Monday, January 20, 2020
Ted Bundy The name Theodore Bundy, more commonly known as Ted Bundy, is a household name. Not only is Ted Bundy a household name, it is one that sends chills through the bodies of those who hear it mentioned. This bone gnawing effect is felt more so through those who have daughters away from home, in college. For over two decades now, the mentioning of his name has gotten this exact reaction and will continue to do so for decades to come. Over the course of his killing career, Ted Bundy made himself one of the most notorious serial killers of all time, while going undetected for years. "He hid his murderous 'hobby' from all those who knew and loved him," (Faces of Ted 1). He was a very deceiving man, through his actions, his speech, everything about him. It was very easy for Ted to deceive his victims. "He was described at various times as the perfect student, a genius, as handsome as a movie idol, a sensitive psychiatric social worker, and 'a young man for whom the future could surely hold only success'," (Sears 1). All of these are traits that are incredibly dangerous in a serial killer. Serial killings have been one of the most terrifying, violent crimes in the United States for a great deal of time now. Serial killers "Typically commit their murders over a considerable span of time - sometimes years," (Serial Killers). Serial murderers tend to have a bit of down time between murders. They also tend to target a certain type of victim and commit their murders in similar places (Serial Killers). "Serial murder has become one of the central concerns in homicide investigationÃ¢â¬ ¦" (Keppel 3). There are two distinct reasons for this. One is because it happens so frequently. The other is because it befuddles investigative agencies with its unique problems (Keppel 3). Ted Bundy grew up in what today's society would call "a dysfunctional home." For the first 23 years of his life, Ted believed that his grandparents were his parents and his mother was his sister. He was born Theodore Robert Cowell on November 24, 1946 to 22- year-old Eleanor Louise Cowell (Bell 2). Throughout his entire life, Ted never knew his real father, Lloyd Marshall. The confusion that Ted lived his life through came into play shortly after his birth. He and his mother moved back to Philadelphia, Pennsylvania to live with her paren... ...y is a four-year-old child who has spent most of his life on the road with his mother, whom he thinks is his sister. He has never seen his real father, although he did live with his grandfather for a while and thought he was his father. Then he was pulled away from a home where he thought he lived with his parents, brought across the country to live with different relatives, and forced to change his name. Granted, at the age of only four, Ted might not be able to grasp all that has been going on, but he must have been a bit confused. Ted then grew up and went to school, only to be made fun of and bullied. He then grew older and moved on to college, only to have his heart broken, an event that would lead directly to his twisted ways. So right from the day he was born, Ted Bundy was basically living a false life. He was not Theodore Robert Cowell as he was at birth. Nor was he Theodore Robert Nelson as he was when his name was legally changed. The entire time, he was Ted Bundy, the demented serial killer who got his thrills through brutally torturing and tormenting beautiful, young women. Now, the name Ted Bundy will forever be synonymous with murder (Bell 2).
Sunday, January 12, 2020
The title of the poem itself is a clear indication of what follows (Ã¢â¬Å"piedÃ¢â¬ meaning Ã¢â¬Ëof more than one colourÃ¢â¬â¢), a celebration of imperfection; of diversity. The poem opens with the poet praising and thanking God for spotted or dappled (imperfect) things, Ã¢â¬Å"Glory be to God for dappled thingsÃ¢â¬ . This one line alone sends the reader into contemplationÃ¢â¬âhaving always associated beauty with perfection, this makes one look at things from a whole new perspective; a perspective not tainted with the artificial and superficial human ideals about beauty. The poet then draws the readerÃ¢â¬â¢s attention to the ever-changing skies and compares them to a Ã¢â¬Å"brinded cowÃ¢â¬ . The poet uses a simile because, just like the cow, which is usually white with streaks of brown or black, the sky too is streaked with different colours: red, yellow, purple, blue, white and orange. And while most of us acknowledge the brilliance of the sky (Ã¢â¬Å"most of usÃ¢â¬ meaning those who take the time Ã¢â¬Å"to stop and smell the rosesÃ¢â¬ as the saying goes) we rarely ever give a second thought to cowsÃ¢â¬â let alone ever perceive them as an object of beauty. In our quest for Ã¢â¬ËperfectionÃ¢â¬â¢ we tend to overlook the earthly kind of beauty. But if perfection was the key word, then clear, blue skies should hold more appeal than cloudy, stormy ones; instead, though we might wish for one now and again, blue skies would bore us pretty soon; it is the variety that keeps us enthralled. Though the things described in the poem are normal, everyday things, it takes a poetÃ¢â¬â¢s eye to draw our attention to the everlasting, Ã¢â¬Å"realÃ¢â¬ beauty. For example, trout, which is mainly seen as a source of food, is described as something which would (or should) most definitely earn a second glance. The word Ã¢â¬ËmoleÃ¢â¬â¢ usually always invokes the ungainly imagery of warts, however, in Ã¢â¬Å"For rose-moles all in stipple upon trout that swimÃ¢â¬ , Ã¢â¬ËroseÃ¢â¬â¢ is associated with Ã¢â¬ËmolesÃ¢â¬â¢, banishing all thoughts of ugliness and enabling the reader to be able to see the beauty in something as common as trout. Ã¢â¬Å"Fresh-firecoal chestnut-falls; finchesÃ¢â¬â¢ wingsÃ¢â¬ . Here, chestnut kernels are compared to smoldering embers; the reddish-brown meat inside the chestnut, being similar to the fiery reddish-orange hue of glowing coal. However this alliteration is contradictory since Ã¢â¬ËfreshÃ¢â¬â¢ chestnuts are covered with spiky, green moss and are most definitely not like coal; it is only when they are ripe, and burst open when they fall to the ground, that the insides are revealed. While until now, the author had been mainly dealing with two colours, Ã¢â¬Å"FinchesÃ¢â¬â¢ wingsÃ¢â¬ brings to mind a great big melting pot of vibrant hues; the black and white wings, the sun glinting off their airborne feathers, transforming this common bird into a kaleidoscope of colours; a blur. This might also mark an end to the concrete references, since from the next line, things become more general and abstract (just like how one cannot pinpoint a single colour on the finchesÃ¢â¬â¢ wings; therefore, their reference is also perhaps a glimpse of what followsÃ¢â¬ ¦). Hopkins now talks about one of the most ancient and relevant occupations: farming. Farming is one occupation which brings humans closer to nature; helps them get in touch with their humble and down-to-earth side. However, we have now started seeing it as something mechanical; lifeless. The joy and exhilaration our forefathers used to link with this has given way to routine; we have started taking it for granted, which is why the poet feels the need to thank God for Ã¢â¬Å"Landscape plotted and piecedÃ¢â¬âfold, fallow and ploughÃ¢â¬ (ALLITERATION), the result of a farmerÃ¢â¬â¢s daily toil. And though farming has changed the land and it no longer looks natural and unspoiled, it bears harvest, which gives way to joy. And now Hopkins talks about all the other trades that have brought us closer to Nature and God: Ã¢â¬Å"And all trades, their gear and tackle and trimÃ¢â¬ . Here the poet is also thanking God for all the little things that help us get by; things that we take for granted (when have we appreciated the fishing net, or the mining machines? ) The poet now moves on to Ã¢â¬Å"All things counter, original, spare, strangeÃ¢â¬ ; thereby effectively including every single component of nature. Here, the poet celebrates uniqueness as in Ã¢â¬Å"strangeÃ¢â¬ or Ã¢â¬Å"originalÃ¢â¬ and Ã¢â¬Å"spareÃ¢â¬ as in the context of being one of a kind, and balance in nature due to all things having an opposing creation-Ã¢â¬Å"counterÃ¢â¬ . This tone is continued in Ã¢â¬Å"Whatever is fickle, freckled (who knows how? ). Barely has the fact that fickleness in humans is something which is looked down upon registered, that one is hit by the realization that this very fickleness in nature is exactly what makes it so appealing in the first place. Ã¢â¬ With swift, slow; sweet, sour; adazzle, dimÃ¢â¬ . The poet uses these oxymorons to illustrate that it doesnÃ¢â¬â¢t matter if something is fast or slow, sweet or sour, because they all hold some intrinsic beauty. Here the author is once again celebrating fickleness in nature, for something which is sour, say, an unripe apple, can also be sweet, when given enough time, there are two sides to every coin ;but each form is as valuable as the other, for example, a river, in its early stage is swift and might seem exciting and alluring with its fresh water, but as it slows down, it is just as important, for now it deposits all of the goodness it carried along with it in its early stage; or take diamonds, those dazzling lumps of carbon are not any more important than graphite, which is just another form of carbon. The poet plays on all our sense by choosing these particular words. Ã¢â¬Å"He fathers-forth whose beauty is past changeÃ¢â¬ This gives a sense of continuity, enforced by the words, Ã¢â¬Å"fathers-forthÃ¢â¬ the bond remains unbroken. The beauty of His creation is transitional; they do not end, but simply moves on to become something else. The concluding line Ã¢â¬Å"Praise himÃ¢â¬ is simply a reiteration of the first line and not in any way a reference to Christianity; Ã¢â¬Å"himÃ¢â¬ is simply God or whatever you would like to name the Divine Creator. The poem speaks of happiness; of finding joy in everything around you and being able to appreciate it. The usage of the hyphen in the first 3-4 lines is to link together words one would normally not associate with each other, thereby forcing the reader to revisit his views on the objects around him.
Saturday, January 4, 2020
Refer the theories of language acquisition (Behaviorist theories, nativist theories and interactionist theories) and write an evaluation of them.Consider the stages of language acquisition in the evaluation of these theories. Human language development is a huge debate between Nature Vs Nurture within theorists of various fields in psychology.There are three major schools of thought that will be mainly focused on; behaviourist, nativist (rationalist) and interactionist(cognitive and social). The cognitive approach and social context of language development is known as interactionist approach as the language depends upon the child having interaction with its physical and social world. TheÃ¢â¬ ¦show more contentÃ¢â¬ ¦In behaviorist theory it is believed that infants do learn the language through imitation, rewards and practice through other role models. (Cooter Reutzel, 2004) Nativist theory/ Rationalist Approach: Rationalism is the opposing view of behaviorism. Just like birds do fly and fishes swim, the capability to learn and use language is also genetically innate. Chomsky is one of the leading rationalist linguist. Noam ChomskyÃ¢â¬â¢s theory of language acquisition. (1957; 1965) He suggests that language acquisition is an innate faculty. ChomskyÃ¢â¬â¢s approach incorporates that children use an inherited hypothetical blueprint known as Language acquisition Device (LAD) (1968). Chomsky believes that people are born with a set of rules about language, which is called Ã¢â¬Å"Universal GrammarÃ¢â¬ . When a child begins to listen to his parents speaking, H/ she will unconsciously recognize which kind of language the child is dealing with, and setting the grammar to the correct language is known as Ã¢â¬Å"Setting the ParametersÃ¢â¬ ChomskyÃ¢â¬â¢s theory attempts to explain the competence acquired in language. Evidence shows the existence of LAD, which comes from the speed of language learned. Without LAD it will not be as easy to acquire a language, although itShow MoreRelatedLanguage Acquisition Of Language Development Essay2014 Words Ã |Ã 9 PagesLanguage is perceived as the way human s communicate through the use of spoken words, it involves particular system and styles in which we interact with one another (Oxford 2009). ChildrenÃ¢â¬â¢s acquisition of language has long been considered one of the uniquely defining characteristics of human behaviour. Even today, it is widely thought that children acquire their native language from the imitation of their parents, caregivers or the people in their daily environment. In this essay I will go throughRead MoreThe Theories Of Language Acquisition1707 Words Ã |Ã 7 PagesLanguage Developmental research is fascinated with how young children are able to acquire language. This fascination has led to the development of numerous theories of language acquisition. Two major theories of language acquisition include the behaviorist theory and the innatist theory. Both contrasting theories are influential to developmental research and inspire much research in an attempt to support or disprove each theory. Behaviorist Theory of Language Acquisition The behaviorist theoryRead MoreLanguage Acquisition7926 Words Ã |Ã 32 PagesÃâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦......Ãâ¦Ãâ¦..Ãâ¦ 3 Main body 1. Language acquisition Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦.Ãâ¦.Ãâ¦.......Ãâ¦ 4 2. The stages of language acquisition Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦....Ãâ¦......Ãâ¦.. 5 2.1. The prelinguistic stage Ãâ¦Ãâ¦Ãâ¦.Ãâ¦.........Ãâ¦...........Ãâ¦ 7 2.2. Babbling Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦........Ãâ¦...........Ãâ¦Ãâ¦ 7 2.3. One-word utterances Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦..Ãâ¦....Ãâ¦...........Ãâ¦ 9 2.4. Two-word utterances Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦..............Ãâ¦..Ãâ¦.... 10 2.5. Telegraphic speech Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦Ãâ¦........Ãâ¦...Ãâ¦Ãâ¦ 13 2.6. Language learning during the pre-school period Ãâ¦.. 16 Read MoreThe Language Acquisition Of Children1524 Words Ã |Ã 7 PageswillCompare the language used by three different children who are all different ages, they are all staggered in age at two years a part. Their ages are: Rhys: Age 8, Archie: Age 6, Poppy: Age 4 The development of language in children changes as a child gets older. Ã¢â¬Å" The Language Acquisition Device (LAD) is a hypothetical brain mechanism that Noam Chomsky postulated to explain human acquisition of the syntactic structure of language.Ã¢â¬ I will be investigating the change in language used by a fourRead MoreSecond Language Acquisition2674 Words Ã |Ã 11 PagesSecond Language Acquisition Assignment: TheÃ subjectÃ assignmentÃ consistsÃ ofÃ answeringÃ thisÃ question:Ã AccordingÃ toÃ Swain,Ã Ã ... producingÃ theÃ targetÃ languageÃ mayÃ beÃ theÃ triggerÃ thatÃ forcesÃ theÃ learnerÃ toÃ payÃ attentionÃ toÃ theÃ meansÃ ofÃ expressionÃ neededÃ inÃ orderÃ toÃ successfullyÃ conveyÃ hisÃ orÃ herÃ ownÃ intendedÃ meaning.Ã (SwainÃ 1985:Ã 249)Ã InÃ SwainsÃ view,Ã learnersÃ needÃ notÃ onlyÃ input,Ã butÃ output:Ã theyÃ needÃ toÃ useÃ languageÃ inÃ order toÃ learnÃ it.Ã Ã Krashen,Ã however,Ã asÃ recentlyÃ asÃ 2009,Ã statedÃ that:Ã Read MoreLanguage Acquisition Essay1724 Words Ã |Ã 7 PagesWhat is language? Language is a set of arbitrary symbols that enables every individual in the community to communicate and interact. These symbols contain acceptable meanings by the society and culture. Possessing a language is essential in all human; every normal human speaks but nonhuman does not. Acquisition, on the other hand, means learning or getting. Therefore, language acquisition basically means the learning or the gaining of a language. Language acquisition is normally viewed as a partRead MoreLanguage Acquisition Theory And Language Learning1488 Words Ã |Ã 6 PagesA language acquisition theory was first proposed by Skinner (1957). He argued that children acquire a langua ge by being exposed to the influence of environment they live in. The hypothesis on the distinction between language acquisition and language learning was proposed by an American linguist and educational researcher Stephen Krashen. When we consider Ã¢â¬Ëlanguage learningÃ¢â¬â¢ broadly speaking - we usually mean all activities performed by second language learners in order to attain a required levelRead MoreThe Language Acquisition Of Children2684 Words Ã |Ã 11 Pagesis a well-known fact that all children acquire language the same way, regardless of what the language in question is. For example, we can create an analogy by comparing the process of acquiring a language to learning how to play a new game. If one wishes to play a new game he must first go over some basic rules, which in our case would be: understanding sounds, words and sentences and how they can be combined into meaningful structures. Since language can be considered a highly complex game thereRead MoreSecond Language Acquisition2561 Words Ã |Ã 11 PagesASSIGNMENT: SECOND LANGUAGE ACQUISITION Name and surname(s): Heber Guerrero Giron Login: PEFPMTFL966476 Group: 31 Date: February 29, 2012 INTRODUCTION Second language acquisition is a process by which people learn a second language. It refers to any language learned in addition to the first language and the differencesRead More Language Acquisition Essay3233 Words Ã |Ã 13 Pageschildren acquire language? What are the processes of language acquisition? How do infants respond to speech? Language acquisition is the process of learning a native or a second language. Although how children learn to speak is not perfectly understood, most explanations involve both the observations that children copy what they hear and the inference that human beings have a natural aptitude for understanding grammar. Children usually learn the sounds and vocabulary of their native language through imitation
Friday, December 27, 2019
The Prince As A Modern Political Treatise Written almost 500 years ago by the so called first political scientist in the world, Niccolo MachiavelliÃ¢â¬â¢s Ã¢â¬Å"The PrinceÃ¢â¬ brings forward a new definition to virtue. A definition which argues against the concept brought forward by the Catholic Church. Machiavelli did not impose any thoughts of his own rather he only wrote from his experience and whatever philosophy that lead to actions which essentially produced effective outcomes in the political scene of Italy and in other countries. While he is still criticized for his notions, the truth is that, consciously or subconsciously we are all thinking for our own benefit and goingÃ¢â¬ ¦show more contentÃ¢â¬ ¦Once he became the emperor, he quickly expanded his empire in all fronts resulting in the deaths of thousands. However after one point he converted to Buddhism and ruled his land with peace till his death. The philosophy prescribed by Machiavelli is still used by different governments to some degree. There are law s and rules of conduct which enforces certain behaviors in the society. However an important distinction to be noted is that while Ã¢â¬Å"The PrinceÃ¢â¬ deals with an autocrat, the world right now is mostly democratic. It is not about a person ruling the masses, rather one person out of the masses being selected to serve them. Intimidation and fear are tactics which are obsolete right now. In case a leader of the country fails to perform according to expectations he will be faced with consequences. Either someone new will be selected or an election will result with an opposing party participating. The whole concept of democracy was to shift the power from a ruler to the mass. People now have a fundamental right to voice their opinions and concerns and it is part of a healthy democratic system. However this does not mean that one could trample over a government if someone wanted to. There are laws which everyone has to follow. If we take a broader perspective, such as taking a 3rd world country where democracy is not strong we see the same controlling methods prescribed in
Thursday, December 19, 2019
Introduction The doctorÃ¢â¬âpatient relationship has been and remains a keystone of care: the medium in which data is gathered, diagnoses and plans are made, compliance is accomplished, and healing, patient activation, and support are provided. Maintaining and reinforcing this special relationship is crucial in implementing effective healthcare. Individuals with disabilities, however, often face varying degrees of discrimination within the field of healthcare from its providers, ultimately hindering the doctor-patient relationship and its span of effectiveness. This paper seeks to synthesize and analyze findings from an array of literature research to answer the following question: What are the social explanations for the often negatively biased attitudes of healthcare providers toward individuals with disabilities? A sociological perspective on the doctor-patient relationship, perceptions of disability, physician experiences, and medical education will be discussed, concluding with future rec ommendations for advancement. The Doctor-Patient Relationship Since negatively biased attitudes of physicians towards those with disabilities are displayed within the doctor-patient relationship, its conception is used throughout the analysis of this paper. It is therefore necessary to define the term and discuss the sociological importance of this interaction. Talcott Parsons was the first social scientist to theorize the doctor-patient relationship, and his functionalist, role-basedShow MoreRelatedTechnology and Social Change in Healthcare1606 Words Ã |Ã 7 PagesSecurity and the Transportation Security Administration made permanent changes in our US government. Social change and technology are cross-interactive disciplines. They allow people and industries to interact both from a personal perspective as well as a social perspective. A good example would be the invention of the Internet and how it has changed the way people and corporations function in society. Over the past several years the technological growth and availability of laptops, computers, cellularRead MoreSoc the Rise of Nurse Practitioners667 Words Ã |Ã 3 Pagesnurse practitioners Using a sociological perspective, write a paper which explains what health sociology can contribute to an understanding of your selected issue. The paper must use the following headings: Issue Description Provide a minimum 200-word detailed description of the health issue you have chosen. Theoretical Perspective Provide a minimum 500-word sociological analysis of the issue you have chosen. Use your textbook as well as other sociological sources (e.g., textbooks, journalRead MoreSociology : A Very Good Understanding Of Sociology955 Words Ã |Ã 4 Pagesand how important it can be. Sociology is defined as the study of human social relationships and institutions. It ranges from crime to religion, racial issues and social class, and so on. The purpose of sociology is to understand how actions and consciousness are both shaped and shape cultural and social structures. Sociologists dedicate their lives to studying the nuances of society and culture and their relationship to everything else. They attempt to understand how what is done effects everyoneRead MoreSociological Knowledge in Nursing Essays1301 Words Ã |Ã 6 Pages, 2009 p.2). Nursing is a health care profession which concentrates in supporting individuals, their families, and societies as a whole in preserving, attaining and improving best possible health and functioning (Kozier, et al., 2010 pp. 8-9). Sociological knowledge play s a dynamic and elementary role within nursing profession. Besides medical knowledge a nurse needs to be socially aware of a clientÃ¢â¬â¢s social values. In todayÃ¢â¬â¢s society, nursing goes further than focusing on health related problemsRead MoreThe Sociological Perspective On Medical Conditions1687 Words Ã |Ã 7 Pagesbiomedical perspective is used to explain various medical conditions. This can include, but is not limited to using an individualÃ¢â¬â¢s body and pathogens to explain poor health. On a different note, the sociological perspective takes on a different approach to explain medical conditions. The sociological perspective focuses on the external influences, rather than then internal influences, such as the social environment, institutions, and relationships to assess and explain illness. The sociological perspectiveRead MoreApproaches to Health1526 Words Ã |Ã 6 PagesINTRODUCTION This report will be investigating the various sociological perspectives on health as well as the models and definitions of health and ill health. These topics will assist in the understanding of how different people and different cultures react to ill health. 1.1-CONTRASTING SOCIOLOGICAL PERSPECTIVES ON HEALTH In modern society there is a general consensus that Ã¢â¬Ëgood healthÃ¢â¬â¢ is something that everyone wants to experience and that each individual knows what this involves. Because thereRead MoreMedical Sociology Is Usually Referred To As The Sub Branch1539 Words Ã |Ã 7 Pagesglobal, national and local sectors (Pacquiao, 2016). Effective addressing of these social determinants of health is done by virtue of utilizing certain sociological theories and concepts for the sake of better understanding health and illness (Adler cutler, 2016). In the following sections discussions will be made with reference to two such sociological theories to gain an insight into the matter and in stating the discrepancies that occur between these two and the biomedical model for elucidating theRead MoreFunctionalism : Functionalism And Functionalism1100 Words Ã |Ã 5 Pages2005, p91). The middle class was considered important for Weber which consisted of occupational groups with qualifications and skills with market advantage, which provided higher wages, prestiges and good working conditions. He looked into the relationship between the form of Protestantism and the advancement of capitalism. Whereas, Marx regarded capitalism as a production of economic conditions and forces. Weber thought that the ideas were just religious ideas which also played a part of a majorRead MoreSociology and Healthcare Essays1578 Words Ã |Ã 7 PagesSociology and Healthcare Health-care is a sociological institution within the American Culture. Health-care has many different aspects that pertain to patients, care givers and governmental approach to supply healthcare to all citizens. Sociology is the Ã¢â¬Å"scientific study of social behavior and human groups.Ã¢â¬ (Schaefer, 2009) Sociology plays a large role in how Americans look at our health-care systems and approach health and illness in oneÃ¢â¬â¢s own life. Health-care has many different definitionsRead MoreThe Spiritual Aspect Of A Person Is Crucial Because It1098 Words Ã |Ã 5 Pageswhich people make decisions that influence the environment they live in and society. Moreover, based on this aspect, a person is provided with guidance to make relevant choices that affect their life and health. Thus, having a healthy spiritual perspective is needed for a person to live in harmony with themselves and the rest of society. Meanings of Spirituality Spirituality has multiples different meanings. People tend to see spirituality as religion, but even though spirituality is the core of
Tuesday, December 10, 2019
Question: Discuss about the Report of Fall Prevention Among Older People in Hospital Settings. Answer: Introduction Falls have been a common cause of morbidity and mortality in people of all ages. However, their risk increases with age. Hospitalization further increases the risk of falls due to the unacquainted environment, ailments, and treatments. It has been found that nearly 30% of the falls cause injury. These cause unrest to the patients, clinicians, and the health care system as a single fall may built up the fear of falling and initiate a downhill trend of reduced mobility. This leads to further loss of function and increased risk of falls. It also increases the hospital costs and length of stay. In severe cases, there may be a risk of institutionalization of the patient and legitimate complaint with following lawsuit against the hospital. Thus, clinical governance and practice improvement in relation to fall prevention among older people in hospital settings is extremely essential. The following summary table gives and overview of the published literature in this field followed by its critical appraisal. Summary table Sl.no. Author/s, year, Country Aims Sample/setting Design/methods Main findings Strengths and limitations of the study Article 1 Cameron et al., 2012, Australia To evaluate the effectiveness of interventions designed for reducing falls by older people in care facilities and hospitals. The Cochrane database 2012;MEDLINE, EMBASE, and CINAHL (all to March 2012); ongoing trial registers (to August 2012), and reference lists of articles were searched. 43 trials (30,373 participants) in care facilities and 17 (29,972 participants) in hospitals were studied. Review of randomized controlled trials of interventions to reduce falls in older people in residential or nursing care facilities or hospitals. For exercise interventions the results were inconsistent. Vitamin D supplementation decreased the rate of falls but not the risk of falling. Multifactorial interventions in care facilities and hospitals suggested a decrease in the rate of falls and risk of falling. Additional physiotherapy did not significantly reduce rate of falls but achieved a significant reduction in risk of falling. Carpet flooring significantly increased the rate of falls compared with vinyl flooring and potentially increased the risk of falling. Training and education of nurses and patients significantly decreased the risk of falling. Strengths: Two review authors independently assessed the risk of bias and extracted data. A rate ratio was used to compare the rate of falls between intervention and control groups. Risk ratio (RR) was used to assess the risk of falling in each group. Results were pooled where appropriate. Limitations: No conclusive results obtained. More trials are needed to confirm the effectiveness of multifactorial interventions in acute and subacute hospital settings. Article 2 Haines TP et al. 2011 Australia To identify single intervention strategies that prevent falls across a mixture of hospital wards Participants were older adults admitted to acute and sub-acute wards of the Princess Alexandra Hospital, Brisbane, Australia, and the acute and sub-acute wards of Swan Districts Hospital, Perth, Australia. 3-group randomized control trial. There were two intervention groups and one control group. One intervention group was given complete patient education by providing written, video-based materials and 1- to-1 follow-up with a health professional trained to provide this program at the patients bedside. The second intervention group was provided with materials only. The rate of falls was significantly lower among participants with intact cognitive function and allocated to the complete program group compared with the rate among similar participants allocated to the control and materials-only groups, and the proportion of these patients who became fallers was lower in the complete program group than in the control group. Strengths: Appropriate randomization and blinding. Limitations: Patients who were too ill to provide informed consent or those who had previously participated in the trial were excluded. Article 3 Dykes PC et al. 2010 US To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients) Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates The number of patients with falls differed between control (n = 87) and intervention (n = 67) units. Site-adjusted fall rates were significantly higher in control units than in intervention units. The FPTK was found to be particularly effective with patients aged 65 years or older. No significant effect was noted in fall-related injuries. Strengths: This is the first fall prevention clinical trial that provides evidence for using a specific HIT intervention to reduce falls in short-stay hospitals Limitations: It was conducted in 4 hospitals within a single health care system. The intervention was not blinded and the reporting of falls was biased. The FPTK was not effective with younger patients. The sample size was small. Article 4 Gates et al. 2008 England To evaluate the effectiveness of multifactorial assessment and intervention programs to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings. Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previous reviews. Systematic review of randomised and quasi randomised controlled trials, and meta-analysis. Eligible studies were randomised or quasi-randomised trials (n=19) that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors. No clear overall effect was found on the number of fallers during follow-up in 18 studies. Only one study gave accurate data on the number of falls per person year of follow-up. Evidence that multifactorial fall prevention programmes in primary care, community, or emergency care settings are effective in reducing the number of fallers or fall related injuries is limited. Strengths: NA Limitations: No studies reported quantitative data on health related quality of life or physical activity. Data was insufficient to assess fall and injury rates. The overall quality of the evidence was not high. Most of the trials were small and many had methodological drawbacks leaving them open to bias due to either insecure allocation concealment, lack of blinding of outcome assessment, high losses to follow-up, and poor reporting. Article 5 Cumming et al. 2008 Australia To determine the efficacy of a targeted multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay. 24 elderly care wards in 12 hospitals in Sydney, Australia. 3999 patients, mean age 79 years, with a median hospital stay of seven days. Cluster randomised trial. A nurse and physiotherapist each worked for 25 hours a week for three months in all intervention wards. They provided a targeted multifactorial intervention that included a risk assessment of falls, staff and patient education, drug review, modification of bedside and ward environments, an exercise programme, and alarms for selected patients. Intervention and control wards were similar at baseline for previous rates of falls and individual patient characteristics. In all, 381 falls occurred during the study. No difference was found in fall rates during follow up between intervention and control wards. A targeted multifactorial falls prevention programme was not effective among older people in hospital wards with relatively short lengths of stay. Strengths: Large sample size, which resulted in fairly narrow confidence intervals. Limitations: Relatively short average length of stay (7 days). data were not collected blind to intervention status. Some falls prevention activities were already occurring in control (and intervention) wards before the start of the study. Critical appraisal of literature Critical appraisal of literature helps us to assess the reliability of the sample, methods and design used for the study. It is used to analyze the relevance and results of published papers so that we can decide if the information is believable and useful. Various tools have been developed for the critical appraisal of published literature. One commonly used one is the Critical Appraisal Skills Programme (CASP) tools and checklist (Anon, n.d.). Article 1 and 4 are review articles taking data from previous studies. So, for these systematic reviews tool by CASP may be used (Anon, n.d.). Article1was unable to address the focused question the need for more trials was ascertained as no conclusions were drawn from the existing trials. In article 4 also the aim could not be achieved as no clear overall effect was found in the studies chosen. Article 2, 3, 5 are randomized control trials. So, for these randomized control trial tool by CASP may be used (Anon, n.d.). Article 2 was able to reach conclusions pertaining to its aim as the study methodology was planned and appropriate randomization and blinding. Article 3 also justified the aim of the study though it was having some limitations. Lack of blinding however ascertains biasness in the results. Article 5 did not aim correctly for reaching any definitive conclusion as they aimed at the follow up (7 days) of patients with a short length of stay and there was no blinding. Findings Article 1 states that exercise interventions, physiotherapy, carpet flooring did not produce ay consistent results. However, vitamin D supplementation, multifactorial interventions, training and education of nurses and patients significantly affected the rate of falls and risk of falling. Article 2 added to the knowledge by stating that the rate of falls decreases significantly when the complete program (including written, video-based materials and 1- to-1 follow-up with a health professional) as compared with the rate among similar participants when only materials were used. Article 3 adds the role of FPTK in patients aged 65 years or older. No significant effect was noted in fall-related injuries. Article 4 reviewed that no clear overall effect was found on the number of fallers during follow-up. Limited evidence was found in relation to multifactorial fall prevention programs were found to be effective in primary care, community, or emergency care settings in reducing the number o f fallers or fall related injuries. Article 5 also gave no conclusive results for multifactorial interventions applied in the hospitals to prevent falls. Thus, the overall findings indicate that though multifactorial approaches for prevention of falls in hospitals have been studied but due to their limitations they have not been able to give any conclusive results. So, further research, and training and education of nurses about this aspect of nursing is needed. References Anon, CASP checklist for randomized control trials. Available at: https://media.wix.com/ugd/dded87_40b9ff0bf53840478331915a8ed8b2fb.pdf [Accessed July 30, 2016a]. Anon, CASP checklist for systematic reviews. Available at: https://media.wix.com/ugd/dded87_a02ff2e3445f4952992d5a96ca562576.pdf [Accessed July 30, 2016b]. Anon, Critical Appraisal Skills Programme (CASP). Critical Appraisal Skills Programme (CASP). Available at: https://www.casp-uk.net/ [Accessed July 30, 2016c]. Cameron, I.D. et al., 2012. Interventions for preventing falls in older people in care facilities and hospitals. The Cochrane Database of Systematic Reviews, 12, p.CD005465. Cumming, R.G. et al., 2008. Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital. BMJ, 336(7647), pp.758760. Dykes PC et al., 2010. Fall prevention in acute care hospitals: A randomized trial. JAMA, 304(17), pp.19121918. Gates, S. et al., 2008. Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. BMJ, 336(7636), pp.130133. Haines TP et al., 2011. Patient education to prevent falls among older hospital inpatients: A randomized controlled trial. Archives of Internal Medicine, 171(6), pp.516524.
Tuesday, December 3, 2019
The Theme of The Outsiders Human Nature The Outsiders, an enthralling tale by S.E. Hinton, is an excellent story about the hardships and triumphs experienced by the Greasers and the Socs, two rival gangs. This novel suggests the stories? content because the Greasers are a gang of social outcasts and misfits. This novel?s theme is very specific; people, no matter what their social background, strive for the same goals and experience the same disappointments. This novel shows this theme throughout a detailed story line. The fictional novel is set in a moderate-size city, possibly near Texas, in the late 1960?s. Ponyboy, the main character, lives with his brothers as a greaser. One day Ponyboy and Johnny, Ponyboy?s best friend, get jumped by a group of Socs. The Socs start to drown Ponyboy in a fountain. Johnny, realizing they might kill Ponyboy, kills Bob, one of the Socs with his switchblade. Johnny and Ponyboy run to a fellow Greaser, Dally, who is always in trouble with the law. Dally helps them by giving them some money, a gun, and a place to hide. They hide in a church outside of town for a week until Dally says it?s okay to come out. They go out to eat and when they get back to the church they find it burning. When they see that there are kids inside and the fire could have been started by their cigarettes, they run inside to save the kids. Johnny and Dally are hurt in the fire and taken to the hospital. They are hailed as heroes in the local paper. Dally breaks out of the hospital to fight in a rumble against the Socs. While the Greasers beat the Socs, Johnny dies in the hospital. When Dally finds out he goes out and robs a grocery store. When the cops pull up he pulls out an empty gun so the cops shoot him. The theme of this novel is that all people are set back at times and they all want the same basic things. This theme is expressed in the novel several times. Disappointments are shown when Bob dies and the Socs grieve for him, when Ponyboy?s parents die and they are upset, and when Johnny dies and it disturbs the Greasers. It is shown that the Greasers and Socs strive for the same goals when Darry, Ponyboy?s older brother, tells him that he should succeed in school and make something of himself, and Bob is always trying to make his father happy with him. These examples show that all people, Soc, Greaser, or whatever, all strive to achieve the same goals and encounter the same disappointments. The theme that all people experience the same disappointments and strive for the same goals is also depicted in modern times. All people want to have a good job, make a lot of money, and live a good life. Everyone also encounters hardships throughout their life. Their car can break down, their l oved ones can die, and they can run out of money. As you can see, this theme is important not only in The Outsiders, but in everyday life as well.