Thursday, October 31, 2019

Literature and Community Essay Example | Topics and Well Written Essays - 500 words - 1

Literature and Community - Essay Example Faulkner introduces Miss Emily Grierson as a woman who has been strictly contained within the boundaries of her father’s old Southern ideals. â€Å"None of the young men were quite good enough to Miss Emily and such. We had long thought of them as a tableau; Miss Emily a slender figure in white in the background, her father a spraddled silhouette in the foreground, his back to her and clutching a horsewhip, the two of them framed by the back-flung front door† (437). As a result of his behavior and her confinement, the Grierson family becomes the town’s idealized image of what the Old South should be. As a result, the town insists upon Emily maintaining this role even after her father dies and she is left all alone. Miss Emily attempts to break out of this mold by dating Homer Barron and adopting more Northern ideals. â€Å"Her hair was cut short, making her look like a girl, with a vague resemblance to those angels in colored church windows – sort of trag ic and serene† (438), but the town sees her as defying the old order of her class. Her cousins are quickly sent for (by the townspeople) to bring Miss Emily back into her ‘destined’ role. Franz Kafka’s story â€Å"Metamorphosis† centers on the character of Gregor Samsa who wakes up one morning to discover he’s been transformed into the shape of a large bug, possibly a cockroach, which reflects his position in society and the expectations they have for him. It can be argued that Gregor’s transformation is a literal indication of his feelings of separation from humanity, including the members of his own family. Despite waking up to find himself in the form of a bug, Gregor’s primary concern is to get to work so that he can still support his family as he’s been doing for five years. This is the expectation society has placed on him and he has adopted for himself. As he thinks about his condition, he realizes the level of disconnection that has already occurred between

Tuesday, October 29, 2019

Bless Me Ultima Essay Example for Free

Bless Me Ultima Essay What will Antonio become when he grows up? A priest? A vaquero? A curandero? A farmer? Antonio’s future is not clear because, at the end of the novel, he has finally decided to choose his own path. Instead of listening to the beliefs of his mother or the desires of his father, he will fulfill Ultima’s encouragement to follow his heart. With this in mind, it seems likely that Antonio will probably become a man of learning according to Ultima, Whether or not this means that Antonio will become a priest as well is uncertain. Considering his questions about religion and morality and his anxieties about sin, it seems as if the life of a priest is not for him. However, no matter what he decides to do when he becomes an adult, the most important thing is that he has learned to make his own path. â€Å"I had more time to spend with Ultima, and in her company I found a great deal of solace and peace.† (Anaya 223) If Antonio found solace and peace with Ultima because of what she did (being a curandera). So why should he give up his solace and peace once she was gone? If becomes a curandero he would give himself solace and peace because of what he would do like Ultima. â€Å"I dropped to my knees; bless me, Ultima† (Anaya 260) Antonio asked to bless him right before she died. Antonio did not ask her to bless him in the name of God but a being a curandera. This seems to make Antonio not believe in God but in the powers of curandera. â€Å"I bless you in the name of all that is good and strong and beautiful, Antonio. Always have the strength to live. Love life, and if despair enters your heart, look for me in the evenings when the wind is gentle and the owls sing in the hills. I shall be with you†(Anaya 261) Ultima’s final blessing to Antonio Her statement also gives Antonio a idea with which to understand her death by offering a sequence of physical objects that he can see as symbols of her life and through which he can continue to feel her presence. Antonio will be without Ultima and will have to make his own choices without her guidance from now on, but she makes it clear in this blessing that her spirit will endure with him and that the lessons she has taught him will still serve him well even after she dies.

Saturday, October 26, 2019

Complications Of Skeletal Traction Health And Social Care Essay

Complications Of Skeletal Traction Health And Social Care Essay In the last two decades, there have been major changes in the management of lower limb long bone fractures, surgical management has become the norm. Skeletal traction is now rarely used as the definitive form of management. Most of the patients admitted to our hospitals have skeletal injuries, and these patients have prolonged length of stay as they are initially managed non- operatively. Complications of traction have been looked at since 1947 and have been published but literature from the developing countries is lacking. This study is being conducted to evaluate the prevalence of complications associated with skeletal traction with lower extremity fractures. Objective : To determine the proportion of patients with Lower Extremity fractures who develop complications associated with skeletal traction. Study Design:- This is a Hospital based Prospective Descriptive study, that will be carried out from December 2010 to March 2011. Study Setting :- The study will be carried out at the KNH orthopaedic wards. Materials and Methods :- Patients who are put on lower limb skeletal traction will be recruited into the study, They will be reviewed weekly for complications namely pin tract infection, pressure sores, venous thrombo-embolism, orthostatic pneumonia and knee stiffness, until upto the point they are taken off traction. The data will be collected using pre-designed questionnaires. INTRODUCTION Fractures of the femur are almost always the result of great violence and are sometime a threat to the patients life, not only because of the immediate complications such as bleeding or associated injuries but also because of subsequent complications related either to the treatment of the fracture or to the complications of the associated injuries. Immobilization of the fracture was recognised as essential for union. The development of splints, such as the Thomas splint and the subsequent combinations of the splints with traction methods either fixed or balanced, allowed for better control of the fracture, patients never the less had to remain in traction for three months or longer before the fracture was sufficiently stable to allow ambulation. Skeletal traction is seldom used in modern practice, usually it is only a temporary mode of treatment. Internal Fixation is still the treatment of choice for most closed injuries, this is because of higher union rates, lower rates of complications, earlier weight bearing, shorter hospital stays and early return to daily activites. In KNH majority of the patients admitted with femoral fractures are managed initially on skeletal traction. Patients with proximal femoral fractures are on Russel Hamiltons traction while patients with femoral shaft fractures are on Perkins traction. When the patient is managed on skeletal traction the patient is on prolonged bed rest and hospital stay increases also nursing care is difficult and the patient is at risk of developing morbidities due to the skeletal traction and prolonged immobilisation. The cost of care is increased and as seen in our setting most of the patients we manage come from a low socio-economic background who have difficulties in financing their healthcare. The prolonged confinements of the patients on traction is associated with certain complications, such as pin tract infections, decubitus ulcers, which can be overcome by better nursing care, but the complications of prolonged bed rest such as bladder and bowel derangements, deep venous thrombosis, osteoporosis, muscle wasting, to mention only a few cannot be prevented hence the need for early internal fixation. Literature Review Motor vehicle crashes are the leading cause of death in adolescents and young adults (1,2,3,4) and of the estimated 856 000 road deaths occurring annually worldwide, 74% are in developing countries (5). In both Nigeria (6,7) and Kenya (8), for example, a fivefold increase in traffic-related fatalities was observed over the last 30 years. Injuries cause profound morbidity and are one of top 10 causes of death and disability in both developing and developed economies (9). Kenya, like other developing countries, lacks organised efforts to reduce the burden of injuries. Although there is debate as to whether trauma systems in high-income countries are transferable to developing economies, baseline studies providing accounts of injury and injury trends in least developed countries are scanty.(10) Media reports have raised concern over rising road accident injuries in Kenya. Most of these occur in the capital city, Nairobi (11). Those injured mainly receive treatment at the Kenyatta National Hospital (KNH) the citys main hospital. The city lacks a systematic pre-hospital care and the patients arrive at the institution at any time and unannounced. As demonstrated in Saidis study, the injured are transported to hospital by private vehicles in the majority of cases. Ninety two per cent of the casualties arrive at KNH without any pre-hospital optimisation. (10) Saidi et al (12)found 31.0% of all admissions at KNH are due to injury indicating that a large volume of trauma admissions is handled at this public hospital. The average length of hospital stay of 14 days is from Saidis study is much longer than in reports from established trauma facilities. At the Vancouver General and Teaching Hospital, Canada, the length in 1997 was 9.14 days despite caring for patients with severer injuries (24% with ISS > 16) than in Saidis (12) cohort of patients (13.4% with ISS > 15) [12,13]. The excess length of hospital stay at KNH is caused by the predominance of skeletal injuries. Long bone fracture fixation is usually performed late, a practice occasioned by the local economic environment and a limiting factor for external validity of this outcome measure. An initial period of nonoperative care, which may last up to 4 weeks, is inevitable. The delay is caused by time spent to raise funds for desired implants. Many patients (90%) pay for the services out of their pockets [14]. If a policy of early fracture treatment incorporating a care reimbursement system that does not delay the operative intervention is introduced, the average length of stay may improve. This early fixation would additionally prevent pulmonary failure state, alleviate pain, ease nursing care, reduce complications [15], and allow early rehabilitation and return to work. The principles of traction are a pulling force that is applied to part of the body i.e. the limbs, the pelvis or spine and another force applied in the opposite direction called counter traction. The forces involved in traction are based on Newtons third law of motion, which states for every action there has to be an equal and opposite reaction. Malgaigne characterized as the greatest surgical historian, and author of the 1st comprehensive work on the diagnosis and the treatment of fractures (18), credits Guy de Chauliac with the introduction of continuous, isotonic traction in the treatment of fractures of the femur. This was accomplished by suspending a weight, attached to the leg by a cord over a pulley at the foot of the bed. The use of traction dates as far back as 3000 yrs. The Aztecs and the ancient Egyptians used manual traction and made splints out of tree branches and bark. (19) In 1847, Malgaigne introduced the first effective device which grasped the bone itself, these hooks were designed for the Rx of displaced patella fractures, the hooks were pressed through the skin and subcutaneous tissue to engage the proximal and distal fragment of the patella.(18) During World War One there was a rapid spread of the use of skeletal traction by application of tongs to the femoral condyles. After the war the tongs were extensively used in the United States but their popularity gradually decreased because of the complications, particularly infection associated with their use, tongs are now mainly reserved for skull traction.(21,22,23,24,25) Skeletal traction by means of the Steinman pin was popularized by Bohler and his students. Isotonic traction still remains an essential element in the closed treatment of many fractures. In many places worldwide it is standard practice to apply skeletal or skin traction to the injured limb following acute fractures prior to surgery Billsten 1996; Brink, 2005 (41). Traction may be either skin or skeletal. The main theoretical advantages of traction are that it will reduce pain at the fracture site and assist the reduction of the fracture thereby making the subsequent operation easier to perform. For intracapsular fractures reduction in circulatory complications has been proposed as traction may reduce any tamponade effect (Pressure caused by build up of excess fluid) which will compress blood vessels and block blood flow within the joint. Traction however has potential disadvantages, it makes nursing of the patients more difficult for e.g. use of a bed pan by the patient, pressure area care prior to surgery. Other adverse effects especially of skeletal traction include complications of sepsis at the pin site, pulmonary complications and knee stiffness because of the prolonged immobilization. In the last two decades there have been major changes in the management of lower limb long bone fractures, where resources permit, surgical management of open closed femoral tibial fractures has become routine.(26) Traction should now be rarely used as the definitive form of management. Orthopaedic surgeons have come to appreciate that there are 4 main treatment goals for fracture management (27). These goals were created by the ASIF (association for the study of internal fixation) and are: Anatomic reduction of the number fragments, ensuring alignment, length, and angulation and rotation are corrected as required. Stable internal fixation to fulfil bio-mechanical demands Preservation of blood supply to the injured area of the extremity. Active pain free mobilization of adjacent muscles and joints to prevent the development of fracture disease There are several studies done to determine the usefulness of pre-op traction, (32,33,34,,35,36,37,38,39), though these studies are mainly looking at proximal femoral fractures. Traction prior to surgery is standard practise in some hospitals, a survey of 78 hospitals in Sweden (40) showed that a quarter of those, routinely applied skin traction to all patients with hip fractures, while another survey done by Brink et al in 2005(41) found that pre-op traction was standard practise in 20% of trauma departments in the Netherlands. These studies have shortfalls in that the type of traction used is mainly skin fraction, and the maximum duration patients are on traction is 2.3 days Brink 2005(41), while in our setting patients are on traction for minimum one week prior to internal fixation . In this study only 4 patients were put on skeletal traction of the total patients put on traction, reasons for the difference are not given. From the Cochrane review article on the pre-op benefits of traction, not many studies have looked at the complications of patients put on skeletal traction. The main outcome measures in these studies (32,33,34,35,36,37,38,39,40,41) were degree of pain, analgesia use, length of surgery, ease of fracture reduction, and it seems like incidence of pressure sores and other complications were secondary objectives. One of the earliest accounts of complications of skeletal traction is from 1946, by Kirby Fills (42) they mainly looked at complications associated with trans-fixation pins and wires in skeletal traction, from a series of 305 fractures of long bones, complications occurred in 12, of these only 3 were related with Steinman pin use one of the patients had pin tract infection (PTI), and 2 had peroneal nerve palsy, however the author clearly states many patients who had a little drainage from the pin but no signs of inflammation were not regarded as pin tract infection . Pin tract infection is defined as an abnormal condition associated with skeletal traction or external fixation devices and is characterized by infection of superficial, deeper or soft tissues or by osteomyelitis. These infections may develop at skeletal traction pin sites. Some of the signs of pin tract infection are erythema at the pin sites, drainage, pin loosening, elevated temperature, and pain. The bone pin construct is not a sterile interface, but it is a pathway between the surface of the skin, which is normally colonized by bacteria, and the medullary cavity which is sterile (43). Factors which predispose to pin tract infection are thermal necrosis (44) and accumulation of fluid around the pin (45). Regular pin care prevents crusting around the pins, thus minimizing fluid accumulation and hence transmission of bacteria, within the underlying tissues (45). Pin insertion using a hammer leads to splintering of the cortex (46). Insertion of the pin using power tools has been indicated as the main cause of thermal necrosis (44) hence hand drills are preferable for insertion. Necrosis of osteophytes and tissues due to the temperature elevation provide a fertile bed for any pathogenic bacteria. Patients who are put on skeletal traction suffer from morbidities associated with prolonged bed rest. A feature peculiar to these patients is morbidities associated with pin tract infections, which results in pain, pin loosening and subsequently need for removal of the pin. Neglect in these cases can lead to abscess formation and osteomyelitis (43). Similar morbidity of pin tract infection is associated with pins used in external fixators. Reported incidence in the world literature on pin tract infection is 5-10% (47,48,49,50). This incidence increases in cases of transfixation pins upto about 80% (51). The prevalence of pin tract infection varies dramatically in the literature from a 1% prevalence of major infections to an 80% prevalence of minor infections (52). Even in the study identified by the Cochrane review (53) the prevalence of pin tract infection varied, based on the treatment of pin sites, from 8-25% (54). A common factor in most studies of pin site complication is the lack of a standard definition of what constitutes a PTI is it inflammation around the pin site as reported in upto 41.6% in one series (55), or is it cellulitis around the pins or pin sites with draining sero-purulent discharge or is it pin loosening. Therefore this study is being done to establish what the rates of pin tract infection are when all the signs of inflammation will be used to diagnose pin tract infection. Looking at studies done closer to home in 1962 procter reported his series of 41 patients in SA (56), he was looking at use of perkins traction in femoral fracture management. PTI was found in 15% of the patients, while all the patients had full knee ROM at a period of 10 weeks. A few years later Usdin reported his own series of 58 patients, managed by perkins traction, and 5 of these patients 8.6% developed pin tract infections, and 2 cases had residual knee stiffness (57). More recently Gosselin in his series of 53 patients from Sierra Leone in 2005 reported that 23 patients (42.6%) of his patients had a pin tract infection and at an average 29 days after being put on traction.(59) Therefore it is noted incidence of PTI varies from centre to centre and is dependent on several factors , it is the purpose of this study to establish what proportion of patients on skeletal traction develop a PTI. Other complications associated with skeletal traction are decubitus ulcers, venous thromboembolism, Knee stiffness and pneumonia. There is sparse literature which reports on the occurrence of these complications in association with skeletal traction. Butt et al in his RCT of operative versus non-operative treatment of distal femoral fractures found that in the non-operative arm, a total of 26 patients developed complications. 3 of these patients had DVT, 4 had chest infections, 4 had pressure sores, 4 had UTIs (58) and 5 out of 26 patients developed pin tract infection. When critically ill patients are under our care it is important to protect them from further deterioration or delays in recovery, especially due to complications that are not related to the underlying pathophysiology that brought the patient to hospital. Immobility is associated with increased risk of VTE, decubitus ulcers and pulmonary insufficiency. Bed rest is a highly un-physiologic form of therapy and can lead to a number of complications (table1). Immobility-Associated Complications System Complications Respiratory Atelectasis Pneumonia Pulmonary embolus Cardiovascular Hypovolemia Dampened carotid baroreceptor response Orthostatic hypotension Deep venous thrombosis Gastrointestinal Constipation Ileus Renal Renal calculi Urinary stasis Endocrine Hyperglycemia Insulin resistance Musculoskeletal Muscular atrophy and deconditioning Bone demineralization Joint contractures Skin Decubitus ulcers Psychosocial Depression Decreased functional capacity Decreased respiratory excursion and stasis of secretions leads to atelectasis and pneumonia, lesser muscle contractions of the lower limbs results in reduced venous return, venous stasis and VTE. Reconditioning, loss of skeletal muscle mass and strength, is often seen because of immobilization. Bone demineralization due to absence of weight bearing stress on the skeleton, joint contraction occurs because of muscle atrophy. Pressure sores develop because of prolonged pressure on bony prominences. DVT and PE have long been recognized as major causes of morbidity and mortality in patients undergoing both elective and emergency orthopedic surgery. Numerous studies have investigated the incidence of DVT PE associated with hip and total knee arthroplasty, also the role of prophylactic anti-coagulation has been extremely investigated. When considering orthopedic trauma patients extrapolation from the arthroplasty literature is not appropriate. The incidence of DVT PE in association with hip and pelvic fracture has been looked at extensively, however there is insufficient information on patients with femoral fractures managed with skeletal traction, so as to allow the orthopedic surgeon to determine the risk or benefit rational of anti coagulation. In a prospective study done in Canada a co-host of 349 following major trauma was studied, and DVT cross found in 126 of the 182 with lower extremity orthopedic injuries, 61% of patients with pelvic fractures, 80% of patients with femoral fractures, 77% of patients with tibia fractures had confirmed DVT using venographic studies. Patients with fracture of tibia, femur are known to be at almost a 5 times more risk to have DVT as compared to patients without fractures. Geerts et al also found that only 3 of the 201 patients with confirmed DVT (ODS 1.5%) had clinical characteristics suggestive of DVT, therefore it is questionable whether clinical characteristics are adequate to make a diagnosis of DVT. Although it is well known that elderly patients have an increased risk of thrombosis. Geerts et al also found that younger patients with trauma those that are under 30years had a 46% incidence of DVT. The incidence of DVT in patients with femoral fractures on skeletal traction is unknown. The purpose of this study is to determine the incidence of DVT with positive clinical characteristics and confirmed by Doppler U/S in patients on skeletal traction for femoral fractures. Respiratory problems are common after long bone fractures, The main common complication of long bone fracture is fat embolism syndrome (FES),(60) followed by respiratory dysfunction and insufficiency.(61,62) Despite the development of medical and anesthetic management, evidence indicates that early treatment of the fractures in a multiply injured patient has a profound effect in reducing the risk of subsequent respiratory complications. (61,63,64,65,66) There are numerous studies showing that early fixation of femoral fractures can decrease the incidence of ARDS and multiple organ failure (MOF).(67,68,69,70,71,65) Over the last decade the beneficial effects of early stabilization of femoral shaft fractures by intramedullary nailing have been challenged. The association between early femoral fixation with reamed nailing and a higher risk of ARDS/MOF has been suggested.(56,64,60,61,65,66,) The first prospective study on this subject showed that among 178 patients, the incidence of pulmonary complications was significantly higher in those with late stabilized fracture.(71) In patients with single fracture, the complication rate after late fixation was 22% in comparison with 4% after early stabilization. In multiple fractures, these rates the traction were100% and 32%, respectively.(69,70) Early fixation can lead to the prevention of thrombosis, subsequent bed ulcers, and decreases the needs for analgesics.(65,74) Furthermore, early stabilization eliminates the need for supine position for skeletal traction, it improves pulmonary function and prevents atelectasis.(63,65,67,74,75) This study is aimed to determine the incidence of respiratory problems in patients who have single femoral or multiple fractures, and are awaiting operative stabilization. Severely restricted knee motion is a recognized complication of operative procedures or trauma around the knee. This is a significant problem in underdeveloped countries where the initial management of many of these injuries is suboptimal. The reported rate (76,77,78,79) of significant knee stiffness after various injuries and procedures around the knee is as high as 11% in the western literature, but may be much higher in underdeveloped countries, where ideal management of trauma is not readily available (80). A large percentage of these cases present with adhesions inside as well as outside the knee, and the management of these cases then becomes complex. Loss of extension is labelled more debilitating in western cultures, with small extension deficits impeding normal walking ; restricted flexion however is a serious problem in the Asian countries, where social and religious mores make sitting on the ground a normal requirement of everyday life. Flexion loss is mostly due to intra-articular fibrosis and scarring in the quadriceps-femoral mechanism. Anterior adhesions involve the quadriceps expansion in the lateral and medial recesses, the suprapatellar bursa, muscle adhesions to the femur, patella , or even shortening of the rectus femoris (77). A number of studies have described the complications of traction however no study from the region where patients are primarily managed on skeletal traction have looked at the complications due to skeletal traction and those associated with prolonged immobilization. STUDY JUSTIFICATION:- American College of Surgeons Committee on Trauma has recommended that femoral shaft fractures in polytrauma patients be treated within 2-12 hours after injury, provided they are hemodynamically stable.(81,82) Studies have also shown the significant benefit of intervention within the first 24 hours. Immediate fixation has been shown to decrease fatalities, respiratory complications, multisystem organ failure, and the length of ICU stays in most patients. The type of early fixation used can be debated, but the timing appears to be what makes the difference (83,84). World over fracture fixation has evolved whereby early fixation is advocated for. In the resource-poor local setting with large volumes of patients occasioned by persistently high RTA, the primary management modality is skeletal traction. There is lack of skilled personnel (surgeons/traumatologists) in most peripheral hospitals and hence most patients who have sustained fractures of the lower limb are put on skeletal traction as ORIF cannot be done therefore it is important to establish what are the common complications suffered by these patients. There is a large volume of patients who are seen at KNH, this is mainly because of the poor infrastructure at peripheral hospitals in managing major orthopaedic injuries hence most patients are referred to KNH causing a strain on its resources and ultimately leading to substandard orthopaedic care. The complications associated with skeletal traction and prolonged immobilization have been reported by several authors however most of the numbers of patients who are managed on skeletal traction in these studies are few. In our setup most of the patients with femoral fractures are put on skeletal traction while awaiting operative management therefore it is important to know what the incidence of these complications in our setting are. The incidence of pin tract infection in most studies is not adequately reported as there is no standardized definition of pin tract infection therefore this study will look at pin tract infection broadly . In KNH patients with femoral fractures are put on skeletal traction while awaiting fixation, this is mostly done on an elective operating list and it is not known what duration these patients are on traction, from this study we will establish what the mean waiting time is for a patient with femoral fracture to be internally fixed. It is not known what number of patients with femoral fractures who are put on traction in our setting develop complications hence this study is being done to establish the proportion of patients who get pin tract infections, and other complications associated with skeletal traction. BROAD OBJECTIVE:- To determine the proportion of patients with Lower Extremity fractures who develop complications associated with skeletal traction. SPECIFIC OBJECTIVE:- To determine the proportion of patients on skeletal traction for LE fracture who develop pin tract infections venous thrombo-embolism knee stiffness pressure sores orthostatic pneumonia 2. Determine the proportion of those who recover from the complications 3. To determine the duration patients are on traction 4. Proportion of those with adverse outcomes following complications PATIENTS AND METHODS STUDY DESIGN This is a Hospital based Prospective Descriptive study. STUDY SETTING:- The study will be carried out at the KNH orthopaedic wards. STUDY PERIOD:- The study will be carried out over a period of four months or?until the sample size is achieved SELECTION CRITERIA :- All patients eligible to the study will be enrolled until the sample size is obtained. INCLUSION CRITERIA:- All skeletally-mature pts with lower extremity fractures put on skeletal traction as a definitive or temporary treatment option Those consenting to be recruited in to the study. EXCLUSION CRITERIA:- Skeletal immaturity determined radiologically. Pre existing disease: pneumonia, VTE, pressure sores SAMPLE SIZE CALCULATION:- The sample size will be determined by the use of the following formulae to achieve an adequate sample to accurately estimate the prevalence of complications in pin tract infection in the study population. n = Z2ÃŽÂ ±/2 X P (1-P) D2 Where n = required sample size P = prevalence of pin tract infection (42.6%, 24%  [1]  , 26%  [2]  ), based on the estimated prevalence from a similar study in Sierra Leon by Gosselin. This is the only study in the developing country performed in a similar setting. D = Precision with which to measure prevalence, set at plus or minus 1%. The ZÃŽÂ ±/2 is the cut off points along the x-axis of the standard normal probability distribution that represents probability matching the 95% confidence interval (1.96). Substituting the above in the formulae we get; n à ¢Ã¢â‚¬ °Ã‹â€  93.9 = 94 patients DEFINITIONS OF COMPLICATIONS AS WILL BE USED IN DATA COLLECTION :- Pin Tract Infection :- will be defined by signs of hyperemia,pain,crusts,seropurulent discharge around the pin site or pin loosening. Venous Thrombo-embolism :- Patients with unilateral leg swelling, calf pain, will be subjected to doppler u/s to confirm presence of a thrombus. Pressure sores : Trochanteric,sacral,calcaneal regions of the body will be examined and the use of the pressure sore grading system will be used to record presence of pressure sores :- Grade 1 :- non blanchable erythema of intact skin Grade 2:- Partial thickness skin loss involving epidermis,dermis or both Grade 3:- Full thickness skin loss involving damage o or necrosis of subcuataneous tissues that may extend down to but not through underlying fascia Grade 4 :- Full thickness skin losswith extensive destruction, tissue necrosis or damage to muscle or bone. Knee Stiffness :- Patients have a reduced range of motion of the knee of the injured limb and will determined by range of motion of less than 30 degrees, less than or equal to 90 degrees or more than 90 degrees. Pneumonia :- Patients who have recorded high temperatures, respiratory distress, cough, chest pain will be used to make a diagnosis of pneumonia. DATA COLLECTION:- Patients will be recruited into the study Consecutively Use of a questionnaire to gather data, including demographics, cause of fracture, traction system and its duration, incidence of complications and their outcome. Data will be collected as pertains to the date of commencement of traction up to the date patient undergoes operative management or is taken off traction. Patients will be recruited into the study as they are put on traction, and will be followed upto the time they are taken off traction. DATA ANALYSIS:- The data will be collected using a structured questionnaire. The questionnaires will be coded to make the data entry easy. The filled questionnaires will be kept in a safe place ready for the data entry and for the confidentiality of the patients details. After cross checking the questionnaires for any missing entries a data base will be designed in MS Access which will allow the researcher to set controls and validation of the variables. On completion of the data entry exercise the data will be exported in a Statistical Package (SPSS Version 15.0 Chicago , Illinois) for analysis. The data will be presented in tables and figures where applicable. Non- Parametric tests (Mann Whitney U test) will be used to examine whether there is any significant association between the continuous variables e.g. age and duration count, while chi-square will be used to establish the significant associations between the categorical variables. Odds Ratios (OR) and associated 95%C

Friday, October 25, 2019

The Synthesis of Knowledge :: Mind Mental Knowing Knowledge Essays

The Synthesis of Knowledge "Society values mental labor more highly than manual labor." This is a claim that Ruth Hubbard makes in her essay "Science, Facts, and Feminism." This claim suggests that those who are the thinkers, the innovators, the inventors, and the great minds are highly valued by society; however, those who are the doers, the laborers, the hand-crafters, and the workers are not valued as greatly. Hubbard implies that society regards mental labor as more important than manual labor because it requires more specifically human qualities. Knowledge making is one of these specifically human qualities. Mental laborers and manual laborers are distinguished by this knowledge making process. For Hubbard’s claim to have meaning, there are assumptions that must underpin the claim. First, society must value labor. Labor must be something usable in society. A distinction between manual labor and mental labor must exist. A line must be drawn as to what makes mental labor mental and manual labor manual. There exists a specifically human quality, like knowledge making, which classifies the mental and manual laborers. Labor must exist in society to place value upon it. One also must assume that the more knowledge making ability one has, the more successful one can potentially be. These assumptions must be accounted for, for the claim to have any validity. This claim, to me, explains what can be said about the value of knowledge making and experience. Knowledge making is valued greatly by society and society values those who posses this knowledge making ability. Knowledge comes from personal experience and these experiences make that person more intelligent. One makes a decision, and then one learns from the consequences of that decision resulting in more apprehension. An example of building knowledge making is when a small child touches a hot pan on the stove and gets burnt. This child’s knowledge making has increased and the child knows to never touch a pan on the stove without proper protection. Book knowledge is another important element. This type of knowledge can be defined from what results in a college degree, a doctorate, or just a secondary degree of education. One must have base comprehension of empirical insight. Mental laborers have this intuitive synthesis of knowledge where manual laborers do not posses as much. An example of this book knowledge is taking a course in trigonometry and how it affects future comprehension. With trigonometry learned, mathematical calculus can be more easily learned.

Wednesday, October 23, 2019

The Effects of Drugs on Our Society and Youths

While most People use drugs to help, some choose to abuse them. This is what leads to crime, and it affects our kids and society. The increasing phenomenon of drug abuse in society impacts American society in ways that economically cost society almost $100 billion a year. Illegal drug use has to stop! It hurts the society, it hurts us, and mainly, it hurts the user. Drug users feed of society’s money, insurance, and taxes. If we let this behavior continue the crime rate will shoot sky high. Drug use has increased over the years at an alarming rate and can be fatal to a person’s health. In this paper, I haven’t chosen to elaborate on any particular drug; just drugs in general and the effects they have on our society and our youths. A survey was conducted and showed that most people found it to be true that youths between the of 14-22 use recreational drugs. Recreational drugs are not limited to any particular group in society, meaning that a very wide variety of people choose to use the drugs; including teenagers, parents, business people, and often very dedicated students. As we possess an interest in how drugs affect a number of social groups. These groups range from teens to high-class elderly individuals who will have different reasons. It is generally known that most drugs do have negative effects on people. No matter race, sex, or age. Addiction is blind Drugs are substances used without medical supervision to alter a person’s feelings, or behavior, especially teens with a family history of substance abuse. Most drug use begins in the preteen and teenage years. During these years, teens are faced with difficult tasks of discovering their self-identity, learning to cope with authority, and searching for something positive that would give their life meaning. One of the most important reasons of teenage drug usage, is peer pressure. This is what represents social influences that effect teens. It could have a negative or positive effect, depending on a person’s social group. References The Journal of Early Adolescence, Vol. 14, No. 1, 24-48 (1994), Retrieved August 4, 2009 from http:/drugsandyouth. adolescence. com

Tuesday, October 22, 2019

Scarlett essays

Scarlett essays "Scarlett" is about a southern woman who had survived the Civil War, had been widowed twice with two children. She got married again to Rhett Butler, and they had a daughter who was killed when she fell off a horse. Since the death of the child, her husband did not want anything to do with Scarlett. Rhett gave Scarlett all the money she needed, but she wanted him. Heartbroken, she went to Ireland where her father came from. She did not tell anyone in America that she was going, except for her lawyer. She met her Irish relatives, and loved them. She bought a town and a Big House in Ireland and had it refurbished. Scarlett found out that she was pregnant with Rhett's child, but before she could tell him, he divorced her and married someone else. She vowed to not tell Rhett about the baby until it was grown, even though she loved him. She told her Irish friends that she was a widow and that her two children lived with her sister on a plantation in Georgia, which she owned two-thirds of. She gave birth to a girl on Halloween and a wise old woman had to deliver her because the doctor couldn't get there. The Irish called the woman a witch and the baby a changeling because of when she was born for they were very superstitious people. They never liked the little girl and were always scared of her. One of Scarlett's cousins in Ireland was a priest, whose name was Colum O'Hara, and they had become good friends. He taught her all about how the Irish relatives and friends were at war with the English who had bought most of the land, and most were not good landlords. The landlords evicted people and burned their houses because they only wanted the land. Scarlett hired alot of these people to work in her Big House and raise crops for her. She also gave them places to live. Colum took Scarlett to a horse sale in another county one day and she was bidding on a horse that she didn' ...

Monday, October 21, 2019

review sheet Essays

review sheet Essays review sheet Essay review sheet Essay M. J. Jarzombek and V. Prakash, A Global History of Architecture, 2nd ed. , New Jersey: John Wiley Sons, 2011. Moffett, Marian, Michael Fazio and Lawrence Wodehouse, Buildings Across Time, an Introduction to World Architecture, London: Laurence King Publishing, 2004. Trachtenberg, Marvin and Isabelle Hyman, Architecture from Prehistory to Postmodernism: The Western Tradition, 2nd ed. , New York and Englewood Cliffs, 2002. Ingersoll, Richard and Spiro Kostof, World Architecture: A Cross-cultural History, New York and Oxford, 2012. Nuttgens, Patrick, The Story of Architecture, 2nd ed. , London: Phaidon Press, 1997. Sutton, Ian, Western Architecture: From Ancient Greece to the Present, London: Thames and Hudson, 1999. Relevant readings from these texts are indicated in the detailed course syllabus. A glossary of architectural terminology is available at the end of Ingersolls book (pp. 957-964, Chings book (pp. 799-807), Moffetts book (pp. 68-571), and Trachtenbergs book (pp. 83-589). Bibliographies are organized chronologically at the end of Ching (pp. 809-818), Moffett (pp. 572-575), Trachtenberg (pp. 591-601), and at the end of each section of Ingersolls book. EXAMS: There will be three hour-exams on the following dates: First Hour-Exam: Monday, September 30, 10:00 am Second Hour-Exam: Monday, November 4, 10:00 am Third Hour-Exam: Monday , December 16, 1 1 am ASSIGNMENTS: discussion sections: October 24/25 November 21/22 These writing assignments will be linked to specific assigned readings and are intended to address reading comprehension skills. The readings will be available at east one week in advance and you will be required, in your discussion section, to respond to specific questions about the content and the authors arguments. Your responses will be written during your discussion section in blank Blue Books; all responses must be handed in at the end of the class. IMAGES: Powerpoint images shown in lectures will be accessible on Blackboard Learn, organized by lecture. Each student registered for the course will also be registered on Blackboard Learn. GRADING for students enrolled ARCH 2350: First Hour-Exam Second Hour-Exam Third Hour-Exam Writing Assignments x 2 @ 15% each Attendance, professionalism and class participation in discussion sections GRADING for students enrolled ARCH 6340: First Hour Exam Second Hour Exam Third Hour Exam Essays x 2 @ 15% each Short paper (1000 words), topic, due date tba GENERAL INFORMATION Prerequisite for students enrolled in ARCH 2350: English 1304, 1310 or its equivalent, completed or being taken concurrently. The content of the discussion sections (labs) will include discussion and clarification of the weekly lectures, specifically with the intent of understanding how architectural history can be relevant to the present, especially to contemporary rchitectural design. Attendance will be taken at each session and students are expected to participate in discussions. In order to perform well in this course, you must regularly attend both the lectures and the discussion sections. The material covered on the hour exams derives directly Make-up exams and make-up essays will be given only with a legitimate doctors note, police report or court order. There will be no make-up for the third hour exam. Plagiarism, defined as the appropriation or imitation of the language, ideas, or thoughts of another author, and representation of them as ones original work, will NOT be tolerated. Penalties may include a failing grade in the course, suspension, or expulsion from the university. The last day to drop the course with a grade of MT is Friday, November 1, 5:00pm. The university will NOT allow any withdrawals after this date. The University of Houston System complies with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, pertaining to the provision of reasonable academic adjustments/auxiliary aids for students with a disability. In accordance with Section 504 and ADA guidelines, each University within the System trives to provide reasonable academic adjustments/auxiliary aids to students who request and require them. If you believe that you have a disability requiring an academic adjustments/auxiliary aid, please contact the student disability services center at 713-743-5400. Schedule of Lectures Monday, August 26 Introduction and overview of the course Wednesday, August 28 Prehistoric Architecture-Late New Stone Age Monday, September 2 NO CLASS: Labor Day Holiday Wednesday, September 4 Egypt: Old and New Kingdoms Monday, September 9 Pre-Columbian Meso-America Wednesday, September 1 1 Buddhist and Hindu Sanctuaries in India and Cambodia Monday, September 16 Architecture and Culture of China Wednesday, September 18Architecture and Culture of Japan Monday, September 23 Greece: Site Planning: the Acropolis and the Agora Wednesday, September 25Greece: the Architecture of Temples Monday, September 30 First Hour-Exam Wednesday, October 2 Introduction The Roman Civic Presence l: Forum, Basilica Monday, October 7 The Roman Civic Presence II: Market, Theater and Amphitheater Wednesday, October 9 The Roman Civic Presence Ill: Gate, Arch, Aqueduct Monday, October 14 The Roman Religious Presence: Temple and Tomb Wednesday, October 16The Roman Residence: Villa and House Monday, October 21 Early Christian and Byzantine Architecture Wednesday, October 23 Architecture of the Islamic World: the Mosque Monday, October 28 Romanesque Architecture: Pilgrimage Churches and Cistercian Monasteries Monday, November 4 Second Hour-Exam Wednesday, November 6 Introduction to the Renaissance The Work of Brunelleschi Monday, November 1 1 The Work of Alberti and Bramante Wednesday, November 13 The Work of Michelangelo and Palladio Monday, November 18 Renaissance France: the Architecture of the Chateau Wednesday, November 20 Baroque Italy: the work of Bernini and Borromini Monday, November 25 Baroque nd Rococo in Austria and Germany Wednesday, November 27 NO CLASS: Thanksgiving Holiday Monday, December 2 France in the 17th Century 16th and 17th-Century Landscape Design Wednesday, December 4 England in the 17th Century Monday, December 16 Third Hour-Exam 11:00 am ARCH 2350/6340 Prehistoric Architecture Late New Stone Age (Neolithic) 3000-1000 BCE Suggested Reading: I ngersoll, pp. 23-32; Trachtenberg, pp. 57-61; Nuttgens, pp. 10-15; Ching, pp. 23-24, 47-51; Moffett, pp. 9-14. France, Carnac (in the region of Brittany) and England, Avebury, menhirs (megaliths literally, large stones] or monolithic upright stone markers), dolmens (two menhirs supporting a horizontal block, usually used for marking tombs (substructure of a barrow), post and lintel structural system), ca. 2000-1500 BCE. England, Stonehenge (near Salisbury), composed stone group based on a circular plan (henge monument), ca. 2750-1500 BCE, post and lintel structural system, mortise and tenon Joints; optical refinements: tapered pillars, inclining lintels. France, Gordes (in the region of Provence), The Bories, reconstructed prehistoric village; domestic architecture built up with relatively thin stone slabs, use of orbeling technique, ca. 2000 BCE. trilith [literally three stones] entry portals, (combination of corbeled construction with post and lintel construction). University of Houston Egypt: Old and New Kingdoms Suggested Reading: Ingersoll, pp. 48-60, 86-97; Trachtenberg, pp. 62-71; Nuttgens, pp. 28-41; Ching, pp. 39-45, 64-73; Moffett, pp. 23-37. Important Historical Information: ca. 3200-2160 BCE Old Kingdom ca. 1570-1100 BCE New Kingdom Old Kingdom Saqqara, Mortuary Complex of King Zoser, ca. 2650 BCE mastaba (bench in Arabic; bench-like quadrangular form); architect Imhotep. Giza, complex of Great pyramids, 2580-2500 BCE Cheops (Khufu), Chepren (Khafa) and Mycerinus (Menkure) Predetermined architectural procession: river, Valley Temple, causeway, Mortuary Temple, tomb. New Kingdom Deir el Bahari, Mortuary Temple of Queen Hatshepsut, ca. 1500 BCE architect: Senmut; dedicated to the sun god Amon-Ra; Proto Doric colonnades. Pre-Columbian Meso-America Suggested Reading: Ingersoll, pp. 83-190, 251-263; Nuttgens, Ch. 6; Ching, pp. 225-27, 432-34; Moffett, pp. 283-293. City of Teotihuacan, 150-650 CE, (when it was burned), located in the Valley of Mexico, ca 40 miles northeast of Mexico City: Pyramid of the Moon?talud/tablero profile; pen plaza in front of Pyramid of the Moon; Pyramid of the Sun; Citadel with Temple of the Feathe red Serpent; open compound: probably marketplace and administrative center; Street of the Dead. City of Chichen Itza, (Yucatan Peninsula), ca. 750-1200 CE: open plaza cont. pyramid, known as Castillo, Temple of Warriors to east, surrounded by rows of columns that create second open plaza, ritual Ball Court opposite, to west. Very north end of site occupied by sink well (place of sacrifice); city extends also toward south, w/ palaces and other temples (Red House) a round astronomical observatory (Caracol or snail). Buddhist and Hindu Sanctuaries in India and Cambodia suggested Reading: Ingersoll, pp. 141-147, 216-225, 265-279; Ching, pp. 30-31, 176-81, 214-15, 235-37, 244-45, 281, 594-95, 318-20; Moffett, pp. 67-85. Mohenjo-Daro (city in Indus Valley), today in Pakistan, ca 2500 BCE Buddhist sanctuanes (Buddha [565-480 BCE]) Sanchi, Great Stupa, 1st. century CE stupa relic mound with four gates (torana) Ajanta, Chaitya Hall, 250 CE chaitya = assembly hall or cave shrine, rock-cut sanctuaries Mahabalipuram, (Mamallapuram), Shore Temples, ca 700 CE two shrines dedicated to Shiva, one to Vishnu vimana = terraced tower above each shrine Madurai, Great Temple (Sri Meenakshi Temple), 1623 CE gopuram = terraced tower above a threshold (over a portal) Hindu Sanctuaries in Cambodia Angkor Wat, temple of the capital, 1 112-52 CE Architecture and Culture of China Suggested Reading: Ingersoll, pp. 175-182, 240-250, 424-436; Nuttgens, ch. 5; Ching, pp. 185, 286, 298-99; Moffett, pp. 86-99. Great Wall(s), first begun 221-206 BCE; maintained and upgraded primarily during the Ming Dynasty (1368-1644 CE). Guangdong (modern city with older districts); precedents: clay models buried in tombs, primarily from Han Dynasty burials (1st-2nd cents. CE); vernacular example: Hakka Housing. Chinese beam frame construction: Shanxi Province, Foguang Temple, 857 CE: wood frame construction, bracket clusters (tou-kung), concave roof profile. Various garden pavilions. beneficial, and the actions of man are in harmony with the social, cultural and political situations, then the feng Shui is auspicious. Three religious philosophies: Buddhism [imported from India; founded by Buddha (565-480 BCE)]. Confucianism: based on teachings of Confucius (551-479 BCE): based on moral conduct Cen) and combination of etiquette and ritual traditions (II). Taoism: based on Tao te Ching (The Book of the Virtuous Way), written by Lao-tzu, 6th cent. BCE. Songyue Pagoda, Henan Province, 520 CE Architecture and Culture of Japan Suggested Reading: Ingersoll, pp. 521-533; Nuttgens, ch. 5; Ching, pp. 287-92, 486-93; Moffett, pp. 9-109. Ise, Shinto Shrine, (Naiku), founded in 3rd cent. CE: dedicated to the Sun Goddess; tori, katsuogi, chigi, Wabi-Sabi. Nara, HoryuJi, Buddhist Shrine and Monastery, 7th cent. CE: hosho. Nagano, Matsumoto Castle, 16th cent CE. and Kobe (Hyogo), HimaJi Castle, 16th cent. CE; shogun garrison castles. Residential Archite cture Lashed frame structures: indigenous (vernacular) development. Two types develop from the lashed frame, and eventually merge together: . ) minka: based on lashed frame; rectangle, modular grid, interchangeable use of space; shoji. Teahouses (Sukiya)?influenced by Zen Buddhism Kyoto Province, Talan Teahouse, 16th cent. CE: tea-room with tokonoma, anteroom, entrance for tea master, garden path, exterior portico. Sukiya Style Residential Architecture Kyoto, Katsura Imperial Villa, 1625 CE. SURVEY OF ARCHITECTURAL HISTORY, I Greece: Site Planning: The Acropolis and the Agora Suggested Reading: Ingersoll, pp. 117-141; Trachtenberg, pp. 91-115; Nuttgens, pp. 86-101 ;sutton, pp. 10-17; Ching, pp. 121-24, 132-34 Moffett, pp. 53-56, 60-62. Important historical information: Dorians and Ionians: two of the tribes that settled in Aegean, beginning in 1100 BCE. Greek culture based on polis (city-state) and anthropomorphic polytheism (the worship of many gods who were divine but had human-like characteristics and form). Athens, Agora, 5th cent. BCE; open marketplace and civic center of the city; surrounded by several different building types arranged casually around the open square: Stoa of Zeus (stoa: long and narrow structure, usually open to one side with a colonnade, used for many civic purposes), New Bouleterion (bouleterion: council ouse), Temple of Hephaestus, Tholos or Skias (tholos: round temple type, here adapted for use as a dining room for the heads of the city council), South Stoa, Stoa of Attalus (added in the 2nd cent. BCE); the Panathenaic Way cuts across the Agora at a diagonal. Panathenaic Way: ceremonial path from Piraeus (the port city of Athens) through Athens up to the Acropolis; used for an annual procession in honor of Athena, the goddess who protected the city. Athens, Acropolis; the hill was inhabited as early as 3000 BCE; in the 13th century BCE the hilltop was occupied by a Mycenean citadel; transformed into an Archaic

Sunday, October 20, 2019

Important Female Artists of the Surrealist Movement

Important Female Artists of the Surrealist Movement Founded in 1924 by writer and poet Andrà © Breton, the Surrealist group was comprised of artists whom Breton had handpicked. However, the movements ideas, which focused on exposing the subconscious through exercises like automatic drawing, were not contained to the select few whom Breton capriciously favored or shunned. Its influence was worldwide and found its strongest outposts in Mexico, the United States, Europe, and Northern Africa. Due to Surrealism’s reputation as a male discipline, female artists are often written out of its story. Yet the work of these five female artists upends the traditional narrative about Surrealism’s focus on objectifying the female body, and their participation in the movement is testament to the fact that the Surrealist ethos was more expansive than art history has previously assumed. Leonor Fini Leonor Fini was born in Argentina in 1907, but she spent her youth in Trieste, Italy after her mother fled an unhappy marriage to Fini’s father. As an adult, Fini became well-acquainted with the Surrealist group in Paris, befriending figures such as Max Ernst and Dorothea Tanning. Her work was exhibited in MoMA’s seminal 1937 â€Å"Fantastic Art, Dada, and Surrealism† show. Fini was taken by the idea of the androgyne, with which she identified. Her lifestyle was in keeping with her unconventional approach to gender, as she lived in a menagetrois with two men for over forty years. She spent summers in a rundown castle on Corsica, where she gave elaborate costume parties, for which her guests would plan for months. Leonor Fini with one of her paintings. Francis Apesteguy/Getty Images Finis work often featured female protagonists in positions of dominance. She illustrated erotic fiction and designed costumes for her friends’ plays. She would also design her own costumes for social events. Her often over-the-top self image was photographed by some of the era’s most well known photographers, including Carl van Vechten. Perhaps Fini’s greatest commercial success was in designing the perfume bottle for Elsa Schiaparellis â€Å"Shocking† perfume. The bottle was made to look like the naked torso of a woman; the design has been mimicked for decades. Dorothea Tanning Dorothea Tanning was born in 1911 and grew up in Galesburg, Illinois, the daughter of Swedish immigrants. Stifled by a strict childhood, the young Tanning escaped into literature, becoming acquainted with the world of European arts and letters through books. Confident that she was destined to become an artist, Tanning dropped out of the Art Institute of Chicago in favor of living in New York. MoMA’s 1937 â€Å"Fantastic Art, Dada, and Surrealism† cemented her commitment to Surrealism. It was not until years later that she became close to some of its key characters, when many moved to New York to escape the growing hostility in Europe due to the Second World War. Portrait of Dorothea Tanning, 1955.   Michael Ochs Archives/Getty Images When visiting Tanning’s studio on behalf of his wife Peggy Guggenheim’s â€Å"Art of this Century† Gallery, Max Ernst met Tanning and was impressed with her work. They became fast friends, and eventually married in 1946, after Ernst had divorced Guggenheim. The couple moved to Sedona, Arizona and lived among a cohort of fellow Surrealists. Tanning’s output was varied, as her career spanned around eighty years. Although she is perhaps best known for her paintings, Tanning also turned to costume design, sculpture, prose, and poetry. She has a large body of work consisting of plush humanoid sculptures, which she was known to use in installations throughout the 1970s. She died in 2012 at age 101. Leonora Carrington Leonora Carrington was born in the United Kingdom in 1917. She briefly attended the Chelsea School of Art, then transferred to Londons Ozenfant Academy of Fine Arts. She met Max Ernst in her early twenties and soon moved with him to the south of France. Ernst was arrested by the French authorities for being a hostile alien and later by the Nazis for producing degenerate art. Carrington suffered a nervous breakdown and was hospitalized at an asylum in Spain. Her only means of escape was to marry, so she married a Mexican diplomat and left for the United States, where she was reunited with many of the Surrealists in exile in New York. She soon moved to Mexico, where she helped to found the Womens Liberation Movement and ultimately spent the rest of her life. Carringtons work centers on symbols of mysticism and sorcery, and often deals with significant recurring images. Carrington also wrote fiction, including The Hearing Trumpet (1976), for which she is best known. Sculpture by Leonora Carrington in Mexico City.    Meret Oppenheim Swiss artist Meret Oppenheim was born in Berlin in 1913. At the outbreak of the First World War, her family moved to Switzerland, where she began to study art before moving to Paris. It was in Paris that she became acquainted with the Surrealist circle. She knew Andrà © Breton, was briefly romantically involved with Max Ernst, and modeled for Man Ray’s photographs. Oppenheim was best known for her assemblage sculpture, which brought together disparate found objects in order to make a point. She is most famous for her Dà ©jeuner en Fourrure also called Objet, a teacup lined in fur, which was exhibited at MoMA’s â€Å"Fantastic Art, Dada, and Surrealism† and was reportedly the first addition to the collection of the Museum of Modern Art by a woman. Objet became an icon of the Surrealist movement, and though it is responsible for Oppenheim’s fame, its success has often overshadowed her other extensive work, which includes painting, sculpture, and jewelry. Though she was crippled by the early success of Objet, Oppenheim began to work again in the 1950s, after several decades. Her work ËÅ"has been the subject of numerous retrospectives around the world. Often addressing themes of female sexuality, Oppenheim’s work remains an important touchstone for understanding Surrealism as a whole. Dora Maar Dora Maar was a French Surrealist photographer. She is perhaps most famous for her photograph Pà ¨re Ubu, a closeup of an armadillo, which became an iconic image for Surrealism after it was exhibited at the International Surrealist Exhibition in London. Maars career has been overshadowed by her relationship with Pablo Picasso, who used her as muse and model for many of his paintings (most notably his â€Å"Weeping Woman† series). Picasso convinced Maar to close her photography studio, which effectively ended her career, as she was unable to revive her former reputation. However, a significant retrospective of Maars work will open at the Tate Modern in the fall of 2019. Photographs by Dora Maar of her lover, Pablo Picasso.   Getty Images Sources Alexandrian S.  Surrealist Art. London: Thames Hudson; 2007.Blumberg N. Meret Oppenheim. Encyclopedia Britannica. https://www.britannica.com/biography/Meret-Oppenheim.Crawford A. A Look Back at the Artist Dora Maar. Smithsonian. https://www.smithsonianmag.com/arts-culture/pro_art_article-180968395/. Published 2018.Leonora Carrington: National Museum of Women in the Arts. Nmwa.org. https://nmwa.org/explore/artist-profiles/leonora-carrington.Meret Oppenheim: National Museum of Women in the Arts. Nmwa.org. https://nmwa.org/explore/artist-profiles/meret-oppenheim.

Saturday, October 19, 2019

Health care marketing techniques Essay Example | Topics and Well Written Essays - 750 words

Health care marketing techniques - Essay Example Initially the health care marketing was using mass media marketing approach to reach the customers where uniform messages were provided to the general public. This was the era, ‘all things to all people’. This is done through television, radio and internet. But gradually the health professionals learned that this was not an efficient means of reaching the potential customers. They started to adopt the more targeted approaches to get better potential customers. As the marketing of health care become more accepted, they jumped on the marketing of health care organizations. The most well known hospital’s was emphasized and marketed its image rather than the services. They focused on the infrastructure and reputation of the organization. But this era of hospital marketing was also not realistic. Hospital marketing was considered fundamentally different from the product and service marketing. Then the health care marketing targeted on specific audience. They started em phasizing the service marketing. A specific service is provided for the particular needed audience. Marketing communication is to attract more patients’ volume by promoting high expectations. But only when the patient expects better experience, better confidence, better outcomes and strong basis for preferring one provider over another. Thus, marketing communication often promise or provide hints at better experience or outcomes. In the consumer driven market, the quality and safety issues are informed. The consumers are not making purchase once a year they choose a health plan for every day and they have a lot for choice. They want to gather maximum information about the product or services with the quality and cost. They take the suggestions of the third party and evaluate it. It’s the ability of the company to provide maximum information about the product or service. They

Friday, October 18, 2019

Statistics questions Assignment Example | Topics and Well Written Essays - 1500 words

Statistics questions - Assignment Example (a) From the box plot and the table presented, it is evident that the most deprived group exhibits the most variability in employment scale. An evaluation of the minimum and maximum value says it all. Similarly, the standard deviation backs the conclusion. It is evident that the minimum and maximum values for the least deprived and most deprieved are 1681, 3811 and 5000, 90780 respectively. The standar deviation for the least deprieved group was 649.67 while that for the most deprieved group was 20,388. (b) Measure of central tendancy are used to give readers an overview about the data. In this paper, there is a huge difference between the mean and median for the most deprived group. This can be explained by the fact that there are outliers at both side, too large data and too small data. In order to best represent the center of the employment scale values for the most deprived group, I will use mean since the data is derived from a large sample size. (c) Based on the findings above where the calculated t is in the acceptable region the null hypothesis is accepted at 5.0% level. Therefore, the percentage of adults supporting the healthcare law at the end of March is significantly higher than the percentage who supported the law in November (d) There are a number of factors that contribute to significant changes in the findings of research that study the same issue using data from a sample derived from the same population. In this case, it was established that there was a conflicting conclusionarrived by two major polls. The major explanation can be on the wording used on questions to collect the relevant data. The AP-GfK poll provided respondents with three options support, oppose and neither support nor oppose. The other poll provided respondents with only two option, oppose and support. This usually gives different data hence findings. More importantly, the timing is another significant factor. Polls conducted before a

Just Health Essay Example | Topics and Well Written Essays - 3000 words

Just Health - Essay Example "Is health, and therefore health care and other factors that affect health, of special moral importance?" 2. "When are health inequalities unjust? 3. â€Å"How can we meet health needs fairly under resource restraints?" (Daniels, 2008) This essay will evaluate the conceptualization of healthcare, global poverty, and world hunger on a common moral basis related to human need through an analysis of these ‘Three Questions of Justice’ in the works of Amartya Sen, Ronald Dworkin, John Rawls, and other modern scholars. In relating the issue of human needs to human rights through the lens of the moral imperative, the essay will seek to understand how societies and groups build political consensus and collectively address issues of human suffering through political organizations. This analysis includes an exploration of the theoretical and practical limits of humanitarian activity related to egalitarian economic rights frameworks and the goals of universal healthcare that are f ound in democracy, capitalism, and human rights. The moral awareness of the individual creates the categorical imperative to act, join into groups of free-association, build policies, and reform institutions to provide universal healthcare globally. This is based in human altruism fundamentally by definition. The issues of resource scarcity in society are only limited if the individual chooses to perceive them that way or they are controlled forcibly in a way that is inconsistent with the equality of human need defined through altruism. Similarly, they will only be enacted as policy or viewed as â€Å"universals† in society if enough people share these goals in group organizations collectively. Reform of institutions to implement economic rights or universal healthcare popularly is based in the shared moral awareness. The means of funding this process is limited only by resource restraints as individuals conceive them, and these are not inherent to society. Rather, the cost o f universal healthcare is negligible compared to what society wastes on what can be considered non-essential goods and services or â€Å"socialism for the rich† as it operates under the hegemony of corporate democracy in modern America. Because the coercive aspects of wealth distribution are resisted politically, an ideal solution to Daniels’ â€Å"Three Questions of Justice† can only be implemented if people base their social decisions and policies on selfless, compassionate, and altruistic understanding of human needs and global development, highlighting the need for mind-change (metanoia) in the individual as the basis for the reform of institutions and policy. The shared fundamentals of both humanism and religion provide a basis for the realization of these goals in human society, yet education in moral values can be seen as the preferred method of achieving for lasting change in institutions and governance. II. Healthcare - Human Need Creates the Moral Impe rative One way to interpret Daniels’ ‘Three Questions of Justice’ as they relate to the evolution of culture and civilization historically is to view healthcare issues related to global poverty, hunger, clean water, and sanitation of a special

Submit Negative Message based on ideas in Chapter 9 Essay

Submit Negative Message based on ideas in Chapter 9 - Essay Example When interacting with workers and other members of management, listening helps in avoiding confusion, helps in understanding task and the creation of a positive connection with the speaker. As a leader, one must be a keen listener of others so as to understand their ideas and concepts. The understanding these ideas are helpful in the developing of a compromised system of communication that increases the understanding of the information put across by the speaker. In order, to be an effective listener, a manager must be able to have face to face encounter with the customer and speak effectively. Words aptly spoken are like petals of gold in a silver lining. This statement is true even in leadership and organization management. Speaking must not be underestimated because it has massive influence on the people both customers and workers. It is indispensable as a leader to allow coworkers to speak. There is no sense to call a meeting and interrogate or lecture coworkers without giving them a chance to contribute their ideas. As a leader, allow coworkers to participate and write notes on the various points or issues mentioned by the workers. Do not cut the short to respond to their pleas to show courtesy and respect. In response to their ideas, share your argument with them in an orderly manner without forcing your idea or belittling their idea to make them feel inferior. It is necessary for the leader to highlight the points of argument and reasons for the decision choice made. This is noteworthy because it helps in maintaining the goals and objectives of the organization. Eff ective communication allows every member of the organization to participate in the running of the organization. During the conclusion of the meeting, the leader must summarize the main points and conclusions arrived at, so that every member present at the meeting is informed of the final decisions

Thursday, October 17, 2019

Positives and negatives of obamas presidency period Research Paper

Positives and negatives of obamas presidency period - Research Paper Example One of the most commendable aspects of the Obama presidency has been his rapprochement with the Iranian government over its nuclear program. The fact that the Iranian nuclear program has been a source of major controversy over the past decade can be considered to have been a source of much contention on the international scene. This is mainly because of the fact that the United States has been drawn into the issue as a result of the activities of the powerful Israeli lobby which has had much influence in the formulation of American policies over Iran. It is for this reason that Iran has been largely isolated from the international scene due to the sanctions imposed against it by most of the western powers (Mostofi 226). In addition, the economic sanctions that have been imposed against it have created a situation where its people have come to face many hardships mainly because of the constant shortages of food as well as the reduction of the purchasing power of the state because of t he blockade on its financial sector. Moreover, the decision to impose sanctions against it has ensured that the prices of natural gas and oil have remained high on the global markets in addition to the lack of exploitation of the extensive reserves that Iran possesses. Therefore, the initiative taken by Obama to promote dialogue with Iran has ensured that American interests will be protected within this country once the negotiations come to an end. The wars in Afghanistan and Iraq have come to be extremely unpopular with the American public and this is mainly because of the fact that there has been massive loss of American life as well as high expenditure in wars which have failed to achieve their intended objectives ("Obama Commits to Troop Withdrawal from Iraq by 2011" 3). It is for this reason that Obama’s order to withdraw American troops from both of these

Positive and Negative Impact of Tourism Essay Example | Topics and Well Written Essays - 750 words

Positive and Negative Impact of Tourism - Essay Example Tourists are attracted to seek different experiences from another environment oftentimes different from their usual surroundings. Currently, tourism has become a popular global vacation activity that actually generates profits for the visited community and this will contribute to its economic growth and development. â€Å"Tourism is alive with dynamic growth, new activities, new destinations, new technology, new markets, and rapid changes.† (Goeldner, 2008) The influx of tourists to a certain community will help local businesses sell their goods and services and even provide employment opportunities in the services industries related to tourism. These service industries cover transportation services on land, sea, and air; hospitality services such as hotels, resorts, and other venues for accommodations; entertainment services such as amusement parks, casinos, bars and other music venues, shopping malls, theaters, spas; and restaurants. â€Å"A parallel effect is argued with respect to employment, wherein the labor-intensive tourism industry would provide a large number of direct and indirect jobs suitable in particular for largely unskilled labor forces bedeviled by high unemployment and underemployment.† (Weaver, 2006) The need for some of these services is seasonal and unfortunately, the majority of these employment opportunities mean unimportant employments relating to low-skilled and low-waged levels. Most of the times these types of so-called employment can result in prostitution, drug trading, hustling, and gamblers. These will eventually lead to some negative lifestyles such as begging, the spread STD-related illnesses, hustling, and drug abuse. When there is growth in the tourism industry, the local government finds it necessary to improve some infrastructures such as new and passable roads will be built and old ones will be renovated especially those leading to tourist spots.

Wednesday, October 16, 2019

Submit Negative Message based on ideas in Chapter 9 Essay

Submit Negative Message based on ideas in Chapter 9 - Essay Example When interacting with workers and other members of management, listening helps in avoiding confusion, helps in understanding task and the creation of a positive connection with the speaker. As a leader, one must be a keen listener of others so as to understand their ideas and concepts. The understanding these ideas are helpful in the developing of a compromised system of communication that increases the understanding of the information put across by the speaker. In order, to be an effective listener, a manager must be able to have face to face encounter with the customer and speak effectively. Words aptly spoken are like petals of gold in a silver lining. This statement is true even in leadership and organization management. Speaking must not be underestimated because it has massive influence on the people both customers and workers. It is indispensable as a leader to allow coworkers to speak. There is no sense to call a meeting and interrogate or lecture coworkers without giving them a chance to contribute their ideas. As a leader, allow coworkers to participate and write notes on the various points or issues mentioned by the workers. Do not cut the short to respond to their pleas to show courtesy and respect. In response to their ideas, share your argument with them in an orderly manner without forcing your idea or belittling their idea to make them feel inferior. It is necessary for the leader to highlight the points of argument and reasons for the decision choice made. This is noteworthy because it helps in maintaining the goals and objectives of the organization. Eff ective communication allows every member of the organization to participate in the running of the organization. During the conclusion of the meeting, the leader must summarize the main points and conclusions arrived at, so that every member present at the meeting is informed of the final decisions

Tuesday, October 15, 2019

Positive and Negative Impact of Tourism Essay Example | Topics and Well Written Essays - 750 words

Positive and Negative Impact of Tourism - Essay Example Tourists are attracted to seek different experiences from another environment oftentimes different from their usual surroundings. Currently, tourism has become a popular global vacation activity that actually generates profits for the visited community and this will contribute to its economic growth and development. â€Å"Tourism is alive with dynamic growth, new activities, new destinations, new technology, new markets, and rapid changes.† (Goeldner, 2008) The influx of tourists to a certain community will help local businesses sell their goods and services and even provide employment opportunities in the services industries related to tourism. These service industries cover transportation services on land, sea, and air; hospitality services such as hotels, resorts, and other venues for accommodations; entertainment services such as amusement parks, casinos, bars and other music venues, shopping malls, theaters, spas; and restaurants. â€Å"A parallel effect is argued with respect to employment, wherein the labor-intensive tourism industry would provide a large number of direct and indirect jobs suitable in particular for largely unskilled labor forces bedeviled by high unemployment and underemployment.† (Weaver, 2006) The need for some of these services is seasonal and unfortunately, the majority of these employment opportunities mean unimportant employments relating to low-skilled and low-waged levels. Most of the times these types of so-called employment can result in prostitution, drug trading, hustling, and gamblers. These will eventually lead to some negative lifestyles such as begging, the spread STD-related illnesses, hustling, and drug abuse. When there is growth in the tourism industry, the local government finds it necessary to improve some infrastructures such as new and passable roads will be built and old ones will be renovated especially those leading to tourist spots.

Learning Styles Inventory Essay Example for Free

Learning Styles Inventory Essay Taking the Learning Styles Inventory Test was an insightful, informational, and introspective experience as a whole. It measures seven areas of standards or measure that clearly define an individual’s behavioral approach on learning – the visual, social, physical, aural, verbal, solitary, and logical learning styles. Each question within the test inquires about an individual’s leaning or inclination to harboring the outcomes of learning from each means or scenario indicated. The questions provide a learning situation where one will determine how he identifies with it, and one’s identification with each specific scenario determines how one learns through various situations. Putting oneself within each scenario allows one to review or evaluate one’s motivations in learning in order to understand clearly how one’s behavior and learning environment would and should be altered to facilitate greater learning. The result of the Learning Styles Inventory Test clearly indicates my personality or takes on the learning situation. Out of the seven learning styles, the Memletic Learning Styles Graph, as shown below, depicts that I am more inclined to learn effectively when I utilize my physical functions. The rating for each of the learning styles was remote that the bodily-kinesthetic learning style (18 points) stands out among the seven. (â€Å"Learning Styles Inventory – Results Page,† 2007) This piece of information I find true as I do tend to want or need to manipulate or experiencing things in order to learn or realize the structures or dimensions of objects, concepts, occurrences, and such. (â€Å"The Physical (Bodily-Kinesthetic) Learning Style,† 2007) Therefore, the result from the test did not surprise me at all. Next to the physical learning style, the aural learning style (15 points) follows as the second dominant one that applies to me. This is yet another factual information because I do find myself enjoying the learning experience when I work with music or sounds in the background. (â€Å"The Aural (Auditory-Musical-Rhythmic) Learning Style,† 2007) Music, as part of the learning environment, sets the mood or rhythm that motivates me to carry on and finish, not to mention enjoy, what I am doing. On the contrary, the least learning styles that I can identify my learning behaviors with is the verbal learning style (11 points), also including the visual, social, and solitary learning styles (12 points each). This means that I am not motivated enough to learn by reading or writing, looking at or watching visuals, socializing with other people, and even keeping to myself. The results of the test suggest that my strengths lie in my motivations and capabilities to do, or to become more productive by being actively involved during the learning experience. However, it might be difficult to become motivated within the learning environment as learning media such as visuals, written texts, the processes of socialization and independent learning are part of learning strategies or approaches being utilized in most cases. Moreover, the learning environment is balanced, such that it fosters various methods or approaches in learning; and my unbalanced learning styles suggest that I will not be able to keep up with the learning environment. Perhaps the most logical thing to do at this point is to try to even out or balance the learning styles that I should be accustomed to in order to draw out the advantages from it whenever the learning environment or situation calls for it. If it remains to be unbalanced, like my test results indicate, inflexibility will not facilitate learning but hinder the process of acquiring knowledge and skills as learning environments vary every time. Accomplishing this goal means that I would have to expose myself to varying learning situations, and understand the importance of each one in order to balance out my learning inclinations for the seven learning styles indicated. With this in mind, as the realization of the need to balance out these learning styles I have come to realize, I believe that taking the test allows one to understand the importance of being exposed to various learning situations and experiences which fosters creativity, flexibility, and competence in the workplace. References â€Å"Learning Styles Inventory – Results Page. † (2007). Retrieved November 26, 2008, from Advanogy. com. Website: http://www. learning-styles-online. com/inventory/results. asp â€Å"The Aural (Auditory-Musical-Rhythmic) Learning Style. † (2007). Retrieved November 26, 2008, from Advanogy. com. Website: http://www. learning-styles-online. com/style/aural-auditory-musical/ â€Å"The Physical (Bodily-Kinesthetic) Learning Style. † (2007). Retrieved November 26, 2008, from Advanogy. com. Website: http://www. learning-styles-online. com/style/physical-bodily-kinesthetic/

Monday, October 14, 2019

Physical Activity Among School Age Children

Physical Activity Among School Age Children I am looking at physical activity among school ages children K-12. Physical Education programs and recess are being cut across the country, so that more time and can be spent on increasing test scores. It is no secret that, todays kids are much less active than in past generations and their health is suffering due to their lack of activity. I want to create a survey, or try to combine ones that already have been used, to assess how kids feel towards physical activity. I also am interested in their opinions on what types of activities they would like to be doing in physical education classes. Research questions: I think that if kids were given the ability to choose the activities offered in Physical Education class, they will be more actively involved in the activity since they picked it. I think that if given the choice, kids will pick lifestyle activities as opposed to team sports, which is the current popular focus of physical education. There will be no difference in the amount of physical activity between inner city kids and rural kids. Abstract There is an epidemic brewing in this country now, with the lack of physical activity among children and adults. This lack of activity has lead to an exponential increase in obesity related diseases. The lack of physical activity is being confounded by school districts that are cutting recess and physical education programs. At this point nearly 40% of American elementary schools either eliminated or were considering eliminating recess [1]. It has been documented many times that lack of physical activity leads to a decrease in the quality of life for the individual not partaking in any physical activity. The CDC found that the amount of TV that children watch directly correlates with the measures of their body fat [1]. I think that children should be given a voice in what types of physical activity they would like to do in school since it is to their benefit to exercise. Introduction It is no secret that there is a major problem with obesity in America today. One of the biggest contributing factors to this epidemic is the lack of physical activity in children. I consider myself more active than most of my peers however; even I struggled to do all the requirements for the presidential fitness test in primary school gym class. Today, two thirds of American children cant pass a basic physical: 40 percent of boys and 70 percent of girls ages six to seventeen cant manage more than one-pull-up; and 40% show early signs of heart and circulation problems, according to a recent report by the Presidents Council on Physical Fitness and Sports [1]. More than just a lack of overall physical activity, children today are much more likely to be found inside. When fourth graders were asked why they play indoors rather than outdoors, one responded by saying I like to play indoors better cause thats where all the electrical outlets are [1]. Although it may have always been the case, today it seems politicians are the ones who are deciding what is really important in schools and what should be left out. There is an obsession going on right now about improving math and science test scores. To increase class time for these subjects the schools are cutting out recess and physical education classes. This emphasis has led to many schools dropping their recess programs and reducing their Physical education time to a minimal. A teacher was asked about the Physical Education of her students at the school where she worked, in which she responded that with all the testing in schools there is no time for physical education, let alone exploring the outdoors. In one of my kindergarten classes, the kids get to run to a fence and then run back. Thats their PE [1]. I have been unable to locate any evidence that show scores on math and science tests have increased due to more time spent in the class. I have come across multiple papers cl aiming students that are more physical active have higher test scores than students who do not, but I have not found any scientific evidence to prove these claims. Without scientific proof I can only predict that students that are physical active will have higher test scores based on personal experience. I know that the more physically active I am the better I feel dealing with the stresses of school life. The point of this study is to find out how we as a society can increase physical activity levels in children. It is extremely frustrating to me to think of how kids today do not have the ability to have recess and blow of some stress that has built up over the course of the day. I know from personal experience that recess was a very fun time for me and I was excited about what type of non-structured activity my friends and I were going to do that do at recess. I do not know why it does not shock more people but I cannot believe that more is not being done over the fact that todays children are going to have a shorter lifespan than their parents generation. If my study finds that kids are more inclined to choose lifestyle activities in PE class as opposed to team sports, I feel that should be taken into account on a national level. Physical activity levels need to be increased regardless of the location of the school (inner city vs. rural). Three research questions of particular inter est to me are; 1) I think that if kids were given the ability to choose the activities offered to them during Physical education class, they will be more actively involved in the activity since they had a role in selecting it. 2) I think that if given the choice, kids will pick lifestyle activities as opposed to team sports, which seems to be the focus of physical education today. 3) I also think there will be no difference in the amount of physical activity between inner city kids and rural kids. I will select schools from Northeastern Pennsylvania. I want to select schools that represent all types of income levels. To select the schools I will simple draw a quadrant over the state of Pennsylvania, if the school district falls in the Northeast section, a survey will be sent to that school. I will then take into account the location of that school by zip code and make sure that I have a balanced ratio of rural and inner city schools. I am doing this to determine what relationship th e area in which the children live has on their levels of physical activity. Review of the Literature Authors Jan Fenczyn and Czeslaw Szmigiel conducted a study to determine attitudes towards physical activity among girls and boys with simple obesity. Their study found that the attitudes of the young people towards compulsory physical exercises and active movement outside of school were tested by means of an original questionnaire developed by the authors. The results of the research show that overweight young people of both sexes attempt more often to avoid physical activity (movement) than their non-obese peers, both during physical education classes and outside school. Sex turned out to be a factor that differentiated attitudes towards physical activity. Almost total avoidance of physical activity by obese girls as compared with obese boys was observed. The boys to a greater extent than the girls did engage in physical exercise. The results of the research show the necessity for increased interaction to strengthen motivation to take up physical activities by obese pupils, particul arly girls. What is also worth considering is ones potential for physical fitness amongst young people when choosing activities, which becomes limited due to existing obesity [2]. It has been determined from literature reviews of peer-reviewed literature that interventions focusing on increasing activity performed during physical education were more effective than those targeting overall levels of physical activity. Strategies to promote activity during adolescence are needed to combat the decline in activity during the transition from school to work [3]. The amount of time students participate varies, depending on the school district. There is also a variation among grade levels, on the amount of time required in Physical Education. A study published in the SportsMed Journal found that, PE times range widely from 30 minutes to 5 hours/week in the lower school grades, but in many high schools, PE is not required during of the final 2-3 years of education. Minor adjustments to current PE and/or school based PA programmes have yielded a variety of potential short-term benefits. Relative to traditional PE, it has been observed in grade 9 girls that PE classes that were oriented toward personal fitness instruction (conceptual PE) resulted in a decrease of sedentary behaviour 1 year later. Other programmes resulted in an enhancement of school spirit, increased participant self-esteem, greater academic progress, alleviation of learning disabilities, short-term amelioration in various components of physical fitness, improved fundamental moto r skills and a reduced risk of juvenile delinquency. School PE interventions have also been used to control blood pressure, and cardiovascular risk factors, and to increase bone mass in both pre-pubescent children and early pubertal girls. However, not all of the benefits claimed are documented by well designed experimental studies. Furthermore, a number of controlled investigations of PE programmes have found little difference in body fat between experimental and control groups. One study showed that one additional weekly hour of PE during kindergarten was associated with a decrease of body mass index (BMI) the following school year in a sample of American overweight and borderline schools overweight girls. However, in girls with adequate BMI or in boys, no such effect was measured [4]. An important study that was reviewed by Francois Trudeau and Roy. Shephard was The Trois-Rivieres Growth and Development study. For this growth and development study, A total of 546 primary school students, both boys and girls, were recruited for their study. Approximately equal numbers of students were allocated to experimental and control programmes, based simply on their year of enrollment in school. Immediately preceding and succeeding years served as controls for the experimental cohort. The experimental students received 1 hour/day of a quality, specialist taught PE programme in grades 1 through 6. In the first 2 years, emphasis was placed on the learning of motor skills, and in subsequent years, a wide variety of indoor and outdoor activities were practiced with a view to developing both aerobic and muscular endurance. The primary objective of the intervention was to keep all students as active as possible throughout the nominal class hour of PE. The intensity of activity was checked by telemetry and further proof of an effective intervention was seen in significant increases of physical fitness. The experimental intervention was terminated when the children left primary school for high school, at an age of 11-12 years, but participants were recalled when they had reached the age of 30-35 years. At this later stage in their life course the authors examined perceived PA, lifestyle, attitudes towards PA and selected physical fitness variables in a sub sample of participants and controls. The long term effects of the intervention were assessed by two types of comparison: (i) between members of the original experimental and control cohorts; and (ii) between experimental subjects and a matched cohort of controls from other parts of Quebec who had participated in a province wide survey of PA and health. The latter comparison was intended to check for potential cross contamination between experimental and control subjects. Such contamination was minimal during the intervention phase of the study, but remained a distinct possibility in subsequent years particularly for the rural cohort. Although >20 years had elapsed since the intervention, 76.8% of experimental subjects were able to recall the name of their PE teacher in primary school and 71.4% remembered that they had received five PE classes per week. Among women from the experimental group, the percentage currently participating in at least three sessions of strenuous activity per week was substantially higher in the experimental than in the control sample (42.1% vs. 25.9%). However, no such difference was observed among men. One question asked of the subjects was: do you exercise or perform physical work at least three times a week? In females only, a positive answer to this question (i.e. a higher frequency of current weekly PA) was significantly associated with previous participation in the enhanced primary-school PE programme. Females exercising more than three times per week had previously also been more involved in intense, organized intense, non-organized intense and recreational intense PA as well as in PE instruction. The association between enhanced primary school PE and an exercise frequency higher than three times per week as an adult confirmed previously reported findings [4]. Trudeau and Shephard also found a survey of retrospective questions of adults in Dallas, Texas. This revealed a surprising prevalence of negative attitudes towards exercise imposed at school. Adult PA was lower when the frequency of being forced to exercise before adolescence was higher. However, it was unclear if PE was considered as much an imposed PA as organized sports [4]. There are many different types of interventions that have tried to increase Physical activity. It was found that among children, studies that focused on increasing physical activity during physical education lessons, as well as incorporating curriculum and/or environmental changes, were more effective than curriculum only interventions. Previous research suggests that children may compensate for higher levels of PA during school by reducing their PA outside school. Interventions that utilized activity breaks and those that made simple environmental changes in the school setting also showed promise. Although not always reported, such strategies are likely to be sustainable, little training is required, and they are likely to promote less structured types of physical activity that can be performed any time with little equipment [5]. Although PA decline among boys is becoming smaller, among girls it seems to be increasing. PA decline was basically the same 21% between self reported (questionnaire) and objective (accelerometry) measure in an analysis of a sub sample of adolescents from 11-12 to 13-14 years old. The decrease in PA may be positively associated with its baseline level, although a possible effect of regression to the mean phenomenon may not be ruled out. That is, those with high levels of baseline PA can potentially present a large decrease in PA levels, compared with those who start with lower PA levels. The decline seems to be higher in adolescents of low socio-economic level and lower in adolescents with more social friend support. It was presumed that physical activity level declined during the lifespan, particularly in adolescence. However, there were no studies quantifying this change or pooling results for a common interpretation. Having conducted a systematic review of the international litera ture, we found consistent evidence showing that physical activity declines over adolescence. On average, the mean percentage physical activity decline per year, across all studies reviewed, was 7.0% (95% CI: 8.8 to _5.2). Although earlier studies revealed a higher physical activity decline among boys, the decline has been greater among girls in more recent studies. Moreover, although the decline among girls was greater at younger ages (9-12 years old), among boys it was greater at older ages (13-16 years old). Interventions that attempt to attenuate the physical activity decline, even without an increase in physical activity levels, could be considered as effective [6]. Purpose and Rationale The purpose of this study is to find out why kids are not as physical active today as kids of previous generations. Some barriers as to why they do not like to do physical activity are listed as lack of facilities, such as playgrounds, gyms, sporting grounds, swimming pools, green spaces or cycle lanes, as well as safety issues that include too much traffic, the presence of teenage gangs, no or unclear traffic signs and bad condition of cycle lanes and footpaths. Conditions at school are often not optimal either, due to too short breaks and lack of space to play. Lack of organized activities for younger children and lack of sports organizations contribute to children doing little physical activity. Low-income families regarded the price of doing sports in a sports club as a major obstacle, although they would see the participation of their children in organized activities as a way to keep them in a safe environment [7]. It is very important that this epidemic be understood and fixed in todays society. The independent variables for my study will be gender, age and zip code of the school districts involved in the study. The dependent variables of my study are how much physical activity do they participate in daily, if the children do any physical activity, and what types of physical activity do they choose to do. If it comes back that students would rather play team sports, more research needs to be done to figure out why then do students have such low physical activity levels if they are most interested in team sports. Perhaps liability issues have discouraged schools from allowing students to play pick-up basketball and football games on school grounds, so kids have nowhere to play their team sports that interest them the most. I do not really understand why common sense cannot be employed by people today. If my kid(s) were playing pick-up basketball and broke an arm or were injured some other way, I would not even think of it being anyones fault. Things someti mes happen when kids are being kids and it should not be the schools fault. Without threat of legal action, kids may be provided use of school grounds during time off from school, thus being able to play teams sports with their friends. However if my hypotheses do come true it is extremely important to implement this studys findings. Children today need to be given the opportunity to be physical active and start reversing the health complications that they may have started by being so inactive. Methods A search of relevant peer reviewed literature was conducted by using EBSCOhost. Academic Search Complete, Alt HealthWatch, CINAHL, Education Research Complete, Health Source, MEDLINE, SocINDEX, SPORTDiscuss were selected for use on this topic. Physical activity in youth, attitudes towards physical activity, effectiveness of physical activity interventions, effectiveness of physical activity campaigns, youth and outdoor education were all different searches I did in order to find relevant sources. Sources were used if the seemed to provide information specifically on physical activity in youth or they provided insight on the barriers between youth and physical activity. I am interested in increasing physical activity in all children grades K-12. I had to piece together different studies because the ones I was able to find were very specific on ages. For example, ages 9-11 or ages 6-10 or high school students only were what some studies were focused on. Physical activity levels are a p roblem for all ages of children today and it needs to be increased for all ages of people infant to adult. I would like to sample schools from varying economic backgrounds. I do not believe there will be a difference in the amount of Physical activity between inner city children and rural children, however the activities they might wish to do, may differ. I will provide students K-12 with a survey so that their attitudes, what they would like to have offered, and what they would like to change can be accessed. I will select 250 schools, equally representing inner city, rural, and suburbs schools. They will be put into groups based on the median salaries for each town that the schools are located in. I think that rural schools will choose activities that are less expensive and more outdoors in nature, such as hiking, fishing, camping etc. I predict that inner city kids may choose activities such as wall-ball, or playing in the park. I predict that children going to schools in the sub urbs will choose to do activities that tend to cost more money, such as skiing or snowboarding, indoor rock climbing gyms and fitness centers. I also am predicting that regardless of the area each student lives, they will pick one of these lifestyle activities as opposed to organized team sports where it can be more embarrassing for students that do not possess the skill level needed to do team activities, like football, volleyball and baseball to name a few. At this point I am gathering data to show that there is a need to provide alternatives to the current curriculum in physical education. Kids should have the choice on which physical activities they wish to pursue so that they are more likely to find activities that they continue to do for the rest of their lives. It is highly unlikely that team sports, such as football and volleyball, will be played by anyone once they get out of high school and college. People at that point in their life are much more likely to run, bike, or hike, and if they have prior experience doing these activities they will be much more comfortable doing that by themselves when they are out of grade school. I will not manipulate the experiment in any way. I wish to find out what students with ranging demographics, want to do for physical activity and why they do not do any now. I am looking to provide participants with the ability to have input on what they would like to see being taught to them. I think that students know that it is not healthy to not exercise, but that they are not interested in what they are being provided with as options for physical activity. Once information is collected on what types of activities they wish to be given the opportunity to do, I believe that their opinions should be taken seriously and be given significant consideration by the teachers when creating their lesson plans. The information from my research will be more for the benefit of the teachers and other physical activity instructors, so that they can see how to best provide others with the information that they need to be the most physically active that they can be in their daily lives. Statistical Tools to be Employed Data gathered from my survey comparing grade level vs. grade level, ordinal data, and the amount of physical activity ( ratio data, min/day), will need to use a T-test independent samples to analyze this data. Data from my survey set it up comparing gender, nominal data, and the amount of physical activity (ratio data, min/day), a T-test independent sample like above to analyze the data. Information comparing zip code (inner city vs. rural, nominal) and amount of physical activity (ratio data, min/day), will also need to use a T-test independent sample. I will create a survey, Likert type scale, and then look at how those scores ranked when comparing gender and zip code with the type and amount of physical activity. A Mann-Whitney U test will need to be preformed when looking at the data generated from my likert scale when comparing zip code and gender with this scale. The data collected will help determine what factors impact Physical Activity levels in kids in relation to their difference in gender or zip code. I also will be able to draw conclusions on what type of Physical Activities that kids would prefer to do if given complete control over what activities they were offered at school. From this, it can be recommended what could possibly be done in order to increase the levels of PA among children. Summary of data If my data confirms my predictions, I will be able to see what some of the reasons are as to why kids are not active today like they used to be in previous generations. I think that the increase in availability of technology has a role in why kids would rather be inside than outside. I also think parents are showing a lack of interest in spending time doing physical activity as a family now-a-days. If parents do not wish to increase physical activity levels then it must be left to the school to increase the amount of activity. In addition to physical education, schools can promote physical activity in a variety of other ways. For example, physical education teachers might provide ideas for fitness breaks to classroom teachers, where 5-minute aerobic activities could be used to break up the school day. Extracurricular physical activity programs may also be employed, which could coordinate physical activities with community agencies and provide physical and social environments that enc ourage and enable physical activity. If there is a difference between kids living in different areas, more opportunities could be offered to expose kids from each area to more activities that they previously had no experience with. I also think more unstructured physical activity time during school or after school would go a long way in promoting physical activity for fun rather than for a specific sport or reason.