Great Gatsby and Elizabeth Barrett Browining Essay

The Great Gatsby by F.Scott Fitzgerald and Sonnets from the Portuguese by Elizabeth Barrett Browning are influenced by their varying context in their portrayal of love in their respective texts. Both authors explore the concept of love using various language features such as metaphors the use of irony. The Great Gatsby explores how the desire for the American Dream has taken prevalence over romantic love during post world war 1. This is contrasted with Elizabeth Barrett Browning’s Sonnets from the Portuguese where we are able to visualise her passion towards her lover through linguistic construct and also through the construction of an intimate sonnet. The Great Gatsby is set in what is commonly known as â€Å"The Roaring Twenties† or â€Å"The Jazz Age.† Given the 20s was about opulence, the nihilist attitude is reflected in romantic needs. Fitzgerald dismisses the idea of idealised love and refers to America’s love with the American Dream. Post World War 1 was a period of hedonism that reflected people’s determination to forget the sufferings and loss of the war. It was also a time of moral confusion. There was a mood of superficial optimism as people tried to hide their disillusionment. Fitzgerald explores the difficulty of individuals maintaining moral integrity in a material society that values wealth above all others. It was a time where there was great importance placed on what people had and not what people were. Fitzgerald’s use of Nick as the unreliable narrator is meant to represent cultural mores of the 20s. He represents the voice, failings and cynicism of the time and acts as a filter through which ideas and characters are reflected and mediated. We gain a pessimistic and fragmented insight into the tragic love story of the novel. The fragmentation and complex structure of the novel builds up Gatsby as the paragon of the Jazz Age and epitome of the American Dream. Ultimately, someone who represents the 20s cannot gain true love in the face of Tom’s wealth and riches. At the end of the play, Nick comes to fear that he is living in a loveless and faithful w orld. The narrative structure shows that time is a representation of love. The exploration of love in The Great Gatsby is treated with great ambiguity as Gatsby who is to be admired for his hope and vision, is sadly tragic and is unworthy in a society in which he loves. Fitzgerald is alluding to the fact that in successful America at the time, many were preoccupied with their social standings and wealth. The American Dream took precedence over romantic relationships. He condemns  love to be distrustful and faithless. This is shown through the numerous relationships throughout the novel. The relationship between Daisy and Mr. Gatsby is a clear example. Before Gatsby went to war, Daisy promised to wait for him but instead, married the very wealthy Tom. It becomes clear that Gatsby loves and wants the idea of Daisy rather than the real version. In order to eligible for Daisy’s love, Gatsby recreates himself to become a successful and wealthy man; hence he shows Daisy all his possessions after their meeting at Nick’s house. When Daisy cries over Gatsby’s â€Å"beautiful shirts† it highlights, the materialistic views she possesses and the relationship between love and money at that time. Part of Gatsby’s yearning for Daisy is her link to an exclusive society that he desperately wants to join. Gatsby’s love for Daisy is clear when he takes the blame for the death of Myrtle. We are positioned to see his devotion to Daisy as being foolish. â€Å"I love you now, isn’t that enough?† Although Daisy is unsatisfied with her marriage and enjoys her relationship with Gatsby, she never intended to leave Tom. In the end, it is not enough as Gatsby is not accepted in society or accepted by Daisy. F.Scott Fitzgerald shows the shallowness of love through the relationship of Myrtle and Tom. Their relationship is a symbol of an exploitative relationship. Myrtle is not content with her marriage and vies for a higher position. Myrtle admires ‘breeding’ and the aristocratic society and sees nothing immoral about her position as Tom’s mistress. She feels more superior when walking around New York with Tom and looks down on people who cannot afford materialistic goods although she normally would not be able to afford these products either. Tom provides Myrtle with presents that she normally would not receive. Ironically, Myrtle condemns her husband, George Wilson, for not owning his wedding suit. However, Tom doesn’t want to sustain the relationship with her. It is purely for his sexual needs. Hence, Fitzgerald depicts love to be superficial and is determined by the amount of wealth and social standing of a person. F.Scott Fitzgerald critiques the American Dream. Gatsby is an apparent self-made man who went from almost nothing to extravagance and wealth. However, Gatsby, Myrtle and George are seeking a better life but only achieve humiliation and death. Myrtle dies in the pursuit of the American Dream. Ironically, she is killed by Daisy who represents the idealised woman of her time in terms of wealth and status. Elizabeth  Barrett Browning’s Sonnets from the Portuguese explores love from the perspective of a 19th century women in order to convey the passion she feels for her lover. Barrett Browning ref lects a society where idealised love is admired and where there is faith in the individual. Barrett Browning presents an optimistic view of love. She manipulates the Petrarchan sonnet form, which is traditionally written from a male perspective, by subverting the writing scheme. She subverts the form by writing as the subject and object of the poem. Elizabeth Barrett Browning writes of her personal experience of love and idealised love. She is challenging how the art form challenges woman and celebrates love as a liberating force. By exploring her emotions, she explores her own identity. Elizabeth Barrett Browning believes her love with Robert has elevated so much that they approach transcended beings, â€Å"Our two souls stand up erect and strong.† Barrett browning is suggesting that if they didn’t have a body they would still move towards each other in passion. She captures the intensity of their love and the depth of their love through the line â€Å"Until their lengthening wings break into fire† This reiterates their passion and connection of love. There is a stark contrast with F.Scott Fitzgerald’s bleak view towards idealised love to Barrett Browning’s optimistic representation of love. In each sonnet, Browning portrays the notion of love has empowered her and made her value herself as an individual, â€Å"I love thee with the love I seemed to lose† (sonnet 43) She reveals to us that before she met Robert, her life was characterised by fragmentation and loss. This reinforces how love has transformed her life. She attempts to measure her love for Robert through the line, â€Å"I love thee to the depth & breath & height.† The use of the half-rhyme unifies Sonnet 1 but fractures it at the same time. Half rhymes show the impact of the love she is feeling and the reassessment she is feeling. The half rhymes are created to show how the predictable known ways of seeing the world have led her to innovation. In conclusion, it can be seen that both authors deal with love in their respective texts. However, F.Scott Fitzgerald takes a pessimistic view towards idealised love and rather, comments on the love for the American Dream in his society. Elizabeth Barrett Browning takes a more optimistic view, suggesting that it is a liberating force.

How Huckelberry Finn Defines His Moral Character

Defining a Moral Character The journey through life is broad, but early on, people learn values and morals. Often times, these characteristics are influenced by daily experience and contact with others. Although developing morals and values may be difficult at times, adequate time and experience brings gratification. As it was for Huck Finn, the adventure through independence and experience brought knowledge of values including, responsibility, accountability, compassion, and gratefulness which ultimately helped Huck define his moral character.In most situations, Huck was able to make decisions based on his perception of right and wrong, and learns life lessons in doing so. No matter what trial or tribulation he encountered, Huck was grateful he was not subject to Papp’s abuse. When he was caught trying to be a girl by Judith Loftus, he learned compassion when she still accepted him in her home.Huck didn’t want to feel accountable for the death of the murders on the aba ndoned ship, so he did what he felt was necessary, and took on the responsibility of trying to see they were rescued. Stating, â€Å"†¦wishing I knowed who shot the man and what they done it for,† Huck sought and found meaning in most circumstances and understands every choice has its consequence (133). Whether or not to turn Jim in was something Huck toggled with constantly throughout his adventure.He knew that Jim belonged to the widow Douglas who had done so much for him, but Huck still felt compassion for Jim, who he had developed a deep friendship with on account of their experiences together. Because of his bond with Jim, Huck did not want to feel guilty if something bad were to happen to his friend, but at the same time, he did not want to be held accountable for helping a runaway slave.Altogether, the lessons Huck learned on his adventure were a contributor to the definition of his moral character. In the end, Huck acted on what he felt was right according to his set of developed morals and values, regardless of whether it was accepted by society or not. He later affirms his decision by stating â€Å"All right then, I’ll go to hell† as he ripped up the letter to Ms. Watson (239). Huck’s influence and experience led him to be a loyal friend, and a virtuous individual.

Cancer and Nutrition Research Paper Example | Topics and Well Written Essays - 3500 words

Cancer and Nutrition - Research Paper Example A variety of fruits and vegetables need to be added to once diet and it is good to select these fruits and vegetables based on different color. Different phytonutrients are present in fruits and vegetable with different color and a variety based on this criterion would be easy for identification by a layman. A diet that has high fiber food such as whole wheat, a balanced ratio of omega 3 and omega 6 fats, antioxidants and phytonutrients from fruits and vegetables, such as ? & ?-carotene, ?-cryptoxanthin, vitamin C, vitamin E, selenium, and other nutrients can aid in prevention of different types of cancers. This paper focuses on the role of nutrition in prevention of cancer and recurrence in those undergoing treatment for cancer. Cancer and Nutrition Introduction Cancer has always been a dreaded disease that I have ever come across in my life. There are many who have cancer and unfortunately, in many cases, it is because of ignoring some of the basic aspects of life such as good nutr ition. I have seen people suffer and die of this disease. My grandfather died of bone cancer and my mother has had thyroid cancer. Today, though there are easy methods of detecting and good treatments available, I believe that it is better to prevent cancer rather than look for treatments after having it. Over the years I have been keen to find natural methods to prevent cancer and nutrition is one of the prime subjects that I have come across. This paper highlights the importance of balanced nutrition in preventing cancer and also looks into the role of balanced nutrition in the recovery phase among the survivors of cancer. Hippocrates (460-377 BC) stated that â€Å"†¦.let food be your medicine and medicine be your food†. Today, after several centuries I would like to believe that what goes into the body as food mainly determines the health of a person. Though environment and other exposures may be reasons for a disease, a healthy person will be able to withstand advers e circumstances. Therefore, if nutrition has to take care of us, then what kind of nutrition is best for preventing diseases such as cancer? Researchers suggest that a plant based diet that includes fruits, vegetables, whole grains and legumes are the best for cancer prevention (Mahtani, 2010a, para. 1). It is estimated that about one third of all cancers are due to poor nutrition. The use of tobacco is another major reason for additional one third cancers and if these two factors are controlled many people can be protected from this dreaded disease. Understanding the basic fact that a healthy diet plan together with regular exercise, a check on the body weight and avoiding tobacco and alcohol are some of the most simple techniques to keep one healthy and free from cancer or at least lower the risk of cancer. A plant based diet is rich in chemicals known as phytonutrients. These are healthy nutrients that are very essential for the well being of individuals. Phytonutrients include v itamins, minerals, and other chemicals such as antioxidants necessary for the prevention of cancer. Researchers suggest that the intake of phytonutrients is directly linked with the prevention of cancer. It is important to consume variety of fruits and vegetables rather than the same set of fruits and vegetables on a day-to-day basis. This gives us the benefit of a variety of plant based nutrients maximizing the cancer fighting agents in the body (Mahtani, 2010a). Another important question to be answered is that how will nutrition help cancer survivors? Though there are many researchers who have studied the role of nutrition in prevention of cancers, very less research has gone into role of nutrition for cancer survivors. Today, there are an increasing number of researchers who are contributing to

Quench and temper Lab Report Example | Topics and Well Written Essays - 750 words - 1

Quench and temper - Lab Report Example The first step in a quench and temper process is the intense heating that that aims at ensuring homogeneity of the steel’s elements and requires a temperature that is above the component’s transformation potential. This therefore eliminates possible asymmetries that reduce strength of normal steel. The sudden cooling then yields a â€Å"body centered ‘martensite’, which is hard† but is brittle (Black and Kohser, 2011, p. 133). The temper process however, defines a reheating of the material, at moderate temperatures to reduce the brittleness towards more malleable material (Black and Kohser, 2011, p. 133). The achieved strength of the material however depends on a number of factors. One of the factors that determine the achieved strength, and toughness, of a material from a quench and temper process is the level of orientation of microelements of the materials. Quenching and tempering process alignS the microelements to a level of homogeneity, a process that is done at the tempering process. Homogeneity can however only be achieved if the material is heat to a higher temperature, above the transformation level of each element of the material. A lower temperature exposure, relative to the elements’ transformation temperature is therefore expected to have little impacts on the achieved level of toughness and strength of a material while a high temperature heating is likely to achieve an increased level of toughness and strength. This factor directly relates to the nature of treatment (Shah, 2007, p. 58). The nature of treatment that a material is subjected to also plays a role in the acquired strength. Inappropriate processes are for instance identified with lower gained strength and hardness. In some cases however, poor treatment conditions even worsen a material’s strength and hardness to make it weaker than its original condition. Other factors that affect the effects of

Complusory Insurance bill Essay Example | Topics and Well Written Essays - 3000 words

Complusory Insurance bill - Essay Example Whilst participation consent is implied in respect of injuries falling within the ambit of inherent risks in the game, the extent of this "consent" has become contentious in practice with negligence liability arising for non-contact sport in addition to contact sport. For example, in the case of Condon v Basi ([1985] 1 WLR) it was asserted that an "inherent risk" in the game for the purpose of determining implied consent was essentially a question of fact, dependent on the circumstances of the game, including the regulations, the rules and customs and the inherent dangers. It was further stated that this was an objective test. Accordingly, the parameters of liability have remained uncertain with regard to who the appropriate tortfeaser is, along with the extent of liability for both professional and amateur players bringing claims in negligence. For example, in the leading case of Smoldon v Whitworth (1997] PIQR 133) it was determined that a referee of the Rugby Union match was liable for injuries suffered by a rugby player by another player as a result of a collapsed scrum. In this particular case, the referee had failed to enforce the rules of the International Rugby Board as applied to a rugby game, in which there were more than 20 collapsed scrums. Furthermore, there had also been complaints from certain players, a warning from one of the touch judges and shouts from the spectators. Furthermore, in the more recent case of Vowles v Evans ([2002] EWHC 2612), the Court of Appeal asserted that at all levels of sport a referee owed a duty to take reasonable care for the safety of players. Legal commentators have suggested that these cases by analogy point towards potential liability of coaches for failing to take reasonable care for the safety of their players. However, the liability of coaches remains ambiguous as it has been untested, however in light the Smoldon decision, the categories of potential defendants has clearly widened in sports injury claims. It is also important to mention that the relevant organisation putting on the game could also be liable for the player's injuries. For example, in the case of Watson v British Boxing Board of Control [2001]2 WLR 1256, it was held that the Board owed Watson a duty of care to provide appropriate resuscitation equipment and a person or persons qualified to use such equipment at the ringside. The Court made it clear that it was the duty of the Board and of those advising it on medical matters to be proactive in accounting for foreseeable risks and to seek competent advice as to how a recognised danger could be combated. Firstly, in the case of Condon v Basi ([1985]) the Court of Appe

A Soldier's Home by Ernest Hemmingway Essay Example | Topics and Well Written Essays - 750 words

A Soldier's Home by Ernest Hemmingway - Essay Example There are many different aspects in the story, as in its various use of comparisons from the view point of the narration of the main character, thus, creating a rather interesting transition in how I followed the relationship of the character to the settings involved in the story. Furthermore, I found that, the notion of having the main character clash with a variety of real issues was highly effective in harnessing the reality felt in the story, such as, in the encounter with the choices he makes concerning the values of sociality, sexuality, individuality and family. The opening of the story is especially interesting in my opinion, as it creates an immediate image in the compare and contrast of the two worlds involved around Krebs, which exposes us to his diverse social standards. These descriptions represent a vital point in the course of the story, as stated: â€Å"these snapshots introduce the double backdrop against which Harold Krebs’s story will unfold, and they prefigure the antagonism that will direct its narrative† (Baerdemaeker 56). In the first image, â€Å"There is a picture which shows him among his fraternity brothers† (Hemingway 111). In my opinion this picture portrays Krebs as a traditional American student who is full of masculine pride in the bonding of his fraternity brothers, but I felt that he was unsure of his identity as a man, for Hemmingway states that â€Å"He enlisted in the marines† (111) making this decision his choice only. Moreover, in the second image, â€Å"There is a picture which s hows him on the Rhine with two German girls and another corporeal† (Hemingway 111). This in my opinion was a rather interesting transition from Krebs’s education background to the militant background, which now consist of social norms involving politics and sexuality. As I read â€Å"Soldier’s Home† I felt a profound distinction in Krebs, in conjunction with the indifferences to the people in his home town, as to seem as if his decision to

Pharmacology Assignment Example | Topics and Well Written Essays - 750 words

Pharmacology - Assignment Example Here, they are absorbed into the blood through the epithelial cells and into the blood stream. From the bloodstream, they may enter the tissue fluid and then into the cell where they are metabolized and converted into active form. During this process, the drugs encounter several obstacles in their path that they have to overcome. They occur at almost every stage of the process from administering to action at the target sites. The main barriers are the cell plasma membrane, epithelial cells, endothelial cells, blood capillaries, glomerular membrane, capillaries and renal tubules among others. The plasma membrane is a lipid barrier. It only allows passage of lipophilic molecules and hydrophilic molecules, like water, into the cell. It is partially permeable to larger molecules such as larger lipophilic ones. The intestine is the main site for absorption be it drugs or food. The gastrointestinal epithelium also acts as great barrier to the movement of drugs. This layer is a single cell thick. These cells are closely packed together making it difficult to for drugs to move from the intestines into the blood stream. The layer is covered with a mucosal membrane which bars the movement and absorption of the drug. The drug has to go through two plasma membranes to get to the bloodstream. In the bloodstream, the drug is transported to various tissues where the vascular endothelium must be overcome for the drug to enter the tissue. The cells may so closely packed together that they impede the passage of large drug molecules into the tissue fluid. A good example of vessels with tightly packed epithelial cells is the capillaries at the central nervous system. The endothelial cells may also be loosely packed making it easy for the body to eliminate the drug. The spleen has ‘leaky’ epithelial lining. There is also the capillary membrane that is very selective of the size of molecules that go through. They allow movement of both polar and non-polar molecules. Thi s is useful in the kidney during elimination of drug and waste products that are polar. The kidney is a site for drug elimination as well as re-absorption. Due to the nature of its membrane, only non-ionized and lipid compounds get reabsorbed (columbia.edu). The method of transportation also affects drug activity. Methods such as active transport require a lot of energy to perform, therefore, delaying the time of action of the drug. There could be delays in the time taken for the stomach to empty its contents into the ileum, thus, postponing absorption. Intestinal motility is also crucial when bringing the drug into contact with the cells of the epithelium for absorption. The duration of contact between the cells the drug should be adequate to promote absorption. For absorption to be successful, the flow of blood should be high for maximum absorption. Blood determines the diffusion gradient. Other factors that affect the rate of drug absorption include: the food we eat, the pH of th e gastrointestinal environment, age and state of health (Washington et.al, 2000). Question 2 The half life of a drug is the time it takes to for a drug to move from full pharmacological, physiological and radioactive potency to half. This information is useful to the nurse in that is informs him or her that the drug might not be as effective. The nurse should therefore request fro the replacement of the drug with a potent one. This will ensure a patient receives proper treatment using active drugs.

Bioterrorism and Disease management, Communicable disease Prevention Essay

Bioterrorism and Disease management, Communicable disease Prevention and Control - Essay Example The planning, evaluation and implementation of programs meant to prevent or control communicable diseases require nurses to first identify the nature or type of communicable disease and the mode of transmission (Heymann, 2008). The second step is the development of the manual indicating the common symptoms that are shown by the disease and then devising the preventive measures that the public should take to avoid being infected. This first step is essential to enable the nurses immediately devise a public awareness campaign that informs the public regarding the outbreak of the communicable disease and the manner in which it is transmitted, as well as the most common and observable symptoms that the public should look out for (Heymann, 2008). The second step helps the public to avoid contacting the communicable disease through its various transmittable ways, by observing and then applying the preventive measures. The nurses also develops he right treatment procedures for the affected population, while applying other preventive measures such quarantines and isolations where necessary, most especially when the disease is categorized as contagious (Schlipkà ¶ter& Flahault, 2010). The Centre for Disease Control and Prevention (CDC) defines bioterrorism as the deliberate act of releasing of harmful biological, living microorganisms or their products to the population, with the intention of causing illnesses or even death to the target population (CDC, 2007). The target population for bioterrorism could be humans, animals or plants, which are targeted for destruction by the bioterrorists, with the intention of generating and accelerating fear and panic among the public. This is owing to the fact that the biological destruction can be gradual and less noticeable than the physical destruction, and thus capable of causing more panic and anxiety (CDC, 2007). The positive effect of

Illustration Essay Example | Topics and Well Written Essays - 500 words

Illustration - Essay Example This butterfly emerged more quickly, but seemed somehow unwell. After watching for some time, the boy realized that the newly emerged butterfly was in fact dead. Years later at university he learned that a butterfly’s struggle is a necessary part of its lifecycle. Without the opposition of the chrysalis, important biological changes can not take place and the butterfly will not be able to unfurl its wings once freed. I agree with Helen Keller’s quote. My personal experiences have taught me that true character and strength develop most deeply when an individual is encountering opposition. For me personally, I can’t say that all of my character has been developed in the crucible of affliction. I believe that the first lessons in character I learned were learned through watching the examples of adults that surrounded me and being taught explicitly how to become a person of integrity. In some ways, I would liken this to the butterfly before it struggles to even emerge. I can still remember witnessing significant adults in my life displaying good character by returning money to a cashier that had been given to them by mistake, making good on promised gifts or rewards and apologizing to others when they were found to be in the wrong. I was not an active participant in these displays of good character, but I was witness to them. In this way I feel they prepared me to stand up by displaying good character when it was my turn to be tempted to take the easy way out. Looking back a few years, I can see how difficult it is to have good character when in the throes of puberty and adolescence. I can recall such a drive to find the easiest way out of everything when I was in 7th or 8th grade. I found it so easy to lie about an assignment or to tell a half truth to my parents to avoid a punishment. It seemed to me that the whole world was a thousand shades of grey and that right and wrong didn’t really matter. What mattered was avoiding negative

Baseball Essay Example | Topics and Well Written Essays - 750 words

Baseball - Essay Example Everyone wants to get out there and pitch that perfect curveball, or hit the first home run of the game. The air is rich with the scent of hotdogs as the vendors go to work feeding the masses. Young barmen and women do their best to satisfy thousands of thirsts filling endless plastic glasses with ice-cold beer. For some, a freshly baked pretzel is the way to go, plenty of salt and mustard, and a soda to wash it down. The wonderful mixture of odours in the air adds to the atmosphere and anticipation before the game. There's nothing quite like it. The stands are full of activity as everybody swarms to their seats. Not long until game time now. A hundred little boys hold on tightly to daddy's hand still not sure quite what to expect at their first ball game. They can feel the excitement building all around them and it is a new sensation. Although they may not know it they are beginning to understand the love of the game. Once full the ballpark is a magnificent picture of color and excitement. Music blares from the powerful sound system and adds to the already breathtaking atmosphere. Many fans are dressed in the shirts of their favorite teams. Others proudly wear their team's jacket, some just stick to the cap. The signs and banners are everywhere around the stadium held up high for all to see. Some of them simply display the name of a team; others send messages to the players wishing them luck in the game ahead. As the players make their way onto the park the stadium erupts with noise as so many thousands cheer, whoop and whistle for their favorite team and player. The sound is almost deafening but at the same time truly awesome. Everyone is on their feet knowing that all that stands between them and the first pitch of the game is a unifying rendition of the national anthem. Hands on hearts, the song brings everyone within the stadium together as it does every time. Even opposing fans are best of friends at this moment, proud to be American. The game starts and the crowd begins to settle down and enjoy the spectacle. The tension builds as several pitches fizz past the bat and smack into the heavily padded glove of the catcher. It's not long until the batter makes the first satisfying contact and the wonderful sound of bat on ball reverberates around the park. It is the sound that the fans love to hear, and to see the ball fly over the fence just makes it even better. Devout fans are pleased to be able to mark a home run on their scorecards, scorecards which they will no doubt show their children in years to come. The excitement of the final few innings is almost unmatched by any other game. Even after hours of play the crowd are once again on their feet yelling words of encouragement and willing their team to finish the job. Then it is over. The winner is decided and it is time to go home. As the stands gradually empty there is a feeling of satisfaction around the ballpark, even from among the supporters of the losing team. They have had their dose of the game, and nothing can take that away. Empty now, the ballpark stands and waits. It has done its job once again, providing a home away from home for the baseball fan. For now it rests, but soon its gates will open once again and the people will come. Baseball, what a

Global Warming Essay Example for Free

Global Warming Essay Every day we go about our own business. Many of us never take the time to look around and see how we are affecting our earth’s atmosphere. Everywhere you look today you are bound to see some factory or machinery polluting our air. Just think how many times you have seen those large semi trucks or big fossil fuel factories emitting thick dark smoke into the atmosphere. We need to come to reality and realize that all that polluting we have been doing over the last half-century is finally catching up to us. It is very easy to detect through scientific research that our earth’s climate is changing, Time magazine reports in its 2004 issue that the earth’s average temperature is increasing at a steady rate. Yes, we all have heard the term â€Å"global warming†, however many people don’t know in depth what global warming is, or how our actions will affect our earth if we don’t respond to the issue. If we can educate ourselves on what global warming is and how it will affect us in the near and far future, we can then begin to change our old habits of polluting and create new habits and goals to living in a much healthier and cleaner environment. During the earliest times, the life-styles of our ancestors were very simple. The air they breathed was clean. The streams were clear and free of harmful organisms. They used natural fertilizers for their agricultural crops. The surroundings were free of household throwaways. Today, there has been a tremendous growth in science and technology. Such advances have brought about changes in terms of new products, improved equipment, and more effective methodologies. Unfortunately, this same technology which made life easier for us produced wastes which are now affecting the quality of our surrounding air, water, and land. Factories and motor vehicles send tons of pollutants into our air. Excessive air pollution poses a danger to our health and environment. It can likewise cause stunted growth and even death to our plants. Out streams are polluted by discharges from industrial plants that use chemicals. Garbage and sink wastes are carelessly thrown in our surroundings. Synthetic fertilizers and insecticides pollute our land and farm products. At the same time, the burning of fossil fuels, particularly coal and oil, produces sulfur dioxide and nitrogen oxides which are hazardous to the atmosphere. Findings show that a single smokestack may produce as much as 500 tons of sulfur dioxide a day. When these gases combine with oxygen and moisture, sulfuric acid and nitric acid is formed. The rain will carry the acids to the ground (acid rain) which may cause the depletion of calcium and magnesium in the soil, elements needed by plants for the formation of chlorophyll and wood, or it may cause the release of aluminum in the soil, which are poisonous and can kill the roots of trees. How can we take care of our environment? We must undertake measures to preserve our resources and minimize utilization of energy before it’s too late. Our fight against pollution is an initial step toward conserving our environmental resources and energy. We must all join hands for this common goal. Furthermore, of all issues affecting humanity, climate change is the most pervasive and truly global, posing a very real and serious threat to our environment. Climate change is the alteration of the pattern of global climate that may be due to human activity that alters the composition of the atmosphere.

The Main Causes Of The Holocaust History Essay

The Main Causes Of The Holocaust History Essay The holocaust is considered as one of the most horrific times faced by the Jewish community in Europe and the world at large. German dictator, Adolf Hitler is blamed for having initiated the Holocaust which saw more than ten million people murdered including about six million Jews. The German dictator was known to be a very anti-Semitic character as reflected in his Mein Kampf. Though much of the blame for the holocaust has been put on Hitler, he is not solely to blame as other various causes can be identified to have initiated the holocaust (Yahya, para 3). This paper shall provide an overview of the causes that resulted in one of the worlds worst war crimes to have ever been committed in the human history. The holocaust is regarded as a systematic, bureaucratic state sponsored persecution and murder that was directed towards the Jewish community in Europe just before the Second World War. It is claimed that close to six million Jews were killed by the Nazi regime together with their accomplices. The holocaust did not just target the Jewish community but also other groups that were seen to be inferior including the Roma [Gypsies], the disabled, and people of Slavic origin. There were also other groups which were persecuted based on their political, ideological and behavioral grounds. Such groups included the Communists, Socialists, Jehovahs Witnesses and the homosexuals (United States Holocaust Memorial Museum, Para 2). A pictorial representation of the massacre during the holocaust By the early 1930s, the Jewish population in Europe was above the 9th million mark and most of them resided in nations which the Nazi would occupy or had influence during the time of WW II. By the time the Second World War came to a close, the Germans together with their associates had killed two in every three Jews as part of the Final Solution policy adopted by the Nazi regime (United States Holocaust Memorial Museum, para 3). The Jews were exterminated by being confined in overpopulated camps, being subjected to systematic murder by use of gas chambers, overworking them without food to death and committing them to mass murder before being buried in mass graves. This has been argued to be the largest scale of genocide to have ever been committed in human history. The holocaust is said to be a history of enduring horrors and sorrows as it reflects the extremes that human beings can go without any spark of human concern nor any act of humanity. According to one survivor of the holoca ust, it was painstaking to explain how the holocaust was carried out. He had this to say, There were not six million Jews murdered; there was one murder, six million times (BÃ ¼low, para 3). The Nazi rise to power is seen as the leading cause of the holocaust experience. Following the defeat of the Germans in the First World War I, the Versailles Treaty inflicted more pressure on the wounded Germany. The treaty is known to have required Germany to accept the blame of instigating the War and therefore accept responsibility of paying huge sums of money to the Allies. Germany did not have money and therefore took loans from the United States to pay the financial penalties of the war. With the toll of the Great Depression taking a high on the United States economy, the financial institutions in the US which had lend Germany started to demand that Germany repay the loan advancements. This resulted in even more economical suffering for the Germans. According to Yahya (para 4), the Nazis promised to make Germany a great country, they took over the government to fulfill these promises by rebuilding the nation. Since everyone wanted to see change in their country for the better, the Nazis were elected and took control of the government with the hope that they would bring the much desired change The holocaust could not have been carried out without the support from the public. Propaganda therefore became a very crucial element in the Nazi political orientation. Josef Goebbels was made the Minister for propaganda by Hitler and he rose to become one of the most known figures amongst the public. He worked hard to convince the Germans that the Aryan race was the most superior. In addition the use of propaganda was extensive in the whole country especially against the Jews. The Jews continued to receive much hatred and suffering in the hands of the Nazis: The economic troubles of Germany were blamed on the Jews. They were accused of taking all the money for themselves. The Nazi party generated extensive propaganda to this end. As anti-Semitism grew within the population, the things done to the Jews by Hitler and his army began to be widely seen as acceptable. Herding Jews into slums, burning and taking their businesses and finally sending them to camps all became common (Rakoczy, para 4). The Jews found themselves on the receiving end as the propagandist minister worked hard to spread hatred towards them from the public. According to Goebbels and Hitler, propaganda was an important aspect since they reasoned that when lies are repeatedly heard, eventually they gain acceptance among the public. To ensure that the public was able to listen to the propaganda, radio sets were sold to the public cheaply and the government had control of all the radio stations while forbidding treason charges against the government in the media (Lieberman, para 4). Once the propagandas became popular anti-Semitic sentiments gained momentum. Hitler supported the racial anti-Semitism as opposed to the religious anti-Semitism which was the hatred that was directed towards the Jews who refused to be converted to Christianity. Racial anti-Semitism on the other hand was the hatred directed towards anybody who could be traced back to a Jewish linage even if the person in question was practicing Christianity. Hitler is known to have facilitated the creation of the Jewish ghettos, burning of the businesses belonging to the Jews and distributed The Protocols of the Elders of Zion, a book that claimed that the Jews were out to take over the world. It can be argued that Hitlers belief in anti-Semitism was one of the key aspects of his motivations (Lieberman, para 5). The other concept that contributed to the development of the holocaust can be said to be the lack of intervention from the other nations in stopping what was happening in German. During the Evian conference that took place prior to the war, the US and Great Britain together with some other countries gathered to discuss the events in Germany and during this time, the Jews were allowed to voluntarily leave Germany in case they wished. The nations at the conference discussed the need to raise the Jewish quota that could be admitted in their territories. Surprisingly, by the end of the conference, only the Dominican Republic had opened their boundaries for the Jews fleeing away from the Germans. The obsession that Hitler had, of completely destroying the Jews has also been associated with the fact that He had suffered from syphilis while in Austria as a young boy which was not treated and it may have resurfaced in his later years. The resurgence of syphilis can lead to many eventualities as it may affect the nervous system and the brain. Critical examination of Hitler indicates that he might have contracted syphilis in 1908 while in Vienna which only reappeared in 1935 when it was at the tertiary stage. The effect of the disease on the brain includes aspects of paranoia, megalomania, loss of sense of reality, loss of moral senses and fits of anger (Rakoczy, para 6). These are the characters which were observed in Hitler during later life. Conclusion It can be argued that there were various factors attributed to have caused the holocaust. Such factors range from the social, economic, political and individual factors. In a nutshell, they include the anti-Semitism sentiments, demonization of the Jews, the Versailles Treaty with its economic woes on Germany, the Nazi regime and the subsequent the public support without leaving out the mental health of the Nazi leader that is said to have been aggravated by the untreated syphilis (Kimel, para 1). The holocaust has gone down the history books as the most atrocious event to have ever happened among the human race. The holocaust was encouraged by the Nazi regime and the world failed to act fast to stop it. Nevertheless, the causes of the holocaust are many and varied as opposed to being though to have been Hitler alone. Though Hitler was to squarely be blamed for he was the German leader at the time of the holocaust, the causes of the holocaust were gradual and cumulative for over an ex pansive period of time. Work Cited BÃ ¼low, Louis. The Holocaust: Crimes, Heroes, and Villains. 2010. Retrieved on 20th October 2010 from; Holocaust.Web.28 Dec 2010 from; http://www.auschwitz.dk/anker /holocaust/. Kimel, Alexander. Direct Causes Of The Holocaust. 2010. Retrieved on 20th October 2010 from; http://kimel.net/direct.html. Lieberman, Daniel. Causes of the Holocaust. 2009. Retrieved on 20th October 2010 from; http://www.associatedcontent.com/article/1353270/causes_of_the_holocaust.html. Rakoczy, Christy. Why Did the Holocaust Happen? 2010. Retrieved on 20th October 2010 from; http://answers.yourdictionary.com/history/why-did-the-holocaust-happen.html. United States Holocaust Memorial Museum. The Holocaust. 2010. Retrieved on 20th October 2010 from; http://www.ushmm.org/wlc/article.php?ModuleId=10005143lang=en. Yahya, Hasan, The Causes of the Old Holocaust Are Building Up For a New One. 2010. Retrieved on 20th October 2010 from; http://www.articlesbase.com/strategic-planning-articles/the-causes-of-the-old-holocaust-are-building-up-for-a-new-one-1918168.html

Panayiotopoulos Syndrome in a 3 Year Old Child

Panayiotopoulos Syndrome in a 3 Year Old Child Benign occipital epilepsy of childhood -Panayiotopoulos syndrome- in a 3 year old child Menon Narayanankutty Sunilkumar *, Vadakut Krishnan Parvathy Department of Pediatrics, Amala Institute of Medical Sciences, Amala Nagar, Thrissur-680 555, Kerala, India M N Sunil Kumar V K Parvathy Running title: Panayiotopoulos syndrome in a 3 year old child Manuscript type: Case study * Author for correspondence, Dr. Menon Narayanankutty Sunilkumar ABSTRACT Panayiotopoulos syndrome (PS) is a relatively frequent and benign epileptic syndrome seen in children in the age group of 3-6 years and is characterised by predominantly autonomic symptoms and/or simple motor focal seizures followed or not by impairment of consciousness. Although multifocal spikes with high amplitude sharp-slow wave complexes at various locations can be present in the EEG, interictal electroencephalogram (EEG) in children with this particular type of epilepsy characteristically shows occipital spikes. This syndrome has known to be a masquerader and can imitate gastroenteritis, encephalitis, syncope, migraine, sleep disorders or metabolic diseases. In the absence of thorough knowledge of types of benign epilepsy syndromes and their various clinical presentations, epilepsy such as PS can be easily missed. The peculiar aspects of this type of epilepsy in children should be known not only by paediatricians but also by general doctors because a correct diagnosis would avo id aggressive interventions and concerns on account of its benign outcome. In this case study, we report a case of PS in a 3 year old child. Keywords: Benign occipital epilepsy, Panayiotopoulos syndrome, Autonomic symptoms, Emesis, EEG I NTRO DUCTION The International League Against Epilepsy in their expert consensus has given due importance for the various benign childhood seizures which have good prognosis.1 PS is a common idiopathic childhood-specific seizure disorder formally recognized by the league and is included in the category of benign epilepsy syndromes and is recognized worldwide for its autonomic presentations.2,3 This early-onset benign childhood seizures was described by Panayiotopoulos.4 . It has been defined by Panayiotopoulos as consisting of brief, infrequent attacks or prolonged status epilepticus and characterized by ictal deviation of the eyes and/or head and vomiting, occurring in children usually between the ages of 3 and 7 years.5 Seizures are usually followed by postictal headache and are often associated with interictal occipital rhythmic paroxysmal EEG activity that appears only after eye closure.5 The PS has excellent prognosis and parents can be definitely reassured about its benign course 4,6,7,8,9. The risk of developing seizure disorder in later life is negligible 6. Detection of occipital epilepsy at very early stage is needed to successfully treat this condition and allay the fears of the parents and care givers of these children with PS.In this case report, we discuss about the occipital epilepsy in a 3 year old girl child. CASE REPORT A 3-year-old girl, only sibling from a poor socioeconomic family of a non-consanguineous couple, presented in the Out-patient Department of Paediatrics, Amala Institute of Medical Sciences, Thrissur, Kerala, with complaints of becoming limp after sudden episode of vomiting, followed by uprolling of eyes, stiffening of the both upper limbs and lower limbs and a brief period of drowsiness.The child was happily playing in the house about half an hour back.There was no associated fever,trauma,ear discharge ,no common paediatric illnesses like diarrhea,dysuria,cough,running nose,wheezing,throat pain. A detailed history was taken. The child was born of a non-consanguinous parents,fullterm normal vaginal delivery,with a birth weight of 2.215 kg. She was immunized to date and had normal milestones of development.The history revealed that she had similar episodes of vomiting especially getting up from sleep and having deviation of eyes to one side,becoming limp and followed by drowsiness for few minutes in the past from the age of 1 Â ½ years old. Overall she had 5-6 such episodes and 3 times she had these episodes when she was sleeping.There was no associated fever during these episodes. Two times she had stiffening of all the limbs with deviation of eyes to one side,and followed by drowsiness. There was no focal type of seizures in this child. The parents attributed these to indigestion and gave home remedies as always there was vomiting and tiredness following the episodes.The child then used to play around normally. One month back the child was seen by a local doctor who advised EEG and it was done which was reported as normal and parents were advised follow up. The child on admission was tired, but was conscious. On examination,she was afebrile,signs of meningeal irritation were absent, central nervous system examination was normal,neurocutaneous markers were absent,fundus examination was normal. Other systemic examinations were normal.Laboratory investigations showed hemoglobin (11.7 g/dl) with low indices, total leucocyte count (11,550/cumm), neutrophils (75%), lymphocytes (22%), platelets (210000/Â µl), ESR (35mm at1 hr),serum calcium(10 mg%),SGPT(28mg/dl),serum electrolytes levels were normal.EEG was done(Figure- 1A and B) and reported as symmetrically distributed normal sleep activities,with activation of rare sharp wave discharges arising from the left occipital region.An awake record could not be obtained. The diagnosis of PS was made based on the clinical history and EEG which showed the predominantly occipital spikes. She was started on carbamazepine with increasing the dose schedule to her required weight. The child did not have any allergic reaction to the drug and did not progress autonomic instability. She and her parents were given excellent emotional and pschycological supportive care, After completion of 5 days of observation for her symptoms and any allergy to the she was discharged on day 6 with improvement in clinical conditions on multivitamins, hematinics and deworming drugs with an advice to follow-up . DISCUSSION PS described by Panayiotopoulos4 is a common autonomic childhood epileptic syndrome with a significant clinical, pathophysiological characteristics and is multifocal.10 PS is now formally recognized as a distinct clinical entity within the spectrum of benign focal epilepsies of childhood.11 PS affects 13% of children aged 3 to 6 years who have had 1 or more afebrile seizures and 6% of such children are in the 1- to 15-year age group.6,7,12. Autonomic epileptic seizures and autonomic status epilepticus are the cardinal manifestations of Panayiotopoulos syndrome.12. The main aspect of PS is that irrespective of their location at onset, there is activation of autonomic disturbances and emesis, to which children are particularly vulnerable. These symptoms and pattern of autonomic seizures and autonomic status epilepticus in PS do not occur in adults and are very specific to childhood. 12 PS is often confused with occipital epilepsy and acute non-epileptic disorders such as encephalitis, syncope, cyclic vomiting or atypical migraine even with characteristic clinical and EEG manifestations. 13 The clinical and EEG features of PS is due to a a maturation-related diffuse cortical hyperexcitability 4,6. This diffuse epileptogenicitywhich may be unequally distributed,is predominating in one area of the brain , and is often posterior. The explanation for the characteristic involvement of emetic and the autonomic systems may be attributed to epileptic discharges which are generated at various cortical locations andthis in turn influence the children’s vulnerable emetic centers and the hypothalamus 4,6. The diagnosis is based entirely on clinical presentation and EEG.12 PS has some of the key clinical features which are often present as single, focal seizures with an unusual constellation of autonomic, mainly emetic, symptoms,associated behavioral changes, and sometimes seizure like clinical manifestations such as unilateral deviation of the eyes and convulsions 3,4,7,8,9,13. The emetic triad in PS (nausea,retching, vomiting) culminates in vomiting in 74% of the seizures; in others, only nausea or retching occurs, and in a few, vomiting may not be present. Other autonomic manifestations include pallor, , mydriasis or miosis, flushing or cyanosis thermoregulatory and cardiorespiratory alterations. Frequently incontinence of urine and/or feces, hypersalivation, cephalic sensations, and modifications of intestinal motility are also seen9. Half of the convulsions end with hemiconvulsions or generalized convulsions. Two thirds occur during sleep as was seen in our child for about three times.. Autonomic status epilepticus enveals then.. The seizures usua lly last for 5–15 min, but half of them are prolonged, sometimes for hours, constituting autonomic status epilepticus. The patient recovers within a few hours. even after the most severe seizures episodes and status.12 An electroencephalogram is the only investigation with abnormal results, usually showing multiple spikes in various brain locations.12Multifocal spikes that predominate in the posterior regions characterize the EEG 6.The EEG variability in our child of 3 years is showing the characteristic occipital spikes from the left occipital region. The EEG done 5 months back was normal in our child. PS is the second most frequent benign syndrome of childhood after rolandic epilepsy,which primarily affects 15% of children at a peak onset at age 7–9 years 1. Another epileptic syndrome categorized with PS and rolandic epilepsy is the Gastaut type childhood occipital epilepsy 2, manifesting with frequent and brief visual seizures. However, this is rare,of uncertain prognosis, and markedly different from PS,despite common interictal EEG manifestations of occipital spikes 6.Occipital spikes in non-epileptic children with defective vision, occipital slow spike-and-wave found in some patients wi th the Lennox-Gastaut syndrome, focal epilepsy due to occipital lesions, seizures originating in the temporal lobe secondary to an occipital abnormality, and complicated or basilar migraine must be considered in the differential diagnosis.5 There are typical and atypical case of PS15,17,18 .Lada et al 15 conducted a retrospective study of 43 patients with PS who were seizure free >2 years. In their analysis girls predominated ,as in our child was a girl.. The first seizure was seen in 5 years of age. 86% had emesis as the symptom with the seizures. Seizures during sleep (84%) were more common than those in wakefulness. EEG showed occipital spikes in more than 50% of patients.. Prognosis was excellent and 80% children have been free of seizures for > or =2 years as is in a typical case of PS.15 DeÄÅ ¸erliyurt et al16 did a case series study of patients with PS and postulated that PS is associated with high rates of febrile convulsions, afebrile convulsions/epilepsy, migraine, and breath-holding spells in the patients and families suggested the importance of genetic factors 17.Febrile seizures are to be considered in the differential diagnosis because the recovery of consciousness from seizure is fast and Control of the seizure is paramount. uncomplicated usually.18 Ferrie et al. 17 postulated an atypical evolution of PS in a case report. The management of PS is not complicated. Education and knowledge about PS is the cornerstone of management. Control of the seizure is paramount. Prophylactic treatment with antiepileptic medication may not be needed for most patients. The emphasis is on treatment of possible fever and mainly of the underlying illness.One third (30%) of the seizures are relatively brief and self-limited. They subside spontaneously within 2–10min. The other two thirds (70%) have long-lasting seizures(>10 min) or status epilepticus (>30 min to hours). These should be appropriately and vigorously treated as for status epilepticus19,20. Parents of children with recurrent seizures should be advised to place the child on its side or stomach on a protected surface and administer a preparation of intravenous rectal benzodiazepine (BZD). In an emergency facility, the child’s airway should be kept clear, oxygenation maintained, and intravenous or rectal antiepileptic drug (AED) given to halt the s eizure. A BZD is probably the first choice. The great majority with PS do not need AED treatment even if they have lengthy seizures or have more than two recurrences. There is no increased risk of subsequent epilepsy or neurologic deficit. If a child has multiple recurrences (only about 5% exceed 10 seizures) and if the parents too worried prophylaxis can be given.Continuous prophylaxis consists of daily medication with any AED with proven efficacy in partial seizures.Although there is no evidence of superiority among monotherapy with phenobarbitone, carbamazepine(CBZ), sodium valproate or no treatment in PS, most authors prefer CBZ 14.Our child was started on Oxcarbazepine ,a structural derivative of CBZ with no side effects since last 1 month.Autonomic status epilepticus in the acute stage needs thorough evaluation; aggressive treatment may cause iatrogenic complications including cardiorespiratory arrest.12The adverse reactions of the antiepileptic drugs such as severe allergic r eactions ,abnormal liverfunction tests and idiosyncratic reaction should be kept in mind and monitored.14 The prognosis of PS is excellent 4,6,7-9. The lengthy seizures and status do not have any adverse prognostic significance, and the risk of developing epilepsy in adult life is probably no more than that of the general population 6. One third of patients (27%) have a single seizure only, and another half (47%) have two to five seizures. Only 5% have >10 seizures, but outcome is again favorable. Remission usually occurs within 1 to 2 years from onset.6. CONCLUSION PS is a common cause of epilepsy in children and a knowledgeable doctor does not miss it. Physician education of PS and recent guidelines on epilepsy management is vital in detecting PS at very early stage, so further lifesaving interventions can be done and prevent delay in the trearment administration. Multiple antiepileptic drugs use is required in only in a small proportion of patients. Seizures in PS, like febrile convulsions, despite their excellent prognosis, are a frightening experience for the in experienced parents, who often think that their child is dead or dying. Parents of young children should have general information by the family doctor regarding PS. Parental education and a supportive group comprising the paediatrician, neurologist, nursing staff and the social worker can help and reassure these distort parents as was done in our child who is doing fine with no recurrence in the last 1 month. ACKNOWLEDGEMENT The authors acknowledge the help of Dr Ajith TA, Professor Biochemistry, Amala Institute of Medical Sciences, Amala Nagar, Thrissur, Kerala during the preparation of the manuscript. REFERENCES Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989;30:389–99. Engel J Jr. A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: Report of the ILAE Task Force on Classification and Terminology. Epilepsia 2001;42:796–803. Berg AT, Panayiotopoulos CP. Diversity in epilepsy and a newly recognized benign childhood syndrome [Editorial]. Neurology 2000;55:1073–4. Panayiotopoulos CP. Panayiotopoulos syndrome. Lancet 2001;358:68–9. Andermann F, Zifkin B.The benign occipital epilepsies of childhood: an overview of the idiopathic syndromes and of the relationship to migraine. Epilepsia. 1998;39:S9-23. Panayiotopoulos CP. Panayiotopoulos syndrome: a common and benign childhood epileptic syndrome. London: John Libbey, 2002. Panayiotopoulos CP. Vomiting as an ictal manifestation of epileptic seizures and syndromes. J Neurol Neurosurg Psychiatry 1988;51:1448–51. Caraballo R, Cersosimo R, Medina C, et al. Panayiotopoulos-type benign childhood occipital epilepsy: a prospective study. Neurology2000;55:1096–100. Kivity S, Ephraim T, Weitz R, et al. Childhood epilepsy with occipital paroxysms: clinical variants in 134 patients. Epilepsia 2000;41:1522–33. Guerrini R, Pellacani S.Benign childhood focal epilepsies. Epilepsia. 2012;53::9-18. Koutroumanidis M. Panayiotopoulos syndrome: an important electroclinical example of benign childhood system epilepsy. Epilepsia. 2007;48:1044-53. Covanis A. Panayiotopoulos syndrome: a benign childhood autonomic epilepsy frequently imitating encephalitis, syncope, migraine, sleep disorder, or gastroenteritis. Pediatrics. 2006 ;118:e1237-43. Michael M, Tsatsou K, Ferrie CD. Panayiotopoulos syndrome: an important childhood autonomic epilepsy to be differentiated from occipital epilepsy and acute non-epileptic disorders. Brain Dev. 2010;32:4-9. Ferrie CD, Beaumanoir A, Guerrini R, et al. Early-onset benign occipital seizure susceptibility syndrome. Epilepsia 1997;38:285–93. Lada C, Skiadas K, Theodorou V, Loli N, Covanis A.A study of 43 patients with panayiotopoulos syndrome, a common and benign childhood seizure susceptibility. Epilepsia. 2003;44:81-8. DeÄÅ ¸erliyurt A, Teber S, BektaÃ…Å ¸ O, Senkon G. Panayiotopoulos syndrome: A case series from Turkey. Epilepsy Behav. 2014;36:24-32. Ferrie CD, Koutroumanidis M, Rowlinson S, Sanders S, Panayiotopoulos CP.Atypical evolution of Panayiotopoulos syndrome: a case report. Epileptic Disord. 2002;4:35-42. Knudsen FU. Febrile seizures: treatment and prognosis. Epilepsia.2000;41:2–9. American Academy of Pediatrics. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure: Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Pediatrics 1996;97:769–72. Mitchell WG. Status epilepticus and acute repetitive seizures in children, adolescents, and young adults: etiology, outcome, and treatment. Epilepsia 1996;37:S74–80. Legend to figures Figure (1A and B): EEG of the child showing the occipital spikes (arrow heads).

The Negative Effects of Media on Society Essay -- Television, Video Ga

Children are exposed to the negative effects of the media every day. Shows such as Bad Girls’ Club and Real World serve as poor role models for young people. There are many steps parents and guardians can take to lessen or completely stop the influence. Parents and guardians should offer children proper supervision, plenty of play, and education to shield them from the negative effects of the media. A very effective way to keep children from the negative influences of the media is to properly supervise. Overly excessive interaction with violent movies, music, and video games can influence a child’s behavior. Becoming media literate may help gain control. Parents should know what kind of media children are interested in and should keep them from watching any inappropriate material, and all programs should be age appropriate. Most television shows and movies announce the age preferences at the beginning of the program. Parents should be aware and strictly limit your children, also â€Å"limit children’s total media time (with entertainment media) to no more than 1 to 2 hours of quality programming per day† (Shelov and Bar-on, par. 9). Children who watch a lot of television can end up doing poorly in school. This should give them time to do more productive activities with their free time. Caregivers should pay careful attention to the shows school children are viewing. They should approve only programs that are â€Å"informational, educational, and nonviolent† (Shelov and Bar-on, par. 9). Caregivers should watch television programs along with young people. Also, they should discuss the content of a program with the children. (Shelov and Bar-on, par. 9). I remember growing up in my grandparents’ home, where we spent quality time together, wa... ...(â€Å"Achieve a Balance, 32). Although, my team mates and I disagreed on many things, the game taught us to come together and talk it through until we came to an agreement. â€Å"By giving children a way to expend their energy, sports can be a vehicle to achieve peace† (â€Å"Achieve a Balance†, 32). These three steps can help parents, guardians, and all other caregivers bring peace and serenity to a child’s life. All the wrong television shows, music, and video games can be damaging beyond repair. Music by artists such as Gucci Mane and Wocka Flocka can teach your child that bad habits such as smoking marijuana can be okay. Video games such as Grand Theft Auto and Saints Row may teach your child that they can get away with any crime and that gang violence is acceptable. Starting your child off early with healthy activities can benefit you and your child in the future.

In Book Two of Homer’s The Odyssey Telemakhos gains a significant amount :: Classics

In Book Two of Homer’s The Odyssey Telemakhos gains a significant amount of confidence and decides to call an assembly. At the assembly The Odyssey In Book Two of Homer’s The Odyssey Telemakhos gains a significant amount of confidence and decides to call an assembly. At the assembly a wise man Aigyptios presents the listeners with a rare introduction. He states that an assembly has not occurred for about twenty years and commends the individual that had the audacity to call one. At this assembly Telemakhos protests fervently that his mother’s suitors be expelled since they have no respect and appreciation for their generosity â€Å"these men spend their days around our house killing our beeves and sheep and fatted goats , carousing , soaking up our good dark wine, not caring what they do†. At the end of Telemakhos’s first battle to persuade the minds of the Akhaians against the suitors, a fellow leader named Antinoos decides to defend his fellow suitors. Antinoos counteracts Telemakhous claims informing everyone that the suitors should not be criticized since Penelope is the one to blame â€Å"you should know the suitors are not to blame but it is your own dear –incomparably cunning mother â€Å".He further adds that she has been deceiving them with her clever ability to avoid any decisions about marriage and gives the example of her unwoven loom. The suitors then commands that Telemakhos takes immediate action and either evict Miss Penelope from the house or compel her to marry the man her father suggests. Telemakhos makes a firm stance against the suitor’s suggestions and insists that he will never turn his mother out. During Telemakhos’s plead to save his mother; a pair of eagles appears in the sky. Another heated debate then rises between Halitherses and Eurymakhos in which Halitherses argues that the sighting of eagles foretells that Odysseus arrival is near and that the suitors will face grave danger if they don’t leave, while Eurymachus protests that the sighting of the birds are insignificant â€Å"Bird life aplenty is found in the sunny air, not all of it is significant†. Telemakhos concludes that he is finished with appeals and will let the Gods do the justice. All he desires is to locate a fast ship and a crew of men to carry out a voyage and arrive at a conclusion about his father whereabouts â€Å"If he’s alive and beating his way home you might hold out for another weary year;†¦..then I can come back to my own dear country and raise a mound for him†¦.†. After the assembly Telemakhos feels a sense of defeat and decides to

Media Texts, Brands, and Identity: For Him Magazine (FHM Magazine) Essa

Media Texts, Brands, and Identity: â€Å"For Him Magazine† (FHM Magazine) In this essay I will firstly introduce the magazine I am discussing, and talk about ideas of representations and gender in their issues, and also how it in effect they market themselves as a brand that articulates identity. FHM magazine stands for â€Å"For Him Magazine†; its core target audience is males 25-35. The magazine is produced monthly at the cost of  £3.40 per issue. FHM is now on global release as it publishes 27 different editions around the world in every continent, each with its own unique content. The UK version sells approximately 600,000 copies per month making it one of the most popular magazines in the country. For their company Emap under an umbrella of 58 magazines it is the most popular. Its content varies inside as it is essentially seen as a lifestyle magazine. Every month it has recurring themes of reviews and articles centrally focused around the opposite sex and hobbies the magazine assumes the audience has. A way we can look at the notion of identity is through representations given through the magazine. Since the magazines are aimed at men, we can assume that the magazine has underlying issues about gender. Therefore FHM would like to express itself through masculinity to create a meaningful link to its audience. In the following I will show how different men and women magazines are completely different in content and identity. Contemporary ideas of masculinity and femininity will be different to those of previous generations. Current themes may be stereotypical but to study it using binary oppositions gives it greater meaning; men are seen as masculine, dominant, strong, aggressive, intelligent, rational, and active. Whilst women are the opposed, they are feminine, submissive, weak, intuitive, emotional and communicative. As well as theses factors men and women are also seen to like different things, men like cars, technology, getting drunk and having casual sex with strangers whilst women like shopping, make-up, social drinking with friends, and having committed relationships. However, it is also clear that these lists are not truly representative of what men and women are really like. You all probably know a woman who likes cars and can be aggressive or a man who doesn’t drink and cries at weepy romantic comedies. These stereotypes exist, to ... ...romotional day where FHM itself confirmed their brand status. Since Topman is Europe’s biggest men’s retail store, they hired it out for the duration of a whole day. They had many attractions as well as the clothes feature. They also had new technology testing, massaging, tasting of alcohol and everything else they magazine stands for. By doing this it influences people’s choices and decisions regarding their lifestyle, by doing so it alters people’s identity. So was this just an identity building process or did it happen because there was demand? I finish with a quote from Hermann Bausinger who talks about how the new media sphere has evolved, â€Å"Technology has long since been integrated into the everyday. Tools themselves are distinguished by the fact that they rapidly take on the character of artificial limbs† (1995: 537). Brands are now extensions of our bodies. Sources used: Bausinger, H. (1995) â€Å"Media, Technology and Daily Life†. London: Edward Arnold. Hall, S. (1997) â€Å"Cultural Representaions and Signifying Practices†. London: Sage Hermes, J. (1995) â€Å"Reading Women’s Magazines†. Cambridge: Polity Press FHM - January 2008 FHM – March 2008 Marie Claire - January 2008

Negative Influence of Social Media Essay

Today, Mass Media is notoriously known to project a negative influence on teens and society. It manipulates several aspects of our lives including, but not limited to, the choices we make about our overall physical appearance, how we perceive beauty, healthy decisions we make regarding drug and alcohol use, engaging in premarital sex, and our peer and social interactions. We emulate what the media portrays as acceptable and desirable, though it goes against the norms and values put forth from society. As we mature, our goals and values seem to change as we break from the traditional values and connect with those portrayed as cool and current, through the media and pop culture. During adolescence, one often struggles with choosing between what is right from wrong and the media often accentuates the lives of celebrities. Young children are known to emulate their role models, unconscious of the consequences that may result in their actions. The media has been proven to be detrimental to the health and lifestyle of the youth. The media has a strong impact on the appearance satisfaction of today’s youth. Young women are constantly comparing their bodies to the ones seen advertised on television commercials. Around 10 million females and 1 million males in the United States are suffering from eating disorders such as anorexia, bulimia, etc. After seeing these beautiful and flawless models on billboards and advertisements, many women are disturbed with their personal body images. This is known to be a main contributor to eating disorders around the world. Thus, the media has the effect to change one’s mental set up. Beauty and Body Image in the Media† is an article that explains the negative affect the media has on young women and how they view themselves. Images of female bodies are seen in films, TV, magazines, ads, etc. These models are engraving the perfect body image into the minds’ of the youth. Women’s magazines are full of ads influencing women that if they lose weight they’ll have it all. Researchers have observed that these images of thin and airbrushed models are associated with depression, loss of self-esteem, and the development of harmful eating habits. It’s been suggested that almost half of all preadolescent girls are dissatisfied with their appearances and either diet or think about dieting. Further, 50 to 70 percent of average weight girls feel that they’re overweight and 90 percent of women are frustrated with their body images. These advertisements are not only advertising their products, but they’re also selling an entire way of life. The media promotes tan, fit, and outward physical perfection in men and women. It is not only middle-aged adults who seek cosmetic surgery to alter their appearance. Today, children also undergo cosmetic procedures. In fact, in 2005 it was reported that children under the age of 18 underwent approximately 333,000 cosmetic procedures. Some included liposuction, breast augmentation, otoplasties (ear pinnings), and rhinoplasties (nose jobs). Teenagers of both genders are trying to acquire a perfect figure rather than living a healthy lifestyle and appreciating themselves for who they truly are. The media also has a reputation for promoting unhealthy choices, such as unprotected premarital sex and drug and alcohol use. The media is sending the wrong message to young adults that taking part in these activities is okay. The article, â€Å"The Media’s Influence Undermines America’s Morals†, by Tim LaHaye contains numerous examples of how the media is detrimental to the future of the United States. AIM, Accuracy In Media, and PMRC, Parents Music Resource Center, are organizations that support government regulation of the media. They believe that the media is destroying our culture and altering our values. Moviemakers, producers, and journalists are provoking sexual immorality in our society by explicitly exposing and promoting sexual relationships. The media is even found glamorizing teen pregnancies in the MTV series, 16 and Pregnant and Teen Mom. LaHaye states that, â€Å"the media’s power is seen in its degrading influence not only on the nation’s morals, but on†¦ virtually every area of life. † Music also plays a huge role in influencing teens toward becoming sexually active and provocative. â€Å"Rock Music Has a Negative Effect on the Youth†, by Rob Lamp is another article which states that rock music is somewhat accountable for the increase in teenage pregnancies. A counselor for pregnant teenagers believes that young girls are emulating celebrities. They are buying their albums and dressing like them. Today, 30 percent of all women loose their virginity before age sixteen. Violence sexuality has also become popular in music videos and song lyrics. Rap lyrics are being criticized by child advocate groups such as the American Academy of Pediatrics, for imparting the wrong message to the youth about sex and drugs. Misogamy is a derogatory or hateful comment geared towards girls and women and a lot of rap artists tend to include misogamy in their lyrics. The  APA has determined that today’s youth actually spends more time listening to and reading to the lyrics via the Internet to their favorite music than they do watching television. This council urges parents to be vigilant when it comes to knowing what their children are listening to. Lamp also states â€Å"the kind of electronic music played at raves has been associated with the use of drugs and alcohol. † The Robert Wood Johnson foundation backed a report titled â€Å"Substance Abuse: The Nations Number One Health Problem†, which shows juveniles are starting to use drugs and alcohol between the ages of 12 and 13. In fact, by eighth grade 52 percent of adolescents have used alcohol and 20 percent have used marijuana. This figure jumps to 80 percent use of alcohol and 49 percent use of marijuana by the 12th grade. A research conducted in 1997 showed that in the 200 most popular movie rentals, alcohol appears almost 93 percent of the time and illicit drugs appeared roughly 25 percent of the time. Further, of the 1,000 most popular songs, 27 percent were shown to include alcohol or drug references. These numbers have surely risen since 1997. In addition to music videos and song lyrics promoting premarital sex and drug/alcohol use, this form of media is also seen promoting violent behavior among adolescent teens. Robert Lamp also believes that â€Å"heavy metal and rap have been associated with reckless behavior and below-average academic performance†¦ heavy metal and rock music have also been associated with an increasing risk of suicide, depression, delinquency risk behavior, smoking, and conduct problems† (Neale 1). In recent years, lyrics are becoming more vulgar and inappropriate. The violence heard in rock music instigates adolescents to commit violent crimes. In Northport NY, a seventeen-year-old boy was slaughtered; the names of Ozzy Osbourne and his former band members were spray painted at the crime scene, along with many satanic symbols. Doctor Guttman, a Professor of Psychiatry at Northwestern University states that, â€Å"Rock has so often been involved in these things (violence, teen suicide, etc. ) many of us in psychiatry have had to take it more seriously. † 45 percent of about 1,200 rock music videos supervised were viewed as explicitly violent. Video games and movies also play a prominent role in promoting violence among youth. The article â€Å"Most Teens Play Violent Video Games†, by Ben Berkowitz and published in the Washington Post, states that â€Å"70 percent of American teenage boys have played the violent, but popular â€Å"Grand Theft Auto† video game, and they are more likely to have been in a fight than those who have not played. † It is clear that the violence depicted through these games are mimicked by youth who have difficulty distinguishing between fantasy and what is appropriate and acceptable in a realistic environment. Tim LaHaye gives a real life example of how the media affects certain people. In San Diego, a High School honor student watched An ABC horror movie on the life of Lizzy Borden, an infamous axe murderer in the 1890’s. After viewing this film, he decided to murder his mother, father, and sister. These examples illustrate how juvenile violence is promoted through music, video games, and movies. We live in a society that depends greatly on the media to impart information, allow for communication, and provide entertainment on a regular basis throughout our daily lives. It is vital that we are attentive and vigilant in deciding what our youth should be allowed to view and listen to, as we know there is a direct connection between what one consumes and what one in turn values, how one behaves and how one interacts in society. Too much exposure to the negative aspects of the media can be detrimental to one’s mental, emotional and physical health. The media influences how we perceive beauty, the healthful decisions we make, and how we interact socially. The negative media is harmfully transforming our ethical values of life and our outlook on society.

Experience Of Facilitating Cpbl Tutorials Education Essay

I am asked to ease PBL and CPBL at St. George ‘s ( SGUL ) on a regular footing. Consequently, I selected this learning experience as the subject of this assignment, in order to let an chance to see the function of these tutorials within undergraduate medical instruction and how to maximize the acquisition experience for the pupils. When I was a medical pupil, PBL was comparatively new and merely comprised a really little proportion of the course of study. Since so, PBL has been progressively used in the UK and some medical schools now offer classs which about entirely employ PBL as the acquisition method. This has stimulated me to believe about the theory underlying PBL and how it compares to traditional undergraduate medical instruction. SGUL runs three separate undergraduate classs. One of these is the traditional five-year class, which accepts both school departers and alumnuss. In this assignment, I shall mention to this class as MBBS5. The other class that is relevant to this assignment is the four-year class, which is merely unfastened to alumnuss. I shall mention to this class as MBBS4.The experience of easing CPBL tutorialsI shall be depicting my most recent experience of easing a series of five hebdomadal CPBL tutorials with a group of seven pupils in the next-to-last twelvemonth of the MBBS4 class. I have chosen to concentrate on the 2nd tutorial in the series, as I felt that this was a peculiarly successful larning experience. As usual, the tutorial started with one of the pupils showing a patient that they had seen. Once the instance had been presented, the other pupils asked inquiries, easing a treatment about diagnosing, direction program and any other issues that the instance generated. The pupils identified subjects that they would wish to read more about and put larning aims consequently. They so researched these larning aims for treatment at the following tutorial. Once the pupils felt they had exhausted the treatment about the instance, we moved on to discoursing the larning aims set the old hebdomad. In the first tutorial, the pupils had identified the mental province scrutiny ( MSE ) as a subject that they would wish to read more about. In the tutorial, the pupils discussed each country of the MSE, with peculiar focal point on what inquiries to inquire to arouse symptoms from a patient. This stimulated an interesting conversation about the different ways each pupil had learnt to arouse the symptoms. I besides shared the inquiries that I use to analyze a patient ‘s mental province. The pupils reached the decision that there was no individual right manner to inquire the inquiries and that they needed to develop their ain manner that they felt comfy with. We so used function drama, during which I acted as a patient and the pupils were given an chance to pattern executing a MSE. The pupils reported that they found this highly utile, as it helped them to get down to develop their ain method for MSE and improved their assurance for executing the scrutiny on a existent patient.Critical contemplation on the experienceI frequently feel dying prior to learning Sessionss. My specific anxiousnesss around PBL tutorials include actuating the pupils, as I have found it hard in old tutorials to promote MBBS5 pupils to originate a treatment ; staying within the boundaries of my function as a facilitator, instead than supplying a didactic instruction session ; and a fright that the pupils will inquire inquiries that I am unable to reply. I exhaustively enjoyed easing this set of tutorials. This was my first experience of tutorials with the MBBS4 pupils. I found them to be much more occupied with the tutorials than their equals on the MBBS5 class. They were able to bring forth first-class treatments without motivating from me. I found it easier to stay within my function as a facilitator, instead than supplying active instruction. The pupils discussed complicated psychological constructs at a high degree, which I found peculiarly exciting. This highlighted the deepness of cognition that can be gained from others and reminded me how of import it is for physicians to pull upon this cognition as they progress through their callings, instead than dismissing their juniors as pedagogues. The MBBS4 pupils come from a huge assortment of backgrounds, so each was able to convey a different set of accomplishments and cognition to the tutorials. For illustration, one of the pupils had a background in catering and she was able to raise of import issues about a patient ‘s nutritionary position that I would non hold considered. In the past, I have found myself learning instead than easing in CPBL and PBL. However, during this set of tutorials, I found that I was better at inquiring inquiries to motivate the pupils to believe about the right replies, instead than stating them the reply. I felt that this was besides what the pupils wanted, whereas in my old experiences with MBBS5 pupil groups, the pupils frequently seem acute to be ‘spoon-fed ‘ the replies, instead than utilizing treatment to obtain cognition from their equals. This may be because the MBBS4 class uses PBL as its chief acquisition method from the start of the class, so the MBBS4 pupils are more familiar with the format and anticipate to larn by autonomous acquisition and sharing of cognition. On the contrary, the MBBS5 pupils have a batch more traditional talks and are accustomed to being taught in this mode. I did non see in anxiousness during this set of tutorials. We successfully created a safe, relaxed environment and the pupils seemed to experience comfy inquiring inquiries and discoursing hard feelings that they had experienced. This may hold been because all the pupils in the group knew each other and were used to working with each in PBL scenes. Again this is different to easing tutorials with MBBS5 pupils, who frequently are non well-acquainted with the other members of the group because until now the MBBS5 class has had a much larger cohort than the MBBS4 class. However, the Numberss accepted onto the MBBS4 class are increasing and I wondered whether this will impact on the group kineticss in MBBS4 PBL tutorials. In footings of countries for betterment, I think it would hold been helpful if I had besides researched the larning aims each hebdomad. I was surprised by the deepness and comprehensiveness of reading by the pupils. At times, they discussed really complex topics and I was non ever able to reply their inquiries. For me, this highlighted the abrasion of my cognition since finishing my postgraduate scrutinies two old ages ago and encouraged me to set about more professional reading and alteration. On a positive note, I think the pupils found it helpful to see that I was able to work aptly as a senior physician despite being unable to remember everything I have learnt. Students can experience overwhelmed by how much they have to larn and retain. I felt that I was able to reassure them that it is acceptable non to be able to remember everything you have learnt and that you can mention to text books. I received positive feedback through verbal remarks from the pupils and written feedback to the class organizers. The pupils seemed to bask the tutorials and found them of educational value. Equally good as discoursing the instances and larning aims, we discussed a calling in psychopathology, as a figure of the pupils expressed an involvement in this field. I think I was able to give the pupils a realistic and enthusiastic penetration into my profession. My hope is that, even if the pupils do non prosecute a calling in psychopathology, they will hold a positive position of mental wellness professionals, assisting to decrease stigmatization of the profession.Key pointsWhat is the grounds behind the development of PBL course of study? Does holding an adept facilitating PBL impact on pupil acquisition? Are graduates better suited to PBL?Literature reappraisalMy literature hunt revealed really minimum literature on CPBL. Therefore, I have decided to concentrate my cardinal points and literature reappraisal on the broader subject of PBL.The theoretical footing of PBLOriginally, PBL was based on the theory of contextual acquisition. The basic rule is that when stuff is learnt in the context of how it will be used, it supports acquisition and capacity to utilize the information. PBL uses this rule by supplying a instance in the real-life context of a patient sing a physician. Colliver ( 2000 ) undertook a reappraisal of the literature and concluded that the contextual acquisition statement was based on a weak research determination. Albanese ( 2000 ) concurred with Colliver ‘s unfavorable judgment of contextual larning theory as an statement for PBL and proposed four new theories for understanding how and why PBL works, specifically information-processing theory, concerted acquisition, self-government theory and control theory. Schmidt ( 1983 ) claimed that information-processing theory underpinned PBL. This theory involves three major elements, viz. anterior cognition activation, encoding specificity and amplification of cognition. Prior cognition activation is the procedure of pupils utilizing previously-gained cognition to understand and organize new information. Encoding specificity is similar to contextual acquisition theory, i.e. acquisition is promoted when the environment in which something is learned resembles the environment in which it will be applied. Amplification of cognition describes how information will be better understood and easier to remember when there is an chance for amplification in the signifier of treatment and replying inquiries. This theory incorporates contextual larning theory but provides a more comprehensive theory for understanding PBL. I will now briefly discuss each of the other three larning theories of PBL proposed by Albanese ( 2000 ) and reflect on my experience of easing PBL with regard to these theories. First, concerted larning refers to an person ‘s perceptual experience that they can merely carry through their ends if the other group members besides do so. Qin et Al ( 1995 ) conducted a meta-analysis of surveies measuring the consequence of concerted versus competitory acquisition on job work outing. They defined cooperation as the presence of joint ends, common wagess, shared resources, and complementary functions among members of a group. In competitory acquisition state of affairss, persons perceived that they could merely make their ends if the other group members could non. They found that members of concerted squads outperformed persons viing with each other with regard to job work outing. These consequences held for persons of all ages and for surveies of high, medium, and low quality. The high quality of cooperation, nevertheless, was greater on non-linguistic than on lingual jobs. I observed concerted acquisition in action during the set of CPBL tutorials that I have described in this assignment. The pupils were acute to portion the cognition that they had reaped from autonomous acquisition and support all group members to achieve the same degree of understanding. I felt that the pupils were better able to place the beginnings of misconstruing if a fellow pupil was fighting to understand a construct than I was as an adept facilitator. Self-determination theory may underlie affairs of motive and behavior relevant to PBL. Williams et Al ( 1999 ) argue that self-government theory has the possible to significantly better instruction. The theory differentiates between two types of actuating conditions, controlled and independent. Controlled incentives are thought to be maladaptive and include external demands every bit good as â€Å" introjected ordinance † , which are internalized beliefs about what one â€Å" should † make. These are all associated with either explicit or inexplicit wagess or penalties. Under controlled signifiers of motive, persons act with a sense of force per unit area and anxiousness. In educational footings, this refers to ephemeral, rote acquisition, which pupils do non incorporate into their long-run values and accomplishments. Albanese ( 2000 ) inferred that traditional course of study tended to affect controlled signifiers of motive. Albanese ( 2000 ) described independent incentives as â€Å" those which are personally endorsed by the scholar and reflect what the single finds interesting and of import † . In comparing to the external wagess and penalties associated with controlled motivation conditions, independent motive allows the person to act with a sense of will, bureau, and pick. PBL promotes independent incentives by sing the positions of the pupils and encouraging pupils to accept more duty for their ain acquisition. I felt that I was able to back up this by inquiring the pupils what they wanted to accomplish from the tutorials, easing their treatments by inquiring motivating inquiries and seeking the sentiments and feelings of pupils in a non-judgemental mode. As I discussed in my contemplation, we were able to make a safe, relaxed environment, which minimised force per unit area and control and encouraged a high degree of public presentation and collaborative acquisition. The concluding theory of PBL proposed by Albanese ( 2000 ) was control theory. This theory was foremost introduced by Glasser ( 1986 ) , who conjectured that all behaviors, including acquisition is intended to fulfill one or more of the undermentioned five internal demands: 1 ) To last ; 2 ) To belong and be loved by others ; 3 ) To hold power and importance ; 4 ) To hold freedom and independency ; and 5 ) To hold merriment. Albanese felt that PBL satisfies all five demands. It allows freedom because the pupils are able to construction their clip and take what to discourse. It satisfies the demand for power, as pupils have the power to put their ain acquisition aims. PBL promotes love and belonging because it allows pupils and facilitators to go more personally involved with one another than in talks. The literature ( Albanese and Mitchell, 1993 ) foreground how both pupils and module enjoy PBL, thereby fulfilling the demand for merriment. PBL promotes survival through pupils assisting pupils. These claims by Albanese ( 2000 ) are in harmony with what I experienced as the facilitator of the CPBL tutorials. To reason, although Colliver ( 2000 ) found the theoretical development of PBL to hold been weak, there is an array of theory that can be applied to PBL. I have described four theories but there may be others. Further research is required to look into how theory can be transformed into effectual PBL.Comparison of PBL-based and traditional course of studyIn the early 1990s, four separate systematic reappraisals comparing PBL to traditional course of study were published. I shall summarize these reappraisals before traveling on to discourse the more recent literature. The first reappraisal was published in 1992 by Norman and Schmidt, who examined the psychological footing for PBL. They found no grounds that PBL brought about betterment in â€Å" general, content-free problem-solving accomplishments † . However, they felt that there was some preliminary grounds to propose that PBL may â€Å" heighten both transportation of constructs to new jobs and integrating of basic scientific discipline constructs into clinical jobs † . Their other decisions were, â€Å" acquisition in a PBL format may ab initio cut down degrees of larning but may further, over periods up to several old ages, increased keeping of cognition † ; â€Å" PBL enhances intrinsic involvement in the capable affair † ; and â€Å" PBL appears to heighten autonomous acquisition accomplishments, and this sweetening may be maintained † . Albanese and Mitchell ( 1993 ) conducted a systematic reappraisal and meta-analysis of literature on the results and execution issues of PBL. They concluded from their findings that, compared with conventional medical instruction, PBL is more nurturing and gratifying ; PBL graduates perform every bit good, and sometimes better, on clinical scrutinies ; and they are more likely to come in household medical specialty. However, they besides found that PBL graduates tended to prosecute in backward concluding instead than the forward concluding experts engage in, and at that place appeared to be spreads in their cognitive cognition base that could impact pattern results. Vernon and Blake ( 1993 ) published a really similar meta-analysis of the literature, which supported â€Å" the high quality of the PBL attack over more traditional methods † . They found that pupil attitudes, category attending and temper were all systematically more positive for PBL than for traditional classs. In footings of clinical operation, PBL pupils performed better than traditional pupils. However, there was no important difference between the two groups on steps of clinical cognition. The decisions of a literature reappraisal by Berkson ( 1993 ) were much less positive, saying, â€Å" the alumnus of PBL is non distinguishable from his or her traditional opposite number. The experience of PBL can be nerve-racking for pupil and module. And execution of PBL may be unrealistically dearly-won. † In 2000, Colliver reviewed the medical instruction literature from 1992 to 1998, including the four chief reappraisals of PBL from the early 1990s, and produced a critical overview of PBL, its effectivity for cognition acquisition and clinical public presentation, and the implicit in educational theory. Colliver concluded, â€Å" the reappraisal of the literature revealed no converting grounds that PBL improves knowledge base and clinical public presentation, at least non of the magnitude that would be expected given the resources required for a PBL course of study † . Unlike old reappraisals, Colliver ‘s reappraisal challenged believing about the educational effectivity of PBL. Colliver suggested that farther research was required to clear up both theory and pattern. Subsequently in 2000, Norman and Schmidt responded to Colliver ‘s paper with their ain reading of the research grounds. They did non believe its was sufficient to trust on randomized controlled tests and argued for the usage of a wide scope of research designs and variables. Albanese ( 2000 ) besides produced a paper as a rejoinder to the reappraisal by Colliver. Albanese used consequences of pupils from differing course of study on the United States Medical Licensing Examination ( USMLE ) to propose that PBL produced higher tonss than traditional talks. Albanese concluded that the positive consequence that PBL has on the acquisition environment is â€Å" a worthwhile addition in, and of, itself † , despite the absence of a thorough apprehension of its consequence on cognition. Since 2000, PBL has been used progressively in undergraduate medical instruction in the UK. During this clip the educational theory behind PBL has continued to develop and several new reappraisals and surveies have been published. A reappraisal was conducted by Newman ( 2003 ) , which included merely randomised controlled tests and quasi-experimental surveies in which pupil public presentation or other results were objectively measured. They concluded that results for pupils in the PBL groups were less favorable than those in the â€Å" control group † . However, there was no consensus in the surveies that they reviewed on what constituted a control group. Dochy et Al ( 2003 ) were responsible for another recent meta-analysis of the effects of PBL, which showed that PBL had a positive consequence on cognition application of pupils. However, no consequence on cognition was found. A figure of surveies including that by Prince et Al ( 2005 ) ( look into ref ) have used self-report questionnaires to compare the sentiments and competences of alumnuss from PBL and non-PBL schools. The consequences suggest that PBL alumnuss are better prepared with regard to several of the competences. Antepohl et Al ( 2003 ) conducted a questionnaire survey of all alumnuss of the new PBL medical course of study at the Faculty of Health Sciences, Linkoping University, Sweden. They found that â€Å" alumnuss of the new medical course of study showed a high grade of satisfaction with their undergraduate instruction and how it prepared them for medical pattern † . However, this survey had some restrictions. The usage of postal questionnaires introduces response prejudice. They had a good response rate of 77 % but it is possible that the 23 % who did non react may non hold a positive position of their medical instruction. This survey raised inquiries sing the grade to which alumnuss ‘ subjective retrospective rating of their ain undergraduate instruction can supply relevant information refering the quality of the class. Schmidt and van der Molen ( 2001 ) overcame this issue when comparing PBL alumnuss to traditional alumnuss. They identified and corrected self-overestimation among PBL alumnuss by mentioning to self-ratings consequences in countries in which a difference between PBL and traditional pupils was non expected. If differences did occur, they were used to quantify self-overestimation and to rectify for it. Tiwari et Al ( 2006 ) conducted a randomised controlled test aimed at comparing the effects of PBL and talking attacks on the development of pupils ‘ critical thought. Their consequences revealed that PBL pupils had â€Å" significantly higher critical thought temperament tonss on completion of PBL compared with talk pupils † . â€Å" They besides continued to hold higher tonss, albeit to a lesser grade, than the talk pupils for two old ages afterwards. † This survey involved little Numberss of pupils and relied upon self-report by pupils, which can present recall prejudice. Despite these restrictions, this survey highlights the demand for farther research to find whether the differences in critical thought are maintained in subsequent old ages. Besides in 2006, Schmidt et al conducted a big, robust survey comparing professional competences of PBL alumnuss to traditional alumnuss in the Netherlands. Participants were asked to finish a questionnaire, evaluation themselves on 18 professional competences derived from the literature. They concluded, â€Å" PBL non merely affects the typical PBL-related competences in the interpersonal and cognitive spheres, but besides the more general work-related accomplishments that are deemed of import for success in professional pattern † . More late, Koh and co-workers ( 2008 ) performed a systematic reappraisal of how PBL during medical school affected the competency of physicians after graduation. The writers merely included publications that incorporated a control group of alumnuss from a â€Å" traditional † course of study. This high quality study employed a thorough methodological analysis, whereby physicians ‘ ego appraisals of their competences and appraisals by independent perceivers were considered individually. Small correlativity was seen between self-assessed and observer-assessed competence. Self-assessment showed a strong degree of grounds against PBL for ownership of medical cognition, but this was non confirmed by independent observation. The writers concluded that PBL has positive effects on alumnus competences in of import societal and cognitive spheres. Again, one of the jobs with this reappraisal was the absence of a definition of the control â€Å" traditional † course of study . In 2009, Macallan et Al evaluated which constituents of CPBL contributed most to the success of the theoretical account utilizing semi-structured questionnaires, focal point groups and a consensus method. They showed that pupils found CPBL a â€Å" positive acquisition experience † . They found that successful CPBL was supported by â€Å" the coach ‘s degree of expertness and a non-threatening acquisition environment, contributing to student oppugning † . This survey verified the thought that CPBL is â€Å" a parallel instruction attack that helps construction the instruction hebdomad, but does non replace traditional bedside instruction † .AndragogyUpon contemplation, I noted important differences in the manner in which the MBBS 4 pupils interacted in the CPBL tutorials and their ability to utilize these tutorials as a larning tool compared to pupils on the MBBS 5 class. I wondered whether this may reflect how learning manners change as we become grownups and mature. McCrorie ( 2002 ) described graduate-entry pupils as â€Å" extremely motivated and committed † and â€Å" much more autonomous, ambitious, demanding, oppugning † . â€Å" Alumnuss have already larn how to analyze and how to ration the other enticements of pupil life in order to maintain up with their surveies. This makes them better able to manage a autonomous acquisition attack † ( Rushforth, 2004 ) . Taylor et al stated, â€Å" the major difference between grownups and younger scholars is the wealth of their experience † ( Taylor, Marienau, & A ; Fiddler, 2000, p.7 ) . This is something that I reflected on following the CPBL tutorials, as the pupils in the group came from a assortment of backgrounds. Each pupil was able to convey a different position and cognition to the group, leting for a richer acquisition environment. On the other manus, pupils on the MBBS 5 class who have started their medical grade heterosexual from school tend to hold a similar educational background and experiences. In the 1950s, Malcolm Knowles developed the theory of andragogical acquisition, contrasting the larning methods of grownups with those of kids, pedagogical acquisition. Knowles claimed that one of the chief differences between these two signifiers of acquisition was that the function of the pedagogue was minimised in grownup acquisition. Andragogy is based on the undermentioned five premises about how grownups learn and their attitude towards and motive for larning ( Kaufman, 2003 ) : Adults are independent and self directing ; They have accumulated a great trade of experience, which is a rich resource for acquisition ; They value larning that integrates with the demands of their mundane life ; They are more interested in immediate, job centred attacks than in capable centred 1s ; and They are more motivated to larn by internal thrusts than by external 1s. Learner-centeredness is described in the literature as a separating feature of grownup instruction. Traditional medical course of study reflect inform pupils as to what they should larn and what sorts of cognition are considered of import ( Sheared & A ; Sissel, 2001 ) ( Titmus, 1999 ) . In contrast, PBL places scholars at the Centre of their learning experience and promotes flexibleness and individualization for autonomous, sceptered grownups ( Manusco, 2000 ) . However, andragogy has been criticised, as grownups do non automatically go autonomous upon accomplishing maturity. They may non be psychologically equipped for it and may prefer or necessitate way from others ( Beitler, 1997 ) ( Titmus, 1999 ) ( Courtney, Vasa, Luo, & A ; Muggy, 1999 ) . Kaufman ( 2003 ) suggested that alumnuss may hold some restrictions to their acquisition, including fixed learning attacks, greater fiscal concerns and a limited scientific background at registration. Survey of the literature reveals a deficiency of empirical grounds to back up the distinction between childhood and grownup acquisition. Nonetheless, many instruction methods that are frequently used in higher instruction, including experiential acquisition, pupil liberty and autonomous acquisition, root from andragogy.Analysis of literature and treatmentWhat is the grounds behind the development of PBL course of study?In the early 1990s, four systematic reappraisals of undergraduate medical instruction carefully supported the short-run and long-run results of PBL compared with traditional acquisition ( Albanese & A ; Mitchell, 1993 ; Vernon & A ; Blake, 1993 ; Berkson, 1993 ; Norman & A ; Schmidt, 1992 ) . There were restrictions to the reappraisals, as highlighted by Albanese and Mitchell ( 1993 ) , including failings in the standards used to measure the results of PBL ; general failings in survey design ; a limited research base, with surveies of PBL course of study coming from merely a smattering of medical schools ; and diverseness in what different persons call PBL. Furthermore, these surveies were conducted at a clip when PBL was a comparatively new and advanced manner of medical instruction. Therefore, studies of negative experiences may non hold been submitted or accepted for publication. There was besides a hazard of confusing, as it is really hard to randomly assign pupils to different learning methods for big sections of their preparation. These restrictions lessen the assurance one can give decisions drawn from the literature sing the results of PBL at that clip. On the whole, recent research mostly supports the findings of the earlier reappraisals, which suggested that alumnuss of PBL course of study are better able to use cognition and map clinically. However, the literature does non show differences in the cognition base of alumnuss from the two different course of study. Albanese ( 2000 ) argued that PBL improves clinical competency by doing pupils more confident and self-conscious as professional scholars, thereby bring forthing more efficient and enthusiastic physicians. However, non all the literature is consistent with this position. Rolfe et Al ( 1995 ) demonstrated that alumnuss from a traditional course of study were rated higher for instruction, diagnostic accomplishments and apprehension of basic mechanisms compared to those from a PBL course of study. There is a wealth of grounds to back up the claim that PBL consequences in greater participant enjoyment and enthusiasm for larning than traditional medical instruction. For illustration, Colliver ( 2000 ) found that pupils value the interpersonal accomplishments that PBL encourages and that are besides cardinal to effectual clinical pattern. Research into this field continues to be debatable. A batch of the recent surveies used questionnaires to compare the results of different course of study, which introduce callback and response prejudice. When measuring some PBL quantitative surveies, I noticed that the surveies were non based on any learning theory or were non proving anticipations from a larning theory and, therefore does non offer better apprehension of why or why non PBL might work. A challenge for future research is to utilize larning theory to plan quantitative PBL surveies and use the information from surveies to back up theory. Macallan et Al ( 2009 ) considered CPBL from the pupils ‘ point of view. They acknowledge that this is a common restriction of PBL research, as â€Å" pupils may non right perceive those factors that truly heighten their acquisition † . However, I agree with their remark that more nonsubjective steps are hard to use in this context. Another of the failings of the surveies that I have encountered is that comparings are frequently made between pupils or alumnuss from different medical schools. Consequently, it is hard to cognize whether any differences observed are the consequence of course of study design or the overall context of the school. Although randomised controlled tests have non been able to turn out statistical effectivity of PBL, there is considerable practical grounds from the 1993 reappraisals that pupils and module enjoy PBL more than traditional instruction methods. There are a assortment of statements for believing that it is excessively early to accept the negative findings of the literature. It seems that more refined research methods and a wider scope of research designs and variables are required to place educational alterations in a complex, larning environment. Bligh ( 2000, page ) stated, â€Å" deficiency of difficult `scientific ‘ grounds for the effectivity of PBL is non a ground for detaining execution of PBL in course of study † . There is chance for more UK-based surveies following the debut of PBL-based course of study at many UK medical schools over the past 10 old ages. The literature sing CPBL is really thin, so this could be a cardinal focal point of future research.Does holding an adept facilitating PBL impact on pupil acquisition?There is much contention in the literature as to whether an adept PBL facilitator promotes larning or non. Barrows ( 1985 ) suggested that non-directive facilitation was more of import than subject-matter expertness when he described the function of PBL coach as follows: â€Å" Alternatively of giving pupils the information and facts they need through talks and readings, they must larn to ease and indirectly guide pupil larning. They must let pupils to find on their ain what they need to cognize and to larn through the survey of varied resources. Alternatively of stating pupils precisely that they should larn and in what sequence they should larn it, the coach must assist pupils find this for themselves. † Hendry et Al ( 2003 ) claimed that some PBL coachs are excessively dominant. They reported that â€Å" a dominant coach causes tenseness and struggle in groups which leads to miss of committedness, cynicism or pupil absenteeism † . However, it has besides been shown that excessively small ordinance by the facilitator besides causes jobs. Silver and Wilkerson ( 1991 ) demonstrated that adept coachs impede student-to-student treatment by taking a more directing function in the tutorials, talking more frequently, supplying direct replies to pupils ‘ inquiries and proposing more points for treatment. However, other surveies have found the opposite consequence. A survey by Eagle et Al ( 1992 ) found that in tutorials facilitated by an adept coach, pupils generated twice every bit many larning issues and spent about twice the sum of clip on autonomous survey than pupils go toing tutorials facilitated by non-experts. Macallan et Al ( 2009 ) found that pupils â€Å" greatly appreciated it when adept clinicians demonstrated how clinical logical thinking applied to the instance † . As a consequence of these contradictory findings, some research workers began to look into the relationship between coach features and differential contextual fortunes ( Dolmanset al, 2002 ) . These surveies were based on the impression that â€Å" PBL is a complex acquisition environment in which different variables influence each other reciprocally † ( Dolmans et al, 2005 ) . Schmidt examined the consequence of coach expertness on trial tonss under conditions of PBL classs with low or high construction and curricular stuffs that match ill or good to pupils ‘ degree of anterior cognition ( Schmidt, 1994 ) . He found that when the construction of a class is low and/or pupils lack anterior cognition, the coach ‘s expertness has a greater impact on pupil public presentations. Dolmans et Al ( 1999 ) demonstrated that tutorial groups with comparatively low degrees of productiveness require much more input from a coach than extremely productive groups. As discussed in my contemplation, this is consistent with my experience. The MBBS4 pupils were extremely productive and my function in the tutorials was minimum. On the other manus, my old experience of PBL and CPBL with MBBS5 pupils has been that the pupils did non prosecute in the procedure or bring forth sufficient treatment or larning aims. In these tutorials, I found myself taking a much more cardinal function. Bochner et Al ( 2002 ) identified one contributory factor to the inconsistent findings is as the fact that there are no established criterions by which to find expertness. Although there has been debate as to whether the facilitator needs to be an â€Å" expert † , the consensus position seems to be that expertness in group kineticss together with supportive enthusiasm is more valuable than deep capable cognition. I found that, for the most portion in this series of tutorials, my function was entirely as a facilitator. However, the pupils on occasion discussed complex clinical issues, which were non easy to to the full understand from reading a text edition. This was when I would step in to explicate the construct in the clinical context.DecisionHelped to understand how PBL should run to be effectual – attempt to utilize motivating inquiries instead than give direct replies Use ice surfs at first tutorial to assist with group kineticss The accomplishment of PBL facilitation is that of cognizing when to supply aid to the group, be it proposing utile resources they might wish to see or come ining with thought arousing remarks to steer the comprehensiveness and deepness of acquisition, without needfully leaving facts.4a† Ã‚ µ4Maudsley G. Roles and duties of the problem-based acquisition coach in the undergraduate medical course of study. BMJ1999 ; 318:657-61.