Jean Piaget Essay Example | Topics and Well Written Essays - 500 words

Jean Piaget - Essay Example The primary job during the time spent cognizance has a place with mental capacities of individual: newborn children are brought into the world with specific plans working during childbirth (reflexes), however while in creatures these plans control conduct all through life people use them to adjust to nature and build up their intellectual capacities. Piaget distinguishes four times of intellectual turn of events: tangible engine, pre-operational, concrete-operational, and formal-operational. Every one of these periods is related with acing certain aptitudes and capacities, for example, utilization of images, dynamic reasoning, and so forth: Pre-operational stage (baby and youth): insight is shown using images, enhancements in the utilization of language, improvement of memory and creative mind. Be that as it may, thinking stays silly and nonreversible; egocentric speculation commands during this stage; Concrete operational stage (rudimentary and early youth): knowledge is shown through legitimate and orderly control of images identified with solid items. Operational reasoning creates (mental activities that are reversible) while egocentric reasoning lessens. Formal operational stage (immaturity and adulthood): insight is exhibited through the intelligent utilization of images identified with unique ideas.

Lets Party!

Lets Party! Lets Party! Lets Party! By Maeve Maddox From a peruser comes the inquiry: Would you be able to cover the term cutting loose and how to utilize it effectively, alongside other gathering related terms? Much appreciated! Partying proposes uproarious, inebriated festival. Individuals leaving bars singing and yelling can be supposed to be cutting loose. Models: The neighbors celebrated into the early morning hours. Jack and his companions were partying in Florida when the mishap happened. The word originates from Middle French carousser drink, swallow, gulp. Gulp, as an action word, recommends greedy over-guilty pleasure: He gulped one beverage after another. Here are some different articulations, some of them doublespeaks, for celebrating in the feeling of over-enjoying drink or other state of mind enhancers. celebrate party party down rave it up make cheerful paint the town (party like there's no tomorrow) let loose relax celebrate the good life have a great time make some wild memories have a blow out (indicates sexual guilty pleasure just as intoxication) who live at her chateau, Ekeby Manor, and work in her iron mine. These men, the Cavalieri di Ekebu, are surely a celebrating bundle of slackers. Be that as it may, Giosta goes along with them, and through different plot inventions everybody is recovered (www.nytimes.com) of walks and gatherings that can without much of a stretch overpower even the most outgoing among us. Yet, there are a lot of approaches to observe Pride away from a portion of the weekend’s most jam-packed occasions - including Ms. Minogue’s Sunday appearance a (www.nytimes.com) national Democrats have praised the President Trump-motivated flood of extremist vitality flowing through the gathering in their endeavors to assume responsibility for the House, a considerable lot of those equivalent chiefs have moved to tame that vitality, from Co (www.nytimes.com) Need to improve your English in a short time a day? Get a membership and begin getting our composing tips and activities every day! Continue learning! Peruse the Expressions classification, check our famous posts, or pick a related post below:70 Home Idioms and ExpressionsHang, Hung, Hanged50 Tips on How to Write Good

QA with Professor Dirk Salomons COLUMBIA UNIVERSITY - SIPA Admissions Blog

QA with Professor Dirk Salomons COLUMBIA UNIVERSITY - SIPA Admissions Blog Looking back on his career, former track and specialization director discusses his current thinking on humanitarian action Professor Dirk Salomons, 76, a special lecturer in international and public affairs, has been a SIPA faculty member since 2002. From 2009 to 2015 Salomons served as director of the School’s Humanitarian Affairs track (within the Human Rights concentration) and International Organizations specialization. He kept his position on the faculty and this semester is teaching introductory courses on international organizations and humanitarian affairs. Read Dirk Salomons new op-ed on humanitarian challenges facing the world today A native of the Netherlands, Salomons describes his long career as a “mix of design and opportunity.” After earning a PhD in comparative literature in 1967, he worked as a literary critic and eventually as a columnist on international affairs, which led to a job with his home country’s ministry of foreign affairs. In 1970 he moved on to the UN, where he remained until 1997. Among the highlights of his tenure was his service in 1992-93 as executive director of peacekeeping operations in Mozambique, where he coordinated a major new operation. Immediately before joining SIPA, Salomons worked as a managing partner at an international management-consulting firm. In that role he provided advisory services to several UN agencies and other international clients in the public sector. His fieldwork largely focused on stabilizing countries coming out of conflict, such as Sudan, the Democratic Republic of the Congo, and Timor Leste. On October 27, Salomons will moderate one of two panels at the conference  â€œBeyond Neutrality: The Humanitarian System at a Crossroads.”  The conferenceâ€"presented by SIPA’s Human Rights and Humanitarian Policy concentrationâ€"marks Salomons’s retirement and his contributions to the field. Earlier this month, Coralie Martin MIA ’17 spoke with Salomons about his career and his current thinking on humanitarian action. A condensed and edited version of that conversation follows. You’ve said in the past that you entered the field of development with naiveté and innocence. What did you mean by that? When I joined the UN in my late 20s, it all seemed very simple. The world had gone through a period of decolonization, and many countries had emerged [from that process] with enormous hopes. It seemed a technical problem to build capacities that would allow them flourish. But we found very quickly that technical assistance would run into important blockages: difficulties finding partners to work with, difficulties getting used to governance systems which had no tradition of democracy. In that context, “bringing in development” seemed very naive. My real insights came later in life, when I was asked to be the executive director of peace operations for the United Nations in Mozambique, in 1992. Before that, I had done a lot of management work, troubleshooting and internal work with the UN. But during and after Mozambique, I saw that we really had to move from thinking top-down to bottom-up in development. We had to start seeing the communities as building blocks for development, instead of governments. How did you manage to apply this insight to your next assignments? In my consulting roles and in my years in the UN after Mozambique, I focused very much on developing models to move resources to communities, and allow them to develop merit-based leadership. It was done mainly by allowing UN agencies to work more closely with NGOs, with a higher level of autonomy from government donors. I have worked on initiatives such as pooled funds, where governments no longer individually manage their own programs. Instead, they give authority to the UN to use their money when there is a particular need. This way, the UN can channel funds to NGOs, to communities. It ties in with simple things such as simplifying contracts. UN agencies have been moving toward new systems where under a certain amount of money, contracts are shorter and can be signed with fingerprints. This removes some of the barriers that usually make small-scale grants impossible. I spent a lot of time working on small solutions to push aid down to the bottom instead of feeding it into the top. You have worked extensively on supporting peace efforts in countries emerging from conflict such as Sudan, Kosovo, or the Democratic Republic of the Congo. Could you share an example of successful post-conflict recovery? A successful example of post-conflict recovery is hard to come by. But I can find a few examples where things would have been much worse if the international community had not made a major effort. The first examples of situations where the UN helped countries maintain at least basic security and stability date back to the nineties. The UN developed a model in Namibia, which had been a South African colony since World War I, based on a mandate that was no longer valid. Martti Ahtisaari, who later became the president of Finland, made an enormous effort to think through what the UN could do when the country would gain its independence. I was part of the team that gathered information and analyzed the situation. Namibia became a model of setting up elections, creating a response program for short-term needs, developing political parties with their own platforms, and their own conflict resolution models. With Cambodia, the UN scaled up and managed to maintain some stability in a very difficult context. In Mozambique, I went in with an annual budget of $300 million [U.S.] in 1992. The country was just coming out of a civil war that killed a million people. It gave us a chance to plan elections, mobilize humanitarian aid, analyze where the seeds of development were, how to get markets functioning again. Those were the beginnings. But what was developed was later carried over to Liberia, Sierra Leone, and the Balkans. You wrote recently that “Humanitarians are contrarians. They go where reason tell them not to.” What did you mean by that? The first challenge for humanitarians is that they have to accept that there are no good solutions; otherwise they would not be there. They are working in highly traumatized situations, with severe lack of resources, in environments that are threatening, among people that do not normally trust them. So why go in there at all? It may be out of some kind of revulsion at the hypocrisy of modern-day politics, which demonstrates one thing: people can know all about human suffering, and they don’t care. I believe that during World War II, if the statistics of the number of Jews gassed had been available, it would not have made any difference in the policies of the Allied forces. We cried “never again” routinely after every major crisis. Every time, we had all the information we neededâ€"like in Rwanda or Congo, where 3.5 million people died. I really look at my generation, and the generation of the people after me, as the ones who have betrayed humanity. And I look at the humanitariansâ€"the ones who went there, set up tents, dug latrines, looked for water, and looked people in the eyes and said “We are here to witness and to help.” I look at them as the contrarians, those who tried to live out, act out some kind of moral values, knowing well that it is not going to make a global difference. Have you ever felt a sense of discouragement? Not discouragement, but rather anger. I get angry all the time. But if you stop getting angry, then you get depressed. So it is better to retain your fury, and acknowledge that uphill battle is still being continued by new generations, who are a minority, as we were a minority in our days. Look at years and years of UN conferences, and all the people who have come to plea for a better world. It has fallen on the political system like the rain on raincoats. Nothing seems to penetrate the mind of the real power to the point that it is going to make any concessionâ€"not in the corporate world, if you look at the way we have been extracting our resources from the global south shamelessly, to this day; not in the political world, if you look at the way we have been empowering and protecting lowlifes pretending to be politicians in the Global South; not in the way most recently the UN pretended that people like Salva Kiir, the current president of South Sudan, or his former deputy Riek Machar, could even be thought of as politicians, despite their record of war crimes. By legitimizing them, we allowed them to lead their countries down into ruins. What were we thinking? What, then, would be your message to the next generations? We should continue the battle, even without expecting that the world is actually going to change. As is said in the Abrahamic religions, Judaism, Christianity, and Islam, “If you save one life, you save humanity.” All you can do as an individual is to wonder what challenges are right in front you, and what you can do about them. You might make a marginal difference, but it is still better than just sitting there and do nothing. My years as a professor at SIPA have given me a lot of hope in the next generation, which I consider as the “last chance generation”. The people who are in their late 20s today, will have to find solutions to the issues of climate change, resource scarcity and poor governance. Otherwise my sense is that we are going to face major consequences. Now that you’re no longer directing a concentration and specialization here at SIPA, what are doing with your free time? I am going back to my roots. I drifted into this whole business of international development by accident, when my plan was originally to become a professor of German literature. But now I think it is time to think of what I want to do when I grow up. I am back reading things that have nothing to do with international issues, back to some of my favorite German authors, trying to revive my Latin and my Greek. I am taking some pleasure in slowly shifting away from international affairs to my own world of literature. â€"  Coralie Martin MIA ’17

Essay on Chapter 63 Nursing Management Musculoskeletal...

Chapter 63: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery Test Bank MULTIPLE CHOICE 1. When teaching seniors at a community recreation center, which information will the nurse include about ways to prevent fractures? a. Tack down scatter rugs in the home. b. Most falls happen outside the home. c. Buy shoes that provide good support and are comfortable to wear. d. Range-of-motion exercises should be taught by a physical therapist. ANS: C Comfortable shoes with good support will help decrease the risk for falls. Scatter rugs should be eliminated, not just tacked down. Activities of daily living provide range of motion exercise; these do not need to be taught by a physical therapist. Falls inside the home are responsible†¦show more content†¦The nurse will instruct the patient with a fractured left radius that the cast will need to remain in place a. for several months. b. for at least 3 weeks. c. until swelling of the wrist has resolved. d. until x-rays show complete bony union. ANS: B Bone healing starts immediately after the injury, but since ossification does not begin until 3 weeks postinjury, the cast will need to be worn for at least 3 weeks. Complete union may take up to a year. Resolution of swelling does not indicate bone healing. DIF: Cognitive Level: Apply (application) REF: 1513 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity USTESTBANK.COM 7. A 48-year-old patient with a comminuted fracture of the left femur has Buck’s traction in place while waiting for surgery. To assess for pressure areas on the patient’s back and sacral area and to provide skin care, the nurse should a. loosen the traction and help the patient turn onto the unaffected side. b. place a pillow between the patient’s legs and turn gently to each side. c. turn the patient partially to each side with the assistance of another nurse. d. have the patient lift the buttocks by bending and pushing with the right leg. ANS: D The patient can lift the buttocks off the bed by using the left leg without changing the right-leg alignment. Turning the patient will tend to move the leg out of alignment. Disconnecting the traction will interrupt the weight needed toShow MoreRelatedFundamentals of Hrm263904 Words   |  1056 Pagescom/college/quickstart Technical Support 24/7 FAQs, online chat, and phone support www.wileyplus.com/support Your WileyPLUS Account Manager Training and implementation support www.wileyplus.com/accountmanager MAKE IT YOURS! Fundamentals of Human Resource Management Tenth Edition David A. DeCenzo Coastal Carolina University Conway, SC Stephen P. Robbins San Diego State University San Diego, CA Tenth Edition Contributor Susan L. Verhulst Des Moines Area Community College Ankeny, IA John WileyRead MoreCase Study Essay33967 Words   |  136 Pagesdischarge treatment plan is to facilitate successful patient selfmanagement, minimize symptoms, and prevent readmission. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. ââ€"   Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg PO bid Pioglitazone (Actos) 45 mg PO every morning Furosemide (Lasix) 40 mg/day PO Potassium chloride 20 mEq/day PO 2. Which of these medications may have contributed to M.G.s heart

King Arthur Essay - 1664 Words

Tales Of King Arthur Since the romanticizing of the Arthurian legends by Geoffery of Monmouth, the historian, during the twelfth century, the legendary king of England has been the source of inspiration for kings, poets, artists and dreamers alike. The most famous work is probably Sir Thomas Malorys Le Morte dArthur, completed around 1470, and published in many abridged and complete versions. Malorys work contains in one the legend that had been continually added to over the years by many different writers who introduced such elements as Sir Galahad, and the ill-fated love affair between Lancelot and Guinevere. Geoffery of Monmouth had been the first to put the legends surrounding Arthur into literary form in†¦show more content†¦When Guinevere first appears in early Welsh stories, she is the daughter of a giant, but later she becomes the daughter of King Leodegrance of the West Country. In her original Welsh form of Gwenhwyfar, she was an folk figure before being connected to Arthur, and may originally have been a lesser goddess. Geoffery located Camelot at the very real Roman town of Caerleon in South Wales; Malory placed it at Winchester, which was the headquarters of the kings of Wessex and remained a royal seat after the Norman invasion. Other stories place it near Arthurs supposed birthplace at Tintagel. Cadbury Castle in Somerset has been named as another possible location of Camelot, which has been revealed during excavations to have been occupied during the time of Arthur and to have been the headquarters of a leader, if not a king. The real Arthur may have been buried at Glastonbury Abbey, which lays around twelve miles north-west of the castle. It is said to have been a secret burial, so the news of his death would not raise Saxon morale; the mystery may have given rise to the rumors that he still lived on. In 1190, the monks of Glastonbury Abbey reported that they had dug up a coffin made from a hollow log, and a lead cross inscribed with theShow MoreRelated King Arthur Essay1157 Words   |  5 PagesKing Arthur Character Analysis Although King Arthur is one of the most well-known figures in the world, his true identity remains a mystery. Attempts to identify the historical Arthur have been unsuccessful, since he is largely a product of fiction. Most historians, though, agree that the real Arthur was probably a battle leader of the Britons against the Anglo-Saxons in the sixthth century. In literature, King Arthurs character is unique and ever changing, taking on a different face inRead More King Arthur Essay1428 Words   |  6 PagesKing Arthur Character Analysis The character of King Arthur is unique in literature. Most characters are known through their actions and words as described by the author of a story. Arthur, however, is a conglomerate of characters described by many different authors over a fifteen hundred year span. There is no single depiction of him, and one cannot trace his origin to a single author for the definitive description. As such, the character of Arthur is different depending on the era, cultureRead More King Arthur Essay2674 Words   |  11 PagesKing Arthur The Arthurian legends are well known in todays society. However, very few people know of the real Arthur -- who he was and what his accomplishments were. This paper will establish a difference between legend and truth, show evidence to support and explain who the real Arthur was, and shed some light on the sometimes confusing Arthurian legends. To establish any sort of idea that there was, in fact, a real Arthur, it is imperative to look over the legendary ArthurRead MoreThe Legend Of King Arthur1308 Words   |  6 PagesKing Arthur King Arthur was one of Britain’s and Wale’s most influential literary figures from the early 800’s. Through the ages more caught on to these Arthurian Legends, and they began to embrace them as part of their culture. Some believe that he is only a legend, yet others believe that there is even an Arthur living among us today. While growing up, Arthur was oblivious to his heritage. From becoming a King at the age of 16, Arthur showed courage and strength in the darkest of timesRead MoreKing Arthur Essay1506 Words   |  7 PagesThe stories and legends surrounding the character of King Arthur are among the best known of all stories about kings and knights. The stories and legends surrounding the character of King Arthur are among the best known of all stories about kings and knights. 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Though there isn’t one solid story, like Beowulf, there are multiple stories that agree on the same things, such as Arthur’s allegiance to the Knights of the Round table, his companion Merlin, his relationships with his fellow knights, family, and close friends, and the legendary sword Excalibur. When all aforementioned qualities are explained and put together, it can truthfully define Arthur as an epic hero. The legendRead MoreWho Is King Arthur?526 Words   |  2 Pages2010). This quote is the perfect way to describe King Arthur. The stories of King Arthur have been passed down for centuries. He is a huge figure it literature and his stories have impacted many people. What if that is it? What if it is all just stories. History has provided us with much evidence that he is real. We also have a lot of counter evidence as well. So, who exactly was King Arthur and is he a hero born, or just made up? 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He goes after Garlon the invisible evil night and finds the Castel Carbonek. He stricks King Pelles with the Dolorous Stroke then fights his brother unknowingly and they kill each other. The First Quest of the Round Table- King Arthur

Lipid Profiles In Postmenopausal Women Health And Social Care Essay Free Essays

string(158) " Writers concluded that Letrozole modestly decreases TC at 3 months ; nevertheless, the consequence is non sustained throughout the intervention clip period\." Aim: Aromatase inhibitors are presently used in accessory to the former gold criterion Tamoxifen or as first line hormone therapy in postmenopausal adult females with chest malignant neoplastic disease. Suppressing the aromatase mechanism of action impedes the synthesis of estrogen, forestalling estrogen protection on lipid profiles. This literature reappraisal examines, discusses, and analyzes peer-reviewed published clinical tests analyzing the effects of anastrozole, exemestane, and letrozole, on lipid profiles in postmenopausal adult females with estrogen dependent chest malignant neoplastic disease. We will write a custom essay sample on Lipid Profiles In Postmenopausal Women Health And Social Care Essay or any similar topic only for you Order Now Decisions: Overall, there are minimum, if any, unfavourable effects of aromatase inhibitors on lipid profiles. However, restrictions of little population sizes, fluctuations in design methods, and old Tamoxifen usage, make it hard to accurately assess hazard. Long term prospective surveies utilizing big sample sizes and patients with no exposure to any other hormone intervention besides aromatase inhibitors, are needed to accurately measure if inauspicious effects on lipid profiles exist from the utilizing aromatase inhibitors. Healthcare professionals should go on to supervise lipoids in postmenopausal adult females with chest malignant neoplastic disease and develop individualized intervention programs utilizing current recommendations. Cardinal Wordss: aromatase inhibitor, chest malignant neoplastic disease, post-maturity, lipid, Anastrozole, Letrozole, Exemestane, cholesterin, and lipid metamorphosis. Aromatase Inhibitors Risk of Adverse Effects on Lipid Profiles in Postmenopausal Women with Breast Cancer: A Literature Review Introduction Breast malignant neoplastic disease pestilences about 2.5 million adult females in the United States, 1 doing it one of most prevailing signifiers of tumor that healthcare practicians dainty today. The hazard of developing chest malignant neoplastic disease increases with age, with one in 13 postmenopausal adult females developing the disease.2 Nearly 70 per centum of those postmenopausal adult females will hold a endocrine dependant ( estrogen positive ( ER+ ) , progesterone positive ( PR+ ) ) signifier of chest malignant neoplastic disease that utilizes estrogen as its chief alimentary beginning for the proliferation of the tumour. 2, 3, 4 In postmenopausal adult females, estrogen is chiefly synthesized in the peripheral tissues, chest, musculus, adipose, tegument by the enzyme aromatase.4,5 Aromatase converts adrenal androgens into estrogen via the CYP450 enzyme pathway.4, 5, 6, Suppressing aromatase and hindering this transition limits the sum of estrogen available for use by tum our cells, later forestalling growing and spread. Through this mechanism of action, steroidal ( Exemestane ) and non-steroidal ( anastrozole and letrozole ) aromatase inhibitors have shown to be extremely efficacious in the intervention of ER+/PR+ chest malignant neoplastic disease in postmenopausal adult females compared to that of Tamoxifen.5 Multiple landmark surveies ( MA.17, 2 ATAC, 7 BIG 1-98, 8 and EORTC9 ) , suggest that Tamoxifen is no longer a gilded criterion, and now recommend utilizing AIs as first line hormone therapy in these patients.5 With the spread outing usage of AIs by practicians in the intervention of endocrine dependent chest malignant neoplastic disease and the subsequent betterment in disease free endurance rates, more postmenopausal adult females are populating long plenty to see other comorbidities, such as cardiovascular disease ( CVD ) .4 Since CVD is the primary cause of mortality in postmenopausal adult females, 10 understanding the associated inauspicious effects AIs pose on cardiovascular hazard factors is pertinent. Lipid biomarkers are often assessed clinically to find a patients hazard of developing CVD. Previous epidemiologic surveies have shown that estrogen is protective and good to some cardiovascular hazard factors, specifically lipid profiles, via its direct effects on the endothelial cells found in blood vessels.6,11 Estrogen alters concentrations of lipoids in the blood ; diminishing serum concentrations of entire cholesterin ( TC ) , low-density lipoprotein ( LDL ) , and triglycerides ( TRG ) , while increasing serum concentrations of high-density lipoprotein ( HDL ) .11, 12 Therefore, it is thought that postmenopausal adult females taking AIs are deprived of this cardioprotective consequence of estrogen since its synthesis is being prevented by suppressing the aromatase transition mechanism. Therefore, the inquiry can be proposed: Make aromatase inhibitors adversely affect lipid profiles and later present an increased hazard of developing cardiovascular disease in postmenopausal adult females with ER+/PR+ chest malignant neoplastic disease? This literature reappraisal of current clinical test informations examines and assesses the usage of AIs, Exemestane ( Aromasin ) , Anastrozole ( Arimidex ) , and Letrozole ( Femara ) , on the inauspicious effects of the lipid profiles of postmenopausal adult females with ER+/PR+ chest malignant neoplastic disease. Search footings included cardiovascular, aromatase inhibitor, chest malignant neoplastic disease, post-maturity, lipid, Anastrozole, Letrozole, Exemestane, plasma lipoid, cholesterin, and lipid metamorphosis. MEDLINE in Pubmed, MEDLINE ( on EBSCO ) , and OVID were used to seek for peer-reviewed diary articles published between the old ages 2005 to 2010. Recent grounds showing the effects AIs render on the lipid profiles of postmenopausal adult females with estrogen dependent chest malignant neoplastic disease is discussed, analyzed, and reviewed in the undermentioned subdivisions. AROMATASE INHIBITORS EFFECT ON LIPID PARAMETERS Depriving chest malignant neoplastic disease stricken postmenopausal adult females of the benefit of estrogen via the AI mechanism is thought to hold damaging effects on CVD hazard factors. Several clinical tests utilizing assorted design methods have been conducted and show variable effects of AIs on the different cholesterin parametric quantities and lipoproteins. Table 1 summarizes the effects of AIs on assorted lipid biomarkers in the postmenopausal adult female with ER+/PR+ chest malignant neoplastic disease, and all surveies in the tabular array are discussed in the following subdivisions. Placebo Controlled Tests Two surveies have evaluated the consequence of AIs versus placebo on lipid biomarkers. As a secondary end point, Cigler et al13 studied the effects of Letrozole versus placebo on serum lipid parametric quantities ( TC, HDL, LDL, TRG ) in 60 seven postmenopausal adult females utilizing a random, placebo-controlled design. Lipids were measured at baseline and during the 3rd, 6th, 12th, and 24th months, and the per centum alteration from baseline was calculated for each month. Researchers noted a statistically important lessening in the TC at month 3 ( P value=0.052 ) in the Letrozole arm of the survey. The other parametric quantities ( TRG, LDL, and HDL ) measured were non significantly changed from baseline in either the Letrozole or the placebo weaponries. Writers concluded that Letrozole modestly decreases TC at 3 months ; nevertheless, the consequence is non sustained throughout the intervention clip period. You read "Lipid Profiles In Postmenopausal Women Health And Social Care Es say" in category "Essay examples"13 The cogency of consequences in the lipid part of this survey are questionable because of the imbalanced figure of participants in each intervention group, and the little population size that remained at the terminal of the 24 months ( Letrozole: 26 patients, and placebo: 16 patients ) . It is hard to measure accurate tendencies in informations with little population sizes, and consequences should be verified utilizing similar survey methods with larger population sample sizes. A confusing variable in this survey was the old usage of Tamoxifen in some patients and non others. Tamoxifen has shown to hold good effects on lipoids ; 14, 15 therefore, the consequences from patients that had antecedently taken Tamoxifen may non be a true representation of the effects of the AI entirely on lipid profiles. Another placebo controlled test utilizing different design methods was conducted by Lonning et al16 and contrasting consequences were found. The effects of Exemestane versus that of placebo on plasma lipoids in postmenopausal adult females with resectable chest malignant neoplastic disease was studied by Lonning et al.16 In a dual blind manner, one hundred 40 seven patients were indiscriminately assigned to an Exemestane intervention group or a placebo intervention group. Measurements of lipid biomarkers ( TC, HDL, LDL, TRG, ApoLipoprotein A1, lipoprotein A, ApoLipoprotein B, homocysteine ) were taken at baseline, and at the 3rd, 6th, 12th, and 24th month. Results revealed that the Exemestane intervention group had a statistically important ( P value A ; lt ; 0.001 ) lessening in HDL versus that of the placebo intervention group. Besides, a statistically important ( p=0.004 ) lessening in Apolipoprotein A1 occurred in the Exemestane intervention group versus that of the placebo intervention group. Writers concluded that the steroidal AI, exemestane has modest effects on HDL lipid biomarkers and those hazard factors for C VD should be followed overtime.16 This survey included more participants than Ciglers study ; hence, the consequences seen here may hold more cogency. Besides, a different AI was used in each test, and this variable could account for the disagreement in consequences between the two surveies. No old Tamoxifen usage was denoted in the survey by Lonning et Al ; 16 therefore, the consequences are a better representation of the effects of the AI on lipoids without confusing influences of Tamoxifen. More placebo controlled tests are necessary to to the full understand the effects of AI on lipoids in postmenopausal adult females with endocrine dependent chest malignant neoplastic disease, and to denote if a true lessening in HDL exists. The following subdivision discusses tests in which AIs were compared with Tamoxifen alternatively of a placebo as the intercession intervention groups to be assessed. Tamoxifen Comparative Tests Surveies have been conducted utilizing Tamoxifen as a comparative intervention group to that of Exemestane, and their several inauspicious effects on lipid profile alterations are discussed. The TEAM Greek bomber study17 randomized postmenopausal adult females with early chest malignant neoplastic disease into an Exemestane arm ( 77 patients ) or into a Tamoxifen arm ( 65 patients ) , and evaluated HDL, LDL, TRG, and TC at baseline, and at 12, 18, and 24 months. Results indicate that TC decreased overtime in both intervention groups ; nevertheless, those in the Tamoxifen arm had a crisp diminution at month 18 and 24, doing the difference between groups at that clip period statistically important with P value=0.020 and P value=0.0087, severally. Both interventions had a statistically important lessening in HDL ; nevertheless, the Tamoxifen group maintained higher degrees of HDL, leting for a more favourable consequence than exemestane, with a statistically important average difference ( P=0.011 ) between the intervention groups. The Tamoxifen intervention group had a important consequence on the LDL parametric quantity doing a steep lessening in values overtime. exemestane had failed to demo any important alteration on LDL. The TRG parametric quantity revealed no noticeable tendencies for either intervention regimen. Research workers concluded that Tamoxifen has a favourable consequence on TC and LDL, while Exemestane has a more indistinct consequence on lipid biomarkers.17 The lessening in HDL in this survey is in harmony with that of Lonning et al.16 One restriction is that all four lipid parametric quantities were non accounted for in all patients in each intervention group ; hence, tendencies seen in each parametric quantity may non stand for the true tendency that would be present if all values were recorded for all patients at all measurement clip periods. This survey reiterates the idea that Tamoxifen has good effects on lipoids ; accordingly, it is hard to accurately measure the hazard of AI when the comparative intervention group is Tamoxifen. 14 Though some restrictions were present in this survey, comparative consequences were seen by Francini et al14 in another test utilizing different methods than the TEAM Greek bomber survey. Francini et al14 conducted a survey in which 55 postmenopausal adult females who had antecedently been treated with no less than 2 old ages of Tamoxifen were randomized into two intervention groups: either continue Tamoxifen or exchange from Tamoxifen to Exemestane. Lipid parametric quantities were measured at baseline and at 6 and 12 months. Consequences yielded were statistically important in the Exemestane arm of the survey entirely demoing a lessening in HDL overtime ( p value A ; lt ; 0.05 ) , an addition in LDL overtime ( p value A ; lt ; 0.01 ) , and a lessening in TRG overtime ( P value A ; lt ; 0.01 ) . The differences between the Tamoxifen and Exemestane intervention group were non important except for the LDL biomarker ( p value A ; lt ; 0.05 ) . Writers concluded that the addition in LDL of the Exemestane group may be due in portion to participants being antecedently treated with Tamoxifen, which is known to hold good effects on LDL.14 Francinis survey and the TEAM Gr eek bomber study17 indicate that there was a lessening in the HDL parametric quantity in the Exemestane intervention group versus that of the Tamoxifen intervention group, proposing that AIs may hold an inauspicious consequence on HDL degrees. This lessening in HDL was besides noted in the ATENA trial18 in which Tamoxifen had been antecedently used for 5-7 old ages before the patients were assigned to have either Exemestane or no intervention, merely observation. The addition in LDL found in the survey by Francini14 was besides seen in the ATENA test ; 18 nevertheless, the TEAM Greek bomber study17 did non back up this determination. It must be kept in head that patients in the survey by Francini14 and the ATENA trial18 had antecedently been treated with Tamoxifen before get downing intervention with AIs, while patients in the TEAM Greek bomber study17 were non. Hence, the design differences could account for the fluctuation of consequences between surveies on the LDL, TRG, and TC p arametric quantities. A likewise designed survey by Montagnani et al15 exposed comparable consequences to the survey by Francini. Montagnani et al15 investigated the effects of Exemestane after anterior intervention with Tamoxifen, and indiscriminately assigned 60 eight postmenopausal adult females to go on taking Tamoxifen ( 20 milligrams daily ) or exchange to the aromatase inhibitor, Exemestane ( 25 milligrams daily ) for 2 old ages. Parameters ( TC, HDL, LDL, TRG ) were measured at baseline and at 12 and 24 months. Consequences showed that the Exemestane intercession had a important lessening in HDL, while the Tamoxifen group showed no significance in alteration from baseline. Therefore, a important difference between the intercession groups ( p value A ; lt ; 0.05 ) was noted. Besides in the Exemestane group, LDL was increased from baseline ; nevertheless, no alteration was seen in the Tamoxifen group. The between group differences were besides statistically important with a P value A ; lt ; 0.05. The Exemestane group besides had a statistically important lessening in TRG doing the between group differen ces important with a p value of A ; lt ; 0.05. The consequences found in this survey showed some similarities with those discovered by Francini et al.14 Montagnani revealed important differences between groups for HDL, LDL, and TRG parametric quantities, while Francinis survey merely showed important differences between groups for LDL. In both surveies, the aromatase inhibitor was compared with go oning Tamoxifen after the patients had already used Tamoxifen, hence some of the consequences may hold occurred from taking the good effects of Tamoxifen instead than uncovering damaging effects of the AI. Both Francini and Montagnani revealed lessenings in TRG in the Exemestane arm. This would be considered a favourable consequence of utilizing AI, but since Tamoxifen negatively affects TRG and Tamoxifen was antecedently used by the Exemestane patients, the simple remotion of the unfavourable consequence of Tamoxifen could account for the consequence. To increase the respectability of th ese findings, comparable consequences should be confirmed in likewise designed surveies utilizing larger sample population sizes without old exposure to Tamoxifen. Banerjee et al19 designed yet another survey comparing a different AI, Anastrozole, to Tamoxifen, and to a combination of Anastrozole with Tamoxifen. The IMPACT trial19 compares the effects of utilizing Anastrozole, Tamoxifen, or a combination of Anastrozole/Tamoxifen on the lipid profiles of postmenopausal adult females with chest malignant neoplastic disease. In a stage III, randomized, double-blind multicentre trial,19 three hundred 30 patients were assigned to have either Anastrozole ( 1 milligrams daily ) + Tamoxifen placebo, Tamoxifen ( 20 milligrams daily ) + Anastrozole placebo, or a combination of both ( Tamoxifen 20 mg day-to-day + Anastrozole 1mg daily ) for a period of 12 hebdomads. Measurements for TC and HDL were taken at baseline and three months. Results revealed that the Tamoxifen merely intervention group had a statistically important lessening in the TC lipid parametric quantity ( p value A ; lt ; 0.05 ) , while the Anastrozole merely intervention group had an addition in TC lipid parametric quantity that was non statistically important ; nevertheless, the difference between the two groups was important. The co mbination group consequences showed a important lessening in TC ( P value A ; lt ; 0.05 ) , nevertheless the between groups differences were non important. A statistically important addition in HDL from baseline was noted overtime in all intervention groups ( P A ; lt ; 0.05 ) , nevertheless the difference between the groups was non important. Writers suggest that, although there was a little addition in TC in the Anastrozole merely group, this negative consequence was counterbalanced with the positive consequence of the addition of HDL in the Anastrozole group, and that there is no damaging consequence on the lipid profile when utilizing the AI, Anastrozole.19 Measurements were merely taken over a 3 month clip period, therefore consequences are limited and the effects seen may non prolong through longer intervention tests. This addition in HDL in the AI intervention group is contrary to the consequences seen in antecedently discussed surveies. Different AIs were used in each test and this unsimilarity in methods could account for the differences. Studies reexamining the disparities between AIs are necessary to find their several effects on lipid profiles and to measure if an AI is more good or damaging than the others. Comparison between Aromatase Inhibitors It is of import to understand the differences between each aromatase inhibitors several effects on lipid profiles to assist healthcare practicians choose the appropriate drug regimen for each single patient. In a multi-centre, unfastened, randomized survey, McCloskey et al5 compared the effects of Anastrozole, Letrozole, and Exemestane on lipid profiles in one hundred and two postmenopausal adult females, and randomized them into one of three intervention groups: Anastrozole ( 1 milligrams daily ) , Letrozole ( 2.5 milligrams daily ) , or Exemestane ( 25 milligrams daily ) , for 24 hebdomads with a 12 hebdomad follow up period. Measurements of lipid biomarkers ( TC, TRG, LDL, HDL, LDL/HDL ratio, Apolipoprotein B/Apolipoprotein A-1 ratio ) were taken at baseline and at the 12th, 24th, and 36th hebdomad. Consequences revealed that Exemestane had a important lessening from baseline in TC, nevertheless the differences between the three intervention groups were non statistically important ( p value=0.535 ) . The LDL/HDL ratio parametric quantity was significantly different for all three groups at the 12th and 24th hebdomad measuring, with Exemestane giving the greatest alteration ( p=0.007 ) compared to Letrozole ( p=0.025 ) and Anastrozole ( p=0.045 ) . This increased ratio in the Exemestane intervention group was due to the statistically important lessening in HDL ( p value A ; lt ; 0.001 ) . The TRG measuring for all groups showed much variableness, with Letrozole demoing a statistical important addition at 12 hebdomads ( p=0.011 ) versus the other AIs. This alteration from baseline did non last through the 24 hebdomad measurement period. No other alterations were noted between the three intervention groups. Writers suggested that those treated with Exemestane have an addition in hazard of inauspicious effects on the ratios finding atherogenesis.5 The lessening in the HDL parametric quantity in patients utilizing Exemestane is in understanding with the anteceden tly mentioned surveies that used Exemestane as an AI comparator of pick. Since Tamoxifen was non a confounding factor here, the suggestion that Exemestane perchance adversely effects HDL, now becomes a more significant and valid statement because the consequence is still seen without Tamoxifen act uponing the consequence. However, it must be considered that this survey used healthy postmenopausal adult females, non breast malignant neoplastic disease patients, as the sample population evaluated, and the consequences can non be imposed as the same consequences that might hold occurred if the population had used a sample of postmenopausal adult females with chest malignant neoplastic disease. Long clinical surveies utilizing the right population sample and sample size should be conducted to further understand the impact of each AI on the postmenopausal chest malignant neoplastic disease patient. This is one of the lone surveies available measuring the inauspicious effects of each part icular AI compared to one another. More surveies are necessary to corroborate the consequence that Exemestane offers more inauspicious hazard compared to Letrozole and Anastrozole. Decision Tamoxifen has been in usage for more than 30 old ages, and was considered the gilded criterion hormone therapy for handling postmenopausal adult females with endocrine dependent chest cancer.15, 20 Large epidemiologic surveies have shown that AIs are more efficacious than Tamoxifen in overall and disease free endurance rates, and hence are now recommended as first line accessory hormone therapy for postmenopausal adult females with chest cancer.3,15 With their known mechanism of action of striping postmenopausal adult females of serum estrogens, therefore taking estrogens protective effects on these cardiovascular hazard factors,6, 11 there is concern that AIs may hold inauspicious effects on lipid profiles. Most writers concluded that aromatase inhibitors have minimum effects or no inauspicious effects on lipid profiles in postmenopausal adult females with chest malignant neoplastic disease. However, it is hard to measure the true consequence of AIs on lipid profiles with Tamoxifen as the comparator since it has proved benefit on some lipid parameters,14 and because of the many different design methods used. Small sample sizes were restrictions in a few surveies ; therefore, the tendencies yielded in those tests may non be genuinely declarative of postmenopausal adult females with chest malignant neoplastic disease. Long term prospective surveies utilizing big sample sizes and patients with no exposure to any other hormone intervention besides AI, are needed to accurately measure if inauspicious effects on lipid profiles exist from the usage of AIs. From the current available information, though minimally, HDL is the parametric quantity most adversely affected by the usage of AI. This may be a cause of concern for some practicians since lessenings in go arounding sums of HDL are linked with additions in cardiovascular disease.15 Since HDL is considered good cholesterin and a positive hazard factor, diminishing the sum available in blood could perchance hold damaging effects on CVD. Healthcare practicians should be cognizant of this possible hazard of diminishing HDL with AI usage so that proper monitoring in their patients may be performed. Given that a current intervention option still includes the usage of Tamoxifen followed by exchanging to an AI, it is particularly of import to supervise lip id profiles since some studies14, 15, 17 have shown unfavourable effects on lipid profiles when doing this switch. To find if an existent hurt on CVD hazard factors occurs in adult females taking the non steroidal and steroidal aromatase inhibitors, more long term clinical tests should be conducted. In decision, aromatase inhibitors are being used more and more as first line accessory intervention in postmenopausal adult females with chest malignant neoplastic disease. Though it depletes estrogen beginnings, surveies show no well damaging effects on lipid profiles, with most merely demoing minimum, if any, inauspicious consequence. Placebo controlled surveies utilizing equal patient populations and sample sizes for appropriate sums of clip, are necessary to accurately depict the hazards of AIs on cardiovascular hazard factors. Healthcare practicians should go on to supervise lipid profiles in postmenopausal adult females with chest malignant neoplastic disease and develop individualized intervention programs utilizing current recommendations. Specific safety steps for patients utilizing AIs are non necessary,16 and the effects seen in the surveies mentioned in this reappraisal suggest that long term monitoring of all lipid parametric quantities should be a portion of the postmen opausal adult female with chest malignant neoplastic diseases intervention program. Surveillance of hazard factors overtime in these adult females with should assist forestall unfavourable cardiac events. How to cite Lipid Profiles In Postmenopausal Women Health And Social Care Essay, Essay examples

Jazz Ken Burns free essay sample

JAZZ Is a documentary by Ken Burns released 2001 that focuses on the creation and development of jazz, Americas greatest cultural achievement. The first episodes entitled, Gumbo, Beginnings to 1917 and The Gift (1917-1924), explain the early growth of Jazz as it originates In New Orleans and its expands to Chicago and New York during the Jazz Age. In assessing the first two episodes of Ken Burns 2001 documentary, JAZZ, this essay will explore the history of Jazz, the musics racial implications, and its impact on society. In doing so, attention will also be given to the trucker of the documentary, and the effectiveness of documentary film in retelling the past. In the first episode of JAZZ, Ken Burns demonstrates how the creation of jazz was made possible by the social and political circumstances in New Orleans during the late seventeenth century and early eighteenth century. By combining the historical explanations of narrator Keith David and the emotional commentaries of African American artists, he retells history In an unconventional way that gives a more meaningful description than textbooks and encyclopedias. We will write a custom essay sample on Jazz Ken Burns or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page As Keith David explains, New Orleans was the home to two different social circumstances: it was the most cosmopolitan city in America as well as the center of the slave trade, New Orleans was a place filled with people from all nationalities living side by side who brought upon a musical gumbo of Caribbean rhythms, classical music, minstrel music, the blues, ragtime and more. These diverse musical styles were taken advantage of by the African American people, in a period of time where they were deprived of the freedom that America promised to all of her Inhabitants.African Americans found the liberty they sought for In music and dancing. Ken Burns supports this idea by explaining how blacks were allowed to sing, dance and play the drums in the Congo Square as he demonstrates it in a series of photographs. Wanton Marshals, an African American Jazz musician from New Orleans explains that when African slaves arrived to America, they were faced with a new, unfamiliar world that required them to improvise in order to survive. For this reason, their music incorporated a lot of dynamic improvisation and creativity, a characteristic that separates Jazz from the other musical styles at the time of its birth.One of the two most Important musical Influences was Ragtime. Style of music of insistent syncopated ragged rhythm created by black piano players. Photos and video clips of people playing and dancing to ragtime are examples of Burns amazing use of art photography and photojournalism to make the story more vivid for the viewers. Ragtime was a style of music the youth enjoyed to listen and dance to while the older generation of white men considered it a product of anarchism.A quote by a Massachusetts attorney and politician of the nineteenth century, Edward Baxter Perry explains that victim s in [his] opinion can be treated successfully only eke the dog with rabies, with a dose of led, when talking about people who listened, and danced to ragtime. As segregation took over New Orleans, formerly freed creoles, whites who were of black descendants began to play together with the African 1 OFF incorporated which came to be known as Jazz. Creoles were affluent in classical music and piano, which they incorporated into the making of Jazz music.The second main musical influence was the blues, which Ken Burns shows to be a result of political circumstances at the time. The efforts of racial integrations in the South were halted in 1877 when the northern publicans and southern democrats make an agreement that removes the federal troops from the south. While Ken Burns gives a very short background of the agreement, he does explain that a new system of segregation laws is established named under the minstrel hit Jim Crow that makes way for a time where white rule was brutally re-imposed and lynchings became a routine. This brought upon a stream of African Americans that escaped to New Orleans from the segregation in the Mississippi Delt a. With them, they brought the blues, which according to Gerald Early, an African American essayist and American culture critic, was an aesthetic that reed them from the burden of minstrelsy. The blues were a combination of spirituals, work songs, call and response, shouts only made possible because of the suffering of the blacks during their oppression as Alberta Hunter, an American blues singer and songwriter explains that the blues are like spirituals, almost sacred.When we sing blues, were singing out our hearts were singing out our feelings. Maybe were hurt, and Just cant answer back, then we sing or maybe even hum the blues. Jazz was a music that came from an aspiration for freedom combined with creativity. However racial conflicts are still prominent during the creation of Jazz as it becomes a well-known popular style of music. While Jelly Roll Morton, an American ragtime and early Jazz pianists claims to have invented Jazz, the first Jazz recordings are by white artists.Wanton Marshals reads a quote by Nick Loran saying, Negroes learned to play this music from the whites. Amarylliss facial expressions and his long pause as he reacts to Loras statement represents how horrifying this was for all of the blacks. The film transitions smoothly from the first episode to the second, The Gift when World War I transforms the American society. In Europe, as whites and blacks fought together in the war, racism started to diminish and blacks gained some respect by their fellow soldiers as well as their allies. The Hell Fighters led by James Reese Europe were an infantry Jazz band that exposed ragtime to the European countries. Back in America, the center of Jazz has a geographical shift from New Orleans to Chicago and New York when large influxes of immigrants populate these two cities. Studs Trekker, an American historian explains that people from the southern states moved up to Chicago and New York in what is called the Great Migration in search for better Jobs, and freedom.These cities become major urban cities full of flappers, gangsters, unlicensed saloons, that create an atmosphere suitable for Jazz, which is still considered an unorthodox style of music. When prohibition, the national ban of the sale of alcohol is enacted, the American people become even more loosened up. According to Gerald Early, the jazz age became an umbrella term for this whole loosening up this whole lubrication thanks to prohibition where everyone was drinking more than they should Just to defy an absolutely unenforceable law in this time period. Burns champions the use of first-person narratives in his film.As he explains, If youre going to talk to a lot of people, youve got to talk in stories Louis Armstrong is explained to have survived a fatherless childhood in the roughest part of New Orleans and grows up to become the first true Jazz soloist and influence the course of Jazz for decades to come. Armstrong Joins his tutor King Oliver, a Jazz cornet player and the two artists influence a new generation of white and black musicians. Armstrong is considered the most important improviser in Jazz. Duke Elongating on the other hand, is considered to be Americas greatest composer. He was n African American from for Harlem, who synthesizes Americas many musical styles into one consistent style. These two African American artists among with others such as the arranger Fletcher Henderson, and the bandleader Paul Whitman, have a profound impact on Jazz music in the 20th century, which still continues in the 21st century. Ken Burners first two episodes of JAZZ accomplish much more than the retelling of the history of Americas musical creation. The documentary tells the story of a continuously evolving nation that struggles to fulfill its promises of opportunity and freedom to its variety of people.It explains how African Americans fought their way out of racial discrimination by expressing themselves in music and incorporating the influence by the nations coexisting personalities, nationalities, races and religions. The documentary has a unique way of showing and telling the story of Jazz vividly with never before seen footage of photographs and video clips, and th e commentaries and narration of African American artists and American historians. Through the visual and audio components of the documentary Ken Burns JAZZ successfully introduces viewers to the birth of jazz in the eighteenth and nineteenth centuries.