Narrative Structure in A Farewell to Arms Essay Example | Topics and Well Written Essays - 500 words

Narrative Structure in A Farewell to Arms - Essay Example Even though the emotions of the story have an emotional depth and complexity of spirit, the language that is used throughout the novel is that of simplistic sentence structures and short, pointed sentences that move the story forward. Using skills that reflect his ability to construct a complexity of emotion, Hemingway also provides the male perspective, the use of language designed to reflect the way in which a male experiences his story. The narrative style in the novel by Hemmingway is based upon tensions that are placed at intervals so that the reader is pulled from one end to the next through styles and motifs that alternate from one extreme to the next. As an example, the dialogue will run until a certain point has been achieved, and then will be contrasted with an active element, the contrast providing a narrative structure that provides the building of tension through episodes of revelation that place context into the action of the work. The build up throughout the work is ac complished in this back and forth contrast through themes, narrative styles, and the development of the ways in which these contrasts develop the emotional build up provides for a momentum that carries the reader through the novel.

Health Resources and Policy Analysis Essay Example | Topics and Well Written Essays - 250 words - 2

Health Resources and Policy Analysis - Essay Example Among the issues faced include; lack of proper funding, increase in cases of mental disorders as well as stigma faced by victims of mental health disorder (U.S Council of States Government, paras2-3). The third component focuses on organization systems and how they were funded by different entities. Finally, the forth component focused on policy recommendations on effective delivery of mental health services. For example, it was recommended that individuals, families, entities, government and all stake holders should participate in formulating and implementing plans on mental health (U.S Council of States Government, paras2-3). In above connection, the U.S federal government via several departments such as; department of Substance Abuse, Mental Health and Service Administration(SAMHSA) provided funding to the above components (Sultz & Young pp.315-329). Whereby, the victims of mental disorders were not supposed to receive funding directly but rather through certain bodies (U.S Council of States Government, paras2-10). For instance, in 2004 the department of Substance Abuse, Mental Health and Service Administration in-conjunction with Medicaid and Medicare Center Services provided a total funding worth $434millions in funding mental health system. In addition, the department of Medicaid contributed more funding than any other departments (U.S Council of States Government, paras2-10). Sultz, Harry A, and Kristina M. Young. Health Care USA: Understanding Its Organization and Delivery. Sudbury, MA: Jones and Bartlett, 2011.Web. 8 May 2013. U.S Council of States Government. Elements of Effective Health and Social Service System: Mental Health Care Systems. Justice Center.Web.8 May 2013< http://www.reen

Marketing Considerations and Plans Essay Example for Free

Marketing Considerations and Plans Essay McDonald is one of the most internationally recognizable companies within the hospitality industry. Although I have not worked with McDonald ever, I am quite familiar with it as one of closest friends has been working with the marketing team of this restaurant chain for last four years. He keeps telling me about his company, how it runs its business so that it can maintain its top position within the fast food sector world wide. Apart from listening to my friend about his company, I also do research on McDonald by reading stories relating to McDonald published in various magazines, newspapers and on various websites as I am a fond of McDonald food staffs and love this fast food restaurant chain. McDonald Corporation listed in New York stock exchange has emerged as one of the world’s largest chain of fast food restaurants. It is most popular for its hamburger. Its customer base is so huge that worldwide it sells its products to around 47 million people on daily basis. The menu of McDonalds includes various sorts of burgers like hamburgers, cheese burgers etc. , products made of chicken, different sorts of breakfast items, French fries, various kinds of shakes, desserts and soft drinks. Mcdonald’s, however, quite often gets criticized over the healthiness of its products. These products are considered to be one of the important factors which are taking active part in increasing obesity in the western countries. The company, however, has made some effective measures in response to the rising obesity trend in the western countries and the criticism over the healthiness of its signature products. It has made some modifications to its menu by introducing several healthy food items like different types of salads, wraps and fruits. In spite of getting criticized over the healthiness of its products and having increasing competition within the industry, McDonald has been able to maintain its strong position within the industry it operates in. Its popularity has not decreased. Thus it would be quite interesting to look at the sources of its competitive advantage which have helped it to win the competition. In order to examine the sources of competitive advantage of McDonald, the strengths of the company will be analyzed in detail as strength of any company can be defined as a distinctive competence of the firm that gives it a competitive advantage in the market place. A firm can gain its strength from its financial resources, the image of its brand, leadership quality within the market and buyer-supplier relationships. (Competitive advantage, 2010; Ghosh, et al. n. d) In case of McDonald’s, its biggest strength is its brand image. Since McDonald’s is one of the most known chains of fast food in the world, its brand recognition seems to be its biggest strength. Its marketing campaign always focuses on brand recognition through continuous promotion of the brand name. Through its extensive marketing campaign world wide the company has been able to create an image in the people’s minds and introduce them to the fast food culture. Its customer base ranges from kinds to old generation. It has nearly 30,000 branches in as many as 120 nations across the world. However, 80 percent of its revenues are generated from the market of eight countries including US, UK, Japan, Australia, Canada, France, Brazil and Germany. The company has been able to expand its stores on the basis of three core strengths- cleanliness, delivery speed and customer care. McDonald has created a corporate symbol and through its highly successful marketing campaigns all round the world it has been able to develop a brand image and establish its logo in the minds of the people across the world. People are attracted to this logo and brand image and this attraction brings them to the stores. Although a number of competitors have emerged in the fast food industry, its rigorous marketing campaigns which are based on the company’s internal resources, external conditions and its relations with its shareholders have been able to strongly maintain its brand value in the market. (Ghosh, et al. n. d; Vijayarani, n. d. ) The brand name will not work in longer run unless brand value is mixed up with high quality product value. In order to obtain and maintain a strong position in the market, every company needs to use an appropriate marketing mix and product occupies one of the most significant positions within the marketing mix. Product value has been one of the greatest strengths of McDonald’s. When a customer enters into a McDonald’s store he/she know what to expect. The company places huge importance on its human resource and takes appropriate steps to satisfy it customers as well as its employees. As far as the product related issue is concerned, the company is also found to be quite innovative in introducing new products according to changing trends and tastes of the people. Not only that, it also offers different menu to the people living in different countries according to their tastes and the country’s culture. Fro example, in India it offers a menu which is completely different from its international offerings. In the stores situated in India, it has eliminated ham, mutton and beef burgers from the menu. India is found to be the only country where McDonald offers vegetarian menu. Which is more interesting is sauces, cheese etc, are also completely vegetarian in India. In India according to changing taste and preference of the customers, it has introduced Chicken Maharaja Mac. Thus the biggest strength of McDonald lies in the fact that it brings an internationally reputed brand with high class food quality and brilliant customer specific product features. This strength provides the company with huge competitive advantage. Vijayarani, n. d. ; Ghosh, et al. n. d) Till now only the sources of competitive advantages of McDonald have been discussed. But in order to survive amidst strong competition a company has to possess sustainable competitive advantages. Hence, it is now the time to look into sustainable competitive advantages of McDonald’s. For a company, its sustainable competitive advantage can be defined as the advantage which seems to be difficult or unfeasible for other co mpanies to own or infiltrate. The brand value, cost structure, vibrant customer care or its patent can be considered as sustainable competitive advantages for a company. An advantage should be considered as sustainable advantage only if the advantage has a distinct character or it is proprietary in nature. The sources of sustainable competitive advantages for McDonald’s can be as follows: ( Reidenbach and Goeke, 2006; Vijayarani, n. d) In order to build sustainable competitive advantage there should be a good integration and coordination between the company’s managerial and organizational process. If such integration takes place then there would be created the essential value as everyone will be chasing a common goal. In order to develop sustainable competitive advantage an organization is required to learn and introduce changes according to the need of the time and it should always be flexible towards changes that takes place in the external environment of the company, such as changes in customer’s taste and preferences, changes in government or legal restrictions, and development in the areas of technology. For McDonald’s, one of the principal reason behind surviving within current market competition is that the company is placing its focus on sustainable competitive advantages by making efforts to integrate organizational behavior with managerial expertise. McDonald’s, however, did not recognize the need of building sustainable competitive advantage previously. Earlier McDonald’s used to ignore this advantage as it was more interested in expanding its outlets across the globe than focusing on its core advantages. As a result of it, the company did not experience any massive change in its revenues with opening up of new outlets. In fact, it suffered huge loss unless it recognized the importance of building sustainable competitive advantage. The company was right in detecting the need of the hour and bringing about changes in its management process in order to possess completive edge over its competitors. ( Lamb et al. 2008; Levy and Weitz, 2001) A company can obtain an excellent position in the market through its financial, structural, and technological assets. All these assets significantly help in building sustainable competitive advantage for an organization. McDonald’s has been able to obtain a strong position in the market by its abundant financial resources along with plentiful structural and technological assets. Since 2003, the company has started to concentrate on identifying and implementing these assets in right direction that would bring improvement to the company. Thus these assets build one of the greatest advantages for the company. (Lamb et al. 2008; Levy and Weitz, 2001) Apart from all these, the vision and mission with which the company started its journey can be considered as one of the biggest competitive advantage fro McDonald’s. McDonald’s ability to sustain its dream over the years has provided it with a huge competitive advantage over its competitors. When a brand revolves around its vision in order to sustain and work in lieu with it, this results in developing significant sustainable competitive advantage for the brand. The McDonald’s started its business in order to help those people who did not have much time to cook or were too busy to go to an appropriate restaurant. The vision of McDonald’s was to offer quick service, and high quality food staffs at cheap rate. Over the years the company has been able to sustain this vision. Lamb et al. 2008; Levy and Weitz, 2001) Thus to sum it up it can be said that McDonald’s has been able to implement its best value based strategy by utilizing all its advantages which are unique to it and can not be copied by any of its competitors and thus it has build its competitive advantages which the company has been able to sustain over the years.

The congenital heart disease

The congenital heart disease Does an Exercise Program following Cardiac Surgery for Congenital Heart Defects improve a Childs Cardiopulmonary Response to Exercise and Increase Exercise Tolerance? Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Paediatric Cardiac Problems are prevalent throughout the world with 1.5 million new cases diagnosed each year. Congenital Heart Disease (CHD) is the most common diagnosis of heart problems at birth. Between four and nine per one thousand live births each year are diagnosed with the condition (Draper 2008). In 2007, 989 live births were recorded of babies with cardiovascular abnormalities (National Statistics 2007). Congenital Heart Disease is an umbrella term which encompasses all heart defects that are present when a child is born. The child may have one or multiple defects at birth which can either be detected by a scan ante-natally or are diagnosed soon after birth. Although the diagnosis of CHD is now becoming easier, some diagnoses of the condition do not happen till later on in life. Statistics show that around 60% of congenital heart disease are diagnosed in babies aged from birth to one year, 30% in children aged one to fifteen, and 10% in adul thood (16 years and over) (BHF 2003). Many common conditions include a Ventricular Septal Defect (VSD), an Atrial Septal Defect (ASD), Pulmonary Artery Stenosis, Tetralogy of Fallot (TOF) (Fig. 1) and Transposition of the Great Arteries (TGA) (Fig. 2). Congenital Heart Disease is now not just a problem of the child, many people with the condition are now living into adulthood. It is predicted that by 2010, 185,000 people will be living in the UK with CHD (Deanfield (BHF) 2003). Treatment for Congenital Heart Conditions has changed rapidly over the last 50 years. Now surgical management is needed in most cases however some defects will either resolve themselves or require medication. Surgical treatment has changed in recent times, fewer patients are requiring open heart surgery and more are receiving a catheterisation technique. Around 3,100 operations and 725 interventional cardiac catheterisations are performed each year on babies and children with CHD (BHF 2003). The effects of surgical interventions on cardiopulmonary function have been thoroughly researched in the past. The studies have concluded that surgery does improve lung and cardiac function and reduces secondary complications (Picchio 2006). Exercise is widely known as the best treatment for most musculoskeletal problems but its effects on the cardiopulmonary system has only recently been researched into (Cullen 1991). Pulmonary and Cardiac Rehabilitation have now been shown to have an effect in adults but the research into paediatric rehabilitation classes is not widely known about. Other studies have looked at exercise training or a cardiac rehabilitation programmes following surgery and the effect of this on the patients exercise tolerance. I am going to use this review to assess these studies which look at both cardiac rehabilitation programmes and also levels of exercise tolerance following surgery. I want to discuss whether there are any gaps in the knowledge base surrounding the effects of exercise in cardiac surgery of paediatrics. I also want to conclude whether the assumption that exercise is positive, can be correctly justified. Method After deciding a topic I was able to start researching into the background area of paediatric cardiology. I started by using a combination of terms including, Exercise, Sports, Physical Activity, Paediatrics, Children, Post-Cardiac Surgery, Congenital Heart Disease, Congenital Heart Defects and Cardiac Rehabilitation. The search pages I found highlighted articles of relevance and then I used the link to related articles to find the studies (see appendix 1). I also searched on individual journal websites including, Paediatric Cardiology and Cardiology in the Young. I used databases such as Pubmed, Medline, Ovid, Sciencedirect and Springerlink to read abstracts of articles and decide their relevance to my review. I then selected the most relevant and used excel to compile a table where I could easily see the differences in the studies under headings (see appendix 4). The studies I am looking at are all based on paediatrics and are randomised controlled trials dating from 1981 to 2009. Although some of the studies are nearly thirty years old, they hold some strong evidence compared to present day studies and therefore I have not discounted older studies from this review. Other reviews have assessed whether exercise has an impact on cardiopulmonary performance and have been shown that an exercise rehabilitation class does provide benefits in cardiopulmonary performance and exercise capacity. Some of the studies that are being reviewed however are concluding with insignificant findings. The reviews have stated that research lacks long-term effects of training and also a clear understanding as to which exercise type is best (Tomassoni 1996). In this review I will try look at newer studies and see if the areas of knowledge that were found to be omitted after previous reviews have now been researched into. Review of Studies Firstly I am going to discuss the testing of the participants. All of the studies completed two exercise tests to assess the participants ability before and after either the cardiac rehabilitation program or surgery. Exercise testing is very difficult to reproduce. Many studies have problems with ensuring the test is accurate and reliable and many struggle, causing results and testing to be different and therefore not comparable. If the results are not accurate and cannot be compared to other studies the results can cause a change in average results and therefore may mislead readers into a false positive result. Each of the studies used either a treadmill test or a cycle ergometer to test their participants cardiopulmonary function and exercise tolerance. Using these two tests is the most common technique of testing function as it is very reliable. (Washington 1994) All studies used a specific protocol outlined in the Washington Guidelines with all of the studies using a treadmill test with five of the thirteen studies using Bruces protocol. Bruces protocol is where the grade of exercise is increased every 3 minutes until the participant has reached their maximum capacity and cannot continue. The bicycle ergometer tests are where the participants are required to cycle continuously at approximately 50-60rpm where the grade of exercise is increased by 10-20 watts/ minute every three minutes. This is also completed until the participant can no longer continue (Washington 1994). Exercise testing using a treadmill or a cycle ergometer causes problems because the task they are undertaking in the test are is not functional and do not relate to daily tasks. Running and cycling is functional but not to that grade of exhaustion. Many children normally will stop an exercise when they are tiring and will never push themselves to the level that these exercise tests are pushing them. The tasks are also not fun for the participants and I feel that it should be fun otherwise children will get bored. This is the same with the intervention as well and the programmes should be child orientated and individual to each child. Outcome Measures are the basis to the results of a study and therefore its effectiveness. A lack of certain outcome measures may show large flaws in a study as many can be used to assess different parts of function and physiological activities. In the studies looking at the effects of cardiovascular surgery, there were a limited number of outcome measures that were looked at. Sarubbi (2000) only looked at heart rate and blood pressure as outcome measures and this limits results. The main outcome measures were heart rate, blood pressure and maximum work rate in all the studies. These outcome measures although very limited are values that help us to understand cardiovascular activities. Other helpful measures would have been oxygen saturations, which only Rhodes studies (2005/6) looked into. Saturations are helpful to assess whether a change in heart rate or blood pressure affects saturations or whether a change in these may be due to a ventilation problem. (Rivers 2001) The outcome measures of the cardiac rehabilitation studies are all different but all have similarly looked at exercise capacity after the intervention. This is shown by all the studies using VO2 as a measure and that all the participants improved their VO2 maximum to allow for a greater exercise capacity. The only study that did not prove an increase in VO2 max was Goldbergs study (1981) which only showed an improvement in maximum work rate. This could have been due to the date in which the study was undertaken. This was one of the earlier studies done in 1981 and therefore technology may not have been as accurate or as reliable as some of the later studies done since 2000. However Goldbergs study was the one that had the most intervention time of all the studies with exercise of up to 45 minutes completed on alternate days with a strict regime to increase grade of exercise over the 6 weeks. This leads me to believe that maybe it was inappropriate testing or inaccurate technology tha t changed the results of the study as previous reviews have shown that an increase in exercise time has shown to have positive effects on health. As technology has developed since the early eighties, this may be why more accurate testing is used and therefore making results more positive to the outcome we wish. Another problem in trials of this sort is compliance. Compliance is always an issue when completing studies (Burke 1997). Initially recruiting people to participate is difficult and many people with either choose not to participate or may drop-out early in the study. Many people will not participate because of exercise testing being too invasive or because of geographical implications as the distance to the base of the study being an issue. Some of the studies had large drop-out rates with almost 30% decrease in patients initially viable for the treatment plan and those who undertook the tests in the study (Arvidsson 2009). I think this could be explained by that the studies involved child participants that are less compliant to long term programmes and who tire easily to an activity. Also due to the nature of the surgery that they have all completed, many parents will be protective over their children and be pushing the participants exercise tolerance will make many parents worried about their childs health. Much of this can be avoided by specifically explaining the procedures and answering any questions that the parent or participant may have to educate them that this a treatment plan and is not going to hinder their childs recovery or health. Also intervention time is a major issue when looking at trials. Some may be days long and others have follow-ups of years once the intervention has finished. The studies that focus on Cardiac rehabilitation all have various time scales of their intervention with the shortest program being six weeks (Goldberg 1981) and the longest around twenty weeks (Opocher 2005). The difference in timescale and the different number of sessions that the participants attend makes it difficult to assess whether it is the content of the program that affects the patients or whether just exercising over a longer, more sustained period of time effects the participants in the same way. I think studies that look at different contents of treatment programmes but have a fixed intervention time may be beneficial in deciding the aim of this review. When looking at the studies, all of the cardiac rehabilitation programs only assess the patients exercise performance straight after the program and only one study looks at the effects of the program long term. Rhodes et al 2005 firstly looked at the immediate effect of a cardiac rehabilitation program and then in 2006 did another study looking at the same participants of the previous study six months after the original program. The studies that look at exercise capacity before and after surgery also do not look at the effects of the cardiovascular system in response to exercise on a long term scale. Long term effects are the best indicator to say that function and exercise capacity has improved (Miller 2005). Sociodemographics of the subjects in a study are also important to review as to its involvement in accuracy of results. Different age ranges or male to female ratios cause studies to be inaccurate in trying to generalise the population group. Many of the studies had a very large age range within their participant groups with the largest difference being 17.6 years in Marino et als study in 2005. I feel that the exercise difference between a seven year old is very different to that of a twenty-four year old. I feel that a large age range is used to increase subject numbers. Male: Female ratios are also important and that a large majority in these studies had male participants. The biggest ratio of male to female was in Opochers (2005) study where there were nine male participants and only one female participants. The best ratio of male: female was either Moalla (2006) study with 44 males and 39 females. This is important as I believe men and women react differently to exercise. Subject numbers is also a large problem with these studies. Due to most of the studies only looking at the children that have had surgery in their trust or hospital they have decreased their subject numbers and none of the studies look at the effects on large number of subjects on a national scale. The studies that looked at cardiac rehabilitation all have subject numbers under 16 which is a very big limitation. The only studies that have larger numbers are the ones that look at exercise capacity after surgery. By having participants that are only from the immediate area of the study base also means you do not get a generalised view of everyone nationally and you may not cover different children from different backgrounds socially and economically and so may have different attitudes to rehabilitation, treatment and self-management. Studies with participants that are not generalised to their population group can therefore produce a bias result to that specific population group. Also having different backgrounds of participants is important in assessing their compliance and what individual exercise programme they should be given. Having a specific age range is particularly important as many of the subjects may be inappropriate for the programme due to their age. Some of the subjects may be too young and using subjects that are under six years old would be inappropriate due to the subjects being too young to understand the instructions of the study. Using older subjects may also cause different results as their bodies have had longer to regain independent function and the body has had time to compensate for a lack in cardiopulmonary function. I think it is important to keep variables as succinct as possible and trials should be able to based on one variable alone and truly work on whether surgery or exercise has a n effect on that variable independently. Effects of Cardiac Rehabilitation The studies looking at cardiac rehabilitation all have an exercise programme set up for their patients either at home (Moalla 2006) or in an outpatient setting (Ruttenberg 1983). These sessions ranging in therapy time from one hour alternate days to one hour once a week, all show an increase in either cardiopulmonary performance or in exercise tolerance. This shows that a rehabilitation programme is appropriate for these patients and does have a positive effect on the participants life. Rhodes studies (2005/6) had the greatest effect on the patients final outcome. Not only did most of the testing result in significant effects but the large range of outcome measures used means that we can assess not only the cardiovascular performance of the participant but also look at the pulmonary effects of the exercise and their effects of the heart and the cardiac system. What we can also see from this review is that the cardiac rehabilitation programmes are becoming more significant in results as the studies get newer. This is a good indicator that current programmes are being effective in their rehabilitation (Opocher 2005, Rhodes 2005/6, Moalla 2006) and that newer techniques and more knowledge on exercise has lead to better run classes which not only improve results more consistently than the older studies and that the effects from an initial programme can also be maintained for 6months after intervention (Rhodes 2006). Effects of Cardiovascular Surgery Two of the studies looking at effects of surgery only have exercise testing after the surgery. The study by Arvidsson only used the number of sports sessions a week that the participant goes to after the surgery. Therefore a direct comparison between their before and after the surgery ability cannot be done and so the study is only looking at their sports participation after surgery and not the effects of the surgery. However these studies do show that after surgery childrens exercise tolerance increases to the level that healthy participants are achieving (Zaccara 2003) and they are participating in equal amounts of sports participation following surgery (Arvidsson 2009) Future ideas In future studies, long term effects of cardiac rehabilitation should be researched, with a follow-up test of a least a year after their rehabilitation to see if the participant is now more active. I also think a control group should be used in the study to look at the effects of non-surgical patients that also participate in cardiac rehabilitation. This is to assess whether the improvement seen during cardiac rehabilitation is not just a response to any exercise and that if a child went back to normality and participating in sports then they will just be as exercise tolerant as children who do not have CHD. Also I would suggest that an exercise programme for the patients that is more functional but also fun and exciting for the patient should be used to increase compliance and also enjoyment for the participants and their parents. Conclusion In conclusion, Cardiac surgery is a commonly used form of reducing congenital heart defects and has been shown by these studies that the surgery does have an improvement on the patients cardiopulmonary performance. I have also found that a cardiac rehabilitation programme is beneficial for paediatric patients after cardiac surgery for congenital heart defects. References/ Bibliography Arvidsson, D (2009) Physical Activity, sports participation and aerobic fitness in children who have undergone surgery for congenital heart defects. Acta Paediatrica 98 pp. 1475-1482 Balfour, I. (1991) Pediatric Cardiac Rehabilitation. AJDC- Volume 145 pp. 627-630 Bradley, L. (1985) Effect of Intense Aerobic Training on Exercise Performance in Children After Surgical Repair of Tetralogy of Fallot or Complete Transposition of the Great Arteries. The American Journal of Cardiology Volume 56 pp.816-818 Burke, L. (1997) Compliance with cardiovascular disease prevention strategies: A review of the research. Annals of Behavioural Medicine. Volume 19, number 3, pp. 239-263 Cullen, S. (1991) Exercise in Congenital Heart Disease. Cardiology in the Young; 1: pp. 129-135 Deanfield J. (2003) Congenital Heart Disease Statistics (accessed on 8/11/09) British Heart Foundation Statistics Database www.heartstats.org disease participate in sport and in which kind of sport? Journal Of Cardiovascular Medicine, 7: pp. 234-238 Draper, Dr. Richard (2008) Congenital Heart Disease in Children (accessed on 3/11/09) http://www.patient.co.uk/doctor/Congenital-Heart-Disease-(CHD)-in-Children.htm ECHO (Evelina Childrens Heart Organisation) (accessed on 15/11/2009) http://www.echo-evelina.org.uk/ Goldberg, B. (1981) Effects of Physical Training on Exercise Performance of Children Following Surgical Repair of Congenital Heart Disease. Pediatrics Vol. 68 No.5 pp. 691-699 http://graphics8.nytimes.com/images/2007/08/01/health/adam/18088.jpg http://graphics8.nytimes.com/images/2007/08/01/health/adam/8807.jpg Marino, B. (2006) Exercise Performance in children and adolescents after the Ross procedure. Cardiology in the Young 16: 40-47 Miller, T. (2005) Exercise rehabilitation of paediatric patients with cardiovascular disease. Progress in Paediatric Cardiology Volume 20, pp. 27-37 Minamisawa, S. (2001) Effect of Aerobic Training on Exercise Performance in Patients After the Fontan Operation. The American Journal of Cardiology Volume 88 pp. 695-699 Moalla, W. (2006) Effect of exercise training on respiratory muscle oxygenation in children with congenital heart disease. European Journal of Cardiovascular Prevention and Rehabilitation 13: 604-611 National Statistics (2007) Congenital anomaly Statistics Notifications. Office for National Statistics. Series MB3, no.22 Opocher, F. (2005) Effects of Aerobic Exercise Training in Children After the Fontan Operation. The American Journal of Cardiology Vol. 95 pp.150-152 Picchio F. (2006) Can a child who has been operated on for congenital heart Rhodes J. (2006) Sustained Effects of Cardiac Rehabilitation in Children with serious Congenital Heart Disease. Paediatrics Volume 118:3 pp.586-592 Rhodes, J. (2005) Impact of Cardiac Rehabiliation on the Exercise Function of Children with Serious Congenital Heart Disease. Pediatrics Volume 116:6 pp.1339-1345 Rivers, E. (2001) Central venous oxygen saturation monitoring in the critically ill patient. Current Opinion in Critical Care. Volume 7, issue 3, pp. 204-211 Ruttenberg, H. (1983) Effects of Exercise Training on Aerobic Fitness in Children after Open Heart Surgery. Pediatric Cardiology Vol. 4, No. 1, pp. 19-24 Sarubbi, B. (2000) Exercise Capacity in Young Patients after Total Repair of Tetralogy of Fallot. Paediatric Cardiology 21: 211-215 Tomassoni, T. (1996) Role of exercise in the management of cardiovascular disease in children and youth. Medicine Science in Sports Exercise. Volume 28(4), pp 406-413 Washington RL. Et al. (1994) Guidelines for exercise testing in the pediatric age group. Journal of the American Heart Association. Volume 90;pp. 2166-2179 Zaccara, A. (2003) Cardiopulmonary Performances in Young Children and Adolescents Born with Large Abdominal Wall Defects. Journal of Pediatric Surgery Volume 38;3 pp 478-481

Epilepsy Essay -- Neurology Disorders Seizures Papers

Epilepsy Epilepsy is a condition characterized by recurrent seizures which are unprovoked by any immediately identifiable cause (Hopkins & Shorvon, 1995). It is also known as a seizure disorder. A wide range of links and risk factors are associated with the condition, but most of the time the cause is unknown. Epilepsy is one of the most common neurological disorders, affecting approximately two and half million people in the US and about 50 million worldwide. Though seizures can occur at any age, epilepsy is most commonly seen in children and the elderly. Most respond well to treatment and can control their seizures, but for some it is a chronic illness. A clinical diagnosis is the first step to finding a potential cure for the disorder. The diagnosis of epilepsy is usually made after the patient experiences a second unprovoked seizure (Leppik, 2002). Diagnosis is often difficult, however, since it is unlikely that the physician will actually see the patient experience and epileptic seizure, and therefore must rely heavily on patient’s history. An electroencephalography (EEG) is often used to examine the patient’s brain waves, and some forms of epilepsy can be revealed by a characteristic disturbance in electrical frequency (Bassick, 1993). The variations in frequency can take form as spikes or sharp waves (Fisher, 1995). The variations are divided into two groups, ictal electrograph abnormalities, which are disturbances resulting from seizure activity, and interictal electrograph abnormalities, or disturbances between seizures. The EEG can also give clues as to which region of the brain the disturbances arise from. Interictal temporal spikes will predict the side of seizure origin in 95% of patients if three times as ... ...sy (pp. 201-211). New York, Plenum Press. McIntosh, G. (1992). Neurological Conceptualizations of Epilepsy. In T. Bennett (Ed.), The Neuropsychology of Epilepsy (pp. 17-37). New York, Plenum Press. Shorvon, S. (1995). Drug Treatment of Epilepsy. In A. Hopkins, S. Shorvon, & G. Cascino (Eds.), Epilepsy (pp. 171-213). London, Chapman and Hall Medical. Thompson, P. (1991). Memory Function in Patients with Epilepsy. In D. Smith, D. Treiman, & M. Trimble (Eds.), Neurobehavioral Problems in Epilepsy (pp. 369-383). New York, Raven Press. Upton, A. (2002). Vagal Stimulation for Intractable Seizures. In W. Burnham, P. Carlin, & P. Hwang (Eds.), Intractable Seizures (pp. 233-239). New York, Kluwer Academic. Vining, E. (2002). The Ketogenic Diet. In W. Burnham, P. Carlin, & P. Hwang (Eds.), Intractable Seizures (pp. 225-231). New York, Kluwer Academic.

Overcoming Gender Differences Essay -- Papers

Overcoming Gender Differences Men and women come from different worlds. Let's face it, they simply can not communicate. Take the following story for example: Tom and Mary were going to a party. Tom was driving and after about twenty minutes and going around the same block many times, it was clear to Mary that Tom was lost. She suggested that he call for help. Tom became silent. They eventually arrived at the party, but the tension form the moment lasted the entire evening. Mary had no idea why Tom was so upset. Mary, on one hand thought that she was offering Tom help. Tom, on the other hand "heard" that he was incompetent and couldn't get them there, (Gray, 20). In most instances, men and women interpret each other wrongly as well as attempt to make amends in the same mistaken manner. Communication has become the source of our problems. Men expect women to think and react the way men do. Women expect men to feel and communicate the way that women do. Both are mistaken. If we could understand each other better, many conflicts could be prevented. But more importantly, if we could only understand each other better, when conflicts do arise, we could overcome them a lot quicker and easier. Men and women have different values. Men and women cope with stress differently, and are motivated differently. Men and women speak different languages and commonly misunderstand each other. Finally men and women keep score differently and have different needs for support. Painful arguments, regardless can be avoided. Understanding these differences are crucial in day to day situations, but they become even more crucial when dealing in situations when c onflicts must be resolved. "If we recognize and understand the difference... ...portant role due to the fact that negotiations are based solely on the need for good communication. With good communication along with empathy, and a little luck the connections we make and the negotiations we encounter will be successful ones. Bibliography: Author Unknown. "The Economic and Societal Context" (article from Professor Umana in section) Birkoff, Juliana. "Gender, Conflict, and Conflict Resolution," 5-28-2000, *http://conflict-resolution.net/articles/birkoff.cfmplain=t* Edelman. "Divorce: From Pain to Peace" Reader Gray, John, Ph.D. Men are from Mars, Women are from Venus. Harper Collins: New York, 1992. Tannen, Deborah. You Just Don't Understand. Balentine Books: New York, 1991. Ury, William. Getting to Yes. Penguin Books: New York, 1991.

Kant and Socrates

Morality is generally defined as the rightness or wrongness of an action or conduct based on an agreed standard or measure of ethical norms. This argues a society where there is no dissenting voice, which in reality is not true. Cultural subjectivism promotes tolerance, but not for all, as fundamentalist thought excludes any deviation from their prescribed moral values (Jowett, 2000). Society, on the other hand, is a group of individuals that share a common system of beliefs, intent and thought. Moral standards are required so that a stable society may exist; however, the dilemma in ethics theory is how the morality within a society is formed (Vlastos, 1991). Morality and society, apparently, is in a state of flux while ethics theorists attempt to come up with an adequate ethical formula to qualify what is right and wrong based on all cultural, social, political and religious realities.The notion of morality is often taken from a cultural context yet this presumes that societies are likewise always right in their judgments, so to disagree with society is morally wrong (Nikolaos, 2005). Among the most noted for their philosophical studies regarding morality and ethics are Socrates and Immanuel Kant. Both point out that the definition of what is evil depends on culture and experience and motivations of the individual and society. Their definition of morality discusses not only the concept itself but also its implications to man’s existence (â€Å"Kant's Moral Philosophy†, 2007). Thus, understanding what is moral is not to be considered as an intellectual discourse alone but is an endeavor to understand better the world.SocratesSocrates has provided great food of thought in his studies for what he knew but more importantly because of his treatise and understanding of what he does not know. Socrates did not believe in the need to explain his actions or thoughts and instead questioned others’ exhaustively. Socrates’ regard for Sparta, his association with the Thirty Tyrants and his own personal philosophical stance was used by his enemies for the accusation of treason against the state (Vlastos, 1991). At the time of the trial, which led to his subsequent death by hemlock, there was not any element in Greek society that would represent modern day district attorney offices.At the same time jury selection also did not have the criteria that is implemented today and often represents the political dominants of the time. Civil cases were brought to trial by private individuals who often also acted as the prosecution. Thus, there was no way to determine whether there was probable cause as to accusations. There is also a presumption of guilt rather than that of innocence. In Plato’s recollections of the trial, he points out that the prosecution, the restored democrats, deliberately made assumptions contextually of Socrates’ teachings and philosophies (Jowett, 2000).Plato also recognizes that Socrates defense was one that seemed to have ultimately given the jury the behest to find him guilty. His defense did not actually defend his actions but rather questioned the institution by which he was being tried in. Though in hindsight it is obvious that he held Athens in high regard, his philosophical speeches during his lifetime were sufficiently vague that his detractors easily could manipulate to appear the opposite (Nikolaos, 2005).Socrates on MoralityUnlike traditional Sophistic views on the purpose of life which focused on public life or works, Socrates viewed the moral excellence of the soul or virtue as paramount. He considered morality as not just limited to internal aspects or characteristics of an individual but extended its definition into the public life of the individual. One of the key virtues according to Socrates is knowledge. Socrates proposed that rhetorical studies should consider morality practically rather than for the purpose of public service alone.According to Socrates, the lack of knowledge leads to the absence of virtue. Following this viewpoint, understanding what is moral is critical in understanding virtue which in turn is important to be able to lead a moral life. Socrates describes these efforts at gaingin knowledge and thus leaving morally as the means to create value out of life: â€Å"a man who is good for anything ought not to calculate the chance of living or dying; he ought only to consider whether in doing anything he is doing right or wrong – acting the part of a good man or of a bad† (Jowett, 2000, para. 55)The first step for this process is to understand what virtue is and what it is not. What is not moral is considered as evil: an act of evil can then be done by actions against another property causing him loss, against the person by physical harm or by treating him unjustly such as the denial of rights or freedoms.   In Plato’s Gorgias, Socrates states that â€Å"good and evil are not simultaneous, and do not cease simultaneously†, implying that though good and bad contradict each other, they can not exist without the other (Jowett, 1999, lines 361-362).Many of Socrates’ actions may be interpreted as satire on the Athenian society and even his statements during his trial can not be considered as defense was rather a philosophical treatise. When Socrates was asked why he did choose to flee before the trial or after it when his friends tried to liberate him from prison despite what they believed was a mockery of a trial, Socrates replied that since he chose to live in Athens, he must bow to its laws regardless of the trial (Nikolaos, 2005). However, if one already considers the ethical or moral components into the equation, it is then that the question of justice becomes more difficult to evaluate. Thus, Socrates may in fact be making a statement as to the justice of the trial if not to its legality. Considering the components of prosecution, defense, jury and judge alone , one can consider that the trial prescribe to all requirements for the delivery of justice.Kant on SocratesKant’s Moral philosophy is one of the main alternatives to utilitarianism which marginalizes moral humanistic virtues. Kant’s view on morality is essentially deontological which implies a focus on the action to be done regardless of the consequences (â€Å"Kant: The Moral†, 2001). This implies that if a person is doing something that is right, then even if the results of his actions create a negative outcome, then he still did the right thing. There is also a prescriptive quality to Kant’s view: the assumption is that everyone should do what is right and that it should be universally right (Wood, 2004).Thus, for an action to be considered moral, it should be within the capacity of everyone and viewed as a correct action universally (â€Å"Kant's Moral Philosophy†, 2007). Viewing Socrates’ action through Kant’s Moral Philosophy, there are arguments both to support the morality of Socrates actions. The challenge is in deciphering Socrates’ intentions and purpose which can sometime prove difficult since it is basic in and Socratic Method to question something.From Kant’s definition of morals in terms of the action rather than the outcome, Socrates can be considered as moral since his purpose for questioning the state and its leaders is to emphasize the need for the knowledge virtue (â€Å"Kant: The Moral†, 2001). According to Plato, Socrates did not question the institutions of the states but rather the ignorance behind it. Thus, Kant will consider Socrates moral because he in facts teaches other virtue by his philosophical studies. As stated by Socrates in Apology, â€Å"I can give you as proofs of this, not words only, but deeds, which you value more than words,† (Jowett, 2000, para. 59)Another example is Socrates’ lack of defense for himself during his trial. According to Plato’s Apology, the accusations against Socrates were an intimidation scheme gone badly. Rather than acceding to his detractors, Socrates chose not to give up his stands as a testament to his view of the mockery of justice that has become of the Athenian society. Supporting the Kant’s view of universality in the form of the law implemented in Athens,Socrates believed that he should be executed because of the fact that he has been found guilty according to Athenian law as attested by Socrates himself in his statement that to live in Athens, one must bow to its laws regardless. Even his efforts at defensce according to him are not for his sake but rather for the sake of the citizenry: â€Å"I am not going to argue for my own sake, as you may think, but for yours, that you may not sin against the God, or lightly reject his boon by condemning me† (para. 57)Just the same time, it can be argued that Socrates’ actions are immoral based on Kant’s views ( â€Å"Kant: The Moral†, 2001). Socrates questioning the state is indeed against the Athenian law and therefore regardless his intentions for enlightenment, it is considered as sedition. The absolute nature of Kantian moral philosophies leaves no exceptions: commands are imperatives without categories. Though Socrates argued that virtuous characteristics represent absence of virtue is evil, he also stated that â€Å"good and evil are not simultaneous, and do not cease simultaneously† (Jowett, 1999, lines 342-344).Socrates, Kant and MoralityThe main source of conflict between the two philosophies on morality is that Kant’s definition is so absolute and leaves very little space more the resolution of moral dilemmas which in contrast was the focus of Socrates work if not his own life (Wood, 2004). Consider Socrates’ closing statement during his trial:â€Å"For if I tell you that this would be a disobedience to a divine command, and therefore that I cannot ho ld my tongue, you will not believe that I am serious; and if I say again that the greatest good of man is daily to converse about virtue, and all that concerning which you hear me examining myself and others, and that the life which is unexamined is not worth living – that you are still less likely to believe† (Jowett, 2000, para. 63).The strict requirements for rationality then precludes morality for those who are fully rational such as those who are mentally incapacitated or limited because of retardation or any other psychological condition (â€Å"Kant's Moral Philosophy†, 2007). Though moral autonomy does exist in both perspectives, Kant’s moral philosophy leaves less flexibility towards its definition because of its requirement of universality.It should be kept in mind that the setting of the two works is distinctly different. In the case of Socrates, the motivation and the consequences are given as much importance as the act itself. When he was accus ed that he did spoke falsely of the gods, he used as evidence his belief in the spiritual, such as the existence of the soul, and divinities by stating that, â€Å"Can a man believe in spiritual and divine agencies, and not in spirits or demigods?† (Jowett, 2000, para. 49). In the case of Kant, this will not be a valid argument sinceIn Socrates’ discourse, punishment of the act contravenes evil and while in Kant, contravention is from the doing what is right alone. In both instances, what is not moral is considered a reality on man’s life and both definitions require affirmative action against what is not moral. To be able to do so, one’s character and virtue must juxtapose what is considered what is not moral. Therefore restoration of evil done is equated with the punishment that one receives for the act.The fundamental difference in the definition between the two is that Kant’s moral failure is an independent act to a moral right by virtue of the lack of impact of consequences while Socrates’ main model of immorality is based on injustice resulting form the action. Thus the dilemma of immorality in the former is an ethical one and immorality in the latter is presented as a social dilemma. Reflecting on both works, there is a realization that definitions of what is not moral may differ in many ways but all studies that focus on it have a common purpose. In understanding the nature and manner of what is not moral, a person is able to better not according it to it.ReferencesJowett, Benjamin (1999).Gorgias by Plato. Project Guttenberg. Retrieved on April 2, 2007 http://www.gutenberg.org/ebooks/1672?msg=welcome_strangerJowett, Benjamin (2000). Plato’s Apology. Retrieved on April 2, 2007 http://classics.mit.edu/Plato/apology.html=