Veronika Decides to Die

YAK generation girls, she had everything she could wish for. She Is young, pretty and beautiful. She is attractive enough that the list of her boyfriends never ended. She has a steady Job and was blessed to have a loving family. She believed herself to be completely normal. Yet, something was lacking and she Is not happy; and one fine day she decides to die. To find out what was the reason behind such decision, you will have to read the novel and on finding the reason I am sure you will moment â€Å"what a silly reason to die. But If you will give a deep thought you also find yourself getting Irritated while going through same stage. She wished to die smoothly without any pain and so she takes an overdose of sleeping pills only to wake up some days later In Wallet, the local mental hospital or asylum. Unfortunate of not meeting her destiny, she started regretting of being alive but soon was happy to hear from doctor that her heart is damaged and she has only few days to live. Those few days took her to the journey of life where she experienced what deadness is.Of course, what else she could learn in asylum. She got a chance to meet three most important characters of her life in asylum and they were the reason where she understood that the every second of existence is a choice that we make between living and dying. The three characters in asylum; Mari suffering from panic disorder because she wanted to leave everything and help victims of war, Gazed a depressed women searching for her first love and Eduardo a schizophrenic son of Ambassador who wanted to fulfill his dreams or likings going against his parents' wish.All three were normal, but they wanted to do something different and were not allowed to do so but had to follow what other normal people were doing. Did Veronica's stay with Gazed, Mari and Eduardo change the fortune of Veronica? Did she change her decision of dying? But doctor said her heart was already damaged. Did some miracle happen? What happen ed to Gazed, Mari and Eduardo? I won't reveal what impact the three characters had on Veronica, you will have to find out on your own; but I am sure this novel will give you elating impact on your life.Most of us don't choose but always learn to follow and are forced to stay In an environment created by our society. Anyone who chooses their own destiny or dares to do something different or challenge the rules created by our society Is counted as MAD. We all have some form of madness Inside us. People who want to do something different should be allowed to follow their dream and should be encouraged, Instead of denominating them. Discouraging them will lead to psychological disorder and they might end up their life in asylum, Just Like Marl, Gazed and Eduardo.Every second In our life is the choice we make between dying and living, so help people to choose living Instead AT along. This book has given a very good definition of madness; it says, â€Å"Anyone who lives in their own worl d is mad, people who are different from other are mad. † All the four characters described in this story are worth reading and it reminds us that every moment in our life is special and precious. Paulo Cello is a storyteller with the power to inspire nations and to change people's lives. This time as well he has not left any point in giving us a moving and uplifting message of life.

Psychodynamic Counselling Overview Essay

Psychodynamic counselling has a long history and vast literature to condense so only a brief overview is possible here – following on from the themes already discussed and with particular focus on four psychologists: Freud, Jung, Adler and Klein. â€Å"The primary purpose of psychodynamic counselling is to help clients make sense of current situations; of memories associated with present experience, some of which spring readily to mind, others which may rise to consciousness as the counselling develops; and of the images that appear in fantasies and dreams. † (Jacobs) In essence it is concerned with the presenting past, the use of the counselling relationship in terms of its meaning for the client, and insight into unconscious representations which intervene in the perception of everyday life. Philosophy The philosophy guiding the psychodynamic approach is one that views the person as a whole – mind, body and soul – and recognises that there are relationships between these dimensions which constitute the person, or the self. These internal relationships are dynamic, always changing as they form the ‘inner world’ of an individual. Similarly, relationships to others and to objects in the environment are equally dynamic and create the ‘outer world’ of an individual. This understanding provides the key to both psychodynamic theory and practice in that present experiences and feelings can only be understood in relation to those of the past. This is reflected within the current relationship between counsellor and client which is exploring experiences, events and feelings in the conscious and working to bring those suppressed experiences from the unconscious to the conscious. The aim of psychodynamic work remains close to that of Freud, ‘where Id was, there shall Ego be’, or as Jacobs puts it ‘to make the unconscious conscious, and in doing so, to help a person to act with more conscious control and awareness than unconscious reactions permit’. Theory The interrelationship of external and internal worlds The dynamic, the activity, is between people, but also between the three aspects of the psyche – mind/thoughts, emotions/feelings and the soul/spirit. So it is possible to say â€Å"I don’t like her behaviour† which is about a relationship in the external world or to say â€Å"I don’t feel like my usual self today† which suggests a relationship between two parts of the self, the dynamic of the internal world. Great importance is attached to past experiences and feelings. Aspects (objects) of the psyche develop in parallel with external relationships in childhood, i. e. , with mother and father. In addition, the childhood perception of experiences, feelings and relationships may not match reality, so such perceptions are significant. Object relations theory A third type of relationship is added to those of the outer and inner worlds, to non-human objects. The activity is going on all the time, but is increased in some circumstances – in stressful and anxious times, in dreams. The Unconscious Freud identified the unconscious, the preconscious and the conscious in terms of mental activity. Within the unconscious are thoughts, experiences and feelings which are not easily accessible but which have great influences on the current mental activity in the conscious. Memories, half forgotten, but easy to access offer a route to the unconscious, thus belonging to the preconscious. Feelings such as grief and anger can remain in the unconscious and remain unexperienced and forgotten, that is, repressed; or suppressed if not forgotten. The process of moving material from the unconscious to the conscious is often helped by the use of metaphor and imagery, especially valuable when the counsellor gains some understanding of what is in the unconscious of the client who remains unaware. The significance of the past and its repetition in the present This concept is central to the psychodynamic approach, informing both theory and practice and making a contribution to the development of the various layers of understanding which the counsellor works towards achieving. The transference relationship between client and counsellor In addition to respect and acceptance which should characterise a counselling relationship, transference is significant in psychodynamic counselling. Previous patterns of relationships to significant others are transferred to the counsellor. This transference forms a central part of the work undertaken by both client and counsellor, who once again is able to use theory to inform practice. Practice and Techniques Regression Repressed and suppressed material frequently remains in the unconscious because it is so painful. Regression is a way of helping a person return to the past at their own pace, to bring into the conscious gradually and thus experience the feelings and events of the past. The use of the dynamics of the counselling relationship – failures, loss, endings, resistance As may be expected transference is often negative. ‘The value of this within the counselling relationship is that the patterns of past failures, losses and unsatisfactory endings to relationships can be worked with in the present through the counsellor in the ‘here and now’. Resistance is seen as a defensive mechanism, and as such is as much material to be worked with as the story of the client and transference within the counselling relationship. The distinctive feature of the psychodynamic approach is to understand where the resistance comes from, the reasons for it, to try to interpret it in order to help the client understand the reasons for it. The rule of abstinence This is about the counsellor ‘holding back’ from responding in the ‘normal’ way, for example, by not answering a question.

The Apocalyptic Probability Containment Essay Example | Topics and Well Written Essays - 2000 words

The Apocalyptic Probability Containment - Essay Example It also points out the possible remedies that can be implemented so that the depletion rate of the world can be reduced. The main issues that will be discussed in the paper include settlement, alternate means of public transport, provision of alternate energy sources, agriculture, and waste disposal. Introduction The world, as we know it today, is rapidly gaining on an apocalypse. The apocalypse has been depicted in films in a manner that worries us as the inhabitants of earth. Scholars researchers have also given a prediction of how the earth might look after the apocalypse. Wall-E’s film shows a world that reduces to a carcass of a planet after it has been deprived of all the oxygen that it was used to. As disturbing and farfetched as these predictions may be, there lies a sense of reality behind them all. The world today is hungry for resources and will go at any length to get a hold of such resources without having to care about the eventual impact of their actions on the planet. Since the industrial revolution in the 18th century from around 1750, the world has been on a downward spiral accelerating toward a dreaded apocalypse. The revolution cannot be downcast because it saw major changes inflicted in practically every industry. The main problem can be traced to the manner in which industrialization was conducted. No prior strategy was put in place to counter the peripherals of the revolution; the main agenda was to revolutionize the world.The revolution saw the development of urban centers, industries and factories. People were moving to the newly founded centers in such of jobs and wealth. This zeal to be a part of the revolution is what has caused problems that are slowly dragging the world and forming a post-apocalyptic trash site of our highly cherished planet.Because of the revolution, people needed to settle, energy needed to be supplied to the settlers and factories, transport needed to be availed for ferrying both goods and people, waste p roducts needed to be disposed and food supply needed to match the population’s demand. To avoid the seemingly inevitable end of this planet as a post-apocalyptic trash site, we must review, address and reconsider the issues of settlement, provision of alternative energy sources, alternate forms of public transport, agriculture and waste disposal in every corner of the world. How Settlement Can Be Reviewed To Help Contain The Apocalyptic Probability Settlement is the most central issue of all the problems. This is because all the other factors are directly linked to settlement. The people are the driving force of the world. Their innovations and inventions are what have brought change to the world as a whole. The main issue about settlement is the fact that population is concentrated in the urban areas with the suburbs being somewhat marginalized. The technology that is being used in all sorts of settlements seems to be getting out-dated and the impact to the environment are p roving to be detrimental. The best possible solution for settlement in avoiding the disastrous apocalyptic end is developing new cities. South Korea is currently building a self-sufficient city similar to Abu Dhabi’s Masdar city. The city is a high technology and one of its core functions will be learning. The city project has been dubbed the Multi-functional Administrative City-MAC (Dillow, 2010). The idea behind this innovation is to create sustainable cities through technology. This kind of a city will help curb the issue of settlement because it will help disperse or depopulate the densely populated areas. The issue with settlement today is the scarcity of resources and the arguably unmanageable waste disposal. In Portugal, a

Business Synoptic 1f Essay Example | Topics and Well Written Essays - 4000 words

Business Synoptic 1f - Essay Example Other major brands include Arrowhead and Perrier, baby foods like Gerber, cereals like Cheerios, ice cream including the famed Haagen-Daaz, microwavable food like Hot Pocket and Stouffers, health lines like PowerBar and Jenny Craig products, pet food like Dog Chow and Friskies, and professional food products (Nestle, 2010). With a few exceptions like Perrier and Haagen-Daaz, Nestle tends to target the lowest common denominator of the market, and most of their products are worldwide household names. They sell a tremendous variety of products, but all of their products have something to do with nutrition or food. They do sometimes attempt to control all sectors of the market. For example, they sell both the low-end Drumstick ice cream bar and the higher end Haagen-Daaz; similarly, Stouffers and Hot Pockets sell to radically different demographics. Nestle realized that their growth rate, while constant over the 20th century and producing many beloved brands, was unsustainable in the lon g term. â€Å"Nestle realized by the early 1990s that it faced significant challenges in maintaining its growth rate. The large Western European and North American markets were mature. In several countries, population growth had stagnated and in some there had been a small decline in food consumption. The retail environment in many Western nations had become increasingly challenging, and the balance of power was shifting away from the large-scale manufacturers of branded foods and beverages and toward nationwide supermarket and discount chains†. Many companies would experiment with different branding options, opening up new markets, new marketing schemes, etc. but would try to keep the core structure of the company intact. Nestle did these things: Its brand portfolio, as we've seen above, goes from luxury to bargain, is targeted at numerous demographics and income levels, and is increasingly expanding to try to get into different markets. Yet that is not all they did, and the ir choice of a new structure helps explain their success. Nestle's strategy for entering new markets and avoiding the inundation of existing ones is simple: â€Å"In general, the company's strategy has been to enter emerging markets early-before competitors and build a substantial position by selling basic food items that appeal to the local population base, such as infant formula, condensed milk, noodles, and tofu. By narrowing its initial market focus to just a handful of strategic brands, Nestle claims it can simplify life, reduce risk, and concentrate its marketing resources and managerial effort on a limited number of key niches. The goal is to build a commanding market position in each of these niches. By pursuing such a strategy, Nestle has taken as much as 85 percent of the market for instant coffee in Mexico, 66 percent of the market for powdered milk in the Philippines, and 70 percent' of the markets for soups in Chile. As income levels rise, the company progressively mov es out from these niches, introducing more upscale items such as mineral water, chocolate, cookies and prepared foodstuffs†. This is a disruptive strategy (Malstrom, 2008a; Malstrom, 2008b). Disruptive strategies involve creating a new market: â€Å"

PTSD in Adolescents Research Proposal Example | Topics and Well Written Essays - 500 words

PTSD in Adolescents - Research Proposal Example Also, it useful in obtaining information regarding a phenomenon’s current status, in this case, PTSD in adolescents and possibility for the use of technology in research. The population for this research study will be adolescents aged between the ages of 13 and 19 who meet the DSM IV criteria for PTSD. In addition, the guardians or parents will have to provide written permission for the participation of the minors. The participants will be recruited via purposive sampling that will only consider a specific subset of the population (Bryman & Burgess, 2009), in this case, adolescents presenting with PTSD symptoms. Data will be collected from both primary and secondary sources. Secondary sources will include previous research studies and peer-reviewed articles, while primary data will be collected through interviews. The secondary data will provide information about the earlier use of technology in PTSD research, while the interviews will present information about perceptions and behavior of adolescents with PTSD. The interview will have a general inquiry plan with no specific set of questions or any particular order to avoid making the participants uncomfortable (Bryman & Burgess, 2009). The Structured Interview for PTSD has been utilized in numerous studies and assesses symptoms of PTSD, as well as behavioral guilt, survival, and risk factors (Bryman & Burgess, 2009). These are the issues, which the research study is seeking to address. It has 17 items that assign severity rating reflecting intensity and frequency. This method was chosen because it takes less time, around 20-30 minutes, which is important given the mental state of the participants. Other methods that could have been used include document review and observational methods.

Border security issues (week 6) Essay Example | Topics and Well Written Essays - 250 words

Border security issues (week 6) - Essay Example There is a systemic technique of impunity at the state and local levels where the anti-press crimes are under investigation (Lauria, O’Connor, Campbell & Barbeito, 2010). The report by Lauria, O’Connor, Campbell and Barbeito (2010), shows that the US-Mexico border is not only unsafe for journalists, but for citizens. The special report found out that the police and justice system do not uphold the law in cases concerning crimes by cartels. Mexico’s current President Enrique Peà ±a Nieto, continues use of the military to combat drug lords’ activities, which is not the best method to eliminate threats made to journalists from drug cartels. Politicians from United Stated and Mexico can take several measures to fix the broken immigration systems. It is still possible, even when a vacuum of truth exists since some of the officials in both governments may know those who operate the drug cartels. The problem is that there is no transparency if it is only one government that deals with a broken immigration system. However, if the two governments increased their collaboration between each other to curtail border insecurity against the cartels they would fix the immigration system easily. Nevertheless, these calculated measures would be useless if the general population is not involved. Drug cartels operate successfully when both sides are not in good terms because if there are legal consequences in one state, the drug lords cross the border to the other state and continue with their criminal activities. Therefore, if politicians from both states would collaborate on drug policy implementation and other viable strategies, it would be easier to fix the broken immigration system. Meyer, M. (2013). Mexico’s new military police force: the continued militarization of public security in Mexico. The Washington Office on Latin America,

Business Information System written assignment Essay

Business Information System written assignment - Essay Example According to the case, it is clear that the firm needs to use an enterprise resource planning system to manage its operations. In acquiring a business system, the business can acquire a system for each of the functions that it has, or it can acquire an information system that cuts across all the functions of the business. An enterprise resource planning system is a system that is designed to centrally manage all the process of the business. In other word, information is shared across all the departments in the organization. This is achieved by installing a system that incorporates all the functions of the business. If a business acquires this kind of a system, it means that all data from all its departments is centrally collected and managed which makes it easier for each department to collaborate more easily and also eliminates redundancies in functions. A customer relationship system is crucial to make sure that customers are managed properly. According to Gravely (2003, p.12), customer relationship management is a process of finding, identifying, acquiring and maintaining the most dependable customers for the business. In a modern business environment, customer management is important, and the CRM will help BMW in a number of ways. First, it will make it easier to maintain a close relationship with customers. Given the kind of products that the firm is selling, it is clear that its customers are long time customers who are going to remain using the products of the firm for a long time. Being able to have a close business as well as a personal relationship with the customers will be of importance to BMW in the long run and the CRM will help in this. The sales department will benefit from the CRM and the sales staff will be able to interact better with customers, both current and potential customers. A CRM will also help in getting and processing

Computer networks Essay Example | Topics and Well Written Essays - 3500 words

Computer networks - Essay Example Moreover, Cisco devices deliver integration features that will support compatibility and scalability issues with upcoming applications and services. For addressing, network security, again Cisco firewalls are implemented to protect the network from viruses, worms and probes. In summary, Cisco 3845 integrated service router is implemented for exchanging communication from the local area network interface to the WAN interface. The router provides productivity, integration and enhanced features along with Cisco 3845 (ISR) Site-to-Site VPN Support, Cisco 3845 (ISR) Remote Access VPN Support, Cisco 3845 (ISR) Network Admission Control support, Cisco 3845 (ISR) Digital Voice Call support , Cisco Unified Communication Support and Unified Survivable Remote Site Telephony (SRST) support. Moreover, data switches are also acquired from Cisco named as Cisco Catalyst 3750 that provides enhanced features. Moreover, for wireless networks, Cisco Unified Wireless network featuring Cisco Wireless Cont rol System along with Cisco 4400 Series Wireless LAN Controllers are deployed. Furthermore, the wireless network also supports Cisco Clear air Technology. For remote connectivity and scalability, Cisco service mobility engines are installed. For application support, SOAP and XML Support and Context aware Services are available. In addition, for addressing network security, Cisco ASA 5500 Series Adaptive Security Appliances (For Wired Network), AIP-SSM Intrusion Prevention Module and Wireless Intrusion Prevention System (W IPS) (For Wireless Networks) is operational. Fig 1.1 demonstrates the local area network of an organization below: Figure 1.1 (LOCAL AREA NETWORK) Structure and Cabling The current network is constructed on Star topology that is the most widely adopted topology, as it has many benefits when compared to other topologies. By implementing star topology, network engineers can administer and troubleshoot the network more efficiently and effectively. Star topology provid es a one stop monitoring screen that demonstrates activities on the local area network. Likewise, the cost of implementing and managing the local area network is comparatively low, as less resources and low network downtime occurs. Moreover, network security is addressed efficiently, as monitoring of each system or service is carried out

Level of Stress Among Call Centre Employees Essay Example for Free

Level of Stress Among Call Centre Employees Essay Level of Stress among Call Centre Employees Submission date: 8th January, 2008 Submitted By: Ayesha Khalid Ayesha Sarfaraz Nazool-e-Tabassum Saira Khan Mussaffa Butt Submitted to Dr. Farah Malik Associate Professor Department of Psychology Government College University Lahore Introduction Stress is used as a general label for a vast complex, interdisciplinary area of interest and study, much of which is health related. Most often stress is related to personal discomfort associated with an over demanding or distressing lifestyle situation (Adams Bromley, 1998) stress is a part of everyday life, we experience stress each day, although it is acknowledged that the degree of stress varies considerably depending on the complexity of the situation and availability of support. For some, the stress is manageable and work or home life is not affected. For others, however, the stress reaches a critical point where there may be a need for medical or psychiatric assistance (Weiten, 2001). The causes of stress can include any event or occurrence that a person considers a threat to his or her coping strategies or resources. Researchers generally agree that a certain degree of stress is a normal part of a living organisms response to the inevitable changes in its physical or social environment, and that positive, as well as negative, events can generate stress as well as negative occurrences (Frey, 2002). There can be innumerable stress factors since different individuals react differently to the same stress conditions. Extreme stress situations for an individual may prove to be mild for another, for yet another person the situations might not qualify as stressing at all. (http://www. lifepositive. com/stress. html). The fact that women report and exhibit higher level of psychological distress than men has been explained in three major ways. The methodological artifact explanation suggests that women are socialized to be more expressive and therefore will admit more emotional symptoms than men in response to the standard psychological stress (Frey, 2002). The stress exposure argument suggests that women face more stressor in general or more severe, persistent stressors than men. Whereas the vulnerability argument suggest that women lack coping resources such as high self esteem, a sense of mastery or appropriate coping strategies for handling the stressors to which they are exposed. Newman (1984 c. f. Eckenrode, 1991) suggested that women over report minor symptoms that inflate over all distress scores (Eller, 2000). Stress in humans in general results from interactions between persons and their environment that are perceived as straining or exceeding their adaptive capacities and threatening their well-being. The element of perception indicates that human stress responses reflect differences in personality, as well as differences in physical strength or general health (Frey, 2002). Stress is often termed as a twentieth century syndrome, born out of mans race towards modern progress and its ensuing complexities. For that matter, causes such as a simple flight delay to managing a teenage child at home can put you under stress. Listing the causes of stress is tricky yet replete with practical diversity (http://www. lifepositive. com/stress. html). General cause of stress include primarily, Threat; a perceived threat will lead a person to feel stressed. This can include physical threats, social threats, financial threat, and so on. Fear; Fear leads to imagined outcomes, which are the real source of stress. Uncertainty; When people are not certain, they are unable to predict, and hence feel they are not in control, and hence may feel fear or feel threatened by that which is causing the uncertainty (http://www. workstress. net/causes. htm). Apart from certain general causes another reason is cognitive dissonance; it is when there is a gap between what people do and what they think, then the outcome experience is cognitive dissonance, which is felt as stress.

Gender Essay Example for Free

Gender Essay The history of gender and American policy is one crafted and based on historical events and changes in the men’s and societies’ view of women, especially as regards their roles in influencing policy change’s and implementation. According to scholars women roles for the past two centuries have improved remarkably if current events are to go by. Apparently, the study of gender as regards American foreign policy is a completely new aspect which has metamorphosed over the ages to became a crucial and significant approach of analyzing America’s foreign policies as regards, contribution to war, politics, economics and culture. In essence gender studies indicate the expectations, that the society holds to the different genders and the roles each group play. Dating back to the biblical times, the issue of gender and more so gender imbalance having been predominant in our society is, one coined on the society’s understanding and expectation of the male and female members of the society. It’s upon this that women over the ages have found themselves, marooned and dominated by men in major policies that have affected the society especially as regards warfare, diplomacy and violence. From ancient Greek, Roman, Babylonian empires, women have often being regarded as a weak gender compared to men, this has quite often led to maltreatment and abuse of women by the dominant male specie Braudy states â€Å"certainly the tradition of allying weakness with women and strength with men is a long one† (328). Its upon this conceptual thought that women have been destined, to play if any, a minimal role in matters of war. However it’s the statement of scholars and historians that though regarded as a marginalized group and less often actively involved in war, women â€Å"occupy a privileged place as an alternative source of national moral strength† (Braudy 328). In essence a good woman was always portrayed as pliant, submissive and subordinate. Thus the concept of gender imbalance has been with us for long, this was especially portrayed by the remarks and views held by male and society as regards women. For instance some scholars portrayed them as a â€Å"savagery within civilization† and as Braudy, states a â€Å"source of both fascination and disgust† (328). This is vehemently expressed by the 19th century view of women menstruation as a wound. However scholars do agree that progress has been witnessed over the ages as regards women role in society as research show that women have tremendously established themselves as a dominant force in society though, they still lack behind in a world where war, politics, economics, diplomacy issues are dominated by male. It’s thus upon this views that women remain less actively involved in war. According to scholars women have partly participated in wars and hence as history shows wars have been attributed to men. So is war a man’s affair. War and especially violence was, and still continues, to be a man’s affair in that men have always been attributed to intolerance and aggressive behavior, which is replicated in the art of war. Barash, states â€Å"if we could eliminate or even significantly reduce male violence we would pretty much get rid of violence† (1). For ages the art of war has been and still is dominated by men. For instance looking back at past war events ,its difficult to find any war which might have been instigated by a woman, on the contrary men have been responsible for all major wars and even violence related incidents in the society including genocide and homicide. Experts thus postulate that, war is a man’s affair in which men seek to dominate others, by the crudest of ways. It’s a concept that has been among the male species. The ancient warriors thus were taught to be strong and vicious, going contrally to that was risking ones sexuality in the sense that one would be braded as an â€Å"effeminate† a term often used to refer to men who were weak and coward. Thus it’s an agreed fact that a true warrior or man was identified on his possession of power attributed to ones manhood. Thus in order to show the effect of gender as regards war the male dominated societies used the most atrocious and ridiculous way such as castrating, homosexuality, masturbation and circumcision to humiliate individuals , thought to be weak, a trait that was attributed and reminisce of the women. This was done to portray other men as having qualities akin to women as demonstrated by the act of penetration. For instance during the ancient times homosexuality was used to render punishment on the male enemies. Sodomizing war captives was cogently used by Babylonians. Also studies indicate that war captives were treated on the basis of their gender in that women were raped, children enslaved while the males were subsequently killed and humiliated, in one incidence they were forced to masturbate while get the erect before being sodomized. This according to Trexler proofed to â€Å"show linkage between gender and humiliation in war fare† (20). By castrating the others scholars do ascertain that it was to be â€Å"a basic element in man’s fighting instincts. †(Trexler 19). To crowns it all, this acts were often instigated against other men in order to prove ones superiority over the others. Castrating and cutting the enemies manhood became a way of showing how the enemy had been subdued. This is depicted by the ancient Jewish society where warriors would cut their enemies private parts and foreskins to present to kings as a show of victory in war. In modern society violence and war is overwhelmingly dominated by male, for instance according to a researcher conducted in America, over 90% of homicide cases in America have been perpetrated by men. Moreover a great number of men are enlisted in the national army. What makes it more interesting is how terrorist groups are predominantly male established . In essence any where there is violence and war man is. It has thus been concluded that war is the art of man, as depicted by the studies of ancient history of warfare and current affairs. Barash cogently states that â€Å"what can be called killing establishment, soldiers, executioners, hunters, even slaughters is overwhelmingly male†(1). he concept of war and gender can thus be summarized as follows; war is a mans affair, violence and war is something that men direct at each other, men are the instigators and subsequently victims of their acts of violence, women are the victims of men’s warfare but not partakers or instigators and finally when people are murdered and slaughtered as in case of genocides and war, men are always the culprits. Religion and war According to Merriam-Webster Online Dictionary religion re fers to a personal set or institutionalized set of religious beliefs, attitudes and practices. In that point, the debate over whether religion is responsible for the many wars witnessed in the history of mankind has continued to rage with both critics and proponents ascertaining their views and subsequently providing proofs to justify and authenticate their claims. Before understanding this issues it’s important thus to define war. According to Merriam –Webster online dictionary war is thus a state characterized by hostility, conflict, or antagonism Thus the concept of intermarriage between religion and war and especially its contribution to war, its one which has found favour in the ideologies of atheist and scientist as such. So does religion cause wars? Religion has been the greatest threat to mankind and thus it’s been the cause of many bloody confrontations. Charles Kimball, states â€Å"It is somewhat trite, but nevertheless sadly true, to say that more wars have been waged, more people killed, and these days more evil perpetrated in the name of religion than by any other institutional force in human history. †(1) This has often led to some critics of religion pointing that, if man is to live peacefully then religion should be scraped or rather the belief in God should be descanted. Timothy Fitzgerald quips that; â€Å"religion should be regarded as a form of mystification and scrapped† (26). The contemporary attitude on religious contribution to war arises due to a number of factors or rather reason that is religious conflicts, religious wars, religious ideologies based on teachings of some religions and modern fundamentalism attributed to different religious groups. It’s the statement of scholars that the history of religions contribution to war in modern world and as regards organized religions is to be traced to the Roman Catholic which was responsible for some of the greatest conflicts in history of mankind. During the dark reign of the Catholic Church in Europe many people were slaughtered and mercilessly killed due to their beliefs. According to Hitcher, the church has a history responsibility for the crusades, persecution of Catholics, Jews and deserters (17). Thus the Roman Catholic Church which represents Christianity is accountable for grave atrocities that culminated in the murder, persecution of millions of people based on its principle of heresy. It’s been the overwhelming statement and consensus of scholars that the blood birth witnessed during the dark reign of the church by far surpassed the jihads. Also the pope at the time is believed to have contributed tremendously in influencing major wars at the time. On another point, historians ascertain that, the competition for support and the fundamental believe that one religion is superior than the other has fueled animosity between religious groups, often leading to bloody confrontations that have often led to war. Moore in describing about this competition states â€Å"it had to be cruel in the general sense that any group identity is liable to be formed in hostile competition† (29). Its was this religious dreams of superiority that led to the Islamic conquest and expansion during the 18th century ,at that time, its estimated that millions of people were killed and others taken as slaves. This competition among religious groups has often led to war between the different opposing religions. For instance according to Price most of the greatest conflicts such as the Northern Ireland, Bosnia, Iraq and even 9/11 attack are as a result of religious differences. These facts are clearly demonstrated in the crusades that were responsible for fighting the spread of Islam in Europe . during this time the pope coined what was termed as â€Å"just war†. Thus it was believed that some wars were justifiable especially if it entailed safeguarding the very cores of the religion. On their part the Muslim desire for expansion was characterized by forced conversion through war commonly referred to as Jihad. What has come to be the greatest threat to mankind in this century it’s also attributed to religious fundamentalism . Following the aftermath of the 9/11, the world witnessed the rise of terrorism ,a new tool used by Muslim fanatics and which is based on Islamic fundamentalism though the 9/11 event has been regarded by some as not influenced by Islamic fundermentalism,the facts point to the contrary . For instance the known mastermind of the attack and the leader of Alquieda, Osama Bin Laden ,in his speech calling for the murder of citizens in western countries attributed his action to Islam and more so the holy book Koran. These proofs to show that despite the denials by some Islamic leaders, the calls of Osama seek to justify the views held by majority of the Islamic community. The Muslim have also used the word â€Å"Crusade† to describe the policy of western countries especially America to occupy Islamic states. This is a symbolic meaning to the crusades, organized to counter Islamic conquest during the 18th century. It’s thus the belief of scholars, that the Islamic fundamentalism is based on religious beliefs of Islamic faith though some Islamic scholars do oppose these beliefs. Scholars have thus argued that the terrorist attack on America that killed innocent civilians could not have happened if not for religious believes. The Palestinian and Jewish conflict has been continuing for long, this conflict has often led to bloody confrontation between the two groups. According to scholars this conflicts is the brain child of religious fundamentalism based on Islam and Judaism. Thus critics do argue that the history of enmity between this two religious groups, bases its root on hard core ideologies attributed to the groups religious affiliations, thus as long as the groups seek to identify themselves on religious background, it will be hard to tackle has been their for long hence as long as each group seeks to identify the other in terms of religious background, it will be hard to tackle. This conflict has led to the extend of isolating the Jewish state of Israel from the rest of Middle East countries with calls by some Muslim fanatics and religious leaders for the murder of Jewish citizens. It’s thus the statement of historians that the Yom Kippur war between Israel and other Arab countries was as result of religious differences. Thus critic’s quip that religion has led to nations forming alliances on bases of religious believes, thus leading to conflicts which have led to emergence of hardcore ideologies and conflicts across the world. It has also been said that, religion has been instrumental in influencing wars in Europe. for instance the French religious wars are attributed to religion , Holt, says â€Å"the French civil wars which began with the massacre at vassy in 1562 and concluded with peace of the alass 1629 was a conflict of religion†(56) Different religions also have been known to encourage war of such is the Buddhism religion in which the tales of Bhagavad-Gita are based on war and made to justify war as an act of self protection, in its case Judaism and especially the old testament depicted war as necessary in order to defend the convictions of their teaching, in the bible the Israelites who believe that they are Gods children and the chosen ones called on God to fight for their course According to some studies conducted it has further been established that some individuals use religion in order to advance their political ambitions ,for instance , having used Jews and Judaism as a ladder to ascend to political power Hitler gained the channel he so much needed to murder 6 million Jews, in our modern society prominent personalities and politician have been known to make grievous remarks based on religious conviction, the calling by Iranian president for complete annihilation of the state of Israel and calling of Musl ims to unite against Judaism that stands for the Jewish state of Israel is a sure way of describing how religion has been used to sphere head murder of innocent civilians. A true religious individual thus does not advocate for violence. Thus according to proponents of religion it has subsequently been ascertained that the absence of religion in the modern nations especially communist did not deter their leaders such as Stalin from leading any less violently.  Despite the growing claims that religion causes war, proponents and researchers have criticized, this claims by ascertaining that religion and especially organized religions are peaceful the teachings of most religion call for peaceful existence of individuals, this is depicted by the teachings of individuals who have been ardent followers of their respective religions. According to martin Luther king Jr, the knowledge of God brings inner peace, in his teaching also he advocated for tolerance and use of non violence. Also Gandhi one of the staunchest supporter and believer of Buddhism advocated for the use of non violence (ahisma) in his philosophies which have become instrumental in influencing the thoughts and ideas of modern leaders.

Case Summary Hypertension In Pregnancy Health And Social Care Essay

Case Summary Hypertension In Pregnancy Health And Social Care Essay Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is at 37 weeks and 5 days of gestation. She was diagnosed to have hypertension in pregnancy during antenatal routine follow-up in Klinik Kesihatan Simpang Renggam at 36 weeks and preeclampsia (blood pressure 160/100mmHg, urine dipstick albumin 1+) 3 days before admission. She was admitted to Hospital Kluang and started on Tab. Methyldopa 250mg TDS. She was advised for induction of labour in view of preeclampsia at term and she requested to be transferred to Hospital Batu Pahat (HBP). She did not have any signs and symptoms suggestive of severe preeclampsia or labour. During admission to HBP, tablet prostin 1.5mg was inserted into the posterior fornix twice to induce labour but there was no change in cervical os and symptoms of labour. Decision was made to try artifical rupture of membranes. However, following the procedure, internal monitoring detected fetal distress and as spontaneous delivery was not imminent, Mdm. S M was agreeable for emergency lower section caesarean section under general anaesthesia. A healthy infant boy was delivered (weight 2.9kg, Apgar score 91105) and there were no intra or post-operative complications. Following the surgery, both mother and infant were well in the ward. Mdm. SM was ambulating and tolerating orally and by the 2nd post-op day, both had passed urine and motion. Wound inspection on day 2 showed clean, non-gaping wound. As she was well, decision was made to discharge her and she was given appointment to review her blood pressure and operative wound at the postnatal clinic at KKSR. On discharge, her blood pressure was 140/70mmHg (without medication) and urine dipstick albumin was trace. Analgesia given on discharge were mefenemic acid and paracetamol. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology PATIENTS DETAILS I/C NUMBER: 800318015794 AGE: 30 SEX: Female DATE OF ADMISSION: 20/6/2010 R/N: 1358593 2) CLINICAL HISTORY Chief Complaint Elevated blood pressure detected in pregnancy at 36 weeks of gestation. History of Present Illness Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is currently at 37 weeks and 5 days of gestation. She was referred to Hospital Kluang from Klinik Kesihatan Simpang Renggam (KKSR) for elevated blood pressure detected on routine antenatal follow-up and subsequently transferred to Hospital Batu Pahat (HBP) for induction of labour in view of her development of high blood pressure in pregnancy. Her elevated blood pressure was first detected during her routine antenatal follow-up at Klinik Kesihatan Simpang Renggam 10 days before admission to HBP. During this visit, her blood pressure was recorded as 150/90mmHg and she also complained of slight bilateral swelling of her feet but otherwise had no other complaints. The feet swelling resolved after 3 days. Throughout the next 7 days, she went to KKSR every alternate day for monitoring and 3 days before admission to HBP, her blood pressure was noted to be 160/100mmHg with presence of albumin 1+ on urine dipstick that was prev iously not present. She was immediately given tablet labetolol 100mg and admitted to Hospital Kluang where she was subsequently started on tablet methyldopa 250mg 8-hourly. Three days after admission to Hospital Kluang, she was advised by the doctor to undergo induction of labour and she thus requested to be transferred to HBP so her family members in Batu Pahat could take care of her. During the course of these events, she did not experience shortness of breath, headache, blurring of vision, epigastric pain, seizures, abdominal pain, vaginal bleeding, nausea, vomiting, palpitations, or recurrence of the foot swelling. At time of admission, she did not experience contraction pain, show, leaking of liquor. Fetal movements were good. Systemic Review Mdm. SM did not have fever. Her appetite was good and her urinary and bowel habits were normal. Her sleep was unaffected. Antenatal History This was an unplanned but wanted pregnancy. Mdm. SM realized she was pregnant when she missed her period, of which the last was 28/12/09. She bought a pregnancy test kit and it tested positive. She subsequently did her booking at KKSR at 7 weeks of period of amenorrhoea. At booking, her blood pressure was 120/80mmHg, hemoglobin 13.4g/dL, sugar undetected, and urine albumin negative. Infective screening was negative and blood type O positive. Her expected due date was given as 14/8/10. During follow-up 1 month later, she had her first ultrasound scan which found her uterus to be larger than dates. Her due date was revised to 6/7/10. Modified glucose tolerance test done twice during pregnancy were negative. She experienced morning sickness and vomiting during the first 3 months of pregnancy but it was not severe and she could cope without medication. Throughout the pregnancy, she was diagnosed to have urinary tract infection twice and was treated with antibiotics. A further 3 ultrasoun d scans were done and all were normal. She was also compliant to the supplements given throughout pregnancy. There were no other problems during the antenatal follow-up until the detection of elevated blood pressure 10 days before admission to HBP. Past Obstetric History This is her fifth pregnancy and her last childbirth was in 2008. She has 3 children, 2 boys and a girl, of whom all were born via vaginal delivery at postdate after induction of labour. Birth weights ranged from 2.7 to 3.0kg, all are healthy with no complications and were breastfed. However, during her 3rd pregnancy, she suffered a miscarriage during the 12th week and dilatation and curettage was performed during that admission. Gynae Menstrual History Mdm. SM achieved menarche at the age of 12. Her menstrual cycles have always been regular with 28 days per cycle and 5 to 7 days of flow. She does not experience menorrhagia or dysmenorrhoea. She has never had a cervical smear done and has never used oral contraceptive pills. She has not required medical attention for any gynaecological problem. Past Medical History Mdm. SM has never been diagnosed with any chronic disease such as diabetes, hypertension, and asthma before. She has also never been admitted for non-pregnancy related reasons. She also does not have any known food or drug allergies. Family History Mdm. SM is the eldest of three siblings. Her youngest sister also had gestational hypertension. Her father has hypertension and her mother had diabetes, but passed away 2 years ago due to tuberculosis. All family members have been screened and all tested negative for tuberculosis. Social History Mdm. SM is now a housewife. She formerly worked in a factory but decided against returning to work following her last pregnancy in 2008 for her childrens benefit. She is a non-smoker and does not consume alcohol. Her husband is a short-haul lorry driver and smokes, but only outside their home. They live slightly off Kluang, and it takes them slightly over an hour to reach HBP, and 15 minutes to reach KKSR. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 3) FINDINGS ON CLINICAL EXAMINATION (Mdm. SM was examined by me on the 2nd day of admission) Mdm. SM was alert, conscious and cooperative. She was not in any pain or distress. She was sitting comfortably on her bed. On examination, there was no pallor, jaundice or pedal edema. Her reflexes were not brisk. Her clinical parameters are: Blood Pressure : 124/80 mmHg Heart Rate : 95 beats per minute. Regular rhythm Respiratory Rate : 20 breaths per minute Temperature : 37 °C Examination of the cardiovascular system, respiratory system, fundus, thyroid and breasts were normal. On examination of the abdomen, it was distended with gravid uterus as evidenced by linea nigra, and striae albicans. There was no striae gravidarum, scars, or pulsations noted. On palpations, the abdomen was soft and non-tender, uterus non-irritable, and fetal parts felt. The symphysio-fundal height was 36cm, which corresponds to dates. On examination, this is a singleton fetus at longitudinal lie with cephalic presentation, with the fetal back on the maternal left. The fetal head was four fifths palpable. Estimated fetal weight is 2.8 to 3.0kg. Liquor is adequate. Fetal heart was heard and the rate was 142 beats per minute. Vaginal examination (by medical officer on admission) revealed no perineal, vulval or vaginal abnormalities. Cervical os was 1 cm with cervix tubular, soft and axial, station high and membrane intact. Bishops score was 3/10. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONING Provisional Diagnosis Preeclampsia in pregnancy Mdm. SM developed new onset elevated blood pressure of 160/100mmHg at 36 weeks of gestation and urine dipstick albumin of 1+ (300mg/L). This fits the minimum requirement of preeclampsia among the hypertensive diseases in pregnancy. However, Mdm. SM did not experience any symptoms to suggest a severe preeclampsia or impending eclampsia such as headache, visual disturbances, epigastric pain, vomiting, liver tenderness. The urine dipstick for albumin is not the best way to detect proteinuria required for the diagnosis of preeclampsia 3 and is usually only used for screening, but as the blood pressure and urine albumin were persistently elevated, it is better to err on the side of caution and treat Mdm. SM as such since patients with relatively mild preeclampsia can rapidly progress into severe disease 1. Following the repeated positive detection of urine albumin of only 1+, more definitive tests should be performed to better quantify her proteinuria 2,3. Differential Diagnosis Pregnancy-induced hypertension, late onset As Mdm. SM has been compliant to her antenatal follow-ups and did not have elevated blood pressure detected at any time before 36 weeks of gestation, it is likely that she has developed the onset of a hypertensive disease in pregnancy and it appears to be of late onset as it developed only after 32 weeks gestation. However, as subsequent visits showed urine dipstick albumin of 1+, indicating the onset of proteinuria (although poor predictive value and not as significant as 2+) 3, it might prove wiser to be more vigilant and assume that Mdm. SM does indeed have preeclampsia as it would be foolish to dismiss these warning features despite the fact that she does not demonstrate any suggestive symptoms because it is possible that even patients with no prodromal signs may suddenly progress into eclampsia 1,3. Essential hypertension in pregnancy with superimposed preeclampsia Another possibility that we may entertain is that Mdm. SM has had previously undiagnosed essential hypertension with currently superimposed preeclampsia. However, this seems rather unlikely. Firstly, Mdm. SM is young at the age of 30 and unlikely to suffer from essential hypertension as this disease common presents after the age of 40. Secondly, at no time throughout antenatal follow-up did she have elevated blood pressure recorded before that particular visit at 36 weeks of gestation. However, following delivery of her infant, she should have her blood pressure rechecked during postnatal follow-up care at 6 to 12 weeks post-delivery. If her blood pressure if still elevated at that time, then it will be more likely that she has essential hypertension. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 5) IDENTIFY AND PRIORITISE THE PROBLEMS 1. Elevated blood pressure and its implications in pregnancy Mdm. SM has newly discovered elevated blood pressure at 36 weeks of gestation. This is considered late onset but is not uncommon, and gives rise to a spectrum of hypertensive disorders in pregnancy. While it seems that at first she has gestational hypertension, the mildest of the disease spectrum, she demonstrated proteinuria on her subsequent antenatal visit, therefore concluding that she has preeclampsia. Hypertensive disorders in pregnancy have the potential to put both mother and infant at increased risk of mortality. Its complications are elaborated below. During admission, Mdm. SM should be monitored for any change in her condition as she may quickly progress into severe disease states and this would require urgent intervention, the most definitive being the delivery of the infant. Ward management includes close observation of both mother and infant, and medication to control the elevated blood pressure. 2. Induction of labour in view of preeclampsia at term Termination of the pregnancy is the only definitive sure for preeclampsia. On presentation, Mdm. SM has features categorized as mild preeclampsia. Normally, severe preeclampsia would dictate the need for antihypertensive and anticonvulsive therapy followed by subsequent delivery and symptoms such as headache, epigastric pain, and visual disturbances may indicate this. The fetal age is usually an important deciding factor when it comes to inducing labour as the treatment goals seek the best outcome for both mother and infant. As Mdm. SM is already at term and there have been no issues previously detected regarding the health of her fetus, it should be safe to proceed with induction of labour. There is also no reason to prolong the pregnancy as the risk of eclampsia increases. If for any reason an obstetric reason arises e.g. fetal distress, delivery should proceed via caesaren section. 3. Impending eclampsia and other potential complications Warning signs and symptoms of impending eclampsia or severe preeclampsia include headache, visual disturbances, epigastric pain, reduced urine output, edema and ultimately, convulsions. These symptoms should be recognized early so the necessary intervention can take place. Seizures increase the risk of maternal and perinatal morbidity and mortality rates. Some maternal complications are placenta abruption, neurological deficits, aspiration pneumonia, pulmonary edema, cardiopulmonary arrest, and acute renal failure. Other major complications that may occur as a result of severe preeclampsia are HELLP syndrome, pulmonary embolism and stroke. Fetal complications include growth restriction, fetal distress, and death. 4. Risk of post-partum eclampsia It is possible for eclampsia to occur in the postpartum period especially when the patient has reached term. In such cases, up to 44% of eclampsia occurs postpartum 3. As the risk is quite high, Mdm. SM should continue to be monitored in the ward for the development of any signs and symptoms. As she is comfortable and relatively symptom free while in the ward, it appears unlikely that she may worsen into an eclamptic state but the risk should not be afforded. As there are no guidelines to suggest an optimum postpartum inward observation period, it would depend on her clinical situation during the subsequent days following her delivery. 5. Hypertension in pregnancy and its long term implications As Mdm. SM has developed preeclampsia during this pregnancy, she is at increased risk to develop hypertensive or metabolic complications in future pregnancies. The risk of recurrence is generally higher in earlier onset preeclampsia. At the same time, she should be evaluated in the postpartum period for the possibility of essential hypertension at the 6 week postnatal review. Also, women with preeclampsia are at an increased risk for developing hypertension, diabetes, hyperlipidemia, chronic renal disease, stroke and ischemic heart disease. Mdm. SM should be made aware of all these implications and should be educated on how she can prevent these via the modification of her lifestyle. She should also be advised to attend preconceptual counseling in the event of a future pregnancy and to come early for booking. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS 1. Urine Dipstick for Albumin To look for the presence of albumin in the urine firstly, to confirm proteinuria, and secondly, to evaluate the severity of the preeclampsia. Urine dipstick for albumin should be repeated daily in the ward. Also, if in doubt, further investigation to quantify proteinuria can be done e.g. urine protein/creatinine spot test 2,3. Results: Urine dipstick albumin on admission was trace. Results at KKSR showed 1+. Interpretation: This result could be due to the fact that the blood pressure has lowered as Mdm. SM has been started on methyldopa and her blood pressure is under control. This does not mean that she no longer has preeclampsia. She should be checked daily for any changes in both blood pressure and proteinuria. 2. Full Blood Count To look for anemia which may require correction, haemoconcentration which may indicate severe preeclampsia 1, and platelet levels as HELLP syndrome is a complication that may arise in preeclampsia. This may also serve as baseline in case operative procedures are required. Result: TWBC 12.0 x109/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ (neutrophils 8.20, lymphocytes 2.70) Hemoglobin 10.7 g/dL à ¢Ã¢â‚¬  Ã¢â‚¬Å" Hematocrit 32.3% à ¢Ã¢â‚¬  Ã¢â‚¬Å" Platelets 354 x 109/L Interpretation: The total white cell count is slightly raised, but this is to be expected in pregnancy. The hemoglobin is slightly low but this is also expected in pregnancy and should be monitored especially if the patient requires surgery or experiences anemic symptoms. There is no haemoconcentration and the platelets are normal. 3. Prothrombin Time, INR, Activated Partial Thromboplastin Time (PT/INR/APTT) To obtain a baseline of the coagulation profile in case operative procedures are required and also to look for potential coagulopathy as it is a possible complication of preeclampsia. Result: PT 12.3s INR 1.05 APTT 39.6s Interpretation: PT/INR/APTT is within normal range. Coagulopathy appears unlikely in Mdm. SM given that her platelets are also normal and her preeclampsia is not severe. 4. Renal Profile To assess renal functions to look for elevation of creatinine as that would indicate severe preeclampsia and also to detect acute renal failure which is associated with increased risk of HELLP syndrome, placenta abruption and postpartum hemorrhage 1. Result: Urea 1.3mmol/L Sodium 140mmol/L Potassium 3.7mmol/L Creatinine 51 µmol/L Interpretation: Mdm. SM renal profile is normal and creatinine is not elevated, adding to the indicators that her preeclampsia is of the mild category. Low urea levels and good urine output also rules out acute renal failure. 5. Liver Functions Test To assess liver functions and its components such as liver enzymes and bilirubin which would be raised in severe preeclampsia or HELLP syndrome in which there is hemolytic anemia and elevated liver enzymes. Result: Total protein 73g/L Albumin 33g/L Globulin 40g/L Total bilirubin 0.5mg/ml Direct bilirubin 0.2mg/ml Indirect bilirubin 0.3mg/ml ALP 121U/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ ALT 7 U/L GGT 7 U/L Interpretation: Liver enzymes (ALT) and bilirubin levels are not elevated, indicating a mild preeclampsia and no biochemical evidence of HELLP syndrome. The ALP is slightly elevated, but this could be due to compression of the gravid uterus on the hepatobiliary tree. 6. Serum Uric Acid Elevated serum uric acid is an early biochemical sign of preeclampsia 1 and may help to predict maternal complications in preeclampsia 4. Results: Serum uric acid 103 µmol/L à ¢Ã¢â‚¬  Ã¢â‚¬Å" Interpretation: Serum uric acid levels are not elevated and are in fact, slightly lowered. This result indicates low likelihood of severe preeclampsia or maternal complications. 7. Serum Lactate Dehydrogenase To check for elevated levels which should indicate hemolytic anemia, a component of HELLP syndrome. Results: Not done during this admission. 8. Cardiotocograph (CTG) Done on admission as a baseline for fetal monitoring. Results: Baseline fetal heart rate was 130 beats per minute, baseline variability was 5 10, accelerations present with no decelerations. Interpretation: CTG is reactive with no signs of any fetal compromise. CTG should be repeated following each procedure e.g. prostin insertion, AROM or if fetal compromise is suspected. 9. Transabdominal Ultrasonography This should be done to confirm fetal age, as confirmation of fetal age is important when it comes to deciding whether or not to induce labour in preeclampsia. Also to check for fetal well-being and growth restriction, but these requires repeated scans and plotting of growth chart over a period of time. Result: No ultrasonography was done during this admission. The last scan was done in Hospital Kluang before patient was transferred to HBP. The last scan reports fetal age corresponding to dates, AFI of 9, and no abnormalities detected with no mention of other findings. Interpretaion: As fetal age is corresponding to dates and there is no suggestion of fetal compromise or restriction, it is safe to proceed with induction of labour. 10. Urinalysis (UFEME) To check the levels of proteinuria which may be more quantitative than urine dipstick. Results: Leukocytes, nitrite, protein, glucose, ketone, urobilinogen, and bilirubin were not detected. Interpretation: No proteinuria was detected. This could mean that the patient does not have preeclampsia but rather gestational hypertension, or it could be undetected as the blood pressure has also become well controlled with medication. However, no risks should be taken and Mdm. SM should be closely observed in the ward. Either way, induction of labour and delivery would still be ideal for her as she has already reached term. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 7) WORKING DIAGNOSIS AND PLAN OF MANAGEMENT ON ADMISSION Working Diagnosis Induction of labour at term in view of mild preeclampsia in pregnancy Comment: As Mdm. SM has elevated blood pressure and urine dipstick albumin 1+ but has no physical or biochemical features suggestive of severe preeclampsia, the working diagnosis is mild preeclampsia. However, she should be monitored closely in the ward for any symptoms indicative of disease progression. As she has reach term, it would also be wise to induce labour in her, especially given her history of postdates as delivery would be the only definitive management in such cases. Plan of management on admission Continue T. Methyldopa 250mg 8-hourly Daily urine albumin dipstick Vital signs monitoring 4-hourly Baseline cardiotocograph on admission Fetal kick charting and Labour progress charting To notify immediately if spontaneous rupture of membranes To notify immediately if strong contractions commence Encourage orally For induction of labour with T. Prostin 1.5mg as Bishops score unfavourable To notify immediately if any symptoms occur STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 8) SUMMARY OF INPATIENT PROGRESS (INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES) Throughout the first two days of admission, Mdm. SM was comfortable in the ward with no development of any symptoms of severe preeclampsia, eclampsia, or labour. Her vital signs were stable with blood pressure ranging 122-138/70-84. On the morning of the 2nd day, tablet prostin 1.5mg was inserted into her posterior fornix under aseptic technique. Cardiotocograph was reactive and vaginal examination 6 hours post-insertion showed cervical os 3cm, cervix 2cm, soft and axial, and high station. Therefore, a 2nd tablet of prostin was inserted on the morning of the 3rd day. Once again, post-insertion cardiotocograph was reactive and vaginal examination 6 hours later showed no changes to before. Mdm. SM still did not experience any signs and symptoms of labour. She also did not have any symptoms indicating progression of her preeclampsia. On the morning of the 4th day, it was decided that Mdm. SM should undergo artifical rupture of membranes (AROM) rather than have a 3rd prostin tablet inser ted. Cardiotocograph monitoring had been difficult so decision was made to insert fetal scalp electrode at the same time for internal monitoring. Following the AROM, internal monitoring revealed a drop of fetal heart rate from 130 to 100 beats per minute with no accelerations. Cervical os was still 3cm with no symptoms of labour. Decision was made to proceed with emergency lower section caesarean section (ELSCS) under general anaesthesia and Mdm. SM gave her consent. Via ELSCS, a healthy baby boy was delivered weighing 2.9kg with Apgar score of 91105. There were no intra or post-operative complications. Post-operative medications given include IV ampicillin 500mg QID, subcutaneous heparin 5000 units BD, IV pitocin 40 units QID, IM pethidine 50mg PRN, Tab. paracetamol 1g QID and Tab. Mefenemic acid 500mg TDS. Throughout the next 2 days, Mdm. SM was comfortable in the ward and had mild operative site pain with no other symptoms and vital signs were stable. All medications except analg esia were stopped. She was ambulating well, tolerating orally and had passed urine and motion by the 5th day. As for the baby, breastfeeding had commenced and he had also passed urine and motion. The uterus was well contracted at 22 weeks size and dressing was not soaked. Inspection of the wound on the 6th day revealed a clean and non-gaping wound. She was counseled on contraception and indicated a preference for intrauterine contraceptive device. As she was well, she was discharged with appointment to return to postnatal clinic at KKSR to review her blood pressure and operative wound in 1 weeks time. On discharge, her blood pressure was 140/70mmHg and urine dipstick albumin was trace. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 9) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTION Discharge Plan Tab. Mefenemic acid 500mg TDS PRN Tab. Paracetamol 1g QID PRN Follow-up appointment at Klinik Kesihatan Simpang Renggam (KKSR) Postnatal clinic in 1 week to review blood pressure and operative wound. Follow-up appointment at KKSR in 6 weeks for review, cervical smear, and contraception. Counseling Advised to return immediately to the hospital if Mdm. SM has problems with the caesarean wound e.g. pain, discharge or if she develops any new or worrying symptoms. Advised on the need to be compliant to postnatal follow-up to review Mdm. SMs condition. Advised for cervical smear during postnatal follow-up as previously never done. Counseling regarding breastfeeding and contraception. Explain about the nature of pregnancy-related hypertensive disorders and its long term implications. Advised to attend antenatal clinic for preconceptual counseling if future pregnancy is desired, or to come for booking immediately once discovered to be pregnant. Advised to observe a healthy lifestyle in order to prevent development of conditions such as hypertension and diabetes. Mock Prescription Tab. Paracetamol 1g QID PRN x 1/52 Tab. Mefenemic acid 500mg TDS x 1/52 STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 10) REFERRAL LETTER (IF APPLICABLE) Medical Officer, Postnatal Clinic, Klinik Kesihatan Simpang Renggam, 86200, Simpang Renggam. 20th June 2010 Mdm. SM (IC.800318015794) Date of admission: 20th June 2010, Date of discharge: 25th June 2010 Problem: Late onset hypertensive disease in pregnancy Dear medical officer, Mdm. SM is a 30-year-old Malay lady of parity 4+1 who was diagnosed to have preeclampsia at 36 weeks of gestation during routine antenatal follow-up at your centre. During admission to our ward, she underwent induction of labour with tablet prostin and artificial rupture of membranes. However, fetal distress developed, picked up on internal monitoring and Mdm. SM underwent emergency lower section caesarean section under general anaesthesia. She delivered a healthy baby boy (2.9kg, Apgar 91105) with no complications intra- and post-operatively. We are discharging her into your care. Please review her blood pressure as scheduled and also offer contraception and cervical smear as previously never done. She has indicated preference for intrauterine contraceptive device. Do not hesitate to contact us immediately should the need arise. Thank you very much for your attention. Yours sincerely, Paul Kong Fu-Xiang (Final year medical student, IMU), Department of Obstetrics Gynaecology, Hospital Batu Pahat. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 11) LEARNING ISSUES IN THE 8 IMU OUTCOMES 1. Disease prevention and health promotion Hypertensive disorders in pregnancy are one of the most common antenatal problems and eclampsia is a major source of maternal mortality. What are the ways in which some element of prevention can be instituted or to decrease the severity of preeclampsia? There haven been certain strategies touted to prevent or modify the severity of preeclampsia. These are categorized as dietary supplements, antihypertensive medications, antioxidants, and antithrombotic agents 5. As low salt diet is one of the recommended dietary changes for hypertensive patients, De Snoo et al 1 was one of the earliest researchers to study the effects of low salt diet in preventing preeclampsia but this practice was discarded as it yielded no significant change. Knuist et al performed a randomized controlled trial in 1998 and they reported that despite helping control blood pressure in non-pregnant individuals, a sodium-restricted diet was ineffective in 361 women in terms of prevention of preeclampsia 6. The dietary supplementation of calcium of at least 1 gram per day is recommended as class I-A evidence 2. Several studies showed that women with low calcium diets were at significantly increased risk of gestational hypertension 7,8,9. Levine et al performed a large , randomized-controlled trial and they found that there was no significant difference in outcome with calcium supplements versus placebos 10. This suggests that unless a pregnant woman has a low calcium intake, calcium supplements may have no added benefit 5. With regards to fish oil supplements and its cardioprotective fatty a

African Americans role of Television Essay -- essays papers

African Americans role of Television The roles African Americans play on television are not satisfactory. Though the roles have changed during the development of television, the current relationship is not representative of true African American people or their lifestyles. The question is how do the past roles African Americans play in television sitcoms compare to the current roles? How does this affect society’s perception of the African American in American culture? Throughout the history of television the roles and the representation of African Americans has developed with the changing cultural conditions. However, the representation of African American’s has not fully simulated into today’s society. What the average citizen views on his or her television does not accurately portray the African American’s influence on America. The early days of television held great optimism and hope for this new form of media as an avenue for African Americans to assimilate into white American culture. However, a pattern became evident, a pattern of type casting African Americans in roles which did not accurately and wholly portray the individual. A misrepresentation of African Americans became the common image on television. Variety shows initially promoted the new media as an opportunity for equal representation and communication between the races. However, a trend developed with African Americans often being â€Å"portrayed as custodians, maids, servants, clowns, or buffoons† (Crenshaw). The negative image, which was developed by these stereotypes, was perpetuated in the Amos and Andy Show. This television show began as a radio show featuring two white men portraying two comedic black men. When the show was transferred to television, two African American men were cast in the roles, acting as buffoons. The popularity of the show was overwhelming. This was the initial image of African Americans in television, which reached mainstreams Caucasian America and was the foundation for which future stereotypes were created. A new image of African American families was presented in the eighty’s with the Cosby Show. The Huxtable’s were a successful African American family with a life similar to the accepted and established Caucasian mainstream. This show was not accepted fully because it failed to represent the full cultural scope of African Americans. The current... ...After giving the presentation there were many different views coming from the audience which were not expected. The audience did not hold the same views presented to them. The point addressed was about how Will Smith was the buffoon on The Fresh Prince of Bel Air. They did not feel Will Smith was acting buffoonish, they thought he just brought comedy to the show. The audience seemed to focus on black people acting white rather than black people acting ignorant. They brought up the character Carlton, and how he acted white. When asked the question how they knew he was acting white they said he went to an all white school and was influenced by the way they acted. The audience also said Will criticized Carlton for acting white. They excused Will's buffoonish actions by saying white people were also made fun of through Carlton's character. This brings up the question how do we know what is characterized as acting "black" or acting "white", and what makes a show a "black" show or a " white" show. Again these questions revert back to the fact television shows have embedded stereotypes in our society. This makes people believe there must be a typical "black" person and "white" person.

Achiles’ Shield in the Iliad Essay -- Literature Art War Papers

Achiles’ Shield as an Element of Contradistinction in the Iliad The Iliad is an epic of death. It is a tale of conflict, battle, agony, and horrific mutilation. Honor and glory are attained through warfare. The great shield of Achiles stands out in this context because it depicts the glories of an orderly, functioning, productive civilization. This depiction of life stands in stark contrast to the scenes of death that constitute a large portion of the narrative. An examination of the shield of Achiles in Homer’s Iliad reveals many ideas in conflict: love and honor, the pleasures of life versus a heroic death, free will and destiny. By viewing the shield as an element of contradistinction—that is to define it on the basis of contrast—one can see that the shield symbollicaly unifies the entire poem. Achiles’ shield is the mechanism through which the poet presents a tool of warfare as a reflection of civilization; explores the concept, structure, and nature of the universe; and examines the role of art in society. I. A Reflection of Civlization on a Tool of Warfare In the epic tradtion, the arming of wariors for batle holds particular significance. The description of a warior’s armor tels much about the individual character of the warior and about the values of the society of which he is part. The Iliad contains many such arming scenes which take the simple description of armor and transform it into a more expansive and iluminating portrait of ancient Greek mentality. When compared with one another, these descriptions of armor reveal some basic distinctions that make the shield of Achiles of utmost importance. As noted by Atchity in Homer’s Iliad: The Shield of Memory, the armor of Paris is described in book thre... ...contradictions. Art is the medium through which humans explore life’s great questions and test its boundaries. Armed with the belief that ordered civlization will prevail, the artist—poet, metalworker, painter, actor—is free to enter into the batlle of ideals. Works Cited Atchity, Kenneth John. Homer’s Iliad: The Shield of Memory. Carbondale, IL: Southern Ilinois Univ., 1978. Becker, Andrew Sprague. The Shield of Achiles and the Poetics of Ekphrasis. Lanham, MD: Rowman & Litlefield, 1995. Duethorn, Guenter A. Achiles’ Shield and the Structure of the Iliad. Amherst, MA: Amherst Colege, 1962. Edwards, Mark W. The Iliad: A Commentary. Vol. V: books 17–20. G.S. Kirk gen. ed. Cambridge, MA: 1995. Homer. The Iliad. Trans. Richmond Latimore. Chicago: Univ. of Chicago, 1961. Keats, John. â€Å"Ode to a Grecian Urn.† 4 Oct. 2003 < htp://www.poets.org/poems/>.

John Cena

John Felix Anthony Cena[1] (born April 23, 1977)[4] is an American professional wrestler and actor. He is currently signed to WWE. [8] In WWE, Cena has won 19 championships in total, including 12 world titles (having won the WWE Championship a record 10 times[9] and the World Heavyweight Championship twice). In addition, Cena has also won the WWE United States Championship three times,[10] and is a four-time Tag Team Champion, having held the World Tag Team Championship twice (once each with Shawn Michaels and Batista),[11] and the WWE Tag Team Championship twice (once each with David Otunga and The Miz).Cena also won the 2008 Royal Rumble match, the 2012 Money in the Bank contract for the WWE Title, and is a two-time Superstar of the Year Slammy Award winner (2009 and 2010). [12] He is the longest-reigning WWE Champion of the 2000s, having held the title for 380 days from 2006-2007, and also has the fourth highest number of combined days as WWE Champion behind Bob Backlund, Hulk Hog an and Bruno Sammartino. Cena is the only man to fail to capture a world title upon cashing in a Money in the Bank contract.Cena started his professional wrestling career in 2000, wrestling for Ultimate Pro Wrestling, where he held the UPW Heavyweight Championship. In 2001, Cena signed a contract with the World Wrestling Federation (WWF) and was sent to Ohio Valley Wrestling (OVW) where he held the OVW Heavyweight Championship and the OVW Southern Tag Team Championship (with Rico Constantino). Outside of wrestling, Cena has released the rap album You Can't See Me, which debuted at No. 5 on the US Billboard 200 chart, and starred in the feature films The Marine (2006), 12 Rounds (2009), and Legendary (2010). [13] Cena has also made appearances on television shows including Manhunt, Deal or No Deal, MADtv, Saturday Night Live, Punk'd, and Psych. Cena was also a contestant on Fast Cars and Superstars: The Gillette Young Guns Celebrity Race, where he made it to the final round before be ing eliminated, placing third in the overall competition.

How to Make Apple Pie

1-1/2 to 1-3/4 pounds Cortland apples (about 4 medium) 1 pound Granny Smith apples (about 2-1/2 medium) 2 teaspoons fresh lemon juice 2/3 cup packed light brown sugar 1/4 cup plus 1 tablespoon granulated sugar 3 tablespoons cornstarch 1/2 teaspoon ground cinnamon; more to taste 1/4 teaspoon kosher salt 1/8 teaspoon ground nutmeg 1 large egg white 2 teaspoons unsalted butter, softened, plus 1 tablespoon cold unsalted butter, cut into small (1/4-inch) cubes 4 to 6 tablespoons all-purpose flour 2 refrigerated piecrusts (or make your own with the Flaky Pie Pastry recipe at the bottom of the page) directionsPosition two oven racks in the lower third of the oven and heat the oven to 400 degrees F. To make the filling: Peel the apples, cut each in half from top to bottom, remove the cores with a melon baller, and trim the ends with a paring knife. Lay the apples, cut side down, on a cutting board. Cut the Cortland apples crosswise into 3/4-inch pieces, and then halve each piece diagonally. Cut the Granny Smith apples crosswise into 1/4-inch slices, leaving them whole. Put the apples in a large bowl and toss with the lemon juice.Combine the brown sugar, 1/4 cup of the granulated sugar, the cornstarch, cinnamon, kosher salt, and nutmeg in a small bowl. (Don't add this to the fruit yet. ) In a small dish, lightly beat the egg white with 1 teaspoon water. Set aside. Assemble the pie: Butter a 9-inch ovenproof glass (Pyrex) pie plate, including the rim, with the 2 teaspoons of softened butter. Rub 2 to 3 tablespoons of flour into the surface of a pastry cloth, forming a circle about 15 inches across, and also into a rolling pin stocking. If you don't have a pastry cloth, rub the flour into a large, smooth-weave, cotton kitchen towel and use a floured rolling pin.Roll one of the disks of dough into a circle that's 1/8 inch thick and about 15 inches across. Lay the rolling pin across the upper third of the dough circle; lift the pastry cloth to gently drape the dough over th e pin and then roll the pin toward you, wrapping the remaining dough loosely around it. Hold the rolling pin over the edge of the pie plate nearest to you. Allowing for about a 1-inch overhang, unroll the dough away from you, easing it into the contours of the pan. If the dough isn't centered in the pan, gently adjust it and then lightly press it into the pan.Take care not to stretch the dough. If it tears, simply press it back together — the dough is quite forgiving. Brush the bottom and sides of the dough with a light coating of the egg-white wash (you won't need all of it). Leaving a 1/4-inch overhang, cut around the edge of the dough with kitchen shears. Combine the sugar mixture with the apples and toss to coat well. Mound the apples in the pie plate, rearranging the fruit as needed to make the pile compact. Dot the apples with the 1 tablespoon cold butter cubes. Rub 2 to 3 tablespoons flour into the surface of the pastry cloth and stocking.Roll the remaining dough into a circle that's 1/8 inch thick and about 15 inches across. Use the rolling pin to move the dough. As you unroll the dough, center it on top of the apples. Place your hands on either side of the top crust of the pie and ease the dough toward the center, giving the dough plenty of slack. Leaving a 3/4-inch overhang, trim the top layer of dough around the rim of the pie plate. Fold the top layer of dough under the bottom layer, tucking the two layers of dough together. Press a lightly floured fork around the edge of the dough to seal it or flute the edge of the dough with lightly floured fingers.Lightly brush the top with cold water and sprinkle the surface with the remaining 1 tablespoon sugar. Make steam vents in the dough by poking the tip of a paring knife through it in a few places; it's important to vent well so that the steam from the cooking apples won't build up and crack the top of the crust. To bake the pie, cover the rim of the pie with aluminum foil bands. This will preven t the edge of the crust from overbrowning. Place a rimmed baking sheet or an aluminum foil drip pan on the oven rack below the pie to catch any juices that overflow during baking.Set the pie on the rack above. Bake the pie until the top and bottom crusts are golden brown and the juices are bubbling, 60 to 75 minutes (to thicken, the juices must boil, so look for the bubbles through the steam vents or through cracks near the edges of the pie and listen for the sound of bubbling juices). During the last 5 minutes of baking, remove the foil bands from the edges of the pie. Cool the pie at least 3 hours and up to overnight before serving. Here are 20 of the Web's best apple pie recipes, along with a recipe for homemade piecrust. ltimate apple pie Cooking the apples separately before adding them to the crust keeps it from getting soggy, making this classic dessert especially good. See the recipe ;; crunchy caramel apple pie Go ahead, indulge. This apple pie features a crumb topping sprin kled with pecans and drizzled with caramel ice cream topping. See the recipe ;; no-peel apple pie How easy can pie get and still be glorious? Skip peeling the apples and use refrigerated piecrusts in a clever, simple recipe for fresh-baked pie. See the recipe ;; autumn apple pieTwo seasonal fruits in one luscious dessert: This two-crust pie is filled to the brim with an apple-cinnamon filling dotted with dried cranberries. See the recipe ;; mile-high apple pie Loaded with juicy apples, this luscious dessert recipe is drizzled with a gooey caramel topping. See the recipe ;; caramel apple cheesecake pie Caramel ice cream topping and toasted pecans add a touch of luxury to this luscious two-layer dessert. See the recipe ;; berry-apple fantasy pie Especially for fruit lovers: This golden, two-crust pie oozes with apples and fresh berries. See the recipe ;; asy apple pie calzones Serve this spiced apple-filled dessert calzone with a scoop of vanilla ice cream. See the recipe ;; triple-a apple pie Apples, Anjou pears, and apricots are the A? s that make this apple pie a knockout. See the recipe ;; rum-raisin apple pie Take apple pie in a whole new direction by adding brandy and raisins to this perennial holiday favorite. See the recipe ;; upside-down apple pie This gooey-good apple pie is hard to pass up. Serve for dessert with rich whipped cream or vanilla ice cream. See the recipe ;; apple-cherry pie Apple pie or cherry pie? No need to decide.This fruit pie recipe combines the best of both. See the recipe ;; apple-cranberry pie Saute the apples, spices, and cranberries in butter, and then put them in the pastry to make this delicious double-crust pie. See the recipe ;; apple-maple cream pie Fold in maple syrup and whipping cream with the apples to add a delicious twist to this dessert. See the recipe ;; dried apple cider pie The dried apples in this yummy dessert save you time because there's no peeling needed. See the recipe >> apple mincemeat pie Delicious fall flavors make this old-fashioned pie a holiday tradition in many families.At the grocery store, look for jars of mincemeat (no actual meat included, just fruit and spices) near the pie fillings during the holiday baking season. See the recipe >> cheesy apple pie There's rich cheddar cheese in both the pastry and topping of this tangy, out-of-the-ordinary apple pie recipe. See the recipe ;; perfect ending apple praline pie After this traditional pie is golden brown, top it with an oh-so-sweet pecan glaze for a dessert that is simply irresistible. See the recipe ;; apple-cranberry-hazelnut pie Hazelnuts in the pastry and the crumb topping add elegance to this mouthwatering apple pie.See the recipe ;; oatmeal-nut crunch apple pie This decadent pie is loaded with juicy apples and adorned with a streusel-lover's crunchy topping. See the recipe >> FLAKY PIE PASTRY ingredients 10-1/2 ounces (2-1/3 cups) unbleached all-purpose flour 1 tablespoon granulated sugar 3/4 teaspoon salt 1/2 teaspoo n baking powder 4 ounces (1/2 cup) chilled, unsalted butter, cut into 1/2-inch cubes 4 ounces (1/2 cup) chilled vegetable shortening, cut into 1/2-inch pieces 5 to 6 tablespoons ice water; more as needed directions In a large bowl combine the flour, sugar, salt, and baking powder.Chill for 20 to 30 minutes. Place the flour mixture in a food processor fitted with a steel blade. Pulse the dry ingredients together for a few seconds to blend. With the processor off, add half of the butter and half of the shortening. Pulse 5 times and then process for 5 seconds. Add the remaining butter and shortening and pulse again 5 times, then process for 5 seconds. You should have a mixture of both large and small crumbs. Empty the mixture into a large mixing bowl. Drizzle 1 tablespoon of the ice water around the edge of the bowl, letting it trickle into the crumbs.Flick the moistened crumbs toward the center with a table fork, rotating the bowl as you work. Repeat with the remaining 4 tablespoons i ce water, 1 tablespoon at a time. As you add the water, the crumbs should begin to form larger clusters. Once you've added 5 tablespoons water total, take a handful of crumbs and squeeze them gently; they should hold together. If they easily break apart, the mixture needs more water. Add the remaining tablespoon, 1 teaspoon at a time, checking the consistency after each addition. If the crumbs still fail to hold together, you can add additional water, but do so sparingly.Gather a handful of the crumbly dough and press it against the side of the bowl to form a small mass, flouring your hand as needed to prevent excessive sticking. Increase the size of this mass by pressing it into more of the crumbly mixture until you've used up about half of the total mixture in the bowl. Make a second mass of dough with the remaining crumbs. If some of the crumbs on the bottom of the bowl need more moistening, add a few drops of water. Form the two masses of dough into balls, dust them with flour, and flatten them into 4- to 5-inch disks. Pat the disks to release any excess flour.Score the tops lightly with the side of your hand to create a tic-tac-toe pattern. With cupped hands, rotate each disk on the work surface to smooth the edges of the disks. Wrap each in plastic wrap. our recipe partners EatingWell delivers delicious, healthful recipes, cooking how-to and nutrition news for people who are passionate about great-tasting food and lifelong healthy eating. EatingWell With a unique perspective on how Americans eat and cook, this chef believes uncomplicated recipes, bright flavors, and fresh food come from â€Å"real kitchens† dedicated to culinary honesty.Tyler Florence see all recipe partners Comments (0) your comment: You must be logged in to leave a comment. Register | Log In more smart savings Silver & Gold Heart within a Heart What a romantic Necklace for your special Sweetheart! Matching earrings also available. crazy4bling. com Privacy VSW FeatureLink free re cipe collections Delicious Chicken Salad Recipes Our Best Grilled Pork Chops Recipes Irresistible Cupcake Recipes Potato Salad Recipe Ideas Best-Ever Burger Recipes

Analysis of The Notebook Essay

The Notebook begins at a nursing home where an elderly man called â€Å"Duke† reads a love story that is written in a notebook to an elderly woman who is also a patient. The story is set in Seabrook Island, South Carolina where a local boy by the name of Noah Calhoun falls in love with a young heiress named Allie Hamilton. In order to get her to go on a date with him, Noah climbs up a Ferris wheel at the local carnival and threatens to jump off unless she agrees to go out with him. Their first date is at the movies and ends with the two dancing in the street. The end of their date leads into a beautiful summer love affair where the two fall deeply in love with each other. Allies parents are dead set against the two young people being together; this is mainly due to Noah’s status (being poor) in the world. Eventually the two break-up and Allie returns home to Charleston with her parents. Even though the two are apart they are still very much in love with each other. Noah writes a letter to Allie every day for one year; unfortunately Allies mother intercepts the letters and does not give them to her daughter. Since neither one hears from the other they decide that they have no choice but to move on. Noah goes on to fight in World War II, while Allie goes on to college and then volunteers as a nurse who cares for wounded soldiers. During her time as a volunteer Allie meets Lon; a young lawyer who comes from old money. The two date for a while and then one night while out with her parents Lon proposes to Allie and she accepts. Even though she is engaged to someone else Allie still thinks about Noah. In the meantime Noah returns home from the war and sees Allie eating at a restaurant with Lon and catches the two of them kissing. Noah decides to go back home and restore the plantations house, thinking that if he can finish it then Allie will eventually come back to him. One day while searching for her wedding dress Allie sees a picture of Noah and the finished house in the paper. Allie decides that she must go back and see Noah. Upon her arrival the two talk for a while and then eat dinner. L ater the next day he takes Allie for a boat ride out on the river and shows her the swans. On the way back it is storming and Allie finally asks Noah why he never wrote to her. Here she finds out that Noah did in fact write to her and after arguing for a while the two ends up making love. The next day Allies mother  shows up and gives her the letters that Noah had written all those years ago and tells her that she needs to make a choice. Eventually Allie chooses Noah and she breaks off her engagement with Lon. In the present we find that â€Å"Duke† is actually Noah and the elderly woman is Allie. The two have been married happily all of these years. The reason that Noah has been reading this notebook love story to her is because Allie has dementia and at times his retelling her the story helps her to remember. At the very end of the movie Allie asks Noah if he thinks that their love is strong enough to take them away together, meaning die together. He believes that it is and the two lie down on the bed wrapped in each other’s arms and die peacefully. I found this movie to be very touching, sad, and happy all at the same time. The way the tw o loved each other so fully and completely through everything is something that I believe is clearly lacking in today’s world. Through most of the movie we find Allie holding her emotions in, fearful of hurting those that she cares about. We can see this when she finally concedes to her parents’ wishes and moves back to Charleston. We also see this when she accepts Lon’s proposal, not just because she cares and loves him, but because he is what her parents would have chosen (and approved of) for her. Another major place where we see this is towards the end when she is trying to make her decision on whom to be with. In each instance we find her extremely fearful of expressing her emotions. Another issue that we see through the movie is inadequate interpersonal skills. This is one of the hardest communication obstacles to overcome. This is because many people simple do not know how to express their emotions. While this can be seen with all the arguing that occurs between Noah and Allie; we also see it more subtly with Allie and her mother. This is because Allie and her mother never simply sit dow n and talk to each other about the issue of the relationship between Noah and Allie. Instead of explaining to Allie from the beginning how she felt and why she felt that way about the relationship she instead decided to yell and hide the letters that Noah had written. Had the two learned to communicate better from the beginning it would have saved a lot of heartache. Through this movie we can also see the Socialization Theory at work. This theory talks about the different ways that men and women are taught to express their emotions. During this movie we see Allie’s mother hold her emotions in when it comes to anything other than he  daughter’s actions. Anne is what would be considered the perfect southern woman. She does not express any negative emotions in public setting; instead she keeps them to herself. We can also see this with her father and how he ever so eloquently addresses Noah and his unhappiness with him seeing his daughter. In both respects Allies parents act emotionally how the upper class of southern society would expected to. This movie shows every aspect of a relationship, from the good to the bad. It shows that no relationship is perfect; they all have their ups and there downs. While many different elements of em otional communication can be seen, for me the concepts of fear, inadequate interpersonal skills and the socialization theory are the most appropriate. I believe that this movie can teach all people something about relationships.