An Analysis of the Urban Issue of Tuberculosisin the Bourough of Newham

1.Introduction Tuberculosis is a very serious infectious disease that primarily affects the lungs, causing cough and breathing difficulties. The infection also causes systemic effects including fever, night sweats and weight loss (Ellner, 2011). In some cases, the infection can spread beyond the lungs and affect the bone/joints, lymph nodes, abdomen and blood stream (Ormerod, 2003). The disease is caused by the bacteria mycobacterium tuberculosis (WHO, 2014), which is spread through respiratory droplets. These droplets are passed when an infected individual coughs or sneezes and the droplets become inhaled by another person (NHS, 2014). Despite this easy method of transmission, tuberculosis is not readily transmitted, and therefore is most likely to affect those in close contact such as family or household members (Castillo-Chavez & Feng). Tuberculosis represents a significant risk of morbidity and mortality and represents a significant cost to society to treat and manage. Tuberculosis has particul arly shown to be a problem in cities, whereby the rates of increase are greater than those of rural areas (Anderson et al. 2006). This essay will address the reasons as to why tuberculosis affects urban areas (the sick city hypothesis), and look in to why tuberculosis contributes to this urban health penalty. As an exemplar of an urban environment suffering from the burden of tuberculosis, this essay will focus on the London borough of Newham. Newham has a tuberculosis rate 8 times higher than the national average and 3 times that of London. This essay aims to investigate the aetiology behind the incidence, and to find ways of reducing the rates of tuberculosis among individuals in the London borough of Newham. The paper will include the intervention strategies and how they should be implemented in order to reduce the rates of new infections and encourage men to get tested and get early treatment before the spread of infection. 2.Tuberculosis in an Urban Environment Tuberculosis tends to be regarded as a problem of the past, and was responsible for 20-30% of all mortality in 17th-19th century Europe (Dye & Williams, 2010). The incidence of tuberculosis declined throughout the 20th century (Watson & Maguire, 1997), however, the disease has been slowly returning to London since the 1980’s (Great Britain 2008, p. 19). The problem seems to be worsening in urban areas. This is illustrated by the example of London, where 3,302 new cases of tuberculosis (TB) were reported in 2010 (Fullman & Strachan 2013, p. 25), a figure that has more than doubled since 1992 (Anderson et al 2006). In 2006, the incidence of tuberculosis in London was 41.5 people in 100,000, a figure that represented the highest number of new cases in any major city in Western Europe (Anderson et al, 2006). Dyer (2010, p. 34) claims that the London borough of Newham is the most affected with some people already referring to it as the TB capital of the affluent western world. In f act, the rates of tuberculosis in Newham are currently higher than that in some impoverished countries. Vassall (2009, p. 48) suggest that Newham has 108 cases per 100,000 and Anderson et al suggest a 2001 figure of 116/100,000, figures that are more than half that in India (174 cases per 100,000) (Public Health England, 2012). Newham has a population of 308,000 with a population density of 85.1 per hectare as compared to 31 in central London (UK Census, 2012). These figures suggest that even in the populated city of London, Newham is an area of urbanisation, with a large number of people concentrated into a relatively small area. The increase of tuberculosis has been described as a ‘penalty for high density urban living’ (Dye 2010, p.859), likely due to the increased potential for transmission in overcrowding, and the increased rates of immigration to inner-city areas. Bhunu and Mushavabasa (2012) propose that tuberculosis thrives in conditions of overcrowding and poverty, issues that are common in urban areas. The high rates of tuberculosis in cities such as London, and areas of urbanization such as Newham, suggest that the incidence of tuberculosis is indeed an urban issue. Newham fulfills the criteria of high immigration rates and being an area of deprivation.. Newham has a diverse ethnic population, with 61% of the people being non-white (Farrar & Manson 2013, p. 54). The population of ethnic minorities continues to grow along with the increasing numbers of refugees and asylum seekers in greater London. Another aspect of urbanisation illustrated in the borough of Newham is that of deprivation and overcrowding. Farrar & Manson (2013, p. 16) claim that Newham ranks as the third most deprived borough in inner London. Most of the people here live in tower housing and overcrowded conditions that are the perfect condition for the spread of tuberculosis. There is a positive correlation between poor housing and poverty and the prevalence of tuberculosis, which is very clear in Newham as evidenced by the findings of 108 and 116 cases per 100,000 people (Vassal, 2009; Anderson et al., 2001). The aetiology of the issue of tuberculosis is highlighted when considering the distribution of the disease across Newham. The occurrence of disease is not evenly spread across the borough, with 70% of cases coming from Manor Park, Green Street and East Ham. These boroughs represent areas of population increase, overcrowding and higher levels of those living in poverty. Manor Park and Green Street also sho w differing dynamics of tuberculosis incidence, representing an overall increase of 40% since 2006 whilst all other areas of Newham either remained static or showed slight decrease (Malone et al 2009, p. 23). It can be seen that tuberculosis presents a significant urban issue, especially when comparing incidence in an urban area such as Newham to those less urbanised areas. Bromley has a population of 309,000 and a population density of 20 per hectare, in comparison to Newham’s population density of 80 per hectare (UK Census, 2012). Tuberculosis incidence in Bromley is between 0-19 per 100,000 compared to that of Newham, which is five times greater at 80-100 per 100,000 (Anderson et al., 2006). It is for this reason that necessary intervention strategies need to be formulated and implemented to help reduce the rates of tuberculosis among individuals living in Newham. 3. The Influence of Urbanisation on Tuberculosis Incidence While the global rates of tuberculosis are declining, the disease is showing steady increase in the United Kingdom. In 2012, 8751 new cases of the disease were identified in the country with 39% coming from London (Fullman and Strachan 2013, p. 43). Indeed London has the highest rates of the disease in Western Europe with Newham borough having the highest rates in the UK. Jindal (2011, p. 55) claims that the rate of tuberculosis in some London boroughs is more than twice higher than the threshold used by the world health organisation to define high rates. These higher incidences support the notion of a sick city hypothesis where there are greater levels of ill health than in rural areas, and may be due to the presence of factors in an urban environment that contribute to ill health (an urban health penalty). One factor that may contribute to the urban health penalty is that of immigration. Cities are easier to access than rural areas, provide areas of congregation and provide more fa cilities for immigrating families and individuals. The majority of individuals suffering from tuberculosis are people born outside the United Kingdom, with 75% of cases in 2003 being born abroad (Anderson et al., 2006). A reason for the high incidence in those born abroad but now living in the UK is exacerbated by the nature of tuberculosis. On initial infection, tuberculosis is confined by the immune system with only around 5% of cases experiencing symptoms within the first two years of infection (Narasimhan et al., 2013). The remainder of cases harbour a latent infection which may reactivate later in life, with about 10-15% of those infected going on to develop an active disease (Narasimhan et al., 2013). This insidious nature combined with the later activation of the disease explains why many people do not get the disease until later in life. It is likely that it is contracted in their country of birth, however then manifests much later once they have moved to the UK. Statistics indicate that over 90% of the residents in Newham diagnosed with the disease in 2011 were born outside the United Kingdom (Fullman and Strachan, 2013, p. 33). Among these, 50% arrived in the country in the last five years. In the same year tuberculosis diagnosis increased by 25% compared to 2010 (Fullman and Strachan, 2013), possibly as a reflection of the increased immigration. Additionally to a high immigrant population bringing significant disease burden from their countries of birth, London and Newham both represent many of the other issues of urbanisation and urban health penalty that can contribute to the high incidence of tuberculosis. Studies have shown that low vitamin D levels are associated with an increased risk of developing tuberculosis (Campbell and Spector, 2012; Chan, 1999). This is an important association in urban populations, as the living and working conditions foster less access to sunlight (the major source of vitamin D). Additionally, Asian immigrants present a problem of low vitamin D due to vegetarian diets, and a tendency to cover up their skin, not allowing to take advantage of the small amount of sunlight available (Chan, 1999). As previously mentioned, Newham is an area of both high urbanisation and with a large immigrant population, and 38.6% of the population being of Asian descent (London Borough of Newham, 2010). The immigrant population of urban areas such as Newham also present a non-vaccinated proportion of society. Whilst the BCG vaccine against tuberculosis was introduced in the UK in the 1950s and was shown to provide a reduction in risk of contracting tuberculosis (Colditz et al., 1994), those immigrating were less likely to receive this vaccination on moving to the UK. London also represents cases of tuberculosis that are socially and medically complex. As a hugely populated area, London includes those with HIV infection and presents other risk factors such as onward transmission and poor treatment. HIV is one of the m ost powerful risk factors for tuberculosis, with a incidence rate of 20 times higher in those that are HIV positive (Dye and Williams, 2010). People’s attitudes towards and access to healthcare also present a complex mix of factors which contribute to an increased incidence of many health problems, including that of tuberculosis. Those in impoverished areas have reduced access to healthcare, which may stem from many reasons such as complex needs, chaotic lifestyles, location of services, user ignorance, and language and literacy barriers (Szczepura, 2005). These can affect the disease process of tuberculosis from prevention, treatment of active disease, adherence to treatment and prevention of the health consequences. Especially problematic are misconceptions and a lack of understanding of the disease, leading to late presentation and delayed access to treatment (Figuera-Munoz and Ramon-Pardo, 2008) With the close living quarters in areas such as Newham, the spread of tubercu losis is facilitated. With poverty, poor housing and overcrowding, these areas concentrate several risk factors and lead to a greater spread of tuberculosis (Bates et al., 2004). These determinants therefore suggest that the incidence of tuberculosis in urban areas is a complex issue. Controlling and preventing tuberculosis in London requires effective social and economic tools that must be incorporated in the development of policies of control in treatment initiation. 4. Consequences and implications of tuberculosis on the general population Tuberculosis ranks with HIV/ AIDS and Malaria as one of the three main health challenges currently facing the world. The Commonwealth Health Ministers Update 2009 (2009, p. 41) indicates that 8 million new cases are reported globally each year. As previously mentioned, when combined with HIV, tuberculosis can prove lethal as the two diseases enhance the progress of each other. It is for this reason that tuberculosis is the major cause of death among HIV patients with the rate standing at 11% globally. The World Health Organization (2009, p. 27) indicates that tuberculosis is responsible for more deaths today than ever before, with approximately 2 million lives claimed by the disease annually. As well as the significant mortality contributed by tuberculosis, the morbidity of the disease can be extremely detrimental both socially and economically. Those with the active disease that are not receiving treatment have been shown to go on to infect 10-15 others every year (WHO, 1998). Those who do receive treatment face a long (up to six months) and complex treatment regime involving several medication side effects. This can affect adherence to the treatment regime, and lead to the disease developing a resistance to the treatment, with this drug resistant tuberculosis contributing to greater mortality and increased expense to treat (Ahlburg, 2000). As well as the significant morbidity and mortality, it is important to consider the economic impact of tuberculosis. The World Health Organisation estimated the cost to treat tuberculosis in 2000 as $250,000 US dollars (?150,000) in developed countries (Ahlburg, 2000). This presents a significant burden to the UK NHS, not to mention the time lost through not working which can dent the economy. London is a global world trade centre whose economy is shaped by global forces, particularly in terms of trade, labour and capital. As a gateway to both the UK and other parts of Europe and the rest of the world, London records a very large number of tourists and immigrant populations. This high number of people accelerates the spread of the disease as people carry it to the country from other parts of the world is indicated by the new infection patterns and is highlighted by the prevalence in immigrant populations. 5. Strategies and intervention for addressing tuberculosis Current UK guidelines for tuberculosis intervention were made by NICE in 2006 (updated 2011). The recommendations propose strategies for identifying those with latent (non-active) tuberculosis to prevent spread or reactivation and also specify criteria for treatment (NICE, 2011). Those recommended for screening for latent tuberculosis include close contacts of infected individuals, immigrants from high incidence countries, immunocompromised individuals, and healthcare workers. Whilst this strategy targets prevention of the spread of tuberculosis, they are only targeting specific groups, and it is likely in high incidence areas such as Newham, people will slip through the net. These guidelines have only changed minimally since 2006, and since then tuberculosis incidence has been on the increase in areas such as Newham, suggesting that changes may need to be made. High incidence areas of the UK such as Newham could learn from New York experience and copy the strategy it used in dealing with the disease. With the implementation of broadened initial treatment regimes, direct observed therapy, and improved guidelines for hospital control and disease prevention, the city managed to halt the progression of an epidemic (Frieden et al., 1995). As mentioned in the previous chapter, adherence to the lengthy treatment regime as well as a lack of understanding may contribute to the spread of tuberculosis. Directly observed therapy (DOT) involves observing the patient take each dose of their medication, with outreach workers travelling to their homes. Evidence from New York showed that through DOT, only 3% of patients in therapy were infectious, compared to a proposed 20% if not receiving DOT (Frieden et al., 1995). Current UK guidelines (NICE, 2006) do not recommend DOT, although they do state that it may be used in cases of patients with previous issues with adherence or at high risk. Although an expensive and time consuming process, if DOT can reduce infectious cases, thi s would also work as a preventative measure. There could be one allocated outreach nurse for the borough of Newham and other high-risk areas. Another method implemented in New York was the downsizing of large shelters for the homeless. These were breeding grounds for tuberculosis, and the subsequent reduction in overcrowding led to a decrease in transmission of the disease (Frieden et al., 1995). Whilst it is not possible to split people up from living with their families in crowded homes in terms of Newham, education about keeping those with tuberculosis from interacting with too many others in crowded conditions may be of benefit. The model should also borrow from those used by other cities like Paris and the rest of Europe in controlling tuberculosis with intervention at the level of the agent, individual and community levels. In Paris, Rieder (2002) suggested that prophylactic treatment could be used to prevent the disease occurring in those at risk, for example those in the hou sehold of an identified case of tuberculosis. Additionally, Rieder (2002) proposed that early or neonate vaccination be used especially in those in areas where tuberculosis is frequent, rarely diagnosed, and adequate contact examinations rarely feasible. It may be possible that in cases where lots of people are vaccinated that they may infer herd immunity and thus protect unvaccinated individuals from the disease. Once the populations have been protected and the incidence (number of new cases) of tuberculosis has been reduced, this allows for a reduction in the prevalence of tuberculosis (number of ongoing cases at any one point in time) with preventative chemotherapy that can treat sub-clinical, latent tuberculosis in the population. This preventative chemotherapy is likely to be extremely relevant to Newham due to the large immigrant population likely harbouring latent tuberculosis. On a country- or city-wide scale, these recommendations from New York and Paris provide excellent m odels for preventing the increase of tuberculosis any further. It is also important, however, to consider the individual communities in Newham, and to promote health awareness and an attitude towards taking responsibility for their health. Their needs to be an encouragement at the level of primary care where immigrant populations feel that they can approach healthcare, and education to encourage tuberculosis prevention and adherence to treatment. The strategy should be all-inclusive in order to encourage people to not only go for testing but also start and finish the treatment process. 6. Recommendations and conclusion Tuberculosis presents an important urban issue in the area of Newham. Incidence is greater than other areas of the UK, and is over half that of India. There are several factors contributing to this including a large immigrant population, crowding and overpopulation, access to healthcare and comorbid health problems such as vitamin D deficiency and HIV. The disease has considerable effect on morbidity and is responsible for high levels of mortality. Further consequences of the disease manifest as economic problems such as cost of treatment and loss of work. London and the UK already have policies and structures for controlling tuberculosis in place; however the implementation process is patchy across the city, and often dependent upon budget. In high-risk areas such as Newham, there is poor access of healthcare due to inaccurate beliefs on the disease, language and cultural barriers, and complex needs of the population. In the case of tuberculosis, these contribute to poor disease pre vention, delayed diagnosis and poor treatment adherence. All of which lead to an increase in transmission and health consequences. The area of Newham would benefit greatly from further education into tuberculosis, how to look for signs and how to get treatment. Encouraging good relationship with healthcare professionals and promoting access to healthcare through outreach programmes and targeting pharmacies may be helpful. Additionally, Newham should look to employ techniques used in New York and Paris, including DOT, prophylactic treatment and neonate vaccination to reduce both the prevalence and incidence of tuberculosis. References Ahlburg (2000). The economic impact of TB: ministerial conference Amsterdam, WHO Bates, I., Fenton, C., Gruber, J., Lalloo, D., Lara, A. M., Squire, S. B., †¦ and Tolhurst, R. (2004). ‘Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part II: determinants operating at environmental and institutional level’. The Lancet Infectious Diseases, vol. 4(6), pp. 368-375. Bhunu, C. P., and Mushayabasa, S. (2012). ‘Assessing the effects of poverty in tuberculosis transmission dynamics’. Applied Mathematical Modelling, vol. 36(9), pp. 4173-4185. Campbell, G. R., and Spector, S. A. (2012). ‘Vitamin D inhibits human immunodeficiency virus type 1 and Mycobacterium tuberculosis infection in macrophages through the induction of autophagy’. PLoS pathogens, vol. 8(5). Castillo-Chavez, C., and Feng, Z. (1997). ‘To treat or not to treat: the case of tuberculosis. Journal of mathematical biology’, vol. 35(6), pp. 629-656. Colditz, G. A., Brewer, T. F., Berkey, C. S., Wilson, M. E., Burdick, E., Fineberg, H. V., and Mosteller, F. (1994). ‘Efficacy of BCG vaccine in the prevention of tuberculosismeta-analysis of the published literature’. Jama, vol. 271(9), pp. 698-702. Commonwealth Health Ministers Update 2009. (2009). Commonwealth Secretarial. Dye, C., and Williams, B. G. (2010). ‘The population dynamics and control of tuberculosis’. Science, vol 328(5980), pp. 856-861. Dyer, C. A. (2010). Tuberculosis. Santa Barbara, California: Greenwood. Ellner JJ. Tuberculosis. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011: vol332. Farrar, J., & Manson, P. (2013). Manson’s tropical diseases. Hoboken, NJ: Wiley. Figueroa-Munoz, J. I., & Ramon-Pardo, P. (2008). Tuberculosis control in vulnerable groups. Bulletin of the World Health Organization, 86(9), 733-735. Frieden, T. R., Fujiwara, P. I., Washko, R. M., and Hamburg, M. A. (1995). ‘Tuberculosis in New York City—turning the tide’. New England Journal of Medicine, vol. 333(4), pp. 229-233. Fullman, J., & Strachan, D. (2013). Frommer’s London 2013. Hoboken, NJ: Wiley. Great Britain. (2008). Diseases know no frontiers: How effective are intergovernmental organisations in controlling their spread; 1st report of session, 2007-08. London: Stationery Office. Jindal, S. K. (2011). Textbook of pulmonary and critical care medicine. New Delhi: Jaypee Brothers Medical Publishers. London Borough of Newham, (2010). Community Leaders and Engagement, Manor Park Community Forum Profile [Online], Available:http://www.newham.info/research/CFProfiles/ManorPark.pdf [12 April 2014]. Malone, C., Beasley, R. P., Bressler, J., Graviss, E. A., Vernon, S. W., & University of Texas Health Science Center at Houston, School of Public Health. (2009). Trends in anti-tuberculosis drug resistan ce from 2003–2007 at Pham Ngoc Thach Tuberculosis and Lung Disease Hospital, Ho Chi Minh City, Vietnam. (Masters Abstracts International, 47-5.) National Institute for Health and Care Excellence (2006) [Clinical Diagnosis and Management of Tuberculosis, and measures for its prevention and control]. [CG117]. London: National Institute for Health and Care Excellence. Ormerod, L.P. (2003) ‘Nonrespiratory tuberculosis. In Davies PDO (Ed) Clinical Tuberculosis. Third Edition. Arnold: London. pp. 125-153. Public Health England (2012), World Health Organization (WHO) estimates of tuberculosis incidence by rate, 2012 (sorted by rate). [Online] Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317140584841 [12 April 2014]. Rieder, H. A. (2002). Interventions for Tuberculosis Control, 1st edn. International Union Against Tuberculosis and Lung Disease, Paris, France. Szczepura, A. (2005). ‘Access to health care for ethnic minority populations’. Postgraduate Medical Journal, vol. 81(953), pp. 141-147. Vassall, A., & University of Amsterdam. (2009). The Costs and cost-effectiveness of tuberculosis control. Amsterdam: Amsterdam University Press. Watson, J. M., and Maguire. H.C (1997). ‘PHLS work on the surveillance and epidemiology of tuberculosis.’ Communicable disease report. CDR review 7.8, pp. R110-2. World Health Organization. (2009). Global tuberculosis control: Epidemiology, strategy, financing : WHO report 2009. Geneva: World Health Organization. World Health Organisation (2014). Tuberculosis. [Online], Available: http://www.who.int/topics/tuberculosis/en/ [12 April 2014] UK Census (2012), UK Census Data, [Online]. http://www.ukcensusdata.com/newham-e09000025#sthash.51Phmj6a.dpbs [12 April 2014]

Marie Antoinette: Research Paper

Melissa Arias Alma Aguilar Political Science 101 24 September 2012 Marie Antoinette â€Å"Let them eat cake† is probably one of the most recited quotes around the world, which is known to be spoken by the last Queen of France, Marie Antoinette. Although often reffered to as â€Å"The Party Queen† or in other words, the Queen who danced while her people starved. But what many fail to recognize is the fact that Marie Antoinette was the Queen who cared for her people. The only think she cared for more than the welfare of her people, was the welfare of her children.In order for one to understand and have the ability to fully understand the French Revolution, and Monarchy, one must go back and analyze Marie Antoinette's personal background, her political contributions and achievements, and her political influences. Personal Background Marie Antoinette (Archduchess Maria Antonia of Austria) was born in Vienna, Austria on November 2nd, 1755. â€Å"She was the fifteenth child, and eleventh (and last) daughter of the Emperor Francis 1st of Lorraine and Maria Theresa of Austria, at the head of the Habsburg dynasty†(Moore 3).Francis 1st died in August 1765, leaving his wife and his elder son to co-rule his empire. â€Å"To promote diplomatic relationships with France, Marie Antoinette was asked to marry Louis Auguste, the Dauphin of France† (Campan 3). With the conclusion of the Seven Years' War in 1763, an alliance between Austria and France became a priority for Empress Maria Theresa; cementing alliances through matrimonial connections was a common practice among European royal families at the time. In 1765, the son of French Emperor Louis XV, Louis Ferdinand, died, leaving his 11-year-old grandson Louis Auguste heir to the French throne.Within months, Marie Antoinette and Louis Auguste were pledged to marry each other. A child of only 14 years, delicately beautiful with gray-blue eyes and ash-blonde hair, in May 1770, â€Å"Marie Antoinette set out for France to be married, escorted by 57 carriages, 117 footmen and 376 horses. On May 16, 1770, Marie Antoinette and Louis Auguste were married†. (Campan 6) † Louis XV passed away in 1774, and Louis Auguste succeeded him to the French throne as Louis XVI, making Marie Antoinette, at 19 years old, Queen of France†(Barker 9).However, as personalities went Louis XVI and Marie Antoinette could not have been more different. He was introverted, shy and indecisive, a lover of solitary pleasures such as reading and metalwork. She was vivacious,outgoing and bold, a social butterfly who loved gambling, partying and extravagant fashions. Political Influences and Development Though many have argued that Marie Antoinette did not have any political development or influences, due to her social and eccentric ways, Marie always referred to someone in her life as the main source of admiration. Her Mother, Queen Maria Theresa, Marie often spoke of her with profound respect, but she based all her schemes for the education of her children on the essentials which had been neglected in her own†(Barker 9). Maria Theresa, often was inspired awe by her great qualities, taught the Archduchesses to fear and respect rather than to love her. â€Å"The Empress was too much taken up with high political interests to have it in her power to devote herself to maternal attentions. â€Å"(Campan 8) The queen's influence on domestic policy before 1789 has also been exaggerated. Her interference in politics was usually in order to obtain jobs and money for her friends. It is true, however, that she usually opposed the efforts of reforming ministers such as A. R. J. Turgot (1727–1781) and became involved in court scandals against them. â€Å"( Moore 12 ) â€Å"Activities such as the â€Å"diamond necklace affair,† where the queen was accused of having an improper relationship with a wealthy church official in exchange for an expensive necklace, inc reased her unpopularity and led to a stream of pamphlets and articles against her†(Barker 11).The fact that after the birth of her children Marie Antoinette's way of life became more restrained did not alter the popular image of an immoral and extravagant woman. As soon as the arrival of a stranger of rank at Vienna was made known, the Empress brought her family about her, admitted them to her table, and by this concerted meeting induced a belief that she herself presided over the education of her children. Contributions and WrittingsFrom the beginning of the revolution, Marie Antoinette and Louis had hopes for a compromise: in other words, a constitution that would include the monarchy. Trying to re-establish normalcy, Marie Antoinette continued her generous patronage of the poor children of Paris. â€Å"At the fireworks celebrating the marriage of the young prince and princess in May 1774, there was a stampede in which many people were killed. Louis and Antoinette gave all of their private spending money for a year to relieve the suffering of the victims and their families. (Campan 2)Marie-Antoinette's reputation for sweetness and mercy became even more entrenched in 1774, when as the new Queen she asked that the people be relieved of a tax called â€Å"The Queen's belt,† customary at the beginning of each reign. â€Å"Belts are no longer worn,† she said. She also spent as much time as possible with her own children, particularly the dauphin. â€Å"(Moore, 8). Much of the writings Marie wrote was her diary which is filled with a young girl's feelings about her arranged marriage.She describes a French Court dominated by intricate rules of etiquette and protocol and excessive attention to fashion and grooming. In her last letter, Marie-Antoinette wrote to her sister-in-law Madame Elisabeth: â€Å"‘Happiness is doubled when shared with a friend'†¦. † ( Campan 4 )In those words are contained the value she placed on friends hip to her happiness. The queen had a great capacity for friendship, although she was not always smart in her choice of companions. Conclusion The story of revolution and resistance in 18th-century France is a complicated one, and no two historians tell the story the same way.However, it is clear that for the revolutionaries, Marie Antoinette’s significance was mainly, powerfully symbolic. â€Å"She and the people around her seemed to represent everything that was wrong with the monarchy and the Second Estate: They appeared to be tone-deaf, out of touch, disloyal (along with her allegedly treasonous behavior, writers and pamphleteers frequently accused the queen of adultery) and self-interested†( Moore 17 ). What Marie Antoinette was actually like was beside the point; the image of the queen was far more influential than the woman herself. Marie Antoinette was the Austrian born child bride of the future King Louis XVI of France. It was an arranged marriage designed to (hopefully) create a better relationship between the two countries which was a common practice by the Monarchy to reduce conflicts and warfare between Nations†(Campan 7). The French people resented the Austrian Queen and she was the subject of numerous rumors that she had been planted in France as a spy, was a spendthrift, was cold, cruel, evil, mean and any number of other charges.In truth, she was a well educated woman with excellent regal poise, she was a well qualified linguist, played the Harp with great versatility, was an accomplished equestrian and was considered to be an excellent mother to her four children. † She was put to death during the French Revolution at the age of 37 on 16 October 1793. † (Marie Antoinette Biography 3) Marie Antoinette was a symbol of goodness and of everything that was right with the French monarchy. Also as queen, she made many changes that affected France's system of government and law.Marie had abolished the law of segregated dining spaces, as she felt it was wrong. She had gained popularity with people of France at first with her generosity as she continuosly gave to the poor of Paris. † After the Revolution, Marie faced the women who stormed Versailles and when her family and her were forced to live in Paris as prisoners she never lost hope that she would find a way to get out and hold her family's reputation as well as her political career; Even after the Republic was proclaimed in 1792, and her husband was executed. (Barker 5) Despite the tragic outcome of Marie Antoinette's life, she never blamed her people. She remained a devoted mother and wife, although her life as the Queen of France ended in a moments notice. Although many through time have viewed her as a shallow, weak and a self- indulgent person. But through recent years many historians have concluded the opposite; seen more as a lively, misunderstood, and compassionate character. She was a devoted mother,making sure her children were well educated, and cherished.And even when she knew her life was coming to an end, she made sure her children were in safe hands. And as Queen, she wanted the best for her people, giving generous donations and contributions to the minority. Marie Antoinette as a person and a friend was quite possibly one of her best traits, marked through history. The Political side of her and her family status was the main source of The French Revolution. She was proud to be french, but in the end all the hopes she had for her country demolished right before her eyes. But as terrible as she might be portrayed in your history books.Marie Antoinette will always be the last Queen France ever had. Bibliography Barker, Nancy. â€Å"Let Them Eat Cake: The Mythical Marie Antoinette and the French Revolution. † Historian (Summer 1993): 709-25. Madame Campan. Memoirs of Marie Antoinette. N. p. : Barker, n. d. Memoirs of Marie Antoinette. Web. 01 Sept. 2012. . â€Å"Marie Antoinette Biography. † Marie Antoinette Biography. N. p. , 01 July 2012. Web. 25 Aug. 2012. . Moore, Marianne. â€Å"Marie Antoinette. † New World Encyclopedia. N. p. , 03 Apr. 2007. Web. 01 Sept. 2012. .

Motor Development Autobiography Essay

The motor development was consisted of seven periods across the lifespan, each period is characterized by the different motor skills. Progression from one period to another would depend on the changes in three critical constraints, as well as individual’s skills and experiences. According to the developmental perspective, the changes in the motor skills were defined as sequential, cumulative and individual. Everyone would follow the same sequence of the motor development, however, age does not determine the sequence because the skills are built based on individual’s background experiences and knowledge. Prenatal Period The first stage of motor development is the prenatal period, it is the period from conception to birth. The prenatal period is characterized by three major sub periods: Germinal, embryonic and period. The germinal period represents the first two weeks after the fertilization, where the ovum attached the uterine wall and the cell layers are formed. The embryonic period began from two to eight weeks, when the cephalacadual and proximodistal growth took place. At this time, infants could move around to obtain the upright posture, where different parts of the body are also distinguishable. Our motor development began prenatally, usually started from the embryonic and fetal period. The fetal period started from two to nine months, when most of the body systems were getting more structurally developed. However, the organs and body systems were still functionally immature. The fetal period was characterized by rapid growth and organ completion, as well as reflex activities and movements. As early as three months, babies could demonstrate both spontaneous and reflexive movements. My mother told me that she first felt my kicking and hand movement around the fourth month, and she also went to do the ultrasound to check if I was a healthy baby. My mother kept the testing record updated, the doctor also told her about my gender when I was a six-month-old baby. During the prenatal period, the development represented the interaction of  heredity and environment. The organism constraints such as genetic makeup, would dominate the development, while the environmental constraints could also affect the development. Teratogen was an environmental factor that cause harm to the embryo or fetus, it could lead to the birth defects. However, the baby’s genetic makeup and the amount of exposure would play important roles that affect the degree of harmfulness. The epigenetic crisis represented a time of particular susceptibility to harm, that different trimester exposed to teratogen would lead to different degrees of functional or structural damages. I was a healthy baby and received high APGAR scores mainly because my mother did not drink alcohol nor smoke during the pregnancy. My mother was a housewife, she stayed home most of the time looking at baby pictures and listening to classical music. Her daily exercise was walking, when she had to g o to the supermarket near my house. During the pregnancy, my mother’s life was simple and worriless, she was also a happy and a healthy mother. Reflexive Period The reflexive period started from birth to two weeks, the reflexive or spontaneous movements are used to insure the infant’s survival. There were two types of reflexes, the primitive and postural reflexes. The primitive reflexes were used for the protection and nutrition purposes, usually disappear by the sixth month. I demonstrated the rooting reflex when I was one month old, when my mother tactile my cheek, I immediately turned my head toward her finger (see picture five). My mom also told me that I used to like sucking my thumb before I go to sleep (see picture four). It showed sucking reflex, which was the biological response for the basic needs and helped infants to survive. The asymmetric tonic neck reflex appeared around the same time, when my right arm was extended and the left to keep my body facing a direction (see picture four). On the other hand, the postural reflexes are used for the development of later voluntary movements. The postural reflexes may never disappe ar, those reflexes also automatically provided the maintenance of infant’s upright position in relation to the environment. Setting up an upright posture could also help infants survive in the environment, as the environmental constraints began to have more  influences on the development. Overall, the organism constraint dominated the development during the reflexive period, and the environmental constraints were influential. Preadpated Period The motor development of preadapted period would usually take place when an infant is around two weeks to a year old. During this early developmental period, the organism constraints played a dominated role, the environmental constraints were influential, and the task constraints organized the action. The goal of the movement would be the attainment of independent walking and independent finger feeding. When I was an infant, I followed the sequence of motor development to obtain my upright posture. At two weeks, I couldn’t lift my head off the support surface to gaze about the environment. I would need help on lifting my head, therefore my mother would put her hand behind my trunk to support my body (see picture two). The posture at this age was the prone position (see picture one). At birth, infants would show their first motor movement by learning to prone. Soon after that, I began to elevate myself on my arms. As soon as I reached five months old, I was able to sit alone without support (see picture seven). Around five and half month old, I could demonstrate rolling, which was the earliest pattern of infant locomotion development. However, I skipped the stage of crawling, an important stage of motor development that helps infants to prepare for later walking skills. Because I was the oldest child in the family, my parents thought maybe I was too fat to demonstrate crawling (see picture six – I couldn’t crawl up to a chair). I thought the main reason for not crawling was that I often played with older children in our community. Since I am able to see many â€Å"role models†, it is likely that I learn how to stand first, thus skipped the crawling. The environmental constraints played an important role for me in the process of learning to stand, walk, and later running. The rate enhancer would be the opportunity for me to play with the older children, and to learn more motor skills from them. However, the rate limiter and organism constraints for not acquiring the walking or running skills would be the strength. Because my  mother was a housewife, she spent a lot of time taking care of me. She taught me how to stand by holding both of my arms first, to give me strength support (see picture nine). Soon I was able to acquire the standing motor skill, I can stand by myself (see picture ten). My parents then bought me a â€Å"walker† to help me learn how to walk (see picture eight). The walker was very helpful because it had wheels under the chair, I can actually go anywhere I wanted, just like a walking person. Around approximately ten-months old, I began to cruise and showed walking patterns. However, the rate-limiter and constraint of walking is my posture, because I have not yet obtained the upright posture for walking. It might be the fact that I wanted to play with the older children, and I was also able to see how other children walk, I showed early mature walking patterns at the age of eleven-months old. At this time, I was an independent walker with newly learned walking skills! When I first began to walk, I was walking very slowly, making short strides and put my arms up high to make balance. The primary rate limiters for not acquiring the upright position in walking were the postural control and strength. My body proportion was also a disadvantage to obtain the walking skills, because the proportion of my head was thirty percent of the body while my legs are only fifteen percent. I had heavy body and short legs, (heavy center of mass and light base of support) it would be hard for me to keep the upright postural control and balance for walking pattern. At this point, the environmental and task constraints would show more influences on the motor development. As I obtained the skill of independent bipedal locomotion (walking), I encountered movement problems. According to dynamical systems perspective, the degrees of freedom and context-conditioned variability are the problems for a new walker. If I was able to go anywhere I want, then I had the right of choosing where to go, or how to get to the desired place. However, the problems were solved from self-organization of the body system and the emerging of the constraints. The major rate limiters for not acquiring the running skills would mainly come from the organism constraints, such as the posture, strength and motivation. For me, I was motivated to learn those motor skills because I  wanted to play with older children. I was a fast learner also because my parents spent time and efforts to help me obtain the locomotion skills. Therefore, six months after I learned how to walk, I was able to run anywhere I want to go (see picture eleven). I have also developed manipulative skills as I learned to use hands to feed myself, and I was able to show better hand-eye coordination and movement. Fundamental Motor Skills Period The fundamental skills period began at the age of one, ends by the age of seven. In a way, this period of time would be a sensitive period to learn certain motor skills for later skillful movements. The fundamental motor skills period would be the building blocks for later emerging skills, and acquiring those skills were essential to later developing motor skills. Those skills were characterized as the phylogenetic skills, which are skills typical to individuals. Obtaining the locomotion and manipulative skills would be the fundamental and developmental process to obtain later movements. At this time, both fine and gross mother skills were beginning to develop. Those skills might not be maturational determined, and the arm and leg coordination were still immature. When I was a year old, I would throw a ball only using my arm movement, my legs and trunks barely made any movements. As I grow two more years older, I could demonstrate the pattern of block rotation, at the point where my body moved as one long axis. I would step my feet first, then put my arm backward ready to throw. My arm, leg and trunk have lined up as straight along the axis, and allowed me to have more power in throwing. Around the age of six or seven, I was able to demonstrate the differentiated rotation movement. My arms, legs, hip and shoulder would move separately as I began to obtain higher level of throwing. When I threw, my hip usually showed the first movement, followed by my shoulder and arms. At this young age, I had difficulties to demonstrate the locomotion skills of skipping. Skipping would be the latest motor movement for children to learn, not only because it had higher level of difficulty, but also it required the ability to hop on each leg sequentially. Older children would have no problem demonstrate skipping because they have better postural control, movements and coordination. Fine motor skills were begun to develop, such as drawing skills. When I was a one-year-old child, I would draw some scribbles on the paper, the outline and the shape of the objects were not clear to see. As I grew older, I showed more realistic drawings by making more clear lines, shapes and forms. I was also able to draw many different emotions on the faces and I used more variation in coloring my pictures. At the age of six, both my sister and I were interested to learn roller-skating. My father had brought two roller-skates for us, and we also took roller-skating class. It was really hard for me when I first started to learn roller-skating, and it was difficult to keep the balance. Skating is a complex motor skill because the arm and leg movements could not be in the same direction. My arm and leg coordination was also messed up, because I would always freeze my arms as I put it up high to obtain the balance. After many practices and countless falls, my sister and I have finally learned some basic fundamental skills of roller-skating (see picture fourteen). We wore kneepads because it was impossible not to fall, but we took them off as we were able to perform better in roller-skating. My father have also signed me up for a swim class, because he thought swimming was a very healthy exercise and it would help me to become healthier (see picture fifteen). Swimming was also a complex motor activity, while I tried to keep my legs padding in the water, the degrees of freedom limited me from doing any arm movements. Overall, the organism constraints dominated the development, the environmental constraints were influential and the task constraints organized the action. The rate limiter would be the proficiency barrier, the immature functional organism constraints held me back from acquiring the higher level of motor movement. Context-Specific Skills Period As I began to get older, around the age of seven to eleven, I reached the context specific period. The context specific period was characterized by the ontogenetic skills, which are skills unique to individual. Most children  at this period have obtained context-specific knowledge and experience to acquire their individualized skills. The context-specific period also represented a transition period between the attainment of the fundamental motor skills and the transformation into skillful motor performance. Because it was influenced more by the environmental and task constrains, motivation and parental support would be important to help children move on successfully to the skillful period. Organism constraints also played important roles, such as physical, social and emotional development. At this time, I have grown taller and gained more body weight. There were also changes in my cardiovascular system, the aerobic power increased because I was able to uptake more amount of oxygen at a time. The improvement can be seen from exercising, such as swimming. I was still at the swimming class, my swimming had improved and I was moved up to a higher level. In order to graduate from the swimming class, it was required for everyone to pass an examination by performing the swimming skills in a weekly competition. I remembered how nervous I was when I had to swim butterfly in the competition, I felt so relieved when I passed the examination and get the award. Because of the training from swim class, I had more swimming experiences and obtained better swimming skills. Swimming has also helped me to improve arm and leg coordination in the development of gross motor skills. At this time, both fine and gross motor skills have also improved. I was still in love with roller-skating, but I have also fallen in love with ice-skating. Once my friends asked me to go ice-skating with them, they were surprised to see my skating skills. I have never gone ice-skating before, but because I knew how to roller-skate, thus it was easier for me to stay balanced. I showed better skating skills because I had already obtained the gross motor skills needed for skating, the arm and leg coordination had also improved as I gained more skating experiences. During the winter of my senior year in high school, my uncle asked me to go skiing with him. I was a little nervous because I have never skied before, and also I heard that skiing was a dangerous sport. However, all those worries had gone away as I began to learn skiing. As my uncle taught me how to ski, he was surprised to the pattern of well-coordinated arm and leg movement, as well as my balance. I was still in love with flute, and I had also become a member of the concert band in my middle school. At this time, I am more skillful in playing flute. Because I have been practicing everyday, my fingers are also more flexible as I gained more experiences. As I practiced more, the perceptual and speed processing increased, which allowed me to read the music faster. During my last year of the school, our concert band was informed to attend a National Musical Competition. We were invited to go to Florida State for three days for the competition, which we had to play against ten middle schools in the United States (see picture sixteen). I still could remember that moment when the judge announced our school to be the one winning the first price, for a moment I thought I was dreaming. It was unbelievable, it was the happiest moment in my life, and all the hard work has been paid off. I felt so proud to be a member of our concert band, because I had also contributed my effort to win the price. My parents and friends were very happy for me, and they encouraged me to take more challenges. The environmental and task constraints are the rate enhancers to help me move on to the next skillful period, and I have also gained more confidence in myself. However, the rate limiter for not acquiring the skillful skills would be the proficiency barrier, because of the functional organism limitation. I have not yet obtained the skillfulness of the perceptual cognitive functioning, such as not having enough knowledge base and a slower speed of processing. Skillful Period The skillful period usually started at the age of eleven, the word â€Å"skillfulness† could also represent context-specific because the skills were also individualized. After winning the first price and gaining the recognition, I decided to devote myself into playing flute. My parents supported me, they have also asked a professional flutist to be my tutor. With the hope that I might be a professional flutist someday, I have been practicing two hours per day to improve my playing skills. It was the organism constraints that influenced my determination and persistency, because I was motivated go achieve the goal (see picture seventeen). The environmental constraint also played an important role during the skillful period. For me, not only because my parents set high expectations toward me,  but also we were in the middle socio-economic status where the money for tutoring was affordable. If I ever become a successful swimmer or flute player, I’d thank my parents for gi ving me the opportunities. I have also been consistently going to swim, and it had become my regular exercise every week. At this time, my father did not need to force me nor sign me up for a swim class, because I liked swimming as much as I loved playing flute. I would still go ice-skating with my friends, and I have also learned how to perform some tricks. My uncle would still take me up to the mountain every winter to ski, I was able to ski on a higher hills and under more complex tasks. For those motor activities, I know if I were able to be persistent to practice, it would enhance my knowledge and experiences and my performance would get closer to the professional level. From the dynamical systems perspective, self-organizing system and organism constraints have set a balanced, equilibrium and coordinated state in the individuals. Compensation Period The compensation period represented a time when a skilled individual is compensating for a change in an organism constraint. Throughout the life span, our motor skills performance would keep on improving. As we reached at the point where organism constraints took place to change, our motor skills performance would decline. It showed the adjustment of our motor behavior, and our movements might not be as skillful. Due to the changes in organism constraints, a person at this period of time was also particularly vulnerable in gross motor skills, because those skills required larger forces and aerobic efforts. Changes in organism constraints are due to the declines in the body system such as maximum oxygen uptake, stroke volume, or maximum heart rate. There would be changes in our fundamental motor skills, such as locomotion and balance. At this time, our walking skills and balance have declined and we became more vulnerable to falls and injuries. It is also because the decreased bone ma ss, led to the changes in strength characteristics of the bones. In addition, our auditory and somatosensory systems would not be functioning well; a person could suffer from hearing loss or loss of sensitivity. Changes in the environmental constraints would also influence an individual at this period of time. The lifestyle, societal expectations or socio-economic status would make differences on their perceptions and actions. At the compensation period, the declining of physical abilities had impact on individual’s psychological and emotional systems. A person at this period might lose the interests in doing their favorite sports, or change the interest or hobby. Other than obtaining an active lifestyle, the higher socio-economic status would play a role to help an individual at this period to live longer and healthier, because of the better medical care. Future Goals As for now and the future, I would keep up with the concert band in the University of Maryland College Park, and attend as many musical performance as I could. I would still take private lessons and practice one to two hours per day to get myself on the right track. I know my dream would come true if I could keep up my persistency and hard work. This could be characterized as my organism constraints, because I was self-motivated and have confidence at what I do. My uncle would still invite me to go skiing with him every winter, we have been great skiing partners. However, it was harder to keep up with the skiing skills at a certain level if you just practice once or twice a year. The environmental constraint had limited my skiing skills, if I were to live somewhere in Alaska, I would have better chance to be a skillful skier. I also would continue my swimming practices, because it would be hard to catch up the butterfly if I stopped practicing it. I know I would never forget how to m aster those motor skill performances, they have been a part of me. However, to reach a certain level of expectation and goals, I would still need my parental support and encouragement, as well as my persistency and practices.

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In Chitra Banerjee Divakaruni's short story, Clothes (page 533), Essay

In Chitra Banerjee Divakaruni's short story, Clothes (page 533), Sumita, the protagonist, comes to America where she exp - Essay Example Conflicts in the Life of Sumita Culminated through the Symbolic Scheme Chitra Banerjee Divakaruni’s fictions are generally set against the background of India or in America and mostly they centre round the experiences of the South Asian immigrants especially the women. The story â€Å"Clothes† is not an exception in this regard. The story presents the transition that the protagonist, Sumita undergoes in her life. The story revolves round the transition of Sumita from a young girl to a woman; from woman to a wife and finally facing the climax and the predicament in her life by being a widow. Sumita accepts the tradition of her society and accepts the concept of arranged marriage and marries a man whom she has never met before. She accepts the fact and is shown at the outset of the story to explore the unexplored and know the unknown and with this vision; she whole heartedly starts dreaming of her new life which is going to place her to a complete different socio-cultural milieu. She undergoes a paradoxical transition in her life and that evolves at different times through her clothes and their colours (Almeida, â€Å"The politics of mourning: Grief Management in Cross-cultural Fiction†). Conflict essentially builds up and strengthens the dramatic qualities of any fiction and that conflict does not necessarily mean a conflict with an antagonist in its physical form. The antagonist as in the case is society and the cross cultural transition which treats the existential discourse of the protagonist. Sumita in the US faces difficulty to adept complete change in her attire from eastern styling to that of western. The conflict which she faces is from the transition that she undergoes while changing her identity from wife to a women. One of those dresses includes a T-shirt which is orange in color and symbolizes hope and change on a brighter note. But the destined predicament at the last segment of the story where Sumita has to encounter an unfortu nate incident in the face of her husband’s murder washes all sort of colour and possibility in her life and places her with a confrontation of uncertainty where she is confused to continue her life in a country where the life of her husband was not secured even or get back to the soil i.e. her country from where she was uprooted long back as she fails to identify herself in both the nations and their societies. This is probably the greatest threat encountered by the protagonist of Chitra Banerjee Divakaruni’s short story, â€Å"Clothes† presented in the form of diasporas of existential and identity crisis from the perspective of feminist discourse. Transition in Sumita’s life does not only take place at physical plane but it takes place also mentally. Quite natural to the human nature, it gets reflected through the outward appearance of Sumita precisely through her clothes and its colours. The Indian traditional attire for women is Sari and Sumita at the beginning of the story is seen clad in it fully at one with the tradition of her soil. The selection of each cloth in the story and its colour has a purpose. The story begins with a stage in Sumita’s life when she is about to be a bride and puts a yellow sari, all set to meet her prospective

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Strategic Human Resource Planning - Essay Example "The range of activities and themes encompassed by SHRM is complex and goes beyond the responsibilities of personnel or HR managers into all aspects of managing people and focuses on management decisions and behaviors used, consciously or unconsciously, to control, influence and motivate those who work for the organizations - the human resources" (Price, 2007) What Charmagne was considering was a combination of this and Issues-Based Strategic Planning, under which goals are prioritized. According to her, producing products with good quality corresponding to the specifications of the contract is more important than getting the larger contract. She is also carrying out a cost-benefit analysis which helps her predict that recruiting trained workers from the market in this short span of time means high costs for the firm. Probably even higher than the benefits that they will enjoy from the large contract. However, she is more concerned with delivering a good quality product rather than motivating Proper Corporate Strategic planning comes with proper analysis of all the different aspects of the scenario, its alternatives and the external factors affecting decisions. Charmagne's strategy is not based on impulse but has facts, figures and practical study to support her argument. And when she is challenging Brian, this strategic plan will help her put forward her points to him concretely and more clearly.

Different behavioral pattern Essay Example for Free

Different behavioral pattern Essay People from different countries have different behavioral pattern, depending upon their culture, values and ethics. They develop their mannerism from these factors. If we take into account Americans, Japanese, and Saudi Arabian and try and find out how they behave on one particular way, specially when making contact with each other while talking. We can make out amongst them who are who. An American will try and make himself stand at distance he will try to adjust himself at a comfortable position from the person he is talking to at the same time he will try and maintain eye contact. A Japanese may shake hand and stand very close while talking but he usually keep his gaze down, unlike American where his habit of constantly gazing will make you feel as you are been screened. An Arab will like to be at a very close distance from the person he is talking to, may be as close as you can feel his breath, they also like lot of check-to-check social kissing, the Hollywood style. The body language do half the talking, we all know that. But for that, we have to understand cross-cultural differences, like the one stated above in which how the people from three different countries are behaving in a different manner. If we do not understand that then we might make the people we are talking to feel uncomfortable. As an American can make a Japanese uncomfortable with his continuous gaze, and similarly Arab can make American uncomfortable with his closeness. In some South American and Mediterranean societies eye contact, touching and smiling and standing at a foot distance is preferred style of communication where on the other hand in Northern Europe, a lingering gaze may feel invasive, manipulative or disgraceful, they chat at a distance of two and a half feet. If we look at Estonians, they are non-contact people. On the other hand, Russians are high contact people. So the reaction for each other is like, Russian feels Estonians are cold and Estonians feels Russians are pushy. Caucasians feels averting eye contact may be a gesture to hide misbehavior, where for Asian it’s a sign of respect. An American will suspect an unknown person who took a elevator with him and tries to smile and stand at a very close distance, where usually he would have taken another corner and gazed in space. Thus a very suspicious feeling for such person will arise. It is mostly seen this kind of behaviour from a criminal or from the patients of schizophrenia where he approaches and get closer to the other person more than usual. Be very sure the closer you let your stranger to be the more vulnerable you become. The spatial differences amongst cultures points more than self-protection. In Middle East people get the information about the strangers by their sense of smell and touch, which requires close approach. Americans, rely on visual information, therefore, they don’t need to be so close to the subject. They rather step back and see an intelligent whole picture of the person. Conversational distance tell us the about the standard greeting distance in each culture. The need for more or less space means something of the cultural temperament. There is gender difference also other than country difference. A woman seems to have more eye contact than men. Also a woman feel neglected if this conversational distance is too much. They feel that the partner is indifferent. With the businesses growing global a need for a new breed of consultants has immerged, who interpret to these globe-trotters of all nationalities the meaning and use of personal space. There are special classes also for this kind of cultural behaviour, which will be a great help to understand each other.

How Can a Nurse Improve and Develop Professional Identity?

How Can a Nurse Improve and Develop Professional Identity? According to DeJong 2014, professionalism can be defined as the means of acting in an acceptable and appropriate way while adhering to a professional code of conduct. It also means completing given tasks and responsibilities on time. On the other hand a Professional identity can be described as a set of principles that define a person in their professional career. A professional identity can also be defined according to the attitudes, beliefs, experiences, ideals, professional involvement, need for advancement and codes of a given career. These virtues determine the kind of people we interact with in our lines of profession. These experiences and professional interactions tend to define ones professional identity. In the line of nursing professionalism is significantly essential if nurses are expected to provide quality and effective services and care to their clients and to the population as a whole. In health care Professionalism is regarded as a bridge between the interests of the nurse and the needs of society. It is evident that better professionalism is associated with good medical care and better health outcomes in general. (DeJong et al 2014). Nurses need to be able to develop and improve their imaginative and creative skills in order to attain and improve effective patient care. In a research by O’Brien, Strzyzewski and Szpara 2013, on nurses working in the surgical department it was found that by creating an organized process of educational projects to encourage, support and promote professionalism nurses were able to improve their professional identity and complete their practice successfully safely and effectively. In order to achieve the best results Clinical Nurse Specialist (CNS) and Educational Nurse Coordinators (ENCs) in the surgical unit developed meetings for nurses with the medical librarians and unit leaders. Teaching was carried out by use of posters and oral presentations. Through this nurses were able to master effective ways of generating ideas and implementing them to complete projects. (O’Brien, Strzyzewski and Szpara 2013). There are many factors that influence professional competence for nurses for example organization of work, personal characteristics, cognitive abilities and clinical knowledge. In order for a nurse to be able to undergo Professional growth they need to be committed to their work in order to able to fulfill their work tasks. Professional identity is usually accompanied by the workers’ self-concept; self-respect, identity, essential nature, team spirit and values. Moreover for a nurse to improve their professional identity they need to be flexible and resilient in their field of work. This means that nurses need to believe in oneself and be willing to take risks. In addition to that they have a career insight in order to be able to establish realistic career goals by being aware of their strengths and weaknesses. (Tamm 2010). There are some inevitable factors in the health sector that demand for professional growth and that has impact on the management, employers and the employees. First creation of new knowledge, there are changes in the scientific and technical knowledge every few years which demand nurses to update their education levels from time to time. Secondly technological innovations are taking place so rapidly that nurses have to be willing to sharpen their skills and change with the changing times. Lastly, the upcoming of more challenging tasks demands for professional development in order for nurses to be able to cope efficiently. (Willetts and Clarke 2012). Development of professional identity according to Tamm 2010, starts with how individuals view their work roles and how good they manage their work life and related practices. Moreover professional identity is a process of becoming independent and having self-awareness through work. For a nurse to be able to develop and improve their identity they first have to have a professional self-concept and respect, in short they need to accept their roles as nurses. Nurses begin to build their professional identities during their study period and continue to develop all through their work life. Development of professional identity is a life course process comprising of different stages. Which range from novice to expert. (Tamm et al 2010). In conclusion development is accompanied by professional maturity which is a nurse’s preparedness to handle work tasks in different phases of their work. Nurses need to be cognitively prepared, this means that they need to have sufficient knowledge on principles of health care to be able to apply them in real life situations. In additional to that nurse need to have knowledge on the nature of the profession and the occupational sphere. (Willetts et al 2012). In my opinion there are numerous number of factors that have effect on the development and improvement on a nursing professional identity. I have learnt a lot of new information from this assignment. It is a broad topic and I feel I still have a whole lot more to learn about developing my professional identity in the future. REFERENCES D. O’Brien, N. Strzyzewski and T.Szpara 2013, Getting to Success: Supporting Staff Nurses to Enhance Practice and Professionalism. Journal of PeriAnesthesia Nursing. Volume 28, Issue 3, June 2013, Pages e34  Available: http://www.sciencedirect.com/science/article/pii/S1089947213002037#  Accessed 7th September 2014 G. Willetts and D.Clarke 2012 The shaping of Professional Identity in Nursing: An ethnographic Case Study  Available: http://global-qhr.org/wp-content/uploads/2012/02/Abstracts.pdf Accessed 7th September 2014  S .M. DeJong 2014 Chapter One–What is Professionalism? Social Media and Online Professionalism in Health Care 2014, Pages 1–11  Available: http://www.sciencedirect.com/science/article/pii/B9780124081284000011  Accessed 7th September 2014 Tiia Tamm, 2010 Professional Identity and Self-concept of Estonian Social Workers .University of Tampere  Available: http://tampub.uta.fi/bitstream/handle/10024/66631/978-951-44-8115-4.pdf?sequence=1#page=69zoom=180,-4,613  Accessed 7th September 2014 Stem Bark Extracts of Anthocleista: Antioxidant Properties Stem Bark Extracts of Anthocleista: Antioxidant Properties Original 1 Research Article PHYTOCHEMICAL AND ANTIOXIDANT PROPERTIES  OF STEM BARK EXTRACTS OF ANTHOCLEISTA NOBILIS ABSTRACT Aim: This study was carried out to determine the phytochemical and antioxidant properties of extracts  of Anthocleista nobilis. Methodology: Acetone and methanol extracts of A. nobilis were investigated for their free radical scavenging activities in the presence of diphenyl picrylhydrazyl (DPPH) using ascorbic acid as positive control. Results: In the phytochemical screening of the plant extracts, results showed that both extracts recorded the presence of alkaloids, tannins, flavonoids, and glycosides. The acetone and methanol extracts of A. nobilis exhibited significant free radical scavenging activities in the DPPH assay with the  acetone extract recording better activity. The antioxidant activity of the two extracts was however, lower than that recorded by the positive control-ascorbic acid. Conclusion: The result suggests that the extracts have potential antioxidant properties which could be  exploited in medicine and food industry. Keyword: Anthocleista nobilis, antioxidant, DPPH. 1. INTRODUCTION Plants have been utilized by humans to treat various infectious and non-infectious diseases since the  beginning of time as they constitute a reliable source of therapy. In addition, they are also the primary  source for many of today’s medicines [1,2,3]. For instance, purified secondary metabolites such as vinca alkaloids are used widely in cancer chemotherapy [4].Quinine and artemisinin, derived from the  bark of the cinchona and qinghaosu trees respectively and their derivatives have been widely used for  the treatment of malaria [5,6,7]. Some of these secondary metabolites are synthesized for specific purposes by plants. Others may be  by-products of plant metabolism which currently have no known biological function. Hydroxylated  coumarins have been reported to accumulate in carrots in response to fungal invasion [8],  glucosinolates, recognized for their antimicrobial properties[9], have also been reported in Brassia  rapa in response to fungal infection/attack [10]. These secondary metabolites fall under one of the major phytochemicals such as flavonoids, tannins,  glycosides, steroids, terpenes, etc. Although these compounds are known to be bioactive, a lot is yet  to known about their mechanisms of action. Some of these groups of compounds such as flavonoids,  proanthocyanidins and tannins are polyphenols or phenolic [11]. Phenolics are known for their  antioxidant properties [12]. Antioxidants are molecules that halt oxidation processes while the molecules get oxidized in the  process. The antioxidant activity of phenolics is derived from their ability to act as reducing agents,  donating hydrogen, electrons and stabilizing reactive oxygen species (ROS) [13]. ROS such as  hydroxyl radicals (OH.), superoxide anion radicals (O2  .) and singlet oxygen (145 O2) have been implicated  in many disease processes such cancer, diabetes, ageing, atherosclerosis and neurodegeneration[14]. Consumption of fresh fruits and vegetables rich in plant polyphenols(antioxidants) as food has  been reported as a protection against several diseases which include cancer, cardiovascular  diseases, diabetes, asthma etc. [15] suggesting that the mechanism of action of the secondary  metabolites can be traced to their antioxidant properties. ROS can cause the deterioration of food by  causing lipid peroxidation. The rancid odor and taste of lipid containing food such as palm oil occur as  result of lipid peroxidation which in turn affects the nutritional value and safety 52 of such food items  [16]. Recently, the use of synthetic preservatives and other additives has been linked to increased  prevalence of cancer. For instance, sodium nitrate and sodium nitrite used to preserve processed  meat has been implicated in bowel cancer [17]. As a result, the demand for natural food preservatives  has been rising steadily [14] and that prompted the European Union funded AGROCOS to include the  replacement of synthetic preservatives and other ingredients as part of the FP7 research topics which  has yielded about 30 natural compounds for the food and cosmetic industries presently being further  tested by Greek and German companies [18]. Anthocleista nobilis which is commonly called the candelabrum or cabbage tree in English language,  Duwa Kuchi in Nupe language, Kwari in Hausa language and Apa Ora in Yoruba language belongs to  the family Loganiaceae [19]. Anthocleista nobilisis used in local medicine in parts of West Africa for  curing fever, stomach ache, diarrhoea, and gonorrhoea, and are also aspoultice for sores [20,21]. The  present study was designed to investigate the antioxidant properties of extracts of Anthocleista nobilis  by measuring their free radical scavenging properties with aim of confirming the ethnobotanical use  and assessing their suitability as preservatives in the food industry. 2. MATERIALS AND METHODS 2.1 Sample collection The stem barks of A. nobilis were collected in March, 2014 from Ezza Community in Ebonyi state,  Nigeria. They were identified by a plant taxonomist in the Department of Pharmacognosy and  Traditional Medicine, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria.  The plant material was pulverized into fine powder using a mechanical grinding machine. 2.2 Extraction   500 g of thepulverized plant was macerated in 1 Liter of acetone and methanol respectively for 48  hrs.The mixture was sieved using porcelain cloth and was further filtered using No. 1 Whatman filter  Ã‚  paper. The filtrate was concentrated using rotary evaporator and the crude concentrate was then  stored at 4o80 C until required for further experiment. 2.3 Phytochemical Screening   In the phytochemical analysis of the extracts of A. nobilis stem barks, tests for alkaloids, tannins,  saponins, flavonoids, steroids, cardiac glycosides, and terpenoids were carried out using standard  methods reported by Trease and Evans [19]. 2.4 In vitro free radical scavenging activity of the extract (Diphenyl dipicrylhydrazyl (DPPH) free  radical scavenging activity) The free radical scavenging activity of the various extracts and ascorbic acid was measured with  DPPH. Three (3) mL of DPPH in methanol solution was added 100 ÃŽ ¼L of different concentrations of  extracts (10-1000 ÃŽ ¼g/mL). After 30 minutes, the absorbances of the extract solutions ion methanol  were measured at 517 nm after calibration with methanol. Lower absorbance indicated higher free  radical scavenging activity. The antioxidant activity of the extracts was expressed as IC50 which was  defined as the concentration of the extracts that inhibited the formation of DPPH radical by 50 %. Each  experiment was carried out in triplicate. The average absorbance for each triplicate was calculated  and the percentage inhibition of the extracts at different doses calculated using the formula:   %Inhibition 100 o s o A A x A −   Ãƒ ¯Ã¢â€š ¬Ã‚ ½ Where Ao is absorbance of control and As the absorbance of tested extracts. 3. RESULTS AND DISCUSSION The antioxidant activity of the extracts of A. nobilis was investigated and the results were compared to  Ã‚  that of ascorbic acid which was used as the positive control. The results are shown in Figures 1. Also,  Ã‚  the result of the phytochemical analysis links the presence of flavonoids and other polyphenols to the  Ã‚  antioxidant activities observed. Different levels of the secondary metabolites based on the tests  Ã‚  carried out were observed as displayed in Table 1. Table 1. Result of the Phytochemical Analysis of A. nobilis Extracts UNDER PEER REVIEW Alkaloids Tannins Saponins Flavonoids Glycosides Terpenoids Steroids Methanol extract ++ +++ ++ + ++ Acetone extract + ++ ++ + ++ +++ = Abundantly present; ++ = Moderately present; += Mildly 108 present; =Absent Figure 1. Comparison between free radical scavenging activities of acetone and methanol  extracts of A. nobilis and ascorbic acid determined using DPPH. IC50 for Acetone extract= 400  ÃŽ ¼g/mL; Methanol extract= 800 ÃŽ ¼g/mL; Ascorbic acid= 30 ÃŽ ¼g/mL. The bark of A. nobilis is used as warm expellant and as antimalarial remedy amongst other  Ã‚  ethnobotanical uses by the Ezza people in Nigeria. The result of this study showed that the crude  Ã‚  extracts showed significant antioxidant properties with the acetone extract of A. nobilis recording an  Ã‚  IC50 of 400 ÃŽ ¼g/ml. The methanol extract of A. nobilis had the lowest antioxidant activity with an IC50 of  Ã‚  800 ÃŽ ¼g/mL.   However, the acetone extract of A. nobilis which had the best antioxidant activity compared to the  methanol extract had moderate presence of terpenoids, flavonoids and tannins. Flavonoids and  Ã‚  tannins are polyphenols which are known to have potent antioxidant properties due to there reducing  Ã‚  ability [23]. The lower activity observed can be explained by the fact that flavonoids only exihibit  Ã‚  antioxidant properties if features such ortho-dihydroxy substitution in the B-ring, C2-C3 double bond  Ã‚  and a carbonyl group in C-4 of the C-ring are present [24]. Quercetin is a good example of a flavonoid  Ã‚  with such structural features and it has a high antioxidant property [25]. Although the free radical scavenging activities observed for the extracts were not as much as that  observed for ascorbic acid which was the positive control, the antioxidant activity of the extracts, can  be said to be significant considering that the extracts were in the crude form. Further purification of the  aqueous extract is expected to produce pure compounds with improved antioxidant property. 4. CONCLUSION The findings of this study reveal that Anthocleista nobilis possess antioxidant property. This provides a  scientific basis for the ethnomedicinal utilization of this plant. The antioxidant property of this plant  may qualify it for use as preservatives of natural origin in the food industry. Further tests are needed to explore the exact mechanism of action at the molecular level and to know the actual 138 constituents  responsible for these activities. %inhibition Concentration(ÃŽ ¼g/ml) % Inhibition Versus Concentration Acetone extract Methanol extract Ascorbic acid UNDER PEER REVIEW REFERENCES Krishna S, Bustamante L, Haynes RK, Staines HM, Artemisinins: their growing importance in  medicine. Trends PharmacolSci. 2008, 29(10):520-527. Akhondzadeh S, Noroozian M, Mohammadi M, Ohadinia S, Jamshidi AH, Khani M, Melissa  officinalis extract in the treatment of patients with mild to moderate Alzheimer’s disease: a double  blind, randomised, placebo controlled trial. J Neurol, Neurosurgery Psych. 2003, 74(7):863-866. Luciano-Montalvo C, Boulogne I, Gavillà ¡n-Suà ¡rez J. A screening for activities of Carribean herbal  remedies. BMC Comp Alter med. 2013, 13:126. Sahenk Z, Brady ST, Mendell JR. Studies on the pathogenesis of vincristine-induced  neuropathy. 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Rodrigues HG, Diniz YS, Faine LA, Galhardi CM, Burneiko RC, Almeida JA, Ribas BO, Novelli EL,  Antioxidant effect of saponin: potential action of a soybean flavonoid on glucose tolerance and risk  factors for atherosclerosis.Int J Food Sci Nutr. 2005. 56(2):79-85. Chen Y, Miao Y, Huang L, Li J, Sun H, Zhao Y, Yang JY, Zhou W. Antioxidant activities of  saponins extracted from Radix trichosanthis: an in vivo and in vitro evaluation. BMC Complement  Ã‚  Alt Med.2014,14:86-94. Zhang H, Zhou Q, Tyrosinase Inhibitory Effects and Antioxidative Activities of Saponins from  XanthocerasSorbifolia Nutshell, PlosOne 2013, 8:e70090-e70096