Sonny's blues( The story) Essay Example | Topics and Well Written Essays - 500 words

Sonny's blues( The story) - Essay Example is darkness through differentiating himself from black people who did not make it out of their miserable lives, but after the death of his loved ones and Sonny’s release from prison, he embraces his darkness through the music that binds the fears, disillusions, and dreams of his fellow black brethren. Before his mother’s death, the narrator has attained his own whiteness, where he rejects the reality of his blackness. When he gets married, he focuses on his family and raising his children. He does not even visit his mother anymore, and he has lost contact with his brother. In a sense, he has left his darkness behind. Being less dark, in other words, being whiter is critical for him because he does not want to be like any other black man. When he reads about his brother being jailed in the papers for drugs, he does not want to accept the truth e: â€Å"I didnt want to believe that Id ever see my brother going down, coming to nothing, all that light in his face gone out, in the condition Id already seen so many others† (Baldwin par. 6). By saying â€Å"others,† he spaces himself from these people. They are not him, and he is not part of them. But after the deaths of his mother and young daughter, the narrator reaches out to his brother, as he becomes more conscious of how his race impacts his social class and identity. His mother knows this, especially after what happened to her husband’s brother. She asks for her eldest to take care of Sonny: â€Å"It aint only the bad ones, nor yet the dumb ones that gets sucked under† (Baldwin par. 98). She is too painfully aware that being black in itself can push anyone to inner darkness, a darkness that is so deep and entangling that not many can escape it. When the narrator’s daughter died of polio, he realizes that pain intersects them all: â€Å"My trouble made his real† (Baldwin par. 183). From here on, he began piecing his brother together like a puzzle, which helped him understand his own identity too. The narrator

Q and Answers Essay Example | Topics and Well Written Essays - 1250 words

Q and Answers - Essay Example Answer: There is a release of stress hormones within the body when a person in under stress. These include cortisol and catecholamines. These hormones are mobilizers of glucose. Under stress the glucose is released and this leads to insulin release. The insulin causes the glucose to move inside cells because of the increased levels of hormone. This can lead to hypoglycemia. This is the reason why it is a good idea to have a meal before going to the dentist so that the blood glucose level can be maintained. Answer: During trauma there is damage to the cells of the body. The energy requirement of the body increases. This increase is due to many reasons. The cell turnover rate increases hence there is increased requirement for proteins for making new cells as well as the energy requirement increases because of the additional energy required. This leads to a depletion of the body energy stores. Glycogen stored in the liver is utilized first. Gluconeogenesis also ensues to overcome the energy requirement. Hence the lipids and proteins of the body are also utilized. This accounts for the weight loss seen in trauma. Answer: Diet is very important in people who are recovering from illness. This is because during illness there is breakdown of cells in the body. When a person is recovering there is greater cell differentiation of cells and utilization of not only proteins, carbohydrates, lipids but also vitamins and minerals which are required by the body. If the diet of these patients is not monitored they can suffer from deficiency conditions of these essential nutrients. This can also compromise the immunity of the patient hence making him susceptible to infections. Therefore the diet of convalescent patients is important. Answer: Exercise is important in weight loss programs because during exercise the body utilizes initially the carbohydrate stores of the body for energy and then it also starts using the

Literature Review of biopsychosocial model of back pain

Literature Review of biopsychosocial model of back pain The bio psychosocial model is now widely accepted for the diagnosis and the management of multifaceted nature of pain. The bio psychosocial model of pain presents an integrated view of biological, psychological and socio cultural factors, which could occur in pain (Jull and Sterling 2009). Seventy-five percentages of individuals in the western world during their lifetime affected with acute or chronic low back pain, which leads to major cause of disability (Kirk et al.2005). Low back pain must be considered as a bio-psycho-social syndrome that consequently requires a multidisciplinary bio-psycho-social treatment approach. (Negrini et al .2008, p.55). The result of a dynamic interaction between psychological, social and patho- physiological factors of chronic pain makes difficulty for the individual patient to determine the pre-eminent factor in his experience of chronic pain, which emphases the importance of bio-psycho-social treatment approach (Kirk et al. 2005). European guidelines also recommend the bio-psycho-social treatment approach for the treatment of chronic low back pain (Balague et al .2007). 1.1 Rationale behind investigating this topic. In clinical area of practice, low back pain is a common health problem for both healthcare professionals and patients, which reflect the thought to find out the role of bio psychosocial perspective in assessment, diagnosis and treatment of chronic low back pain. This would lead us to better understanding of low back pain and pain in general. The aim of this assignment is to critically evaluate the available evidence regarding biopsychosocial model in relation to chronic low back pain. It will also reflect on clinical practice, taking into account the principles of evidence based practice. 2.0Literature review A literature search was carried out using the Science direct, Pub Med, Medline, Ovid, Cochrane and Google Scholar was undertaken for relevant studies in the last 5years and then extended into 10 years .the initial search did not yield enough evidence for assignment aim. The keyword search included :bio psychosocial approach, chronic low back pain, psychosocial factors, mood disorders and combination of key word also used. The search was limited to studies published in English and conducted in human beings. The strength of evidence was established using the Sacketsc hierarchy of evidence (1997) (Please see appendix 1). Each of the papers were analysed for validity and rigour according to the framework given by (Rees 1997, cited in Taylor 2009). (Please see appendix 2). Case history to relate to bio psychosocial model into clinical practise. Mrs smith 35 year old mother of one child, a health professional has been suffering from chronic back pain since 2006 to2008, who feels so depressed as she has some family problems (son was sick with heart problem) and problems with her manager at work (never agreeing with shift adaptation to look after the child). She went to see her GP and complete medical assessment was negative, started on analgesics .The conflict existed, which lead her into severe depression. In 2009 she went see a psychotherapist. The manger agreed with her job flexibility to look after the child, by the time childs condition improved lead her to less frequent and less intense episodes of pain. Like many other patients the patient had never considered the possibility of psychological or social factors for two years, which could contribute to her chronic pain. Mrs smith she was told by psychotherapist that any biological reason together with psychosocial concerns can exacerbate the experience of pain and she realized the contributing psychosocial factors to her pain gradually. As she was a health care professional she started to use coping mechanism effectively with the help of psychotherapist, which helped her to control her stress with subsequent less intense episodes of pain. In the light of the above case, one of the reasons that her medical treatment had failed to respond is because of the underlying psychosocial factors have been left un-addressed. The health care professionals should understand and exploit the bio psychosocial approach to the management of chronic pain will provide effective treatment modality for patients. The bio psychosocial model relates to chronic low back pain: Evidence from studies A systematic review of randomised controlled trials conducted by George (2008) ,to evaluate the effectiveness bio psychosocial approach for the management of chronic back pain .The study also aimed to evaluate the role of individual physiotherapist in bio psychosocial approach for treating for chronic back pain The result of the review was supporting bio psychosocial approach .The sample studies were 9 randomised control studies, where individual physiotherapist has major role in intervention. George (2008,p.4) The result demonstrated significance p The NNT odds ratio reported also showed clinical significance for the result. Compared results of different studies established generalisability and consistency (lack of heterogeneity) of study findings. The included studies were experimental studies and systematic review of experimental studies where intervention provided by individual physiotherapist with minimal support from other health professionals. These studies were concentrated only to chronic back pain treated with psychosocial interventions in adults. The inclusion criteria for selected studies for the review was specific to question set for review, which contributed to get a reliable and accurate result from the review. The selected studies were scoring high to moderate quality on PEDro(physiotherapy evidence data base) appraisal tool, which can provide quality data to support the validity of the result. The interventions carried out in these studies differ from basic physical therapy treatment, which highlights importance of the capability of individual physiotherapist. The generalisability of these finding needs to consider as all care settings does not have trained physiotherapist who can provide interventions to achieve bio psychosocial approach in chronic back pain management. The search strategy identified 99 potential sample studies and the final sample was only 9 randomised control studies after filtration through the inclusion criteria. There is potential chance of bias through objectivity as because there is chance for choice of articles to support the authors viewpoint. . The review gives the strong evidence for the bio psychosocial approach for the management of chronic back pain. The similarity or homogeneity of studies involve d in this review broadening the applicability of bio psychosocial approach by an individual physiotherapist who has appropriate knowledge and capability to carry out the interventions The study reported that individual physiotherapist who manages the bio psychosocial approach for the treatment of chronic back pain is effective as multidisciplinary management of chronic back pain .As it sounds cost effective and may more feasible for patient because of one to one interaction further research must be essential the to promote individual physiotherapy approach. .Waxman et al. (2008) conducted an observational study to examine the impact of psychosocial factors in chronic back pain patients and their relationship satisfaction. The observed sample included was24 men and 30women(N=54) with chronic low back pain who were married or cohabitating and were recruited through chronic pain clinic. The finding from the study reported that depression and negative partner response have significant impact on relationship satisfaction among chronic back pain patients. Table:2 Standardized regression (Path) Coefficients of mediational models with psychosocial variables as mediators of pain and relationship for total sample (Waxman et al. 2008,p.438) The total effect of pain on relationship satisfaction was significant,B=-.32p The association between pain and depression was significant=.63p Indirect effect of pain on relationship satisfaction through depression was significant =-.21,p The relation between pain and negative responses was significant=.38,p The indirect effect of pain on relationship satisfaction through negative response was significant indirect effect =-.20p From this significant evidence reveals that negative response by partner is also a mediator of pain and relationship satisfaction The study reported significant evidence to reveal the relation between various components in bio psychosocial model which include pain(bio),relationship satisfaction(social) depression(psycho) perceived negative response(psychosocial) . (SeeApeedix:5) Reflecting the study back to the case of Mrs smith Its not clear about her partners involvement in her treatment, but she was showing signs and symptoms of depression which might contributed to the chronic nature of pain. The study result underscores the importance of partner involvement in patients pain assessment and treatment the study. In clinical practise there is a need to promote education programme for partners of patients with chronic back pain as part of treatment plan to achieve bio psychosocial approach. When reflecting this finding to clinical practise which explain the reason why the widow or patients who lives alone are more vulnerable candidates for the chronic nature of the pain. These finding consistent with previous following study results .Future research need to consider to compare self reported data from both patients and partners to know the response and behaviours that related to pain. The ethical consideration was done on study as the study was approved by the local IRB, and written consent was obtain from patients as a proof or willingness also promotes the strength of the study. The reliable tools used for data collection was rigor to the study. The recruitment method for sample selection was based on self selection which can contribute to selection bias, which can affect the rigor of the study. The patients who has greater pain and psychological symptoms may not take initiative to participate in the study. The results in this study were based on self-reported outcomes from the questionnaires that were sent to the patients, which makes the data subjective and are most likely to be true and contribute to the rigor of the study, can promote the rigor of the study. The study also reported that the approximate time for completion of questionnaires was 45 minutes. The reliability of data can affect because of length of time especially these patient who are with pain and psychological symptoms. The study is ranked as class 3c on the hierarchy of evidence considering the design and methods employed in the study. The evidence reaffirms the bio psychosocial model for assessment and treatment of chronic back pain. Tang et al. (2008) conducted an experimental study to examine effects of mood on pain responses and pain tolerance in chronic back pain patients. The recruited sample was 55 patients suffering from chronic back pain aged between18-65.The patients were randomly allocated into three groups ,depressed group:18,neutral group19 elated group:18.The the participants were asked to perform a baseline task (reading magazine) to establish a baseline for mood and pain ratings. An artificial mood was induced to participants (musical mood induction)and followed by pain provoking task(holding a heavy bag) to assess the pain rating and tolerance. The study result proved that the participants with depressive mood showed high pain ratings and lower pain tolerance at rest, but happy mood induction resulted in lower pain ratings and higher pain tolerance. The table:3 shows that depressive mood positively correlated with increase in pain ratings(Tang et al. 2008,p.399) The participants were manipulated to examine the effect of artificially induced mood on artificially induced pain which may affects the reliability result when it apply into real mood and pain of chronic back pain patients. Even though researcher adapted a pre-determined mood change criteria to judge the effectiveness of mood on the participants during the study. This can contributed to rigour to study and it can promotes the reliability of the result. The sample population was aged between 18-65,tolerence of induced mood and pain may not be same between these age groups .The difference in sex also can affect the mood and pain tolerance. The Researcher failed to mention about the method of randomisation to overcome confounding factors. Blinding not performed and can affects the performance bias The study design was experimental designwhich comes under level 1a in hierarchy. This study also proved that music therapy is effective to improve pain and pain tolerance in chronic back pain patients. It agrees with (Guetin 2005),music therapy is a effective complementary treatment in chronic back pain associated anxiety-depression and behavioural consequences. Future research needs to consider for evaluating the effectiveness music therapy as part of multidisciplinary rehabilitation. Bio psychosocial approach for assessment helps to identify the matching treatment for patients based on their characteristics and refine the focus of treatments and achieve effective outcome. Even though there are weaknesses for this study it proved that mood can influence the pain. The result is consistent with Waxman et al.(2008 ) discussed in previous study. These studies highlights the importance of cognitive behavioural therapy in bio psychosocial rehabilitation for chronic back pain patients NICE(2009). Mitchell et al. (2009) conducted a cross sectional study to evaluate the role of personal bio psychosocial factors on low back pain, in nursing students. The results proved that modifiable life style, psychological, physical factors were relates to low back pain in nursing students. One hundred and seventy undergraduate nursing students from two university nursing schools of western Australia were enrolled for this study. The study compared three groups of students (no LBP group, mild LBP group significant LBP group) and reported that students with significant low back pain were more physically active compared to no low back pain group group. The DASS total score and stress subscale score were higher in significant low back pain group compared to NO LBP group .The study also reported that social measures did not influence their pain intensity. The study result mentioned that the social measures including household income and smoking did not affect the significant low back pain patients. This cannot be generalized into general population types, as it conducted on healthy university sample may not be much influenced by social factors. There are contrasting findings which mention the relation between low back pain and social measures(Shiri et al.2009) Study gives the evidence for sufficient statistical power and ethical consideration. The researcher used triangulation in data collection, which overcome the limitations of a single method of collecting data and hence increased the validity of the results. The results of this study were based on self-reported (questionnaire) outcomes that were collected from patients. It can contribute to validity of the results, because they are more subjective and most likely true. The inclusion criteria on sample selection was appropriate to focus bio psychosocial approach in chronic back pain patients, as the criteria excluded patients with inflammatory disorders ,neurological or metastasis disease, pregnancy or less than 6 months postpartum. The study was conducted as cross sectional study which classified in to class 3c on level of evidence.,and researcher failed to include other factors like fear avoidance and genetic factors. This study was carried out in the Australia and their socio cultural factors and life style may differ from United Kingdom , decreasing the accuracy of reproducing these results to UK practice.Even though study result is consistent with other studies conduced in united kingdom . In the area of practice physical and psychosocial factors has important role on experiencing low back pain among healthcare professionals and potential candidates, which reflects the necessity of education related to stress management such as relaxation techniques and meditation and mandatory manual handling training. Job stress and fear related to pain are mediators to inability to return to work Gheldof et al.(2005) The high prevalence rate of low back pain highlights the importance of targeting prevention interventions among healthcare professionals and patients. The case study of patient discussed has not had much benefit from the conventional treatment pattern and showed clear evidence of personnel and psychological factors that can contribute to pain. The understanding of bio psychosocial factors helps to find out cause diagnosis treatment and prevention of chronic back pain Suprina (2003) conducted a case study to discuss the efficacy of bio psychosocial model. The sample for this study was a 32-year-old woman who suffers from chronic back pain for almost ten years and study reported that bio psychosocial model helps the women for successful reduction of symptoms. This study also proves that single practitioner can plan bio psychosocial model for the treatment of chronic back pain. The researcher reports that the treatment can be more effective when implementing one person integration model than multidisciplinary approach as it has easy access to patient also saves money and time. This study classified under level 3d as this is a study of only one individual. There is chance of performance bias as the subject blinding done in this study . Even though it is individual case study it agrees with widely accepted bio psychosocial model. The study reveals that all health professional should consider individual patient as one with complex behaviours and emotions and not just organism with physiological changes .The researcher who conducted this st udy in United states is supporting the one-person integration model, practicability of this one- person integration model in United kingdoms clinical practise is questionable because the way of clinical practise may vary in different countries. The current trouble within heath care system in European countries is relegate mainly to biomedical perspective and not considering psychosocial aspects because of time constrict and inadequate training. Mauksch (2005) compared the current state of bio psychosocial approach to a dormant seed, which is sitting on the shelf, which need to be watered with bio psychosocial education by health care professionals and placed in an environment fertile with bio psychosocial practise. The knowledge about bio psychosocial approach helps healthcare professionals for better assessment and treatment of patients, which also agrees with case study discussed. Currie and Wang (2004) examined prevalence and correlation between major depression and chronic back pain. The data collected from 118,533 household residents from Canadian community health survey .The study result showed that low back pain is significant factor as a predictor for major depression (Fig:1). Individuals with severe pain intensity represented highest risk of major depression(odds ratio,1.61;95%confidence interval L:1.34-1.97;p Fig1:Prevalence of major depression(MD)in persons with chronic back pain stratified by pain severity . Currie and Wang (2004,p.55) The study also proved that individuals with chronic back pain and major depression were younger and they were more likely to be single and younger. The personal factors play an important role for contribution to low back pain which agrees with Mitchell et al. (2009). The episode of depression were measured by WHOS fully structured diagnostic interview, Composite International Diagnostic Interview -Short Form for depression. Which produce internal validity to the study.(scott et.al.(2000), The study mentioned that this is the largest sample size(118,533 residents)ever used in population -based study of chronic pain and depression. This sample size from national population health survey gives power to the study and promotes the reliability and generalisability of the results. The sample included in the study was aged from 12 years .As age, gender and cultural factors have an influence on level of perceived pain and influence of depression,these are important factors to consider to avoid selection bias and to make the study rigorous. The researcher used multi staged stratified random sampling procedure in the study would have added rigor to the study. The population for this study was from Canadian community health survey. As we discussed cultural factors and personal factors has influence in experiencing pain and depression in individual, reflection of the results into United Kingdom population may be not accurate. Even though study result is consistent with other studies conduced in United Kingdom The study was conducted as cross sectional study which classified in to class 3c on level of evidence Mrs smith case report also illustrates signs and symptoms of depression, which could contribute to her chronic back pain. She was lacking multidisciplinary  Ã‚   bio psychosocial rehabilitation in her treatment. Multidisciplinary  Ã‚   bio psychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain(Lang et al.2003,P.270), (Demoulin et al.2010). Woby et al.(2007)aimed a study to determine the relation between cognitive factors and level of pain and disability in chronic back pain and reports that pain intensity and disability strongly related to cognitive factors . The sample selected for the study was 183 C L B P(chronic low back pain) patients with onset of back pain>3 months who had been referred to an physiotherapy rehabilitation programme which underpinned by cognitive-behavioural principles and revealed that higher levels of functional self -efficacy (b=0.40;p The researcher used triangulation in data collection, which overcome the limitations of a single method of collecting data and hence increased the validity of the results. As all data collected by self reported measures the validity of data can be affected by social desirability .The selection bias in sample selection needs to be considered because patients selected for study was from rehabilitation programme, who had been referred to cognitive behavioural based intervention. It indicates that sample may be already affected with psychosocial factors, which can affect the validity of the result. The results suggest that psychosocial factors should consider as integral facet for treatments for chronic low back pain. The cause of chronic pain in case Mrs smith should have been identified by the team involved in her care than trying to alleviate her suffering through the conventional treatment like pain killers.  The pathway in fig:2 explaining Mrs smith painful experience, disability and its recovery, which also agrees with the Woby et al.(2007)study results. Mauksch (2005) reported that average visiting length between physician and patient is highly stressed for 15 minutes in primary care system in European countries, which may possibly happened with Mrs smith case, which emphasis the need of the adequate structured training to all healthcare professionals to practise bio psychosocial model with in limited time. Fig2: Revised fear-avoidance model incorporating the mediational role of functional self-efficacy (Woby et al.2007,p.716). The health care professionals should understand that the psychosocial factors are very important prognostic factors in the prediction of chronic pain and disability. 2.3 Bio psychosocial model can promote patient satisfaction -evidence from study Margalit et al.(2004) conducted a experimental study to find out the effect of bio psychosocial approach for patient satisfaction in their care. The study confirms that bio psychosocial model approach can reduce the heath care expenditures and can promote patients satisfaction.( Table:2,appendix:6). The study sample was 44 general practitioners randomly selected from 523 practitioners who works with North Israel district. Again researcher used randomisation to allocate teaching methods, which gives rigour to the study. In this study he compared pre teaching effect and post teaching effect of two teaching interventions with two groups of general practitioners. The first method (didactic) consisted with reading assignments and lectures. The second method consist (interactive) consisted with role-play and group discussions. The result reported that the interactive teaching method elicited higher patient satisfaction. Finestone et al. (2008) included a set of suggestion for physician to introduce bio psychosocial model in his study. Fig:4(Appendix:3). There are limitations to this study. The method of randomisation is not mentioned on this study. The researcher highlighted the reasons for dropouts of patients from study but not mentioned anything about intention to treat analysis. Even though recruited sample were consented, the researcher did not request approval from institutional review board. There is chance of bias through hawthrown effect because subjects known that they are video taping for the study. It is worth mentioning that the study is conducted in Israel and application of the results to UK clinical practise needs to consider as their teaching method may differ. This study highlights the importance of interactive assessment to achieve bio psychosocial model treatment. Future researches are needed to support this study result and apply to UK clinical practise. 3.0 Conclusion: The systematic review conducted by George (2008) reported after that bio psychosocial approach for assessment and treatment of chronic back pain can make the successful reduction of symptoms . This study result also agrees with Suprina (2003) and Margalit et al.(2004) which reported that the approach can reduce the health care expenditures and can promote patients satisfaction .these studied also proved that single trained practitioner can achieve bio psychosocial model for the assessment and treatment of chronic back pain. Tang et al. (2008) , Currie and Wang (2004) and Waxman et al .(2008)also reported the same fact which explains the relation between depression and pain intensity. Depression can significantly leads to higher pain ratings and higher pain ratings can also leads to severe depression. The studies also proved that psychosocial factors like fear avoidance behaviour, stress ,negative responses by a partner and cognitive factors are contributing to chronic back pain. The cross sectional study conducted by Mitchell et al.(2008) reported that modifiable personal factors like lifestyle,physical sctvity can contribute to low back pain. After extrapolating the results and considering the nature of the studies, the findings suggest that bio psychosocial factors have important contribution to low back pain. One of these factors could trigger the other and vice versa. In practice, it is difficult, rather impossible, to dissociate one factor from the other, which emphases the importance of bio-psycho-social treatment approach. References . . . Balaguà ©, F., Mannion, A., Pellisà © , F. and Cedraschi, C. 2007 Clinical update: low back pain. The Lancet, 369(9563), pp.726-728. Breen, A., Austin, H., Campion-Smith, C., Carr, E. and Mann, E. 2007 You feel so hopeless: A qualitative study of GP management of acute back pain. European Journal of Pain, 11(1), pp.21-29. Currie, S. and Wrang, J. (2004) Chronic back pain and major depression in the general Canadian population. Pain, 107(1), pp.54-60. Demoulin, C., Grosdent, S., Capron, L., Tomasella, M., Somville, P., Crielaard, J. M. and Vanderthommen, M. (2010) Effectiveness of a semi-intensive multidisciplinary outpatient rehabilitation program in chronic low back pain. Joint Bone Spine, 77(1), pp.58-63 Egwu, M. and Nwuga, V. (2008) Relationship between low back pain and life-stressing events among Nigerian and Caucasian patients. Physiotherapy, 94(2), pp.678-688. Finestone, H., Alfeeli , A. and Fisher, W. (2008) Stress-induceed physiologic changes as a basis for the Bio psychosocial model of chronic musculokeletal pain. Clinical Journal of pain, 24(9), pp.767-775. Guà ©tin, S., Portet , F., Picot , M. C., Pommià ©, C., Messaoudi, M., Djabelkir, L., Olsen , A. L., Cano , M. M., Lecourt, E. and Touchon, J. (2009) Effect of music therapy among hospitalized patients with chronic low back pain: a controlled, randomized trial. Ann Phys Rehabil Med, 53(1), pp.3-14. Gheldof, E., Vinck, J., Vlaeyen, J., Hidding, A. and Crombez, G. (2005) The differential role of pain, work characteristics and pain-related fear in explaining back pain and sick leave in occupational settings. Pain, 113(1,2), pp.71-81. Johnston , V., Jimmieson , N., Jull, G. and Souvlis, Tina . (2009) Contribution of individual, workplace, psychosocial ;and physiological factors to neck pain in female office workers. European Journal of Pain, 13(9), pp.985-991. Jull, G. and Sterling, M. (2009) Bring back biopsychosocial model for neck pain disorders. Manual therapy, 14(2), pp.117-118. Kirka, L., Underwoodb, M., Chappellc, L., Martins-Mendezd, M. and Thomas , P. (2005) The effect of osteopathy in the treatment of chronic low back pain-a feasibility study. International journal of osteopathic medicine, 8(1), pp.5-11. Lang, E., Liebig, K., Kastner, S., Neundà ¶rfer, B., Heuschmann, P. and (2003) Multidisciplinary rehabilitation versus usual care for chronic low back pain in the community: effects on quality of life. The Spine Journal, 3(4), pp.270-276. Margalit, A. P. A., Glick, S. M., Benbassat, Jochanan and Cohen, A. (2004) Effect of a bio psychosocial approach on patient satisfaction and patterns of care. Journal of general internal medicine, 19(5), pp.485-491. Mauksch.Larry (2005) But first,training in biopsychosocial care :A Commentary on The Bio psychosocial Model Is Shrink Wrapped ,on the Shelf, Ready to be used ,but waiting for a new process of care. Families Systems, Health, 23(4), pp.448-449. Mitchell, T., Osullivan, P., Smith, A., Burnett, A., Straker, L., Thornton, J. and Rudd, C. (2009) Bio psychosocial factors are associated with low back pain in female nursing students: A cross-sectional study. International Journal of Nursing Studies, 46(5), pp.678-688. Negrini, S., Fusco, C., Atanasio, S., Romano , M. and Zaina , F. (2008) Low back pain :State of art. European journal of pain supplements, 2(1), pp.52-56. NICE. (2009)

Historical Misconceptions About Abraham Lincoln and John F. Kennedy :: American America History

All Presidents have faced the challenge of keeping people united in times of conflict and turmoil; this specifically applied to Presidents Abraham Lincoln and John F. Kennedy. They were faced with solving delicate situations involving segregation and the civil rights of American citizens in two different centuries. While there has been the enduring impression that both presidents held high ideals with regard to the African American population, a closer examination of history could lead one to believe that Lincoln was the false freer of the enslaved and Kennedy was the false figurehead for the Civil Rights movement. Abraham Lincoln entered his first term as president following the leaders Franklin Pierce and James Buchanan. Pierce was known as "an outspoken critic of federal involvement in state and locale issues" (http://www.npr.org). His veto of a bill which would have provided services and support for the mentally handicapped "established the rationale behind government uninvolvement in public health issues into the twentieth century" (http://www.npr.org). This climate of governmental uninvolvement persisted into the term of James Buchanan, a time well-known for the Dred Scott decision, which stated that "congress had no constitutional power to deprive persons of their property rights in slaves in the territories" (http://www.whitehouse.gov). Later, Buchanan "reverted to a policy of inactivity that continued until he left office" (http://www.whitehouse.gov). Therefore, upon entering office, Lincoln found the stage set for an uphill climb with a sharply divided country and a government unused to active leadership by a president whose main agenda was to unite the country, even if this meant an involvement in previously "untouchable" states rights. The issue of slavery was at the center of the controversies, and decisions in the previous two administrations only compounded the difficulties encountered in any actions that Lincoln might make. The issue of segregation continued even up to one hundred years later when Kennedy became president following Harry S. Truman and Dwight D. Eisenhower. However, unlike Pierce and Buchanan, the decisions and actions of both of these presidents should have made any stand that Kennedy would take for the civil rights movement easier. After World War Two had ended, Truman proposed twenty-one main policy points for the betterment of America in an attempt to calm the unrest among the American workers, as this was a time of many labor strikes and problems involving citizens who were unsatisfied with the economy. These twenty-one points included innovations such as minimum wage, guaranteed employment, medical insurance, housing aid, improving benefits for war veterans, and price and wage controls. Historical Misconceptions About Abraham Lincoln and John F. Kennedy :: American America History All Presidents have faced the challenge of keeping people united in times of conflict and turmoil; this specifically applied to Presidents Abraham Lincoln and John F. Kennedy. They were faced with solving delicate situations involving segregation and the civil rights of American citizens in two different centuries. While there has been the enduring impression that both presidents held high ideals with regard to the African American population, a closer examination of history could lead one to believe that Lincoln was the false freer of the enslaved and Kennedy was the false figurehead for the Civil Rights movement. Abraham Lincoln entered his first term as president following the leaders Franklin Pierce and James Buchanan. Pierce was known as "an outspoken critic of federal involvement in state and locale issues" (http://www.npr.org). His veto of a bill which would have provided services and support for the mentally handicapped "established the rationale behind government uninvolvement in public health issues into the twentieth century" (http://www.npr.org). This climate of governmental uninvolvement persisted into the term of James Buchanan, a time well-known for the Dred Scott decision, which stated that "congress had no constitutional power to deprive persons of their property rights in slaves in the territories" (http://www.whitehouse.gov). Later, Buchanan "reverted to a policy of inactivity that continued until he left office" (http://www.whitehouse.gov). Therefore, upon entering office, Lincoln found the stage set for an uphill climb with a sharply divided country and a government unused to active leadership by a president whose main agenda was to unite the country, even if this meant an involvement in previously "untouchable" states rights. The issue of slavery was at the center of the controversies, and decisions in the previous two administrations only compounded the difficulties encountered in any actions that Lincoln might make. The issue of segregation continued even up to one hundred years later when Kennedy became president following Harry S. Truman and Dwight D. Eisenhower. However, unlike Pierce and Buchanan, the decisions and actions of both of these presidents should have made any stand that Kennedy would take for the civil rights movement easier. After World War Two had ended, Truman proposed twenty-one main policy points for the betterment of America in an attempt to calm the unrest among the American workers, as this was a time of many labor strikes and problems involving citizens who were unsatisfied with the economy. These twenty-one points included innovations such as minimum wage, guaranteed employment, medical insurance, housing aid, improving benefits for war veterans, and price and wage controls.

High School vs. College Essay

I think a good education is an important part of one’s life. To achieve a good education, one should attend both High School and College. The transition from High School to College is a step that a student will either adjust to or struggle with. Although, some people think High School has a lot in common with college, I find they have a few differences. There are also certain similarities as well, by which, one won’t feel as if College is a new world. The more prepared a person is to face the differences and similarities, the more successful they might be. High School and College are both educational grounds for a student to grow with knowledge. A student graduates from High School and again from College with a degree. Both places are full of experiences and filled with numerous memories. The government runs them. They both play an important role in making a person into a collected individual and a member of a society. High School students know that there are differences between High School and College, but sometimes what they think is not how it is. To begin with there are many ways in which the attitudes of the teachers in High School differ from the attitudes of the teachers in College. In High School, my teachers seemed to be stricter and have more rules for the students to follow. There was an everyday time schedule for each student to go by. Students go through drama in High School which some cannot get out of. Attendance is very important in High School as well as in College. Many teachers enforce it while others do not. I have noticed that it is the student’s responsibility to come to class. They believe that the students should be mature enough to make their own decision on whether to attend class or not and leave it to them to make that decision. When a student graduates from High School, a sense of maturity comes in them. They start realizing that everything in High School was materialistic, and College is practical. College is different than High School just by the personal freedoms, the classroom and the social life. In College, no one would be concerned about the basic everyday drama that would surround a student in High School. College prepares a student to face the real world, and how to handle it. It separates the mature people from the immature people. However, a person who wants to attend College has to pay to further her education. If a student doesn’t take College seriously and apply herself, she knows she wasted her hard earned money, or her parents. So, since students must pay to get into College, she works and studies harder than she did in High School. Therefore, she will study those required courses and finish her education with a degree and start a career. I don’t think I would ever want to go back to High School. I love College and all the freedom that comes with it. All there is in College is education. Now I am learning to be a better person and to improve and to learn different study habits. High School is only the first step into growing up and preparing you for College, whereas, College is preparing you for your career.

Influence to the Indian populace Essay

His influence to the Indian populace was so great that when he met an accident while filming the movie, Coolie, the whole nation prayed for his recovery. There was also a great number of Indians who donated blood for the actor. During the taping for the movie, Bachchan wanted a scene to be realistic so he suggested how the punch should be undertaken unfortunately, the acting got so intense that he ended up in pain. For several days, the doctors cannot find the source of Bachchan’s hurt, until one day, a doctor was able to detect a dark spot on his intestine. The dark spot was his undigested when the punch in his abdomen was made. After seventy-two hours of pain, the undigested food could have turned into poison (Mishra 142-143). His intestine was also ruptured as a result of his fall on the steel table after the punch administered by the stuntman (Chopra n. pag. ) The doctors opted for an immediate operation, however, while he was in the operating table, he lost signs of life. He was declared clinically dead until his wife, Jaya shouted that he saw him move his toe. After this remarkable statement of his wife, the doctors were able to revive him (Mishra 142-143). Throughout the period that he was in the hospital, his supporters speculated that the punch that he received was real and intentional—that it was meant to hurt him. However, no proof was established to back up the claim. After the recovery, Bachchan continued filming the movie to where he left off. He also thanked those who offered prayers for his recovery and the support that the entire nation devoted to him. To date, he is the only movie actor who received such sympathy. People from all walks of life showed all the support they can give and it was as if life in India stopped for Bachchan. Life only returned to its normal shape when it was declared that he is already safe (Mishra 142-143) Aside from acting, Bachchan also tried his luck in politics after he was swayed by his friend Rajiv Gandhi, whose mother was assassinated and won by sympathy vote. Bachchan was elected to a Parliamentary seat, however, this prestigious position did not prove beneficial to him as his name was included to a political controversy. Bachchan, his brother and Rajiv were accused with bribery. It was rumored that the Boffors company bribed Indian politicians to ensure that the government will buy tanks and other military equipment from them (Mishra 144). This hullabaloo seriously injured the name that Bachchan was able to established through time so he decided to quit politics two years after he first explored it. After his flop in the field of politics, Bachchan returned to his first love—film making. Bachchan is well loved by the Indians and his acting widely accepted, however, these love and acceptance were not enough to keep his star shining after the political controversy he faced. Mishra, however, points out that his breakdown in politics is not the direct cause of his collapse as a star. Just like the period when he started his sensational career as an actor, the people then were looking for variety, for something new to watch, the Indians also felt this way at some point when Bachchan was the king of the charts. The people were worn-out with the constant revenge and anger theme in his movies and were looking for something new—for a new approach in movies. This was the time when the need to revive Romanticism was felt. The revival of romance in the films brought back the idea of a character and once again motivation replaced generic predictability, something which Bachchan turned his back on (Mishra 138). For Bombay cinema to survive, the romantic twist had to return. And so, as Bachchan’s star waned, romance returned (Mishra 138). After his political stint and cinema flops, Bachchan shifted his attention to a new venture. He created a multi-faceted commercial enterprise known as the Amitabh Bachchan Corporation Limited or ABCL. The company delved in production and distribution of films and other ventures that involved the movie industry. For sometime, the company enjoyed success in producing movies and even catered the Miss World pageant in India in 1996. However, in its latter years, it faced so many debts that it reached bankruptcy (Indiaoye). His failure both in the political and business worlds, prompted him to go back to where he established his name—the entertainment industry. At 55, he filmed his comeback movie, Mrityutada. It was not as successful as his previous movies but it was enough to sustain him in the entertainment field. Two years after his comeback film, he was named in a BBC poll as the Superstar of the Millennium. This title placed him in equal footing with Sir Lawrence Olivier, Charlie Chaplin and Marlon Brando. Aside from this, he is also the first Asian actor to be included in Madame Tassaud’s wax museum (hindi lyrix n. pag. ). According to Mishra, Bachchan’s success in his career is not only because of his talent in acting but also because of his skill in building his image outside the theater houses. The author suggests three stages in the life of Bachchan that moulded his image as an actor. First is his relationship with his leading ladies, particularly Rekha. Rekha, the daughter of the Hindi actor Ganeshan, is a tall and good looking woman who exhibited real acting talent. She was one of the few actors then who brought â€Å"real sense of character to the films†. She was suspected by journalists to have established a romantic relation with Bachchan and this suspected relationship was â€Å"extensively documented in the fanzines†. Mishra suggests that this added to the growth of the â€Å"quietly sanctioned counternarrative† by the actor himself. However, Bachchan imposed censorship when journalists began to pester him (Mishra 140). The affair of Rekha and Bachchan was better revealed in the movie Silsila (Continuity, 1981). In this movie the actors showed what they could not reveal in real life—depicting the love triangle that exists between Jaya, the wife; Bachchan, the husband; and Rekha, the mistress (Mishra 141).

Great Recession How It Can Be Avoided

Great Recession How It Can Be Avoided The great economic recession is a period marked by persistent decline in the economic growth of different countries across the globe with the Gross Domestic Product (GDP) contracting within a period that is not less than six months. The 2008-2010 great recession affected the global economy and it arose from the developed economies in the world.Advertising We will write a custom essay sample on Great Recession: How It Can Be Avoided specifically for you for only $16.05 $11/page Learn More This period is marked by high levels of unemployment, decline in retail sales, real income, GDP, slow growth for businesses, and stagnant wages (Altig Fitzgerald and Rupert 66). When there is high unemployment rate, housing prices decline because of the inability of consumers to meet their obligations. A normal recession does not last longer than a year but the great recession does, and it is milder than an economic depression. Due to its effects, it is necessary to avoid th e great recession at all costs through various measures as discussed in this paper. An economic recession can be avoided through various measures undertaken by the government given the causes of the recession. To begin with, the central bank or the Federal Reserve should increase the level of liquidity in the economy by pursuing expansionary monetary policies. This involves increased supply of cash in the economy through overnight market operations and reduced interest rates. A recession is caused by reduced level of consumption in the economy. Therefore, an increase in the supply of liquidity will increase the purchasing power of consumers thereby stimulating the level of production in the economy. This will reduce unemployment while increasing output and economic growth. The recession can also be avoided by pursuing an expansionary fiscal policy such as increased government expenditures in various sectors of the economy. Such type of a policy would see the government reduce the le vel of unemployment while increasing the purchasing power of the public. This will stimulate the level of productivity while leading to economic growth and ending the recession. In addition to increased spending, the government can end the recession through bailout of bankrupt institutions especially the financial institutions that do not have enough credit for lending out to borrowers.Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More The economy can avoid the great recession through adjusting the bank interest rates according to the projected economic situation. High bank interest rates discourage investors from borrowing and hence the money circulation in the economy decreases. By reducing interest rates, banks will increase the rate of borrowing and investments since more investors will borrow more funds. This will also encourage payment of bank loans. The government should set an interest ceiling and floor to be applied by commercial banks. This will bring an end to the recession experienced within an economy gradually. An economy should maintain equilibrium in the balance of payment (BOP), which is the graph showing the trade between a country and the other countries across the globe. To avoid the recession, exports should balance with the imports or even exceed the imports. When imports are in excess, it means that imports are cheaper than the domestic products hence there is excess demand and flow of foreign currency causing economic imbalance in the country. This leads to unemployment because the products produced by the domestic companies face a low local demand as compared to imports (Tcherneva 120). Therefore, increased imports could end the recession since the high level of exports increases production, reduces unemployment and promotes economic growth. Altig, David, Terry, Fitzgerald and Rupert, Peter. Okun’s law revisited: should we worr y about low unemployment? Economic Commentary. Cleveland: Federal Reserve Bank of Cleveland, 1997. Print. Lee, Jim. The Robustness of Okun’s Law: Evidence from OECD Countries. Journal of Macroeconomics 22.2 (2000): 331–356. Print. Tcherneva, Pavlina. Permanent on-the-spot job creation- the missing Keynes Plan for full employment and economic transformation. Review of Social Economics, forthcoming 2.1 (2011): 112-127. Print.Advertising We will write a custom essay sample on Great Recession: How It Can Be Avoided specifically for you for only $16.05 $11/page Learn More