Willa Cather’s A Lost Lady - Captain Daniel Forrester Essay -- Willa

Willa Cather’s A Lost Lady - Captain Daniel Forrester   Ã‚  Ã‚  Ã‚  Ã‚  In Willa Cather’s A Lost Lady, Captain Daniel Forrester is a gardener at heart. His lifetime is spent encouraging growth, whether of railroads, personal lives or flowers. His philosophy is to dream â€Å"because a thing that is dreamed of in the way I mean is already an accomplished fact† (44). Close friends described the Captain as clearly looking like â€Å"†¦ pictures of Grover Cleveland. His clumsy dignity covered a deep nature, and a conscience that had never been juggled with† (39). Because of his clear conscience Captain Forrester became a rich soil for many around him to take root in. As this soil, he could always be in the background and many never noticed how important he was until he was missed. Once the Captain’s career outside his home ended he truly opens up to the peacefulness of nature, including his flowers, which eventually illustrate the phases of his life.   Ã‚  Ã‚  Ã‚  Ã‚  The location of the Forrester’s homes gives a hint towards Captain Forrester’s dreams throughout his life. They had seasonal homes, spending â€Å"†¦winter in Denver and Colorado Springs,-left Sweet Water soon after Thanksgiving and did not return until the first of May† (23). Of three places they stayed during the year, two of them had optimistic names, encouraging ideas of eternal springs, which would be wonderful places for gardening. During the summer at Sweet Water, â€Å"The wild roses were wide open and brilliant, the blue-eyed grass was in purple flower, and the silvery milkweed was just coming on† (10). This picture of wild blooms is a reflection of Mrs. Forrester enjoying summertime, complimented with her barrenness of winter. Niel who enjoyed Mrs. Forrester staying on in Sweet Water throughout the winter noticed â€Å"The frosty air had brought no colour to her cheeks,-her skin had always the fragrant, crystalline white ness of white lilacs† (26). This picture of Mrs. Forrester displays a reproduction of the nature around her. That same day as Niel gave Mrs. Forrester a ride home, â€Å"The poplars looked very tall and straight, pinched up and severe in their winter poverty† (28). Throughout A Lost Lady Mrs. Forrester reacts to the seasons as a rose does. With the Captain around he quietly gives her the support she needs, reacting to all of her seasonal needs, always supplying an endless supply of sweet or spring water.   Ã‚  Ã‚  Ã‚  Ã‚  The Capta... ...tain gone could it be seen that: It was Mrs. Forrester herself who had changed. Since her husband’s death she seemed to have become another woman. For years Niel and his uncle, the Dalzells and all her friends, had thought of the Captain as a drag upon his wife; a care that drained her and dimmed her and kept her from being all that she might be. But without him, she was like a ship without ballast, driven hither and tither by every wind. She was flighty and perverse. She seemed to have lost her faculty of discrimination; her power of easily and graciously keeping everyone in his proper place. (130) Mrs. Forrester was the rose of her husband, who carefully tended her. Without his leadership she slowly became a memory of a rose garden who eventually mangled its self into a briar rose patch. From before the couple met Captain Forrester thought as a gardener, applying his technique throughout his life. He grew the railroads and his fortunes until he could no longer and then he appreciated his organic companions, which kept him company through the twilight of his life. Throughout A Lost Lady it is easy to see who is the beautiful flower many admire, and who keeps it lively.

Limitations From Suffering Chronic Asthma

One of the major public health problems facing Australia today is Asthma. It is disturbing that there has been an apparent increase in its prevalence and severity, and increased rates of hospital admissions. (E.J.Comino, 1996) For the diagnosed patient, the degree to which he or she suffers is related to severity of the condition, compliance with recommendations by medical experts, the immediate environment and the effectiveness of education programs. Like other major health problems, asthma has varying degrees of symptoms. As such, the degree and frequency of the symptoms limits many aspects of the asthmatics life. To describe the main limitations suffered by those with chronic asthma, asthma must be defined. Asthma is a condition whereby the sufferer has difficulty breathing due to widespread narrowing of the airways of the lungs. This narrowing can be caused by a local inflammation of the air-ways, muscle contraction or the production of excess mucus with in bronchi. (R.Roberts, 1996) Most common is bronchial asthma. Medical definitions of asthma suggest that environmental triggers can substantially contribute to the occurrence of an asthma attack. The review of asthma in Victoria (1988) by the Asthma Foundation of Victoria outlined infection, exercise, climatic conditions, exposure to airborne irritants and emotional upsets as the main trigger factors. However, doctors use a general classification to identify a patients pattern of asthma†¦classifying people who experience some symptoms of asthma on most days as having a chronic asthma condition. The classification system also extends to the categories of children, occupational asthma and asthma in later life. Usually regular medication is required to keep the lungs functioning as normally as possible. Some chronic asthmatics have severe symptoms over a long period of time and may require long term or indefinite medication to be able to lead a normal life. (Lane, 1996) The most obvious limitations suffered relate to the asthmatics physiological dysfunction. However, physiological dysfunction can in turn contribute to greater social and psychological limitations. This area is related more specifically to quality of life and morbidity and will be discussed further on. The main physiological limitation is related to the presence of the bronchial narrowing slowing the movement of air into and out of the lungs. Thus, there is difficulty both breathing in and out. Asthmatics commonly describe the feeling – tightness of the chest, congestion and wheezing. Although these symptoms can commonly occur in other chest diseases, in asthma it is a characteristic that can occur in an aggravated attack. This may be either brief episodes of chest tightness lasting a matter of minutes or a prolonged episode of wheezing lasting up to and hour, which can merge into a full blown attack of asthma. (D.J.Lane, 1996) Other physiological limitations relate to the sufferers sensitivity to known triggers factors and the consequential effect on their daily functioning. The Global Strategy for Asthma Management and Prevention (1995) states that triggers are risk factors that cause asthma exacerbation†s by inducing inflammation or provoking bronchio-constriction. This report also describes the main triggers as allergens, air pollutants, respiratory infections, exercise and hyperventilation, weather changes, allergies to foods, additives and drugs, and emotional stress. For example it is well established that viral respiratory infections can exacerbate asthma, especially in children under the age of 10. (Busse, 1993) Because the triggers may vary from person to person and from time to time, it is important to take the sufferers natural history into account and identify each individuals triggers. Therefore, an individuals identified trigger can restrict the sufferers ability to function normally. For example – an asthmatic child may try to avoid exercise for fear that it may trigger an asthmatic attack. This may in turn limit the sufferers physiological development over the long term and hence further contribute to the problem. (Global Strategy, 1995) Some psychological and social problems can also be considered as a consequence of the interaction with physiological limitations. The Global Strategy for Asthma Management and Prevention (1995) states that â€Å"asthma is a chronic disorder that can place considerable restrictions on the physical, emotional, and social aspects of the lives of patients and may have an impact on their careers†. Chronic asthma sufferers have to live with the need for treatment and with the limitations that having asthma places on their everyday lives. It is in this context that the asthmatics life area†s are most likely to be handicapped. In general, the chronic asthmatics activity choices are particularly handicapped. †¦. especially physical education. Exercise incites airflow limitation in most children and young adults who have asthma. Exercise appears to be a specific stimulus for people with asthma because it seldom leads to airflow limitation in people without asthma. (Global Strategy, 1995) More specifically sports where sustained effort is needed over a considerable period (eg long distance running) are not recommended. From a psychological point of view, the development of a positive sense of self (ie self-esteem) can be adversely affected by asthma. In one study, nearly 41 percent of parents of children with asthma said that asthma caused their children to feel self-pity. These children also were found to have low self-esteem as well as poor relationships with their peers. (Charmaz, 1983) For an adult, occupation and social life may be handicapped. A comparative study from Edinburgh (1996) between asthmatics and people with other forms of physical disability were found to have similar levels of anxiety or neuroticism. It was found most asthmatics exhibited varying levels of anxiety in relation to their beliefs and, in particular, their constant fear of another attack and anxiety over school and work prospects. (Lane, 1996). Similarly, fear also plays a predominant role in children who suffer from asthma†¦. with one in four Victorian children fearing not being able to breathe as a result of asthma (King, 1988). Furthermore, the relationship between asthma and emotional andor severe behavior problems is documented in a 1995 study by R,Bussing et al. In particular they tend to suffer from limited school functioning, inability to attend school and need for special school or special classes. In Australia, school loss caused by asthma accounted for approximately 965,000 days annually. (Aust Bureau Statistics, 1991) In particular poor academic performance and greater risk to learning difficulties were found to be the greatest negative consequences. (Fowler, 1992) The asthma sufferer can have a limited choice of occupations, because they are exposed to an increasingly large number of potential irritants in their working lives. In particular if specific allergies are known to exist then an occupation that exposes them to the allergens must be avoided. For instance, those sensitive to pollen should not become gardeners or those who have recurrent shortness of breath, should not become marine biologists. (Lane, 1996) 3. What can an individual do to prevent the occurrence of unnecessary as asthma attacks, or to minimize the seriousness of those that do occur? In 1989 an Australian Asthma management (AMP) plan was set up as a guideline for health professionals. The guideline was set up as a common consensus among health experts to help tackle the irregular diagnosis and treatment of asthma. More particularly, to help combat the increase of asthma induced admissions to hospitals due the occurrence of unnecessary asthma attacks. This report outlined 6 important steps to aid the doctor and the sufferer as to the basis of good asthma management. They include (1) Assess the severity of asthma; (2) achieve best lung function (3) maintain best lung function by identifying and avoiding triggers; (4) maintain best lung function with optimal medication; (5) develop an action plan; and (6) educate and review regularly. (Woolcock, 1989) Current research by Beilby (1997) highlighted that having an action plan can play a vital role in preventing hospital admissions and death from asthma. An asthma action plan is a co-ordinated method of management that covers all aspects a persons asthma – medication, triggers factors, lung function measurements, etc. To ensure greater adherence, both the patient and the doctor should fill out an asthma management chart together. It encourages self management and focuses on the importance of identifying the main trigger factors and monitoring the warning signs of an asthma attack. Essentially this involves a regular check on airway function by the use of a peak flow meter and the additional measurement of lung capacity twice a day those with severe asthma. Use of symptomatic (quick working) medication such the bronchodilator ventolin aerosol type to maintain best lung function, is recommended to reduce the seriousness of an acute attack. Doctors prescribe preventative medication such as Intal (sodium cromogylcate), anti-allergy injections and inhaled steroids for people who have severe asthma. Long term use of preventative medicine is used in conjunction with bronchodilators. After several months on preventative medicine, asthmatics find they are able to reduce their use of bronchodilators dramati cally. (Prendergast, 1991) Identifying trigger factors such as allergens, infection, exercise, weather changes and emotional stress is also important. The use of a bronchodilator or Intal, before being exposed to an identified trigger factor, can reduce the likelihood of an asthmatic reaction. The asthma management chart also describes what to do if following warning signs are observed : (1) the bronchodilator doesn†t bring expected relief, (2) a decrease in the peak expiratory flow, (3) Increased breathlessness and variation in peak flow rates during the day, (4) more frequent wheezing and a persistent dry cough and (4) disturbed sleep. (Prendergast, 1991) Asthmatics who live in highly polluted areas and are surrounded by electrical appliances, high tech equipment and power lines can benefit from air ionisers and a purifiers. Individuals can also prescribe to alternative treatment (for instance the Buteyko method), various breathing exercises, physical exercise (such as swimming), a healthy diet, and natural remedies such a homeopathic and acupuncture. It has been found that these treatments should complement orthodox medication and also help reduce the reliance on it. Roberts (1996) suggest that there is evidence that the Buteyko method is effective in treating chronic asthma. Devised by professor Beteyko of Siberia, this program consists of specific relaxation techniques and shallow breathing to correct breathlessness and wheezing. For those who are prone to exercise induced asthma choosing the right type of exercise is important †¦ particularly choosing a sport that requires longer and slower breathing and/or short bursts of effort. Examples include gymnastics, cricket and basketball. Swimming with its controlled breathing pattern is also recommended as it promotes chest development, flexibility and, therefore better breathing. (Roberts, 1996) There has been extensive research into new drug treatments of asthma by pharmaceutical companies and universities over the last 20 years. One such new effective drug to emerge is a Leukotiene receptor antagonists (LTRA). It was recently introduced into Australia this year and the USA 3 years ago. In people with asthma, leukotrienes play a key role in causing the inflammation, bronchoconstriction, and mucous production that lead to coughing, wheezing, and shortness of breath. LTRA†s prevent leukotrienes from attaching to the proinflammatory receptors on circulating and lung cells, which contribute to asthma symptoms. Leukotriene research is the direct result of a Nobel Prize-winning discovery made by scientist Beng Samuelsson in 1979. (Lipworth, 1999) However, there needs to be further research into the efficacy and its side effects. 4. How effective are the educational programs undertaken by organizations such as Asthma Victoria? Current statistics indicate that there has been a reduction of asthma mortality and morbidity in Australia over the past 10 years. The fall in deaths from 964 in 1989 to 715 in 1997 may indicate that some of Australia†s strategies for asthma management have been successful. (NAC, 1998) The Australian Asthma Management Program provides a systematic and methodical approach to asthma care. Nevertheless, it was not formulated as an evidence based document. This means that its recommendations (devised in 1989) were not based on systematic reviews or had been ranked according to the strength supporting them. However, today there have been a number of studies reviewing the effectiveness of the AMP. One such report by the National Asthma Campaign (1999), commented on the crucial role of education in improving the management of asthma rather than the token gesture of handing over a leaflet at the end of a patient consultation. This was in relation to the 6th step – educate and review regularly and highlights the importance of education programs undertaken by organizations such as the Australian National Asthma Campaign, Asthma Victoria, the Thoracic society of Australia and New Zealand and other relevant educators. The 1990 and 1993 national surveys of 22,000 adults and 16,000 children conducted by the National Asthma Campaign (NAC) showed improved asthma management practices in the three year period. Although the changes are not necessary the direct result of the National Asthma Campaign, it is considered to be consistent with the campaign and other agencies having been successful in promoting awareness and optimal management of asthma. (Comino, 1996) One of the goals of the NAC was to reduce the reliance on daily medication and hence increase the use of preventative therapy (such as inhaled corcosteroids) for patients with moderate or severe asthma; together with written action plans based on symptom severity and measurements of lung function. Use of preventative medication was found to have increased among both children and adults. The study highlighted also that there was a significant decline in the use of daily inhaled bronchodilator drugs among children and also inappropriate medications such as antibiotics and oral prescriptions. In addition this study also showed that in 1993 survey, doctors measured lung function significantly more often than in 1990; with similar increases observed in the use of peak flow meters and written action plans. (Comino, 1996) These results suggest that the Australian Asthma Management Programs are relatively effective. However, the study also points to the fact that limitations still exist. In particular there is a lack of communication and joint management strategies between specialists and GP†s, hospitals and the community; whilst the use of action plans still has considerable room for further improvement. Nonetheless, not all studies on education programs show positive conclusions. A British research paper ‘Greenwich Asthma Study† of 1291 asthmatics conducted in 1993 and 1996 found that their model of service delivery was not effective in improving the outcome of asthma in the community. The intervention program used was based on the British Thoracic Society†s guidelines and was conducted by specialist nurses in community based settings. There were similarities in the methodology and intervention measurement. However, they concluded that no evidence was found for an improvement in asthma related quality of life among newly surveyed patients in intervention practices compared with control practices. (Premaratne, 1999) Altogether this highlights that the variability of the asthma educational programs undertaken by various major organisations make it difficult to comparatively evaluate. A comprehensive world wide study, ‘Objectives, methods and content of patient education programs for adults with asthma: systematic review of studies published between 1979 and 1998†³ found that there was great difficulty in identifying the most effective components of asthma educational programs. The main reason cited was that education programs for adults with asthma vary widely. Most reports did not specify the general (56%) and educational objectives (60%) of the intervention. Important training characteristics were often not available: duration of education (45%) and number of sessions (22%), who delivered education (15%), whether training was conducted in groups or was individualised (28%). (Sudre, 1999) Such variability suggests a lack of consensus on what educational components actually work. With insufficient documentation of asthma education programs for adults, replication is limited. In conclusion there is some evidence to suggest that written treatment management plans are most effective in improving the quality of life for people with asthma. In the Australian context the National Asthma Campaign has clearly documented program goals. However, the limitations lie in its lack of empirical evidence. In addition the reliability of the research documents in general has been brought into question by the Sudre (1999) study. Therefore it is difficult to demonstrate the most effective management plan for asthma sufferers. This issue is currently being addressed by the National Asthma Campaign and the Asthma Foundation of Victoria. The Asthma foundation is currently conducting a study into the effectiveness of their schools based program. Hopefully, this and other studies will help fill the gap associated with the effectiveness of asthma education programs. And hence secure the continuation and development of asthma education in the community. Limitations From Suffering Chronic Asthma One of the major public health problems facing Australia today is Asthma. It is disturbing that there has been an apparent increase in its prevalence and severity, and increased rates of hospital admissions. (E.J.Comino, 1996) For the diagnosed patient, the degree to which he or she suffers is related to severity of the condition, compliance with recommendations by medical experts, the immediate environment and the effectiveness of education programs. Like other major health problems, asthma has varying degrees of symptoms. As such, the degree and frequency of the symptoms limits many aspects of the asthmatics life. To describe the main limitations suffered by those with chronic asthma, asthma must be defined. Asthma is a condition whereby the sufferer has difficulty breathing due to widespread narrowing of the airways of the lungs. This narrowing can be caused by a local inflammation of the air-ways, muscle contraction or the production of excess mucus with in bronchi. (R.Roberts, 1996) Most common is bronchial asthma. Medical definitions of asthma suggest that environmental triggers can substantially contribute to the occurrence of an asthma attack. The review of asthma in Victoria (1988) by the Asthma Foundation of Victoria outlined infection, exercise, climatic conditions, exposure to airborne irritants and emotional upsets as the main trigger factors. However, doctors use a general classification to identify a patients pattern of asthma†¦classifying people who experience some symptoms of asthma on most days as having a chronic asthma condition. The classification system also extends to the categories of children, occupational asthma and asthma in later life. Usually regular medication is required to keep the lungs functioning as normally as possible. Some chronic asthmatics have severe symptoms over a long period of time and may require long term or indefinite medication to be able to lead a normal life. (Lane, 1996) The most obvious limitations suffered relate to the asthmatics physiological dysfunction. However, physiological dysfunction can in turn contribute to greater social and psychological limitations. This area is related more specifically to quality of life and morbidity and will be discussed further on. The main physiological limitation is related to the presence of the bronchial narrowing slowing the movement of air into and out of the lungs. Thus, there is difficulty both breathing in and out. Asthmatics commonly describe the feeling – tightness of the chest, congestion and wheezing. Although these symptoms can commonly occur in other chest diseases, in asthma it is a characteristic that can occur in an aggravated attack. This may be either brief episodes of chest tightness lasting a matter of minutes or a prolonged episode of wheezing lasting up to and hour, which can merge into a full blown attack of asthma. (D.J.Lane, 1996) Other physiological limitations relate to the sufferers sensitivity to known triggers factors and the consequential effect on their daily functioning. The Global Strategy for Asthma Management and Prevention (1995) states that triggers are risk factors that cause asthma exacerbation†s by inducing inflammation or provoking bronchio-constriction. This report also describes the main triggers as allergens, air pollutants, respiratory infections, exercise and hyperventilation, weather changes, allergies to foods, additives and drugs, and emotional stress. For example it is well established that viral respiratory infections can exacerbate asthma, especially in children under the age of 10. (Busse, 1993) Because the triggers may vary from person to person and from time to time, it is important to take the sufferers natural history into account and identify each individuals triggers. Therefore, an individuals identified trigger can restrict the sufferers ability to function normally. For example – an asthmatic child may try to avoid exercise for fear that it may trigger an asthmatic attack. This may in turn limit the sufferers physiological development over the long term and hence further contribute to the problem. (Global Strategy, 1995) Some psychological and social problems can also be considered as a consequence of the interaction with physiological limitations. The Global Strategy for Asthma Management and Prevention (1995) states that â€Å"asthma is a chronic disorder that can place considerable restrictions on the physical, emotional, and social aspects of the lives of patients and may have an impact on their careers†. Chronic asthma sufferers have to live with the need for treatment and with the limitations that having asthma places on their everyday lives. It is in this context that the asthmatics life area†s are most likely to be handicapped. In general, the chronic asthmatics activity choices are particularly handicapped. †¦. especially physical education. Exercise incites airflow limitation in most children and young adults who have asthma. Exercise appears to be a specific stimulus for people with asthma because it seldom leads to airflow limitation in people without asthma. (Global Strategy, 1995) More specifically sports where sustained effort is needed over a considerable period (eg long distance running) are not recommended. From a psychological point of view, the development of a positive sense of self (ie self-esteem) can be adversely affected by asthma. In one study, nearly 41 percent of parents of children with asthma said that asthma caused their children to feel self-pity. These children also were found to have low self-esteem as well as poor relationships with their peers. (Charmaz, 1983) For an adult, occupation and social life may be handicapped. A comparative study from Edinburgh (1996) between asthmatics and people with other forms of physical disability were found to have similar levels of anxiety or neuroticism. It was found most asthmatics exhibited varying levels of anxiety in relation to their beliefs and, in particular, their constant fear of another attack and anxiety over school and work prospects. (Lane, 1996). Similarly, fear also plays a predominant role in children who suffer from asthma†¦. with one in four Victorian children fearing not being able to breathe as a result of asthma (King, 1988). Furthermore, the relationship between asthma and emotional andor severe behavior problems is documented in a 1995 study by R,Bussing et al. In particular they tend to suffer from limited school functioning, inability to attend school and need for special school or special classes. In Australia, school loss caused by asthma accounted for approximately 965,000 days annually. (Aust Bureau Statistics, 1991) In particular poor academic performance and greater risk to learning difficulties were found to be the greatest negative consequences. (Fowler, 1992) The asthma sufferer can have a limited choice of occupations, because they are exposed to an increasingly large number of potential irritants in their working lives. In particular if specific allergies are known to exist then an occupation that exposes them to the allergens must be avoided. For instance, those sensitive to pollen should not become gardeners or those who have recurrent shortness of breath, should not become marine biologists. (Lane, 1996) 3. What can an individual do to prevent the occurrence of unnecessary as asthma attacks, or to minimize the seriousness of those that do occur? In 1989 an Australian Asthma management (AMP) plan was set up as a guideline for health professionals. The guideline was set up as a common consensus among health experts to help tackle the irregular diagnosis and treatment of asthma. More particularly, to help combat the increase of asthma induced admissions to hospitals due the occurrence of unnecessary asthma attacks. This report outlined 6 important steps to aid the doctor and the sufferer as to the basis of good asthma management. They include (1) Assess the severity of asthma; (2) achieve best lung function (3) maintain best lung function by identifying and avoiding triggers; (4) maintain best lung function with optimal medication; (5) develop an action plan; and (6) educate and review regularly. (Woolcock, 1989) Current research by Beilby (1997) highlighted that having an action plan can play a vital role in preventing hospital admissions and death from asthma. An asthma action plan is a co-ordinated method of management that covers all aspects a persons asthma – medication, triggers factors, lung function measurements, etc. To ensure greater adherence, both the patient and the doctor should fill out an asthma management chart together. It encourages self management and focuses on the importance of identifying the main trigger factors and monitoring the warning signs of an asthma attack. Essentially this involves a regular check on airway function by the use of a peak flow meter and the additional measurement of lung capacity twice a day those with severe asthma. Use of symptomatic (quick working) medication such the bronchodilator ventolin aerosol type to maintain best lung function, is recommended to reduce the seriousness of an acute attack. Doctors prescribe preventative medication such as Intal (sodium cromogylcate), anti-allergy injections and inhaled steroids for people who have severe asthma. Long term use of preventative medicine is used in conjunction with bronchodilators. After several months on preventative medicine, asthmatics find they are able to reduce their use of bronchodilators dramati cally. (Prendergast, 1991) Identifying trigger factors such as allergens, infection, exercise, weather changes and emotional stress is also important. The use of a bronchodilator or Intal, before being exposed to an identified trigger factor, can reduce the likelihood of an asthmatic reaction. The asthma management chart also describes what to do if following warning signs are observed : (1) the bronchodilator doesn†t bring expected relief, (2) a decrease in the peak expiratory flow, (3) Increased breathlessness and variation in peak flow rates during the day, (4) more frequent wheezing and a persistent dry cough and (4) disturbed sleep. (Prendergast, 1991) Asthmatics who live in highly polluted areas and are surrounded by electrical appliances, high tech equipment and power lines can benefit from air ionisers and a purifiers. Individuals can also prescribe to alternative treatment (for instance the Buteyko method), various breathing exercises, physical exercise (such as swimming), a healthy diet, and natural remedies such a homeopathic and acupuncture. It has been found that these treatments should complement orthodox medication and also help reduce the reliance on it. Roberts (1996) suggest that there is evidence that the Buteyko method is effective in treating chronic asthma. Devised by professor Beteyko of Siberia, this program consists of specific relaxation techniques and shallow breathing to correct breathlessness and wheezing. For those who are prone to exercise induced asthma choosing the right type of exercise is important †¦ particularly choosing a sport that requires longer and slower breathing and/or short bursts of effort. Examples include gymnastics, cricket and basketball. Swimming with its controlled breathing pattern is also recommended as it promotes chest development, flexibility and, therefore better breathing. (Roberts, 1996) There has been extensive research into new drug treatments of asthma by pharmaceutical companies and universities over the last 20 years. One such new effective drug to emerge is a Leukotiene receptor antagonists (LTRA). It was recently introduced into Australia this year and the USA 3 years ago. In people with asthma, leukotrienes play a key role in causing the inflammation, bronchoconstriction, and mucous production that lead to coughing, wheezing, and shortness of breath. LTRA†s prevent leukotrienes from attaching to the proinflammatory receptors on circulating and lung cells, which contribute to asthma symptoms. Leukotriene research is the direct result of a Nobel Prize-winning discovery made by scientist Beng Samuelsson in 1979. (Lipworth, 1999) However, there needs to be further research into the efficacy and its side effects. 4. How effective are the educational programs undertaken by organizations such as Asthma Victoria? Current statistics indicate that there has been a reduction of asthma mortality and morbidity in Australia over the past 10 years. The fall in deaths from 964 in 1989 to 715 in 1997 may indicate that some of Australia†s strategies for asthma management have been successful. (NAC, 1998) The Australian Asthma Management Program provides a systematic and methodical approach to asthma care. Nevertheless, it was not formulated as an evidence based document. This means that its recommendations (devised in 1989) were not based on systematic reviews or had been ranked according to the strength supporting them. However, today there have been a number of studies reviewing the effectiveness of the AMP. One such report by the National Asthma Campaign (1999), commented on the crucial role of education in improving the management of asthma rather than the token gesture of handing over a leaflet at the end of a patient consultation. This was in relation to the 6th step – educate and review regularly and highlights the importance of education programs undertaken by organizations such as the Australian National Asthma Campaign, Asthma Victoria, the Thoracic society of Australia and New Zealand and other relevant educators. The 1990 and 1993 national surveys of 22,000 adults and 16,000 children conducted by the National Asthma Campaign (NAC) showed improved asthma management practices in the three year period. Although the changes are not necessary the direct result of the National Asthma Campaign, it is considered to be consistent with the campaign and other agencies having been successful in promoting awareness and optimal management of asthma. (Comino, 1996) One of the goals of the NAC was to reduce the reliance on daily medication and hence increase the use of preventative therapy (such as inhaled corcosteroids) for patients with moderate or severe asthma; together with written action plans based on symptom severity and measurements of lung function. Use of preventative medication was found to have increased among both children and adults. The study highlighted also that there was a significant decline in the use of daily inhaled bronchodilator drugs among children and also inappropriate medications such as antibiotics and oral prescriptions. In addition this study also showed that in 1993 survey, doctors measured lung function significantly more often than in 1990; with similar increases observed in the use of peak flow meters and written action plans. (Comino, 1996) These results suggest that the Australian Asthma Management Programs are relatively effective. However, the study also points to the fact that limitations still exist. In particular there is a lack of communication and joint management strategies between specialists and GP†s, hospitals and the community; whilst the use of action plans still has considerable room for further improvement. Nonetheless, not all studies on education programs show positive conclusions. A British research paper ‘Greenwich Asthma Study† of 1291 asthmatics conducted in 1993 and 1996 found that their model of service delivery was not effective in improving the outcome of asthma in the community. The intervention program used was based on the British Thoracic Society†s guidelines and was conducted by specialist nurses in community based settings. There were similarities in the methodology and intervention measurement. However, they concluded that no evidence was found for an improvement in asthma related quality of life among newly surveyed patients in intervention practices compared with control practices. (Premaratne, 1999) Altogether this highlights that the variability of the asthma educational programs undertaken by various major organisations make it difficult to comparatively evaluate. A comprehensive world wide study, ‘Objectives, methods and content of patient education programs for adults with asthma: systematic review of studies published between 1979 and 1998†³ found that there was great difficulty in identifying the most effective components of asthma educational programs. The main reason cited was that education programs for adults with asthma vary widely. Most reports did not specify the general (56%) and educational objectives (60%) of the intervention. Important training characteristics were often not available: duration of education (45%) and number of sessions (22%), who delivered education (15%), whether training was conducted in groups or was individualised (28%). (Sudre, 1999) Such variability suggests a lack of consensus on what educational components actually work. With insufficient documentation of asthma education programs for adults, replication is limited. In conclusion there is some evidence to suggest that written treatment management plans are most effective in improving the quality of life for people with asthma. In the Australian context the National Asthma Campaign has clearly documented program goals. However, the limitations lie in its lack of empirical evidence. In addition the reliability of the research documents in general has been brought into question by the Sudre (1999) study. Therefore it is difficult to demonstrate the most effective management plan for asthma sufferers. This issue is currently being addressed by the National Asthma Campaign and the Asthma Foundation of Victoria. The Asthma foundation is currently conducting a study into the effectiveness of their schools based program. Hopefully, this and other studies will help fill the gap associated with the effectiveness of asthma education programs. And hence secure the continuation and development of asthma education in the community.

Deviance, Psychiatry and Cultural Relativism

The paper â€Å"Borderlands: Deviance, Psychiatry and Cultural Relativism† by Robert Bartholomew discusses cultural differences i. e. what is considered normal and rational in one culture may be considered abnormal in others. Therefore, the author analyzes different attitudes towards human actions (e. g. suicide), and provides overview of cultural relativism and psychiatry. The author’s thesis is that people interpret the world depending on their social and cultural context. He argues that science can’t be applied to identifying and treating abnormality.Bartholomew says that normality is â€Å"not an objective given from which simple assessments of behaviour can be rendered independent of historical era, culture, or group†. (P. 36-37) Normality is defined by cultural background and cultures have their own interpretations what to consider rational or irrational. For example, suicide is not acceptable in Western countries, whereas it is considered normal in Japan. Further, Bartholomew defines cultural relativism as theory of knowledge which is responsible for working out criteria how to judge behaviour of other culture.It is not static and depends on circumstances. There are few standards of universal conduct to evaluate this or that society. The author claims that the problem of cultural relativism results in serious dilemmas for mental health professionals. Actually, psychiatric diagnoses don’t involve assessment of cultural development and influence. However, psychiatry is more interested in religious, social and cultural background than other medical fields. Bartholomew assumes that psychiatry is the most contentious medical branch.In psychiatry ‘illness’ is defined as experiencing living problems, rather than discernible cerebral disease that affects human behaviour. The negative moment is that Western medicine is still transmitting social and professional stereotypes constituting its own values and norms. Summ ing up, the author recommends – when to judge whether the person is normal, it is necessary to get acquainted with his social world and cultural background. Works Cited Bartholomew, Robert. â€Å"Borderlands: Deviance, Psychiatry and Cultural Relativism†. Skeptic, 8, 3 (2000): 36-40.

Repression Essays - Freudian Psychology, Mental Processes

Repression Essays - Freudian Psychology, Mental Processes Repression When forming a memory, the brain takes what we see, hear, smell, feel, and or taste, and fills in the blank spots with information that we have perceived from common knowledge and stores it as a memory. But sometimes something happens that is so shocking that the mind grabs hold of the memory and pushes it underground, into some inaccessible corner of the unconscious. There it sleeps for years, or even decades, or even forever- isolated from the rest of mental life. Then, one day it may rise up and emerge into consciousness. When the unconscious tucks away a memory, to hopefully be forgotten, it is called Repression. Repression is a defense mechanism derived from Sigmund Freud near the beginning of the century (Gay 18-19). But if a person cannot recall a memory, was it ever really a memory? Did it ever really happen? If so, can the conscious be manipulated and made to think that, through controversial methods such as hypnosis or a truth serum called sodium pentathol, a false event ac tually happened? (Accused) And if these false events are believed, then can the manipulated mind be used in court cases to sue the people who caused the traumatic experience? When Freud discovered the idea behind repressed memories he then had to come up with a way to recover then. A process known as psychoanalysis was formed. The theory of repression and recovery became a corner stone to understanding some of our own neurosis (Gay 18-19). When Freud began to use this method frequently, he did not know what psychologists would do with the theory today, nor did he realize that people would ever use this as a method of fraud. In 1990 a case went to trial against a man accused of murder 20 years earlier. He was accused of killing his daughters best friend. The daughter, now an adult, began to remember slowly events that occurred and pieced together enough information to convict her father. He was the first man to ever go to trial and be convicted of murder of the grounds of a recovered memory (repressed memories). In this particular case, was the daughter beginning to remember these events before she began therapy or was this such a traumatic event that in order to settle it within her own mind, she had to come up with her own solution? When a memory becomes locked away, it can be permanent or temporary depending on the severity of the traumatic experience. Through psychoanalysis, the memory can be brought back. The process is a detailed inquiry of the persons past and past relations and events, which are recorded and analyzed. (Gay 479) Through this process, the psychologist then can determine whether or not there is more there to be brought out. This is where hypnosis and other controversial methods can come into play. When you are under hypnosis, you are completely vulnerable and susceptible to influence. Memories can then be implanted by use of descriptive details, inserted characters and fictitious plot elaboration. (Accused) There are also three ways in which memory can be affected: when it is stored, while it is being stored and when it is retrieved. During each of these times something could be misunderstood, or implanted. Psychologists are not the only influences our brain has. Recollections of horror movies, comic books, nightmares, anything on TV are liable to get garbled in our memories and tossed around to confuse us. Possibilities of retrieval of lost memories are plentiful. Memories of these things can come out in the hypnosis therapy and therapists think it to be true and valid information. But not only is it up to the techniques reliability, but it is also up to the mind and soul of the person to distinguish these other influences and recapture the true event. Knowing that evidence exists that memories can be implanted and that the mind is so easily mislead, it makes you wonder about your own past. It makes you almost want to remember things that your not even sure existed. It also makes you wonder why people would want to dredge up memories if they are not real. There is no easy answer or explanation to the theory of

8 Benefits to Start a Homework Writers Career

8 Benefits to Start a Homework Writers Career 8 Benefits to Start a Homework Writers Career We feel your pain. This is a lot harder than you thought it would be, isn’t it? You want to achieve stunning grades in your classes, but you also need to work as much as you can to finance your education at the same time. So you’re a burning candle at both ends. What if you could combine your studies with a lucrative career succeeding in your classes and at your job at the same time? Consider starting a career as a homework writer. Here are some of the benefits that you will gain: 1. Convenience Even work-study jobs require at least a minimal commute eating up your valuable time. But homework writers can do their job from the comfort of their own apartments or dorms. Imagine coming home from the university and being able just to sit down at your desk and earn some cash. 2. Flexible Schedule Did you oversleep this morning? Or do you have a test to study for the whole night? No worries; it won’t impact your work schedule. You can choose your hours and work when it’s convenient for you. 3. Building a Professional Reputation The fact is that you are a research and paper-writing expert. Once you’ve gained a few clients, buzzes about your expertise will spread around the campus. This can help you especially if you are considering the education field for future employment. 4. Earning Extra Money As a college student, you have many things to budget, so at times it is quite hard to make ends meet. Wouldn’t it be great to have extra money on hand for entertainment, food, and tuition fees? A little extra spending cash would definitely relieve some of your worries. 5. Gaining New Knowledge and Skills Why do college instructors assign homework papers in the first place? It’s because the completion of these tasks helps you learn more and improves your knowledge. So just imagine how knowledgeable you will become if you are completing not just your own assignments, but those of your clients as well. You can acquire learning in a variety of areas, and will therefore be able to converse intelligently about everything from social science to math, from literature to medicine. That well-rounded intelligence will make you very appealing to future employers. 6. Gaining Experience Any employment gives you something to add to the â€Å"work experience† section of your resume. You will have a distinct advantage over those who have never had a job, or even those who just worked as a dishwasher or a store clerk. 7. The Opportunity to Help People Your clients are struggling students, just like you. You have the opportunity to make their lives just a little bit better and easier. You are reducing their stress by offering help when they need it. 8. Getting to Know Different People College is supposed to be the time for meeting new people and building friendships. But often students find themselves under such stringent demands that they just don’t have time to seek out new acquaintances. As a smart homework writer, you will meet a lot of students. Your world will become a richer place for getting to know international students, mature students with jobs and families, and those from low-income backgrounds. These are people that you might never get to meet otherwise. Becoming a homework writer can expand your horizon and opportunities in many ways. So, go ahead and embrace the opportunity.

Describe the political warfare between the federalist and their Essay

Describe the political warfare between the federalist and their opponents,the Jeffersonians ,during the 1790s, - Essay Example His objective was to rally national support for Hamiltons economic programs and creation of a strong national government. He formed acquaintances with like-minded supporters of independence or nationalists on realizing the need for vocal political support in the states. He used his network of treasury agents to bond friends of the government, especially bankers and merchants in the dozen major cities of the new nation. The Federalists Party became popular with businesspersons, mostly people from New England. Its distinguished representatives included Alexander Hamilton, John Adams, John Jay and author Noah Webster. The Jeffersonian Republicans on the other hand emerged within three years of the Constitution inauguration. Americans.net records that no longer able to agree to the various policies that President Washington advocated, Thomas Jefferson left the Cabinet in 1793. Together with James Madison and lesser figures in the infant federal government, they formed a coalition that took to the leadership of popular opposition to economic and financial programs of Alexander Hamilton. They feared the intense threat to the American experiment in popular self-governance by the broad interpretation of the Constitution advanced on their behalf, the policies of the first secretary of the Treasury, and the anti-populist reactions that some of Hamiltons supporters expressed. The opposition deepened after 1793 when Britain and revolutionary France entered into twenty years of war. It extended into foreign policy and marshaled a large enough portion of the population such that historians describe Jeffersonian Republicans as the first American political party. By 1792, newspapers started referring to Hamilton supporters as Federalists while they referred to Jefferson’s supporters as Democrats, Republicans, Jeffersonians or Democratic-Republicans. They were generally farmers and opposed a strong central government. The state networks of both Federalist and

Other Assignment Example | Topics and Well Written Essays - 1000 words - 1

Other - Assignment Example , with regards to the price of LASIK, this follows the national average and is generally represented between $1,500 and $2,000 per treatment (Bethke, 2012). Ultimately, the individual can understand accounting an action where oil process as an integral means by which prices ultimately sets. Due to the fact that different regions of the nation have different expenses, this can be seen as one of the prime motivators for why prices fluctuate to such a great degree with regards to the services which it previously been analyzed. For instance, the price of LASIK eye correction may be in order of magnitude higher in San Diego that it might necessarily be in Little Rock Arkansas. This is due to the fact that a host of expense differentials exist between these two locations. For instance, the heating/cooling and light bill that the San Diego office will necessarily have to engage with, is necessarily much greater than that of the somewhat less developed, less densely populated, and lower costs will rock Arkansas. Similarly, the average wages of the employees that will be required to run such an office will also be higher. This necessarily requir es the price setting to match these actual aerial and accounting realities (Levinrad, 2012). Similarly, with regards to actuarial services, the overall level of risk that might exist within current market has a direct impact on the amount of money that the entity/a group will be required to pay with regards to their insurance furthermore, if insurance prices within a given region are necessarily high, prices will be forced to match this as a means of continuing to generate a profit margin. Obviously, the same can be said of prices are necessarily lower than the national average with regards to insurance and the given market. a. Argue for or against men and women being charged the same price for health care coverage ( as of 2014, it will be illegal to adjust premiums based on gender, but it will be fine to do so based on age, place