwest which is the home of the majority of the hydropower projects in USA is an island of low carbon emission, and this is conclusive proof that hydropower can reduce the CO2 emission into the atmosphere. Thus, renewable energy like wind energy and hydropower are the energies of the future and both Australian and Bangladesh government energy policy makers should give more priority in the near future to these sectors so as to afford a clean, economical and environmental friendly energy to its citizens.

Free Will Essay Example | Topics and Well Written Essays - 1750 words

Free Will - Essay Example He argues that though indeterminism and freewill are incompatible, human being’s ‘self-forming’ or libertarian actions are essentially the result of freewill. Therefore, they are morally responsible for their actions. Unlike Kane, Derek Pereboom argues that both determinism and libertarianism are incompatible with freewill. Indeed, he remains agnostic about the truth of determinism. But he argues that whether determinism is true or not, freewill is incompatible with it. So, human being should learn to live without freewill. Yet the incompatibility of freewill with determinism does not imply that man is free from moral responsibility. Since, according to him, an agent’s action is either the result of causal determinism (self-forming action) or the manipulation of some external power, in both cases, the agent will remain responsible for his action. It is because though freewill does not exist, man’s action (even though the agent is tricked, by some ext ernal power to perform that action) will seem to be caused by his freewill. In fact, Kane has an impulsive tendency to argue against â€Å"compatibilism† on the ground that man will never be able to learn whether his ‘will’ is determined by some other power or not. Therefore, the question about the compatibility of Freewill and determinism is absurd. Referring to Frazier’s perception of Skinner’s â€Å"Walden Two†, he says that â€Å"the deeper freedom of the will is an illusion in the first place. We do not have it anyway† (Kane 427). This assertion has two meanings simultaneously: first, it can be assumed that he attempts to says that man does not freewill, since it is an illusion. Secondly, it can be assumed that since the concept of freewill is an illusion, man is free to act according to what he calls his will. Kane calls this freedom of man to act on his own at some particular moment as ‘libertarianism’. Indeed, he believes in the agent’s mundane power

Hindu Temple Architecture in the Taj Mahal

Hindu Temple Architecture in the Taj Mahal Traces of Hindu Temple Architecture in Taj Mahal As mentioned earlier in the previous chapter that many critics have found Urdu traces and Taj building is a symbolical representation of Mughal monument only. But Professor P.N. Oak challenges such ideas and brings out a critique that the Taj Mahal is actually a Hindu Temple of Lord Shiva (Tejo-Mahalaya). As P.N Oak also theorizes that a stone inscription which is known as the Bateshwar inscription is kept in the Lucknow Museum which shows that this monument can be a temple of Lord Shiva. It was found that the size of Mumtaz’s cenotaph is not of height of an average Islamic woman of the seventeenth century and the grave is not of appropriate dimensions. It could be said that the Shiva Linga which is considered as very sacred and holy is actually under the grave. The grave is on the first floor so it is not clear if Mumtaz’s body is really buried in Taj Mahal because bodies are usually buried in the earth and not in the flooring. This grave of Mumtaz is of the height of Hindu Shiva linga and if further digging would be allowed the result would come hence forth. Taj Mahal bears a lot of Hinduism traces and all such marks have been pointed out by P.N. Oak in his book. On the arch of Taj Mahal’s main tomb there is a trident (trishul) which is emblem of all Hindu Temples in India and no mosque or any other Muslim monument has a trident over its tomb. All plants and trees which are present in the gardens of the Taj Mahal are sacred to Hindus like Lotus, Tulsi, Banyan trees, etc. The main patterns are drawn which are found are Bel leaves and Harshringar flowers, these are actually used as an offering to Lord Shiva. There is a central chamber in between of eight doors which provides us the idea where the emblem of Lord Chandra-manleeshwar was present. The proper flooring of this central passage also gives us an idea that Lord Chandra- manleeshwar used to dance to worship Lord Shiva. The high doom above it is also a common feature is dripped over the Shiva linga from a bowl hanging on a certain height. Even the guides of Taj Mahal tell to all visitors about the tradition of a drop of rain water which is falling from height of the dome on the grave in the central chamber, this is actually a place from where the water used to drop on the Shiva Linga in the older times. There are silver doors and golden railings which are in the fixtures of the Taj Mahal, clearly give the Indianness to the monument because till date we can find such fixtures in our Hindu Temples. There are some ancient Hindu colored sketches of eight directional pointers, sixteen cobras, thirty two tridents, and sixty four flowers of lotus which are in the multiple of four which is considered auspicious in Hindu religion. This sketch is designed in the Taj Mahal’s central chamber, from the grave of Mumtaz this pattern can be seen very clearly. Even Tavernier also mentioned that the bazar used to be placed in the six courts of the Taj Mahal and this thing is everyone knows that in the tradition of Hindus fairs and bazars are set up around temples till date. On all four side entrances of the Taj Mahal, there is trident (trishul) is inlaid, which is exclusive weapon of Lord Shiva. It clearly proves that it is a Shiva temple. Some pointed out that the Taj Mahal dome has the Arabic engraving ‘Allaho Akbar’ meaning ‘God is Great’. These words were engraved on pinnacle ordered by Shah Jahan after he took over the Hindu temple and commandeered to change in Islamic use. But the same replica of the pinnacle inlaid in the red-stone courtyard does not have that Islamic inscription. Then there are spacious decorated chambers and an adjoining long corridor with the entire length of those apartments. These chambers are basically at the lower level than the basement central chamber. The chambers which are right under the graves of King and Queen on two floors which are sealed in a haphazard way with bricks are likely to have Hindu idols and inscriptions. The corridors which may be running under the red-stone terrace, they all are sealed. Likewise all the ventilator type openings and doors in the apartment row have also been crudely walled up under the red-stone terrace. We will be able to see the beauty of the underground apartments if those fillings are removed. It is very much possible that Taj Mahal has two floors above the river bed and one in the basement which has been sealed by Shah Jahan. ‘Taj Mahal’ is a foul form of Sanskrit ‘Tejo Mahalaya’ meaning ‘Resplendent Shrine’. This name also attach to Lord Shiva because his third eye is said to emit a fit if luster that is ‘Tejo’. Even if we look at the real meaning of the term ‘Taj Mahal’ it means a ‘crown residence’ and not a tomb . If these graves would have been the real graves, they wouldn’t have been so much decorated because in Muslim culture graves wouldn’t have been so much decorated. The corpse of Mumtaz, if it is buried in the Taj Mahal, it cannot be in the ground floor or in the basement chamber. There are other a Hindu symbols which are found in the Taj Mahal, like use of the sacred Hindu chant ‘OM’. ‘OM’ is crafted into the marble flower of lotus both lotus and OM are symbolically apart of Hindu culture which are present on the walls of Taj Mahal even on the so called â€Å"graves†. Any student or scholar of architecture can clearly tell that the ‘flower’ drawn on the marbles is a part of ancient Hindu temple drawings and not of any Muslim sepulcher workmanship. There is one important point also that time or rather span of death of Mumtaz is not clear. Some historians says that, she died in 1630 or 1631or 1632 A.D., and in the illustrious sepulcher it is written that she died in 1629 A.D. It is absurdto think nobody knows the correct timing of Mumtaz’s death. In fact, Taj Mahal has Hindu palace dimensions. Taj Mahal has many doors which are in spiked shape. There are red stone corridors, thorns and rooms all these attributes are just like typical Rajput building. ‘Ghat’ which is very common in temple palace, exists in Taj Mahal. Gateways of the Taj Mahal which are now closed were earlier the place to bathe in the river and go boating. Many rooms in the Taj Mahal complex are the drum houses. These drum houses are a part of Rajputana architecture. It is obvious that in memorial place no drum houses are planned to make, and there is no music places made in any Islamic buildings, music is actually restricted, hence the drum houses clearly prove the hand of Hinduism in the Taj Mahal. There are so many rooms for guests, army detachments, waiters, caterers etc for any royal purposes. Such architecture is never used in making any tomb. All the walls and doors are also in Hindu dimension, like silver doors which have been discussed earlier. In the Taj Mahal there are four towers at the each doorway. The top of the tower is made up by brass Kalases. Kalases is a Sanskrit word and this word can never be connected to any tomb and also does not fit the Taj building architecture. ‘Kalas’ signifies a shinning pinnacle made up by brass or gold. This word only comes in a connection of temples or any Hindu palace but Taj Mahal’s top of the tower uses similar material and hence this also gives us the hint of Temple like palace instead of a burial tomb. Three different scientific tests took place to find out the actualities of Taj Mahal. First one is Donodo chronology, in this test wood sample is taken of respective historic building. Second one is Thermoluminescence, in this test a brick powder or whole brick is taken and find out when this brick was baked. This test is very helpful in finding the age of the historic buildings. Third test is Carbon-14 test; this test is helpful in finding out the actual age of any living organism like wood piece or bone. Professor Mills from New York took the Carbon-14 test by taking out small wooden piece of one of the Taj Mahal’s wooden door. This report published in the Itihas Patrika. It was found out that the probable age of the sample is from 1448 and 1270 A.D. This test clearly proves that the Taj Mahal existed much before Shah Jahan. But here I would like to tell readers clearly that the age which was proved in the test was of the Northeastern doorway and not of the Taj Mahal’s marble. In this chapter, many examples have been discussed which clearly tell that Taj Mahal is basically a Hindu ancient temple (Tejo Mahalaya) and not a tomb.

Medieval Europe †Papal Reformation Essay

Since the Council of Nicaea called in the fourth century by Constantine to the early eleventh century, the Church was never established as a free standing institution. For over eight hundred years the Church had been under the authority of secular powers. Charlemagne and the Carolingians emperors saw themselves as the ones to maintain the Church materially, organizationally, and spiritually, while the pope was only an example of ideal Christian living. Social deterioration led to the corruption of the Church and its offices; simony being the biggest problem. The papacy itself was corrupted by simony and Roman politics. While reform had been taking place in the local levels for some time, the papacy was the last part of the Church to be reformed. The papacy reformation came about through three major popes: Leo IX (1049-1054), Nicholas II (1059-1061), and Gregory VII (1073-1085). The actions by these popes in the eleventh century would root out the corruption within the church and caus e conflict between the secular authorities and the papacy resulting in the separation and establishing of the Church as a power on its own. After numerous corrupt popes, Leo IX is considered to be the pope that started the papacy reformation. Ironically, he was appointed pope by his cousin Emperor Henry III. After being coroneted, Leo spent less than six months in Rome traveling through Italy, Germany, France, and as far as Hungary ( Blum, 485). According to Backman, â€Å"Leo recognized two things from the very start: first, the papacy could not be properly reformed so long as it remained mired in Roman factional politics; and second, the papacy needed to be seen by the faithful in order to secure the gains of the reform† (Backman, 268). Leo was literally the first pope to be seen by most Christians (Backman, 268), and he wanted to â€Å"project an image of the papacy in action† (Blum, 485). For a long time the title of pope was just a name without any meaning or power; however, Leo would change that with his travels. Leo’s great accomplishments were abolishing simony, help ending the practice of cl erical marriage, and improving the clergies training and education. Pope Leo IX, through his travels had plans of establishing his authority while also rooting out corruption still in local churches. â€Å"Leo staged large-scale Masses, pronounced Peace and Truce decrees, and offered all the faithful the opportunity to air grievances about their local church and ecclesiastical leaders† (Backman, 269). Clergy that had obtained their position by way of simony were given the chance to retain their office only if the confessed their faults and swore publicly to dedicate themselves to the reformed Church. According to Backman these acts were performed in public for two reasons: First, the people themselves got to hear the confession of their clergy, and second, the pope got the pleasure of having the faithful see the priest, bishops, and archbishops kneeling before Leo, in other words, used the reform-celebration itself as a means for establishing papal authority over the episcopacy. Henceforth, everyone understood that the bishops served as the legitimate leaders of the Church because the Holy Father himself had publically bestowed their office upon them. The papacy now stood at the head of a new hierarchy and determined its legitimacy. 269 The last major contributing act Leo had towards the reformation was the creation of the College of Cardinals. Leo saw that the Church was not intellectually able to deal with issue it was faced with. He created a body of advisors for the papacy that included theologians, lawyers, philosophers, historians, scientists, and diplomats. These handpicked advisors would lend expert council to the pope on settling and resolving doctrinal issues never really solved by the Church. One of the issues they dealt with was celibacy for the clergy; this would not be settled until Pope Nicholas II. The papacy was now the decision making center on doctrinal issues for the Church. Leo IX was a major turning point for the Church, but unfortunately he would not finish what he started. The next pope to further the papal reformation was Nicholas II. Pope Nicholas II built upon what Leo IX had already done. Nicholas and a council produced the Lateran synod of April 1059. The synod ended clerical marriage and established clergy celibacy. It also added to the strict prevention of simony. Also with the synod, Nicholas and the council made two major decisions that would shape the papacy up until today. The first of these decisions was to condemn the practice of lay investiture. â€Å"The ritual by which a lay prince â€Å"invested† a priest or bishop with the insignia of his office suggested that the ecclesiastical authority was subordinate to the secular† (Backman, 270). The papacy now condemned this seeing as the reforming popes were trying to establish the Church as an entity on its own. The Church wanted to control everything about itself and completely cut off any secular ties trying to control it. The second major decision Nicholas and the council made was mad in the Papal Election Decree of 1059. This was to ensure no pope could ever be placed in power by a secular ruler but only elected by the College of Cardinals. Backman describes it as this: †¦for all eternity the only way for any individual to become the legitimate pontiff of the Holy Catholic Church was to be freely elected to the position by the College of Cardinals. This decree removed the Holy See from the clutched of the Roman magnates, but it also declared the papacy’s independence from the imperial power. 270 These actions changed the state’s authority over the church that had been present since Constantine. When Henry IV came to power in 1056, he did not like the actions taken by the Church and trying to separate from his authority. The tension between the papacy and secular powers came to a high during the pontificate of Pope Gregory VII. Now Gregory VII had begun his career in Rome during the pontificate of Leo IX as Leo’s â€Å"‘secretary of state’ and author of his important papers† (Blum, 485). So Gregory had been around since the beginning of the papal reformation. His actions and policies would lead to the biggest conflict between the Church and State during this reformation. After dealing with carious rebellions, Henry IV’s resent meant lead him to prepare to attack Rome and deal with the papacy’s action. Henry wanted to show that he had supremacy and was the ruler of both Church and State. Before Henry could attack, Gregory responded with a declaration called the Dictatus Papae. This was a list of twenty-seven single sentence decrees about papal power. Gaudemet defines them as, â€Å"lapidary and unrestrained terms the universal power of the pope; his authority over bishops, clerics and councils, and his right to depose the emperor, to certify every canonical text, to make law and to deliver judgment from which there is no appeal† (Gaudemet, 470). Gregory was trying to establish that he alone, as the pope, had complete supremacy over both Church and the emperor. Henry took these Dictates as a direct attack on his royal rights and power. This led to both Gregory and Henry writing letters back and forth to each other with increasing t ensions with each letter. These letters led to both of them excommunicating and deposing the other from office at the end of 1076. The excommunicating of each other would lead to a major event in establishing supremacy to the pope. Gregory, being the pope, was still head of the Church, and Henry found himself still excommunicated. Henry and his advisor devised a plan to get him forgiven and restored into the Church. Being the pope meant that Gregory was a priest, and he would have to forgive a penitent sinner. Gregory was caught off guard at his castle in Canossa, Italy by Henry’s arrival and asking of forgiveness. This had made Gregory furious, but he had to forgive him. Gregory used this to his advantage, showing that he had supremacy over the emperor. Gregory made Henry stand outside his window barefoot wearing penitential rags for three days begging for forgiveness and pleading for restoration. While this move by Henry helped him with his enemies and restored him back into the Church, this move also hurt him. This move now shifted the supremacy towards the pope. The emperor was now seen as submissive to the pope and had to do what the pope said. While more conflicts happened between Gregory VII and Henry IV, the investiture struggle would not end with them. It was officially ended in 1122 with Henry IV’s son, Henry the V, and Pope Calixtus II (1119-1124) with the Concordat of Worms. This allowed ecclesiastical appointment to be made by the Church alone but also allowed secular rulers to participate with the lands and appurtenances supplementary to the positions. The issue of papal supremacy over imperial supremacy was circumvented, only to erupt again in centuries later. While Urban II (1088-1099) was able to finalize the reform of the Church during his pontificate, it wasn’t really until the end of the twelfth century that the Church reform came to a conclusion. Gregory VII and the popes following openly proclaimed the Church’s supremacy and sovereignty over the secular world. They had not only made the Church a standing institution on its own, but they had reversed the historical roles of the Church and State. Since the time of Gregory VII, the papacy had become a massive bureaucracy. The Church now had an ostentatious financial machinery, judicial system, bureaucratic structure, police network, and standing army. The Church was now its own free standing institution and would eventually become its own sovereign city-state.

Genetic Testing For Haemophilia Health And Social Care Essay

MFA presented to the day care of the Paediatric section with left mortise joint swelling for one twenty-four hours after hitting his mortise joint on a rock while playing in the flushing one twenty-four hours prior to admittance. There was hurting and bruising seen at the mortise joint articulation after the injury. The swelling increased in size and became more painful throughout the dark. His parents so brought him to the day care early the following forenoon. Physical scrutiny revealed swelling and tenderness at the left ankle joint every bit good as decreased scope of motion on both inactive and active motion due to trouble. There were besides multiple ecchymosis in different phases seen at the upper and lower limbs. A diagnosing of haemarthroses of the left mortise joint articulation was made. MFA was transfused with 200IU of Factor VIII. The hurting and puffiness were reduced in badness but persisted throughout the twenty-four hours. MFA returned to the day care the following twenty-four hours for more Factor VIII. He was given Factor VIII transfusion 200 IU twice daily for the following two yearss. The hurting and puffiness subsided after 3 yearss. MFA was diagnosed with terrible Haemophilia Angstrom when he was eight months of age. The diagnosing was made at the national blood bank. Familial testing besides done at the national blood bank revealed that his female parent was a haemophilia cistron bearer. MFA receives transfusion of Factor VIII when he develops haemarthroses or shed blooding due to trauma. He requires factor transfusion on an norm of one time every three months. He has had repeated hospital admittances with an mean continuance of stay for three to four yearss. MFA has good household support and is a member of the haemophilia society. He and his household have adapted good to his unwellness. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: PediatricssPATIENT ‘S DETAILSI/C NUMBER: ( B ) 630902-01-6092 Age: 9 old ages old Sexual activity: Male DATE OF ADMISSION: 23/04/09 R/N NUMBER: N/A2 ) CLINICAL HISTORYChief ailment: MFA is a nine twelvemonth old male child who was diagnosed with haemophilia A since eight months old. He presented with swelling in the left mortise joint for one twenty-four hours. History of present unwellness: MFA was running in the field at school when he knocked his mortise joint against a big rock in the land on the eventide of the twenty-four hours prior to showing at the day care. There was hurting after he hit his mortise joint but he was able to bear weight and walk. There was some bruising but no hemorrhage at the site of hurt. The joint became more painful towards the dark and there was some puffiness, heat and inflammation which increasingly increased. The hurting increased in badness so much so that MFA was unable to bear weight and used a wheelchair belonging to his brother to travel about the house. The hurting caused him some uncomfortableness but he was able to kip. He did non take any analgesia for the hurting. The following twenty-four hours, MFA ‘s parents brought him to the day care of the pediatric section for a factor transfusion. Systemic reappraisal was everyday. MFA was foremost diagnosed with haemophilia A when he was 8 months of age. His parents noticed that he developed contusions at his custodies and articulatio genuss. This occurred when he was tilting to creep. A blood trial was done in the national blood bank, and his parents were told that MFA had terrible hemophilia A. His immediate household underwent testing and his female parent was found to be a bearer of the haemophilia cistron. MFA receives factor VIII transfusion on an norm of one time every three months. The transfusions are required when he develops haemarthroses or gum hemorrhage due to tooth decay. The joint most normally affected is his right articulatio genus articulation. He has non developed any contractures. He does non normally seek medical intervention for contusions which are a common happening. He has non had mucosal shed blooding as nosebleed or hematuria. MFA would sometimes necessitate hospital admittance for factor VIII transfusion. This is normally when he has hemorrhage or terrible hurting due to a haemarthroses or a hematoma. At other times he would have the transfusion at the day care and return place. His parents would convey him once more to the infirmary for the following dosage till the hurting and puffiness in the joint resolutenesss. If a transfusion were required at dark when the day care is non unfastened, MFA would travel to the pediatric ward where the medical officer would be able to administrate the factor VIII. His symptoms would better with the factor VIII transfusion. MFA is an active male child who likes playing and running about. However his instructors in school restrict his physical activity to non-contact athleticss such as badminton and running. He is besides discouraged from unsmooth drama with his classmates. He wears elastic guards around his cubituss and articulatio genuss to protect them from hurt. However the elastic guards do non assist much as he still develops haemarthroses at those articulations. MFA is presently casting his decidual dentition. As such he requires factor VIII transfusion screen prior to tooth extraction. MFA is under followup at the pediatric clinic of Batu Pahat. He has defaulted the followup as his parents feel that nil much was done during the visits. He merely presents to the day care when necessitating factor VIII transfusion. MFA has besides been referred for physical therapy after episodes of haemarthroses which limit motion in the articulations. He has attended a few Sessionss of physical therapy in order to forestall contracture at articulations which have haemarthroses. He does non hold regular assignments. MFA is a member of the haemophilia society. His parents on a regular basis attend meetings where negotiations are given to educate parents on caring for haemophiliac kids. The members besides relate their experiences and promote one another. MFA has a medic qui vive necklace which says that he has haemophilia A. However, he rarely wears the medic qui vive. Past medical history MFA has non had any other infirmary admittances other than those due to haemophilia. Family history MFA is the youngest of three siblings. His senior sister is twenty old ages old and is good. His senior brother is 15 old ages old and has a bone cyst. He has undergone eight surgeries to mend the bone cyst every bit good as due to complications such as refractures. The wheelchair which MFA used at place was bought for his brother ‘s usage. MFA ‘s parents are good. There is no household history of hemophilia on his maternal side even though she is a bearer. MFA ‘s female parent has 3 brothers but all of them are good and do non hold hemophilias. There is no history of shed blooding upsets in the household. Social history MFA ‘s parents are both instructors. However they have to lose traveling to work frequently due to MFA ‘s status which necessitates frequent visits to the infirmary. As such, MFA ‘s female parent has a particular agreement with her schoolmaster which allows her to learn from 11 to 4 autopsy. As such, she is free in the forenoon to convey MFA to the infirmary when he needs it. His parents besides provide good support for MFA in that they frequently attend haemophilia meetings to update themselves on agencies to outdo attention for their kid. Birth history MFA was born at term in Hospital Batu Pahat. He was delivered through an elected cesarean delivery subdivision due to a breech presentation. There were no prenatal abnormalcies detected during everyday prenatal medical examination. There were no perinatal or station natal complications. He was nursed with his female parent after birth and discharged uneventfully. Developmental history MFA is presently in primary three of a spiritual school. He is an above mean pupil who finishes in the top 10 of his category. His instructors have no ailments about his school assignment. Developmental mileposts prior to this were all achieved at the appropriate times. Dietary history MFA is on an grownup diet now. He eats balanced repasts which are normally prepared by his female parent. He was breastfed till the age of seven months. Weaning was with porridge at the age of five months. Immunization history MFA has been immunized harmonizing to the immunisation agenda. After he was diagnosed with hemophilia A, his immunisations were done at the pediatric clinic under factor VIII screen. His last immunisation was at seven old ages of age. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss3 ) Findings ON CLINICAL EXAMINATIONOn general scrutiny, MFA was friendly and communicative. He was sitting in a wheelchair with a patch around his left mortise joint. There were some ecchymosis seen at his weaponries and thighs. He looked good nourished. He was non in terrible hurting. Anthropometric measurings: Weight: 24kg ( 10th to 25th centile ) Height:130cm ( 25th to 50th centile ) His critical marks were normal: Pulsation: 82 beats per minute Respiratory rate: 18 breaths per minute Blood force per unit area: 108/72 Temperature: 37 grades Celsius Examination of the lower limbs: There were ecchymosis seen on both lower limbs at the thigh every bit good as at the shin and calf. The left mortise joint was swollen and there was a contusion seen on it. It was stamp on tactual exploration but there was no addition in temperature. There was reduced motion of the left mortise joint articulation due to trouble. The right mortise joint articulation every bit good as both the left and right articulatio genus articulations were normal. There were no contractures seen. Examination of the upper limbs: There was besides some contusions seen on both the upper limbs. The cubitus and wrist articulations were normal on both custodies. The scope of motion for all the articulations on both upper limbs were normal. Examination of the cardiovascular and respiratory systems every bit good as scrutiny of the venters was normal. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss4 ) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONINGProbationary diagnosing: Haemarthroses of the left mortise joint articulation — — Evidence for: MFA has been diagnosed with hemophilia since the age of eight months. The articulations are a common site of shed blooding for hemophiliac. In add-on, MFA has had anterior episodes of hurting and puffiness in the joint similar to this episode. The hurting reduced when he was given factor VIII transfusion which farther supports this diagnosing. He besides has multiple contusions on his weaponries and legs which indicate that he has a hemorrhage upset. Differential diagnosing: 1 ) Juvenile Rheumatoid Arthritis The pauciarticular type of juvenile rheumatoid arthritis nowadayss with hurting and puffiness in the big articulations such as articulatio genuss, mortise joints and carpuss. It may show as symmetrical arthralgia or may merely impact one articulation. Evidence against: Juvenile rheumatoid arthritis normally nowadayss during childhood while MFA has been holding episodes of joint hurting and puffiness since he was an baby at eight months of age. Juvenile arthritic arthritis is besides associated with forenoon stiffness which MFA does non hold. MFA besides has easy contusing which is non a characteristic of juvenile rheumatoid arthritis 2 ) Septic arthritis Patients with damaged articulations are predisposed to infected arthritis. As such, a haemophiliac patient who has repeated haemarthroses may hold damaged articulations which are susceptible to infection. Evidence against: Patients with infected arthritis normally have fever while MFA did non. They are besides more common in patients who are immunocompromised. On physical scrutiny, there was no increased heat in the joint which would be more declarative of infected arthritis. 3 ) Ankle ligament hurt A sudden turn of the mortise joint may do a wrenching of the soft tissue and ligaments around the mortise joint doing hurting and puffiness. Evidence against: Master of fine arts did non writhe his mortise joint while playing. He simply knocked it against a stone. As such the mechanism of hurt does non propose that the ligaments were strained. He was besides able to bear weight after hitting his mortise joint and the puffiness and hurting bit by bit developed. This is contrary to what is expected in a sprained mortise joint where there would be immediate puffiness and hurting around the mortise joint. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss5 ) IDENTIFY AND PRIORITISE THE PROBLEMS1. Swelling at the left mortise joint MFA has hurting and puffiness at the left mortise joint articulation. He was in moderate hurting which he rates as 6 out of 10 on the hurting mark. Analgesics such as acetylsalicylic acid and NSAIDS are non recommended for him as they cause shed blooding in hemophiliac. As such the best agencies for rapid alleviation of the hurting and the swelling would be Factor VIII transfusion. 2. Hazard of joint devastation MFA is presently eight old ages old and is an active male child who enjoys playing with his friends. As such he is prone to injury from even mild injury. He has developed haemarthroses on an norm of every 3 months. Perennial haemarthroses at the same articulation could do devastation of his articulations taking to osteoarthritis, restriction in motion and development of contractures. A hold in intervention could besides do harm to the joint. As such, prompt and equal factor VIII transfusion is indispensable for MFA. He should besides be referred to the physical therapy section when the hurting has subsided. Physiotherapy would assist in forestalling the development of joint contractures 3. Hazard of shed blooding Due to his active nature, MFA is besides at hazard of terrible hemorrhage if he injures himself. He was last admitted to the infirmary for one hebdomad due to shed blooding when he fell while playing. There was terrible hemorrhage from his oral cavity and gums when he hit his face on a tabular array. MFA is besides presently casting his decidual dentition. As such, he is at hazard of gum hemorrhage from the site of tooth extraction. The most unsafe hazard is that of an intracranial bleeding 4. Hazard of perennial factor transfusions MFA requires frequent factor transfusion. As the factor VIII used in Batu Pahat is derived from human plasma, there is a hazard that MFA may acquire Hepatitis B, Hepatitis C or HIV infections. In add-on, MFA has non been screened for any of these infections. As such it is necessary for MFA to be screened as recommended by the Malaysian protocol for the direction of hemophilia. 5. Consequence of unwellness on school assignment and day-to-day activity MFA misses school for about a hebdomad on an norm of one time every three months. This may impact his public presentation in school. In add-on there is an addition demand for him to acquire good academic consequences as he would necessitate to believe about a hereafter with a calling that does non necessitate heavy physical activity due to his status. Trouble faced by caretakers MFA ‘s male parent and female parent are both working and frequently are forced to lose work in order to take attention of MFA when he develops episodes of hemorrhage. Both the parents are instructors who have understanding schoolmasters who sympathize with them and give them much leeway in order to care for their kid. However the uninterrupted emphasis of taking attention of a inveterate sick kid demands to be addressed. Support groups such as the haemophillia society would be able to assist the parents by giving them entree to other parents who face similar troubles. These parents would be able to promote one another and portion tips on caring for haemophilliac kids Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss6 ) Plan OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTSProbes done at 8 months of age by the national blood bank: 1. Curdling profile Justification: MFA presented with peliosis at his limbs which indicates that might hold a hemorrhage upset. As such a curdling profile would be utile to see if the curdling tracts are affected. Consequences: APTT prolonged. More than 90 seconds Interpretation: The drawn-out APTT indicates that the intrinsic tract is affected and that one of the factors in the intrinsic tract may be deficient. 2. Serum factor VIII degree Justification: To determine which specific factor that is lacking doing the hemorrhage upset. Consequences: Factor VIII degree: 0.6 % ( No inhibitors detected ) Interpretation: MFA has severe haemophilia A due to his Factor VIII degree being less than 1 % . He will react to factor VIII transfusion as there are no inhibitors to factor VIII detected. No probes were done for this presentation at the day care. I would propose the undermentioned probes: 1 ) A field radiogram of the ankle articulation AP and sidelong position Justification: In order to govern out other causes of the joint hurting such as infected arthritis or break at the joint. Possible grounds why it was non done: The clinical presentation of the patient did non propose that he has infected arthritis as he did non hold a febrility and the articulation was non ruddy. As the clinical image was typically implicative of a haemarthroses given that he is a hemophiliac, it would be unjust to the patient to subject him to an ten beam as this would intend he would be exposed to radiation every three months. 2 ) Full blood count Justification: A full blood count would be utile to see if there is an increased white cell count which may bespeak an infection. Possible grounds why it was non done: MFA is clinically good with no symptoms of infection such as febrility. As such a full blood count may non be necessary as it would likely be normal. There is besides a hazard of shed blooding or hematoma from venepuncture. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss7 ) Working DIAGNOSIS AND PLAN OF MANAGEMENT ON ADMISSIONWorking diagnosing: Haemarthroses of the left mortise joint due to Haemophilia A My proposed program of direction: I ) Factor VIII transfusion with a mark serum factor degree of 30 % eight hourly till the puffiness and hurting resolutenesss two ) Elastic patch and ice battalion around the left mortise joint three ) To rest the mortise joint articulation by non-weight bearing boulder clay swelling and hurting reduces four ) To analyze patient for joint malformation or contractures prior to dispatch from day care V ) Refer the patient to physiotherapy for joint rehabilitation of the affected articulation. six ) To educate the parents on attention for their kid and protective steps to forestall hurt. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss8 ) Summary OF INPATIENT PROGRESS ( INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES )MFA was given 200 IU of Factor VIII transfusion. He was so asked to return the following twenty-four hours to be reviewed by the medical officer in charge. Merely one transfusion was deficient for the puffiness and MFA had to digest much uncomfortableness and hurting throughout the dark. This is despite the Malayan Paediatrics protocol recommendation that factor VIII is given every 8 to 12 hours. The ground for this could be the prohibitory cost of the factor. The following twenty-four hours MFA was given another 200 IU of Factor VIII transfusion in the forenoon and once more in the eventide, 12 hours apart. He was given two more transfusions on the 3rd twenty-four hours. The transfusions were given at the day care in the forenoons and at the pediatric ward at dark by the medical officer who was on call. The hurting and swelling resolved on the 4th twenty-four hours post hurt. He was examined by the medical officer and was told to merely return to the day care if he had another episode of joint puffiness or open hemorrhage. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss9 ) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTIONDischarge program: I ) MFA was asked to rest him left mortise joint and to partly bear weight till it was wholly pain free. two ) Referral to the physical therapist for joint rehabilitation to be done Guidance: I ) MFA was advised to avoid athleticss which involve physical contact as the even minimum injury may do a bleed. two ) MFA ‘s parents were told to convey him back to the day care if there were any longer episodes of shed blooding into the articulations or self-generated hemorrhage. They were given a eventuality program to travel straight to the pediatric ward and see the medical officer on call if any hemorrhage were to go on when the day care is closed. three ) MFA and his parents were besides educated on complications that they need to look out for such as intracranial bleeding. They were taught about the marks and symptoms that they should be wary of. four ) MFA was encouraged to travel for physical therapy which he had antecedently defaulted. He was told about the dangers of joint devastation due to recurrent haemarthroses and how physical therapy may help in forestalling contractures. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss10 ) REFERRAL LETTER ( MANDATORY )Dr Tan Hai Liang, Paediatric Department, Hospital Batu Pahat Physical therapist, Physiotherapy section, Hospital Batu Pahat 27 May 2009 Dear sir, Patient ‘s name: Mohammad Faiz Affizuddin Patient ‘s I/c figure: ( B ) 630902-01-6092 Problem: Haemarthroses of the left mortise joint articulation Thank you for seeing this nine twelvemonth old male child who was diagnosed with Haemophilia A for the past eight old ages. He has had recurrent episodes of shed blooding into the articulations. The articulations most normally affected are the articulatio genus articulations and elbow articulations. His current presentation is for a haemarthroses of the left mortise joint articulation. Physical scrutiny: Inflammation and puffiness of the left mortise joint articulation. Tenderness on tactual exploration. Reduced scope of motion both active and inactive. He has been given Factor VIII transfusion which has reduced the puffiness and hurting. Kindly reexamine the patient and execute joint rehabilitation for him. He has good household support and his household could besides be taught exercisings to forestall joint contractures that can be done at place in position of his recurrent shed blooding into the articulations. Thank you. Yours genuinely,______________( Dr Tan Hai Liang ) Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss11 ) Learning ISSUES IN THE 8 IMU OUTCOMES1 ) Family and community issues in health careHow are parents affected by holding a hemophiliac kid? I had the chance to speak to MFA ‘s parents and inquire them about the challenges faced when caring for him. They related many of their experiences and confided that many alterations to the life style of the household were done in order to accommodate to populating with and caring for a hemophiliac. Both parents have had to lose work on a regular basis due to MFA ‘s frequent infirmary admittances. Family activities besides are limited to light physical activity with minimum hazard of hurt. Furthermore MFA ‘s female parent admitted to ab initio experiencing guilty as she was the bearer of the cistron that leads to his status. As such, I wondered if hemophilia had an impact on parent ‘s quality of life in visible radiation of the many accommodations that they had to do to their life style. A survey by Beeton et al [ 1 ] involved 12 parents of kids with hemophilias whose age ranged from 18 months to 16 old ages of age. The parents were interviewed and qualitatively assessed on their experiences in caring for a kid with hemophilia. It found that medical direction often focused on assisting the hemophiliac adjust to his or her status with small accent on the wider household web. The early old ages of the kid ‘s life after diagnosing were characterized by the parents missing experience and feeling uncertain. This is coupled with the frequent demand of factor transfusion and the associated trouble in venous entree in babies and immature kids. Quality of life at the early old ages post diagnosing was found to be hapless due to parents experiencing ‘out of control ‘ . Parents caring for a hemophiliac kid besides reported that the manner in which they engaged with the people around them had changed. There was a necessity in being more self-asserting in order to protect their kid. This was confirmed by MFA ‘s female parent who relates that she had statements with the infirmary manager and schoolmaster of MFA ‘s school in order to take a firm stand on particular steps to be put into topographic point to better MFA ‘s quality of life. The survey besides found that female parents normally took up a greater duty in caring for the kid. Fathers who were at work during the twenty-four hours did non hold the same degree of experience and this could be a beginning of struggle between parents. Parents were besides found to hold higher degrees of emphasis and anxiousness. However the degree of the emphasis and anxiousness was dependent upon on the phase that parents had achieved in pull offing the status every bit good as successful version. Another survey by Bullinger et al [ 2 ] showed that the quality of life for patients and households with hemophilia was higher when compared to patients with other chronic unwellnesss such as asthma. This shows that households with hemophiliac are able to populate a comparatively normal life with good quality of life if certain stairss were taken to accomplish successful version. The survey found that betterment in quality of life can be attained by supplying an environment in which patients and parents experience understood and good informed. In decision, I learned that hemophilia has a profound consequence, non merely on the kid who has the disease but besides on his primary caretakers which are his parents. As such I need to besides ask about how parents are get bying and offer professional aid such as reding if necessary.2 ) Critical thought and researchIs coagulating factor dressed ore prophylaxis effectual in the direction of patients with hemophilias?A paper by Ljung [ 3 ] proposed that direction of a patient with hemophilia should travel off from concentrating on the upset itself and alternatively look towards keeping a healthy kid. This means that patient ‘s should non be repeatedly managed with factor transfusions when they present with shed blooding but alternatively be kept healthy by forestalling the hemorrhage from go oning in the first topographic point. As such the writer proposed that primary contraceptive therapy should be the gilded criterion in the direction of patients with hemophilias. However is coagulating factor dressed ore prophylaxis effectual in pull offing patients with hemophilias, and what are the associated factors which prevent this direction from being a practical option? I looked at a Cochranre reappraisal by Stobart et Al [ 4 ] which analysed four separate surveies affecting 37 patients. The consequences of the reappraisal showed that there was a statistically important difference in the decrease of shed blooding episodes in patients who were given standard prophylaxis when compared to a placebo. It besides found that secondary results such as clip loss to school and employment due to the unwellness was statistically significantly reduced among those having primary prophylaxis compared to a placebo. The reappraisal besides quoted one survey which showed that a twice hebdomadal extract of higher dosage of factor dressed ore had a statistically important advantage in cut downing the figure of bleeds a twelvemonth when compared to a lower dosage and less frequent disposal of transfusion. However the writers concluded that there was deficient grounds from randomized control tests to urge the usage of primary contraceptive factor extract in the direction of patients with hemophilias. An independent retrospective survey by Khoriaty [ 5 ] showed that primary prophylaxis has some promise. The survey recruited 133 patients with Haemophilia A and B with a average age of 27.93. It compared the 91 patients who were on primary prophylaxis and the staying 42 patients having on-demand intervention when they developed shed blooding. The survey found that there was a statistically important decrease in the figure of self-generated shed blooding per twelvemonth. Patients on primary prophylaxis were found to hold 3.2 bleeds per twelvemonth while those who received on-demand therapy bled 5.7 times per twelvemonth. It found no statistical difference between the two groups in footings of hemorrhage after injury. However the consequences for this survey needs to be read with attention due to the big age scope. Further surveies need to be done for the pediatric age group due to differences such as a higher leaning for injury and hurt in active kids compared to grownups who are better at caring for themselves. One ground why primary prophylaxis is non used in the intervention of haemophiliacs despite its promise is the high cost of the factor VIII. One phial of 200 IU costs in the part of RM 800. As such it may non be cost effectual for primary prophylaxis to be carried out particularly in the context of the Malaysian health care system with its limited budget. A cost effectivity analysis by Miners et al [ 6 ] in England showed that it would be & amp ; lb ; 547 to forestall one episode of shed blooding from go oning. This cost is mostly prohibitory in the Malayan context. In decision I found that there is grounds that primary prophylaxis has much promise in the bar of shed blooding among haemophilia patients but extra surveies need to be carried out particularly in the local environment in order to determine the cost-effectiveness of primary prophylaxis.3 ) Self directed life long larningWhat is the hereafter in footings of direction of hemophilia? The direction of hemophilia is presently with factor transfusions which aim to halt hemorrhage when it has already happened. The other option is primary prophylaxis with regular factor extracts to forestall hemorrhage. However this attack is dearly-won and does non cover with the job of patients developing inhibitors which make transfusions uneffective. As such, research workers are looking into a agency for a remedy of hemophilia. This remedy is by utilizing cistron therapy. The aim of cistron therapy is to redact a faulty cistron sequence to accomplish complete reversion of disease phenotype in the life-time of the patient. Haemophilia is seen as the ideal campaigner for cistron transportation therapy as foremost there are many cell types which are able to synthesise biologically active coagulating factor. Second, there is a broad remedy window which makes it unneeded to hold rigorous cistron look. Third there are big and little animate being theoretical accounts that permit the survey of safety and efficaciousness prior to induction of human tests. [ 7 ] Phase 1 clinical tests are presently being done utilizing largely viral vectors to infix the cistron. Retroviruss have shown promise in this therapy. The cistrons are inserted via developing hepatocytes or hematopoietic root cells. Presently safe long term look of coagulating factors has been successfully achieved in big carnal theoretical accounts of hemophilias utilizing multiple cistron transportations. [ 8 ] Gene transportation therapy nevertheless still faces many obstructions before it can be seen as a feasible therapy for hemophilia. There is hazard of experimentation in worlds in order to formalize this therapy. Many inquiries besides remain unreciprocated such as inhibitor development after the interpolation of the cistron and besides the transmittal of the extra cistron to the kids of the patient who receives the cistron therapy. One paper suggested a generous timeline of at least 20 to 30 old ages before the potency of cistron therapy can even be considered. These issues are ‘merely medical ‘ issues. Religious and ethical issues besides have to be taken into consideration before prosecuting this direction. In decision, I learned that though there is much potency in this field of cistron therapy, much research still has to be undertaken to determine its safety every bit good as efficaciousness. However it has been a valuable experience in larning about new modes of intervention and to catch a glance of what the hereafter holds. This has taught me to go on larning as there are ever new sentiments and therapies available in the direction of any unwellness. 4 ) Professionalism, moralss and personal development What are the ethical deductions of familial proving for haemophilia? After MFA was diagnosed with haemophilia, his immediate household underwent familial testing. The proving revealed that his female parent was a bearer and that his senior brother and senior sister were normal. The familial testing was done voluntarily. There is no recommendation in the Malayan Paediatric protocol for familial testing to be done. Familial testing is normally done in patients with no clear household history in order to determine which parent is a bearer so that farther stairss of direction can be carried out. These farther stairss may include offering familial testing to the siblings of the bearer parent and besides reding about hazard of holding extra kids. However familial testing besides raises many ethical inquiries. First there is guilt, heartache and ego incrimination when a female parent with no known household history of hemophilia discoveries that she was the cistron bearer that passed it on to her kid. A paper by Thomas et al [ 9 ] on attitudes towards familial proving in an Australian community found that female parents who were ‘sporadic ‘ bearers ( no known household history of hemophilia ) were had feelings of guilt. Performing familial testing to determine that a female parent of a haemophiliac kid is a bearer would merely be of value if extra stairss were taken such as offering familial testing to the female parent ‘s siblings. This in itself would raise inquiries of confidentiality and revelation since offering the testing would necessitate the physician to unwrap to the other household members that the female parent is a bearer. This revelation could so take to stigmatisation. In this specific instance, MFA ‘s female parent was found to be a bearer. She related that she felt anguished at ‘causing ‘ her boy to endure much hurting. The cognition that the female parent was the bearer who had passed on the cistron to her boy did non change the direction of MFA. As such there was small virtue in executing the familial testing in this instance. A 2nd consideration of familial testing is the deductions that it has on a individual ‘s determination of whether or non to hold kids. This is once more more relevant for female bearers. Carriers should be counseled that there is a 50 per centum opportunity that their kid would hold hemophilias if he were a male child. However the ethical issue arises when there is no agency of correlating between the genotype and phenotype. [ 10 ] Just because the kid may hold hemophilia does non foretell the grade of badness of the hemophilia. The lone means to cognize for certain about the position of a foetus in footings of whether he would hold hemophilias and the grade of badness is by making antenatal familial proving such as chorionic villi sampling. Prenatal familial proving itself is associated with many ethical issues such as the deductions of transporting out such a trial. Would the foetus be terminated? There is legal leeway for expiration if it can be proven that the kid ‘s unwellness would convey about mental hurt to the female parent. Where do we pull the line to make up one's mind that such a foetus has excessively terrible a haemophilia so as to justify expiration? Who makes the determination? In the instance of MFA, the parents decided non to hold any more kids due to the hazard of holding another hemophiliac kid. It ca be seen that the familial testing had a profound impact on their determination. However proper and thorough familial guidance was non given to the parents. In decision I learned that familial proving for hemophilia is fraught with many ethical considerations. It should merely be offered when proper followup such as guidance, support and options can be offered to those undergoing the trial. In the absence of proper model of support, it may be better to keep back familial testing.