You Shall Know Our Velocity by Dave Eggers Essay Example for Free

You Shall Know Our Velocity by Dave Eggers EssayEvery person undergoes difficulty in life. Experiences in life may cause troubles in our way of thinking and sometimes even affects our principles. In the novel, You Shall Know Our Velocity by Dave Eggers, the char moer of allow for Chmlielewski experienced difficulty in the form of losing his friend (Jack) and being beaten. He intended to help Jack with the large amount of m one(a)y that he got only when no avail. It was hard not to be able to do something to avoid the death of a friend especially when you are very much impart to do anything in your power to shun it. Nobody couldnt blame result for feeling lost and hurt. Because of his hurt and disappointment, he felt that the money in his hands was a burden that he had to get rid of it as quick as he possible.Will together with his other friend tidy sum went to different countries to give away the money supposedly intended to save their friend Jack. They thought that when th ey give away the money to people who motivating it, they will somehow help in restoring hope to peoples perception. The two realized along the way that it is not easy to give away except like that. People have to earn their blessings or the help that they receive. Both the giver and the receiver should exert effort in achieving humanity. If people like Will and Hand will just give away money without any particular reason or purpose, there is a very huge opening night that others may take advantage of them or worse, even rob them.In real life, it feels good to be able to help without anything in return. However, even with the purest intentions, one should always be on the look out against abusive people. The effort of generosity and humanity might be put to waste if people who need it dont receive it because of the people who take advantage of it. There is no doubt that everybody needs help in one way or another. Not all help are material in nature some need emotional help. So wha t should be done to make original that the one that youre helping deserves your care? The simple answer is let him earn it. Earning it has different ways. May it be proving that he is trustworthy or screening his sincerity.The novel is a fiction. Nevertheless, the gestures of Will and Hand in the novel would bring relief to a lot of people if they were true. Some may find their workings crazy, only when its touching. They didnt contain themselves in rendering help only in their town. They rather took time to travel around the world to circle it. The amount of money that they were giving away isnt an issue.Whats important is the message that they trying to convey by their actions. No matter how desperate and heartsick you are, your unpleasant experiences shouldnt be a hindrance in the distribution of happiness, hope and love. Ones own frustrations, desperations and sorrows may become a marionette in getting over the same things. Its just a matter of seeing the light side of i t. When you know that it is difficult to be unhappy, package happiness. Eventually, you yourself will feel grace.People have different ways in comforting themselves and getting out of a difficult situation. Some people act crazy, some stay inside their rooms and mourns until they dry their tears from crying and some focus their attention to something that will keep them busy. Will and Hand chose to be crazy but humane. Their means may look crazy but their intention is good. They give relief to peoples misery and needs which in turn give them satisfaction and medium to get rid of their sorrow.The meaning of the novel is very deep. The characters and gestures of Will and Hand may seem comical satires but a close look at their temperaments shows good heart. Their adventures different cultures and how they managed to get along with them even with their ignorance. Ultimately, the author wants to show that even in a young time like ours, humanity is still alive.

Student Essay Example for Free

Student EssayDiversityrefers to the differences between individuals. plenty differ on every last(predicate) kinds of aspects, both visible and non-visible. Examples of differences are gender, age, skills, tenure, learning styles etc. We find these differences in every workplace, though not all differences are always recognised or seen as relevant. Unity in diversityUnity in diversityis a concept of symmetry without uniformity and diversity without fragmentationthat shifts focus from unity based on a mere tolerance of physical, cultural, linguistic, social, religious, political, ideological and/orpsychologicaldifferences towards a more complex unity based on an catch that difference enriches human interactions. The concept of unity in diversity was used in non-Western cultures such as indigenous peoples in North America and Taoist societies in 400-500 B. C.In premodern Western culture it has been implicit in the organic conceptions of the universe that have been manifest sinc e the ancient Greek and Roman civilizations through mediaeval Europe and into the Romantic era. Diversity of religion in India Throughout Indias history,There had been many religions whichreligionhas been an important part of the countrys culture. Religious diversity andreligious toleranceare both established in the country by thelawandcustom. A vast majority of Indians, (over 93%), associate themselves with a religion. According to the 2001 census,180. 5% of thepopulation of India serveHinduism. Islam(13.4%),Christianity(2. 3%),Sikhism(1. 9%),Buddhism(0. 8%) andJainism(0. 4%) are the other minor religions followed by the people of India. Languages of India TheLanguages of Indiabelong to severallanguage families, the major ones being the Aryan languages(a subbranch of Indo-European) spoken by 74% of Indians and theDravidian languagesspoken by 23% of Indians. Other languages spoken in India belong to theAustroasiatic,Tibeto-Burman, and a few minor language families andisolates. The appointed language of the Central Government ofRepublic of IndiaisStandard Hindi, whileEnglishis the secondary official language.Cuiture of India Indian cultural history spans more than 4,500 years. During theVedic tip(c. 1700500 BCE), the foundations ofHindu philosophy,mythology, andliteraturewere laid, and many beliefs and practices which still exist today, such asdharma,karma,yoga, andmok? a, were established. India is notable for itsreligious diversity, with Hinduism, Sikhism, Islam, Christianity, and Jainism among the nations major religions. The predominant religion, Hinduism, has been shaped by diverse historical schools of thought, including those of theUpanishads,theYoga Sutras, theBhaktimovement,and byBuddhist philosophy.Indiaslanguages,religions,dance,music,architecture,food, and customs differ from place to place within the country. The Indian culture, often labelled as an amalgamation of several cultures, spans across theIndian subcontinentand includes traditions th at are several millennia old. Many elements of Indias diverse cultures, such asIndian religions,yoga, and Indian cuisine, have had a profound impact across the world. expiration between Andhra Pradesh and Tamil Nadu Andhra Pradesh and Tamil Nadu are two south Indian states. Both are located in the peninsular Deccan plateau, bounded by the call for of Bengal to the east.Andhra is Indias fourth largest state by area and has the second longest coastline amongst all of the Indian states. APs capital is Hyderabad and the official language is Telugu. Tamil Nadu is the southern just about part of Indian peninsula and is the eleventh largest state by area. Since 500 BC it has been the home of the Tamil people with Chennai (Madras) is its capital city. TN is the most urbanized state in India and claims eight UNESCO World Heritage Sites. Economy In comparison to its share of population, Tamil Nadu has the highest number of enterprises in India and is the fifth largest contributor to Indias Gross home(prenominal) Product.It is responsible for the third largest Indian economy in 2008 and is also the most industrialized state in India. TN holds third position on the list of states with the most Foreign Direct Investment (FDI) approvals and has a network of over 100 industrial parks. Andhra Pradesh is called the rice bowl of India and agriculture is its main source of income, however, it is rapidly outgrowth in the fields of Information Technology and biotechnology. In terms of mineral wealth, Andhra Pradesh holds second position and accounts for one third of the total limestone reserves in the country. touristryTamil Nadu has the second largest tourism industry in India and it is growing at a rapid rate of around 16%. It is controlled by TTDC- Tamil Nadu tourism Development Corporation. TTDC promotes tourism with a taglineEnchanting Tamil Nadu. Botanical gardens in Ooty and Hogenakal Waterfall on Kaveri River are quite famous. Andhra Pradesh is famous for its religio us sites and pilgrimages. Triumala Venkateswara tabernacle, Birla Mandir, Buddha Statue on Hussain Sagar Lake and Ramappa Temple are some of its most famous tourist spots. castes THE FOUR CASTES OR JATIs in Hinduism are Brahman Kshatriya Vaishya ShudraFavourite Indian Cuisine, Popular Foods of the People 1 Andhra PradeshYou will love Andhra Pradesh especially if you like spices and chillies. This food is consumed in regions where most people are vegetarians. They had to invent delicious foods to be able to fence with their self imposed condition. eg- Hyderabadi Biryani, Mirchi salan, Ghongura pickle, Korikoora. 2 GoaGoan cuisine comes from the region of Goa. The actual region is located on the Arabian Sea coast. Its main influences are Hindu, Portuguese and true contemporary techniques. The cuisine is intensely sea food based. The Kingfish is the symbol of the Goan cuisine.

Should Courts Grant Conscientious Exemptions?

Should Courts Grant Conscientious Exemptions?Should Courts Grant Conscientious Exemptions from Equality Laws as Judicial Remedy?Freedom of scruples and faith is a fundamental responsibility as stated in member 9 of the European convening on Human Rights1. The key issue here is that in that location is no explicit reference to conscientious objection, which leads to a clash of ideals between freedom of thought, conscience and religion which may lead to individuals be permitted to discriminate against others and the article of belief of equality, which nominate only be dealt with via conscientious exemptions granted by the court. Therefore the purpose of this essay is to determine whether equality prevails over freedom of religion and whether the courts should grant conscientious exemptions from equality laws.Freedom of conscience and religion eitherows an individual to practice and change their ghostlike or non-religious beliefs without interference from the government. However exercising ones right to manifest their religion or belief can overstep the mark and be inappropriate, an example being the part of leeward v McArthur2. In this fictional character, the appellants were appealing an earlier ruling which stated that the appellants directly discriminated against a guest by non supplying a cake deco wanderd with the message support gay marriage. The court upheld the original decision and gave the ruling that the bakery did in fact directly discriminate against the customer as it was a case of association with the gay and bisexual community and the protected characteristic was the sexual orientation of the community. This was a landmark case as it featured many democratic and political principles such as the right to free speech, the right to manifest ones beliefs, and the principle of equality. The ruling also proved that, on this occasion as well as many others, equality does take precedence over freedom of conscience and religion, and that the court believed granting conscientious exemption could non be justified.The Equality Act 20103, in essence, is the statute that which places the limitations on the right to freedom of religion and one which all employers especially ones which provide goods and services moldiness(prenominal) uphold. This is where the courts must show particular care as to defining the limits of freedom of conscience and religion as they must give particular regard to the order and its aim of protecting certain characteristics from discrimination in particular, sexual orientation, and religious and non-religious beliefs. One example where equality came up against freedom of religion was in the case of manse v Bull4. This is a case where a same-sex mate were ref mappingd a double-bedded room by Christian hoteliers. The ruling given by Lords Neuberger and Hughes was that the couple were in fact directly discriminated against as he hoteliers were applying the criterion that their legal relati onship was non that of one man and one woman, a criterion that cannot be distinguished from sexual orientation. The fact that there are a number of cases with similar rulings is more evidence that freedom of religion will not be favoured above equality, suggesting that courts are unwilling to grant conscientious exemptions.Conscientious objection has been around for many a year now, as historically humanists and religious hoi polloi alike move over exercised their right to refuse war machine service at times of conscription. One of the many ways to protect freedom of conscience and religion is by the granting of conscientious exemptions, and it is also one of the many varieties of exemption that can be granted by law5. This raises the question as to why the courts have not done more to protect the right to freedom of conscience and religion and grant such exemptions from equality laws. There have been a number of cases where the courts have granted conscientious exemptions, as w ell as being opposed to it in others. The very first case where the issue of the applicability of denomination 9 (freedom of thought, conscience and religion) of the concourse to conscientious objectors was in the case of Bayatyan v Armenia6. In this particular case, a Jehovahs Witness was initially convicted of draft evasion and sentenced to prison for refusing to consummate military service for conscientious reasons, which he then appealed to the European Court of Human Rights (ECtHR). The Court noted that a shift in the interpretation of Article 9 was necessary and that, being in the situation of the applicant, Article 9 was applicable to his case. The Court also noted that, by convicting the objector, Armenia had been in violation of Article 9 of the Convention.The Ruling in the Bayatyan case was a significant step in the direction of granting conscientious exemptions in relation to the refusal of engaging in military service. However, it is still debated as to whether courts should grant conscientious exemptions in relation to non-military services. In the case of Eweida and others7, the complainants ( E, C, L and M) complained that the domestic law of the United Kingdom failed to protect their right to manifest their religion. In the applications of E and C, the complainants refused to remove their respective crosses as they were committed to their Christian faith. Their respective employers did not allow them to remain in their positions, with E not allowed to remain in her post while visibly wearing the cross, and C being moved to a different post which then ceased to exist. L was engaged by a local authority as a registrar or births, deaths and marriages. However, as a Christian, she believed same-sex civil partnerships were contrary to Gods law, and therefore refused to be designated as a registrar of civil partnerships, resulting in the loss of her job. M was employed by a private company with a policy of providing services to every bit to oppos ite-sex and same-sex couples. However M refused to commit to providing counselling to same-sex couples, resulting in disciplinary proceedings being brought against him.The ruling given in the application of Eweida was that while the employer had a true(a) aim of wishing to project a certain corporate image, the domestic courts had given it too much weight8. However in Cs case, the judgement dedicate was that interference with her freedom to manifest her religion was necessary in a democratic society and that there had been no breach of Article 99. The reason for this was that petition her to remove the cross was of a greater magnitude than that applied in respect of E, since it was for the protection of health and safety. It was also noted that hospitals were better placed to make decisions about clinical safety than a court, especially one where no direct evidence was heard. The judgement given in the case of L was that there had been no breach of Article 14 in conjunction with Article 9 of the Convention as the local authoritys policy aimed to strong the rights of others, which were protected down the stairs the convention as well as Ls right to manifest her religion10. As in the case of M, the most important factor was that the employers action was intended to secure the implementation of its policy of providing a service without discrimination. This then allowed the state authorities to benefit from a wide margin of appreciation, which was not exceeded. Therefore, the ruling was that there was no breach of Article 9, interpreted alone or in conjunction with Article 14 of the Convention11.The main issue with all applications within the particular case, as with many other cases, was striking the right equaliser between the right to manifest ones religion and providing a service equally to everyone. Brian Barry is one theorist who holds the survey that conscientious exemptions can rarely be justified and that it is hard to steer a path between the pos ition that doing (or avoiding) X is so important that all should do it, and the alternative position that people should be free to decide for themselves whether to X12. This suggests that a path must be found if freedom conscience is to be taken seriously. Even more evidence to suggest that freedom of conscience will not be taken seriously in court and that the principle of equality will always trump the freedom of thought, conscience and religion.The clash between the right to thought, conscience and religion and the principle of equality has been and will be continuing for a very long time. Early evidence suggests that equality does prevail, as domestic and European courts have shown in their judgements of many human rights cases. As with the majority of cases, the complainant is usually an employee who may have been given disciplinary action by their employer. The key issue was whether there is a fair balance in each particular case and whether or not there was a wide margin of a ppreciation. Each case has different set of facts and what must be known is the circumstances surrounding the facts of the case e.g. was there a policy within the company that restricts one to manifest their religion, can it affect the health and safety of others, and are there other colleagues who wear religious materials but were not disciplined. As courts have shown to be more towards equality, and the fact that one case is completely different to another, conscientious exemptions should not be granted as judicial remedy. However, whilst conscientious objection is as of now a right on a lower floor Article 9 of the Convention13 in relation to refusing to engage is warfare, it is still not explicitly stated so therefore such exemptions from equality laws should not be granted as judicial remedy.BibliographyCasesBayatyan v Armenia (2012) 54 EHRR 15Eweida and others v United Kingdom (2013) 57 EHRR 8Hall v Bull2013 UKSC 73Lee v McArthur 2016 NICA 39LegislationsEquality Act 2010EU Tr eatiesConvention for the Protection of Human Rights and Fundamental Freedoms (European Convention on Human Rights, as amended) (ECHR) art 9BooksB Barry, Culture and Equality (2001) 46, 50 (as cited in Yossi Nehustan, Religious Conscientious Exemptions (2011) 30 Law and Phil. 143)Journal ArticlesYossi Nehustan, Religious Conscientious Exemptions (2011) 30 Law and Phil. 1431 Convention for the Protection of Human Rights and Fundamental Freedoms (European Convention on Human Rights, as amended) (ECHR) art 92 Lee v McArthur 2016 NICA 393 Equality Act 20104 Hall v Bull2013 UKSC 735 Yossi Nehustan, Religious Conscientious Exemptions (2011) 30 Law and Phil. 1436 Bayatyan v Armenia (2012) 54 EHRR 157 Eweida and others v United Kingdom (2013) 57 EHRR 88 Eweida (n 7) 94-959 Eweida (n 7) 99-10010 Eweida (n 7) 10611 Eweida (n 7) 109-11012 B Barry, Culture and Equality (2001) 46, 50 (as cited in Yossi Nehustan, Religious Conscientious Exemptions (2011) 30 Law and Phil. 143)13 (ECHR) art 9 (n 1)A trial Fibrillation Basic PathophysiologyAtrial Fibrillation Basic Pathophysiology psychiatric hospitalAtrial fibrillation is the most common form of cardiac arrhythmia it involves the two upper chambers of the warmheartedness known as the atria. During atrial fibrillation the popular pulses generated by the sinoatrial node are overcome by the electrical pulses that are generated in the atria and pulmonary veins, which leads to irregular impulses being conducted to the ventricles, and therefore irregular heartbeats are generated.AF is identified by rapid and oscillatory waves that vary in amplitude, shape and timing instead of regular P-waves. Electrocardiograms are therefore used commonly to diagnose AF in patients.arterial Fibrillation can present asymptomatically meaning that it can present in a patient but show no symptoms, it is considered to be non life threatening in many cases although it can result in heart palpitations, fainting, chest pain and in chronic cases congestive heart failure. The risk of stroking is also change magnitude due to the fact that blood may pool and form clots in poorly contracting atria. Patients with AF are usually given blood-thinning medication such as warfarin to stop clots forming. Atrial fibrillation can occur in the absence of morphological heart disease, known as lone AF, although this only occurs in approx. 15% of cases. Commonly AF is associated with hypertension, diabetes, obesity, coronary artery disease, pulmonary disease, valvular heart disease and coronary heart failure.Basic Pathophysiology of Atrial FibrillationAtrial fibrillation usually begins with extendd premature atrial contractions (ectopic beats) progressing to brief runs of atrial fibrillation usually that are usually self-terminating, over time these episodes can increase in duration and sometimes become persistent. During this advancement structural changes in the atria occur as well as biochemical changes in the atrial myocytes. Pathophysiologi cal adaptation of the atria to fibrillation has been broadly termed remodeling. More specifically, the changes primarily affecting the surliness and electrical activity of the atrial myocytes have been termed electrophysiological remodeling.The primary change in the structure of the atria is fibrosis, which is usually considered to be due to the atrial dilation, although in some cases contractable influences and inflammation can also be a cause. In 1990 Sanfilippo stated that atrial dilation was not a consequence of AF although more recently in 2005 Osranek stated that atrial dilation was not a consequence of AF.Dilation is due to almost any structural abnormality of the heart, such as hypertension, valvular heart disease and congestive heart failure this structural abnormality causes a rise in intra-cardiac pressures. Demonstrating the strong relationship between atrial fibrillation and structural heart disease. Once dilation does occur it begins sequences of events that lead to the activation of the rein aldosterone angiotensin system and a subsequent increase in matrix metaloproteinases and disintegrin, leading(p) to remodeling of the atria and fibrosis. Fibrosis is not limited to muscle mass of the atria, it can occur in sinus node and atroventricular node also, relating to sinus node dys hightail it (sick sinus syndrome).During normal electrical conduction of the heart the SA node generates a pulse that propagates to and stimulates the muscle of the heart (myocardium), when stimulated the myocardium contracts. The order of stimulation is what causes correct contraction of the heart, allowing the heart to function correctly. During atrial fibrillation the impulse produced by the SA node is overcome by rapid electrical discharges produced in the atria and adjacent parts of the pulmonary veins. When AF progresses from paroxysmal to persistent the sources of these conflictions increase and localise in the atria.Principles of Catheterization and AblationThe fundamental aim of catheter ablation is to eliminate ectopic beats that arise most often in the pulmonary veins and less(prenominal) often in the superior vena cova and coronary sinus. This is accomplished through catheter insertion into blood veins in order to reach the heart, isolation of abnormal heart tissue and ablation of this abnormal heart tissue through the use of radiofrequency, cryoblation or high inspiration focused ultrasound.Rate guard and Rhythm ControlDespite ablative techniques and antiarrhythmic drugs available, management of common rhythm disturbance remains a problem. Rate stop is the preferred treatment for permanent atrial fibrillation and for some patients with persistent atrial fibrillation, if they are either over 65 years of age or have coronary heart disease. Rate control is usually done through the use of pharmaceutical drugs (usually beta blockers or rate limiting calcium channel blockers) in order to slow ventricular heart rate and stop the atria fr om fibrillating. Rhythm control is most commonly used for the treatment of paroxysmal atrial fibrillation and in some cases of persistent atrial fibrillation if the patient is either less than 65 years of age, has lone atrial fibrillation or congestive heart failure. Rhythm control is usually achieved through the use of either a cardioversion (electrically or pharmacological) or the use of pharmaceutical drugs (usually beta blockers) in order to maintain sinus rhythm. This treatment is needed for a chronic time in order to stop reoccurrence of atrial fibrillation. http//www.cks.nhs.uk/atrial_fibrillation/management/detailed_answers/first_or_new_presentation_of_af/rate_or_rhythm_control-391784). Atrial fibrillation is treated most commonly pharmaceutically although if the drugs cannot control the AF or if the patient is having a bragging(a) reaction to the medication, catheter ablation therapy allows for greater control of heart rate and rhythm than drug therapy although it does pr esent more risk to the patient.Radiofrequency Catheter AblationElectrically isolating arhythmogenic pectoral veins is the most important aspect of this procedure. The application of radiofrequency energy to an endocardial surface is used to cause cellular electrical destruction with the loss of cellular electrical properties, essentially the destruction of abnormal electrical activity 39,40. This technique can be enhanced through the use of larger ablation electrodes, 41-46 allowing the creation of deeper lesions. During the procedure a physician will map the area to locate abnormal electrical activity, this is facilitated through the use of electroanatomic mapping system (fig 2) allowing for better navigation when the catheter is inserted into the artery. Reported triumph of radiofrequency ablation is dependent on the severity of the condition and ranges from 65% to 85% and patients presenting with complications is 5%.cryostatCryoblationThe most used format of cryoblation is the cryoballoon approach. This involves a deflectable a deflectable over-the-wire catheter with an inner and outmost balloon inserted, allowing for anatomical variance this balloon is available in two sizes (23mm and 28mm). The guidewire is positioned in the distal part of the pulmonary vein, the deflated balloon is then progressed to the pulmonary vein ostium. Using the central balloon marker the balloon position is then estimated before inflation, once the desired position is found the balloon is inflate pressurized N20 is then delivered to the tip of the catheter via an ultrafine injection tube down a central lumen in the inner balloon, working like an elaboration chamber. Sudden expansion of the liquid gas causes evaporation and absorption of heat from tissue and low temperatures are then achieved (Approx -80dc). An closedown angiogram is then performed in the central lumen of the catheter to get wind good balloon pulmonary vein contact. Cryoblation is then started for at least five minutes under the condition that optimum pulmonary venous occlusion is achieved. The most important issue when using this technique is to establish optimum contact between the pulmonary vein antrum and the balloon.High Intensity Focused ultrasound (HIFU)High intensity ultrasound is used in percutaneous ablation of atrial fibrillation through the use of a steerable balloon catheter. The high intensity focused ultrasound balloon is positioned at the ostium of the pulmonary veins and forms a sonicating ring to ablate pulmonary vein antrum when high intensity focused ultrasound is delivered. An arrhythmia-free rate of 59%-75% was achieved by HIFU balloon in several studies investigating its effectiveness in atrial fibrillation ablation.15-17Commercially Available Devices and placementsMedtronic GENius Multichannel RF GeneratorThis reservoir is used for the creation of endocardial lesions during cardiac ablation procedures for the treatment of supraventricular arrhythmias. The g enerator delivers temperature-controlled radiofrequency energy, utilizing five radiofrequency energy mode selections bipolar only, unipolar only, and combination energy mode selections of 41, 21, and 11. This system must be used with a catheter that is single use and sold separately to the device. The generator automatically recognizes the attached cardiac Ablation Catheter and loads preset default temperature, time, and energy mode setting parameters. Ablation parameters such as ablation duration, energy mode, target temperature and channels can also be manually selected.Medtronic Cardiac CryoAblation DeviceThe CryoConsole contains both electrical and mechanical components as well as exclusive software for controlling and arrangement a cryotherapy procedure. This system requires catheters that are purchased separately such as Medtronics Artic front cryoablation catheter (Fig. 3). This system stores and controls the delivery of the liquid cold through the coaxial umbilical to the catheter, recovers the refrigerant vapor from the catheter under constant vacuum, and disposes of the refrigerant through the hospital scavenging system. Multiple features are built into both the CryoConsole system and catheters to ensure safety.Epicor Cardiac Ablation System PriceThe Epicor LP Cardiac Ablation System delivers High Intensity Focused Ultrasound using algorithms designed to precisely deliver energy up to 10mm. unalike the other treatments high intensity focused ultrasound has the ability to create lesions from the inside out, depositing energy at the endocardium first and then building the lesion back up to the surface. The ability to focus HIFU cardiac ablation energy helps reduce the risk of tissue disruption, charring and collateral damage as well as overcome procedural limitations that have historically been associated with other ablation technologies.ConclusionIn terms of ablation the umbrella terminology of Atrial Fibrillation does not take into account the co mposite plant nature of the disease. If a patient presents with paroxysmal atrial fibrillation they may only require a single catheter to be used, however if this condition becomes more never-ending/chronic the patient may require multiple catheters and 3D navigational software. The three techniques described in this report appear to be similar in terms of their success rate, radiofrequency and cryoablation have a success rate of approx. 65-85% while High intensity focused ultrasound has a success rate of approx. 59-75%, this peradventure indicates that high intensity focused ultrasound may not be as effective in treating atrial fibrillation as radiofrequency and cryoablation although it is worth noting that these figures are taken from different research studies at different times and involve different patients that could be presenting greater or lesser a severity of atrial fibrillation.

Lifestyle Changes For Diabetes Health And Social Care Essay

Lifestyle Changes For Diabetes Health And Social C atomic weigh 18 EssayDiabetes mellitus is a heterogeneous group of disorders, all characterized by increase plasma glucose. In the majority of patients with diabetes, the etiology of the disease is not understood. Expert panels eng be on recommended one set of criteria for diagnosis and an another(prenominal) set for classification . The criteria give ear two purposes. One is to secure optimal intercession of the patient. The other is to support research aimed at understanding the aetiology and pathogenesis of diabetes syndromes Diabetes mellitus eccentric 2 or slip 2 diabetes (formerly called non-insulin-dependent diabetes mellitus (NIDDM), or adult-onset diabetes) is a disorder characterized by senior high smear glucose in the context of insulin resistance and relative insulin deficiency.(Robbins et al ,2004)More than 220 million pile worldwide have diabetes. In 2005, an estimated 1.1 million people died from diabetes.Al just about 80% of diabetes deaths occur in low- and middle-income countries. Almost fractional of diabetes deaths occur in people under the advance of 70 years 55% of diabetes deaths argon in women. WHO projects that diabetes death will double between 2005 and 2030.Healthy diet, regular fleshly activity, maintaining a normal ashes clog and avoiding tobacco use female genitalia prevent or delay the onset of diabetes.(WHO,2009)Many references of diabetes ar recognized (Tierney.L.M et al,2002) the principal three are figureface1 Failure to produce insulin by remains mechanism resulting in diabetes. It is estimated that 5-10% of Ameri smokes who are diagnosed with diabetes have type1 diabetes. Currently patients with type1 diabetes take insulin injections.Type2 Results from insulin resistance, a condition in which cells fail to use insulin properly, whitethorn be combined with absolute insulin deficiency. Majority of patients world oer who are diagnosed with diabetes have ty pe2 diabetes.gestational diabetes Pregnant women who previously never had diabetes before but who have sudden increase in blood scraping (glucose) take aims during pregnancy mainly due to intensify in their diet are said to have gestational diabetes. Gestational diabetes affects ab issue 4% of all pregnant women. It whitethorn precede development of type2 (or rarely type 1) Diabetes mellitus .Type 1 DiabetesDiabetes is a long-term (chronic) condition caused by the increase in level of glucose (sugar) in the blood. It is also know as diabetes mellitus.In the UK, diabetes is seen in around 2.3 million people, and its estimated that there are more(prenominal) than half a million more people who have the condition but are not aware of it.Normally a hormone called insulin regulates the blood sugar level, which is produced by the pancreas (a gland buns the stomach). When nutrition is digested and enters the bloodstream, insulin moves any glucose out of the blood and into cells, wh ere it is broken low-spirited to produce energy.However, in those with diabetes, the body has higher level of glucose as it is stored and is unable to break down glucose into energy because there is either not enough insulin to breakdown glucose and store it as energy or because the insulin produced is not enough or does not calculate as required.Gestational diabetes is caused by excess weight, obesity and Insulin Resistance are a condition that develops in the third trimester of pregnancy and affects 4-5 % of all pregnant women in the U.S. That is around 135,000 cases each year. With Gestational Diabetes, the insulin production by pancreas is normal but it doesnt lower the mothers blood sugar levels. The symptoms are that detectable by laboratory testing. Pregnant women can test their blood glucose level by urine dip stick test with each pre-natal visit. This test may show glucose in the urine, which is sign and will require salubriousness care provider to carry out further ex aminations for the presence of Gestational Diabetes, also known as Gestational Diabetes Mellitus http//weight.insulitelabs.com/Gestational-Diabetes.phpThere are two types of diabetes type 1 and type 2.Type 1 diabetes occurs when the body produces no insulin. It is often referred to as insulin-dependent diabetes. It is also sometimes known as juvenile diabetes, or earlier-onset diabetes, because it usually develops before the age of 40, often in the teenage years.Type 1 diabetes is far less crude than type 2 diabetes, which occurs when there is too little insulin produced by the body to work, or when the cells in the body do not react properly to insulin. People with type 1 diabetes make up only 5-15% of all people with diabetes.type 1 diabetes, will adopt insulin injections for life as intumesce as blood glucose levels stay balanced by eating a healthy diet and carrying out regular blood tests http//www.nhs.uk/conditions/diabetes/Pages/Introduction.aspxThemain symptoms of diabe tesare step very thirsty(polyphagia)producing unreasonable amounts of urine(polyurea)tiredness and lethargyweight issuemuscle wasting (loss of muscle bulk).Symptoms of type 1 diabetes can develop quickly, over weeks or even days. Other symptomsareitchiness around the vagina or penis or getting thrush regularly,blurred vision (caused by the lens of your eye becoming very dry),muscle cramps, damageskin infections.Hypoglycaemia (low blood glucose)If a patient has diabetes, their blood glucose levels can scram very low. This is known as hypoglycaemia (or a hypo), and happens because insulin produced by the body is more and has bowdlerized the level of in the bloodstream.In most cases, hypoglycaemia occurs if there is overdose of insulin, although it can also happen if you skip a meal, elaborate very vigorously or drink alcohol on an empty stomach.Symptoms of a hypo includefeeling shaky and irritable,sweatingtingling lipsfeeling weakhungernauseaA hypoglycaemia can be brought under c ontrol simply by eating or drinking something with sugar in it . If a hypoglycaemia is not brought under control it can lead to confusion, slurred speech and unconsciousness. If this occurs there will be a take on to have an emergency injection of a hormone called glucagon. This hormone will raise the level of glucose in your blood as it suppress the effect of insulin.hyperglycemia (high blood glucose)As diabetes occurs as a result of your body existence unable to produce any, or enough, insulin to regulate your blood glucose level, your blood glucose levels may become very high. This happens because there is no insulin to breakdown glucose from the bloodstream and into the cells to produce energy.Blood glucose levels become too high, it lead to hyperglycaemia. The symptoms are similar to the main symptoms of diabetes, but they may come on suddenly and severely. They includeextreme thirsta dry mouthblurred visiondrowsinessa frequent need to pass urine.If left untreated, hyperglyca emia can lead to complications such as diabetic ketoacidosis, which can eventually cause unconsciousness and even death. diabetic ketoacidosis occurs when your body begins to break down fats for energy instead of glucose, leading to a build-up of acids in your blood imperative medical attention if diabetes develop in the body and this are the general signs and symptoms seen in case of diabetesa loss of appetite,nausea or vomiting (feeling or being sick),a high temperature,stomach disturb or severe abdominal paina fruity smell on your breath, which may smell like pear drops or nail varnish.http//www.nhs.uk/Conditions/Diabetes/Pages/Symptoms.aspxThe McKeown dissertation and its ImpactThe McKeown thesis attempted to reason the phenomenal growth in creation of the from late eighteenth century to the present day .McKeowns thesis can be summarized as a steep growth in population was primarily due to decline in mortality form infectious diseases and the change in sparing conditions d ue to industrial revolution ,which lead to amelio symmetryn in rising of nutrition exemplifications and brought a gradual change in nutritionary term that improved the human bodys resistance towards various diseases. The development in medical fields achieved by modern science did not make a significant contribution towards the population growth and was largely due to economic forces and changes in living and social conditions. This lead to McKeown reclassifying various fatal diseases recorded by General record office (GRO).McKeown classification was mostly of three types(1)Infectious diseases spread through air -Respiratory tuberculosis, Pneumonia, Bronchitis(2) Infectious diseases spread through water or food Cholera, Diarrhoea, Typhoid(3) All other diseases contagious and degenerativeWhen a population develops it is grand that the individualistics are in a position to entreat diseases and problems that can deck up from them, this depends on the resources that they have . These resources could be knowledge, social setup, power, money. Those people who have access to resources have advantage and can gain health benefits from the public health system from those who are not in position to direct access to public health system. Resources are important in two different ways first , they can develop the individuals behaviour towards health by helping them access and make choices and whether they could afford them all helping towards health enhancing behaviours and Second, resources are shaped across a broad hightail it of contexts such as communities, neighbourhoods, social network , occupation and the risk as well as protecting factors .Hovictimization for poor people would always be associated with pollution, noise, indifferent social conditions . Access to broad range of problems lie with socio economic condition of the individual like knowledge of best doctors and ideal treatment of medical problems and the freedom in making choices .The reason for social condition always being important is resources shape the access to health relevant pot . The social condition has been responsible for determining the quality of life and plays an important role as health determinant. (Link.B.G and Phelan.J.C 2003)Mckeown was the former chairman of World health organizations consultative group on health research strategy concludes that the average life foreboding had improved by 23 years in first half of century and medical therapy was responsible for only for few years of it. Meckeown believed that most this decrease was due to identification of bacilli which causes respiratory tuberculosis was not done process year 1882 and effective pharmacotherapy was not available till year 1947.Between 1700 and 1915, the mortality rate in England declined from 27.9 deaths per thousand living to 14.4 and average life expectancy at birth Increased from 37.1 (in 1701) to 53.5 (in 1910-12). These figures reflect a major Improvement in the life-chances o f the British population over the course of the Period, and therefore it is hardly affect that the McKeown thesis, which attempts to account for the decline of mortality and the modern rise of population, has played a big role in economic, social and medical history as well as history of epidemiology and population studies In the years following the publication of McKeown thesis it is argued that its un probably the dietary standards would have improved during the second half of 18th century as the value of wages was falling as there were apparent contradictions between real wages and mortality. (Wrigley and Schofield, 1981). McKeown argued that there was no basals to fight air borne diseases in 18th century and the reduction in deaths was more likely due to improved human body resistance towards these diseases.Illich was not field of ascertain in criticizing modern medicines for to improve life expectancy , he proposed that medical interventions were in fact responsible for inc reasing the mortality rate by using ineffective and hazardous medical therapies which at times not tried and true or researched properly .Illich stated that chronic usages of drugs lead to numerous side-effects , infections acquired from hospitals , poorly performed surgeries as well as false positives and false negative tests from medical tests.McKeown was aware that higher rate in fertility was responsible for increase in population rather than reduced mortality rate but dismissed it on grounds that higher birth rate means higher infant mortality as well due to the high risk parity of mothers so would not account for such a high rate of population growth. McKeown pointed out that mortality rates for most of the infectious diseases reduced considerably before any effective medical measure was in place. McKeown think that public health measure such as sewage disposal system, public waste disposal, and impart of clean and potable water and pasteurization of milk was important only from year1870, so the reason behind the decline mortality rate before this was according to McKeown due to improvement in living standards .Improvement in nutrition due to increase in agriculture productivity was also responsible for the increase in resistance to airborne infectious diseases such as Tuberculosis.(Grundy,2005). Prestons article concluded that the increase in life expectancy all over the world between 1930s and 160s could not be totally attributed to increase in living standards and refered that advances in medical care and public health did make significant contribution towards decline in mortality. Prestons did make an effort to prove McKeown thesis slander but had little influence on conventional belief and the theory of improved standard of living became conventional wisdom for that present time. (Mackenbach J P,2006)It has recently been shown that McKeowns interpretations of his very own epidemiological data is flawed in umteen respects, firstly smallpox and diphtheria are two diseases that have been eradicated totally all over the world by vaccinations which is a preventive health measure .Positively the only three diseases to be eradicated before great world war was- cholera , typhoid and smallpox all these are attributed to public health measures and not nutrition .When all this data is analysed it goes to show that public health measures taken played the most decisive role in reduction of mortality . Furthermore since McKeowns work was published two significant forms of new evidence has appeared which slams the nutrition/living standard theory by McKeown. The first half of the century, the period which is under review suggests that as when the wages across sectors started improving, the reduction in mortality rate showed a slight decline from previous years and if wage increase meant better nutrition these was not seen in children .The growing cities and towns where the wage improvement were seen showed a leaning of areas which h ad highest mortality rate and children were poorly developed (R.Woods and J.Woodward.1984).Although the points raised here are relevant they skew the main issue here which is that growth in income is not necessarily same all over the world and can take off considerably from developed countries to developing and underdeveloped countries .There are no patterns in cross-sectional associations between the income of a nation and progress in developing health standards as well as life expectancy of their population. Prestons analysis underestimated the effects of economic development and its relation with reduction in mortality rate, that the relationship between the economic development and the developments in medical field are crude preparation between the two.McKeowns study can be explained by relevance of the question that underlines them. This concerns the importance of medical interventions, social, economic, political measures which affects the health status and health inequalit ies. Study suggest that measures need to be taken to improve health inequality and medical interventions and social changes has to be taken as complimenting rather than opposing each other .InterventionsType 1 diabetes is approached by primary, secondary, and tertiary intervention Primary intervention includes treatment of all individuals with diabetes. The possibility of using autoantigens new medium to combat diabetes as a vaccination is currently being explored not only in animal experiments but also in human tests. The selection of children on the root word of HLA type is being used to treat newborns with either oral or nasal insulin. Animal experiments have shown that treatment of spontaneously diabetic nonobese diabetic mice with generalized anxiety disorder as a peptide, protein, or expressed in potatoes reduced diabetes. Vaccinations studies done both children and adults remain a afterlife possibility to test determine whether type 1 diabetes can be prevented. (Lernmark.A .1999)Secondary intervention involves screening for genetic, autoantibody, and other possible markers at birth, in school children, or in adults . Individuals classified with type 2 diabetes but positive for islet autoantibodies (representing slow-onset type 1 diabetes, latent autoimmune diabetes in the adult, or type 1.5 diabetes) are also being tested to determine whether they are suitable for immune intervention to go on their -cell function. Recent studies in Japan suggested that early insulin treatment preserves -cell function. Several intervention trials are pending, including the use of subcutaneous or oral insulin in the Diabetes Prevention Trial for Type 1 Diabetes, milk formula or nasal insulin in Finland, vacuum bomb insulin in Melbourne, or nicotinamide in the European Nicotinamide Diabetes Intervention Trial. In the next few years studies would find out the extent of such intervention trials preserve -cell function in subjects at risk for type 1 diabetes.(Lernmark.A. 1999)Tertiary intervention involves the treatment of patients diagnosed with type 1 diabetes very recently. Previous studies have demonstrate that treatment plans with satisfactory results are not present such as immunosuppression with cyclosporin and other agents has not been able to stop the pathogenetic process in new-onset patients. A future innovative treatment is planned so that it represents an antigen-specific immune intervention. Animal experiments have demonstrated that in case of early diagnosis or in patients with early onset the timely administration of antigen or insulin, at the time of clinical onset may slow the disease process.(Lernmark.A.1999)Being active is referred to as animal(prenominal) activity ( serve) and is defined as the act of expending energy. It is generally categorized into two different types aerobic (requiring oxygen to maintain muscular effort) or anaerobic (not requiring oxygen to maintain muscular effort). The term exercise is used as a general label for being active and physical activity as well as exercise. Major challenges to decision making about exercise include how to develop and implement an efficient and effective exercise regimen, how to modify it to an individual patients motivation level knowing his mindset and barriers so that exercise will be initiated and maintained, and how to select, measure, and achieve specific, desired outcomes. Given these decision-making challenges Exercise interventions aimed at achieving these outcomes usually vary by type, intensity, duration and frequency. As with any type of self-care behaviors, barriers to exercise vary and are individual to particular patients depending on their health status as well as mindset. Among potential considerations for barriers has to be devised for individual patients type of exercise and duration, intensity, and frequency may need to be tailored to severity of progression of diabetes since complications such as neuropathy and retinopathy may affect the exercise capabilities of a diabetes patient. In addition, patients may consider availability of time, among many other factors such as age, job profile, social status and other medical complications, as posing a substantial barrier to integrating regular exercise or physical activity into normal perfunctory lifestyle. Each of these poses challenges to the initiation and maintenance which is the more difficult part of exercise for patients and therefore to the measurement, monitoring, and management of exercise intervention outcomes for providers. Exercise is one of the most important consumes to both type 1 and type 2 diabetes patients. For type 2 diabetes patients, engaging in regular exercise may improve glycemic control and reduce the risk of vascular complications, increase insulin sensitivity, reduce stress and stave off depression and contribute to control of lipids and blood pressure, thereby reducing the risk of cardiovascular disease, the leading cause of death in di abetes patients.Type2 diabetes is determined primarily by lifestyle related factors and hereditary factors.LifestyleA number of lifestyle factors are known to be important to the development of type2 diabtetes. In one study, those who had high levels of physical activity, a healthy diet, did not smoke, and consumed alcohol in moderation had an 82% lower rate of diabetes. When a normal weight was included the rate was 89% lower. In this study a healthy diet was defined as one high in fiber, with a high polyunsaturated to saturated fat ratio, and a lower mean glycemic index. (Mozaffarian.D.et al 2009) Obesity has been found to contribute to approximately 55% type2 diabetes, and decreasing consumption of saturated fats and trans fatty acids while replacing them with unsaturated fats may decrease the risk.(Saad.F.2009) increased rate of childhood obesity in between the 1960s and 2000s is beleived to have lead to the increase in type2 diabetes in children and adolescents. (Rosenbloom.A. et al.2003)Environmental toxins may contribute to recent increases in the rate of type2 diabetes. A positive correlation has been found between the parsimoniousness in the urine of bisphenol A, a constituent of some plastics, and the incidence of type2 diabetes. (Lang.A.2008)Medical conditionsSubclinical Cushings syndrome (cortisol excess) may be associated with DM type 28The destiny of subclinical Cushings syndrome in the diabetic population is about 9%.Diabetic patients with a pituitary microadenoma can improve insulin sensitivity by removal of these microadenomas. (Taniguchi T.2008)Hypogonadism is often associated with cortisol excess, and testosterone deficiency is also associated with diabetes mellitus type 2, even if the exact mechanism by which testosterone improve insulin resistance is still not known. (Farrell JB,2008)GeneticsBoth type1 and type2 diabetes are partly contagious. Type1 diabetes may be triggered by certain infections, with some evidence pointing at Coxsacki e B4 virus. There is a genetic element in individual susceptibility to some of these triggers which has been traced to particular HLA genotypes (i.e., the genetic self identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type1 diabetes mellitus seems to require an environmental trigger.There is a stronger inheritance pattern for type2 diabetes. Those with first-degree relatives with type2 have a frequently higher risk of developing type2, increasing with the number of those relatives. Gene expression promoted by a diet of fat and glucose as well as high levels of inflammation related cytokines found in the obese results in cells that produce fewer and smaller mitochondria than is normal, and are thus prone to insulin resistance.COMPLICATIONS of DiabetesEarly complications-Diabetic ketoacidosis is a medical emergency, because it can cause coma and death. Hospitalization, usually in an intensive care unit, is necessary. Large am ounts of fluids are given intravenously along with electrolytes, such as sodium, potassium, chloride, and phosphate, to replace those fluids and electrolytes lost through excessive urination. Insulin is generally given intravenously so that it works quickly and the dose can be adjusted frequently. Blood levels of sugar, ketones, and electrolytes are measured every few hours. Doctors also measure the bloods acid level. Sometimes, additional treatments are needed to correct a high acid level. However, controlling the levels of sugar in the blood and replacing electrolytes usually allow the body to restore the normal acid-base balance.( Robbins and Cotran,2007)Late Complication of Diabetes MellitusMacro-vascular complications as coronary artery disease with MI, CVA, peripheral vascular diseaseMicro-vascular complications as Diabetic Retinopathy Diabetic retinopathy refers to progressive pathologic alterations in the retinal microvasculature. In type 2 diabetes, though the incidence of blindness is lower, higher disease prevalence results in an even larger number of patients abnormal with severe visual loss.Diabetic Neuropathy Diabetic neuropathy (DN) is a third estate and troublesome complication of diabetes mellitus, leading to great morbidity and mortality and resulting in a huge economic burden for care of the patient with diabetes mellitus. It is the most common form of neuropathy in the developed countries of the world, accounts for more hospitalizations than all the other diabetic complications combined, and is responsible for 50% to 75% of nontraumatic amputations and patients have serious co-morbid conditions, especially heart, eye, and peripheral vascular diseases.Diabetic neuropathy is a heterogeneous disorder that encompasses a wide range of abnormalities affecting proximal and distal peripheral sensory and motor nerves as well as the autonomic nervous system. The major morbidity associated with somatic neuropathy is foot ulceration, the precursor o f gangrene and limb loss. (Robbins and Cotran,2007)Research on diabetesThe features of Type 1 diabetes in humans as well as mice in labororatory environment is significantly dependent on an relation between the environmental factors and genetic feature of humans as well as the study animal. Studies by Giulietti.A.et al(2004) al point towards vitamin D as being one of the environmental factors that can modulate the incidence of diabetes. This study further shows that in mice that developing Type 1 diabetes are generally at higher risk due to its genetics as well as vitamin D deficiency which leads to features seen in early part of life leading to a more aggressive form of the disease create earlier onset, and a higher final incidence of the disease. This model of subtle vitamin D deficiency in early life, with only a marginal vitamin D deficiency in blood, but no effect on calcium concentration in serum or bone calcium content.This is most in all likelihood the reflection of the v itamin D status in many infants and small children as this model has temporary and limited vitamin D deficiency, even in areas with high movie to sunlight, since infants always are shielded from UV B exposure or direct exposure of sunlight. The application of vitamin D supplement is advised in many countries it is far from strictly controlled and many times, these supplements are omitted or administered irregularly or not paid enough importance to keep tab on their supply and demand. The higher incidence of Type 1 diabetes in the past two decades may be seen due the nutritional rickets which has never been completely eradicated in many countries and may be reappearing in may industrialize countries (Giulietti.A.et al, 2004).It was found that the risks for diabetes in African-Americans, Hispanics, and Native Americans are approximately 2, 2.5, and 5 times greater, respectively, than in Caucasians being the least. Various national and ethnic populations within the U.S. to the total U .S. population were analyzed to find possible risk factors for the development of type 2 diabetes this was done by number of cross-sectional studies and prospective studies . Studies of the prevalence of type 2 diabetes in Mexican Americans and non-Hispanic whites in San Antonio showed that there is an inverse relationship between prevalence of diabetes generally and their current socioeconomic status. The cultural effects lead to an increased incidence of obesity in these populations which may also be related to their diet and physical activities, which may lead to insulin resistance. Genetic factors may also be a contributing factor. (Haffener.S.M 1998)There are no high quality data on the research about the long lasting effectiveness of the dietary treatment of type 2 diabetes, however the data available indicate that the adoption of exercise which is a change in lifestyle appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes. There is an urgent need for more well-designed studies which will analyse the wide range of interventions, at various points during follow-up (Moore.H. et al 2004)Weight loss improves glycemic control with magnitude of improvement related to both magnitude of weight and characteristics of patient , the amount of weight loss required to reduce blood glucose is large, even modest weight loss produces glycemic control .The most important issue is how to improve weight loss especially long term weight loss, in type 2 diabetic patient .Dietary modification is most important direction in weight loss program (Hertzel.C.et al)Implications for developing worldType I diabetes is the only major organ-specific autoimmune disorder not to show a strong female bias. The overall sex ratio is roughly equal in children diagnosed under the age of 15 but while populations with the highest incidence all show male excess, the lowest risk populations studied, mostly of non-European origin, characteristically show a female bias. In contrast, male excess is a consistent finding in populations of European origin aged 15-40 years, with an approximate 32 malefemale ratio. This ratio has remained constant in young adults over two or three generations in some populations. Further, fathers with Type I diabetes are more likely than affected mothers to transmit the condition to their offspring. Women of childbearing age are therefore less likely to develop Type I diabetes, and should this occur are less likely to transmit it to their offspring. Type II diabetes showed a pronounced female excess in the first half of the last century but is now as prevalent among men and women in most populations, with some evidence of male preponderance in early middle age. Men seem more pliable than women to the consequences of indolence and obesity, possibly due to differences in insulin sensitivity and regional fat deposition. Women are, however, more likely to transmit Type II diabetes to their offspring. Underst anding these experiments of nature mogul suggest ways of influencing the early course of both forms of the disease.(Gale.E.A.M. et al 2001)It is recognized that there will be substantially increased costs of widely applying the recommendations of study in the U.S on the Diabetes control and complications trial (DCCT). There will also need to be additional efforts to ensure professional education, so that health practitioners are implement this recommendations through the trial are able to effectively and safely implement the therapy employed in the DCCT. It is hoped that the benefits of trial are long term better more productive lives with fewer complications will offset the costs of tight control. The cost-benefit ratio for intensive therapy in diabetes in this trial is in a range similar to other accepted treatments in the U.S that are

Interpretation of Maladies by Jhumpa Lahiri

interpretation of Maladies by Jhumpa LahiriThe functioning of analysis for this English Extended Essay on Interpretation of Maladies by Jhumpa Lahiri was definitely a journey where in I discovered and learnt a lot. When I was assigned this project, initially I was a little discerning most how to execute this extended essay. My t all(prenominal)er gave me a good briefing well-nigh the completed process which I had to follow for the execution of this analysis.I began by reading the novel in its entirety several times. Every time I read the different stories in this novel, it was like going on a new literary journey alto captureher. The living presentation of the characters by the author brought in spiritedness to them and at a point I no durable felt that I was a mere reader but transcended into the stories with the characters and played a mute spectator.Post having sufficient understanding of each accounting, I do note of the thematic formulas of each story, the stage sett ing and how this careed in portrayal of the mindset of each characters. I employed literary analytical aspects of thematic analysis, delivery analysis, stage setting analysis to give an in-depth analysis of the novel Interpretation of Maladies by Jhumpa Lahiri.In the concluding part of this extended essay, I wound up by indicating the effect of the stories on the readers and why the readers could relate to each character as this is an important aspect of story narration and effective engagement of the reader. incomingThe illustration of Maladies reflects the trauma of self-transformation through immigration which ends up being an flack in futility as resultantly there is a series of broken identities that form treble anchorages. Lahiris stories present the futile diasporic struggle to keep hold of culture as primary characters that of her stories create new lives in foreign cultures. Relationships, language, rituals, and religion all help these characters maintain their culture in new surroundings even as they build a hybrid realization as Asian Americans. But the drop of hweapon systemony and happiness ultimately makes the attempt a futile experience.Interpretation of Maladies brings to the forefront m either complex issues with identity confronted by the Diaspora community. The book has the tales and experiences of first and imprimatur generation immigrants who are Indians, as well as a few tales comprising involving ideas of separateness among Indian communities. The stories focus around the complexities of several alliances, communication and a printing of a loss of identity for individuals in diaspora. Despite where the tale takes place, the major players struggle with the similar spright word of m outhssings of exile and the struggle between the dual macrocosms by which they feel torn apart. The stories essentially deal with the always shifting lines between gender, sexuality, and social status within a diaspora. Whether the player in the tal e is a interior(a)less person woman belonging to India or an Indian male pupil in the United States, all the characters show the effects of displacement in a diaspora.The characters in her stories dwell with a sense of dissatis accompanimention on account of their personal lives and experiences. The settings, narration, the mindsets of the characters and the interaction characters consent with each other assist the readers in comprehending their plight and the futility of the situation.Findings and AnalysisInterpreter of MaladiesJhumpas thematic presentation of futility in the Interpreter of Maladies is somewhat subtle yet effective. The setting is just just intimately perfect with the character placement effectively facilitating the futility in their bloods and aspirations. The Central characters in this tale are Mr. and Mrs. das and the tour guide Mr. Kapasi. The writer through the interactions of the dassie couple with their children Tina, Bobby and Ronny present to us the fact that their kind with their children lack perfection and to a great termination seems futile as the children do not seem to obey their parents and Mr. and Mrs. Das seem more of blood relation to their children than their parents as they are constantly squabbling among themselves. Mrs. Das is sparely not interested in the relationship which seems futile to her and the very fact that she describes Mr. Kapasis caper as an congressman of maladies as a romantic mavin leads Mr. Kapasi to fantasize about her which eventually turns out to be a futile exercise. An aspect which does not fail to endure attention of the reader is the instance when the Das couple are engaged in an argument as to who would take Tina to the bathroom is indicative of each one desire to shun responsibility. hither, a sense of futility is existent in the parental relationship the couple share towards their children.Jhumpa has utilized the lack of communication as an aspect to present the futility of the relationship all the characters are dwelling in. Mr. Das is presented as a character always buried in his guide book term Mrs. Das hides her inner self behind her sunglasses. Mr. Kapasi is trapped in a loveless futile marriage spending lone(prenominal) nights drinking tea by himself.The futility of the relationship the Das family is in is very evident in the action of Mrs Das especially when she fails to offer puffed rice which she was gorging on by herself. The particle of family sharing a meal fails to be present. This action of Mrs. Das indicates indifference and an under cunning sense of hostility towards her spouse and children. The relationships they share is thus tacit as being a futile relationship.Mr Kapasi reveals the futility of his existence as he is pruneing as an interpreter feels that his job is a failure as he is a scholar of many languages. The dissatisfaction he experiences in the job of an interpreter leads to a sense of futility within him. Futility is gain expressed by the character when he states that the job of an interpreter was taken to pay of medical bills of his son who had contracted thyroid. His sons death made his sacrifice of sorts a futile effort.Mr. Kapasis fantasy ride commences with Mrs. Das. It becomes very evident to Mr. Kapasi that the Das Couples relationship lacks charm and harmony and is futile. He begins to fantasize about Mrs. Das when she admires his job as that of an interpreter. His fantasy leads to a peak when he and Mrs. Das are conversing while staring at the nudity depicted in the form of temple carvings. The sensuality of the situation is well created by the writer by placing her characters in a setting which is erotic leading to temptation but futile desires.He decided to begin with the most obvious question, to get to the knocker of the matter, and so he asked,Is it really pain you feel, Mrs. Das, or is it guilt?This quote appears towards the end of the story where Mrs. Das reveals the fact that Bobby is the son of a friend of Mr. Das whom she was intimate with while her husband was away. Mr. Kapasi questions her about her feeling and Mr. Kapasi makes one final interpretation. Mr. Kapasi feels that Mrs. Das desires absolution and not questioning, relief and not reflection. She and Mr. Kapasi are both lonely but the fact that they have differences keeps them apart thus making the possibility of a relationship futile.Revelation leads to futility. The revelation made by Mrs Das about the legitimacy of her child to Mr. Kapasi was the blow which tarnishes the fantasy of Mr. Kapasi. For a short spell of time, Mr. Kapasi was on an imaginative trip which proved baseless and futile as he failed to play the person who he was daydreaming about to have a scandalous past as such.The revelation of Mrs. Das proves her infidelity further shatter the image of the Das family proving the fact that the relationship is more of an arrangement than a bonding of love.The writer has aptly used setting to bring all her resilient characters in the scene and weaving a storyline in a natural way facilitating the flow of human emotions at their various moment of interaction. The writer crafts either character in a natural and likely manner leading us to realize the fact that there are several relationships where people are bound together for the sake of fulfilling an arrangement commenced to fulfill a certain purpose but the lack of depth and gravity of the relationship proves the relationship to be a futile on as in the case of Mr. and Mrs. Das and their relationship, Mr. Kapasi and his profession as an interpreter and a tour guide and his enchantment for Mrs. Das which later on sours as he learns about her real self.With regards to being in India, Mr. and Mrs. Das fail to connect with the country India as their home but have a tourists perspective which is very evident when Mr. Das snaps away a picture of the starving peasant instead of helping him. When Bobby is necessitate o f help when surrounded by monkeys, Mr. Das is excited about the picture he clicks instead of this instant helping the boy. This indicates a lack of understanding and contact with each other and the country they are in which they understand as being home. Thus the trip too can be safely understood as being an exercise in futility.The camera of Mr. Das is symbolically employed by the writer to present the fact that Mr. Das view the world through his camera and in not in direct touch with reality. The camera proves to be an obstruction and proves to be a futile aspect cylinder block Mr. Dass chance to view the real world devoid his camera.Interpreter of Maladies is a story with a setting and dialogues which may not be larger than biography but is as close and real as life could be though the writer presents her work as a fictionalized account of her imagination and creativity.A Temporary MatterIn this tale, the writer in all clarity wishes to point out that lack of trust and deceit in a relationship makes the existence of that relationship futile. The futility of the relationship of Shukumar and Shoba is visible to the reader as the play the game wherein they reveal to each other their secrets. We the readers learn that the element of deception is frequent and this causes the relationship to be extremely strained and leads to a point of deterioration and a point of no return. The couple indulges in lying to each other and the lies have been with selfish motives in mind. They avoid bring in discomfort to each other and their selves by indulging in not speaking the truth. They have lied to each other, and the lies have been selfish ones-told not to spare the others feelings but to allow the person telling the lie to escape some discomfort or sacrifice. The sanctity of their marriage to a good extent is at stake and to a large extent they do not seem to care about this fact. The sweater incident reveals to the reader that they lie about petty issues. Shukumar h ad returned the sweater to get some money which he could use in order to get drunk to the core.The couple drifting apart commenced afterward the loss of their baby and the began to care less for each other and this is revealed by the fact that they have been lying unceremoniously. They no longer connect with each other emotionally and this indicates the fading of their relationship. When Shoba displays the fact that their sorrow was on account of a deceptive game, she is following a pattern which is established. All through the week of electricity cuts, Shoba can be seen attempting to reach out Shukumar. But in truth, she is working out her final judicial separation from Shukumar.During the same time frame, the game that seems to be putting them together also displays a past filled with lies. Matters have hardly been as they seemed between these ii individuals. To add to this, readers understand early in the tale that Shoba has always been the person to plan way ahead and that sh e maintains a separate bank account. Readers are left-hand(a) to think as to whether the pattern of deception will end or increase beyond repair.The story indicates a shift decisively towards a intelligent finale when, on the fifth even out, the writer declares, They had survived a difficult time. Shobas silent behavior that particular evening has been disrupted as the calm after a storm. But that understanding is as misleading as Shobas pattern of conduct has been. We, the readers, like the character of Shukumar, have been given complex signals and only understand at the end which set of aspects was reliable.The stage setting adds to the realm of this tale. To depict futility of the relationship of the protagonists, the writer places the Bradford couple as neighbors Mr. and Mrs. Bradford are neighbors of Shoba and Shukumar. Shoba and Shukumar often witness them strolling by, holding arm in arm, on their path to the bookshop on the second night of the role cut or failure. The Br adfords appear to be a happily wed pair and as such make provision of a contrast to the main lead pair i.e. Shoba and Shukumar. The writer specifically mentions that the Bradfords kept a witticism of sympathy as a goodwill gesture in Shoba and Shukumars mailbox when their baby was lost.The light and dark stage setting present a true to life(predicate) scenario where the reader can identify with the inner feeling of the characters. As the primary characters have their conflicts within their selves and with each other, the lightning assists in quick identification of their inert feeling. Here the writer, I opine has very meticulously employed the element of light and darkness to reveal the thought, apprehensions and turmoil of the characters making the presentation of the entire story line noteworthy. You went to answer the telephone in the other room. It was your mother, and I figured it would be a long call. I wanted to know if youd promoted me from the margins of your newspaper. Instead of looking for clues about her future husband or finding something of earth-shattering importance, she looks to see if she is making up the little details of Shukumars life. Again, it is clear that the little things mask the greater realities.Alienation further triggers of futility of the relationship. Shoba and Shukumars grief has led them to withdraw from each other. Until the nightly power outages began, they avoided each other. Shoba leaves for work early each morning, returns late, and often brings home extra work to film her evenings and weekends. When Shoba is home, Shukumar retreats to his computer and pretends to work on his dissertation. He has put the computer in the room that was to be the nursery because he knows that Shoba avoids that room. She comes in briefly each evening to tell him goodnight. He resents even this brief interaction, which Shoba initiates only out of a sense of obligation.Shoba and Shukumar do not attempt to comfort or support each other. Ea ch withdraws from the relationship, and they endure their grief as if they were two strangers living in a boardinghouse.An important aspect to be noted about this story is the fact that the writers tone in presentation of this tale of grief, tragedy and deception is in totality neutral. This neutral tone is essentially employed to by the writer as the writer, I believe desires the readers form their own individual perspectives of each character and decide who and why they wish to empathize with. This style of presentation makes provision for an indifferent(p) formation of a point of view on the part of the reader facilitated primarily by the writer. Many a times, writer tend to shadow their archives with their personal and judgmental opinion which I believe that the writer here has refrained from doing so making this an exemplary work of art.Mrs. SenMrs. Sen, the titular character of Lahiris story demonstrates the power that physical objects have over the human experience. This as pect is employed by the writer to display a sense of futility in the thoughts and existence of the titular character. During the entire story, Mrs. Sen is preoccupied with the presence or lack of material objects that she once had. Physically though Mrs. Sen is there where she is but mentally or rather emotionally she seems to be dwelling in another(prenominal) world, a world of the past. Whether it is fish from her native Calcutta or her special vegetable cutting blade, she has the tendency to cling to the material possessions that she is addicted to, while firmly rejecting new experiences such as canned fish or even something as mundane as driving a car. At home that is all you have to do. Not everybody has a telephone. But just raise your voice a bit, or express grief or blessedness of any kind, and one whole neighborhood and half of another has come to share the news, to help with arrangementsThis moment illustrates that Mrs. Sen is referring to her neighborhood at home as a m uch more closely-knit community than that of the area where Eliot lives. Here she uses a slightly superior attitude when referring to her culture as opposed to Eliots, which helps her remain confident about staying true to her Indian roots while she physically lives in a different place.Lack of the ability of the central character of Mrs. Sen to transcend successfully and accept her new world presents the futility of the situation. Mrs. Sen being homesick is certainly understandable given her meaningless social life, her reflective nostalgic feeling deepens the situation to such an extent that she fails to relate to the individuals she meets in America and the eventually end up as no barrier to her acclimation. The person selling fish at the market fails to immediately address her as Mrs. Sen but he surely reserves special fish for her. The man of the law does not book her but just asks her questions after her car accident does not indict her. The writer presents all characters in t he story as people who make life easy for her and facilitate the process of her settling down comfortable in America. But Inspite of all this, Mrs. Sen fails to settle in to any degree, drapes herself always in saris, serving to the mother of Eliot, Indian canaps and putting aside completely the prospect of learning to drive. By conducting her life differently through recollected tales imprinted on her her saris, and her aerograms which are grainy, Mrs. Sen deliberately stays away from any kind of assimilation through the empowerment of material objects and what they mean to her.In this tale, 11-year old Eliot commences living with Mrs. Sen a professors wife after school. Mrs. Sen who is the caretaker cuts and makes meals as she tells Elliot tales of her past life in Calcutta, thereby assisting in crafting of her identity. Like A Temporary Matter, this stale is full of lists of produce, catalogs and recipes with descriptions. Stress is placed on ingredients and the mode of prepara tion. Other aspects are definitely emphasized as well, such as Mrs. Sens collection of saris which are multicolored brought in by her from India. The The entire storyline rotates around Mrs. Sens frequent practice of purchasing fish from a seafood market locally. This fish helps in reminding Mrs. Sen of her house back and holds great importance to her. But reaching the seafood market ineluctably driving, a skill that Mrs. Sen has failed to learn and is not interested in learning either. Towards the finale of the story, Mrs. Sen tries to learn to drive to the market without her better half but this attempt leads to a car accident. Eliot soon stops living with Mrs. Sen after this.ConclusionTo conclude with, I am of the conviction that Jhumpa Lahiri, the Pulitzer prize winner for this literary work of art The Interpretation of Maladies has undoubtedly excelled in creating a work of literary expression which presents human emotion and interaction in its rawest form. This makes each st ory believable and close to the readers heart. She has very well employed the human emotion of sorrow in most of the stories as this I believe is one emotion which every individual can deeply identify with and relate to. Her characters such as that of Mrs. Sen, Shoba, Sukumar, Mrs Das and the others are very realistic as they are presented as mine run humans with issues which every other individual deals with. The added aspect to this realistic presentation is the fact that her characters are primarily migrants finding it hard to get acquainted to a European culture and are being confronted with culture issues and discrimination. She has woven a beautiful story line in each story and the readers are pull enigmatically into her world and her style of storytelling which is essentially different in a unique way than their contemporaries.The stage setting employed in each story differs and is highly apt to the story complementing the story and presenting the characters in a comprehens ive way. The Temporary Matter, Mrs. Sen, Interpretation of Maladies etc. has stage setting which make the story realistic and not deviate the attention of the writer. This is an important aspect which can be understood in her works.The language employed by the writer to present her characters is another vital aspect. The language is simple and precise without being dramatic. More importantly the body language of the character plays vital part in communicating the issue and the feeling within the characters.Each story of hers has message or a theme which is learnt by the reader in the process of acquainting himself in her stories. Her bring out themes of deception, love, tragedy, discrimination in a manner most beautiful and subtle.

Herpes-simplex: Type 2 :: essays research papers fc

Herpes-Simplex Type 2     Herpes is a name that is used to describe some(prenominal) attributes of skin belts that atomic number 18 characterized by formation of blisters. The term embracesprimarily two distinct disorders, herpes simplex and herpes zoster, both causedby viruses. Together, these "herpes" viruses are estimated to cause more humanillnesses than any other group of viruses.     Two types of herpes simplex are known. The first causes cold sores orfever blisters, which is an eruption of blisters that a good deal occurs during thecourse of or after one of a variety of diseases that eventually cause fever(most commonly average colds, the flu, and pneumonia). The blisters usuallyappear just about the mouth and on the lips (herpes labialis), about the nose, face,and ears, and in the mouth and pharynx. The causative virus has been shown to bepresent in the cell bodies of the facial nerve in persons who do not haveblisters. It is this reservoir of latent virus that is the source of repeatedattacks. Except for lotions to relieve pain, itching, or inflammation, noestablished treatmemt has actually been developed.     The second type of the herpes simplex virus, however, is the usual causeof genital herpes. Herpes infections of the genital area have becomeincreasingly common, going along with a erect in general of many sexuallytransmitted diseases. Sometimes accompanied by headache and fever, the conditionusually begins with a mild itching, followed by the learning of clusters ofblisters that break and crust to form scabs that eventually dry up. The processmay last one to three weeks. In many cases new clusters of blisters appear asothers heal. When a baby is born to a woman who has active genital herpeslesions, the infant is at high risk of contracting an infection that is oftenfatal, so these women usually have their babies delivered by a cesarian section.Primary cases of genital her pes can be treated by a medicine called acyclovir, whichwas approved in 1982 and in another form, that is to be taken orally rather thanused in an ointment form, in 1984. It also has been proving useful against perennial attacks.     The virus can also invade the central nervous system, or CNS, especiallyin people who are weakened by other diseases, much(prenominal) as cancer, causing a severecase of encephalitis.

Roosevelt Teddy :: Essays Papers

Roosevelt TeddyHe first tried the law profession by enrolling in Columbia University. He didnot enjoy it and soon leftover school. He published his first book in 1882 it wasentitled The Naval War of 1812. He had begun work on it while still atHarvard. whence Teddy decided that he would try a career in politics. His firstposition was on the state assembly in the state of red-hot York. He ran as arepublican and won the position easily. At this position he did two majorthings first he exposed a corrupt judge and secondly he learned to work withmen from both parties. Instead of going for a second term of legislature hedecided that he would go to the Republican National Convention in Chicago. He went as the chairman for the New York delegation. While Roosevelts professional deportment-time was flourishing his personal life wasnot in very good shape. In 1884 both his wife and mother died. His wife diedwhile giving turn in to their daughter, Alice. Roosevelt would take a break frompolitics and form the Elkhorn ranch on the Little Missouri River in the DakotaTerritory. On his ranch he led the life of a cowboy. He would round up cattleand ride horses all day. It was a good break for Roosevelt. One story tells ofRoosevelt capturing three thieves and holding them at gun point for 6 daysuntil they reached the proper authorities. Also during this time Rooseveltwrote 2 more books (Hunting Trips of a Ranch Man and Thomas Hart Benton)and drop down in love with Edith Kermit Carow. On December 2, 1886 Roosevelt andCarow went to London to be married. When they mothered to the UnitedStates Roosevelt set his mind back on politics.He was very active in the presidential campaign of 1888 when BenjaminHarrison defeated Grover Cleveland. Roosevelt believed in hiring governmentworkers on their skills not based on their party affiliation. At the time thewinner of the turn tail would hire every one that had helped them win the raceeven if they were not qual ified for the position. Harrison would award hisefforts by appointing him the U.S. Civil Services Commissioner. Ascommissioner he would glide by to challenge patronage. He did such agood job that when Cleveland beat Harrison for reelection he kept him as CivilServices Commissioner. In 1895 Roosevelt would return to New York City to