Wednesday, March 18, 2020
Social Theories and Concepts in Forrest Gump Ã¢â¬Å"Forrest GumpÃ¢â¬ is a movie that narrates the story of a man from the time he is a child up to the time he is a grown up working in a shrimp boat. The movie presents the audience with a chronological sequence of events that begin from 1960s to date. Therefore, the movie has several sociological ties with this period and the main characterÃ¢â¬â¢s life.Advertising We will write a custom essay sample on Social Theories and Concepts in Forrest Gump specifically for you for only $16.05 $11/page Learn More The main character in the movie is Forrest Gump. The movie focuses on GumpÃ¢â¬â¢s experiences with government, racism, poverty, mass media, and politics among other things. The filmÃ¢â¬â¢s unfolding events are revealed through GumpÃ¢â¬â¢s first person narration. The filmÃ¢â¬â¢s main themes include child abuse, racism, poverty, gender roles, culture, and family violence. This essay explores some of the themes and characters in Ã¢â¬Å"Forrest G umpÃ¢â¬ and how they relate to social psychology. One of the most prominent social theories that can be related to this film is symbolic interactionism. The main argument behind this theoretical concept is that the actions of people can only be well understood through meaningful communication. The main character in this movie goes through a hard time in his formative years. He faces discrimination from both teachers and students in his first school. This discrimination is centered on the fact that Gump has low IQ and suffers from a disability, conditions that make him misunderstood by the rest of the community. The fact that he cannot express himself to his detractors makes the situation worse for Gump. The only time there is an attempt to initiate direct communication on GumpÃ¢â¬â¢s behalf is when his mother confronts the school principal and insists that there is nothing that makes Gump unfit to attend Greenbow County Central School. According to symbolic interactionism theor y, only direct communication makes peopleÃ¢â¬â¢s actions understandable. When Gump grows up the discrimination against him subsides because he can now be able to communicate with those who misunderstood him earlier. In the movie, it is clear that the torment and isolation that Forrest Gump had experienced as a child reduces as he grows older. Moreover, the only way Gump is able to make a solid and sincere friend in Jenny is by being able to communicate with her directly. According to role theory, our behavior as human beings is determined by our own expectations and those of other people in the society. This theory is both exemplified and contradicted in Ã¢â¬Å"Forrest GumpÃ¢â¬ . As a child, other people do not expect Forrest Gump to achieve much.Advertising Looking for essay on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More However, Gump is able to focus on his own expectations and those of the American society. In the end, Gump is an accomplished athlete, military man, spiritual leader, and entrepreneur. However, Gump contradicts several expectations from his own society by decrying racism and rising above discrimination and isolation. The role theory also asserts that people spend a considerable amount of their lifetime being part of groups. Jenny spends most of her time as part of the Ã¢â¬ËhippieÃ¢â¬â¢ movement. According to the movie, Jenny is also a member of an illegal organization known as the Black Panther Party. Moreover, role theory specifies that people always assume different roles and occupy various positions in these groups. Gump is involved in the activities of various groups and organizations where he assumes different roles. For instance, he assumes the leadership of his military group and he is eventually granted a medal of honor. The social constructionism concept holds that individuals and groups form their own reality. This concept explores the dynamics of institution s and actions without necessarily analyzing their cause and effect. The reality that is formed by the filmÃ¢â¬â¢s main character falls under this concept. In one scene, Gump and his friend Jenny are being chased by bullies. Suddenly, the braces in GumpÃ¢â¬â¢s legs fall off and this is when he realizes he is better off without the braces. Before this occurrence, GumpÃ¢â¬â¢s reality was that he could not perform well without the braces. However, this reality is challenged by the actual reality. The same concept applies to GumpÃ¢â¬â¢s relationship with Jenny. Gump believes that their love is eternal but this reality keeps being challenged by several other realities including JennyÃ¢â¬â¢s drug abuse and emotional imbalance. According to social constructionism theorists, socially constructed notions are not always true. For instance, the union between Jenny and Gump is a reality that only exists during certain periods. The same case applies to GumpÃ¢â¬â¢s friend Dan who is co nvinced that Gump erred by saving his life. In the beginning, Dan is convinced that it would have been better if he had died in the war front. However, later on in the movie, another reality occurs to him and he thanks Gump for saving his life. Another social psychological notion that is paraded in Ã¢â¬Å"Forrest GumpÃ¢â¬ is deviance. According to social psychology, deviance is a behavior that contradicts the accepted social norms. In this movie, deviance can be exemplified through the actions of various characters. For instance, JennyÃ¢â¬â¢s involvement in the hippie movement and her subsequent drug abuse can be interpreted as deviant behaviors. Social psychology scholars explain the source of deviance using several theories. In JennyÃ¢â¬â¢s case, her deviant behavior would best be explained using strain theory. This means that Jenny picked up her deviance because of her social environment. Unlike Gump, Jenny came from a poor and abusive background. However, she was still ex pected to achieve the same goals as other kids from wealthy backgrounds. The strain involved in achieving her goals might have caused her to rebel.Advertising We will write a custom essay sample on Social Theories and Concepts in Forrest Gump specifically for you for only $16.05 $11/page Learn More The self-concept is also well explored in this film. Self-concept is the result of self process. It is through self-process that individuals are able to identify themselves. The narrator in this movie uses first person narration and is able to reveal several self-concepts. For instance, in the beginning of the movie he is shown narrating his life to strangers who are seated in a park bench. In this narration, he arrives at various conclusions about his identity. In essence, this narration offers a Ã¢â¬Ësnap-shotÃ¢â¬â¢ of Forrest Gump. The effectiveness of GumpÃ¢â¬â¢s narration is aided by the fact that human beings can be able to talk about themselves as th ey would about an inanimate object such as a chair. This is according to self-concept. In addition, it is through this concept that Gump is able to delve into his self-identity and conduct self-evaluations. Although Ã¢â¬Å"Forrest GumpÃ¢â¬ was supposed to be a film about the life of one man, the movie managed to delve into various social theories and concepts. By exploring the filmÃ¢â¬â¢s plot and characters, one is able to unearth several social theories and concepts. Some of the theories contained in this film aid in character and theme development. The filmÃ¢â¬â¢s maker is also able to present wholesome characters by borrowing on several social concepts.
Monday, March 2, 2020
Calculating the Mean Absolute Deviation There are many measurements of spread or dispersion in statistics. Although the range and standard deviation are most commonly used, there are other ways to quantify dispersion.Ã We will look at how to calculate the mean absolute deviation for a data set.Ã Definition We begin with the definition of the mean absolute deviation, which is also referred to as the average absolute deviation. The formula displayed with this article is the formal definition of the mean absolute deviation. It may make more sense to consider this formula as a process, or series of steps, that we can use to obtain our statistic. We start with an average, or measurement of the center, of a data set, which we will denote by m.Ã Next, we find how much each of the data values deviates from m.Ã This means that we take the difference between each of the data values and m.Ã After this, we take the absolute value of each of the difference from the previous step. In other words, we drop any negative signs for any of the differences.Ã The reason for doing this is that there are positive and negative deviations from m.Ã If we do not figure out a way to eliminate the negative signs, all of the deviations will cancel one another out if we add them together.Now we add together all of these absolute values.Finally, we divide this sum by n, which is the total number of data values.Ã The result is the mean absolute deviation. Variations There are several variations for the above process.Ã Note that we did not specify exactly what m is. The reason for this is that we could use a variety of statistics for m.Ã Typically this is the center of our data set, and so any of the measurements of central tendency can be used. The most common statistical measurements of the center of a data set are the mean, median and the mode.Ã Thus any of these could be used as m in the calculation of the mean absolute deviation. This is why it is common to refer to the mean absolute deviation about the mean or the mean absolute deviation about the median. We will see several examples of this. Example:Ã Mean Absolute Deviation About the Mean Suppose that we start with the following data set: 1, 2, 2, 3, 5, 7, 7, 7, 7, 9. The mean of this data set is 5.Ã The following table will organize our work in calculating the mean absolute deviation about the mean.Ã Data Value Deviation from mean Absolute Value of Deviation 1 1 - 5 = -4 |-4| = 4 2 2 - 5 = -3 |-3| = 3 2 2 - 5 = -3 |-3| = 3 3 3 - 5 = -2 |-2| = 2 5 5 - 5 = 0 |0| = 0 7 7 - 5 = 2 |2| = 2 7 7 - 5 = 2 |2| = 2 7 7 - 5 = 2 |2| = 2 7 7 - 5 = 2 |2| = 2 9 9 - 5 = 4 |4| = 4 Total of Absolute Deviations: 24 We now divide this sum by 10, since there are a total of ten data values.Ã The mean absolute deviation about the mean is 24/10 2.4. Example:Ã Mean Absolute Deviation About the Mean Now we start with a different data set: 1, 1, 4, 5, 5, 5, 5, 7, 7, 10. Just like the previous data set, the mean of this data set is 5.Ã Data Value Deviation from mean Absolute Value of Deviation 1 1 - 5 = -4 |-4| = 4 1 1 - 5 = -4 |-4| = 4 4 4 - 5 = -1 |-1| = 1 5 5 - 5 = 0 |0| = 0 5 5 - 5 = 0 |0| = 0 5 5 - 5 = 0 |0| = 0 5 5 - 5 = 0 |0| = 0 7 7 - 5 = 2 |2| = 2 7 7 - 5 = 2 |2| = 2 10 10 - 5 = 5 |5| = 5 Total of Absolute Deviations: 18 Thus the mean absolute deviation about the mean is 18/10 1.8.Ã We compare this result to the first example.Ã Although the mean was identical for each of these examples, the data in the first example was more spread out. We see from these two examples that the mean absolute deviation from the first example is greater than the mean absolute deviation from the second example. The greater the mean absolute deviation, the greater the dispersion of our data. Example:Ã Mean Absolute Deviation About the Median Start with the same data set as the first example: 1, 2, 2, 3, 5, 7, 7, 7, 7, 9. The median of the data set is 6.Ã In the following table,Ã we show the details of the calculation of the mean absolute deviation about the median. Data Value Deviation from median Absolute Value of Deviation 1 1 - 6 = -5 |-5| = 5 2 2 - 6 = -4 |-4| = 4 2 2 - 6 = -4 |-4| = 4 3 3 - 6 = -3 |-3| = 3 5 5 - 6 = -1 |-1| = 1 7 7 - 6 = 1 |1| = 1 7 7 - 6 = 1 |1| = 1 7 7 - 6 = 1 |1| = 1 7 7 - 6 = 1 |1| = 1 9 9 - 6 = 3 |3| = 3 Total of Absolute Deviations: 24 Again we divide the total by 10 and obtain a mean average deviation about the median as 24/10 2.4. Example:Ã Mean Absolute Deviation About the Median Start with the same data set as before: 1, 2, 2, 3, 5, 7, 7, 7, 7, 9. This time we find the mode of this data set to be 7.Ã In the following table,Ã we show the details of the calculation of the mean absolute deviation about the mode. Data Deviation from mode Absolute Value of Deviation 1 1 - 7 = -6 |-5| = 6 2 2 - 7 = -5 |-5| = 5 2 2 - 7 = -5 |-5| = 5 3 3 - 7 = -4 |-4| = 4 5 5 - 7 = -2 |-2| = 2 7 7 - 7 = 0 |0| = 0 7 7 - 7 = 0 |0| = 0 7 7 - 7 = 0 |0| = 0 7 7 - 7 = 0 |0| = 0 9 9 - 7 = 2 |2| = 2 Total of Absolute Deviations: 22 We divide the sum of the absolute deviations and see that we have a mean absolute deviation about the mode of 22/10 2.2. Fast Facts There are a few basic properties concerning mean absolute deviations The mean absolute deviation about the median is always less than or equal to the mean absolute deviation about the mean.The standard deviation is greater than or equal to the mean absolute deviation about the mean.The mean absolute deviation is sometimes abbreviated by MAD.Ã Unfortunately, this can be ambiguous as MAD may alternately refer to the median absolute deviation.The mean absolute deviation for a normal distribution is approximately 0.8 times the size of the standard deviation. Common Uses The mean absolute deviation has a few applications.Ã The first application is that this statistic may be used to teach some of the ideas behind the standard deviation. The mean absolute deviation about the mean is much easier to calculate than the standard deviation. It does not require us to square the deviations, and we do not need to find a square root at the end of our calculation. Furthermore, the mean absolute deviation is more intuitively connected to the spread of the data set than what the standard deviation is. This is why the mean absolute deviation is sometimes taught first, before introducing the standard deviation. Some have gone so far as to argue that the standard deviation should be replaced by the mean absolute deviation.Ã Although the standard deviation is important for scientific and mathematical applications, it is not as intuitive as the mean absolute deviation. For day-to-day applications, the mean absolute deviation is a more tangible way to measure how spread out data are.
Saturday, February 15, 2020
The Emerald Forest by John Boorman - Movie Review Example Apart from the difference in the authority structures of these two societies, their entire life styles and cultures are different. Western modern society is developed and advanced in terms of technology and uses machine guns and weapons to fight, aero planes to travel and other machines to cut off forests and clear the land for construction, whereas the invisible people do not have much use of technology as they use arrows and spears to fight and travel by walking long distances (Ã¢â¬Å"ProyectÃ¢â¬ ). As wanadi says, Ã¢â¬Å"When I was a boy, the edges of the world was very far away, but it comes closer each year.Ã¢â¬ It means that western world is growing in technology and now travelling across the entire world to reach far off places have become easy and fast. However, as technology is enhancing it is destroying the natural environment more (Ã¢â¬Å"The Emerald ForestÃ¢â¬ ). Air pollution from the aero planes, cars etc have increased resulting in various diseases affecting our respiratory systems when we inhale the oxygen present in the air. Also the modern guns and weapons have resulted in the increasing demolition of mankind who are killed in massacres. The machines used to clear off forests have destroyed the beauty of the world and the indigenous livelihood (Ã¢â¬Å"The Emerald ForestÃ¢â¬ ). The natural resources are being depleted with the adoption of new technology. This is the reason that the people of the western world were called to be Termite as they cut down big trees and destroy the real world which is in forests (Ã¢â¬Å"The Emerald ForestÃ¢â¬ ). The invisible people are loving, caring, innocent people who calls the forest as their world, who keeps to themselves, away from western society and just want... Both the traditional culture and the culture of the western American societies have their own good and bad points but in my view, the culture of the invisible people is far better than that of the westerners. The reason is that the invisible people were good hearted, loving humans who were satisfied with their lives and were happily living with their people in their world. Their culture satisfies all their humanly needs like physiological needs of food, water, sex etc, the safety needs by providing them shelter, resources to survive, health, their emotional needs by providing family, love, and by giving a sense of community in which people can depend upon each other in time of their need, their esteem needs i.e. their culture teaches them how to respect others and confidence and finally the highest level of human need that is self-actualization by providing them problem-solving capabilities and morality. The traditional culture promotes spirituality and the feeling of community which makes them selfless people who unlike the westerners do not tear apart nature and others feel for their own needs or motives. This view is further supported by Karl Marx, Sigmund Freud and Emile Durkheim who also views modern society as a misery in which people are unhappy and never fully satisfied. Even though they all have the same conclusion, they have different reasons for their views. According to Karl Marx, this misery results from capitalism which divides society into two major groups Bourgeoisie and Proletaria.
Sunday, February 2, 2020
Social Awareness - Assignment Example waited without having any interaction with his spouse or girlfriend, he was more or less relaxed with an open stance; however, as soon as she appeared, he closed his legs, removed his arm from the back of the bench and acted as if he were immediately in a more formal setting. With regards to the social awareness that the situation presented, it is the belief of this observer that the level of awareness was directly exhibited by the man on the bench with regards to how the situation changed for him as soon as his wife or girlfriend returned from her shopping experience. As has been previously discussed, the situation itself was more or less informal as it too place within a relatively busy shopping mall and both participants knew each other reasonably well due to the fact that they exhibited being in a relationship. However, even though a level of familiarity existed between the individuals, an analysis of the social awareness that was exhibited by the male specifically helped this observer to quickly note that his overall level of comfort with the situation and/or with seeing his wife or girlfriend was not as easy or as informal as the situation itself dictated. Although the conversation between the two individuals was within earshot of me while I observed the given communication and signals that were transmitted, it was the nonverbal communication that most effectively told me what was truly going on within the given situation. As a result of the maleÃ¢â¬â¢s actions and non verbal stance with regards to seeing the female return, I was able to form a rather rapid determination of my impression of the pair based upon this observation. The second interaction that I observed was that of a general manager of a grocery store discussing the way in which a return could not be accepted due to the fact that the customer was unable to present a valid receipt for the item. What took place between the two individuals was a situational misunderstanding, disagreement, and
Saturday, January 25, 2020
National Academy of Sciences: Human Cloning The National Academy of Sciences (NAS) made headlines when it issued a broadside that would, if followed by Congress, grant an open-ended license for biotech researchers to clone human life. True, the NAS recommended that Congress ban "reproductive" cloning, that is, the use of a cloned embryo to produce a born baby. But it also urged that human cloning for purposes of experimentation--often called "therapeutic" or "research" cloning--remain unimpeded by legal restrictions. Such a public policy would permit virtually unlimited human cloning--so long as all the embryos created thereby were destroyed rather than implanted in a woman's womb. The recommendation from a well-known scientific organization did not appear at this particular time by coincidence. The Senate will soon consider S. 790, legislation authored by Sam Brownback (R-KS) that would prohibit any creation of human clones--whether for research purposes or for reproduction. The House passed a virtually identical ban in a bipartisan vote last summer, and President Bush strongly supports the bill. Thus the legal future of human cloning--and the potential fortunes to be made by Big Biotech in the United States--hang in the balance in the Brownback bill. Limiting the ban on human cloning to procedures designed to lead to the birth of a baby would accomplish next to nothing. Figuring out how to clone human life successfully is going to be very difficult. Thus, early research would likely focus on perfecting techniques. Should this be successful, researchers would next attempt to maintain the resulting embryonic clone for a week to two weeks--long enough to harvest their stem cells. (The biotech company Advanced Cell Technology announced it has created human clones and maintained them to the six-cell stage(Advanced), which is not long enough for stem cells to appear.) Should the stem-cell Rubicon be crossed, implantation of the embryonic clone would then be relatively easy. Hence, the next natural (dare I use the word?) step would be the manufacture of human clones not just for research or genetic manipulation but for implantation, gestation, and birth. In any case, the morally serious question is whether human cloning is permissible-- not when those cloned should be killed once created. Much as an original oil painting can be seen only dimly beneath its patina, an agenda to eventually permit unrestricted cloning for all purposes can be discerned between the lines in the NAS report.
Thursday, January 16, 2020
That this was happening in Chamberlain, in Chamberlain, for God's sake, where he drank iced tea on his mother's sun porch and refereed PAL basketball and made one last cruise out Route 6 past The Cavalier before turning in at 2:30 every morning. His town was burning UP. Tom Quillan came out of the police station and ran down the sidewalk to Doyle's cruiser. His hair was standing up every which way, he was dressed in dirty green work fatigues and an undershirt and he had his loafers on the wrong feet, but Doyle thought he had never been so glad to see anyone in his life. Tom Quillan was as much Chamberlain as anything, and he was thereintact. Ã¢â¬ËHoly God,' he panted. Ã¢â¬ËDid you see that?' Ã¢â¬ËWhat's been happening?' Doyle asked curtly. Ã¢â¬ËI been monitorin' the radio,' Quillan said, Ã¢â¬ËMotton and Westover wanted to know if they should send ambulances and I said bell yes, send everything. Hearses too. Did I do right?' Ã¢â¬ËYes.' Doyle ran his hands through his hair. Ã¢â¬ËHave you seen Harry Block?' Block was the town's Commissioner of Public Utilities, and that included water. Ã¢â¬ËNope. But Chief Deighan says they got water in the old Rennet Block across town. They're laying hose now. I collared some kids, and they're settin' up a hospital in the police station. They're good boys, but they're gonna get blood on your floor, Otis.' Otis Doyle felt unreality surge over him. Surely this conversation couldn't be happening in Chamberlain. Couldn't. Ã¢â¬ËThat's all right, Tommy. You did right. You go back there and start calling every doctor in the phone book. I'm going over to Summer Street.' Ã¢â¬ËOkay, Otis. If you see that crazy broad, be careful.' Ã¢â¬ËWho?' Doyle was not a barking man, but now he did. Tom Quillan flinched back. Ã¢â¬ËCarrie, Carrie White.' Ã¢â¬ËWho? How do you know?' Quillan blinked slowly. Ã¢â¬ËI dunno. It just sort of Ã¢â¬ ¦ came to me.' From the national AP ticker, 11:46 Pm: CHAMBERLAIN, MAINE (AP) A DISASTER OF MAJOR PROPORTIONS HAS STRUCK THE TOWN OF CHAMBERLAIN, MAINE TONIGHT. A FIRE, BELIEVED TO HAVE BEGUN AT EWEN (U-WIN) HIGH SCHOOL DURING A SCHOOL DANCE, HAS SPREAD TO THE DOWNTOWN AREA, RESULTING IN MULTIPLE EXPLOSIONS THAT HAVE LEVELLED MUCH OF THE DOWNTOWN AREA. A RESIDENTIAL AREA TO THE WEST OF THE DOWNTOWN AREA IS ALSO REPORTED TO BE BURNING. HOWEVER, MOST CONCERN AT THIS TIME IS OVER THE HIGH SCHOOL WHERE A JUNIOR-SENIOR PROM WAS BEING HELD. IT IS BELIEVED THAT MANY OF THE PROM-GOERS WERE TRAPPED INSIDE. AN ANDOVER FIRE OFFICIAL SUMMONED TO THE SCENE SAID THE KNOWN TOTAL OF DEAD STOOD AT SIXTY-SEVEN. MOST OF THEM HIGH SCHOOL STUDENTS. ASKED HOW HIGH THE TOTAL MIGHT GO HE SAID: Ã¢â¬ËWE DON'T KNOW. WE'RE AFRAID TO GUESS. THIS IS GOING TO BE WORSE THAN THE COCONUT GROVE.' AT LAST REPORT THREE FIRES WERE RAGING OUT OF CONTROL IN THE TOWN. REPORTS OF POSSIBLE ARSON ARE UNCONFIRMED. ENDS. 11:56 PM MAY 27 8943F AP There were no more AP reports from Chamberlain. At 12:06 AM., a Jackson Avenue gas main was opened. At 12:17, an ambulance attendant from Motton tossed out a cigarette butt as the rescue vehicle sped toward Summer Street. The explosion destroyed nearly half a block at a stroke, including the offices of The Chamberlain Clarion. By 12:18 A.M.. Chamberlain was cut off from the country that slept in reason beyond. At 12:10, still seven minutes before the gas-main explosion, the telephone exchange experienced a softer explosion: a complete jam of every town phone line still in operation. The three harried girls on duty stayed at their posts but were utterly unable to cope. They worked with expressions of wooden horror on their faces, trying to place unplaceable calls. And so Chamberlain drifted into the streets. They came like an invasion from the graveyard that lay in the elbow creek formed by the intersection of The Bellsqueeze Road and Route 6; they came in white nightgowns and in robes, as if in winding shrouds. They came in pyjamas and curlers (Mrs Dawson, she of the now-deceased son who had been a very funny fellow, came in a mudpack as if dressed for a minstrel show); they came to see what happened to their town, to see if it was indeed lying burnt and bleeding. Many of them also came to die. Carlin Street was thronged with them, a riptide of them, moving downtown through the hectic light in the sky, when Carrie came out of the Carlin Street Congregational Church, where she had been praying. She had gone in only five minutes before, after opening the gas main (it had been easy; as soon as she pictured it lying there under the street it had been easy), but it seemed like hours. She had prayed long and deeply, sometimes aloud, sometimes silently. Her heart thudded and laboured. The veins on her face and neck bulged. Her mind was filled with the huge knowledge of POWERS, and of an ABYSS. She prayed in front of the altar, kneeling in her wet and torn and bloody gown, her feet bare and dirty and bleeding from a broken bottle she had stepped on. Her breath sobbed in and out of her throat, and the church was filled with groanings and swayings and sunderings as psychic energy sprang from her. Pews fell, hymnals flew, and a silver Communion set cruised silently across the vaulted darkness of the nave to crash into the far wall. She prayed and there was no answering. No one was there Ã¢â¬â or if there was, He/It was cowering from her. God had turned His face away, and why not? This horror was as much His doing as hers. And so she left the church, left it to go home and find her momma and make destruction complete. She paused on the lower step, looking at the flocks of people streaming toward the centre of town. Animals. Let them burn, then. Let the streets be filled with the smell of their sacrifice. Let this place be called racca, ichabod, wormwood. Flex And power transformers atop lightpoles bloomed into nacreous purple light, spitting catherine-wheel sparks. High-tension wires fell into the streets in pick-up-sticks tangles and some of them ran, and that was bad for them because now the whole street was littered with wires and the stink began, the burning began. People began to scream and back away and touched the cables and went into jerky electrical dances. Some had already slumped into the street, their robes and pyjamas smouldering. Carrie turned back and looked fixedly at the church she had just left. The heavy door suddenly swung shut, as if in a hurricane wind. Carrie turned towards home. From the sworn testimony of Mrs Cora Simard, taken before The State Investigatory Board (from The White Commission Report). pp. 217-218: Q. Mrs Simard, the Board, understands that you lost your daughter on Prom Night, and we sympathise with you deeply. We will make this as brief as possible. A. Thank you. I want to help if I can, of course. Q. Were you on Carlin Street at approximately 12.12 when Carietta White came out of the First Congregational Church on that street? A. Yes. Q. Why were you there? A. My husband had to be in Boston over the weekend on business and Rhonda was at the Spring Ball. I was home alone watching TV and waiting up for her. I was watching the Friday Night Movie when the town hall whistle went off, but I didn't connect that with the dance. But then the explosion Ã¢â¬ ¦ I didn't know what to do. I tried to call the police but got a busy signal after the first three numbers. I Ã¢â¬ ¦ IÃ¢â¬ ¦Then Ã¢â¬ ¦ Q. Take your time, Mrs Simard. All the time you need. A. I was getting frantic. There was a second explosion Ã¢â¬â Teddy's Amoco station, I know now Ã¢â¬â And I decided to go downtown and see what was happening. There was a glow in the sky, an awful glow. That was when Mrs Shyres pounded on the door. Q. Mrs Georgette Shyres? A. Yes, they live around the corner. 217 Willow. That's just of Carlin Street. She. was pounding and calling: Ã¢â¬ËCora, are you in there? Are you in there?' I went to the door. She was in her bath-robe and slippers. Her feet looked cold. She said they had called Auburn to see if they knew anything and they told her the school was on fire. I said: Ã¢â¬ËOh dear God, Rhonda's at the dance.' Q. Is this when you decided to go downtown with Mrs Shyres? A. We didn't decide anything. We just went. I put on a pair of slippers Ã¢â¬â Rhonda's, I think. They had little white puffballs on them. I should have worn my shoes, but I wasn't thinking. I guess I'm not thinking now. What do you want to hear about my shoes for? Q. You tell it in your own way, Mrs Simard. A. T-Thank you. I gave Mrs Shyres some old jacket that was around, and we went. Q. Were there many people walking down Carlin street? A. I don't know. I was too upset. Maybe thirty. Maybe more. Q. What happened? A. Georgette and I were walking toward Main Street, holding hands just like two little girls walking across a meadow after dark. Georgette's teeth were clicking. I remember that. I wanted to ask her to stop clicking her teeth, but I thought it would be impolite. A block and a half from the Congo Church, I saw the door open and I thought: Someone has gone in to ask God's help. But a second later I knew that wasn't true. Q. How did you know? It would be logical to assume just what you first assumed, wouldn't it? A. I just knew. Q. Did you know the person who came out of the church? A. Yes. It was Carrie White. Q. Had you ever seen Carrie White before? A. No. She was not one of my daughter's friends. Q. Had you ever seen a picture of Carrie White? A. No. Q. And in any case, it was dark and you were a block and a half from the church. A. Yes, sir. Q. Mrs Simard, how did you know it was Carrie White? A. I just knew. Q. This knowing, Mrs Simard: was it like a light going on in your head? A. No, sir. Q. What way it A. I can't tell you. It faded away the way a dream does. An hour after you get up you can only remember you had a dream. But I knew. Q. Was there an emotional feeling that went with this knowledge? A. Yes. Horror. Q. What did you do then? A. I turned to Georgette and said: There she is. Georgette said: Ã¢â¬ËYes, that's her.' She started to say something else, and then the whole street was lit up by a bright glow and there were crackling noises and then the power lines started to fall into the street, some of them spitting live sparks. One of them hit a man in front of us and he b-burst into flames. Another man started to run and he stepped on one of them and his body just arched backward, as if his back had turned into elastic. And then he fell down. Other people were screaming and running, just running blindly, and more and more cables fell. They were strung all over the place like snakes. And she was glad about it. Glad! I could feel her being glad. I knew I had to keep my head. The people who were running were getting electrocuted. Georgette said: Ã¢â¬ËQuick, Cora. Oh God, I don't want to get burned alive.' I said, Ã¢â¬ËStop that. We have to use our heads, Georgette, or we'll never use them again.' Something foolish like that. But she wouldn't listen. She let go of my hand and started to ran for the sidewalk. I screamed at her to stop Ã¢â¬â there was one of those heavy main cables broken off right in front of us Ã¢â¬â but she didn't listen. And she Ã¢â¬ ¦ sheÃ¢â¬ ¦ oh, I could smell her when she started to burn. Smoke just seemed to burst out of her clothes and I thought: that's what it must be like when someone gets electrocuted. The smell was sweet like pork. Have any of you ever smelled that? Sometimes I smell it in my dreams. I stood still, watching Georgette Shyres turn black. There was a big explosion over in the West End-the gas main, I suppose Ã¢â¬â but I never even noticed it. I looked around and I was all alone. Everyone else had either run away or was burning. I saw maybe six bodies. They were like piles of old rags. One of the cables had fallen on to the porch of a house to the left, and it was catching on fire. I could hear the old-fashioned shake shingles poppin g like Corn. it seemed like I stood there a long time, telling myself to keep my head. It seemed like hours. I began to be afraid that I would faint and fall on one of the cables, or that I would panic and start to run. Like Ã¢â¬ ¦ like Georgette. So then I started to walk. One step at a time. Ã¢â¬ËMe street got even brighter, because of the burning house. I stepped over two live wires and went around a body that wasn't much more than a puddle. I-I-I had to look to see where I was going. There was a wedding ring on the body's hand, but it was all black. All black. Jesus, I was Oh dear Lord. I stepped over another one and then there were three, all at once. I just stood there looking at them. I thought if I got over those I'd be all right but Ã¢â¬ ¦ I didn't dare. Do you know what I kept thinking of? That game you play when you're kids, Giant Step. A voice in my mind was saying, Cora, take one giant step over the live wires in the street. And I was thinking May P May P One of the m was still spitting a few sparks, but the other two looked dead. But you can't tell. The third rail looks dead too. So I stood there, waiting for someone to come and nobody did. The house was still burning and the flames had spread to the lawn and the trees and the hedge beside it. But no fire trucks came. Of course they didn't. The whole west side was burning up by that time. And I felt so faint. And at last I knew it was take the giant step or faint and so I took it, as big a giant step as I could, and the heel of my slipper came down not an inch from the last wire. Then I got over and went around the end of one more wire and then I started to run. And that's all I remember. When morning came I was lying on a blanket in the police station with a lot of other people. Some of them Ã¢â¬â a few-were kids in their prom get-ups and I started to ask them if they had seen Rhonda. And said Ã¢â¬ ¦ they s-s-said Ã¢â¬ ¦ (A short recess) Q. You are personally sure that Carrie White did this? A. Yes. Q. Thank you, Mrs Simard. A. I'd like to ask a question, if you please. Q. Of course. A. What happens if there are others like her? What happens to the world? From The Shadow Exploded (p. 15 1): By 12:45 on the morning of May 28, the situation in Chamberlain was critical. The school had burned itself out on a fairly isolated piece of ground, but the entire downtown area was ablaze. Almost all the city water in that area had been tapped, but enough was available (at low pressure) from Deighan Street water mains to save the business buildings below the intersection of Main and Oak a~. The explosion of Tony's Citgo on upper Summer Street had resulted in a ferocious fire that was not to be controlled until nearly ten o'clock that morning. There was water on Summer Street, there simply were no firemen or fire-fighting equipment to utilize it. Equipment was then on its way from Lewiston, Auburn, Lisbon and Brunswick, but nothing arrived until one o'clock. On Carlin Street, an electrical fire, caused by downed power lines, had begun. It was eventually to gut the entire north side of the street, including the bungalow where Margaret White gave birth to her daughter. On the west end of town, just below what is commonly caned Brickyard Hill, the worst disaster had taken place. The explosion of a gas main and a resulting fire that raged out of control through most of the next day. And if we look at these flash points on a municipal map (see page facing), we can pick out Carrie's route Ã¢â¬â a wandering, looping path of destruction through the town, but one with an almost certain destination: home Ã¢â¬ ¦ Something toppled over in the living room, and Margaret White straightened up, cocking her head to one side. The butcher knife glittered dully in the light of the flames. The electric power had gone off sometime before, and the only fight in the house came from the fire up the street. One of the pictures fell from the wall with a thump. A moment later the Black Forest cuckoo clock fell. The mechanical bird gave a small, strangled squawk and was still. From the town the sirens whooped endlessly, but she could still hear the footsteps when they turned up the walk. The door blew open. Steps in the hall. She heard the plaster plaques in the living room (CHRIST, THE UNSEEN GUEST, WHAT WOULD JESUS DO, THE HOUR DRAWETH NIGH; IF TONIGHT BECAME JUDGMENT, WOULD YOU BE READY) explode one after the other, like plaster birds in a shooting gallery. (o i've been there and seen the harlots shimmy on wooden stages) She sat up on her stool like a very bright scholar who has gone to the head of the class, but her eyes were deranged. The living-room windows blew outward. The kitchen door dammed and Carrie walked in. Her body seemed to have become twisted, shrunken, cronelike. The prom dress was in tatters and flaps, and the pig blood had began to clot and streak. There was a smudge of grease on her forehead and both knees were scraped and raw-looking. Ã¢â¬ËMomma,' she whispered. Her eyes were preternaturally bright, hawklike, but her mouth was trembling. If someone had been them to watch, he would have been struck by the resemblance between them. Margaret White sat on her kitchen stool, the carving knife hidden among the folds of her dress in her lap. Ã¢â¬ËI should have killed myself when he put it in me,' she said clearly. Ã¢â¬ËAfter the first time, before we were married, he promised. Never again. He said we just Ã¢â¬ ¦ slipped. I believed him. I fell down and I lost the baby and that was God's judgment. I felt that the sin had been expiated. By blood. But sin never dies. Sin Ã¢â¬ ¦ never Ã¢â¬ ¦ dies.' Her eyes glittered. Ã¢â¬ËMomma' Ã¢â¬ËAt first it was all right. We lived sinlessly. We slept in the same bed, belly to belly sometimes, and O, I could feel the presence of the Serpent, but we never did until.' She began to grin, and it was a hard, terrible grin. Ã¢â¬ËAnd that night I could see him looking at me That Way. We got down on our knees to pray for strength and heÃ¢â¬ ¦ touched me. In that place. That woman place. And I sent him out of the house. He was gone for hours, and I prayed for him. I could see him in my mind's eye, walking the midnight streets, wrestling with the devil as Jacob wrestled with the Angel of the Lord. And when he came back, my heart was filled with thanksgiving.' She paused, grinning her dry, spitless grin into the shifting shadows of the room. Ã¢â¬ËMomma, I don't want to hear it!' Plates began to explode in the cupboards like clay pigeons. Ã¢â¬ËIt wasn't until he came in that I smelled the whiskey on his breath. And he took me. Took me! With the stink of filthy roadhouse whiskey still on him he took me Ã¢â¬ ¦ and I liked it She screamed out the last words at the ceiling. Ã¢â¬ËI liked it o all that dirty fucking and his hands on me ALL OVER ME!' Ã¢â¬ËMOMMA!' (MOMMA!!) She broke off as if slapped and blinked at her daughter Ã¢â¬ËI almost killed myself,' she said in a more normal tone of voice. Ã¢â¬ËAnd Ralph wept and talked about atonement and I didn't and then he was dead and then I thought God had visited me with cancer; that He was turning my female parts into something as black and rotten as my sinning soul. But that would have been too easy. The Lord works in mysterious ways, His wonders to perform. I see that now. When the pains began I went and got a knife Ã¢â¬â this knife-Ã¢â¬Ë she held it up Ã¢â¬Ë-and waited for you to come so I could make my sacrifice. But I was weak and backsliding. I took this knife in hand again when you were three, and I backslid again. So now the devil has come home.' She held the knife up, and her eyes fastened hypnotically on the glittering hook of its blade. Carrie took a slow, blundering step forward.
Wednesday, January 8, 2020
Nursing Dissertations - Diabetes Mellitus Affects About 2% Of The UK Population - Nursing Dissertations - Free Essay Example
Sample details Pages: 9 Words: 2686 Downloads: 2 Date added: 2017/06/26 Category Statistics Essay Did you like this example? A holistic nurse prescribing: a case study Introduction DonÃ¢â¬â¢t waste time! Our writers will create an original "Nursing Dissertations Diabetes Mellitus Affects About 2% Of The UK Population Nursing Dissertations" essay for you Create order 1 the patient and their presenting symptoms. Mr Pickles presents an interesting, complex and therapeutically challenging problem. In essence he is a gentleman with multisystem pathology who presents with an almost incidental finding which he was clearly reluctant to discuss. It is a common finding amongst experienced healthcare professionals that in any consultation it is the last 30 seconds which is the most important. As the patient stands up to go, there is the just while Im here moment when they can bring up an issue that really troubles them and may not be the real presented reason for the consultation. In this essay we shall discuss the various aspects of this situation and the measures we can take to try to help him. (Parker and Lawton 2003) 2.a holistic assessment of the pt, including any relevant medical social and psychological issues. If we start with the initial presenting symptom under discussion the impotence it is easier to work backwards from that to discuss the possible pathophysiology that can be relevant. Impotence is said to occur whenever the male fails to get an erection when it is required. This, in itself is neither unusual nor necessarily pathological. It becomes a significant symptom when the male repeatedly fails to get an erection that is sufficient for intercourse. It is quite possible to get full spontaneous erections and yet still be impotent. This is one of the major diagnostic features that distinguishes the psychogenic impotence from the purely physical. (Ackerman MD, Carey MP. 1995) There are a number of obvious physical causes of erectile dysfunction that are relevant to Mr Pickles (see on), but equally there are a number of possible psychogenic causes that may be either primary factors or possibly secondary contributory factors in the aetiology of his problems. The fact that he has recently undergone major cardiac surgery is a very relevant factor. Patients will frequently suffer from a major change in body perception when they have come to a close realisation of their own mortality. If we add to this the fact that, as the major breadwinner in the family, it is likely that Mr Pickles would have felt a major blow to his self-esteem when he was made redundant from a responsible high esteem job and forced to become a taxi driver with long working hours. This is quite apart from the anxiety and fatigue that such a job would engender.(Beck J. 1995) It is possible that the medication that Mr Pickles is taking may have a bearing on his erectile dysfunction as the male erection is dependent on the hydrostatic pressure of the blood for its maintenance. Any medication that reduces the average blood pressure, will effectively reduce the capacity to acquire and maintain an erection. In addition to this the adrenergic beta-blocker group will also selectively block the sympathetic pathways that are vital to the neurovascular control of the mechanisms of erection. Pathophysiology of diabetes and impotence Both of these topics are huge subjects, so in this essay we will restrict out considerations to those aspects which are relevant to Mr Pickles and his problems. We know that Diabetes Mellitus affects about 2% of the UK population with a specifically higher incidence in both the Asian and Afro-Caribbean communities(Nathan 1998). There is also a marked genetic component in the development of Diabetes Mellitus. Mr Pickles has Type II diabetes mellitus which is associated with a number of factors including a high BMI and increasing age. At 56 yrs. old he is currently at the peak incidence age for Type II diabetes mellitus (Gregg et al. 2003). Diabetes Mellitus is known to be associated with a number of complications. The prevalence and incidence of the complications, in general, tends to increase with the length of time that the patient has been diabetic. There is also an independent variable for complications that is directly proportional to the degree of control (as measured by the HbA1 levels). In general terms, the better the control the lower the incidence of complications (Kissebah et al. 1999) As far as Mr Pickles is concerned, there are two major complications of Type II diabetes mellitus that are directly linked with impotence and they are cardio-(macro)vascular disease and neuropathy. (Wagner et al. 1998) We can deduce that Mr Pickles has macrovascular disease by virtue of the fact that he his recovering from a CABG. And this may well be a very relevant factor in his erectile dysfunction but also there is the question of neuropathy which typically occurs in about 2.4% of the general population, but this figure rises to above 8% in the diabetic patient over the age of 60 yrs. ( Hughes 2002) Impotence tends to occur, in varying degrees, in about 10-15% of men under 40 yrs. Its incidence increases with age to the extent that 40% of men at the age of 40 yrs report a degree of impotence and this prevalence rises to 70% at the age of 70 yrs. (Gregoire 1999). If we add to this basic clinical picture the fact that there are other factors such as hypertension, smoking, cardiac neurosis, loss of self-confidence, depression and iatrogenic causes (medication etc.) all of which may well be relevant to Mr Pickles, then it can be seen that there are a plethora of potential causes of his erectile dysfunction. (Barnes, DE. 2004) Both of the first two causes (hypertension and smoking) are independent risk factors for impotence, quite apart for the fact that they are also risk factors for the development of the macrovascular complications of Diabetes Mellitus (Bowering 2001) Mr Pickles diabetic state has been recently well controlled (HbA1 of 6.5%). This is important as the incidence of development of diabetic complications is reduced by between 34-76% (depending on the particular study) for every 10% reduction in the average HbA1 reading. (Bowering 2001). In addition to all of these considerations, atherosclerosis is also a major complication of Type II diabetes mellitus, which, presumably is relevant to Mr Pickles because of his CABG, and this may be a major factor in the development of his erectile dysfunction. Management plan 3.a plan/strategy based on critical understanding of physiological and pharmaceutical issues. Any management plan must firstly be based on an accurate diagnosis. At this point in time we do not have this luxury. As we have discussed, there are anyone of a huge number of possibilities in the aetiology of Mr Pickles erectile dysfunction problem. When confronted with a problem such as this, any experienced healthcare professional may reasonably chose to manage the problem by making a rational judgement of the probabilities of any one particular cause being relevant. Implicit in such a management strategy is the fact that there are some causes that my be correctable (iatrogenic, psychological, and life style related) and there are some that may not (macrovascular damage, neuropathy and atherosclerosis). It is reasonable, in such circumstances, to discuss the situation openly with Mr Pickles and discuss with him the various treatment options. Patient empowerment and education is a vital strategy to adopt in circumstances such as this as Mr Pickles is far more likely to comply and respond if he understands the rationale behind the treatment plan.(Howe and Anderson 2003) We would suggest that an appropriate strategy would be to initially tackle the situation on two fronts. The psychological aspects of the erectile dysfunction are probably best discussed with an experienced psychologist or councillor who has expertise in this particular area. This is important because there is a considerable skill in eliciting the relevant factors from the patient. Many patients are reticent about talking openly about their imitate sexual details and there has to be a careful build up of trust and empathy on both sides. Factors such as good eye contact and a non-judgemental body stance are essential on the part of the healthcare professional if the optimal result is to be obtained Not only can the issues that are relevant be explored, but also any one of a number of psychological treatment techniques can be employed. This is a matter of considerable clinical judgement and skill and therefore probably best done by an experienced healthcare professional in that area. The pharmaceutical area can also be addressed as Atenolol is clearly not the best anti hypertensive to use as, not only will it reduce the blood pressure (which it clearly is important to do) but it also produces a counter productive beta-blockade which will not help the erectile dysfunction problem. The difficulty is that, after the CABG, Atenolol does have a degree of action on the suppression of ectopic electrophysiological foci in the myocardium which is a recognised complication of the procedure. It also is thought to have a cardioprotective effect post-myocardial infarction. It is probably a good idea to change his anti-hypertensive medication, but in the circumstances, it is probably better to seek the advice of the surgical team who performed the CABG. before making the transition. The question of Viagra has been raised by Mr Pickles. This is not as straight forward as it might initially appear. Viagra has been shown to work well in these circumstances. It has the downside that it allows sexual intercourse which is associated with increased peaks of blood pressure. As Mr Pickles is still in the postoperative recovery phase (16 weeks) it would again be sensible to consult with the surgical team as to their advice on the issue. The other problem with Viagra is that if it transpires that the long term aetiology is actually psychological rather than purely physical, then the prescription of Viagra will often breed a feeling of psychological dependence which may firstly be both inappropriate and unnecessary and secondly, very hard to break. It is probably therefore inappropriate to consider such options at this stage in the management. 4.legal and professional accountability should be discussed. The legal and professional issues are largely covered in the making of a management plan. In any area of professional competence, the best defence against criticism or censure, is the fact that a healthcare professional works from a rational evidence-based plan. It is for this reason that we have set out the rational and reasoning for the plan that we have chosen to adopt. It is actually quite permissible (legally) for a healthcare professional to be wrong on any given issue, as long as they have come to a reasoned and rational decision based on the facts that were placed before them. And behaved in a way that the majority of their professional colleagues believe is reasonable in the circumstances. It is, of course, central to these considerations, that all actions are carefully and fully recorded in the patients notes Prescribing decisions 5.a critical discussion of influences on prescribing decisions. The area of prescribing for Mr Pickles is clearly important. To some extent, we have covered the reasoning behind the change of prescription earlier in this essay. There is a common misconception amongst many members of the public (and indeed many of the less experienced healthcare professionals) that the solution to every problem comes in the form of tablets on a prescription. The whole area of patient empowerment and education is often filled with issues of lifestyle change, healthy living, self care and positive thinking which can frequently be more effective that simply giving the patient a prescription. (Boule NG et al. 2001) In the context of the NHS, it is a common observation that sometimes a prescription is given because it is the most expedient short-term measure in a given situation, (Dawes RM et al. 1974), however, time invested in an explanation to a patient as to why other measures might be equally as important is rarely time wasted., (Corrigan B. 1974) Future management 6.consider your future prescribing activity based on experience gained from this case study. In any professional area of activity, the author likes to use the mechanism of reflective practice to allow a critical assessment of a past course of action to modify future actions when faced with a similar situation. (Gibbs, G 1988) On careful reflection of this case, I believe that I may have acted rather rashly in stopping the Atenolol as a first choice. On reflection, I believe that the Atenolol did need to be changed for any one of a number of other anti-hypertensive agents but I feel that, in retrospect, I would have been wiser to take advice from the surgical team before I made that decision. Further reflection and discussion with other healthcare professionals (Marks-Moran Rose 1996), suggested that another appropriate course of action would have been to stop the antihypertensive medication altogether for a short period. This is on the grounds that his hypertension was not severe and was hitherto well controlled. If the erectile dysfunction was simply a reflection of the fact that the medication was holding his blood pressure down to a level where erection could not easily occur, a few days off the medication may allow a transient increase in his blood pressure to the point that erection could occur. As long as one was careful to monitor his blood pressure to ensure that it did not rise too far, I have been advised that this would represent a reasonable therapeutic trial to establish whether the underlying causes were mainly physical or physiological.(Wagner G et al 1998). On the face of it, this does seem reasonable but I believe that I would have to take further advice before I was fully comfortable with that decision. It follows from what has already been discussed, that I also feel that I may have been too quick to consider the pharmacological interventions before making a complete holistic assessment of the patient. There are clearly a number of lifestyle adjustments that may be relevant here such as weight loss and increasing exercise and looking for a new focus in life (to minimise any element of depression) which would be comparatively easy to achieve with appropriate empowerment and education of the patient. (Funnell R et al 2004) All in all, this is not a straight forward case. There are many elements which require careful and considered assessment. I believe that it is one of those cases that helps to point out that although there is a huge emphasis to be placed on modern scientific understanding and application of medical principles, there is also a very large element of human understanding and caring that is so very important to the successful management of patients such as Mr Pickles (Waterlow J. 1998) References Ackerman MD, Carey MP. 1995 Psychologys role in the assessment of erectile dysfunction: historical precedents, current knowledge and methods. J Consult Clin Psychol 1995; 63: 862-87 Barnes, Darryl E. 2004 Action Plan for Diabetes Copyright 2004 ISBN: 0736054596 Pub. Human Kinetics Illinois USA Beck J. 1995 Hypoactive sexual desire disorder: an overview. J Consult Clin Psychol 1995; 63: 915-927. Boule NG, Haddad E, Kenny GP, et al. 2001 Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001;286:1218-27 Bowering (2001) Diabetic foot ulcers. Pathophysiology, assessment, and therapy. Can Fam Physician. 2001 May;47:1007-16. Dawes RM, Corrigan B. 1974 Linear models in decision making. Psychol Bull 1974;81:95-106. Funnell, and Robert M. Anderson, (2004) Empowerment and Self-Management of Diabetes Clinical Diabetes 22:123-127, 2004 Gibbs, G (1988) Learning by doing: A guide to Teaching and Learning methods EMU Oxford Brookes University, Oxford. 1988 Gregg, R. B. Gerzoff, C. J. Caspersen, D. F. Williamson, and K. M. V. Narayan (2003) Relationship of Walking to Mortality Among US Adults With Diabetes Archives of Internal Medicine, June 23, 2003; 163(12): 1440 1447. Gregoire 1999 ABC of sexual health: Assessing and managing male sexual problems BMJ, January 30, 1999; 318(7179): 315 317. Howe and Anderson 2003 Involving patients in medical education BMJ, Aug 2003; 327: 326 328. Hughes RAC. 2002 Regular review: Peripheral neuropathy BMJ, Feb 2002; 324: 466 469. Kissebah AH, Freedman DS, Peiris AN. 1999 Health risks of obesity. Med Clin North Am 1999; 73: 111-138 Marks-Moran Rose 1996 Reconstructing Nursing: Beyond Art and Science London: Balliere Tindall October, 1996 Nathan D. (1998) Some answers, more controversy, from UKPDS. Lancet 1998; 352: 832-833. Parker and Lawton 2003 Psychological contribution to the understanding of adverse events in health care Qual. Saf. Health Care, Dec 2003; 12: 453 457. Wagner G, Seanz de Tejada I. 1998 Update on male erectile dysfunction. BMJ 1998; 316: 678-682 Waterlow J. (1998) Prevention is better than cure. Nurs Times 1988; 84: 69-70 Appendix