Medically Assisted Suicide

Medically Assisted Suicide Medically assisted suicide is an event in which a physician honors a patient’s request for a lethal dose of medication. It has become a very emotional and controversial issue for many in the United States. The only state legally allowing medically assisted suicide is Oregon since 1997. Although some feel it is unethical and morally wrong, medically assisted suicide should be legalized to patients who are terminally ill because it would relieve them from constant and unbearable physical and psychological pain in a respectable and painless way.Individuals in the United States have the freedom to make decisions concerning their life such as where they live, what they wear, who they marry, and occupation. Every individual is able to make a decision about his or her life whether good or bad. Everyone is ultimately in full control of his or her own life. By allowing someone to make choices freely regarding their life, the same should be allowed when regard ing their death. Some patients passively aggressively choose to end their lives by not continuing treatment or therapy for their disease.This emphasizes the theory that people can and should control their own lives. Patients choose to end their lives for various reasons: they fear the loss of their independence, which later results in becoming a burden to their family or friends; they want to die in a dignified way, and they also fear the thought of dying alone. Society should understand why an individual wouldn’t want to have to rely on a family member to take care of them.Knowing that eventually they won’t be able to do even the easiest daily tasks such as showering, eating, or walking alone, does put a heavy burden on whoever would be taking care of them. It is also reasonable to understand that patients don’t want to be remembered by how they were in their sick state. No one should have to go through seeing their loved one whither away to what isn’t e ven the person they were to begin with. It would provide much relief to families and loved ones to remember the patient in a healthy and normal condition.Medically assisted suicide shouldn’t be viewed as a selfish act like regular suicide, but as a dignified and painless way to end a life that would end in the near future regardless. Whether suicides are legal or not, they will occur, and it would be much better if they were brought into the open. Suffering is different then pain. Suffering normally encompasses physical and psychological deterioration for which there is no cure. While many believe taking a life away in any circumstances is immoral, death is a compassionate way to relieve unbearable suffering.When physicians are asked to help a patient into death, they have many responsibilities that come along with that request. Among these responsibilities are: providing valid information as to the terminal illness the patient is suffering, educating the patient as to what t heir final options may be, making the decision of whether or not to help the patient into death, and also if they do decide to help, providing the lethal dose of medication that will end the patient's life. Medically assisted suicide became very familiar to the public in 1990 when Dr.Jack Kevorkian helped to assist his first patient to death. Dr. Kevorkian had invented a machine that consisted of three bottles that were connected to an IV. When the patients were ready to start the process of dying, they turned on the machine in which a sedative was administed first to make them drift off to sleep. Following the sedative was the fatal ingredient potassium chloride. According to Kathlyn Gay, Dr. Kevorkian claimed that he had caused no death; he just helped with his patient's last civil rights.He believes that doctors that don't help assist their patients are like the Nazi doctors during World War 2, those who used experiments on the Jewish people (50-51). Dr. Kevorkian aided 43 patien ts to their death. He agreed to assist patients after thoroughly interviewing each patient and realizing there weren’t any other alternative methods for the patient to deter suffering. It was reported that Kevorkian's male patients had severe terminal illnesses that left them incapable of living, while the female patients suffered from breast cancer and other illnesses that are curable (Keenan 16).Kevorkian’s medical license was suspended and eventually taken away, and he stood trial for murder charges. Dr. Kevorkian was later placed in jail and then released by Judge Richard C. Kaufman who ruled the state’s ban of medically assisted suicide as unconstitutional. It was determined that Dr. Kevorkian’s charges be dismissed due to the basis of the quality of the patient's life, saying that the patient's life was â€Å"significantly impaired by a medical condition that was extremely unlikely to improve. † Kaufman also said that people have a constituti onal right to commit suicide. Worsnop, 405). According to Oregon’s Death with Dignity Act, â€Å"‘Terminal disease† means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgement, produce death within six (6) months† (2). The physician is also responsible for letting the patient know of any experimental drugs and any other treatments that may benefit the patient in any way. Another responsibility of the physician is to educate the patient as to what their final options may be.They are required to inform the patient about their diagnosis, the results of taking any medication that could be given, all alternatives that could be used to treat the patient, and also having the patient contact another physician to confirm the diagnosis (The Oregon Death with Dignity Act 3, hereafter known as The Oregon). It should be agreed that when a patient is left with no other alternatives or methods of survival, th ey should be allowed to decide if they want to end their own life.Physicians who aid in a patient’s request for aid shouldn’t be judged as immoral, but only as someone who has the means and education to help patients with their last request in life. It should also be taken into consideration that everyone has the freedom of choice. â€Å"Since there is no absolute legal, medical, or moral answer to the question of what constitutes a good or correct death in the face of a terminal illness, the power to make the decision about how someone dies can rest with only one individual–the person living in that particular body† (Shavelson 153).When patients are already faced with death due to a terminal illness, medically assisted suicide should be allowed so that they don’t have to go through any pain. Many terminal illnesses involve the decomposition of the brain, vital organs, and physical appearance. Patients normally tend to lose their mental activity su ch as memory and thinking also. It isn’t fair for a patient to have to go through that if they are not willing to. Not only for their mental and physical state of mind, but because of the cost. Patients shouldn’t be required to pay for medical treatment that only prolongs a life with poor quality.Society also shouldn’t blame a patient for not wanting to lie in a hospital bed and rely on a machine to do their breathing. That patient should be entitled to choose an easy and peaceful death. Patients who make the decision to end their life shouldn’t be viewed as doing something wrong because they are choosing to do something to help them. Decisions regarding time and circumstances are personal to each individual. A competent person should be able to choose. While many view the interest in preserving a life, the interest should deteriorate when the individual has a strong desire to end their life.In conclusion, medically assisted suicide should not be viewed a s ethically wrong. It should be viewed as a humane and graceful way for patients with no other alternatives to die. It prevents an individual who is terminally ill from feeling severe pain and deciding when and how they want to end their life. The suffering a patient goes through is incomprehensible to people who haven’t gone through it. Therefore it shouldn’t be decided by anyone but the individual going through it how long and how much suffering they endure. Bibliography Gay, Kathlyn.The Right To Die: Public Controversy, Private Matter. Brookfield, Connecticut: The Millbrook Press, 1993. Keenan, James F. The Case for Physician-Assisted Suicide? America. November 14, 1998. 14-19. Shavelson, Lonny. A Chosen Death: The Dying Confront Assisted Suicide. New York: Simon and Schuster, 1995. â€Å"The Oregon Death with Dignity Act. † Yahoo. January 16, 2000, http://www. islandnet. com/~deathnet/ergo_orlaw. html. Worsnop, Richard L. Assisted Suicide. C Q Researcher. Vo l. 2, No. 7, p. 145-168. Washington D. C. : Congressional Quarterly, Inc. , 1992.

Cat in the Rain Essay

Cat in the Rain is a short story about an American couple on vacation to Italy. They are in their first year of marriage. The husband has a dismissive attitude towards the wife and the wife always wants more. In the story the couple has a lot of selfishness going on in their relationship. The husband ignores his wife’s needs and the wife and the wife is not satisfied with her husband. The theme of this story has a lot to do with loneliness in the couples’ relationship. In this story the American couple is trapped in their hotel room with nothing to do because of the raining weather. The husband wants to read and ignore his wife. So the wife is looking out the window and sees a cat crouched from the rain. She wants to go downstairs and get the cat. She tells her husband about it and he shrugs it off. The wife goes down herself and the story talks a lot about how she likes the inn keeper. I find that this part of the story most affected me when the husband ignored his wife’s wants and needs. She really wanted that cat because it was something for her to do and feel good about. Her husband obviously doesn’t satisfy her which makes her feel lonely and the cat would keep her company. The wife in this story wants to feel appreciated and loved like any other woman would. Being married for their first year is beginning to be hard for them. Hemingway tries to tell about a first marriage of a couple he once knew and how hard it is for some to always keep that happiness. Couples always have disagreements but should never feel alone. A husband should not ignore his wife’s needs and in this story that is what he does instead of trying to satisfy his wife. Close to the ending of this story the wife was not able to find the cat. She came back in the hotel room very sad. She tries to tell her husband but he does not listen. She starts complaining about what she wants to change about herself. She wants â€Å"her hair to be long so she can brush it† and she wants a cat. The husband can only say that he likes things the way they are. He tells her to shut up. He does not care what the wife’s needs are or what she wants. He does not want to listen and he just wants to read which is what he wishes she would do. This part of the story really interested me because I could not get as to why the husband doesn’t respond to what she asks for. The wife desperately wants attention and he is not giving it to her. The story of the American couple explains a lot about how the wife tries to get attention from the husband. Hemingway talks about a cat but behind that cat this story means more. The lack of attention her husband gives her may make her feel that she is restricted on expressing herself and keeps most of her feelings inside. The cat stays compact to stay dry outside, which is how the wife feels she has to be with her husband to make him happy. She hides herself constantly from him. In this story it relates to her as American wife and never tells her name. This kind of says that she is nothing but an American wife which is exactly how she feels. Hemingway had a unique way of telling the story but the way he told it had a lot of meaning to it. He showed the couples loneliness in a different way.

The Return: Nightfall Chapter 26

Ley lines. Stefan had spoken of them, and with the influence of the spirit world still on her, she had seen them without trying. Now, still lying on her side, channeling what remained of that Power to her eyes, she looked at the earth. And that was what made her mind go gray in terror. As far as she could see there were lines converging here from all directions. Thick lines that glowed with a cold phosphorescence, medium-sized lines that had the dull shine of bad mushrooms in a cellar, and tiny lines that looked like perfectly straight cracks of the outer surface layer of the world. They were like veins and arteries and nerves just under the skin of the clearing-beast. No wonder it seemed alive. She was lying on a massive convergence of ley lines. And if the cemetery was worse than this – she couldn't imagine what it might look like. If Damon had somehow found a way to tap into that Power†¦no wonder he seemed different, arrogant, undefeatable. Ever since he had released her to drink Matt's blood, she had kept shaking her head, trying to shake off the humiliation with it. But now finally she stopped as she tried to calculate a way to make use of this Power. There had to be a way to do it. The grayness wouldn't clear from her vision. Finally Elena realized that it was not because she was faint, but because it was getting dark – twilight outside the clearing, true darkness coming into it. She tried again to lift herself up, and this time she succeeded. Almost immediately a hand was extended to her and, automatically, she took it, letting it draw her to her feet. She faced – whoever it was, Damon or whatever was using his features or his body. Despite the almost-darkness, he still wore those wraparound sunglasses. She could make nothing out of the rest of his face. â€Å"Now,† the thing in the sunglasses said. â€Å"You're going to come with me.† It was nearing full dark, and they were in the clearing that was a beast. This place – it was unwholesome. She was afraid of the clearing as she had never been afraid of a person or creature. It resounded with malevolence, and she couldn't shut her ears to it. She had to keep thinking, and keep thinking straight, she thought. She was terribly frightened for Matt; frightened that Damon had taken too much blood or had played too hard with his toy; breaking it. And she was afraid of this Damon thing. She was also worried about the influence this place might have had on the real Damon. The woods around them shouldn't have any effect on vampires, except to hurt them. Was the possible-Damon inside the possessor hurt? If he could understand anything of what was happening, could he distinguish that hurt from his hurt and anger at Stefan? She didn't know. She did know that there had been a terrible look in his eyes when Stefan had told him to get out of the boardinghouse. And she did know that there were creatures in the forest, malach, that could influence a person's mind. She was afraid, deeply afraid, that the malach were using Damon now, blackening his darkest desires and twisting him into something horrible, something he had never been even at his worst. But how could she be sure? How could she know whether or not there was something else behind the malach, something that controlledthem ? Her soul was telling her that this might be the case, that Damon might be completely unconscious of what his body was doing, but that might just be wishful thinking. Certainly all she could sense around her were small, evil creatures. She could feel them encircling the clearing, strange insect-like beings like the one that had attacked Matt. They were in a furor of excitement, whipping their tentacles around to make a noise almost like a buzzing helicopter. Were they influencing Damon now? Certainly, he had never before hurt any of the other humans she knew the way he had today. She had to get all three of them out of this place. It was diseased, contaminated. Once again she felt a wave of longing for Stefan, who might know what to do in this situation. She turned, slowly, to look at Damon. â€Å"May I call someone to come and help Matt? I'm afraid to leave him here; I'm afraidthey'll get him.† Just as well to let him know that she knewthey were hiding in the liverwort and the rhododendron and mountain holly bushes all around. Damon hesitated; he seemed to consider it. Then he shook his head. â€Å"We wouldn't want to give them too many clues to where you are,† he said cheerily. â€Å"It'll be an interesting experiment to see if the malach do get him – and how they do it.† â€Å"It wouldn't be an interesting experiment forme .† Elena's voice was flat. â€Å"Matt is my friend.† â€Å"Nevertheless, we'll leave him here for now. I don't trust you – even to giveme a message to Meredith or Bonnie – to send on my phone.† Elena didn't say anything. As a matter of fact, he was right not to trust her, as she and Meredith and Bonnie had worked out an elaborate code of harmless-sounding phrases as soon as they knew that Damon was after Elena. A lifetime ago for her – literally – but she could still remember them. Silently, she simply followed Damon to the Ferrari. She was responsible for Matt. â€Å"You're not putting up much of an argument this time, and I wonder what you're plotting.† â€Å"I'm plotting that we might as well get on with it. If you'll tell me what  ¡Ã‚ ®it' is,† she said, more bravely than she felt. â€Å"Well, now what  ¡Ã‚ ®it' is, is up to you.† Damon gave Matt a kick in the ribs in passing. He was now pacing in a circle around the clearing, which seemed smaller than ever, a circle which didn't include her. She took a few paces toward him – and slipped. She didn't know how it happened. Maybe the giant animal breathed. Maybe it was just the slick pine needles under her boots. But one moment she was heading for Matt and the next her feet had gone out from under her and she was heading for the ground with nothing to grab onto. And then, smoothly and unhurriedly, she was in Damon's arms. With centuries of Virginian etiquette behind her she automatically said, â€Å"Thank you.† â€Å"My pleasure.† Yes, she thought. That's all it means. It ishis pleasure, and that's all that matters. That was when she noticed that they were headed for her Jaguar. â€Å"Oh, no, we don't,† she said. â€Å"Oh, yes, we will – if I please,† he said. â€Å"Unless you want to see your friend Matt suffer like that again. At some point his heartwill give out.† â€Å"Damon.† She pushed her way out of his arms, standing on her own feet. â€Å"I don't understand. This isn't like you. Take what you want and go.† He just kept looking at her. â€Å"I was doing just that.† â€Å"You don't have to† – for the life of her, she couldn't keep a tremor out of her voice – â€Å"take me anywhere special to take my blood. And Matt won't know. He's out.† For a long moment there was silence in the clearing. Utter silence. The night birds and the crickets stopped making their music. Suddenly Elena felt as if she were on some kind of thrill ride that plummeted down, leaving her stomach and organs still at the top. Then Damon put it in words. â€Å"I wantyou . Exclusively.† Elena braced herself, trying to keep a clear head despite the fog that seemed to be invading it. â€Å"You know that that's not possible.† â€Å"I know that it was possible for Stefan. When you were with him, you didn't think about anything but him. You couldn't see, couldn't hear, couldn't feel anything but him.† Elena's gooseflesh now covered her whole body. Speaking carefully around the obstruction in her throat, she said, â€Å"Damon, did you do something to Stefan?† â€Å"Now, why would I want to do something like that?† Very low, Elena said, â€Å"You and I both know why.† â€Å"Do you mean,† Damon started out speaking casually, but his voice grew more intense as he gripped her shoulders, â€Å"so that you would see nothing butme , hear nothing butme , think of nothing butme ?† Still quietly, still controlling her terror, Elena said, â€Å"Take off the sunglasses, Damon.† Damon glanced upwards and around as if to reassure himself that no last ray of sunset could pierce the green-gray world that surrounded them. Then with one hand, he stripped off the sunglasses. Elena found herself looking into eyes that were so black there seemed to be no difference between iris and pupil. She†¦turned a switch in her brain, did something so that all her senses were tuned onto Damon's face, his expression, the Power circulating through him. His eyes were still as black as the depths of an unexplored cave. No red. But then, he'd had time, this time to get ready for her. I believe what I saw before, Elena thought. With myown eyes. â€Å"Damon, I'll do anything, anything you want. But you have to tell me.Did you do something to Stefan?† â€Å"Stefan was still high onyour blood when he left you,† he reminded her, and before she could speak to deny this – â€Å"and, to answer your question precisely, I don't know where he is. On that, you have my word. But in any case, it's true, what you were thinking earlier,† he added, as Elena tried to step away, to get out of the grip he had on her upper arms. â€Å"I'mthe only one, Elena. The only one you haven't conquered. The only one you can't manipulate. Intriguing, isn't it?† Suddenly, in spite of her fear, she was furious. â€Å"Then why hurt Matt? He's just a friend. What's he got to do with it?† â€Å"Just a friend.† And Damon began to laugh the way he had before, eerily. â€Å"Well, I knowhe didn't have anything to do with Stefan leaving,† Elena snapped. Damon turned on her, but by then the clearing was so dim that she couldn't read his expression at all. â€Å"And who saidI did? But that doesn't mean I'm not going to make use of the opportunity.† He picked Matt up easily and held up something that shone silver from his other hand. Her keys. From her jeans pocket. Taken, no doubt, when she was lying unconscious on the ground. She could tell nothing from his voice, either, except that it was bitter and grim – all usual if he were talking about Stefan. â€Å"With your blood in him, I couldn't have killed my brother if I had tried, the last time I saw him,† he added. â€Å"Didyou try?† â€Å"As a matter of fact, no. You have my word on that as well.† â€Å"And you don't know where he is?† â€Å"No.† He hefted Matt. â€Å"What do you think you're doing? â€Å"Taking him with us. He's hostage for your good behavior.† â€Å"Oh, no,† Elena said flatly, pacing. â€Å"This is between you and me. You've hurt Matt enough.† She blinked and once again almost screamed to find Damon much too close, much too fast. â€Å"I'll do whatever you want.Whatever you want. But not here out in the open and not with Matt around.† Come on, Elena, she was thinking. Where's that vampy behavior when you want it? You used to be able to vamp any guy; now, just because he's a vampire, you can't do it? â€Å"Take me somewhere,† she said softly, intertwining her arm with his free one, â€Å"but in the Ferrari. I don't want to go in my car. Take me in the Ferrari.† Damon paced back to the trunk of the Ferrari, unlocked it, and looked inside. Then he looked at Matt. It was clear that the tall, well-built boy wasn't going to fit in to the trunk†¦at least, not with all his limbs attached. â€Å"Don't you eventhink about it,† Elena said. â€Å"Just put him in the Jaguar with the keys and he'll be safe enough – lock him in.† Elena fervently prayed that what she was saying was true. For a moment Damon said nothing, then he looked up with a smile so brilliant she could see it in the dusk. â€Å"All right,† he said. He dumped Matt on the ground again. â€Å"But if you try to run while I move the cars, I runhim over.† Damon, Damon, will you never understand? Humans don'tdo that to their friends, Elena thought as he brought the Ferrari out so he could bring the Jaguar in, so he could dump Matt in it. â€Å"All right,† she said in a small voice. She was afraid to look at Damon. â€Å"Now – what do you want?† Damon inclined from the waist in a very graceful bow, indicating the Ferrari. She wondered what would happen once she got in. If he were any normal attacker – if there wasn't Matt to think about – if she didn't fear the forest even more than she feared him†¦ She hesitated and then got into Damon's car. Inside, she pulled her camisole out of her jeans to conceal the fact that she wasn't wearing a seat belt. She doubted Damon ever wore a seat belt or locked his doors or anything like that. Precautions weren't his thing. And now she prayed that he had other matters on his mind. â€Å"Seriously, Damon, where are we going?† she said as he got into the Ferrari. â€Å"First, how about one for the road?† Damon suggested, his voice fake-jocular. Elena had expected something like this. She sat passively as Damon took her chin in fingers that trembled slightly, and tilted it up. She shut her eyes as she felt the double-snakebite pinch of razor-sharp fangs piercing her skin. She kept her eyes shut as her attacker fastened his mouth on the bleeding flesh and began to drink deeply. Damon's idea of â€Å"one for the road† was just what she would have expected: enough to put both of them in danger. But it wasn't until she actually began to feel as if she would pass out any minute that she shoved at his shoulder. He held on for a few more very painful seconds just to show who was Boss here. Then he let go of her, licking his lips avidly, his eyes actually gleaming at herthrough the Ray-Bans. â€Å"Exquisite,† he said. â€Å"Unbelievable. Why you're – â€Å" Yeah, tell me I'm a bottle of single malt scotch, she thought. That's the way to my heart. â€Å"Can we go now?† she asked pointedly. And then, as she suddenly remembered Damon's driving habits, she added deliberately, â€Å"Be careful; this road twists and turns a lot.† It had the effect she had hoped for. Damon hit the accelerator and they shot out of the clearing at high speed. Then they were taking the sharp turns of the Old Wood faster than Elena had ever driven through here; faster than anyone had dared go with her as a passenger before. But still, they wereher roads. From childhood on she had played here. There was only one family who lived right on the perimeter of the Old Wood, but their driveway was on the right side of the road – her side – and she got herself ready for it. He would take the sudden curve to the left just before the second curve that was the Dunstans' driveway – and on the second curve she would jump. There was no sidewalk edging Old Wood Road, of course, but at that point there was a heavy growth of rhododendron and other bushes. All she could do was pray. Pray that she didn't snap her neck on impact. Pray that she didn't break an arm or leg before she limped through the few yards of woods to the driveway. Pray that the Dunstans were home when she pounded on their door and pray that they listened when she told them not to let the vampire in behind her. She saw the curve. She didn't know why the Damon-thing couldn't read her mind, but apparently he couldn't. He wasn't speaking and his only precaution against her trying to get out seemed to be speed. She was going to get hurt, she knew that. But the worst part of any hurt was fear, and she wasn't afraid. As he rounded the curve, she pulled the handle and pushed open the door as hard as she could with her hands while she kicked it as hard as she could with her feet. The door swung open, quickly being caught by centrifugal force, as were Elena's legs. As was Elena. Her kick alone took her halfway out of the car. Damon grabbed for her and got only a handful of hair. For a moment she thought he would keep her in, even without keeping hold of her. She tumbled over and over in the air, floating, remaining about two feet off the ground, reaching out to grab fronds, branches of bushes, anything she could use to slow her velocity. And in this place where magic and physics met; she was able to do it, to slow while still floating on Damon's power, although it took her much farther from the Dunstans' house than she wanted. Then she did hit the ground, bounced, and did her best to twist in the air, to take the impact on her buttock or the back of a shoulder, but something went wrong and her left heel hit first – God! – and tangled, swinging her around completely, slamming her knee into concrete – God, God! – flipping her in the air and bringing her down on her right arm so hard it seemed to be trying to drive it into her shoulder. She had the wind knocked out of her by the first blow and was forced to hiss air in by the second and third. Despite the flipping, flying universe, there was one sign she couldn't miss – an unusual spruce growing into the road that she had noticed ten feet behind her when she'd exploded out of the car. Tears were pouring uncontrollably down her cheeks as she pulled at tendrils of bush that had entangled her ankle – and a good thing, too. A few tears might have blurred her vision, made her afraid – as she had been with the last two explosions of pain – that she might pass out. But she was out on the road, her eyes were washed clear, she could see the spruce and the sunset both directly ahead, and she was thoroughly conscious. And that meant that if she headed for the sunset but at a forty-five-degree angle to her right, she couldn't miss the Dunstans'; driveway, house, barn, cornfield were all there to guide her after perhaps twenty-five steps in the woods. She had barely stopped rolling when she was pulling at the bush that had thwarted her and getting to her feet just as she pulled the last entangling stems from her hair. The calculation about the Dunstans' house happened instantaneously in her head, even as she turned and saw the crushed swath she'd cut through the greenery and the blood on the road. At first she looked at her skinned hands in bewilderment; they couldn't have left such a gory trail. And they hadn't. One knee had been skinned – flayed, really – right through her jeans – and one seriously messed up leg, less bloody but causing her sheets of pain like white lighting even while she was not trying to move it. Two arms with quite a lot of skin removed. No time to find out how much or to figure out what she'd done to her shoulder. Ascreeeeeeech of brakes ahead. Lord, he's slow. No, I'm fast, hyped up by pain and terror. Use it! She ordered her legs to sprint into the forest. Her right leg obeyed, but when she swiveled her left and it hit the ground fireworks went off behind her eyes. She was in a state of hyper-alertness; she saw the stick even as she was falling. She rolled over once or twice, which caused dull red flares of pain to go off in her head, and then she was able to grab it. It might have been specially designed for a crutch, around underarm height and blunt on one end but sharp on the other. She tucked it under her left arm and somehow willed herself up from her place in the mud: boosting off with her right leg and catching herself on the crutch so that she scarcely had to touch her left foot to the ground. She'd got turned around in the fall and had to twist to right herself again – but there she saw it, the last remains of sunset and the road behind her. Head forty-five-degrees right from that glow, she thought. Thank God, it was her right arm that was messed up; this way she could support herself with her left shoulder on the crutch. Still without a moment's hesitation, without giving Damon an extra millisecond to follow her, she plunged in her chosen direction into the forest. Into the Old Wood.

Human Services Program and Profession Unit Research Paper

Human Services Program and Profession Unit - Research Paper Example According to the paper the reporter wants to learn how to network clientele with needed society resources and services. Additionally, the degree course should prepare him on how to serve for the worker as a basis to convey a thorough baccalaureate degrees. The human service degree and program should support national agenda approval with the national accrediting body for human service degrees. He expects to take part in students’ election to aim my academic course in the human service, psychological health or gerontology domain. This can be accomplished by following two applied that are aimed particularly in the selected area of concentration.This strudy stresses that the author looks forward to getting a GPA above 2.75 amongst the Human Services candidates. This way, he can get a continuing learning credit for more than half a decade ought to file his familiarity with all units and fields associated with the human services degree course and profession. The course should also e nable him to join groups that create a path to adhering to the guidelines provided by the National Organization for Human Services. The author looks forward to standardizing crucial education anticipations and morals in human services class involved with human services workers. The class should be able to bestow the HS-BCP credentials. The reporter wants to learn how to prim my colleagues to effectually work and knowledgeably operate systems in need of uninterrupted care, assistance and individual support.  

Managing People Essay Example | Topics and Well Written Essays - 750 words

Managing People - Essay Example This will ensure all the work is done at the appropriate time and all the subsequent documentation filed. As such, there will be a sense of accountability in running the firm. In today’s world, it is evident that many employers are reverting to online recruitment, citing its prevalence. It is noted that the internet is one of the rapidly growing service that is in use with more than 60 percent of the world’s population. Therefore, many people will access the internet when they are looking for jobs or when they need to recruit employees (Dowling, Festing and Engle, 2008:19). This makes it easier as both parties are able to easily and efficiently access each other. Secondly, the internet is used on a daily basis which creates an avenue of easy communication characterised by quick feedback. In such a situation, there is minimal dead-time when communicating to an employee or an employer (Lipp, 2005:17). According to recent statistics it is considered that more than 77 perce nt of job seekers use the internet to find employers. This shows that there are large numbers of people who use the internet to find jobs. Similarly, more than half of the firms use the internet to find eligible employees. ... This makes it relatively easy to approach an employee who bears the required qualifications. In addition, it is noted that job advertisements on the internet circulate at a faster rate than using newspapers. As such, many people have reverted to using the internet while seeking jobs. The same applies to employers as they find the internet appealing when advertising for vacant positions (Arthur, 2012:12). Apparently, this has reflected a drop in newspaper sales as a wide population does not feel the need to buy newspapers when the information is available on the internet. There are many firms and businesses that have employed the best practice in regards to online recruitment. One of these firms that expedite online recruitment is Fab Tiger marketing. This is a marketing agency that is specialised in direct mailing, telemarketing and customer relationship management. When in need of employees Fab Tiger marketing embraces online recruitment. This has made it easier to achieve its targe t in the market as it is able to reach out to a wide pool of interested parties (MacKay, 2007:17). The second firm that has appreciated online recruitment is Webactiv, which specialises in marketing consultancy services. Most of its recruitments are done over the internet, which is fast and convenient. The last firm that has the best practice in relation to online recruitment is Insight Marketing Services. All these firms are based in the United Kingdom and have embraced the use of online recruitment. Since they need a massive number of employees, they have to use a method that will attract a large number of job seekers. This has made it possible to cut on recruitment costs (Compton, Nankervis and Morrissey, 2009:14). For

Public School Uniforms Annotated Bibliography Example | Topics and Well Written Essays - 500 words

Public School Uniforms - Annotated Bibliography Example Therefore, when doing a research on the use of school uniforms, I would argue against it by citing this article. As they claim, it mightnot be easier to obtain equality. In fact, it might result into a conflict between the two social classes. This article was written by Brunsma, D. & Kerry A. R and published in 1998. Here, these scholars conducted a research on the influences of the use of uniforms on the learners’ behaviors and academic performance. In their analysis, they report that there is no direct relationship between behavior reforms and academic improvement and school uniform. The article can be of a great value when conducting a research on the demerits of school uniforms on the learners. It can help in justifying that school uniforms should not be mandatory since they can only contribute to poor academic performance, increased behavior problems and rampant cases of substance abuse. The above article was authored by DaCosta, K. and published by the Journal of Negro Education in 2006. In this article, DaCosta examines the reactions of the urban learners towards the use of uniforms in school. While conducting a research on the advantages of school uniforms, I would have to incorporate the use of this article. It has a lot of resourceful information on how uniform can be instrumental in creating equality amongst the learners from diverse socio-economic backgrounds. This is a very important component which must be included in the research. This article was written by Draa, V. in 2005. It presents a candid discussion about the significance of school uniforms amongst the urban-based high school learners. As reported in this article, uniform is necessary in the urban set up in which cases of gang violence, peer influence and classism are rampant. When carrying out this research, I would have to use this article. It is quite resourceful and would provide me with

Managing Organisational Change Essay Example | Topics and Well Written Essays - 500 words

Managing Organisational Change - Essay Example In Charlie’s case, a lot of blame in the collapse of his business can be attributed to organizational change. Basically, Charlie failed because he did not open himself up to positive change. The only change we are told of Charlie undertaking was the change in pricing with the hope of meeting future inflation values. Wallace (2007) notes that for any organizational change, â€Å"target population for the change will come to realize that the change was for the better.† The question will be ‘did Charlie’s customer see the change as a better one?’ Charlie’s decision to increase prices against future inflation was not a step in the right direction. This is because the world seems not to have recovered yet from the global economic crisis. For this reason, there is very little money in the pockets of many consumers. For this reason, undertaking reduced pricing should be a strategy for attracting more and more customers since demand for business has generally gone down. Secondly, Charlie refused to take greater advantage of his competitive advantages. The major com petitive advantage Charlie had was the location of his coaches at the coast, which was a tourist attraction site. So even if Charlie wanted to increase prices, he could have waited till summer when patronage of coast activities and holidays are very common. Since summer holidays come every year and patronage of holidays continue to increase, Charlie should have used that as an advantage to promote and publicize his business during off seasons so that he would have been sure of having more customers when the holiday season starts. Finally, Charlie should have avoided the private participation on ‘part-time’ basis. Frequent change of hands in running a business causes a breakdown in organizational culture. Some of the new people in whose hands the business went might have been people that customers were not well

Financial viability within a health care organization Essay

Financial viability within a health care organization - Essay Example On the other hand, finance deals with concepts, methods, and principles of managing the relevant accounting data for the purposes of attaining certain goals for the business or any given organization (Wiedemann, 2009). Finance involves an aspect of management precisely because it anchors on decision making using available information. Generally, the process of financial management involves the determination of a range of factors that determine the performance of a business or organization. Alternative definitions have explained the difference between accounting and finance by terming finance as a decision science, which relies on the rational methods and means supplied by accounting to arrive at informed decisions, which appertain to the performance of an organization (Wiedemann, 2009). Some theorists have extended this definition to infer that accounting is subordinate to financial management to the extent that it supplies the raw data on which it builds its synthesis. However, experts emphasize on the complementary relationship between the two fields with clear demarcations of areas of specialization. Finance is largely used within the ranks of management although it applies to all levels that have particular interest in financial predictions, budgeting, risk analyses, performance projections, and many other attributes the determine the daily running of businesses and non-profit organizations. The multiple natures of application of the theories and principles of fin ance lend itself to various interpretations in connection with nature of processes and type of organization. The accounting processes and financial management in a healthcare sector are special and different from the usual processes as they relate to normal businesses. According to some financial analysts, the major distinguishing aspect of healthcare finance and accounting is that sources of income are not directly connected to the beneficiaries of

Bless Me, Ultima character analysis Essay Example | Topics and Well Written Essays - 500 words

Bless Me, Ultima character analysis - Essay Example That is why of all her traits, I will focus on Ultima’s firm belief in balance which made her character some sort of a bridge in the problematic conflict of belief systems in the story. My analysis of Ultima starts with her role as a curandera as it reflects some form of universal principle. A shaman or the spiritual leader in a community is useful and performs an important function in authentic culture. She can resort to dreams and visions for help and guidance but she can also resort to the use medical arts with her herbal remedies and her vast experience in healing. Indeed, Ultima is adamant that disharmony and imbalance cause a disruption of health while her approach to healing is aimed at achieving a certain oneness and harmony with nature. Let me begin at the beginning. I do not mean the beginning that was in my dreams and the stories they whispered to me about my birth and the people of my father and mother, and my three brothers – but the beginning that came with Ultima. (Anaya 1991, 1) Anaya also attributes to Ultima, on one the hand the mythical Good Earth Mother and the religious Virgin of Guadalupe, on the other. In the novel, the Good Earth Mother often appears in Antonio’s dreams while the Virgin of Guadalupe is her mother’s spiritual protector. While they both hail from differing establishments they both represent one archetypal feminine principle – the intuitive, loving, life affirming protector and nurturer. Ultima’s character as presented showed that belief systems cannot be always mutually exclusive. Ultima as wise, complex and mysterious stemmed from her openness to receive, understand, assimilate and balance values that do not merely come from a single source, cultural grouping or belief. That is why she is tolerant and understanding as one of her main teachings to Antonio emphasized that those different

Family Medical Leave Act Essay Example | Topics and Well Written Essays - 2500 words

Family Medical Leave Act - Essay Example Until 1993, workers were at the mercy of their employer's demands, and would often be forced to resign to accommodate their sick child or ailing parent. Larger workforces usually had some form of a leave of absence, but there was no standardization or legal protection to guarantee that your job would still be waiting for you when you returned. In 1993, President Clinton signed the Family Medical Leave Act (FMLA) that guaranteed US workers that they would have some amount of legal protection if they are forced to take time off from work to take care of a sick family member, or help a woman through the childbirth period. While the intent of the FMLA is simple enough, there are myriad caveats and regulations that enact the legislation. The 1993 FMLA, and subsequent amendments, have created a law that allows time off to be taken by an immediate family member to care for a sick or injured relative. The time frame allowed is generally 12 weeks, though this may vary in specific situations. Because the law attempts to accommodate a wide range of scenarios, and anticipate the application of the law, it has numerous special provisions and entitlements. The purpose of this paper will be to clearly define the eligibility requirements for FMLA leave. This paper will explain what is required to obtain a leave under FMLA. It will present examples of the proper use of the FMLA, as well as the improper use of the Act. This paper will examine the potential for fraud and abuse under the law, and what is currently done to eliminate or reduce these cases. In addition, it will explain the penalty for abuse, and attempt to reveal why abuse may be difficult to identify and punish. It will accomplish these goals by examining the law fr om the standpoint of the individual as well as the organization. While this paper will strive to be complete, it is recognized that the number of specific rules, regulations, and exceptions makes a full and detailed explanation beyond the scope of this paper. The paper will cover the most widely used, and most common requests that are made to employers by workers that have a family member in need of care. Brief Historical Background The 1993 Act was finally passed and signed into law by President Clinton after two unsuccessful attempts were vetoed by President George Bush SR. in the 101st and 102nd Congresses. A Senate Report from the time noted the "demographic revolution" of the time, as well as the increasing numbers of women in the workforce, the number of adults who care for their parents, and the growing number of single parent families (Lee, 1993, 8). The Senate further contended that these numbers would have "profound consequences for the lives of working men and women and their families" (Lee, 1993, 8). In essence, single parent homes left sick children with no caregiver except the breadwinner, and aging adults that would be left to the mercy of the welfare system. In passing the FMLA in 1993 Congress stated that the Act was to "provide job security as well as a proper balance between work and family life for employees, resulting in increased worker productivity for employers" (Lee, 1993, 9). At the tim e the bill was passed, private employers had "failed to adequately respond to economic and social changes that intensified the tensions between work and

Ethics and Critical Thinking Essay Example | Topics and Well Written Essays - 250 words

Ethics and Critical Thinking - Essay Example Values are things that are of ultimate importance to an individual or society. These values are usually believed to be supported by some truth. Truth is what actually is in reality. All of these concepts are important to criminal justice. They are important to criminal justice for many reasons. For one, it helps people in the criminal justice professions to understand the relationships between these concepts. In so doing, they will be somewhat better equipped to act in such a way that is consistent with some sort of thinking about right and wrong. The problem with it all can be easily seen if you think about it in reverse. Truth begets values and values beget morals. Does anyone actually know any absolute truth? What if what we think is true is actually false? Would that mean our values are baseless? Furthermore, would that mean morality is nothing more than an arbitrary set of

Vernacular Language Essay Example for Free

Vernacular Language Essay According to the dictionary, vernacular refers to the native language of a country. Throughout Rome, the language that was used was Latin; it was used throughout the Mediterranean and became the dominant language. Widely used by people with power, kings and queens. Latin was used as the formal language used in government and politics, this all changed during the 12th century when vernacular language started to become increasingly popular. During the Renaissance, Europe was undergoing a transformation. Cultural change occurs when there is a change in language or idea. During these times, people were interested in intellectual exploration. It was during this time that people felt that only highly educated people knew Latin. Bringing about a vernacular language was a way that they felt the need to educate the ordinary people. It was during this time that they began the transformation into the vernacular language. Up until the 17th century, most scholarly works were said to be in Latin. During the 12th century, many literary works were subject to translating. Most of the time the person translating would change things, they were not concerned with the ending, only how they have changed the various pieces into art. The development of the printing press and other technological advances was thought to be a method that sped up the process of spreading vernacular language. During this time, people who were economically disadvantaged could now read and own a bible. The use of vernaculars was thought of as a way to convert the non-believers. The spread of Christianity proved to be a method for spreading vernacular language. Petrarch was thought of as one of the most important figures of this time. He criticized the habits of the culture and believed their ideas were ancient soon others followed and this brought about the birth of humanism. Humanism was based on the belief that the philosophical works of Ancient Greece and Rome provided the best guide for living. Humanism was believed to be founded on three teachings humanistic studies, moral philosophy, and the qualities that make men and women good. Women played an important role in the spread of vernacular language, noble women insisted that literature was either written or translated to vernacular. Women began to assert their role as preservers of history. (Mccash, 2008) Most women had limited education so they were not proficient in Latin, this led to the acceptance of Romance and Germanic vernaculars. Women were given a chance to express themselves and participate in courtly debates. Women played a huge role in the transformation from clergy to court. (McCash, 2008) Women felt a sense of power by the rise of vernacular language; they began to write poetry, some even became translators. In the 13th century, Margery Kemp wrote the first autobiography in the English language. â€Å"Women turned to literature to express their pain and suffering, their longing and their loss, and their beliefs and vision† (McCash, 2008)

The Ethical Issues Of Abortion

The Ethical Issues Of Abortion Mention the term ethics to a given group of people and it will be amazing the spurred debate on the same. It is a subject spurring debate not only among the scholars but also among the non-scholars within the society. One simply question creating problems is the actual definition or understanding of the term ethics and its relationship to the human actions and relations. With the universal definition of the term ethics as the ability of choosing the right or wrong, good or bad, fair or unfair, responsible or irresponsible, obligatory or permissible with the list unending. Nonetheless, many scholars believe that ethics is a branch of philosophy attempting to establish the concept of morality within a given community. However, from this scholarly definition another important aspect arises asking the clarification of morality and immorality. This is in lieu with the differences in the cultural practices of the various individuals. Morality on the other hand according to Williams (2004) refers to the personal conviction that an action is upright and acceptable not only by the performer but to the public. It is important to do morally upright actions thereby enhancing he peaceful coexistence between the various communities. There are so many moral issues existing within the environment and cultural differences cause so much disparity and incongruent behavior within the same community. Some of those moral issues have become a global issue yielding to a hotly contested debate between for and against personality (Kaczor, 2011). One such moral issue is abortion. This paper establishes the reasons for and against abortion and finally taking a stand on the concept. Reasons against Abortion Abortion is an act of terminating a pregnancy before the natural delivery of by any available means such as operations. Stillbirth is never an abortion as there is natural birth only that the born child is delivered when dead. Many ways are used in the pregnancy termination before the natural and free delivery by the mother after the gestation period is over. Whereas some communities see abortion as an ethical and moral issue, other communities view it as unethical and immoral. In supporting the reasons against the act of abortion, it is believed that it is murder denying the unborn child the chance to live. Every individual has a fundamental right to life and no one should ever take it no matter the circumstances. Fundamental right to life is global basic human rights need to be upheld at all cost. Aborting the unborn child would mean that the basic right and freedom is infringed and these amounts to gross ethical and moral standards. The morality and ethics of the world requires that the basic rights of a person to be taken into consideration and this help in achieving the good and harmonious existence of the individuals. Violation of human rights has become a serious issue and its further violation brings with it so much effects and negative impacts on the people of the community supporting the same concept. Moreover, the life of a person is considered holy and its sanctity is vital on not only the religious aspect but also the social and communal aspects. The Bible, a religious advocates for sanctity of life of individual whether born or unborn. It also establishes that a personà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s life starts from the conception until the natural death or attrition caused by other factors such as road accident and the rest. Without those the an individual is allowed to live and enjoy life whatever the circumstance and this is the combination of the global human rights and the sanctity of life as portrayed by both religious groups and other cultural practices. Therefore, it becomes meaning les for a community to abort and justifies the action. Abortion is wrong since it denies the unborn the chance and the fundamental of human rights and contradicting the sanctity of life. Another reason as to why abortion should be shunned together with this paper is that under no circumstance does a community in the world gives another person a right of living of the others. It is believed that God created every human being and it is only Him who gives and takes away life of individuals. The person however much they may be disable, there is still the need to ensure that all the process of attaining the global human rights are attained. It is ethically and morally incorrect looking at the various responses obtained from the same subject matter. Since it is never allowed by any community to harm or kill another individual of the same community, it is equally immoral and unethical to abort a foetues that is growing into a baby. Its non-acceptance within the community is a reason to cling on in the upholding human dignity and rights of life. The United States of Americas Ministry of Health claims that the number of abortion performed in public and private health institutions perennially costs a lot of money for the offenders. Increase costs of production makes the offenders use a lot of money in aborting when in real sense they could use the amount in uplifting the lives of the mother and the baby. For those having financial crisis for the abortion process, they go an extra mine to borrow huge amount of money that they may never be able to refund (Kaczor, 2011). The result is a discordant relationship between the perpetrator and the mother of the baby to be aborted. Moreover, some go further to steal or engage in other dubious means to get the required cash. The cost associated with abortion is therefore too much thus should be avoid. Instead, the amount of money for abortion can be channeled to perform other functions. This may be translated economically to mean that the process or action of abortion undermines the economic growth. Many economists have already extrapolated that the abortion action will become a serious action with negative economic effects on the way of human live in the nations accepting and advocating for the process. In the end, abortion will have adverse effects to not only the economic status of the individual but also the economic status of the nation as a whole. It is therefore very important to take various measures to advocate for safe and free delivery of the unborn in order to reduce such economical disastrous likely to be experienced in the coming future. Proper strategies need to be in place. Ethical and moral issue behind the action of abortion has resulted into it not being legalized in many global nations. This makes the pregnant women really determined to get rid of the baby to go backstreet abortion posing so many problems to the mother Murti Crossed, 2006). The backstreet abortion endangers the lives of not only the child but the mother as well. This is true also for the legalized abortion where mothers have bled before leading to their demise. Posing of much threat on the human life especially for both the mother and the child is another reason that should discourage a person from committing the unethical and immoral act. Let the pregnant women freely and naturally deliver after all children are a gift from God. Statistics have it that many women lose their lives in the abortion process especially in cases performed by unqualified people. Abortion is a matter of life and death and it is either amazing seeing different persons fight each other verbally or physically concerning the unethical and immoral actions of an individual. Increment of the backstreet abortions is a threat to the person performing it and the nation at large who are depending on such people in the production process and thus in the improvement of the economy. The effect of this is reduced gross national product, this affects the economy in a negative way, and this is extra detrimental as it involves a high risk of life between the baby and the mother. Let the baby stay and enjoy the fundamental and basic rights of living (Pojman, and Fieser, 2009). Since healthcare practice is involved there might be health dangers exposed to the mother of the child. The most common and dangerous complications developed amongst the women who have aborted include the breast cancer. Once the child or the baby is aborted, the mother will have no one to breast feed leading to the interference of the natural cycle or process of releasing of hormones responsible for the breast and milk development. The impact may not be visible during the first few weeks or months of the motherà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s life but will surely increase the chances of the mother contracting breast cancer. Cancers of any type have no cure and therefore it would mean that the mother will eventually and faster die before the expiry of the time of such a woman. This interferes with the population structure of the economy influencing various activities within the economy (Diener, 2000). In addition, numerous complications arise due to abortion other than the breast cancer idea. Such complications as identified by medical practitioners include the pelvic inflammatory disease, ectopic pregnancies, future premature births, subsequent infertility, and miscarriages, placenta praevia, among other many complications. These complications are very adverse for example, it may lead to future infertility, this may affect the individual in future causing in ability to give rise to young ones desperations, and consequently death related stress. Another example is the pelvic inflammatory that will affect greatly the pelvic of the mother and this poses so much health related challenges in the environmental as well as the life of the mother. As the healthcare practitioners propose, it will be important to prevent rather than wait and contract the complications through abortion and then looking for ways of curing them (Kaczor, 2011). Reasons for Abortion Many people and communities accept the fact that abortion is ethical and moral. In other communities, there are efforts to make them legal. On of the basis on which they make their argument is that during rape and incest then a person may seek for adoption. In such a case, the proponents for the reasons for the abortion practice assert that such a kind need to be aborted and reduce shame and trauma. However, this is not a right reasoning as the person punished here is the child yet the offender of the act is left to go free without any trial. The other reasoning for abortion according to those who are for it, is believe that abortion could possibly be a means of reducing the population (Murti, Crossed, 2006). The truth is that abortion cannot be used in the reduction of population. There are many ways of population control employed in achieving the desired family size. The proponents of the reasons for abortion also assert that it is ethical and moral as the woman is allowed to decide on the events she would like to happen within her body. For instance, if the woman wants to give birth she may do so since she has all the rights as well. They also believe that abortion is not murder as it only removes and disintegrate the various body cells incapable of living on the own outside the womb without the aid of other technological devices within the healthcare service provision. They assume that when the pregnancy is allowed to continue even with complications then it may result into more complications. Consequently, there is need for the abortion according to them. According to them, it is wrong to bring up a child of unwanted pregnancy and in order to avoid this the persons involve should abort (Pojman, and Fieser, 2009). Conclusion From the above discussion, it is clear that there is a division between those supporting the abortion concept and those against the concept. The various reasoning of both sides of the debate gives a final verdict that it is true that the debate on the side for the actions of abortion is weaker than the side of the shooting. While many scholars have attempted to change the views of abortion by calling it ethical and emotional others believe that the aspect of abortion are complex and in real sense obtained from the various aspects of the government or a given community. it is therefore true without any doubt that abortion, from the discussed issues is unethical and immoral after all they deprive someone of the right of living.

Benefits of Regular Exercise for the Elderly

Benefits of Regular Exercise for the Elderly The benefits of regular exercise are numerous. Through multiple clinical trials, man has been able to deduce how exercise benefits the body and prolongs life. It reduces the probability of cardiovascular disease a leading killer disease in some countries in the developed world. It also helps keep obesity at bay and enables people across the age divide to maintain flexibility and independence over their lives. Exercise is also beneficial for mental well being in that it reduces the risk of getting depression. Many people have taken the prerogative to enroll in some sort of exercise programme. Due to lack of adequate information, not all individuals who partake in regular exercise are able to glean maximum benefits from their training programme. Time spent during exercise is an important factor. However, it is not the determining factor when it comes to how much an individual will benefit from the physical activity. Nutrition is an essential component of any exercise programme. This article aims at empowering the reader with information on how to maximize benefits from an exercise programme. PROVEN BENEFITS OF EXERCISE. Exercise prolongs life. People who engage in moderate to difficult exercise routines elongate their lifespan by one to four years (Jonker 2006: Franco 2005). Exercise also adds value to those additional years. Through health benefits to the lungs, heart and muscle, exercise ensures that a person not only lives long but is still productive in those extra years. Aging is a natural process of life. With time, the health of an individual deteriorates. This increases the risk of developing chronic health conditions. The good news is that regular exercise such as walking 3 hours per week can ward off the onset of some of these chronic health conditions (Chakravathy 2002). Exercise enables a person to have a better outlook of themselves, elevates self esteem and reduces the risk of getting depression (Elvasky 2005: Schetchman 2001). In recent years chronic non communicable diseases have formed a substantial portion of the disease burden in the world. In people with conditions such as diabetes, multiple sclerosis, stroke, myasthenia gravis and chronic obstructive pulmonary disease, exercise improves the standard of life (Stout 2001: Rochester 2003). Regular exercise spells out more benefits when it comes to metabolism of sugar in the body. It enhances plasma glucose control, can prevent or delay the onset of type 2 diabetes and if one develops the disease, it reduces the risk of death from complications in the cardiovascular system(Golden 2004: Virtartaite 2004: babyak 2001: Suh 2002: Church 2004: Short 2003: American Diabetes association 2003: McFarln 2004. Menopause results in decreased bone density. This is because of reduced estrogen levels in the body. Estrogen is bone protective. Post menopausal women are thus at higher risk of fractures because of weak bones. The fractures are more common at the hip joint and the femoral bone. Exercise has been shown to increase bone thickness and hence stronger bones in women of this age group (Cussler 2005: Kerr 2001). Osteoarthritis is a common skeletal disease that comes with advanced age. It affects joints in the body. Weight training and aerobics exercise has been shown to enhance balance in older people with knee osteoarthritis (Messier 2000). Exercise is not only for the adults. Exercise during childhood and teenage years ensure stronger bones later in life. Exercise during pregnancy is a healthy habit. Through it, an expectant mother is able to influence the size of her infant (Clapp 2003). METABOLISM, GETTING THE ENERGY WE NEED. Various metabolic processes interplay to ensure that body functions are maintained at optimum. These metabolic processes are affected by exercise. Once food is ingested, it undergoes digestion in the alimentary canal. With the aid of enzymes, the food is broken down into its basic components which are glucose, lipids and amino acids. Energy in the body is derived primarily from glucose. In the absence of glucose, fat is the alternative for energy production. Proteins derived from muscle mass are the least favored option when it comes to energy production. Breakdown of proteins requires a lot of energy. Ammonia is a byproduct of protein breakdown and it has harmful effects on health. In the setting of protein breakdown, damage to body organs and systems is inevitable. It also impairs the effectiveness of an exercise programme. Energy in the body is produced in the form of ATP. ATP production occurs in the mitochondria which are found within body cells. ATP is utilized in the body in various ways. It provides the energy required to power every energy consuming process in the body. It is also essential body building. It provides the energy required for repair of tissues and growth. Cleaving of a phosphate molecule from ATP to form ADP is the chemical reaction that releases energy. Nutrition and exercise are thus closely related. The role of nutrition is to provide enough energy to the muscles during the exercise and recovery period. It is important to know how muscles utilize energy during exercise. ATP is the first line energy source for muscles during contraction. However the amount of ATP stored in the muscle at any given moment is only adequate for one contraction. During exercise, rapid synthesis of ATP is therefore necessary to sustain the additional contractions. Creatinine phosphate is a molecule stored in muscle that facilitates the synthesis of ATP. This too has its limitations. This is because the stores of creatinine phosphate in muscle are also quickly depleted. Breakdown of glucose is responsible for replacing the depleted ATP and creatinine phosphate stores. A maximum yield of ATP is found when glucose is broken down In the presence of oxygen. This is called anaerobic metabolism. When oxygen is inadequate during glucose breakdown, lactic acid is formed. When the lactic acid builds up in muscle, it produces a burning sensation. The latter type of glucose breakdown is known as anaerobic metabolism and is common in exercises that are characterized by short bursts of activity. If glucose is depleted in the course of exercise, the body utilizes fat and proteins as alternative sources of energy. After exercise, the body will need to replenish the ATP stores in the muscles. This is an activity with high oxygen consumption. As mentioned earlier, anaerobic exercises are characterized by short bouts of activity. They are intense in nature and performed over a short period of time. They employ use of weights and are used primarily to build muscle bulk and strengthen muscles (Annianson 1981). Aerobic exercises are utilized in endurance training. These types of exercises are characterized by sustained low level muscle activity. One of the primary benefits of endurance training is weight loss. It also confers cardio protective benefits. Aerobic and anaerobic exercises can be carried out simultaneously. This widens the benefits an individual can glean i.e. one is able to lose weight and at the same time build up the muscle bulk. This is known as interval training (Martini 1995). MUSCLES AND AGING. With age, the muscle bulk reduces and muscles progressively weaken. This process is independent of lifestyle and exercise regimes (Brosss 1999). The elasticity of the muscles diminishes with time and they become more prone to injuries (Bross 1999: Braumgartner 1998). Their regeneration potential also decreases and repairs take longer. However age should not be a contraindication for exercise. Strength can be restored to weakened muscles through strength training (Anianson 1981: Frontera 1992). With advancing age, exercise helps keep weight in check and thus wards of diseases such as diabetes. It is advisable for the elderly to engage in activities that are not strenuous (Martini 1995). WHAT I HAVE LEARNED SO FAR. Benefits of exercise include weight control, prolonged life and mental well being. Metabolism is the process by which food is broken down to produce energy. Muscles utilize ATP for energy during contraction. Endurance exercises are cardio protective and result in weight loss while anaerobic exercises are utilized in building up the muscle bulk. TESTESTRONE REPLACEMENT. Andropause is the equivalent of menopause in women. It refers to the gradual decline of testosterone levels in men that occurs with age. Generally, 40-50% of men have low levels of testosterone by age 70 (Anawalt 2000). Symptoms experienced include decline in libido, heart disease and loss of bone and muscle. Growth hormone levels decline concurrently with those of testosterone (Karakelides 2005). Supplementing growth hormone and testosterone to enhance exercise looks like a viable option. However studies that have focused on this issue have found data that is insufficient to support this practice (Anawalt 2000). The risk of hormone dependent cancers is higher in the elderly and therefore any supplementation of testosterone should be approached with caution. Hormone replacement therapy if needed should thus be carried out under the watchful eye of a qualified physician. EXERCISE ENHANCING SUPPLEMENTS. Various supplements enhance muscle function. They include; Carnitine: this is an amino acid that aids in transport of fat into the mitochondria where it is broken down for energy production. Exercise capacity is enhanced when patients with kidney diseases or artery disease are given carnitine supplements (Baker 2001: Brass 1998). Carnosine: carnosine is present in muscle. Concentration of carnosine in muscle is highest during exercise (Suzuki 2002). Exercise is associated with formation of free radicals from the oxygen utilizing processes that take place (Yang 2000: Boldyrev 1997: Yneva 1999: Nagasawa 1999). Carnosine destroys the free radicals and prevents them from oxidizing body cells. It also protects proteins by inhibiting cross linking (Hipkiss 1997: Munch 1995). During strenuous exercise, carnosine also acts as a PH buffer thus protecting muscle from oxidation (Burcham 2000). Coenzyme Q10 (CoQ10): this is an essential enzyme that is utilized in the process of converting food into energy. It is located in the mitochondria. Oxidation processes take place continuously in the mitochondria. This results in the depletion of CoQ10 enzyme (Lonrot 1995: Dimeo 2001: Geneva 2004). Dysfunction of mitochondria coupled with depletion of CQ10 is thought to be an important causative factor in the development of age related diseases (Wallace 2009). This also results in production of less energy and increased synthesis of oxygen radicals (Choski 2007). The radicals further damage the mitochondria resulting in a vicious cycle (Di Lisa 2009). Shilajit: this is an organic substance harvested from biomass in the Himalayas (Schepetkin 2009: Goel 1990). It is famously utilized by ayurvedic practioners. It protects the body from illness and stress by acting as an adptogen. Advance in science has shown that it contains humic substances that enhance the flow of energy within the mitochondria (Agarwal 2007). A study conducted showed that shilajit decreased the rate of ATP decline in heart, brain and muscle tissue when given to rats that had been subjected to strenuous activity (Bhattacharyya 2009. The rate of depletion of CoQ10 was also slowed. When administered together, shilajat and CQ10 were found to have a synergistic effect. Shilajit contains two primary components that are essential for its function. These are fulvic acid and dibenzo-a-pyrones (DBPs). On its own, fulvic acid can initiate energy production in the mitochondria. It also prevents the oxidative damage to the mitochondria and transports DPBs into the mitochondria to aid in reactions that produce ATP(Piotrowska 2000; Ghosal 2006). When the mice were given oral CoQ10 supplements in isolation, there was increase in the levels of the enzyme in heart, liver and kidney tissues (Bhattacharyya 2009). However, when DBPs were supplemented concurrently with the CoQ10, the liver stores increased by 29% (Bhattacharyya 2009). Shilajit preserves ATP in the body. By ensuring that CoQ10 in the body is utilized maximally, it improves exercise performance. This was demonstrated in a recent study. People who took 200mg of Shilajit daily for 15 days had higher levels of ATP in the blood after exercise and the fitness score improved by 15%. Creatine: supplementing creatinine is beneficial. It increases both the lean mass and strength of the muscles (Nissen 2003; Kreider2003; Gotshalk 2002). ATP production requires phosphate molecules. Creatine acts as a donor of phosphate and thus enhances ATP production. In the setting of anaerobic glycolysis, creatine delays build up of lactic acid in the muscles. Muscle is not the only body tissue that benefits from creatine supplementation. Studies have shown that creatine is of benefit in patients with neurological degenerative disorders and it enhances memory in the elderly (Wyss 2002; Beal 2003; Tarnopolsky 2001; Matthews 1998; Tabrizi 2003; Laakso 2003; Yeo 2000; Valenzuela 2003; Watanabe 2002; Rae 2003). Branched amino acids: the basic building blocks of proteins are amino acids. There are two types of amino acids. Essential amino acids cannot be synthesized in the body and are only sourced from the diet. Non essential amino acids are those that the body can synthesis. Leucine and isoleucine are examples of branched essential amino acids that have been shown to enhance performance and prevent breakdown of muscle during endurance exercise (Workman 2002; Shimomura 2006; Ohtani 2006). Unlike carbohydrates supplements, amino acid supplements have been shown to increase muscle strength in the elderly (Scognamiglio 2004). Glutamine: glutamine is an amino acid that is present in abundant amounts in the healthy body. Prolonged exercise, surgery or infection can decreases the levels of glutamine in the body. There is an increase risk of developing respiratory infections in athletes who engage in strenuous activity. This has been linked to reduced glutamine levels in the body as a result of the exercise (Castell 2002; Parry-Billings 1990). Supplementing glutamine in marathon runners had the effect of reducing respiratory infections (Castell 1996). When used in combination with glycine and L-cysteine, glutathione helps enhance synthesis of glutathione which functions as an antioxidant in the body (Rennie 1998). When levels of glutathione are low in the body, muscle tissue is broken down to supply glutathione. Supplementing glutathione will bar this from happening (Antonio 2002; Hankard 1996). Metabolic whey protein: protein supplementation has been a popular practice among athletes and fitness enthusiasts. Exercise may deplete body energy stores. Protein supplementation will therefore provide an alternative source of energy and prevent muscle breakdown. Mechanical muscle function was found to be greater in patients who had protein supplementation compared to those who had carbohydrate supplementation (Andersen 2005). Plant protein: vegetable protein is an important source of proteins for vegetarians. With advancing age, blood vessels tend to lose their elasticity and hence their ability to dilate. Pea protein contains arginine which is used in synthesis of nitric oxide. This is a compound that is essential for dilation and relaxation of blood vessels (Zhou 2001).l. Contrary to common belief some vegetables contain higher amounts of protein when compared to animal based sources of protein. Polyenylphosphatidylcholine (PPC): muscle contraction is mediated by the nervous system. Information from the neural circuit is relayed to the muscle at the neuromuscular junction. Acetylcholine is the chemical mediator at this junction that relays this information. During exercise, PPC maintains plasma levels of choline which is a raw product used in the synthesis of acetyl choline (Buchman 2000). This ensures that there is continuous flow of electric information from the nerves to the muscles. Vitamin D: it is common knowledge that vitamin D is essential for proper bone health. It has recently come to attention that it is also important for muscle health. Vitamin D helps maintain muscle bulk by preventing shrinking of muscle fibers. Research has shown that adequate vitamin D intake reduces the risk of osteoporosis and muscle atrophy in the long run (Montero-Odasso 2005). D-ribose: D ribose is a molecule that is utilized during synthesis of ATP. Physical fatigue as a result of exercise is one of the chief reasons that puts off people from exercising (Annesi,  2005). During strenuous exercise, ATP levels in muscle can drop by up to 20% and it can take up to 72 hours for the muscles to replenish the ATP stores (Hellsten-Westing 1993; Stathis 1994). After exercise, many individuals feel spent. This has been linked to release of products of ATP break down into blood (Hellsten 1999). D-ribose will ensure that ATP levels in muscle are at optimum (Tullson 1988; Zarzeczny 2001). This will result in less fatigue after exercise and a person can happily look forward to the next exercise lesson. Exercise becomes an enjoyable activity instead of the drag many people have come to associate it with. D-ribose supplementation increases ATP stores in the muscle by up to four fold. This provides adequate reserve that can be utilized if need arises (Tullson 1991). D-ri bose also enhances recycling of the products of ATP breakdown. This enhances the speed of ATP synthesis (Zarzeczny 2001; Brault 2001). Muscles that are fatigued take longer to replenish ATP compared to well rested muscles (Hellsten-Westing 1993).. In 2004, a study showed that D- ribose accelerated the rate of recovery of ATP in muscle among sprinters (Hellsten2004). The following protocols may also be of interest. Obesity and weight loss. Trauma and wound healing. Male hormone restoration. Female hormone restoration. LIFE EXTENSION SUGGESTIONS. Creatine: 2 – 5 g daily Carnitine: 1000 – 2000 mg daily Carnosine: 1500 – 3000 mg daily CoQ10 (as ubiquinol): 100 – 300 mg daily Shilajit: 100 – 200 mg daily Branched-chain amino acids: containing at least 1200 mg L-leucine, 600 mg L-isoleucine, and 600 mg L-valine Glutamine: 500 – 1000 mg daily Whey protein: consider taking 20 – 80 g whey protein daily. It is most important to consume whey protein before and immediately after your exercise session to make sure adequate protein is available to depleted muscles. Plant Protein: 18 g protein from a blend of plants including pea Polyenylphosphatidylcholine (PPC): 900 – 1800 mg Vitamin D: 5000 – 8000 IU daily; depending upon blood levels of 25-OH-vitamin D D-ribose: 5 g, 1 – 3 times daily with food Also, the following blood tests may provide helpful information Vitamin D, 25-Hydroxy Female Comprehensive Hormone Panel Male Comprehensive Hormone Panel Creatine Kinase DISCLAIMER. information contained in this article does not intend to disregard advice rendered to individuals by qualified clinicians. Before commencing on any diet or exercise programme, a person should seek professional advice from a qualified healthcare professional. The protocols described in this article are for adults only. Before use of any supplement, a person should familiarize themselves with the product information provided by the manufacturer. This information pertains to the dose, administration and contraindications. The authors and publishers of this article are not liable to injury or damage a person may endure after use of information contained herein.

LeBlanc’s Analysis of Sexuality in Chopin’s The Awakening Essay

LeBlanc’s Analysis of Sexuality in Chopin’s The Awakening Definitions are tricky things. Such is the conclusion of Ross C. Murfin in his attempts to spell out the major literary theories discussed in our text: "attempts to highlight the difference between feminist and gender criticism are inevitably prone to reductive overgeneralization and occasional distortion"(footnote p.226). Such is the conclusion of gender theorists in general in their pursuit of critiquing the traditional definitions of male/ female, masculine/ feminine, and heterosexual/ homosexual. Such is my conclusion in reading Elizabeth LeBlanc's attempts at defining and utilizing the notion of the "metaphorical lesbian" in her analysis of Kate Chopin's The Awakening. Tricky as they may be, however, definitions, at least in our efforts to formulate them, constitute our lives, our thought processes, and our discourse: Who are we? What is our purpose? What does it all mean? With this in mind, what are we to make of the "metaphorical lesbian" or of the "real" lesbian? Although I f ound LeBlanc's essay to be exceptionally interesting in its formulations and insights, after reading it I am, nonetheless, left with the feeling that her definitions have become so broad as to seemingly negate any tangible, differentiated meaning. Within the essay, LeBlanc uses Bonnie Zimmerman's concept of the "metaphorical lesbian," Adrienne Rich's concept of "compulsory heterosexuality," and de Lauretis' rejection of a biological definition of feminine gender in reevaluating The Awakening as a lesbian text. In doing so, she defines Edna Pontellier as this "metaphorical lesbian" in that the character repudiates the societal "myth of woman," fosters "women-identified" experience, crea... ...nature. As the novel progresses, Edna seems to pull away from her female relationships in that she stops receiving her women callers and even visits with Adele less frequently. Edna seems concerned with her sole self and its enrichment more than with forming and/or maintaining bonds with anyone else, except for maybe the male Robert. Even in regards to her sexuality, she appears to be more interested in the sexual feelings themselves than in who is creating them for her, such as with her indifference towards Arobin after their sexual interaction. In this light, perhaps Edna is more of a "metaphorical masturbator" than a "metaphorical lesbian." Regardless of Edna's metaphors, however, LeBlanc's metaphors in describing her are extremely inclusive in a way that leaves telling gaps. LeBlanc's "metaphorical lesbian" can thus be seen in actuality as a metaphorical nebula.

The Battle of Crecy :: Essays Papers

The Battle of Crecy The Battle of Crecy is one of several battles fought during the Hundred Years War between England and France. William I was the first to intertwine England and France. He did this by separating his French and English holdings between his two oldest sons, Robert and William II. This led to intermarriage of French and English, which eventually created land disputes, dramatic affairs and inadvertently led to the Hundred Years war and the Battle of Crecy. The Battle of Crecy took place on August 26, 1346. The battle was waged by two kings, the English king, Edward III, the French king Philp VI and their respective armies. The French forces are thought to have consisted of around thirty-six thousand men, including thousands of Geonese from Italy. On the other side the English are suspected of only having around twelve thousand soldiers. Although the English were outnumbered by thousands of French knights they proceeded to savagely defeat the French that day. On the day of the battle the English were in a defensive position awaiting the attack of the French forces at a place known as Crecy Ridge. The English armies were "trained, disciplined, well-armed and confident" meanwhile the Frenchmen and Geonese were "largely untrained, hastily collected and lacking cohesion" (Burne 186). The English were also thought to have had a crude form of a cannon, the first ever used in a battle. They also had excellent archers who easily defeated many of the French cross bowmen and knights from a distance with a longbow. The English win was enormous, and it is said that "Phillip VI fled the battlefield" (Allmand 15). Jean Froissart helped to to sensationalize and romanticize the battle in his "Chronicles of the Hundred Years War". With this work he helped to create legends about the "Black Prince", Edward III's son who first gained honor through the Battle of Crecy. The work idolizes the warriors who fought in the battles and exaggerates the cowardice of the French.

Shakespeare is Important :: essays research papers

Shakespeare is Important William Shakespeare’s plays are being made into box office film hits at an incredible rate. Films such as Much Ado About Nothing with Kenneth Branagh and Emma Thompson, Hamlet with Mel Gibson and Glenn Close, Othello with Laurence Fishbourne and Henry V with Kenneth Branagh have been seen by a surprising number of teenagers. Often they have not understood it all, or even half of it, but they have been affected by the powerful characters and by the Shakespearean magic which has affected audiences around the world for centuries. They want to know more, they want to understand, and what better motvation can any teacher ask for than that students WANT ? That alone is sufficient reason for any English teacher to start a course in Shakespeare. The other reason is that Shakespeare is a man for our time. He may have been a man "for all times". He certainly speaks directly to the students in my charge. The passions and emotions which he describes find deep echoes in the hearts of the youngsters at the close of the 20th century. He probably was modern when he wrote his dramas. He has retained that modernity seemingly for three centuries. Thirdly, he is the father of all western playwrights. Everybody from Ibsen to O'Neil uses techniques and ideas which can be traced back to Shakespeare. Whatever dramatist in whatever language you are required to study, familiarity with Shakespeare can only be an advantage. Finally, it is fun to study drama. It is fun to dramatise and dress up and fall over dead behind improvised curtains and fence with blackboard pointers and cook up a witches brew and come to school with a spade over your shoulder for the Graveyard Scene. It is fun, and while all the fun is being enjoyed an incredible amount of language is pouring into these students' heads, through listening, reading, watching videos and learning lines off by heart.

MRI Applications Imaging Knee Joint Health And Social Care Essay

The articulatio genus articulation is one of the most complicated articulations in the human organic structure. Because the articulatio genus is so vulnerable in many respects, it is besides the most normally injured articulation, particularly in the younger, athletic population. As a consequence of the enormous emphasiss applied on the constructions of the articulatio genus during athletic activities, articulatio genus hurts are besides the taking cause of long-run disablement of jocks ( Davies & A ; Cassar-Pullicino 2002 ) . In add-on to other imaging modes such as computing machine imaging, ultrasound and general skiagraphy, magnetic resonance imagination ( MRI ) is now normally used to picture the complex anatomy and pathological findings of one of the most of import joint articulations in our organic structures ( Harper et al 2005 ) . The cause of internal mental unsoundnesss of the articulatio genus can run from athleticss activities to effects of devolution. Arthroscopy was the primary method used to accomplish a comprehensive rating of articulatio genus joint constructions before MRI became widely available. In comparing to MRI imagination, the arthroscopic process is both invasive and expensive. With the outgrowth of MRI as a powerful diagnostic tool, arthroscopies are no longer routinely used to name internal articulation constructions. Alternatively, it is now more normally used for curative benefits, and to clear up inconclusive findings ( Grenier et al 2004 ) . MRI has contributed mostly to the basic apprehension and clinical diagnosing of assorted hurts and conditions impacting the articulatio genus. The different constructions in the articulatio genus can be visualized in great item on different MRI pulsation sequences.MeniscusThe semilunar cartilage are made up of fibrocartilaginous constructions that a ttach to the condylar surface of the shinbone. The median semilunar cartilage remainders on the interior of the articulatio genus, whilst the sidelong semilunar cartilage lies on the exterior of the articulatio genus. Meniscal hurts are one of the most common causes of articulatio genus hurting and disablement ( Alatakis & A ; Naidoo 2009 ) . Acute meniscal hurts are normally caused by either valgus emphasis with external rotary motion or varus emphasis with internal rotary motion of the articulatio genus. Patients with meniscal harm normally experience hurting and swelling as their primary symptoms. Other common ailments include joint-locking, starting and snaping within the articulatio genus, or the inability to wholly unbend the articulation. Harmonizing to Feller ( 2002 ) , additive, complex, or diffuse increased signal strength within the semilunar cartilage and communicate with an articular surface are declarative of meniscal cryings on MR images. Meniscal cryings may be descr ibed in assorted ways, which include horizontal cleavage, radial, parrot beak, peripheral or perpendicular, flap, bucket-handle, meniscocapsular separation, complex, and macerated ( Feller 2002 ) . Grenier ( 2004 ) describes the normal semilunar cartilage as a semi-circle of gristle and collagen fibers that appear as low, homogeneous signals with wedged-shape profiles on all MRI sequences, and ‘bow-tie ‘ profiles on sagittal pieces ( Figure 1 ) . Younger patients may look to hold intrasubstance signal around the peripheral border on the scans. This happening is sometimes mistaken for a tear. However, the signal is more frequently showing vascularity, non pathology. Although the axial plane can be used to expose meniscal construction, everyday axial images at 4 to 5mm may be excessively thick to show meniscal pathology. Harmonizing to Fox ( 2007 ) , a piece thickness of about 3 to 4 millimeter is more ideal in showing a meniscal tear in the axial plane. The anterior and posterior horns of the median and sidelong semilunar cartilages are best demonstrated on sagittal pieces, whilst coronal images best show the meniscal organic structures. Hence, the semilunar cartilage are best evaluated on the sagittal and coronal planes. High spacial declaration and an optimized signal/noise ratio ratio are besides required to supply accurate visual image of the semilunar cartilage. At our pattern, PD- weighted fast spin-echo images are preferred for meniscal rating as they can show the assorted classs of meniscal cryings or devolution. Meniscal hurts are frequently accompanied by secondary pathologies of the articulatio genus. Fat impregnation is besides appli ed in the PD sequences to visualise any presence of ligamentous hurts and bone marrow hydrops ( Harper et al 2005 ) . Figure 1. T1-weighted sagittal image of the right articulatio genus showing the normal ‘bowtie ‘ visual aspect of the sidelong semilunar cartilage ( Grenier et al 2004 ) . Meniscal cysts can frequently do marks and symptoms consistent with typical meniscal pathology, and include swelling, hurting, tenderness, limited mobility, and a tangible mass. They are normally unstable aggregations that have resulted from the peripheral borders of horizontal cleavage cryings or complex cryings of the semilunar cartilage. Meniscal cysts besides tend to be more normally associated with cryings in the sidelong semilunar cartilage, and are by and large accompanied by lateralizing joint line tenderness ( Feller 2002 ) . Harmonizing to Grenier & A ; Wessely ( 2004 ) , the cystic mass normally appears with low signal strength on T1-weighted images, but has increased signal strength on T2-weighted MR images. Meniscal cysts can look in all imagination planes, but are best demonstrated in axial and coronal images.Ligaments: Cruciate & A ; CollateralLigamentous hurts of the articulatio genus are common happenings among jocks. The constructions that function as the chief stab ilizers of the normal articulatio genus joint consist of four chief ligaments ; the medial and sidelong collateral ligaments, every bit good as the anterior cruciate ligament ( ACL ) and posterior cruciate ligament ( PCL ) ( Tham et al 2008 ) . The most often injured ligament in the articulatio genus is the anterior cruciate ligament ( ACL ) . The ACL ‘s primary maps are to forestall anterior interlingual rendition of the tibia relation to the thighbone, limit rotary motion of the shinbone when the articulatio genus is in extension, and bound varus and valgus emphasis when the medial and sidelong collateral ligaments are injured. Cryings of the ACL are normally caused by valgus emphasis or hyperextension, and normally occur in featuring activities that involve changeless acceleration and slowing ( Berquist 2001 ) . Although best demonstrated in the sagittal position, the normal ACL appears as a thick set of fibers with low signal strength on all imaging planes. The ACL is best demonstrated in the sagittal plane. In the normal articulatio genus, it is shown to attach proximally at the internal facet of the sidelong femoral condyle, and distally to the anterior shinbone and the anterior facet of the tibial spinal column ( see Figure 2a ) . However, due to partial averaging of the proximal ACL with the cortical border of the sidelong femoral condyle, the proximal femoral fond regard of the ACL is non ever demonstrated faithfully on sagittal images. Therefore, axial images can be helpful in visualising the proximal ACL and femoral fond regard. On the coronal pieces, the ACL is demonstrated as a level set adjacent to the sidelong femoral condyles ( Grenier et al 2004 ) . If there is no visual image or discontinuity of the ACL in merely the sagittal plane, it is normally sufficient in naming the presence of an ACL tear. When there is a tear nowadays, the ACL fibers can be seen to be wholly or partly disrupted with unnatural morphology and signal strength ( Tham et al 2008 ) . Other marks of a tear are discontinuity and an change of the orientation of the fibers ( see Figure 2b ) . Harmonizing to Grenier & A ; Wessely ( 2004 ) , intrasubstance high signal countries tend to be indexs of partial cryings in the ACL. Chronic cryings are characterized with outstanding fibrosis and associated cicatrix formation. Because of the mechanism of hurt, ACL cryings are frequently accompanied by associated ligamental, meniscal, and boney hurts. Figure 2a ) ( left ) Sagittal proton-density image of the articulatio genus demoing the normal ACL ( white pointer ) ( Tham et al 2008 ) . B ) ( right ) Sagittal T1-weighted image of the articulatio genus demoing discontinuity of the ligament fibers ( pointer ) , proposing an acute tear in the ACL ( Grenier et al 2004 ) . The chief map of the posterior cruciate ligament ( PCL ) is to move as the primary stabilizer of the articulatio genus, and prevent posterior interlingual rendition of the shinbone. It is located near the centre of rotary motion of the articulatio genus, and has a normal ‘inverted hockey-stick ‘ visual aspect. Because the PCL is thicker and stronger than the ACL, it is injured less normally. However, hurts to the PCL can be caused by a direct blunt force to the anterior facet of the articulatio genus. The force of the injury can force the shinbone back posteriorly in relation to the thighbone, ensuing in a sprain or tear of the PCL ( Roberts et al 2007 ) . Injuries to the PCL can show the same scope of visual aspects on MR imaging as ACL hurts, including focal countries of unnatural signal to finish break of the ligament. Specific countries of increased signal strength and break of ‘hockey-stick ‘ visual aspect of the PCL are common indexs of a partial tear of the PCL ( Figures 3 a & A ; B ) . However, PCL cryings are non every bit common as ACL cryings, and secondary findings may non be as characteristic or well-described. The PCL is visualized in all MRI planes and sequences with a uniform, hypointense signal. Similar to the ACL, the PCL is besides best visualized on sagittal images, and can hold partial or complete cryings ( Grenier & A ; Wessely 2004 ) . Coronal images may be helpful in measuring the short diameter cross-section of the PCL ( Davies & A ; Cassar-Pullicino 2002 ) . Figure 3a ) ( left ) The upside-down ‘hockey stick ‘ visual aspect of the PCL is shown in a sagittal T1-weighted image of a normal articulatio genus. B ) ( right ) The signal strength of the PCL has changed, and there is besides discontinuity of the fibers. The PCL no longer has an ‘inverted hockey-stick ‘ visual aspect ( Grenier et al 2004 ) . The chief constructions that provide stableness to the medial and sidelong parts of the articulatio genus are the indirect ligaments. MRI rating of the collateral ligaments is effectual, but can be disputing because of the anatomic fluctuation and the thin nature of these constructions. The mechanisms of hurt to the medial and sidelong collateral ligaments are inordinate valgus and varus emphasis ( Helms et al 2009 ) . The median collateral ligament ( MCL ) is normally visualized as a level construction that begins from the epicondyles of the thighbone and attaches into the median shinbone. The MCL is the 2nd most normally injured ligament in the articulatio genus. The sidelong or fibular collateral ligament ( LCL ) attaches the distal thighbone to the fibular caput collectively with the biceps femur, and is the chief restraint to varus forces on the articulatio genus ( Grenier et al 2004 ) . The collateral ligaments are by and large best visualized on coronal pieces, looking as countries of low signal strength ( see Figures 4 a & A ; B ) . The LCL can by and large be evaluated on a individual coronal image due to its oblique class. The short diameter cross-section of the MCL can besides be demonstrated on consecutive axial images. These are indispensable in finding the extent of partial cryings or intrasubstance sprains ( Davies & A ; Cassar-Pullicino 2002 ) . When there is a complete tear of the LCL, irregular contouring of the lacerate ligament with environing fluid or hydrops can be observed on MRI images ( Feller 2002 ) . As with the semilunar cartilage, conventional spin reverberation sequences provide moderately accurate appraisal of the ligaments. The normal ligament may be good visualized on T1-weighted spin-echo images. But in the presence of a joint gush, the unity of the cruciate ligaments may be hard to measure. In our pattern, PD spin-echo sequences are by and large used in all imaging programs as they provide good contrast between the ligament and joint fluid, and show a greater SNR ( Davies & A ; Cassar-Pullicino 2002 ) . Figure 4a ) ( left ) Coronal PD images of the articulatio genus show a normal sidelong collateral ligament ( LCL ) that attaches from the sidelong femoral condyle to the caput of the calf bone ( white arrowheads ) . B ) ( right ) The normal median collateral ligament ( MCL ) can be seen attaching from the median femoral condyle to the median surface of the organic structure of the shinbone ( white pointers ) ( Tham at el 2008 ) .Osseous PathologyBone bruising is frequently associated with coincident soft tissue hurts. Therefore, placing bone bruising besides helps to place other possible hurts. Tension injuries affecting ligaments tend to avulse bony fond regard sites. Bone bruising at the sidelong femoral condyles and the posterolateral facet of the tibial tableland are normally related to acute cryings of the ACL. Assorted hurts to the ligamentous and meniscal constructions are besides associated with osteal pathology. Although blunt breaks can be good visualized on conventional sk iagraphy, bone bruising by and large requires MRI to be visualized ( Grenier & A ; Wessely 2004 ) . Traumatic bony lesions, microfractures or trabeculate hurts that occur in the ague or subacute scene are normally accompanied by bone marrow hydrops. They by and large present as low signal strength countries on T1 images, or increased signal strength countries on T2 and fat suppressed images. Fat suppressed images are helpful as they will show an increased signal strength if bony jobs are present. Fat suppression eliminates the signal from the marrow, therefore leting bone marrow hydrops to go more apparent. Figure 5 demonstrates an country of increased signal strength on a T2-weighted image, bespeaking the presence of bone bruising. Bone bruises and stress reactions can frequently look as a diffuse or localised country of low signal strength on T1- weighted images. A defined break line is normally non seen. However, any cortical or stress breaks that may be present would look as cri sp, chiseled, additive subdivisions with reduced signal strength on all MR sequences ( Feller 2002 ) . Figure 5. Sagittal T2-weighted image showing a big bone bruise within the femoral condyle ( pointer ) ( Grenier & A ; Wessely 2004 ) .Extensor muscle MechanismThe extensor mechanism is made up of the quadriceps musculus and sinew, kneecap, and patellar sinew. Injury to the extensor mechanism seldom occurs. However, should it happen, it is normally indirect, and is frequently caused by strong quadriceps contraction that is opposed by forced flexure of the articulatio genus. Loss of map in the extensor mechanism and sever hurting are direct consequences of complete break of the mechanism ( Feller 2002 ) . Patellar disruption occurs when the kneecap has been wholly displaced from the femoral trochlea, and is the most common cause of break of the extensor mechanism. The disruption about ever occurs to the sidelong side. An arthroscopic process is normally required if a piece of patellar gristle is found on the MR images ( Stoller 2002 ) . Osgood-Schlatter disease and jumperA?s articulatio genus both root from chronic patellar tendinitis. With Osgood-Schlatter disease, redness of the sinew occurs. However, with jumper ‘s articulatio genus, micro-tears and collagen devolution occur as a consequence of puting repeated strain on the joint with gestures such as leaping motions ( Berquist 2001 ) . Both entities have similar MRI findings, and are demonstrated as focal or spindle-shaped thickener of the patellar sinew, and may show with increased intratendonous signal. The increased signal by and large appears near the tibial tubercle with Osgood-Schlatter disease. However, with jumperA?s articulatio genus, the increased signal is normally present near to the part of the inferior pole of the kneecap. Overliing hypodermic hydrops can sometimes happen, taking to countries of low signal strength due to bony fragments ( Feller 2002 ) .Extra InjuriesInjury to the articulatio genus can besides ensue in hurt to other of import soft tissue constructions, such as the Bursa, which includes the popliteal, prepatellar, pes anserinus, semi-membranosus and tibial collateral ligament Bursa. Inflammation, or bursitis, in these countries can frequently be mistaken for other intra-articular pathologies. MRI is able to supply brilliant visual image of these soft tissue constructions. The popliteal Bursa is normally the most common site of hurt. The normal popliteal Bursa may incorporate a little sum of fluid in the posterior facet of the articulatio genus, and by and large nowadayss as a focal country of increased T2 signal ( Grenier et al 2004 ) . Traumatic haemarthrosis can besides happen as a consequence of a meniscal or ligamental tear. MRI imagination is helpful in finding the beginning of the hydrops. A standard articulatio genus protocol is normally sufficient in imaging traumatic haemarthrosis.MR ArthrographyConventional arthrography has bit by bit become unneeded with the debut of MRI of the articulatio gen us. MR arthrography is used merely when there is a demand to foster measure the post-operative meniscua, osteochondral lesions, or show loose organic structures, in a patient with no joint gush. MR arthrography may be direct or indirect ( Helms et al 2009 ) . In indirect arthrography, Gd is injected intravenously. The articulatio genus is so scanned about 10 to 20 proceedingss after, during which some contrast would hold diffused into the articulatio genus articulation. However, indirect arthrography does non supply distention of the articulatio genus articulation with fluid, which is indispensable in this process. Hence, indirect arthrography remains more limited. With direct arthrography, contrast is injected straight into the patellofemoral articulation through the sidelong facet of the kneecap. If the radiotherapist executing the process is experienced, fluoroscopic counsel is non even necessary. MR arthrography of the articulatio genus is non presently performed at our pattern, and at the minute, no protocol has been established for this process. However, harmonizing to Magee et Al ( 2003 ) , T1-weighted images with fat impregnation are typically employed following the injection of Gd. If normal saline is used as the contrast agent, T2-weighted or gradient echo images with T2 weighting may be used every bit good.MR ProtocolWith our 1.5-Tesla MR system, imagination of the articulatio genus is performed with the patient in a supine place, with a dedicated phased-array quadrature articulatio genus spiral. If the patient ‘s articulatio genus is unable to suit into the standard spiral, or that the patient has trouble widening their articulatio genus, a flexible surface spiral may be used. Most patterns have standard protocols for MR imaging rating of the articulatio genus which normally includes coronal, sagittal, and axial positions. A standard articulatio genus protocol at our pattern includes: T1 Sagittal PD FS Sagittal ( Proton denseness with fat impregnation ) T2 GRE ( Gradient echo ) Sagittal PD Coronal PD FS Coronal PD FS Axial Sagittal images are likely the best imagination plane at showing pathologies affecting the internal constructions and assorted pathologies of the articulatio genus. Components of the median and indirect ligaments, every bit good as the next capsule, are well-demonstrated in the sagittal plane. Mid-sagittal pieces can supply visual image of the patellofemoral compartment, quadriceps, and kneecap sinew. The ACL and PCL are besides best displayed on sagittal images. The sagittal plane is normally sufficient in naming cryings of the ACL and PCL, as breaks or unnatural signal strengths bespeaking a tear are easy demonstrated in the sagittal plane ( Davies & A ; Cassar-Pullicino 2002 ) . Images in the sagittal plane can besides be highly helpful in measuring meniscal anatomy for both devolutions and cryings. The coronal plane enables the visual image of the posterior capsule, popliteus sinew, cruciate ligaments and semilunar cartilage, the collateral ligaments, and the extensor mechanism. The collateral ligaments are besides often evaluated utilizing the coronal plane. Coronal images can be used in concurrence with sagittal images to show the cruciate ligaments, and to measure the posterior femoral condyles, which are common sites of articular eroding. The low signal strength popliteal vass are besides identified on posterior coronal images ( Helms et al 2009 ) . Due to the oblique orientation of the median and sidelong patellar aspects, every bit good as the articular gristle, the axial plane is the most equal at showing these constructions through the patella-femoral articulation. Axial plane images by and large serve as a localizer to find sagittal and coronal planning. Majority of the osteal dealingss between the kneecap, thighbone and tibua, every bit good as the fond regards of the cruciate and indirect ligaments can be displayed in axial images. The larger sidelong patellar aspect and the oblique median kneecap aspect are besides seen in the axial plane, as are both the sidelong and median patellar retinacular fond regards at the degree of the patellofemoral articulation ( Davies & A ; Cassar-Pullicino 2002 ) . In order to adequately measure the articulatio genus, images should be obtain in the sagittal, coronal and axial planes. All three imaging planes work in concurrence to show all the internal constructions of the articulatio genus. For illustration, although the semilunar cartilage are chiefly evaluated on sagittal images, they are frequently supplemented by images in the coronal plane. Sagittal images are used to visualise the cruciate ligaments, which can besides be farther assessed on coronal and sometimes axial images. Coronal images are indispensable in showing collateral ligaments, but are besides supplemented by axial images. The patellofemoral articulation is best assessed on axial images, but can besides be evaluated on sagittal images ( Stoller 2002 ) . Hence, all three planes are indispensable in exhaustively showing the articulatio genus. The most normally used sequences for MRI of the articulatio genus include spin-echo or fast spin-echo ( FSE ) proton denseness sequences , with or without fat impregnation, T1 and gradient reverberation ( GRE ) .Image SequencesStandard protocols for MRI rating of the articulatio genus include sagittal, axial and coronal images. A typical modus operandi protocol at our pattern may include sequences such as: PD- leaden spin-echo imagination ; T1-weighted spin-echo imagination ; and T2-weighted gradient reverberation imagination. Other optional protocols include a short tau inversion recovery ( STIR ) sequence in the sagittal plane. In PD-weighted sequences, the image contrast is dependent chiefly on the denseness of protons in the imagination volume. The images are typically acquired utilizing TR that is greater that with T1 sequences, and TE that is less than in T2 sequences. At our pattern, PD sequences are chiefly used in all planes to show the articulatio genus. This is because PD spin reverberation images have high signal to resound ratio, and are able to supply accurate anatomical item. When fat impregnation is applied, PD-weighted sequences have an increased sensitiveness for synovial fluid within meniscal cryings. This makes the sequence highly valuable in measuring meniscal pathology. The combination of fat impregnation with PD weighted sequences besides allows for high sensitiveness to cartilage and intramedullary osteal abnormalcies ( Stoller 2002 ) . Fat impregnation to supply a better presentation of any abnormalcy, appraisal of bone marrow abnormalcies, and enables the distinction between fluid an d fat at their interface. Fat impregnation is applied to take the high signal strength of fat in the articulatio genus, therefore leting bone marrow pathology, semilunar cartilage and gristle to be demonstrated more clearly. Therefore, PD weighted sequences with fat impregnation is used in all three imaging planes to measure the articulatio genus ( Davies & A ; Cassar-Pullicino 2002 ) . However, PD weighted sequences utilizing fat impregnation normally require longer scanning times, which can sometimes be a disadvantage to the injured patient. The effectivity of fat impregnation is besides decreased at low magnetic field strengths, and it is extremely sensitive to local magnetic field inhomogeneities ( Helms et al 2009 ) . A gradient reverberation sequence and T1-weighted sequence are besides performed in the sagittal plane. In imagination, a T1 image is obtained when merely one reverberation is generated utilizing a short TR and TE. The T1-weighted sequence provides a general overview of the anatomy and any gross pathology. Normal anatomy of the ligaments and semilunar cartilages can be adequately visualized on T1 images. However, in the presence of a joint gush, any pathology nowadays may go hard to measure. T1-weighted images are besides non able to adequately show the hyaline gristle as it appears of low signal strength, and is hence identical from joint fluid ( Stoller 2002 ) . A gradient reverberation is formed when a brace of bipolar gradient pulsations is used. In T2-weighted gradient reverberation sequences, a smaller somersault angle is used, along with longer TR and TE. Signal strength alterations within the ligaments ensuing from hurt are more clearly demonstrated on T2-weight gradient reverberation sequences, therefore leting for the accurate appraisal of the unity of the ligament. Gradient reverberation images besides display the hyaline gristle with high signal strength, which in bend contrasts aggressively with next constructions of low signal strength ( Davies & A ; Cassar-Pullicino 2002 ) . However, because gradient reverberation images do non supply equal visual image of bone marrow pathology, they are non by and large recommended for the rating of bony pathology, particularly in the instance of the injured patient.DiscussionStandard articulatio genus imaging protocols can besides include T2-weighted every bit good as STIR sequences. Conventio nal PD sequences were compared to FSE-PD sequences in 216 back-to-back surveies. Amongst the 216 patients, it was found that 42 cryings were missed on the fast spin reverberation ( FSE ) PD sequences, but shown in the conventional PD sequence ( Helms 2009 ) . Hence, Helms et Al ( 2009 ) concludes that FSE PD images are unacceptable in the imagination of the articulatio genus. Alternatively, the writer suggests that sagittal FSE T2-weighted images with fat impregnation would supply brilliant visual image of the cruciate ligaments, gristle and osteal constructions. Similarly, the survey states that although gradient reverberation sequences would do for imaging the gristle, but was unacceptable of showing the castanetss. However, a separate survey by Wolff et Al ( 2008 ) has found that FSE PD-weighted sequences are sufficient in showing meniscal cryings. T2-weighted and STIR sequences are non typically performed at our pattern. T2-weighted fast spin-echo MR imagination with fat impregnation can be an accurate and fast technique for observing and rating articular gristle defects in the articulatio genus ( Alatakis & A ; Naidoo 2009 ) . Because PD-weighted sequences have high SNR and can supply high anatomic item, we chiefly use PD sequences in geting articulatio genus images. However, it has been noted that pathology, which is characterized by an addition in unstable content, can be accentuated in the PD weighted sequences. One of the benefits of the STIR sequence is that the signal from fat is wholly suppressed. Another advantage of the STIR sequences is that because they are based on the rapid T1 recovery of fat, they can be employed utilizing low field strength, and are non affected by gradient field inhomogeneities. Because the STIR sequence does non trust as much on the homogeneousness of the magnetic field, it can supply an alte rnate method of fat signal suppression. Bone hydrops can besides be assessed utilizing STIR sequences. However, STIR images by and large have a comparatively low SNR. Thus, tissues with a similar T1 to flesh out, such as bleeding, melanin and Gd, may besides be suppressed ( Berquist 2001 ) . For this ground, STIR sequences are by and large unsuitable for MR arthrography or scanning following endovenous Gd ( Magee et al 2003 ) . This sequence may be used in our pattern if there is metal artifact nowadays. Metallic devices can make an inhomogenous magnetic field. This can ensue in countries of suboptimal fat impregnation. STIR sequences frequently result in reduced SNR, and as a consequence, images can hold a farinaceous visual aspect with loss of tissue signal declaration ( Helms et al 2009 ) . STIR sequences besides require longer scan times. After reexamining the literature, it has been taken into history that some alterations to our current protocol could be made. It is my continued belief that the PD-weighted sequences utilizing fat impregnation provides that most accurate information sing the constructions of the articulatio genus articulation. However, some consideration is necessary in respects to the add-on of T2 fat-saturated wreath and sagittal sequences may be necessary so as to visualise pathology such as recurrent cryings, perchance replacing the demand for a T1-weighted sagittal sequence. A possible alteration of protocol may include FSE T2-weighted images with fat impregnation in all three planes. A conventional PD-weighted sequence with fat impregnation in the sagittal plane should be included, therefore supplying high truth of the semilunar cartilage, ligaments and gristle ( Helms 2009 ) . STIR sequences may be used to replace gradient reverberation sequences if there is metal present, or if rating of the bone marrow is required. When make up one's minding whether or non to alter the sequences, one must take into consideration the clip alteration that will happen, particularly in respects to imaging the injured patient. At present, MRI of the articulatio genus requires about 30 proceedingss with our current protocol consisting of 6 sequences. The alteration in protocol uses 4 sequences, therefore perchance cut downing the scanning clip. However, using fat impregnation with a sequence tends to increase scanning clip. The add-on of another sequence that requires fat impregnation, or the STIR sequence, could well increase the sum of clip required for a knee scan. It is still a argument as to whether these excess sequences are necessary. Sequences such as the 3-dimensional spoilt gradient-echo and STIR sequences may go unneeded for the separate rating of gristle and bone marrow alterations, particularly in injured patients ( Davies & A ; Cassar-Pullicino 2002 ) .DecisionMRI is progressively going the aureate crit erion in measuring the articulatio genus articulation. It provides a more easy come-at-able, less invasive, and comparatively less dearly-won alternate to arthroscopy. It besides provides the injured patient a comparatively easy and comfy manner of obtaining all right elaborate imagination of their articulatio genus. Although most imaging centres have set standard protocols for MRI of the articulatio genus, these protocols may sometimes necessitate accommodation in order to outdo profit the patient. In order to make up one's mind which protocol is more suited, we must first take into consideration what consequence each sequence will hold on diagnostic truth, curative impact, and the degree of patient comfort.