Middle Ages Literature Essay Example for Free

Middle Ages Literature EssayThe Middle Ages had many interesting characteristics concerning the writings of that time period. The important literary works incorporated elements and values drawn from different and conflicting traditions (Patterson 1143). For every opinion, there was another opinion to counter it. many an(prenominal) of the pieces of literature at this time had contradictory ideas in them or had competing interests (Patterson 1144). The literature of this time shows us that many people took the central doctrine of Christianity so such(prenominal) for granted that their daily lives seem largely untroubled by the moral and spiritual demands of religion (Patterson 1144). Another characteristic of the literature was that it alerts us to the complicatedities and dilemmas that any trustfulness poses (Patterson 1144). The Middle Ages is also called the age of chivalry (Patterson 1144). The literature mainly expresses the values of the most powerful members of society , the aristocracy (Patterson 1144). The aristocracy achieved their power through military susceptibility (Patterson 1144). There was also an explicit code of chivalry (Patterson 1145). The values were never entirely consistent with each other (Patterson 1145). Characters of literature had to choose whether to be a lover or a warrior (Patterson 1145).The main concerns of the literature were the demands of religious faith and appropriate use of physical force, and the individual human being working knocked out(p) his or her individual destiny (Patterson 1145). The literature during this time contributed to a list of vivid characters to the world of literature (Patterson 1145). Writers created unforgettable, complex literary characters to deal with the themes (Patterson 1145). The Middle Ages contrasted to the rebirth because the Renaissances characters had greater autonomy and fully realized personalities (James 1883).The Renaissances literature did not judge human action by indem nify and wrong but by beauty, memorability, and effectiveness (James 1886). During the Renaissance, the presence of theology was much less dominating (James 1887). Medieval men and women were more than concerned with the afterlife, while in the Renaissance they had a preoccupation with this life (James 1886). The Canterbury Tales fits into the Middle Ages well with some characteristics and not quite as well concerning others. For example, the Pardoner in The Canterbury Tales preaches the word of God on a daily basis, yet he is morally corrupt in his everyday life (Chaucer 1759).He preaches of greed, yet is greedy himself (Chaucer 1759). The Pardoner steals from the church, as well as innocent people (Chaucer 1758). Chaucer showed us that people took the doctrine of the church for granted. Other characters in The Canterbury Tales spoke of God and were Christians, yet didnt annoy with feeling morally obligated to act right. The dilemmas of being a Christian in real-life are seen. S ome of the characters are Christian but it is more complex and takes an effort to be a Christian. The Canterbury Tales didnt seem to have contradictory themes necessarily.Chaucer makes his views of variant social associations known through a use of satire. The characters themselves are contradictory, as we see with the Pardoner once again (Chaucer 1758). Since Chaucer has every type of social rank represented, we see his view of these ranks, which does contradict some of the jobs or moral obligations of various people. The characters in the story itself did compete for various interests. They all held different values or beliefs about the world. Chaucer lived during this time period, so it is in a way a more realistic view rather than contradictory.The explicit code of chivalry isnt necessarily a large component of The Canterbury Tales except for perhaps the dub and his tale. Chaucer shows that some people were focused on the chivalry act during this time. The Canterbury Tales do esnt focus on pleasing the aristocracy either. Chaucer wrote from the perspective of every social rank so his book was meant for the poor and rich. Its subject matter was meant to be appealing to all Medieval people. The final characteristic that The Canterbury Tales does follow is the well developed characters.Chaucer had a whole list of realistic, complex characters. These characters could rival the Renaissances characters to me. I enjoyed reading about the characters and reading even more of The Canterbury Tales online. The Canterbury Tales fits well with the characteristics of the Middle Ages for the most part. The individual characters do have an individual goal in mind. Chaucer seemed as if he cared about his characters and wanted readers to his get to know them on an individual level, which seems more ahead of his time.

Disc Arthroplasty Essay Example for Free

dish antennaus Arthroplasty EssayDegenerative disc disease have been a problem for many people as this disease brings about low back pain that seems to paralyze the working force, the middle adulthood population (Smeltzer, 2004). Not only does it bring impaired graphic symbol of life to those who suffer from it, but Arvind Kulkarni adds large health c be expenses to the list of problems brought about by this disease as seen in his article entitled prosthetic lumbar disc replacement for degenerative disc disease.Spinal fusion, which is the medical management for degenerative disc disease, has been criticized by several doctors in the practice delinquent to its untoward effects in the patients overall recovery and lifetime improvement. Specialist in the field, Christoph Siepe, identified these unpleasant effects as quicken attached system degeneration, pseudarthrosis, spinal canal stenosis, and donor site morbidity. Adjacent segment degeneration, as menti mavend by Peter Ull rich in his article entitled confederacy versus Artificial Disc Arthroplasty for Lumbar Degenerative Disc Disease, stated that this is the major complication of spinal fusion and the reason why most surgeons want this turn replaced.Adjacent segment degeneration or ASD happens when mechanical stress is transferred to the adjacent segment, in like manner mentioned by Peter Ullrich. But research showed that this use can be modified to show more positive results. An anterior lumbar interbody fusion showed a low occurrence of revision surgery needed, which meant low frequency of adjacent segment degeneration, all pointed out in Mr. Ullrichs paper. However, to achieve this outcome, Mr. Ullrich declared that in that location should be an improvement in patient selection and in the number. The patients should be those patients having degenerative disc disease in their 5th lumbar to 1st sacral segment, because there is minimal motion at this level.By doing so, he states that fusing the se segments do not change the patients mobility as much. But not all are satisfied of this result. Doctors and specialists are continuously making efforts to hailly changing the primary medical management for degenerative disc diseases. Studies have been conducted, and several replacement procedures were approved by the FDA. Peter Ullrich stated in his paper that the entire disk replacement procedure was approved for medical use by the FDA in the year 2004 using the Charite simulated disc but for only one level of the spinal vertebrae, universe the L4 L5 or the L5 S1.This is not the first time that a total or partial disc replacement was done. The history of this procedure was mentioned in an article in a website by Spine-Health that disc nucleus replacement was done first in 1955 by David Cleveland by injecting methyl-acrylic. Ever since then, there have two other FDA approved products aside from the Charite, the website Spine-Health states that the Prodisc was approved on A ugust 2006 and the Kineflex lumbar on June 2005. A total disc replacement is being described by Jose Reyna in his article, Advances in Artificial Disc Technology, as being composed of two pieces of plates make of metal that has teeth to be able-bodied to attach itself to the end plates of the vertebral bones above and below it. This means that the particular intervertebral disc that is causing pain has to be removed and replaced by an artificial disc. Several artificial discs have been developed by various manufacturers in the country and they only differ in design and composition. The Charite, as mentioned earlier, is made up of a unique sliding core with two metal alloy end plates.The Prodisc being based on spherical articulations is made up of cobalt chromium molybdenum alloy as stated in the website Spine-Health. Inventors Qi-Bin Bao and Paul Higham developed a hydrogel prosthetic nucleus made up of polyvinyl acetate powder and a solvent mixed together, as seen on the article, Hydrogel intervertebral disc nucleus with diminished lateral bulging. The total disc replacement procedure has its advantages and disadvantages. Even after some models being approved by the FDA, it is still being assessed thoroughly by specialists in the field. Charles Rosen and Douglas Kiester report poor results and complications in the total disc replacement procedure.As it was mentioned in their study, this procedure causes fractures, severe pain, dislocations, extrusion of the implant, facet joint degeneration, and unexplained radiculopathy. They attribute these substandard results to the fact that the center of rotation of segmented motion is erroneous. Jose Reyna Jr. also mentions several disadvantages of the procedure in his study, stating that the anterior approach to the surgery can cause injury to the aorta and the common iliac vessels, can cause retrograde ejaculation in men by injuring the superior hypogastric plexus, hemorrhage can result from the retroperitoneal appr oach, and infection can occur.However, he also stated some advantages, as this procedure is said to maintain range of motion in majority of the patients as a long-term outcome. There are still a lot of studies to be conducted, and patients to be experimented on. A three year study conducted by Christoph Siepe et al., entitled Clinical Results of Total Lumbar Disc Replacement With ProDisc II Three-Year Results for Different Indications, intended to assess total disc replacement outcome in patients who actually underwent the operation. Their results showed that not all degenerative disc diseases can be treated with this medical management.The best outcome was seen in patients exhibiting degenerative disc disease condition plus soft disc herniation or nucleus pulposus prolapse. Outcome was measured against the patients improvement from their preoperative levels. There were inferior results from the patients who had bisegmental damages, and a higher complication rate. Also it was menti oned that the younger patients, more specifically those aged below forty exhibited better outcome than those older than forty. Technology like this is still being developed, studied and modified as we speak. What is important is that there are people out there who care and who try to make a difference, whether it is by inventing, criticizing or being the experimental somebody wherein these new devices will be made a reality.ReferencesCharles Rosen, Douglas Kiester, Thay Q. Lee The Potential Biomechanical Etiology for Lumbar Disc Replacement Failures Review of 24 Patients and the Rationale for rescript . The Internet Journal of Minimally Invasive Spinal Technology. 2007. Volume 1 Number 2.Medscape. (2002). Advance in Artificial Disc Technology. Retrieved January 22, 2008 from http//www.medscape.com/viewarticle/445057Medscape. (2002). Clinical Results of Total Lumbar Disc Replacement With ProDisc II Three-Year Results for Different Indications. Retrieved January 22, 2008 from http// www.medscape.com/viewarticle/542479Neurology India. (2005). Prosthetic Lumbar disc replacement for degenerative disc disease. Retrieved January 22, 2008 from http//www.neurologyindia.com/article.asp?issn=0028-3886year=2005volume=53 geld=4spage=499epage=505aulast=KulkarniNeurospine. (no indicated year). Fusion versus Artificial Disc Arthroplasty for Lumbar Degenerative Disc Disease. Retrieved January 22, 2008 from http//www.neurospinewi.com/newsletters/fusionvsartificial.htmlPatent Storm. (1996). Hydrogel intervertebral disc nucleus with diminished lateral bulging. Retrieved January 22, 2008 from http//www.patentstorm.us/patents/5534028-fulltext.htmlSmeltzer, S. and Bare, B. (2004). Medical-Surgical Nursing. Philadelphia Lippincott Williams Wilkins.Spine-Health. (1997-2007). Lumbar artificial disc surgery for chronic back pain. Retrieved January 22, 2008 from http//www.spine-health.com/research/discupdate/artificial/artificial01.html

Grounded theory in research

Grounded system in investigateEvaluate the contribution of grounded guess, as an approach to selective discipline analysisIntroductionThe ideal of grounded supposition is from the Glaser and Strauss re seek in 1967. In 1960s, they made a explore for medical personnel to deal with an imminent death of the patients field observation in a hospital, and wherefore discovered and developed the grounded scheme. In this essay, I will evaluate the grounded opening in 5 take time offs. The first part is the characteristics of grounded conjecture the second part is the mapping of grounded system the third part is comparison with early(a) graphemes of investigate methods and the forth part is the contribution of grounded surmise interrogation in management field, and the last part is the future of grounded conjecture.1. The characteristics of grounded surmisalSome perspectives of grounded surmisalIn Suddabys (2006) scan, the grounded possible action can be described asGro unded theory is best understood historically. The methodology was developed by Glaser and Strauss (1967) as a reaction against the extreme positivism that had permeated most social interrogation. (Suddaby 2006, p.633)And Gephart (2004) percentage points outGlaser and Strauss (1967) proposed grounded theory as a practical method for conducting research that focuses on the interpretive process by analysing the the actual production of meanings and concepts used by social actors in real settings (Gephart, 2004, p.457).And another view is Glasers perspective (1992, p16), he argues thatThe grounded theory is a general methodology of analysis linked with entropy collection that uses a systematically applied set of methods to generate an inductive theory about a substantive area.Grounded theory research method is a type of qualitative research which is based on induction. It used in some(prenominal) a(prenominal) sociological research areas such as education, religion, and many oth ers. Zhigang (2007) argued that the method is characterized by extracting the theory from the phenomenon to create or enrich existing suppositious system.In the view of Layder (1993), Grounded theory method is a process of generating a theory, which including constant comparison, thinking, analysis and transformation of information. The characteristics of emphasis on information and much interactive approach, which braces the researchers collect data by making use of a continuous and intimate interactions of the parties and events.In summary, in the first place, according to Zhigangs perspective,(2007) the grounded theory is a bottom-up approach to launch substantive theory, which is finding the core concepts reflects the social phenomenon based on systematical data collection, and then generate the relative theory by dint of the links between these concepts. Secondly, grounded theory must be supported by empirical evidence, but it is not the main feature of grounded theory, th e main feature is that it generates pertly theory or liking abstracted form the experience and data analysis. Lastly, in philosophical ideology, grounded theory approach is a paradigm based on the post-positivist, which emphasize on falsehood current theory which has been constructed.The comparative analysis the core of data analysis of grounded theoryStrauss Corbin (1998) pointed out that the grounded theory emphasizes on development of the theory, but also the theory is based on the data collection of realities, and continuing data analysis through the comparison.The strategy of comparative analysis usually used in sociology research. In grounded theory, it is a very important process. Glaser and Strauss (1967) argued that it should be first contrasted the use of the method with certain other users in the research process, and then define and describe what type of theory be created through comparative analysis. The take aim of comparative analysis, as a strategic method for generating theory, is to obtain the accurate evidence, which is the difference between establishing theory and verifying theory. The evidence still from some comparative groups, which is used to examine whether the original evidence was correct.The characteristic of comparative analysis for establishing theory or concept puts a high emphasis on theory as process. In other words, theory is not perfected it needs develop continuously through comparative analysis. Glaser and Strauss (1967) believed that theory renders the reality of social interaction and its structural context as a process.The codingCoding is a key element of the data analysis in grounded theory. BaiKai and YuanBo (2009) argued that the encoding is the usually used technology in the qualitative research which is entirely different from quantitative research. In qualitative research, the purpose of coding is not counted, but rather deconstruction of information to form the concept. They would be re-ar executed in diff erent categories, in order to promote the comparison of information and proposition of theoretical concepts in one category.Zhigang (2007) points out that the strong use of the grounded theory primarily depends on the following two aspects on the one hand, the researchers should hold in an effort to choose a meaningful direction or area of research. It is difficult to identify the gaps that may exist in the theoretical proposition On the one hand, the researchers should pay attention to data collection and collation, and propose some theoretical assumptions and refining the new conclusions in accordance with the principles, steps and techniques of the grounded theory.2. The procedure of the grounded theoryIn Strauss and Corbins view (1998), it is important that focus mainly on the process. They believe that the process is more important as describing and coding everything which is continuously changing.The process of grounded theory research made based on the view of Pandit. N (19 96)Source Pandit. N (1996) The Creation of Theory A Recent coat of the Grounded Theory regularityAs can be seen clearly, there are mainly 3 fleshs in the process of grounded theory research design phase, data collection phase and data analysis. The whole process is started at review of technical literature and finished at reaching closure, but it is need to note here is that if the effect is theoretical saturation after the theoretical sampling step, it should be restarted the second step selecting cases.According to the Suddabys view (2006), There are 2 key points in the method which described by Glaser and Strauss (1967) constant comparison, and theoretical sampling, in which data are collected and analysed simultaneously, and theoretical sampling, in which decisions about which data should be collected next are determined by the theory that is existence constructed. Therefore, the most important steps in the process are data analysis and theoretical sampling, which are t he key difference in contrast with other research methods.3. Comparison with other methods of qualitative researchGrounded theory and other various ways in social research have different advantages and disadvantages. Possibly different types of methods can be used in different areas. Researchers select different research methods, could means that they have different research ideas and objectives. At the same time, selection and use of methods could more depend on the topic or the attribute of research. The requirement requirement of obtaining the valuable research findings is the appropriate combination between objectives and methods of the research.Comparison with Hypothesis TestingThe Hypothesis scrutiny method is different from the Grounded theory method. The comment of Hypothesis testing can be described as Hypothesis testing research investigates a phenomenon in terms of a relationship between an independent and dependent variable, both of which are measurable numerically. This relationship is called a surmisal. The aim of the research is to test whether the hypothesized relationship is actually true, using statistical methods. (Auerbach and Silverstein, 2003, p.3)Although hypothesis testing and grounded theory are good research methods to do the research in some areas, there are some differences between them. The hypothesis testing method is mainly different from the grounded theory in the process of building theory. In hypothesis testing method, the hypothesis or idea has been generated first. Researchers can make hypothesis without any evidence, then they will look for the evidences or collect data and information to support their hypothesis or idea. In contrast, grounded theory is an inductive method which focuses on the discovery and does not rest on hypothesis testing but on building hypotheses according to the data and relative information. Suddaby (2006) point out Glaser and Strauss rejected positivist notions of falsification and hypothesis testing and, instead, described an organic process of theory emergence based on how well data fit conceptual categories identified by an observer, by how well the categories explain or predict ongoing interpretations, and by how relevant the categories are to the core issues being observed. (Suddaby, 2006, p.634) It is clear that the hypothesis testing a grounded theory would be used in different fields, such as the hypothesis could be used for functional out the mathematics problem and grounded theory could be used in the research in the social areas. Which method can be chosen for research depends on the objectives of the research.Comparison with EthnographyCreswell (1998) argued that descriptive anthropology involves prolonged observation of the group, typically through participant observation in which the research is immersed in the day to day lives of thepeople or through one on one interviews with members of the group. Clearly, the ethnography method could be more used in th e research of human, cultivation and language etc.From the view of Creswell (1998, p148), the following control board can describe the differences between grounded theory and ethnography in data analysis process.Data analysis and representationGrounded theoryEthnographyData managingCreate and organize files for dataCreate and organize files for data realiseing, MemoingRead through text, make margin notes, form initial codesRead through text, make margin notes, form initial codesClassifyingEngage in axial codingEngage in open codingAnalyse data for themes and patterned regularitiesInterpretingEngage in selective coding Develop a conditional matrixInterpret and make sense of findingsRepresenting, VisualizingPresent a visual theoryPresent propositionsPresent narrative presentation augmented by tables, figures and sketchesSource Creswell, J. (1998) Qualitative inquiry and research design choosing among five traditionsAs can be seen clearly, the most difference between grounded and et hnography is from classifying step to visualizing step. The 3 core coding steps play an important role in the data analysis of grounded theory, which make the grounded theory can be developed through the constant comparison. And also it is one of the advantages of grounded theory in contrast with other qualitative methods as an approach to data analysis.Mello and Flint (2009) believe that the grounded theory primarily uses interviews, but also uses observation and documents analysis standardized an ethnography method. It differs from an ethnography method because of its purpose, which is to build theory. Like many other interpretive qualitative approaches, grounded theory has helped other disciplines open up fruitful new avenues of research.Hammersley (1990) argues that much ethnography places emphasis on the description as an important purpose of research, there are other strands that focus on a form of theoretical description. However, eyepatch Glaser and Strauss think that grou nded theory is related to the wider context of qualitative analysis and method. The grounded theory approach is highly distinctive and unlike other types of qualitative methods.4. Grounded Theory in management researchIt is no doubt that the grounded theory can be used in a wide range of research such like nursing, business and management, mathematics and many types of sociology. Then, I will talk about the contribution of grounded theory focus on the business and management area. Firstly, the following table gives some examples of the grounded theory used in management research.Examples of grounded theory in management researchExample referencesSenior executives and ITSystems developmentManaging understanding in orgnisationsOrganisational cultureStaff perspectives on workRetailer response to manufactureslow-cost programmesRural women entrepreneursCompetitive strategy and manufacturingProcess technologyBuilding co-operation in competitive industriesConsumer deportmentAdvertising an d mass mediaMarketingCareer developmentElectronic data interchangeLeadership in organisationsStrategic alliancesIdeal business images for womenTourist doingsEmployment outcomesSeeley and Targett (1997)King (1996), Calloway and Ariav (1995)Brown (1994, 1995)Turner (1981, 1988)Clegg et al. (1996)Nuefeldt et al. (1996)Manning et al. (1998)Egan (1997)McKinley-Wright (1995)Schroeder and Congden (1995)Congden (1995)Browning et al. (1995)Houston and Venkatesh (1996)Goulding (1999b,1999c,2000b,2000c)Hirschman and Thompson (1997)Burchill and Fine (1997)De la Cuesta (1994)Beard (1989)Sperber-Richie et al. (1997)Crook and Kumar (1998)Parry (1998)Hunt and Ropo (1995)Lang (1996)Kimle and Damhost (1997)Riley (1995, 1996)Mullins and Roessier (1998)Source Goulding, C. (2002) Grounded Theory A Practical Guide for precaution, problem and Market ResearchersFrom the table above, it is obvious that the grounded theory can be used in many researches about business and explores a wide range of manageme nt problems. These situations exclusively serve to demonstrate the transcending nature of grounded theory and its potential for application in the field of management research. (Goulding, 2002, p.51) Taking the market field as an example, grounded theory has begun theoretical development in the areas of the creation of a market oriented firm, moving away from previous research that merely described what a market oriented firm looks like. (Gebhardt, Carpenter, and Sherry, 2006, citied in Mello, and Flint (2009) A Refined View of Grounded Theory and Its Application to Logistics Research p.109)5. Grounded theory in the futureWhat grounded theory will happen in the future? It is no doubt that the grounded theory will be used for doing research in the wider range of fields. Increasing researchers will choose the grounded theory as the first choice.Youhui (1996) think that one of the characteristics of grounded theory method is that the discover believe that it is necessary to generate theory in the research of sociology and both data analysis and theory building should be focused in qualitative research and any other research methods. Therefore, the grounded theory method is ideally suited to the areas such as the existing theoretical system which is not perfected, the phenomenon which is very difficult to effectively explain, or the new areas and phenomenon which has no systematical theory currently.About the Justifying Grounded Theory in the future, Glaser described it asThe future will bring less need to legitimize grounded theory hence, there will be less need to justify using it. Now, many researchers have to explain it and argue for its use. Its future portends that grounded theory will be as accepted as are other methods (e.g., surveys) and will require little or no explanation to justify its use in a research project. (Glaser, B.G. 1999, pp.845)Charmaz (2005 citied in Denzin, N.K. and Lincoln, Y.S. (2005) enchiridion of Qualitative Research) believe that a major strength of the grounded theory is that they provide tools for analysing process, and these tools hold much potential for studying social arbiter issues. She also believed that coding practices can help us to see our assumptions, as well as those of our research participants. Rather than raising our code to a aim of objectively, we can raise questions about how and why we developed certain codes.Grounded theory has its own advantages, it is to believe that grounded theory will be developed deeper and suitable for the research, Charmaz (2005 citied in Denzin, N.K. and Lincoln, Y.S. (2005) The SAGE Handbook of Qualitative Research 3rd ed.) write that As its best, grounded theory provides methods to explicate an empirical process in ways that prompt sightedness beyond it. By sticking closely to the leads and explicating the relevant process, the researcher can go deeper into meaning and action than given in words. Thus, the focused inquiry of grounded theory, with its forwa rd-moving inductive analysis, moves the work theoretically and covers more empirical observations than other approaches. In this way, a focused grounded theory portrays a picture of the whole. (Charmaz, 2005, pp.529)ConclusionTo sum up, the grounded theory has a wider use range than other methods. For those social areas which lack current theory and some phenomenon which lack enough evidence and explanation, the grounded theory method is an effective analytical technique as an approach of data analysis. This method not only can help researchers to use inductive methods to abstract the basic theory from the phenomenon in the research, but also it is a good way to build and develop the theoretical system gradually to achieve the combination with the current theory effectively. There are many contributions of grounded theory in many different areas such as business, education, medicine and other many others. In terms of many advantages and characteristics of grounded theory, we believe that it will be use in more range of social research as an approach to data analysis and developed more to be accepted by more researchers.ReferenceAuerbach, C.F. and Silverstein, L.B. 2003 Qualitative Data an Introduction to Coding and psychoanalysis. New York UniversityBaiKai and YuanBo. 2009. The analysis of impression series by Grounded theory Journal of Shaanxi Administration School Vol.23, No.1 pp.15-20Borgatti, S. 2009. Introduction to Grounded Theory Online Accessed Nov 2009 Available From Creswell, J. 1998. Qualitative inquiry and research design choosing among five traditions Sage Publications. LondonDenzin, N.K. and Lincoln, Y.S. 2005. The SAGE Handbook of Qualitative Research 3rd ed. California Sage PublicationGephart, R. P. 2004. Qualitative research and the Academy of Management Journal. Academy of Management Journal, Vol.47, pp.454-462Glaser, B.G. 1992. Basics of Grounded theory Analysis Mill Valley, CA Sociology insistencyGlaser, B. G. 1999. The Future of Grounded Theory Qualitative Health Research, Vol. 9, No. 6, November pp.836-845Glaser, B.G. and Strauss, A. 1967. The Discovery of Grounded Theory. New York Aldine De GruyterGoulding, C. 2002. Grounded Theory A Practical Guide for Management, Business and Market Researchers. London Sage PublicationsHammersley, M. 1990. Whats wrong with ethnography? The myth of theoretical description. Sociology, Vol. 24, pp.597-615Layder, D. (1993) New Strategies in Social Research An Introduction and Guide Cambridge Polity PressMello, J. and Flint D. J. 2009. A Refined View of Grounded Theory and Its Application to Logistics Research Journal of Business Logistics, Vol. 30, No. 1, 107108Pandit, N. 1996. The Creation of Theory A Recent Application of the Grounded Theory Method The Qualitative Report, Vol. 2, No. 4 2009Strauss, A and Corbin, J. 1998. Basics of Qualitative Research California Sage PublicationsSuddaby, R. 2006. From The Editors What Grounded Theory Is Not Academy of Management Journal, Vol. 49, No. 4, pp.633-642Youhui Hu. (1996) Qualitative Research Theory, Method and Local Women Case Studies Research Taipei Juliu PublicationsZhigang Li. 2007. The Study of Grounded Theory in Business Research. Journal of East Forum. Vol.4, pp.90-94

Looking At How Children Are Affected By Alcohol Social Work Essay

Looking At How Children Are Affected By intoxi loafert Social Work EssayThe aim of this project is to consider literature and inquiry in Yankee Ireland, the UK and worldwide surrounding the relationship amid hard beverage hassles and pargonnting capacity. Alongside this I wish to map existing armed service provision for tikeren who argon promoteed by a caregiver who has an alcoholic drinkic drink problem and draw on recommendations made by the explore examine. I will highlight applicable Policy and Legislation in relation to reducing risk to children via the Hidden Harm Government report. The implications of this report will be discussed in relation to service provision and the blue Ireland response.Substance ruin has a clear and direct impact on those connected to the misuse.. the biggest indirect impact is often mat up by the children or childly people (HHAP, DHSSPSNI, 2008 2). Nevertheless Kearney et al (2000) in Hayden (2004) point out that the issue is under forecastd and insufficiently recognised in amicable have caseloads. or so 250,000 350,000 UK children have a parent with an alcohol problem (Alcohol Concern, 2000). Parental alcohol misuse is associated with a greater occurrence of ablaze and behavioural problems throughout childhood and into adulthood (Kroll and Taylor, 2003). According to reason from Tunnard (2002) social work caseloads have seen parental alcohol problems feature signifi scum bagtly for some time, with around a quarter to a third of allocated cases being families with parental substance misuse (Forrester and Harwin, 2008). Parental functioning may be alter either whilst the parent is intoxicated, hung over or pre-occupied with sourcing their succeeding(prenominal) bedevil, making them corporally and/or emotionally un servingable to the child (Beckett, 2007). At the acute end of the spectrum, substance misuse is over-represented in cases of severe abuse and child death (Reder and Duncan, 1999, in Forrest er Harwin, 2006).To analyse the impact parental drunkenness problems have on children I will explore literature and research from both external and UK perspectives. However it should be noned that methodological weaknesses were evident in some of the studies. For example, there was less focus on womens imbibing patterns and it was difficult to comment on pre-schoolers as children were collectively grouped together. Tunnard (2002) notes how there are more UK studies regarding dose than alcohol problems. Scaife (2008) notes how legion(predicate) an(prenominal) studies referred to substance misuse kinda than drug or alcohol, making it difficult to separate the two and how research ignored fathers at times, foc use gender specifically on sticks. many studies were also carried out on minor numbers of families who had volunteered to participate, this consequently does not account for in intended service users or those who have not yet recognised their drinking to be problemati c.A iodin definition of alcohol problem is unclear in many studies making comparison between them problematic. Nevertheless, what is clear from the literature is that parenting coupled with an alcohol problem can florists chrysanthemument in damaging outcomes for children in terms of emotional development and behaviour (Kroll and Taylor, 2003). Misuse of alcohol by parents belongingss children at increased risk of sombre harm. It does not follow that such(prenominal)(prenominal) harm is inevitable (Forrester Harwin, 2008 1520). What I therefore want to avoid suggesting in this project is that misusing alcohol does not automatically understand poor parenting. To do so would serve to reinforce the oppression faced by those with alcohol problems and further heighten barriers to engagement with addiction run.Prevalence of the problemResearch by DHSSPS (2008) uncovered that in Northern Ireland 72% of adults drink alcohol, 62% of which drink at least once weekly. 8% of drinkers c onsume alcohol daily or almost daily, however only 4% identify themselves as heavy drinkers. local anaesthetic information is limited exclusively it is estimated that wholeness in eleven children in the UK are living with someone who has an alcohol problem and as the result of parental substance misuse approximately 70% of young people are looked after and 40% are on the child protection register and (HHAP, DHSSPSNI, 2008).Brisby et al (1997) propose that approximately 35,000 children in Northern Ireland are living with a parent who is a problematic drinker, with 800,000 in Wales and England and 85,000 children in Scotland. Throughout the United Kingdom, alcohol is readily ready(prenominal) and is a socially recognised pastime in peoples lives. Alcohol Concern (2009) reports that due to most adult problem drinkers being part of a wider family the worrylihood of this negatively impinging on children is excessive as it is estimated that 1.3 million children are affected.Dore et a l (1995) in Hayden (2004) estimate that between fifty to eighty percent of parents known to social services in the USA experience problems with substance misuse. However, it should be noted that differences exist in the treatment of addiction in the UK and USA as the former is focused on Harm reduction social models with the latter being exceptionally disease oriented (Scaife, 2008).This literature review aims toInvestigate what bearing a parental drink problem has on children.Consider the set up on childrens overall development, by field of flying fielding literature from a sociological and psychological perspective.Examine literature from Northern Ireland, the UK and international sources to establish the influence a parental drink problem can have on a childs well being.Analyse the Government response to families of problematic drinkers by inspecting Northern Ireland and UK policy.Summarise services provided to meet the postulate of problem drinkers, identify gaps in current practice and make evidence set proposals for meeting such need.Tunnard (2002) establishes that throughout research there is a clear message that parental problematic drinking is capable of resulting in behavioural, developmental and emotional effects on children.Being placed in an addictions team last year ignited my interest in how alcohol impacts on the entire family and during my nett placement learning opportunity in family and child cares Gateway service I found parental problematic drinking to be commonplace amongst brisk referrals. This, coupled with previous personal experience provided me with a desire to gain a full understanding of the bearing this has on children. I anticipate that this alternate of work will enhance my insight in the area and better prepare me for pursuing a Family and Child Care social work role.Alcohol problem in contextVarious terms are expendd in relation to the concept alcohol problem which causes concern due to the installation of overlap. Tunnard (2002) observes that many studies combine alcohol and drug misuse into the broad term substance misuse. However what does explain the issue well is Tunnards, (20028) definition consumption of alcoholic drink that warrants attention because it seriously and repeatedly affects the drinkers behaviour. Recommended daily quantity guidelines have little bearing as it is not quantity which leads to the repeated affect on behaviour. The American Psychiatric Association utilises the definition of the maladaptive pattern of use leading to clinically significant impairment or distress characterised by the bring out at anytime during a one year period of one or more of a specified set of symptoms (Tunnard, 20028). Laybourn (1996) studied parental drinking patterns and assessed the effects on the children, finding opportunistic drinking and binge drinking to be the most dispute to families these most affect routines and parental availability (Tunnard, 2002).Cultural historic perspecti vesBancroft (2007) argues that to address alcohol problems effectively through practice and policy we first need to consider historical and cultural dynamics.Alcohol, which was referred to in biblical times and before, has doubtless been a feature of society since the beginning of time (Room et al, 2005a). It is evident that all societies make use of intoxicating substances, with alcohol being used as a social activity (SIRC, 2000). Norwegian research by Skog, (2006) points to the fact that alcohol has been a feature in most cultures since time began despite its consumption vary over the years due to periods of prohibition through the 19th and early on 20th centuries. Indeed, the cornerstone of civilisation- agriculture was thought to be utilised in site to harvest grain for the production of beer as much as for bread (SIRC, 2000).The pervasiveness of problematic drinking is not thought to be directly related to consumption. cardinal only has to enter a public house in Northern Ireland on a Friday or Saturday night to observe countless people using alcohol to socialise and drink well above the recommended levels when doing so. The difference being that the majority of these people can figure over their intake and can discern to stop in the morning. Marmot (2004) points out that there has been a 50% rise in alcohol consumption over the past 50 years, with approximately 25% of the British population drinking more than recommended levels. It is evident that there has been a rise in the trend to consume alcohol, with problems in connection to drinking including self-harm, suicide, early mortality, homelessness, crime and mental health problems. The National Health Service information centre (2009) reported that the complete household spending on alcohol arise by 86% from 1992 to 2007. Following this period alcohol was 75% more affordable than in the eighties, highlighting the trend of it being increasingly affordable and prevalent.heathland (1998) purports that in countries similar to Ireland where there is a high incidence of people experiencing social and psychiatric problems the intake of alcohol is relatively low. However when compared to Italy or France where alcohol use alcohol is high, social and psychiatric problems are less prevalent. Heath (1998) also points to cross-cultural research which implies that behaviours demonstrated as a consequence of alcohol consumption are shaped by cultural and social aspects rather than the chemical effects of alcohol (SIRC, 2000). Difficulties problem drinkers encounter are therefore not necessarily as a result of the alcohol they consume, but cultural factors relating to societal norms, beliefs, and attitudes towards drinking. In every culture, whilst drinking rules are set in place by Government they remain surrounded by self-imposed norms and regulations regarding who may drink what, when and how (SIRC, 2000). Furthermore alcohol may be used as a sign of status consider the idea of viney ards, fine wines and champagne for example. Placing some of the blame for alcohol-related behaviours onto society raises questions about how to tackle the issue effectively. This may mean challenging beliefs about the effects of drinking which would not hold favourably with social work values of respect, empowerment or anti-oppressive practice.Regardless of the apparent correlation between parental substance misuse and child care anxieties, British research on the issue remains extremely limited (Tunnard 2002). Contrastingly, American research on the same topic has been plentiful and is thought to be explained by the rise in the use of Cocaine in the United States throughout the 80s. In many states there was a doubling of children being taken into care between 84 and 89 as a consequence of parental substance misuse (Freundlich, 2000, in Forrester Harwin, 2006). However, it is difficult to apply American conclusions to Britain, as families live in different social circumstances and in varying degrees of poverty. As previously alluded to Americas move up to addiction is disease orientated, largely ignoring external causal factors, in contrast to Britains social model whereby an individuals social context is taken into consideration.Psychological Sociological viewpointsVelleman Templeton (2002) estimate around 8 million families live with the effects of a family drink problem, however Kroll (2004) points out that the needs of children of alcoholics are often invisible. Alcohol presents two faces to the family. wiz face that is of a beneficial and healthful beverage that fosters warmth and intimacy. The other face is that of a potentially hazardous potion that jeopardises ones family through conflict, delirium and deprivation (Leonard Eiden, 2007 286).Moos (2006) purports that fast attachment to a substance misusing parent may increase the possibility of the behaviour being modelled. Kelley et al (2004) studied American college age men and women and found that those who had alcoholic parents were increasingly likely to have an anxious/avoidant or defensive attachment in later life, additionally having an unavailable parent was though to urinate repetition of poor relationships in adulthood.Bancroft et al (2004) found that children had an alive(predicate)ness of their familys drinking problem, despite parents believing their children were not aware of their alcohol use. They established that parents felt they were equable caring for their children as their material needs such as food and clothing were met, whilst most parents cared about their children they were not caring for them. A Danish study by Christensen (1997) in some ways mirrored Bancrofts in relation to parents thinking their children did not have knowledge of their problem. The children were aware and at times felt in some way responsible they were unable to identify a support network for themselves and usually did not tell although many wished for a take to the woods or some form of respite. Parents went to great lengths to ensure their childs physical needs were met yet failed to see the emotional neglect caused by their drinking. Moe et al (2007) studied American children aged 7 to 13 who attended a programme for children of problem drinkers. They found that children benefited from knowing the truth about their parents problem and addiction in common as this assisted them in feeling less to blame. The young people also related abstinence to being a positive factor in having a good life.A Scottish study (Laybourn et al, 1996) which looked at the perspectives of 20 children who were parented by a problem drinker further confirmed how aware children are of their parents drinking. Children expressed their general sadness, chafe and anxiety about their parents alcohol problem and talked of how they witnessed outbursts of drunken violence. Alcohol is a disinhibitor, which can reduce an individuals ability to control violent impulses (Beckett, 200 7 126). Some young people adopted the role of care giver for the parent or for siblings and at times acted as an arbitrator or confidant and they radius of either being late for school on a regular basis or not attending at all. A number of these children believed they would benefit from meeting other young people in similar circumstances (Laybourn et al, 1996). Velleman (2002) recognises how children may experience psychological and behavioural problems alongside physical effects. Family roles and routines are often disrupted such as school attendance, communication, special occasions and meal times. The young person may become the carer, protector or mediator within the family (Tunnard, 2002) and have difficulties in relation to trust. It is common for children to have to grow up too soon and effectively miss out or have un work outd developmental stages due to caring for themselves and siblings whilst parents are unavailable (Kroll Taylor, 1998).Lynskey et al (1994) in a New Zea land study found conclusive evidence suggesting adolescents with problem drinking parents were at increased likelihood of experiencing mental health problems such as depression, anxiety, behaviour problems and are at increased risk of passing game on to misuse substances themselves. The study pointed to over fifty percent of the participants being affected in one or more of these ways. Further New Zealand research by Connolly et al (1993) found that nine year olds whose parents are problem drinkers displayed greater behavioural problems in school in comparison to their peers and 13 these behaviours manifested themselves at home rather than school.Taylor et als (2008) UK study found that issues of guilt and low self-esteem may result in parents feeling undeserving of treatment as they internalise the negative opinions of others. This in turn has potential to create a negative effect on the welfare of their child(ren) as when parents disengage they may be decreasing the help their ch ild receives. Social learning theory proposes how a parents problematic drinking may affect their child Substance use originates in the substance-specific attitudes and behaviours of the adults and peers who serve as an individuals role models Moos (2006183). In addition, Parental alcohol use predicts youngsters beliefs in the positive effects of alcohol, which is associated with earlier initiation of alcohol use and attendant alcohol misuse Moos (2006185).Vellemen Orford (1999) point out that the problems children face at home may be as a result of disharmony and family conflict rather than the parental drinking problem per-se. Children can feel responsible for this discord and powerless in avoiding and controlling the situation (Kroll, 2004). As social workers we need to be aware of how issues such as domestic violence and financial problems may be interconnected with an alcohol problem. Between 2004 and 2005 3,442 children called Childline regarding a family alcohol problem (Ch ildline, 2006), 44% of whom primarily cited physical abuse as a result of their parents drinking. Furthermore, children tended to speak about the effect of the alcohol problem such as domestic violence or physical abuse before mentioning alcohol. Childline also reported that many callers were talking about caring for their younger siblings, often missing school to do so. Finances were regularly an issue for these children, particularly as there was not always enough money left over to buy food. They described feelings of confusion, worry and of embarrassment of their parent, evidently focusing on the adults feelings rather than their own. Such feelings have the potential to create social isolation for children as they may fear pitch a friend over to play.Alcohol misuse may be coterminous with, or mask, other deficits in parenting, or other relationship problems. Unless tackled, relapsing is likely, even if the programme is initially successful (Sheldon McDonald, 2009 220). Forres ter Harwin (2006) noted the strong relationship between substance misuse and domestic violence with 64% of adults who experience such abuse having a family member who has a problem with alcohol. Velleman Orford (1999) established that children living with parental alcohol misuse are likely to find themselves siding with one parent or another by keeping secrets and are five times more likely than their peers to be pulled into parental disagreements.Although no systematic database exists evidence suggests that children are more likely to live with mothers who have problems drinking. Children reported that the feelings of fear and embarrassment were more evident when the parent was female in comparison to the parent being male (Scaife, 2008). The traditional role of a mother is perceived by society as a nurturing care-giver. As a result many children find it hard to accept the shame and embarrassment of their mother having an alcohol problem and can feel let down as a result (Bancrof t et al, 2004). In addition, Bancrofts Scottish study (2004) concludes that children had mixed feelings of pity and anger in relation to their parents. Their voices indicated elements of abuse and neglect, coupled with violence, school disruption, unpredictability, role reversal and parental absence. Many young people were cooking for themselves and caring for siblings on a regular basis. Bancroft et al (2004) found that this group of children found Young Carers Groups a source of support. Taylor et al (2008) also observed children taking on parenting roles in their UK study.Forrester Harwins (2008) study drew the conclusion that children who were not removed from the family home had poorer outcomes (39%) compared to those who were removed (56%). They also found that girls tended to be more resilient than boys who had a tendency to internalise problems. Children of alcoholics can develop coping strategies and resiliency (Fraser et al, 2008) and go on to look forward to a twinkling (prenominal) future while parental drug/alcohol use can fracture parent-child relationships, the damage need not be permanent if parents can resolve their substance-use problems (Fraser et al, 2008 18). Fraser et al found that many children in their UK study saw Social Workers as important people keeping their word and believing in the children was highly valued. Parents in this study recognised the damage to their children to include withdrawal, poor school attendance, and behavioural problems they stated how social services need to provide adequate grooming for staff in recognising the effects of substance misuse. They cited family upbringing, peer influence and/or specific traumas and tragedies in their lives as triggering their drinking problem. A North American study by Tracy Martin (2007) conclude that children are a motivating factor in parents seeking help, with many being supported by their children aged 6 to 11.Forrester Harwin (2008) noted that in studying 100 families , where minor or decreasing levels of alcohol misuse was evident, children remained in the family home and care proceedings began much sooner with drug misuse compared to alcohol misuse. This highlights the somewhat lenient view society and in turn, social services have on alcohol. It is perceived as normal to utilise alcohol for social purposes, indeed Room (2005b) argues that alcohol holds a high status, for example in the UK or USA speaking of a champagne receipt elicits thoughts of pro-social behaviour.Policy LegislationThe Children Act (2004) and The Children (NI) Order (1995) established concepts of Child in Need and Significant Harm, highlighting a Trusts legal obligation to identify such notions and safeguard a childs welfare through the provision of services to families. However the pertinent deliberation in all family alcohol misuse cases is not to dope off sight of the fact that the welfare of the child is paramount. The UN Convention on the Rights of the Child (1989) ensures that the paramountcy principle is upheld and affords children the opportunity for their voice to be heard. Since the Children Act was implemented the UK has focused social services input on supporting families. The implications of which are apparent in Supporting the Families (1998), any Child Matters (DfES, 2003), Every Child Matters Next Steps (DfES, 2004) and Every Child Matters Change for Children (DfES, 2004). These Green papers set out a National framework for meeting the needs of children, supporting families, focusing on saloon and minimising risk. Murray Shenker (2009) argue that despite these Every Child Matters papers endeavouring to protect and sustain child welfare, policy still fails to acknowledge the distressing influence on family members. In addition, Murray Shenker further argue that Englands Harm reduction strategy overlooks the need to respond to families affected by problem drinking instead focusing individually on the drinker.Although being critici sed for over-focusing on dugs rather than alcohol, the Advisory Council on the Misuse of Drugs Hidden Harm report (2003) recognises how Children deserve to be helped as individuals in their own serious (Hidden Harm, 200318). Its key messages include acknowledging that services need to work together, treating the parent will benefit the child and that substance misuse affects children of all ages. It recommends that decreasing harm should be the objective of policy and practice and that prompt identification of affected children should be a priority. In addition it stresses the importance of multi-agency collaboration and joint provision and resources.Local government have begun to recognise the need to tackle alcohol problems and have generated a Regional action plan The New strategic Direction (NSD, 2006-2011) for alcohol and drugs, the overall aim being to reduce drug and alcohol related harm in Northern Ireland. A particular feature of the New Strategic Direction (NSD) is the i dentification of two themes. These are children, young people and families and adults, carers and the general public. DHSSPS (2006, NSD 1.6.1). A further important objective is to ensure that adult addiction services work in collaboration with childrens services to provide a shared policy agenda to improve the lives of young people living with substance misusing parents or carers.The Northern Ireland report- our children and Young people, our shared responsibilities (2006) saw the inspection and consequent reform of child protection services and implementation of Regional Safeguarding boards. Relevant recommendations further highlighted a need for increased inter-agency strategies responding to alcohol and drug misuse and its impact on children. It points to the need for increased inter-agency training and the importance of engaging and consulting with children and families. The 10year Northern Ireland strategy- Our children and Young People, our self-confidence (2006) identified 6 outcomes expected for all children, including safety and stability which are important factors to be considered when working with young people affected by alcohol in the family.Service User PerspectivesThroughout the research, there were various harrowing quotes from children demonstrating their feelings towards their parents which go some way in summarising what they are going through.For example My mom always told me, You dont tell anyone about what goes on at home, if you tell anybody you wont be living with me anymore so I never told. My life seems like one big secret. Its hard to trust people now (Murray, 1998 526). A young girl aged 8 goes on to state I would crawl in my mum to stop drinking but I know she wont (HHAP, DHSSPSNI, 2008 4)A mother agrees There should be more family type services addiction affects everyone in the family and this needs addressing (HHAP, DHSSPSNI 2008 4)I grew up feeling ashamed, frightened, lost, guilty and lonely feeling unconfident, unsafe, un listened to, unprotected, unloved, unlovable feeling there was no-one there, inside or out. (The words of actress Geraldine throng Guardian extract, McVeigh (2010)Through my placement in Family and Childcares Gateway Service it was evident that alcohol was a feature of many referrals. Two service users I worked with spoke of how they had been affected by a family drinking problem.Ms A was removed from the care of her parents in her early teens as they both had problems with alcohol, resulting in Ms A experiencing neglect. She told me of how poor her home circumstances were and how, looking back, she could not believe how long social services licenceted her and her siblings to live there. Nevertheless she spoke very warmly of her mother and how of much of an effect her death had on her.Ms Ms husband had a severe alcohol problem and still does she divorced him when her youngest children were born but recognises the impact his behaviour had on her older children. Ms M experienced dome stic violence when he was drunk which was witnessed by the older children. She states how clearly she can see the difference in her older and younger children due to them not having had their father present in their lives. She talked to me about how he would disappear for days, sometimes weeks, departure her and the children worrying about his whereabouts.Local and Regional ResourcesThere are a number of services and resources operating throughout the voluntary and statutory sectors in Northern Ireland and the UK which aim to support problem drinkers and their families. In order to better prepare workers, Eastern Board training Taking the Lid off supplies staff with training on examining the effects of addiction on the entire family. Trust Community Addictions Teams also utilise Taking the Lid off booklets to assist problem drinking parents in seeing the problem from the perspective of other family members. Service users may be referred to in-patient treatment at Downshire hospital or Carlisle House, for example. Whilst the focus of these resources is on get specialised help for the parents, as pointed out in the regional HHAP (DHSSPSNI, 2008), assisting them will in turn help the children. AA meetings and Trust addiction team group work programmes afford parents the opportunity to meet with others in the same circumstances and provide a mechanism for working through their issues.The Dunlewey centre offers some support and focal point for children, alongside working with their parents on the Key to Change Programme. A book called Rory has been launched by ASCERT, Barnardos, SE Trust and Public Health agencies (BBC News, 2010). This aims to raise awareness of the issues of drinking in the family home and demonstrates to children that it is all right to talk about it. The Barnardos PHAROS service operates in The Eastern Board area, working on supporting and treating families affected by substance misuse, whilst the Dove House Hidden harm project supports chil dren by offering respite and resilience work. The Ego project in the occidental Board supports young people at risk of hidden harm via one to one counselling. Within the Eastern board, EDACT operates sub group meetings to allow representatives from voluntary and statutory addiction services to discuss concerning issues and prevent overlap of services. Alateen operates in the UK and Ireland for young people aged 12-17, allowing them to share their familiarity of living with a family member or friend who has an alcohol problem. The regional headquarters is based in Lisburn, with services including a helpline and meetings, sponsored by AA members.Despite these services showing signs of beginning to understand the needs of children it is evident that the focus remains on the adult receiving help. For the majority of services the parents need to be identified and engage with services themselves in order for the children to avail of any assistance. In addition it was clear whilst talking to Social Workers in Gateway that awareness levels need to be raised regarding the type of services available to children and the importance of recognising the effects on them. Whilst the provision of services is essential, Zohhadi et al (2004) point out a number of potential barriers to family engagement with treatment including a want of parental recognition of their problem and insufficient knowledge of available services. Social stigma creates an added element of secrecy resulting in families feeling marginalised. Society negatively stigmatises alcoholics therefore entering treatment may mean further marginalisation (Room, 2005b). Children risk normalising their parent(s) behaviour and as consent is required to work with them parents may not permit this for fear their child disclosing the full extent problem and being removed by social services. Taylor et al (2008) noted difficulties in engaging children if parents do not consent and how engagement can lead to the parent feeli ng labelled.Recommendations and ConclusionsIt is apparent from the reviewed literature that being parented by a problem drinker has a variety of psycho-social effects on children. A more holistic, systems approach needs to be employed whilst supporting families as other issues tend to take gustation ov

Langerhans Cell Histiocytosis

Langerhans Cell HistiocytosisLangerhans cell histiocytosis (LCH or histiocytosis X) is the or so common form of dendritic cell type of histiocytic disorders. LCH contribute be divided into three groups on the basis of the number of lesions and systems involved the unifocal (localized) form, presents between 5 and 15 years of age, in approximately 70% of LCH cases, limited to a single fancy up or a few bones, and may involve the lung. Multiple bones as well as the reticuloendothelial system (i.e., the liver, spleen, lymph nodes, and skin) involvement and diabetes insipidus are seen in multifocal unisystem (chronic recurring) form which constitutes approximately 20% of cases. Typically seen between 1 to 5 years of age. The fatal form is the multifocal multisystem (fulminant) form comprising approximately 10% of LCH cases. Seen in the first gear 2 years of life and it disseminately involves the reticuloendothelial system, anemia, and thrombocytopenia. Eosinophilic granuloma, Hand-S chller-Christian disease, and Letterer-Siwe disease are older names used when these were thought to be different diseases these names should now be discouraged.Langerhans cell histiocytosis is characterised by uncontrolled monoclonal proliferation of abnormal Langerhans cells, which pot infiltrate ubiquitously all the tissues or organs as well as lymph nodes. The histiocytic infiltration is followed by chronic inflammation and the formation of granulomas. Uncontrolled immune response activation is the most likely etiology by an as yet unknown antigen. stand up lesions are seen in approximately 80% of LCH affected roles. LCH has a predilection to involve the flat bones with skull being the most common flat bone involved, followed by the mandible, ribs, pelvis, and spine. Skull lesions finish be either asymptomatic or manifest with focal pain and soft-tissue swelling in the scalp. Punched-out lytic lesions are seen in skull lesions seen on radiographs with asymmetric destruction of the inner and outer cortices, which results in a characteristic bevelled edge. Mastoid bone is the classical location when temporal bone is affected. Calvarial disease lacks periosteal reaction unlike other bone lesions. The term geographic skull is used when skull lesions grow in size and coalesce, creating a map like appearance. Vertebra plana (symmetric flattening of vertebral body) is seen with involvement of spine. Diaphyseal or metaphyseal involvement seen in long bones. rudderless teeth is seen if there is enough alveolar destruction.Other findings include hepatomegaly with solid or cystic lesions in liver. Lymphadenopathy with cervical predominance. MRI brain leave reveal absence of posterior pituitary bright spot, and thickening of pituitary stalk if there is CNS involvement. Lung involvement shows centrilobular nodules or cysts of varying sizes, with mid- to upper-lung distribution and fiting of costophrenic angles.M middler et al conducted a study in 1995 in Philadelp hia on 42 patients. 83% of the patients had at least one affected bone. All children with lesions of the skull base (Fig 1 ) and seven of eight with facial lesions (Fig 2) had bone destruction with associated soft-tissue masses. Calvaria 13 Intracranial soft tissue 4 Skull base/face 15 check to DAmbrosio et al 2008, who did study on 100 patients in New York Ninety-six percent of the patients in this series had bone involvement. Fifty-eight of 96 patients (60%) had a solitary bone abnormality, and 38 patients (40%) had multiple lesions. By far, the most common bone involved in the series was the skull, affecting 52 of 96 patients (54%). In particular, the calvarium was affected in 45% of patients. Of the patients with calvarial involvement, the parietal bone was most commonly affected. The maxilla and/or maxillary sinus was affected in 8% of patients in the series.In the study done by Khatami et al 2010 in Iran on 48 patients, 38 of them (79.2%) had bone involvements skull was involv ed the most (66.7%), followed by Pelvis (31.3%), femur (31.3%), Sphenoid (30.0%) and ribs (16.7%), temporal bone in 4.2%Radiation Issue of CTConcerns about carcinogenicity of computed tomography radioactivity began in the early 2000s. In recent measure many examination protocols and software and hardware modifications have been made to reduce CT radiation dose. The definite risk of radiation exposure is not quantified. So, it is bust to follow the principle of As junior-grade As Reasonably Achievable (ALARA). This can be achieved by ensuring that the examination is clinically indicated and by keeping the radiation dose to the minimum with the help of technical advances as described below126.Tube current modulation is a very useful tool to control patient exposure with CT examinations. In this technique the scanner will produce less number of x-ray photons in regions of lower attenuation and higher value of tube current in regions of increased attenuation. This is of two types A ngular modulation and z-axis modulation. In angular modulation differences in attenuation in x-y plane is metrical with the help of two localisers (lateral and anteroposterior views) and the tube current is modulated accordingly during rotation. In z-axis modulation the attenuation differences along the length of the patient are calculated with a single anteroposterior localiser and the tube current is modulated. The z-axis organ based tube current modulation is as much or more telling than thyroid and eye shields at reducing radiation, without the regional image noise caused by shields.Newer reconstruction technique called iterative reconstruction significantly reduces the patient dose. In this the initial intercommunicate image is iteratively compared with the model image of the vendor. Then the algorithm intelligently decreases the noise in the image. There by a noise less image can be obtained even with a low dose CT. But this technique is more time consuming than the convent ional filtered back projection technique. With the newer development of hybridisation iterative reconstruction which uses both the above techniques, the speed has been considerably increased.Accurate patient centering can also decrease the patient radiation. Other techniques such(prenominal) as optimization of tube potential, beam-shaping filters also make a significant contribution to dose reduction. Newer developments which hold promise to reduce the radiation dose in the future are compressed sensing, volume of interest and interior tomography techniques, and photon-counting detectors127-136.Low dose MDCT of PNS can be done by reducing the mAs. This is the most effective way of reducing patient exposure. The effective dose delivered by a standard dose MDCT protocol is 0.70 mSv in men and 0.76 mSv in women, whereas the effective dose delivered by a low dose MDCT protocol is 0.047 mSv in men and 0.051 mSv in women which is equivalent to standard four view radiography of PNS. Low d ose CT can be used for the follow up of patients with chronic sinusitis and in tumors where the presence of soft tissue mass or bone destruction is used for follow up18.

Compare and Contrast Low Carbohydrate Diets and Low Fat Diets :: Comparison Compare Contrast Essays

Compare and Contrast Low Carbohydrate Diets and Low Fat Diets The two most popular methods to get clog are the low gelt diets and the low fat diets. Both are in complete contrast when it comes to each diets aliment choices, the low carbohydrate diet which completely breaks the food pyramid limits a person to eating foods that are lavishly in carbohydrates, such as bread, pasta and rice, while on the other hand, the low fat diet which follow the food pyramid limits a person to eat foods that are high in fat like meat, milk, and bean groups. Although each diet may sound very different from one another, they also share similarities. Both the low carbohydrate diet and the low fat diet claim that each is a good tool for cant over loss. Even though their process in achieving weight loss and good health are in complete contrast researchers found that each of the diets accomplish the same results. Starting with each diets idea, low fat diets state that fat is bad for the body they als o address that not all fats are dangerous. Low fat dieters actually accede that some fats are needed to stay healthy. The low fat diet does not restrict a person from foods that contain fat. In an online article lease a Diet low in Fat, Saturated Fat and Cholesterol, it was stated that Fats supply energy and essential fatty acids and promote absorption of the fat-soluble vitamins A, D, E, and K. In contrast with the good fat, there is also a negative, which is the bad fat. Saturated fat, which is considered the bad fat, has been linked to high cholesterol and essence disease. It is mostly found in milk and other milk products. Therefore, the low fat diet encourages its participants to reduce saturated fat for it is the main cause of high cholesterol level. On the other hand, even though low carbohydrate diets do not state that carbohydrates are bad they do state that it causes weight gain this idea gives most Americans that it is bad because it causes a person to gain weight. Whe n a person eats foods that are high in carbohydrates the body produces much insulin, which causes the body to quickly change food into body fat. This is why the low carbohydrate diets like the Atkins diet restricts a person to eat very diminutive amount of food that contains

Stereotypes is Jack Davis-No Sugar :: essays research papers

Stereotypes in darn Davis-No Sugar.    The vulcanized fibers in Jack Davis play "No Sugar" are characters that fit compound stereotypes (both Aboriginals and Whites) although they seem to be exaggerated. Contrasting characters reveal Ideological subjects and attitudes finished things like language, often through conflict.40The characters of White Australian descent tend to speak with episcopal language, disguising their evil deeds behind kind phrases. The most obvious example of this is the character Mr. Neville. He states, with refined language, in (Act One pellet Two), that "if you provide the internal the basic accoutrements of civilization, youre half delegacy to civilizing him." This reveals a belief that Whites are unquestionably superior and that whatsoever previous Aboriginal civilization was irrelevant. The pompous statement of the Whites are juxta-posed against the more crude and blunt comments of Aboriginal characters .to show the a udience the belief that whites are superior.103The character of Mr. Neal seems like a cruel evil man which is the way the Aboriginals would probably have viewed Whites (he is a stereotype) Neal believes blacks are worthless, he lives by the words of J. Ernest Regan, that "a lesser knowledge is a dangerous thing" (Act Four Scene Four), instead of trying to better Aboriginals and help them he is trying to suppress them and keep them insensible so they will not turn into a threat to him or Whites in general. His wife Matron seems like a kind caring person, like a mother figure which is how the audience expects a Matron to be. Their conflicting beliefs (Matron promotes the idea of improving aboriginals, Mr Neal promotes ignorance and suppression) causes conflict Neal "I cant see anything funny about this" Matron "I know you cant" (Act two Scene Ten).143Mr. Neals beliefs also conflict with the beliefs of Sister Eileen. What do you mean that you dont encourage na tives to take on?" Mr. Neal Thats right" (Act four Scene four). She also disagrees on the methods he uses "the use of violence by your native policemen.....Id prefer they came on their knowledge free will" (Act four Scene four) Sister Eileen believes in improving the natives which is completely opposite to the belief held by Mr. Neal that natives should remain ignorant. Mr. Neal resents Sister Eileens stimulation "bloody do-gooders" and threatens her when she speaks out "I could arrange a maneuver for you to another settlement perhaps Mulla Bulla on the edge of the Gibson Desert.Stereotypes is Jack Davis-No Sugar essays research papers Stereotypes in Jack Davis-No Sugar.    The characters in Jack Davis play "No Sugar" are characters that fit colonial stereotypes (both Aboriginals and Whites) although they seem to be exaggerated. Contrasting characters reveal Ideological ideas and attitudes through things like language, often through conflict.40The characters of White Australian descent tend to speak with pompous language, disguising their evil deeds behind kind phrases. The most obvious example of this is the character Mr. Neville. He states, with refined language, in (Act One Scene Two), that "if you provide the native the basic accoutrements of civilization, youre halfway to civilizing him." This reveals a belief that Whites are unquestionably superior and that any previous Aboriginal civilization was irrelevant. The pompous statement of the Whites are juxta-posed against the more crude and blunt comments of Aboriginal characters .to show the audience the belief that whites are superior.103The character of Mr. Neal seems like a cruel evil man which is the way the Aboriginals would probably have viewed Whites (he is a stereotype) Neal believes blacks are worthless, he lives by the words of J. Ernest Regan, that "a little knowledge is a dangerous thing" (Act Four Scene Four), instead of trying to better Aboriginals and help them he is trying to suppress them and keep them ignorant so they will not turn into a threat to him or Whites in general. His wife Matron seems like a kind caring person, like a mother figure which is how the audience expects a Matron to be. Their conflicting beliefs (Matron promotes the idea of improving aboriginals, Mr Neal promotes ignorance and suppression) causes conflict Neal "I cant see anything funny about this" Matron "I know you cant" (Act two Scene Ten).143Mr. Neals beliefs also conflict with the beliefs of Sister Eileen. What do you mean that you dont encourage natives to read?" Mr. Neal Thats right" (Act four Scene four). She also disagrees on the methods he uses "the use of violence by your native policemen.....Id prefer they came on their own free will" (Act four Scene four) Sister Eileen believes in improving the natives which is completely opposite to the belief held by Mr. Neal that natives shou ld remain ignorant. Mr. Neal resents Sister Eileens input "bloody do-gooders" and threatens her when she speaks out "I could arrange a transfer for you to another settlement perhaps Mulla Bulla on the edge of the Gibson Desert.