Sample Essay on the Difference Between a Good Mother and a Bad Mother

Sample Essay on the Difference Between a Good Mother and a Bad MotherIf you have decided to write a sample essay on the difference between a good mother and a bad mother, then this is the right place to look for inspiration. You can look through various works that deal with different topics relating to a mother and how she has impacted on her child. These include topics such as parenting, education, relationships, divorce, etc.It is really important to study these topics because it can help you to develop your research skills and narrow down your choices to the best essay material. Remember that the essay you are writing should be rich and long and should contain the best vocabulary, grammar and sentence structure possible. Keep in mind that the essay should also provide the reader with the best way to interpret your words and that it should encourage them to think beyond what they know.This is the best way to judge the effectiveness of a sample essay on the difference between a good mother and a bad mother. It is crucial to include a wide variety of thoughts about how the reader can develop her own opinions about her.If you think that writing a sample essay on the difference between a good mother and a bad mother is just too much for you, then you can do the task online. You can find numerous websites which offer hundreds of sample essays related to various topics concerning mothers and parenting.The first step in writing a great research paper is to find out all the various aspects that you want to incorporate in your essay. You can consider having an interaction with the writer of the essay, whom you will make contact with over the internet, and the interaction can help you formulate your own ideas and develop your own ideas.Another point to consider while preparing your research paper is to decide on the topic of the essay. So, you can read books that deal with mothers, read some articles that discuss the subject, etc.Lastly, your research paper on the diff erence between a good mother and a bad mother can be a fabulous writing experience and your topic will appear short and lucid. This will make it easy for you to have the desired impact.

John Locke - Seperation Of Powers Essays - Montesquieu,

John Locke - Seperation of Powers Separation of Powers Separation of powers is the act of separating of responsibilities of the three branches of the government. The idea of this separation is not a new one either. John Locke originally talked about it. He stated that the legislative power should be divided between the King and Parliament in England. Another man also spoke about this separation, the French writer Montesquieu, who wrote about it in 1748 in his book De lesprit des lois. His point was that liberty is most effective if it is safeguarded by the separation of powers. He highly promoted liberty. As in the Encyclopedia Britannica, it stated that Montesquieu felt that liberty is most highly promoted when there are three branches of government acting independently of each other. Although his model for the three-branch government was for England, it became more important to the United States. His work was most notably shown in America when the Constitution was being created. Finally, Alexander Hamilton raised his point on separati on of powers in the series of essays called The Federalist. The Encyclopedia Encarta said that he wrote this with James Madison and John Jay and that there were 85 essays all together. They were written about how they wanted the new government to run. It was their view as to how each major department in the new central government should run. More specifically, they stated how the three branches of government should run and expounded the idea of judicial review. The way that the power is separated in the United States was that the legislative branch makes the laws, the executive branch executes the laws and the judicial branch interprets the laws. However, as our book and the Encyclopedia Britannica both state, the executive branch in the United States has gained a lot more power. They both claim this because of numerous changes in social and economic life. The idea of checks and balances is closely related to the idea of separation of powers. Checks and balances is the idea that each branch of the government has ways to make sure that each other branch does not gain too much power. Instead, each branch is encouraged to share power with the other. Again, our book and the Encyclopedia Britannica both say that the way that this works is that the courts have judicial review, which is the power of the courts to examine both the executive and legislative branches to make sure that they are doing, is constitutional. Congress has the power to impeach people from both the judicial and executive branches. Plus they have the power to appropriate funds. Finally, the executive branch has the power to veto bills passed by Congress. However, this can be overridden by a 2/3-majority vote in Congress. However, a new concept helps the President, he can line item veto, which means he can blank out certain parts of the bill so it does not have to totally written. The idea of separation of powers is what separates us from Great Britain in the way we run our democracy. In England, the legislative executive branches are integrated. This idea is reinforced with the idea that they should be in constant agreement. It is pretty obvious that they are not in constant agreement here. This can happen because Congress may have a republican majority yet the president and his cabinet may be democratic. The idea is separation of powers is even related to Federalism as a whole. According to the Grolier Encyclopedia, federalism is directly related to the separation of powers. However, it is related to the separation between the state and national government. It said that each level of government is autonomous from the other. Also, neither is dependent on the other for legislation, taxes or administration. The idea of separation of powers has been around for a long time. Our newly founded government decided to use it as a base when writing the Constitution. Its main ideas are related to other aspects of our government such as checks and balances. Its ideals have changed a little bit because now the executive branch has a bit more power, but for the most part it has stayed intact. This concept also

Relative Roles of State and Ngos in Community Development with Respect to Housing as Service Delivery Essay Example

Relative Roles of State and Ngos in Community Development with Respect to Housing as Service Delivery Essay Example Relative Roles of State and Ngos in Community Development with Respect to Housing as Service Delivery Essay Relative Roles of State and Ngos in Community Development with Respect to Housing as Service Delivery Essay What are the developments options the state and the Non-governmental organisations have performed for the Peddie Extension area with regard to the housing delivery. Aims and Objectives of the study: Two aims and objectives have been identified for this study, namely to: * assess whether the stakeholders from the community are satisfied with the housing delivery process and how they have benefitted from the process. * Understand, and analyse the roles played by the state in housing delivery and Non-governmental organisations in service delivery for the rural poor in Peddie Extension.When a state attempts to employ strategies to reduce poverty, to provide necessary service delivery, to involve the poor in their communities in development decision making and resource allocation, it is probable to find its normal and suggested mechanisms inadequate. Additionally when the state endavours to develop the communities by providing with economic policy, basic services and infrastructure, but i s rarely targeted toward rural areas and people. Within the context, more is being asked whether the contribution of voluntarily sector to development provides more emphasis on poverty reduction, a community and participatory development.As the state endavours to develop communities, the social, economic and political environment created an operational environment for the NGOs. Literature on Non-governmental organizations indicates that NGOs have played a major role in an attempt to secure the protection of human rights nationally and internationally. Chakawarika (2011) argues that, the existence of NGOs is proving to be a necessity rather than a luxury in societies throughout the modern world. It is evident that in many developing countries, the role of NGOs has evolved in response to the market gaps left by the government (Gaist: 2009).Impelled by the inadequacies of the state and the market, citizens across the globe have developed NGOs to deal with a diversity of social needs. C onsequently, it could be argued that NGOs are increasingly identified as crucial role-players in community and people-centred development. Gaist (2009) indicates that the NGOs have frequently been regarded as very important for democracy since they have a strong support at grassroots level and their ability to develop and empower poor communities. This is a well-needed attribute in Zimbabwe as most of the communities are beyond being poor.Nzimakwe (2002) also supported this nature of NGOs saying they are enormously vital mechanisms in rural development as they benefit from the goodwill and reception of the community, consequently the NGOs have become very crucial players in the field of social development. There are other researchers who have conceptualized development such as Manuel Castells who was a sociologist who has theorised about the information age. His emphasis on development is mainly on the economic, political and cultural aspects.His major claim relevant to this study i s that, because of the rise of the information age, individual states are no longer able to do what is needed to develop the citizens of their individual countries. He is therefore very pessimistic about the role of the state as agent for development. 2. THE BACKGROUND OF THE STUDY The issue of service delivery in Eastern Cape has become the point of interest in the past few years in South Africa. The Bill of Rights embodied in the South African Constitution (Act No. 108 of 1996) (RSA, 1996) states in section 24 that: ‘Everyone has the right to have adequate housing’.Consequently authorities are increasingly confronted with challenges to increase the delivery of houses to citizens. Scholars (Irurah and Boshoff, 2003) argue that, the delivery has not been followed through in implementation in various sectors of the economy. It is essential that these challenges be addressed by making use of correct implementation knowledge, proper analysis and evaluation policies of hous ing delivery. There is no public service can be rendered without suitable governing and administrative arrangements.Millions of historically disadvantaged South Africans, however, still live in rural communities or informal settlements that lack basic shelter and other services (Lawson, 1991). The Eastern Cape housing department provides the legislative and constitutional mandate to provide houses to the poor rural citizens of this province. It stands to reason that, citizens of this province would have access to decent and adequate houses. Rendering of housing services by government has resulted in uncompleted and defective houses due to inexperienced contractors providing poor workmanship and corruption in the housing programmes.Consequently, the state interventions of attempting to provide basic service delivery such as housing delivery in rural areas have been largely ineffective. Castell (2000:92) argues that some obstacles for development come from government bureaucracies. Ho wever, the latter, is only possible when the government policies are haphazard and an approach to community development is uncoordinated. Thus far, there are comprehensive national housing policies to really guide developments.After 1994 the ANC-led government embarked on housing delivery programme to rectify the past imbalances and this hampers the provision of housing in post-Apartheid South Africa. This provision enhanced human settlement development nationally, provincially and locally to meet the needs of South African citizens. These include, among others, expressing housing policies, confirming adequate access to relevant information so that citizens and civil society can mobilise around housing rights, and ongoing monitoring and evaluation of housing progress and implementation (â€Å"Expanding Socio-Economic Rights and Access to Housing, 29 October 2003, p. ). African communities from urban areas benefited from housing delivery as they were entitled to have title deeds of the houses they lived in and some have their houses built. In contrast, black rural communities were not part of the planning and development decisions that affect the quality of their lives as a result, the state did not build houses for people from rural areas. Consequently, the government has been criticised by many dissatisfied South Africans, politicians and the media. Some criticisms were mainly from the media highlighting the corruption, mismanagement with regard to community projects as well as poor service delivery.According to the state which remains as the major protectors and abusers of human rights, NGOs have materialised as central players in the promotion of human rights around the world. Varona (2006) further argue that, citizens felt that there is a need for organising NGOs to develop alternative strategies and acquire new skills and capabilities in order to facilitate this access to housing, serviced land and basic services as lately, for informal settlements to ge t the attention of government in their bid for housing and land tenure, a presentation of concrete development plans, studies and options for housing development is needed.A year after 2006 local government elections, the Minister of Safety and Security reported some 5085 protests against unskilled and corrupt local government nationwide (Robert, 2007: 14). It stands to reason that, there is an escalation of corruption and squandering of resources by government officials and of which result on poor service delivery. In Philippines for instance Varona (2006) argue that inefficient government housing programs has aggravated and made poor communities lose confidence in an ability of the government to provide for basic services like housing and serviced land.Marie Huchzermeyer (2003) points out that, it is the lack of formal rights that allows for exploitation by politicians, by irresponsible or even repressive bureaucracies, and by informally operating groups or individuals in the cont rol over land, access to services, commercial activities, etc. Some researchers indicate that black rural communities have been excluded from participating in the conceptualisation process, planning and development decisions that affect the quality of their lives.Miraftab (2003) advocates that critics point out that viewed in this way, community participation may indeed ameliorate communities’ immediate problems but seldom then continues beyond the life of the specific projects and does not result in any greater community influence in decision making. As a result of that, the rural communities do not actively participate in local governance. 3. THE PROBLEM STATEMENT The purpose of this study is to show that the state has not been performing or has performed poorly in its role as provider of houses in the rural areas of Ngqushwa Local Municipality in Peddie Extension.Therefore, rural citizens are left with no other option than to make use of alternative building, their houses built with mud of which are sometimes not safe and secure. The absence of the decent houses has the risk involve to citizens namely, catching cold and storms outbreak. This problem is predominant in the remote rural areas. In some areas foundations of houses have been laid or walls are built for almost years but no roofs, windows or doors. But there are elected politicians, NGO officials and appointed officials who are supposed to be role-players for the benefit of the citizens.Theirs is to play the role of local government in terms of community development and service delivery as mandated by the constitution. They need to be able to deal with the challenges confronting the local government with regard to service delivery. It stands to reason that, community involvement in decision making is vital during planning. If community participation is neglected or limited then planning and delivery will experience implementation problem.Other problem that has been identified with regard to officials is a lack of understanding of the service delivery processes as well as lack in capability to administrative work. It is thus clear that there is a fundamental problem of rendering service delivery in Peddie Extenstion by incompetent local and non-government officials who do not play their essential roles in satisfying the demand for rural community development. It is thus evident that the municipal officials hamper the implementation processes of the housing delivery provided by the state policies.Consequently they fail to satisfy the demand for the sustainable housing service. 4. RESEARCH QUESTION What are the community development programmess the state and Non-governmental organisations have implemented for the Peddie Extension with regard to the housing delivery service? 5. AIMS AND OBJECTIVES OF THE STUDY * To assess whether the community members from the Peddie Extension are satisfied with the housing delivery process and how they have benefitted from the process. Un derstand, and analyse the roles played by the state and Non-governmental organisations in housing delivery for the rural poor in Peddie Extension. 6. LIMITATION OF THE STUDY The study will be limited to the Ngqushwa area particularly in Peddie Extension. The intention is to look at community with rural geographical location. Participants in this study will be voluntary. Thus, factors that may limit this study may include access to information, time, travelling funds, unwillingness of participant and insufficient literature on the specific study. 7. THE LITERATURE OF THE STUDYService delivery programmes played an important role in the development of South Africa. The housing sector this is particularly significant as the delivery of housing to low-income communities has been one of the key programmes of the South African government since 1994 (Irurah and Boshoff, 2003). Housing delivery in Eastern Cape in particular which is mostly rural, is forced by a various challenging issues. Pr imarily the Apartheid government has focused only to the white people, the African people in rural areas were almost forgotten, hence the backlog.As a result, this backlog and other challenges overlapped into the present state. Castells (1996) also wishes to demonstrate the role of information technology in transforming the whole economic, social and cultural environment of our times. Researchers such as (Cassier and Kesteloot, 2012) stress that in an information society, there are increasing inequalities that bring about intensifying processes of economic globalisation, capital and labour flexibility and welfare restructuring. Information society, however, is empowered by capital rules in financial form.It stands to reason that the information age comprises of unevenness of development, of the new inequalities and deprivations. Castells claims a new society has risen as a result of the information technology revolution, the economic crisis of capitalism and statism (communism) and the blooming of new social movements like environmentalism and feminism. He argues that more of the worldwide communication is happening through the electronic media, like social networks, electronic mails, cellular phone and so forth.And this network society is global, it is based on global networks and it manifests itself in many forms of production systems and new culture. Castells indicates that, together these three processes are causing a new social structure ‘ a network society’, a new economy ‘a global informational economy’ and a new culture ‘a culture of real virtuality ( in van Dijk, 2001). Harding (2006) argues that multifaceted virtual culture, enforces powerful economic decisions at every moment in the life of the network. Castells’ focus and ideas about development contradicts with those of neo-liberals and neo-Marxists.He focuses on the economic as well as the political and cultural aspects of development while neoliberalsâ€⠄¢ view of development as about the shift of control of the economy from the ‘public sector’ to the ‘private sector’. The philosophy behind neoliberalism is to maximise the role of the private sectors. In essence the aim of neoliberalism is to strive for national success in terms of the global market and that social life should be determined by the market which can be considered to be the best design for the society. Neoliberals also encourage the maximization of contract as well as the entrepreneurial precepts.It also resulted into the forms of work contracts, such as temporary, part-time, contract, and casual workers (Peck, 1996:119) Globalization and neoliberalism are sometimes used interchangeably, if one could argue under the notion of making the economic structure in an outline of a uniform, that is, interconnection of nations through trading. In addition, the keywords between globalization and the neoliberalism are, ‘global capitalism’ a nd ‘privatization’. Neo-liberal restructuring is central to the globalisation process which demands free-market, privatisation, externalisation, casualisation, and more.Conversely, Holm and Sorensen (1995:4) define globalization as the intensification of economic, political, social and cultural relations across borders. Globalisation is made to be valid and it is not seen as an economic aspect, however; one could argue that it is a new phase of capitalism. Harding (2006) adds on what Castells propounds on that the new flexibility offered to capital by information technology is intimately linked to the accelerating progress of globalization, permitting capitalists to keep down labour costs while exploiting emerging markets.Moreover, ideology serves as tool belief with a great political influence to make neoliberalism and globalization acceptable. On the other hand neo-Marxism focuses the most on the social inequalities and it shows the uprising of opposition that counter s inequalities. This theory arose from the work of Karl Marx and it is for the ideas of Max Weber who have theorized on social inequalities for example status and power. Neo-Marxism theory view class division as more important than gender or sex division or issues of race and ethnicity.Moreover Neo-Marxism theory seeks to reveal the hegemony of the dominant class which results to political power. Castells attributes that indeed, the vanguard social and cultural values are in the very design innovations that powered and shaped the oncoming technological revolution (Harding, 2006). There exists what is known as the policy making which is a large sector of elite control within government whereby the corporate community consisting of the upper class work hand in hand in overlapping spheres of economic and political entities (Domhoff,1990: 105).The economy is considered as a fundamental strong point of any society (Livingston, 1939: 53) as people are dependent on an income for basic surv ival necessities, thus if the government favours policies which inadvertently co-operate with the views of the corporate power then the needy are inevitably cared for and corporate elitist take on roles of leadership within the community (Domhoff 2006: 103). 8. FOCUS STUDY AREA The Ngqushwa Municipality is in the ex-homeland an area of the Ciskei. It has only one small town and the majority of the population live in rural areas.Consequently they live in traditional dwellings made of wattle and mud bricks. A large number of citizens build their own dwellings using their own labour and local materials. The most common houses or brick structure are on separate stand or yard, which applies to rural settings. High levels of poverty and difficulties prevails throughout the country, in urban and rural areas alike, due to high levels of unemployment and severe shortages of formal housing. Most members in rural community would not have access to credit for the construction of dwellings in co mmunal or informal tenure areas. 9.RESEARCH METHODOLOGY This will provide an understanding in which the methodology will be used in this study. In this study, it will cover the essence of research design, data collection and data analysis. 9. 1 RESEARCH DESIGN Research design is concerned with defining the type of study to be assumed to produce the intended results. The research design is a key element in its success. Leedy (1997) states that the design process is the planning of the research and includes visualization of the data and problems associated with the use of those data in achieving the results of the research project.The study will make use of an empirical research design which will be informed by the literature review and analysis. Qualitative research is descriptive in that the researcher is interested in process, meaning, and understanding gained through words or pictures. According to Leedy (2001:191) descriptive survey involves distinguishing the characteristics of something. He further suggests that descriptive method is suitable for data obtained from observation. Qualitative researchers are concerned primarily with process, rather than outcomes or products.Struwig and Stead (2001:12) identify that qualitative researchers are very interested in understanding the issues being researched from the perspective of the research participants. The quantitative principles are based on the view that the world is organised and bound by rules. Also quantitative research seeks to use the existing data to analyse the given data in order to validate the representations with regard to the role of state and NGOs in development. Quantitative research makes perfectly clear that seeks to employ mathematical and statistical models pertaining phenomenon.The reason for using quantitative research, intends to understand participants’ experience pertaining to challenges of housing delivery in Peddie Extension by describing housing project management which res ulted in poor or better quality of housing delivery service. It also brings about the broader understanding of the effectiveness of the state or NGOs in rural housing delivery to develop the community. 9. 2 DATA COLLECTION AND ANALYSIS The data to be used in this paper will be developed from both primary and secondary sources.Primary data The primary data will come from in-depth interviews with grass-roots members of community and government officials. The reason to focus on government officials is that they have detailed information and knowledge on housing delivery. Representatives from non-governmental organisations could be interviewed so as to acquire a broader understanding of the social and political relations in Peddie Extension. Observations and photographs will be used to collect more primary data. Secondary dataThis information will be collected through quantitative approach by describing the state and NGOs’ effectiveness in the issues of service delivery in rural areas. A desk study and network research will be employed to review more additional data from archival documents, housing legislations, policies and programmes in government housing interventions. And from resource relevant databases, related case studies, researches, surveys and publications. The quantitative data on housing delivery will be obtained from the local state municipality offices.The other data will be attained through analysis of relevant sources focusing on housing delivery, statistics, housing policy, frameworks, process and practice and other official reports on housing programmes or projects. 10. TIME FRAMES AND BUDGET To make the study to have meaningful analysis with regard to the role of the non-governmental organisations and state, the study will be based on collaboration between NGOs, government officials and other participant in housing delivery projects during the period April to October 2013 in the Ngqushwa rural area.The rationale for this period will be a ffected by factors such as financial constraints and the nature of the study. 11. OUTLINES OF CHAPTERS Chapter one will be concerned with an introduction to the study which describes and explains the background, problem statement, research questions, objectives, necessity, study plan, limitations of the study, and the definition of words and terms used in the study. Chapter two will provide a literature review of study, framework, concepts and theories which are concerned with community development.Theories that describe the role of the state and NGOs in service deliver. The challenges of grow of homelessness of rural community members as revealed by poverty; lack of access to basic services, facilities and lack of participation of communities in decision-making in the poor communities. Chapter three will outline the research methodology; define the research techniques, data collecting instruments, and the analysis techniques. Chapter four will represent the data presentation, analy sis and interpretation and will provide the criteria for analysis and the actual analysis.Chapter five will deal with the conclusion and will summarise the findings and deductions made in the preceding chapters. Specific inadequacies and problem areas in the role of state and NGOs in community development services will be explained and recommendations to remedy such situation and future actions will be provided.

Oral errorr correction for non-native speakers of English Essay

Oral errorr correction for non-native speakers of English - Essay Example Traditionally, errors have been seen as signs of failure in the language learning process (Hedge 2000; Johnson 2008). However, today attitudes towards errors are becoming less negative. The dominating constructive point of view in language learning, emphasizes errors’ role as a part of the language learning process (Bartram and Walton 1991). Already in the late 60s, Corder (1967) notes that errors are a significant part of language learning from two points of view. Firstly, errors give information to teachers about the learners’ language level, including what they have learned and what they still need to practice. Secondly, the nature of errors can enhance both teachers’ and learners’ understanding of the whole language learning process and what kind of knowledge is acquired first and what kind of structures are more difficult to comprehend. This paper will thus help to provide an insight into the role of errors and how they have been treated in language t eaching through decades; the kind of corrective feedback that can take place in English as a foreign language (EFL) classroom; and finally, whether or not corrective feedback has an influence on the development of a learner learning a language. This paper will focus on defining terms concerning errors, corrective feedback and learner uptake. ... Phonological errors are errors in pronunciation, stress, or intonation, grammatical errors to incorrect formulated sentences, phrases or words, and lexical errors refer to errors in word use, phrases or idioms (Chaudron 1986; Allwright and Bailey 1991). In totality, James (1998) explains that errors refer to a deviation of the grammatical accurate rules of a language system. Hendrickson (1978:387), on the other hand, defines error as ‘an utterance, form, or structure that a particular teacher deems unacceptable because of its inappropriate use or its absence in real-life discourse’. According to Allwright and Bailey (1991:85) ‘an error is a form unwanted by the teacher’. In foreign language classrooms, the teacher is able to decide whether or not the students are making errors in oral pronunciation of words and phrases in the language that they are learning. However, errors that are made in the classroom are a result of different causes; Transfer of learners ’ first language such as unfamiliar structures or pronunciation and unfamiliar words can all lead to erroneous utterances (Lyster and Ranta 1997). The definition mentioned previously seems to refer both to an incorrect form of an utterance that a native speaker of the language would not understand or accept as correct language use, and to an incorrect form of an specific utterance or answer that the teacher is looking for (Scrivener 1994). Errors mostly occur when the person learning the language is not able to for correct sentences or structure the use of grammar and phrase composition well. (Scrivener 1994). But despite good chances for a correct guess, the learner ends up doing incorrect hypotheses

Transgender and feminism Essay Example | Topics and Well Written Essays - 2000 words

Transgender and feminism - Essay Example That said, one notices that diversity indicates strength, not weaknesses. Despite polarization and fragmentation, no force can nullify inclusive coalition politics (Connell, 2012). This paper will talk about transgender, with transgender feminists being marginalized from the mainstream of the womens movement. It will then explain relationship between transgender and feminism. Transgender individuals have been subject to extended scrutiny. Feminist literature is among the examination of these individuals. These literatures are the first to expose the antagonistic relationship between feminism and transgender individuals (Riley, 2015). A study by Butler (2010), defined transgender as ‘those who gender identity, expression, or behavior is different from those typically associated with their assigned sex at birth (Butler, 2010, pp 2). Every time the transgender feminists, who had been previously silenced, begin to speak out, some feminists begin to rethink on what they stand for or who they represent. In many cases, the idea of rethinking by feminists leads to the painful realization of their biases. However, in the end, the feminists would have widened their perspectives and constituency (Butler, 2010). Studies indicate that, feminists movements that have expanded their views are encouraging transgender individuals to take part in the feminist revolut ion (Connell, 2012; Riley, 2015). This expands the scope of their movement. The feminism movement formed by transgender individuals is called transfeminism as noted in the study by Koyama (2001). In the past, trans-men have contributed significantly to feminism than trans-women. Experts believe that is important for more trans-women to participate in feminism movements in order to increase the chance of liberating the women (Koyama, 2001). Many people think that transfeminism is in place to take over the existing feminist institutions. However, this is not possible because

Fibromyalgia (FM) Symptoms, Causes and Treatments

Fibromyalgia (FM) Symptoms, Causes and Treatments B. Trimble Fibromyalgia Fibromyalgia (FM) is a condition of unknown etiology, characterized by extensive pain, atypical pain processing, sleep disruption, fatigue, and often psychological distress. People with fibromyalgia may also have added indications, such as morning rigidity, tingling or numbness of the hands and feet, headaches, migraines, irritable bowel syndrome, sleep disorders, cognitive problems, problems with thinking and memory (often called fibro-fog), and additional pain syndromes (CDC, 2010). The American College of Rheumatology (ACR) 2010 criteria is used for clinical diagnosis and severity classification of fibromyalgia (CDC, 2010). The diagnosis is centered on: Widespread pain index (WPI) of greater than or equal to seven and symptom severity scale (SS) of greater than or equal to five, or WPI of three to six and SS of greater than nine (CDC, 2010). Symptoms have been existent at a similar level for at least three months (CDC, 2010) The patient does not have another disorder that would otherwise explain the pain (CDC, 2010). Fibromyalgia often occurs with other rheumatic conditions such as rheumatoid arthritis, up to 25 – 65%, systemic lupus erythematosus, and ankylosing spondylitis (CDC, 2010). The tender point test is replaced with widespread pain index and a system severity scale. The widespread pain index score is determined by counting the number of areas on the body where the patient has had pain in the past week. The checklist includes nineteen areas of the body (Rush University Medical Center, 2010). The symptoms severity score is determined by rating on a scale of zero to three, three being the most prevalent, the severity of three collective symptoms: fatigue, waking tired and cognitive symptoms (Rush University Medical Center, 2010). An additional three points can be added to account for additional symptoms, such as numbness, dizziness, nausea, depression, or irritable bowel syndrome. The final score is between zero and twelve (Rush University Medical Center, 2010). To meet the criteria for a diagnosis of fibromyalgia, a patient would have seven or more pain areas and a symptoms severity score of five or more, or three to six pain areas and a symptoms severity score of nine or more (Rush University Medical Center, 2010). Some criteria remain untouched. The symptoms must have been existent for a minimum of three months, and the patient does not have another disorder that would explain the pain (Rush University Medical Center, 2010). To develop and test the new criteria, researchers implemented a multi-center study of formerly diagnosed fibromyalgia patients and a group of patients with rheumatic non-inflammatory disorders using a physician physical and interview examination (Rush University Medical Center, 2010). The pervasiveness of fibromyalgia affects an estimated five million adults, with more women than men affected (CDC, 2010). Most people with fibromyalgia are diagnosed during middle age, and the incidence increases with age. Although the rates are higher in women, men and children can have the disorder. Women with the disorder that are hospitalized are ten times more likely to return to work, but four times less likely retain work at one year after hospitalization. It is shown that adults with fibromyalgia average around seventeen days of missed work per year compared to six days for those without the disorder (CDC, 2010). The causes and/or risk factors for fibromyalgia are associated with stressful or traumatic events, such as car accidents, post-traumatic stress disorders, repetitive injuries, illnesses (such as viral infections), certain diseases ( such as Rheumatoid arthritis), chronic fatigue syndrome, lupus, genetic predispositions, and obesity (CDC, 2010). People with fibromyalgia respond strongly to things that other people would not find uncomfortable by exhibiting an abnormal pain perception. The ACR recommends a multi-disciplinary treatment plan including screening and treatment for depression, as evidence indicates that depression is a major occurrence with fibromyalgia (CDC, 2010). The recommendation for treatment includes pharmacotherapy, aerobic exercise and muscle strengthening and, education and relaxation therapy (CDC, 2010). Many hormonal, metabolic, and brain chemical deviations have been indicated in studies of fibromyalgia (CDC, 2010).Variations seem to occur in some brain chemicals, although no regular pattern was identified as relevant in most patients with the disorder. Fibromyalgia may be the result of the properties of pain and stress on the central nervous system that leads to alterations in the brain, rather than a brain disorder itself (CDC, 2010). Researchers are concerned with serotonin and the effects on fibromyalgia. Serotonin facilitates feelings of well-being, adjusts pain levels and promotes deep sleep (CDC, 2010). Low levels of serotonin have been noted in patients with fibromyalgia. Research has also found abnormalities in the hypothalamus-pituitary-adrenal gland axis (HPA axis). The HPA axis regulates sleep, stress response, and depression. Changes in the HPA axis may lead to lower levels of stress hormones norepinephrine and cortisol. Lower levels of stress hormones lead to diminished responses to psychological or physical stress (CDC, 2010). According to the ACR, people with fibromyalgia can have irregular levels of substance P in their spinal fluid (FDA.gov). This substance P helps convey and intensify pain signals to and from the brain. Researchers are considering the function of substance P and other neurotransmitters, and studying why people with fibromyalgia have amplified sensitivity to pain and whether there is a gene or genes that cause a person to be more prone to have it (FDA.gov). Many steps have been taken in research in supplying patients with opportunities to understand and address the symptoms of fibromyalgia and quality of life issues. Research continually indicates that a multi-disciplinary approach is the most helpful for the physician and the patient (National Fibromyalgia Research Association). The examination the physician completes when considering a diagnosis of fibromyalgia should include a basic neurologic examination, a referral to a neurologist, and MRI if the exam indicates minimal deficits (National Fibromyalgia Research Association). Exercise is important for fibromyalgia patients. It has an influence on the quality of sleep and helps to keep unaffected muscles strong. Aerobic exercise, strengthening and relaxation assist in decreasing the effects of the disorder (National Fibromyalgia Research Association). There is no one medication that works for all patients (National Fibromyalgia Research Association). Medical professionals and patients must work together to determine which medication or combination of medications are most effective for the individual (National Fibromyalgia Research Association). People with fibromyalgia are normally treated with pain medications, antidepressants, muscle relaxants, anticonvulsants, and sleep aids (FDA.gov). In June 2007, Lyrica (Pregabalin) became the first FDA approved drug for the specific treatment of fibromyalgia; one year later, June 2008, Cymbalta (duloxetine hydrochloride) became the second, and in January 2009, Savella (milnacipran HCL) became the third (FDA.gov). Lyrica, Cymbalta, and Savella reduce pain and improve function in some people with fibromyalgia (FDA.gov). While people with fibromyalgia suffer pain differently from other people, the mechanism by which these drugs yield their result is unknown. There is information proposing that these drugs influence the release of neurotransmitters in the brain (FDA.gov). Lyrica was previously approved to treat seizures, as well as pain associated with damaged nerves in diabetic peripheral neuropathy and those who develop pain from the shingles rash (FDA.gov). Side effects of Lyrica include drowsiness, dizziness, blurred vision, weight gain, swelling of the hands and feet, dry mouth, and difficulty concentrating (FDA.gov). Cymbalta was previously approved to treat depression, anxiety, and diabetic peripheral neuropathy (FDA.gov). Cymbalta side effects include nausea, dry mouth, somnolence, constipation, decreased appetite, and increased sweating. Cymbalta may increase suicidal thinking and the risk of suicidal actions. It may also increase depression in some people (FDA.gov). Savella is the first drug introduced primarily for the treatment of fibromyalgia (FDA.gov). It is not used to treat depression in the United States, but acts like anti- depressants that are used to treat depression and other mental disorders (FDA.gov). Lyrica and Cymbalta are approved for the use in adults eighteen years and older. The drug companies have agreed to study their drugs in children and breastfeeding women (FDA.gov). Other medications used to treat fibromyalgia are pramipexole, tramadol, pindolol, ketamine, sodium oxybate, and gabapentin (National Fibromyalgia Research Association). Many patients achieve pain relief from complementary and alternative medications (CAM). Acupuncture, biofeedback, and massage are popular treatment alternatives. Herbal supplements and medication may also provide chronic pain relief and relieve fatigue (FDA.gov). Much of the research on complementary health approaches for fibromyalgia is still preliminary, and evidence of effectiveness is limited. Some studies have shown that practices such as TaiChi, gi-gong, and massage therapy may help with fibromyalgia symptoms. (Kowlowitz E.J.) Aerobic and strength-training exercises have been associated with important improvements in pain levels, tender point counts, and sleep disturbances. Maintenance of exercise programs indicates that compliance is a problem with patients. Discussion on strategies on improving compliance can be discussed with the patients (Millea Holloway, 2010). A considerable meta-analysis of studies using acupuncture in the treatment of fibromyalgia validates the empiric findings of medical acupuncturists that acupuncture is extremely useful adjunctive treatment for many patients. Acupuncture is not curative but enhances the patient’s quality of life (Millea Holloway, 2010). Cognitive behavioral training has shown improvement in some patients. The training of relaxation response training and movement therapy was found to be effective in patients with fibromyalgia. Training in coping skills was shown to be more effective than physical fitness, but evidence indicates that combining the different types of therapy may be more effective than one therapy alone (Millea Holloway, 2010). Myofascial pain syndrome is a condition commonly found in patients with fibromyalgia. It is a condition in which fascial limitation and trigger points cause extensive pain. A 2010 review suggests that irritation and defectively working fascia encompassing muscle cells were causing the â€Å"all-over† pain of fibromyalgia and may be due to a dysfunctional healing response (Lipton, 2010). Myofascial release on trigger point’s method is a massage technique in which the therapist uses gentle, sustained pressure in the problem areas to release adhesions and smooth out the fascia (Lipton, 2010). Multiple studies show that the Myofascial release can result in decreased pain, better posture, reduced symptoms, increased range of motion, and improved quality of life (Lipton, 2010). Many patients benefit from discussing their day to day lives with others who are also affected by fibromyalgia. Support groups may be located through the local chapter of the Arthritis Foundation (Millea Holloway, 2010). References CDC. (2010). Fibromyalgia. CDC.gov. Retrieved from http://www.cdc.gov/arthritis/basics/fibromyalgia.htm FDA.gov. (n.d.). Living with fibromyalgia, drugs approved to manage pain. Retrieved from http://www.fda.gov/es/umc107802.htmForConsummers/ConsumerUpdates/ucm107802.htm Kowlowitz E.J., M. (n.d.). Fibromyalgia treatment. Retrieved from Spine Universe: http://www.spineuniverse.com/conditions/fibromyalgia/fibromyalgia-treatments Lipton, G. (2010, January 14). Fascia: A missing link in our understanding of the pathology of fibromyalgia. Journal of bodywork and movement therapies, 1, 3-12. doi:10.1016/j.jbmt2009.08.003 Millea, P., Holloway, R. P. (2010). Treating fibromyalgia. American family physician, 62(7), 1575-1582. Retrieved from http://www.afp.org/afp/2000/1001/p1575.html National Fibromyalgia Research Association. (n.d.). Fibromyalgia treatment options. Retrieved from National fibromyalgia research association: http:www.nfra.net/nfra-resource.htm Rush University Medical Center. (2010). New criteria proposed for diagnosing fibromyalgia. Retrieved from http://www.sciencedaily.com/releases/2010/05/100524143427

Factory Labor and the Domestic Sphere in the Lowell Offering Essay

In 1822, a group of Boston merchants and traders began their campaign to transform a riverbank below the thirty-foot falls of the Merrimack River into "the greatest textile manufacturing establishment in the country." These capitalists dug and improved the Merrimack canal, constructed machine shops, and built housing for mill executives, foremen and operatives. The cotton mills of Lowell, Massachusetts, and other New England sites began to employ the first female industrial labor force in the United States. Almost twenty years later, factory workers wrote and edited the Lowell Offering, a literary magazine showcasing the virtues and talents of the female operatives in verse, essays and short fiction (Eisler, 13-22). This ESSAY discusses the female Lowell factory worker as portrayed in the Offering. Although the magazine never expressed an overtly feminist view of the factory girls' condition, nor invoked a working-class consciousness similar to later labor expressions in Lowell, there is evidence of a narrative strategy and ideology speaking both to the factory women and the middle-class readership outside of the mill town. The paper's short stories, epistolary narratives and commentaries seek to legitimize an operatives' role within the feminine ideal of domesticity. In conforming to the norms of feminine literature, the Offering reconstructs the operatives' character. It subordinates the evidence for independence or autonomy to relate stories of familial or sentimental ties binding the factory girl to the world outside of factory life. The magazine sought to provide an answer to this question: given her new liberties, what kept the "factory girl" from losing contact with her moral sentiments? To a great degree, the economi... ..., 1820-1865. Columbia Studies in American Culture Series (New York: Columbia University Press, 1942): 13-14. Cott, Nancy F. The Bonds of Womanhood: "Woman's Sphere" in New England, 1780-1835. New Haven, CT: Yale University Press, 1977. Dublin, Thomas. Women at Work: the Transformation of Work and Community in Lowell, Massachusetts, 1826-1860. New York: Columbia University Press, 1979. Dublin, Thomas. "Women, work and protest in the early Lowell Mills: `the oppressing hand of avarice would enslave us.'" Labor History 16(1975): 99-116. Eisler, Benita. The Lowell Offering: Writings by New England Mill Women (1840-1845). New York: Harper Torchbooks, 1977. Welter, Barbara. "The Cult of True Womanhood." The Many-Faceted Jacksonian Era: New Interpretations. Contributions in American History, number 67, Edward Pessen, ed. Westport, CT: Greenwood Press, 1977.