Communication in Nursing Essay

Since the dawn of time man has been evolving in the ways we think and interact with each other. What was appropriate a generation ago might not be appropriate today. As nurses we know very intimate details of our patients’ lives, those details can blur the line between a friendly relationship and a professional relationship. Even though you feel you know the patient like you know your best friend you still have to treat them with the utmost respect, and dignity. Social communication is something we do on a daily basis whether it is with a patient or acquaintance, we refer to it as small talk. In contrast Therapeutic communication skills are very specific and goal oriented, they aren’t skills one is born with, these skills take time to perfect and build on. What is communication? The Townsend text defines it as â€Å"an interactive process of transmitting information between two or more entities†. In any communication there are â€Å"preexisting conditions† that affect the intended message and the way it is received, some examples include values, attitudes, beliefs, social status and environment in which the communication takes places (Townsend, 2010). A large part of communication is nonverbal communication, how you present yourself and your body language goes a long way in getting your point across. 70-90 percent of all effective communication is nonverbal (Townsend, 2010). A nurse-patient relationship can have multiple types of communication including non-therapeutic, social, and therapeutic. If a nurse errs and uses non-therapeutic communication such as rejecting, giving reassurance, or probing, negative outcomes occur. Non-therapeutic techniques discourage further expression of feelings and ideas and provoke negative responses or behaviors in others (Potter, Perry, Stockert & Hall, 2009) On the other hand therapeutic communication techniques such as; using silence, accepting and offering self, encourage feelings and ideas and convey acceptance and respect (Potter, Perry, Stockert & Hall, 2009). Social communication can be used as small talk on a limited basis. To understand social communication and therapeutic communication we must first define both. social communication can be defined as everyday communication that occurs as the nurse greets the patient and passes the time of day with what is referred to as small talk (Shives, 2008) saying things like â€Å"how is your day? † or â€Å"how are you pets? † are basic statements that aren’t goal specific. Social communication can elicit a negative response from the patient, if that occurs the nurse would â€Å"shift gears† and start a conversation using therapeutic communication techniques. An example would be: Nurse: â€Å"Hey how are you doing? The weather outside is beautiful today† Patient: â€Å"I don’t care about the weather, I hate it here, I don’t belong here, and I want to go home now! † To remedy this, the next sentence the nurse could use is: Nurse: â€Å"Oh, I see, what would u like to talk about today? † That statement gives the patient a broad opening which â€Å"allows the patient to take initiative in introducing the topic and it emphasizes the importance of the client’s role in the interaction† (Townsend, 2010) Therapeutic communication on the other hand is defined as a process in which the nurse consciously influences a patient or helps the patient to a better understanding through verbal or nonverbal communication. Therapeutic communication involves the use of specific strategies that encourage the patient to express feelings and ideas and that convey acceptance and respect (Mosby 2009). In the text Basic concepts of psychiatric-mental health nursing the author uses a very helpful table to compare and contrast therapeutic and social communication, some examples given are: * In social communication a personal or intimate relationship occurs and the identification of needs may not occur. Whereas in therapeutic communication a personal but not intimate relationship occurs. Needs are identified by the patient with the help of the nurse if necessary. * Personal goals may or may not be discussed and constructive or destructive dependencies may occur, in contrast to therapeutic communication where personal goals are set by the patient and constructive dependency, interdependency, and independence are promoted. * In social communication a variety of resources may be used during socialization, but in therapeutic communication specialized professional skills are used while employing nursing interventions. In conclusion we see that communication in nursing is being developed as an entirely separate skill, as profession nurses we have the responsibility to ourselves and our patients to understand what is being said and to get the point across in a precise and efficient manner. By comparing and contrasting the two communication styles we see they are vastly different. When using social communication the nurse wouldn’t be unprofessional, but it is up to the nurse to determine the correct time, place, and situation for which each style is appropriate.

Organizational Focus and Goals Essay

Every organization has a specific set of goals and a differing focus. The only real commonality between them is, and they all strive for success. The focus of an organization will change depending on the needs of the organization and goals are set to attain the focus. Organizational Focus Currently, my organization is focused on doubling our company size in the next five years, growth. We are the second largest manufacturer of our product in the United States. Our overarching goal is to be the number one supplier. My organization understands to achieve this goal, our productivity and profitability depend on making sure all of our employees perform up to their full potential. â€Å"Goal setting is one of the primary tools used by organizations to assist in setting a direction and achieving it.† (Cothran & Wysocki, 2015, para. 1). My organization has set forth many goals some small and some large to obtain. Each goal is a milestone and a stepping stone toward our overarching goal of being number one. Training Needs Training is a central focus right now in my organization. With the size of the company expanding, so does every aspect of it. What this means is that software, tasks, functions, production, processes, and many other areas are all changing. These are just a few to illuminate the need for training. As the organization experiences growth, training is needed to prepare employees to harness the growth that is change. Seasoned employees will need trained in the new software, processes, and even new job duties. Training will keep the wheel of business turning and moving forward to reach the overarching goal, to be number one in the industry. Besides existing employees needing training, with the company expanding its size, this means a lot of new hires will be funneling into all the departments to fill the needs of the organization. These new employees will also need training; however, they will also need to learn the organizational norms, trends, rules, and code of conduct. The new hires will play a vital role in propelling us into the future and meeting our ultimate (overarching) goal. Prioritizing Training The goals set forth by my organization are packaged together to allow for training prior to moving forward. As an example, we rolled out a new software program to meet our needs. This program will take over the current one and move us into position to better keep up with finances as we double our size. The training for the new software was rolled out two months prior to the actual software. The priority of training is relevant to what package is being rolled out. Organizational goals and current focus will significantly impact what training is needed and when it is needed. Specific Training Needs What my organization is doing in regards to prioritizing training is working great. I would not change anything. Prior to something new being rolled out, ample time is given for training. Each new package released has specific training methods attached to bring seasoned employees up to date and introduce new hires. Conclusion The overarching goal is the ultimate goal or where the company wants to be. Training employees according to the ultimate goal will ensure that the workforce is being properly trained to achieve it. If an organization does not keep the overarching goal in mind while prioritizing training, there could be a lapse in training. What this means is that the employees and organizational goals will meet at a crossroads, and the employees will not be prepared. The failure in training will ultimately prevent the organization from reaching the overarching goal. References Blanchard, P.N., & Thacker, J.W. (2007). Employee training and development (3rd Ed.). Retrieved from The University of Phoenix eBook Collection database. Cothran, H.M., & Wysocki, A.F. (2015). Developing Smart Goals for Your Organization. University of Florida IFAS Extension. Retrieved from http://edis.ifas.ufl.edu/fe577 Noe, R.A. (2008). Employee training and development (4th Ed.). Retrieved from The University of Phoenix eBook Collection database.

Analysis Of Sherry Turkle s The Flight From Conversation Essay

Turkle lacks any success in her rhetorical appeal to ethos and does nothing to gain the trust of her audience without citing her quotes or properly identify herself as an expert in the field of social media and human interaction. The audience without her identify herself as an expert doesn’t know whether or not to trust what she is saying or if it is just a paper full of emotion with no proof. Not properly identifying how she is related to the subject matter anywhere in the paper makes the audience feel misguided by any information given which leads to mistrust her as a reliable source of information. This mistrust leads the audience to turn away from Turkle and not to believe her throughout the remainder of the article. She attempts to show that she has done some research by saying â€Å"during the years I have spent researching people and their relationships with technology†¦ listening to me† (Turkle). Turkle wants the audience to trust her that she has done her research, and therefor is an expert in this subject matter and throughout the article is t... ... middle of paper ... ...ticle in The New York Times â€Å"The Flight From Conversation†, she unsuccessfully argues that society needs to drop the habit of using social media as an out for face to face conversation, through her emotionally charged pathos that disrupts her from making valuable arguments that turn into a rant filled paper and the lack of properly assuring the audience that she is an expert in the field of human interactions. Though I do believe that more and more people have relied on technology for interaction with their peers, I don’t believe it has become an epidemic as describe in Turkle’s paper. Social media allows us to be able to connect with each other all around the country and is an effective means of quick communication. People still bond with each other and build meaningful relationships that are not just reliant on a piece of technology like describe so in the article.

Toyota Motor Corporation Essay Example | Topics and Well Written Essays - 1750 words

Toyota Motor Corporation - Essay Example GM is recognized as the largest vehicle manufacturer selling 8.5 billion cars in 2001 while its sales in 2002 accounts for 15% of the trucks and vehicles sold globally (Yahoo Finance 2006). Traditionally, GM's approach in marketing its products is targeting a specific market segment for a specific brand so that the company's products do not compete with each other. These was profitable for the automotive firm as the brand's shared components and common corporate management gave way to a substantial economies of scale while the distinctions between the brands created an "orderly upgrade path." Before 1995, the company has a full range of products ranging from Chevrolet which is offered to an entry level buyer who is more concerned on a more practical and economical vehicle to the upscale Cadillac which is targeted to the elite market as it is regarded as the "standard of luxury (General Motors 2006)." Nevertheless, this strategy did not persist as the GM started to implement a gradual blurring of its divisions during 1995. This strategy leads to cannibalization in the market share of GM as each division competes with each other (General Motors 2006). During 2004, the company has announced a new strategy for its product lines which is apart from the traditional marketing and positioning it employs. This shift in brand strategy is targeted in "building sales, cutting costs, and bolstering brand identity (Garsten 2005)." For Chevrolet and Cadillac, GM is planning to maintain its present strategy of making them high volume brands that offers vehicle in every major segment by having a broad product line up. Buick, Pontiac and GMC will be combined into a single sales channel which offers trucks, premium and near-luxury vehicles and performance models. In addition, these product lines will be trimmed as GM plans to drop some models in this category. Saab is seen to offer exclusive European styled and engineered sedans, crossover and SUV models. HUMMER will continue to manufacture exclusive, premium SUVs and trucks. Lastly, Saturn will be upgraded as this division will offer more upscale models which are styled and engineered to European standards. This product line will be slotted between Chevrolet and Buick (Garsten 2005). Complementing these marketing strategies are three global technology strategies: offering technology which has a real impact and is valued by customer; technology which meets basic objectives of cutting costs to offer competitive prices; and sustainable technology which improves vehicle emissions and fuel economy (GM Global Technology Strategy 2004). Armed with these strategies, GM is geared to conquer the global market in the next decade. External Factors Currently, General Motors Corporation (GM) leads the automotive industry with total revenue of US$192.60 billion during 2005. This is amidst the US$2.6 billion loses incurred during the same year which is due to the weak demand in the North America. Following GM is Ford Motor Corporation (US$178.10 billion), Daimler Chrysler AG (US$177.37billion), and Toyota Motor Corporation (US$162.92 billion). Even though smaller in terms of revenue, it is notable that Toyota recorded the largest net income at US$10.61 billion during 2005 (Yahoo Finance 2006). It is apparent that there is an intense competition between the four largest players

Compare and contrast the total GDP of the Arab world Essay

Compare and contrast the total GDP of the Arab world - Essay Example In the case of France, the country’s GDP ($2.734 trillion) alone is greater than the combined GDP of Arab League members. In 2011, Germany’s GDP was estimated to be $3.55 trillion, which is $1.24 trillion greater than the total GDP of Arab League members. The Arab League members’ combined GDP is nearly half the GDP of Japan ($5.773 trillion) alone in the same year. It is interesting to note that Japan achieved this status despite the massive Tsunami attack on March 2011. Finally, the United States’ GDP is 6 times greater than the total GDP of Arab League members in 2011. According to CIA World Factbook, total GDP of the occupied Palestine was estimated to be $6.641 billion in 2011. As compared to the GDP of Israel ($239.8 billion) in the same year, it seems that the combined GDP of Arab League members represents only 2.77% of the Israel GDP. From the above compare and contrast analysis, it is clear that the combined GDP of 22 Arab League members is less than the GDP of economically developed countries like United States, Japan, Germany, and France. It must be noted that this combined GDP would be smaller if members like Saudi Arabia, UAE, and Egypt are taken away from the list. Countries like US, Japan, and Germany contribute to global economy far better than Arab League members do combinedly. As stated in the Arab League Investment and Business Giude despite the enormous oil and natural gas reserves, the Arab League’s economy greatly struggles to stabilize the region’s growth; and tourism sector is appeared to be one of the fastest growing industries in this area (14). Experts suggest that Arab League members have adequate key resources to enhance their GDP growth rate over the next decades. Finally, the GDP of the occupied Palestine (Gaza Strip and West Bank) constitutes only a small percent of the GDP o f the

Consultancy Report Dissertation Example | Topics and Well Written Essays - 7500 words

Consultancy Report - Dissertation Example The report gives a brief analysis of the industrial scenario within which the firm has been operating and commercial activities carried out by the firm. For resolving the problem few quantitative and qualitative measures had been undertaken. Critical evaluation has also been from different point of view and a potential course of action in a balanced and rational measure has also been suggested. The company has been established in the year 1991 and since then it had been successfully providing the catering and support services to different sectors of industries like hospitals, schools, institute, corporate, government institutes, ministries etc. Their operation presently spreads over fifty locations in all over Oman. Support services undertaken by the company accounts for services like Laundry, cleaning etc and it deals with both the government and the private sectors. Apart from this they also undertake outdoor catering services for marriage and other functions. The company affairs a re managed by a group of qualified and experience management team. They take care of all the needs of the customers by sticking a proper balance of the art of cuisine as per the taste and preferences of the particular customer. For any function they operate from their central kitchen situated at Ghala. Introduction With Oman exhausting oil wealth resources, the role of the food and catering industry had gained its significance with time with a view of sustaining the country’s economy. The food and the catering industries were of insignificant importance when the company started but now with the growing demands and with government initiatives the industry contributes well toward the GDP of the country. The government helped majorly to get a foothold of such industry in the country’s economy. The initiative was taken in 1997 by awarding the trainees of the catering and the food industry with government certified certificates for getting trained for the industry professio nals of different hotels. In this regard the paper would analyze the problems and opportunities faced by Al Althnian Company LLC in Oman (Omaninfo, n.d.). Company Details: General Background and Industry Analysis: With the growing need Al Athnian Company LLC have entered into the trading business of the food stuffs along with the catering operation. For that they import material from different countries and supply them to the corporate and ministries. The company exerts a profound importance over the in the personal safety and health of each of its employees and the society from broader aspect. They also give importance in the environmental protection through their operations. The company maintains a safe and hygienic work environment to meet the requirement of healthy food and safety management system. The company follows a strict grading system for the staff’s welfare. They exert a profound importance over the training of their employees so that they could relate accurately to the needs of the target population and the community. This reflects the mission and philosophy of the company. The company has been segregated into different departments facilitating its smooth functioning. The departments are the operation department, personnel department, finance department, cleaning department, procurement department, logistics department, HSE department and the marketing department. Prerequisites programs are also carried out by the company which is considered as the backbone of the

Financial modeling Essay Example | Topics and Well Written Essays - 1750 words

Financial modeling - Essay Example But this is not to say that financial modeling cannot be performed manually.There are various financial models that a company can use in evaluating its investment projects. The only challenge for the company is to identify the model that will provide the most accurate information that can help the company make the right decision.With the advent of technology and computer, many models nowadays are calculated and evaluated using computer software which makes the whole process easy and faster. It is a fact that in a competitive world, companies should be able to make fast, timely and accurate investment decisions. But this is not to say that financial modeling cannot be performed manually.There are various financial models that a company can use in evaluating its investment projects. The only challenge for the company is to identify the model that will provide the most accurate information that can help the company make the right decision.Some of there models include Value- at- risk mod els, Interest rate models, Equity pricing models, Asset allocation models, Trading models, Investment portfolio models that can be used on equity or derivatives, Business simulation models that include Monte Carlo simulation and binary free and genetic algorithms used in optimization decisions.This is a model of calculating the probability of a collection of investment securities generating returns more than the anticipated. It is a model of analyzing past market performance, security correlation and the security movements. A basic value-at-risk model involves all types of market uncertainties e.g. interest, stock, goods and currency risks. It enables the determination of an estimate on the value of portfolio risk (maximum loss) based on the past performance of the portfolio at a given rate of certainty. The various models under the value-at-risk include the variance-covariance method, historical simulation and Monte Carlo simulation models. Variance-covariance It uses past values of security movements and relationship to determine the estimate of the future loses that could occur. Security movements and security relationship risk is calculated for a given period of time. Historical simulation models It generates a lot of results of the security value. It uses security risk and their associated probabilities to generate these results which are used to estimate the value of VaR. Interest rate models Some of the most commonly used interest rate financial models are the Black-Derman-Toy (BDT) model, Black -Karainsky (BK) model, Heath- Jarrow-Morton (HJM) model and the White-Hull model, Black-Derman-Toy Interest Rate Model It is mainly used for determining the value of derivatives by considering a preliminary zero rate term structure and the movement of the yield by constructing a tree explaining the interest rates. This model can also be a single-factor or multi-factor. The Heath-Jarrow-Morton model It uses statistical data and processes to derive the value of the derivatives by considering preliminary zero rate term structure and the up and down movement of future rates. Hull-white model It is a single factor that uses the preliminary term structure of interest rates with the up and down movement term structure to construct a trinomial free of short rates. Equity pricing models One of the widely used equity pricing model is the Capital Assets Pricing Model developed by William Sharpe and John Litner. It works on the premise that the return of a given security is affected by the risk called systematic. This risk is measured using beta () and it cannot be diversified away by holding a portfolio of securities. This model evolved from the portfolio theory which did not

Answer this question in 2 pages Essay Example | Topics and Well Written Essays - 500 words

Answer this question in 2 pages - Essay Example The further ability of the legal system to attempt to correct inequalities and illegalities that are exhibited within such a system are also severely constrained; as ultimately it is the employer that holds all the power to dismiss and fire an employee based on no reason given. Interestingly, there has been a great deal of study into the impacts of the â€Å"at-will† doctrine on the firing process and how this negatively or positively promotes the interests of the organization. However, there has been relatively little research done as to how this impacts upon the employee and whether or not they choose a specific company or region in which to work. Ultimately, it is the view of this student that the â€Å"at-will† doctrine, in application, provides for a decreased sense of employee security; and likely encourages them to look for other more secure opportunities elsewhere. Has this doctrine been eroded over the last 30 years or so years and if so, what has caused the erosion? The doctrine has ultimately been a road partially abuse is so here’s the reason for this has to do with the litigation and societal understanding that individual employers are attempting to game to sit benefiting from it. However, as more and more stringent legal controls have been established and the â€Å"at will† doctrine has been adopted by more and more states, the ultimate situation which is been affected is one in which the utility options available. Essentially, business has attempted to move towards states that represent the â€Å"at– will† doctrine; in the hopes that this will be able to maximize the overall level of profitability and success that they might otherwise achieved elsewhere. As a result of this dynamic shift, firms are of course interested in seeking to promote profitability; leveraging loopholes in the legal framework and interpretation of employment law as a means of promoting their own interest. Necessarily illegal or wrong, it h as had a

RP2 Essay Example | Topics and Well Written Essays - 250 words

RP2 - Essay Example ed all of his living expenses for his time in Delaware, California and Michigan totaling 30 months, claiming all the expenses for food, rent and transportation were temporary living expenses while he was away from homes. Issues or tax questions: Abdul would like to claim a deduction for his temporary living expenses while he was away from home but IRS examined Abduls returns and challenged the deduction for temporary living expenses. Rationale: Temporary living expenses including travel expenses incurred during temporary work assignment or extended business trip that was intended to last for one year or less (J.k 88). Temporary living expense includes meals, local transportation and hotel accommodation or apartment rent for longer stays. Meals may be estimated using federal per diem rates. On tax return temporary living expenses are deducted as unreimbursed employee business expenses. Authority: IRS periodical 54, page 12, travel expenses are in Form 2106-EZ or Form 2106, allowable unreimbursed expenses are in the 2106-EZ Form or Form 2106 to Form 1040, Schedule A and are subject to a maximum based on 2% of calculated Gross

Final - Project and Program Risk Management Essay Example for Free

Final Project and Program Risk Management Essay This type of management may take on an informal or formal approach, but risk management is essential for every project. Risk Management is not a well accepted standard practice since it points out negative aspects of projects, and there are numerous inhibitions that restrain the dynamics of risk management. According to the Wikipedia, a free web-based encyclopedia, the Project Management Institute (PMI) is a non-profit professional organization with the purpose of advancing the state-of-the-art of project management. The company is a professional association for the project management profession. The PMI sets standards, conducts research, and provides education and professional exchange opportunities designed to strengthen and further establish professionalism. The Project Management Institute, Inc. (PMI() has established a six-step set of processes and practices for the risk management process as documented below: 1. Risk Management Planning: project risk infrastructure is established and a project-specific risk management plan is generated. 2. Risk Identification: events with potentially positive and negative impacts are clearly described. 3. Risk Qualifications: risks are evaluated according to nonnumeric assessment protocols. 4. Risk Quantifications: risks are evaluated according to numeric assessment protocols. 5. Risk Response Planning: strategies to deal with or precluded risks are evaluated and communicated. 6. Risk Monitoring and control: risk management and response plans are put into action. b) Why do professionals mandate Risk Management? Professionals mandate Risk Management in organizations since risk sometimes becomes a secondary issue. This secondary issue occurs since the hope that Project Managers will be able to handle issues and problems as they occur. Since risk remains a secondary issue until an organization’s luck runs out or a profitable opportunity is missed, professionals take a more proactive approach to risk identification and mitigation by applying Risk Management Process and Practices. Based on statistical information, unfavorable risk events eventually occur in good projects without a way to identify and mitigate risk. The Project Manager suffers the repercussions of such type of failure; therefore, professionals mandate Risk Management and support its practices in effort to mitigate risk. . Explain the Delphi Technique and steps for effective application. a) Explain the Delphi Technique. When expert interview techniques are not an option, the Delphi Technique provides an alternate means for extracting information from subject matter experts (SMEs) without pressuring or forcing them to provide much needed information. Many SMEs prefer not to participate in data-gathering processes; therefore, the project manager ( facilitator) applies the Delphi technique to collect information directly from the SMEs without infringing on their schedules. This technique allows the facilitator with directed follow-up capability from experts after peers have been consulted so the highest quality of information is extracted from the experts. b) Steps for Effective Application. To obtain effective information from the Delphi Technique, the Project Manager must posses the ability to generate the original questions to present to the experts and to clarify the information from the experts as it is received. The following six (6) major steps will increase the chances of a successful technique application: 1) Identify experts and ensure their participation 2) Create the Delphi instrument 3) Have the experts respond on the instrument 4) Review and restate the responses 5) Gather the experts’ opinions and repeat 6) Distribute and apply the data The Delphi technique is a time-consuming process, but this technique is promising in extracting information from experts who might not otherwise contribute to a project’s body of knowledge. 3. Explain the Crawford Slip Method (CSM). The Crawford Slip Method (CSM) is a classic tool used to combat the negativism inherent in team members while attempting to identify risk and risk information-gathering for a particular product or process. CSM offers a variety of advantages over other information-gathering techniques, in particular, the ability to aggregate large volumes of information in a very short time period and the complete avoidance of groupthink. CSM is not the hardest risk management technique to apply when properly facilitated. A clearly established question is defined by the facilitator and provided to all qualified participants. The participants then document their response to the clearly established question on a slip of paper. Providing the same clearly established question to the participants again, they document their response to the question on a slip of paper again. This process is repeated ten (10) times using the same clearly established question to better extract all of the unknown information available from the participants involved in the product or process. The initial slips of paper are usually very similar in content; however, as the process repeats itself, the later slips of paper tend to generate identification of issues and risks that could have been overlooked without repetition. The strength of Crawford Slip Method is efficiency. 4. Define SWOT Analysis and their selection criteria. a) Define SWOT Analysis. Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis Technique is a directed risk analysis that identifies risks and opportunities within a higher-level organizational context rather than a project’s narrow vacuum.

Management of Childhood Psoriasis with Acitretin

Management of Childhood Psoriasis with Acitretin Abstract: Psoriasis is a chronic inflammatory disease of the skin which can occur at any age-group. Psoriasis in childhood is not uncommon and has genetic susceptibility but usually an environmental trigger such as infection is thought to initiate the disease process. Childhood psoriasis has profound effects on both physical and psychosocial health of the patient. Treatment of mild psoriasis can be done with topical therapies but those which do not respond to topical therapies can be treated with phototherapy and systemic therapies. The use of systemic therapies in childhood is mainly based on the published data, case series, expert opinion and the experience as there is lack of controlled trials in the age group. Based on the experience retinoid are probably the second line drugs for the treatment of childhood psoriasis which do not respond to topical therapies and phototherapy. Using acitretin in a low dose and with proper physical examinations and laboratory investigations will reduce the h azard of potential serious adverse events. This article gives the review of use of acitretin in the childhood psoriasis. INTRODUCTION: Psoriasis is the chronic inflammatory disease of the skin having the world wide prevalence of 1-3% and is clinically characterized by erythematous papules and plaques covered with silvery scales(1, 2). Psoriasis can occur at any age. Psoriasis in pediatric population is not uncommon and exerts a major impact on physical and psycho-social health of a child. In about one-third of the psoriatic population, the onset of disease is seen during the pediatric age(3). In a study of 419 patients from Northern India, the age of onset of psoriasis ranged from 4 days to 14 years(4). The presence of positive family history was found to be 23% and 34.3% in two different studies(5, 6). Pediatric psoriasis has the genetic susceptibility but the environmental factors often trigger the initiation of the disease process. The most common triggering factors include respiratory infection, sore throat, stress and trauma. There are different variants of psoriasis in children like plaque, guttate, napkin, er ythrodermic, pustular and nail psoriasis(2). Plaque psoriasis is the most common subtype and the pustular psoriasis is the least common subtype(7). Psoriasis in childhood and adolescence require proper management. Both the patient and the parents must be given the knowledge about the disease and its nature. Psoriasis in childhood affects the health-related quality of life. It is found that, the risk of mental illness like depression and anxiety is increased in children with psoriasis than those without psoriasis(8). Due to the presence of visible skin lesions the children with psoriasis suffer from the low self-esteem(9). Fortunately, childhood psoriasis is usually mild and can be treated with topical therapies. Systemic treatment is required only if the disease do-not respond to topical therapies, phototherapy and if the disease is significantly impairing the psychosocial aspect of the child health. Systemic therapies for psoriasis in children are not approved by FDA. Due to the lack of controlled trials use of systemic therapies are based on case reports, published data and expert opinion. On the basis of published data and experience retinoids appear to be the second-line drug of choice for children(10). ACITRETIN: Retinoids encompasses all the compounds either natural or synthetic, which possess the biological activity like vitamin A(11). Synthetic Retinoids are classified into three generations. Acitretin and etretinate are the second generation synthetic retinoids and are also known as aromatic retinoids(12, 13). Acitretin is the free and active metabolite of etretinate. Etretinate is strongly lipophilic and tends to accumulate more in the adipose tissue and thus has a longer elimination half-life, in contrast acitretin is less lipophilic and thus clears rapidly from the body and has the shorter elimination half-life(14).Intake with food increases the absorption of acitretin so, the bioavailability of acitretin is more when taken with food than on the empty stomach(15). Due to the longer elimination half-life of etretinate it has been largely replaced by acitretin. However, it is found that re-esterification of acitretin to etretinate can take place with the concomitant intake of alcohol. So , the female patient especially of childbearing age should be strictly instructed to not take alcohol during the period of treatment with and 2 months after the completion of treatment (16). USE IN PEDIATRIC PSORIASIS: Pediatric psoriasis is usually mild and topical therapies are the first choice of treatment. Systemic therapy is not the first choice in childhood psoriasis. It is used in the treatment of recalcitrant psoriasis which do not respond to topical therapy, phototherapy and if it is significantly impairing the psychosocial aspects of the child health. Due to the lack of controlled trials, the use of acitretin is based on the published data, case reports and the expert opinion. However, the significant risk benefit of the treatment should always be weighed with the risk of disease without treatment. Long term use of acitretin in children with inherited disorder of keratinization supports the safety of acitretin in children, but the monitoring is always required(17). Acitretin is used effectively in the treatment of generalized pustular psoriasis, erythrodermic psoriasis, palmoplantar psoriasis and severe recalcitrant plaque psoriasis but acitretin is not effective in psoriatic arthropathy( 12, 18). Acitretin is used as either monotherapy or in combination with topical agents and narrowband ultraviolet phototherapy. In a multicenter cohort study by Ergun et al. 61 patients among 289 patients were treated with acitretin at a dose of 0.3-0.5 mg/kg/day with the mean duration of treatment being 9.16+-9.06 months. 47.5% of the patient achieved at least PASI- 75 response. 70.7% of the patient well tolerated the treatment with no side effects. 25.9% experienced the mucocutaneous side-effects, 1.7% had hyperlipidemia and 1.7% had nausea(19). In a multicenter retrospective analysis by Lernia et al. including 18 children with plaque psoriasis ,8(44.4%) patient achieved a PASI-response 75 at 16 weeks. The starting dose of acitretin was 0.2-0.5mg/kg/day but the dose was increased to 0.6mg/kg/day in two patients after 8 weeks. Three out of eight patients achieving PASI-75 response stopped therapy for the interval of 2-6 months but had to restart the treatment after relapse and the treatment was effective even after re-introduction. 9 patient discontinued treatment due to lack of efficacy and 1 patient discontinued treatment due to arthralgia. All patients had the mucocutaneous side-effects like chelitis, dry lips, dry mouth and pruritus. The laboratory values of the patients were within the baseline during the treatment(20). Ergin et al. reported a case of infantile pustular psoriasis treated with acitretin with the initial dose of 0.5mg/kg/day which was later increased to 0.7mg/kg/day. The skin lesion was cleared in the end of 4 months and then the acitretin was tapered to 0.3mg/kg/day for three months and then discontinued. Oral prednisolone was used initially then it was tapered and discontinued. Slight increase in serum triglyceride was observed but it returned to normal after the dose was tapered. No other adverse events were observed(21). Salleras et al. reported a case of 4-year-old girl with congenital erythrodermic psoriasis treated with acitretin at a dose of 0.5mg/kg/day and the complete remission achieved in three months. The discontinuation of the drug led to relapse so the patient was maintained in 0.5-0.75mg/kg/day of acitretin during the aggravation of the disease. The patient was followed till 7 years of age and no other secondary effects were observed(22). A case of annular pustular psoriasis in a 14-month old girl reported by Haug et al. was treated with acitretin in the dose of 0.9mg/kg/day and the patient achieved complete remission after 4 months. The dose of acitretin was reduced and tapered at 0.1mg/kg/day and discontinued after 10 months with no relapse in the following three years. The patient experienced mild side effects like chelitis, reversible hypercholesterinemia and elevation of alkaline phosphatase(23). Acitretin is aa excellent option in a child with palmo-plantar psoriasis. A 14-year-old boy with palmo-plantar psoriasis treated with acitretin at a dose of 10mg/day had a good response with improvement within 6 weeks. At 3-month follow-up the patient had almost lesion free. The patient had experienced adverse events like mild chelitis and xerosis but the laboratory values remain unchanged. Later the patient was maintained on acitretin 10mg every other day together with the topical combination of 15% liquor carbonis detergens compounded in triamcinolone 0.1% ointment applied every night(24). Combination with other therapies: Acitretin has been used in combination with NB-UVB phototherapy, methotrexate and cyclosporine A(24, 25). The effect of acitretin together with NB-UVB is found to be synergistic. A case of 3.5-year-old boy with severe pustular psoriasis (von Zumbusch type) reported by kopp et al. was started on acitretin 1mg/kg/day with the short-term use of systemic methylprednisolone for controlling the acute stage. However, any attempt to reduce or discontinue the steroid led to exacerbation of the disease. Then the patient was given NB-UVB phototherapy three times per week. Later, after five exposures the corticosteroid was tapered and discontinued. The patient was then maintained on NB-UVB phototherapy two times weekly together with acitretin 0.3mg/kg/day. Disease was well controlled with this combination regimen. The laboratory values remained unchanged during the acitretin treatment(26). A 9-year-old boy with generalized pustular psoriasis was treated with acitretin 10mg/day and was maintained at 10mg three times week for a year. Later he developed skin pain and localized area of pustules which led to increase in the dose of acitretin 20mg/day during the flare but later tapered to 10mg/day for the next year. But the patient eventually required the addition of NB-UVB phototherapy to maintain the remission. The patient is well maintained by this combination(24). Adverse events of acitretin: Acitretin in known to exert a number of adverse events. Most of the adverse events are dose dependent and reverse back to normal after decreasing the dose or after discontinuation of therapy. However, it is usual to have the minor side-effects on the long term treatment with acitretin. The most common adverse events of acitretin is the muco-cutaneous adverse events. Dry lips being the most common one and be treated with the use of emollients. Others include dry dry mouth, cheilitis, stomatitis and gingivitis and taste disturbances. Acitretin causes dryness with inflammation of mucous membrane and transitional epithelia which occasionally leads to epistaxis, rhinitis, photophobia, conjunctivitis and xeropthalmia. Alopecia, nail-fragility and paronychia have also been observed(27). Rarely patients may have the photosensitivity reactions. Retinoid dermatitis which resembles unstable psoriasis can develop 25% of the patients receiving high dose of acitretin therapy(28). Muco cutaneous side effects can be treated symptomatically, and if severe effects occur the dose reduction can be tried before the discontinuation of the drug. Acitretin causes transient elevation of liver enzymes. The elevation is dose dependent and usually reverse back to normal after reducing the dose or after discontinuation of the therapy. Severe hepatotoxic reactions resulting from retinoids are rare. In a data of 1877 patients receiving oral acitretin only 0.26% of the patients showed overt chemical hepatitis(29). However, the hepato-toxic reactions in children are rare because the cofactors like diabetes, alcoholism, and obesity are less likely in children(12). Acitretin also exerts the effects on lipid profile which is reverse back to normal within 8 weeks after the discontinuation of the drug(30). Retinoids are seen to cause the elevation of triglyceride and cholesterol and decrease in the high density lipoprotein. In a study it is seen that 35% of the patients had the elevation in serum triglyceride above 300mg/dl and about 15% of the patients had the elevation of cholesterol level(31). The decrease in the high density lipoprotein is also observed(29). Retinoids have been known to cause the skeletal abnormalities especially in children. The long term treatment with etretinate is also associated with the extraspinal tendon and the calcification of ligament. However, the study including 19 children and young adults, treated with etretinate for continuous 5 years do not show any skeletal abnormality(32). No cases of diffuse idiopathic skeletal hyperostosis was seen in a retrospective study on long term use of acitretin in a low dose(33). No significant radiologic abnormalities associated with retinoids was detected in a patient of severe pustular psoriasis treated with low dose of acitretin for 9 years(34). It is usually not recommended to use oral retinoids for the treatment of psoriasis in children due to the report of occasional bone changes like premature epiphyseal closure, skeletal hyperostosis and extra-osseous calcification observed in the children on the long term treatment with etretinate(35, 36). If acitretin is to be used in a child, the child should be observed carefully for any abnormalities of growth and bone development. Routine radiography is not recommended because of the radiation hazards, but the atypical musculoskeletal pain must be investigated with x-rays. Growth chart of the child on acitretin should be maintained (27). Arthralgia, arthritis, myalgia may also occur during the treatment with acitretin. A few case of vasculitis, Wegener granulomatosis and erythema nodosum are also observed. Retinoids are teratogenic drugs. The defect due to retinoids is termed as retinoic acid embryopathy. The malformations seen in the fetus include microtia/anotia, micrognathia, cleft-palate, conotruncal heart disease and aortic arch abnormalities, thymic defects, retinal or optic nerve abnormalities and central nervous system malformations(37). Even though only one report of human teratogenicity due to acitretin has been published(27), acitretin should be cautiously used as acitretin is converted to etretinate which has a longer elimination half-life. The female patient of child-bearing should strictly be instructed for the use of two effective contraceptive method stating 1-month prior of treatment, during the period of treatment and 3 years after the discontinuation of treatment(38). However, the risk of teratogenicity by use of acitretin in children is less because of the least chance of a child to get pregnant. The concomitant use of retinoid with tetracycline and minocycline has led to pseudo-tumour cerebri(29). Pseudo-tumor cerebri was reported in a case of 14-year-old boy treated with isotretinoin and tetracycline(39). Retinoids also causes blurring of vision, headache and reduced night vision. Patient with severe headache, vomiting and visual disturbances should stop acitretin immediately and consult the doctor(27). The concomitant use of vitamin A with acitretin must be restricted. MONITORING GUDELINES: Before starting the treatment with acitretin, proper history taking and careful physical examination should be performed. Laboratory investigations including complete blood count, lipid profile, liver enzymes and blood sugar in diabetics should be done. Monitoring of the liver enzymes and fasting serum cholesterol and triglyceride must be done every 2-4 weeks of therapy for the first two months and then every three months(27). Children on acitretin therapy must have their growth charted. Female of child bearing age and their parents should be counselled about the teratogenic effect of the drug and use of contraception during and after the treatment. The pregnancy should be ruled out before the initiation of acitretin therapy with two negative pregnancy tests. CONCLUSION: Acitretin is a non-immunosuppressive drug that can be effective in the treatment of childhood psoriasis. It is seen that acitretin is more effective in pustular and erythrodermic psoriasis and moderately effective in the plaque type psoriasis in children. Acitretin is used both as monotherapy and as combination therapy. As the use of acitretin in children lack sufficient data and evidence, its use in children should always be weighed with risk benefit of treatment and risk if the disease is left untreated. The side effects are mostly dose dependent so it can be minimized by using the lowest possible dose. The dose of 0.5-1mg/kg/day was seen to be effective. It should be used cautiously in the female patient. Long term treatment with acitretin require proper clinical and laboratory evaluation. REFERENCES 1.Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet (London, England). 2007;370(9583):263-71. 2.Al-Mutairi N. Childhood Psoriasis: Springer International Publishing; 2016. 3.Raychaudhuri SP, Gross J. A comparative study of pediatric onset psoriasis with adult onset psoriasis. Pediatric Dermatology. 2000;17(3):174. 4.Kumar B, Jain R, Sandhu K, Kaur I, Handa S. Epidemiology of childhood psoriasis: a study of 419 patients from northern India. Digest of the World Core Medical Journals. 2004;43(9):654-8. 5.Seyhan M, CoÃ…Å ¸kun BK, SaÄÅ ¸lam H, Ozcan H, KarincaoÄÅ ¸lu Y. Psoriasis in childhood and adolescence: evaluation of demographic and clinical features. Pediatrics International Official Journal of the Japan Pediatric Society. 2006;48(6):525-30. 6.Fan X, Xiao FL, Yang S, Liu JB, Yan KL, Liang YH, et al. Childhood psoriasis: a study of 277 patients from China. Journal of the European Academy of Dermatology Venereology. 2007;21(6):762. 7.de Moll EH, Chang MW, Strober B. Psoriasis in adults and children: Kids are not just little people. Clinics in Dermatology. 2016;34(6):717. 8.Kimball AB, Wu EQ, Guerin A, Yu AP, Tsaneva M, Gupta SR, et al. Risks of developing psychiatric disorders in pediatric patients with psoriasis. Journal of the American Academy of Dermatology. 2012;67(4):651-7.e1-2. 9.Fox FE, Rumsey N, Morris M. Ur skin is the thing that everyone sees and you cant change it!: exploring the appearance-related concerns of young people with psoriasis. Developmental neurorehabilitation. 2007;10(2):133-41. 10.Burden AD. Management of psoriasis in childhood. Clinical and experimental dermatology. 1999;24(5):341-5. 11.Orfanos CE, Stadler R, Gollnick H, Tsambaos D. Current developments of oral retinoid therapy with three generations of drugs. Non-aromatic, monoaromatic and polyaromatic retinoids (arotinoids). Current problems in dermatology. 1985;13:33-49. 12.Gautam M, Tahiliani H, Nadkarni N, Patil S, Godse K. Acitretin in pediatric dermatoses. 2016;17(2):87. 13.Brecher AR, Orlow SJ. Oral retinoid therapy for dermatologic conditions in children and adolescents Journal of the American Academy of Dermatology. Journal of the American Academy of Dermatology. 2003;49(2):171-82. 14.Wiegand UW, Chou RC. Pharmacokinetics of acitretin and etretinate. Journal of the American Academy of Dermatology. 1998;39(2 Pt 3):S25-33. 15.McNamara PJ, Jewell RC, Jensen BK, Brindley CJ. Food increases the bioavailability of acitretin. Journal of clinical pharmacology. 1988;28(11):1051-5. 16.Grà ¸nhà ¸j Larsen F, Steinkjer B, Jakobsen P, Hjorter A, Brockhoff PB, Nielsenà ¢Ã¢â€š ¬Ã‚ Kudsk F. Acitretin is converted to etretinate only during concomitant alcohol intake. British Journal of Dermatology. 2000;143(6):1164-9. 17.Lacour M, Mehta-Nikhar B, Atherton DJ, Harper JI. An appraisal of acitretin therapy in children with inherited disorders of keratinization. The British journal of dermatology. 1996;134(6):1023-9. 18.Cordoro KM. Systemic and light therapies for the management of childhood psoriasis: part II. Skin Therapy Letter. 2008;13(4):1-3. 19.Ergun T, Seckin Gencosmanoglu D, Alpsoy E, Bulbul-Baskan E, Saricam MH, Salman A, et al. Efficacy, safety and drug survival of conventional agents in pediatric psoriasis: A multicenter, cohort study. J Dermatol. 2016. 20.Di LV, Bonamonte D, Lasagni C, Belloni FA, Cambiaghi S, Corazza M, et al. Effectiveness and Safety of Acitretin in Children with Plaque Psoriasis: A Multicenter Retrospective Analysis. Pediatric Dermatology. 2016;33(5):530-5. 21.Ergin S, Ersoy-Evans S, Sahin S, Ozkaya O. Acitretin is a safe treatment option for infantile pustular psoriasis. Journal of Dermatological Treatment. 2009;19(6):341-3. 22.Salleras M, Sanchez-Regaà ±a M, Umbert P. Congenital Erythrodermic Psoriasis: Case Report and Literature Review. Pediatric Dermatology. 1995;12(3):231-4. 23.Haug V, Benoit S, Wohlleben M, Hamm H. Annular pustular psoriasis in a 14-month-old girl: a therapeutic challenge. The Journal of dermatological treatment. 2017:1-6. 24.Marqueling AL, Cordoro KM. Systemic treatments for severe pediatric psoriasis: a practical approach. Dermatologic clinics. 2013;31(2):267-88. 25.de Oliveira ST, Maragno L, Arnone M, Fonseca Takahashi MD, Romiti R. Generalized pustular psoriasis in childhood. Pediatr Dermatol. 2010;27(4):349-54. 26.Kopp T, Karlhofer F, Szà ©pfalusi Z, Schneeberger A, Stingl G, Tanew A. Successful use of acitretin in conjunction with narrowband ultraviolet B phototherapy in a child with severe pustular psoriasis, von Zumbusch type. Digest of the World Core Medical Journals. 2005;151(4):912-6. 27.Ormerod AD, Campalani E, Goodfield MJ. British Association of Dermatologists guidelines on the efficacy and use of acitretin in dermatology. British Journal of Dermatology. 2010;162(5):952-63. 28.Kragballe K, Jansen CT, Geiger JM, Bjerke JR, Falk ES, Gip L, et al. A double-blind comparison of acitretin and etretinate in the treatment of severe psoriasis. Results of a Nordic multicentre study. Acta dermato-venereologica. 1989;69(1):35-40. 29.Katz HI, Waalen J, Leach EE. Acitretin in psoriasis: an overview of adverse effects. Journal of the American Academy of Dermatology. 1999;41(3 Pt 2):S7-s12. 30.Vahlquist C, Selinus I, Vessby B. Serum lipid changes during acitretin (etretin) treatment of psoriasis and palmo-plantar pustulosis. Acta dermato-venereologica. 1988;68(4):300-5. 31.Gupta AK, Goldfarb MT, Ellis CN, Voorhees JJ. Side-effect profile of acitretin therapy in psoriasis. Journal of the American Academy of Dermatology. 1989;20(6):1088-93. 32.Glover MT, Peters AM, Atherton DJ. Surveillance for skeletal toxicity of children treated with etretinate. The British journal of dermatology. 1987;116(5):609-14. 33.Lee E, Koo J. Single-center retrospective study of long-term use of low-dose acitretin (Soriatane) for psoriasis. The Journal of dermatological treatment. 2004;15(1):8-13. 34.Halverstam CP, Zeichner J, Lebwohl M. Lack of significant skeletal changes after long-term, low-dose retinoid therapy: case report and review of the literature. Journal of cutaneous medicine and surgery. 2006;10(6):291-9. 35.Prendiville J, Bingham EA, Burrows D. Premature epiphyseal closurea complication of etretinate therapy in children. Journal of the American Academy of Dermatology. 1986;15(6):1259-62. 36.Halkier-Sorensen L, Laurberg G, Andresen J. Bone changes in children on long-term treatment with etretinate. Journal of the American Academy of Dermatology. 1987;16(5 Pt 1):999-1006. 37.Lammer EJ, Chen DT, Hoar RM, Agnish ND, Benke PJ, Braun JT, et al. Retinoic acid embryopathy. The New England journal of medicine. 1985;313(14):837-41. 38.Sarkar R, Chugh S, Garg VK. Acitretin in dermatology. Indian journal of dermatology, venereology and leprology. 2013;79(6):759-71. 39.Lee AG. Pseudotumor cerebri after treatment with tetracycline and isotretinoin for acne. Cutis. 1995;55(3):165-8.

An Inspector Calls :: English Literature

An Inspector Calls Essay There are many aspects that Priestley uses to make ‘An Inspector Calls’ successful on stage i.e. the use of dramatic irony, time zones, twists, cliff hangers and the 7 deadly sins. He also represents the inspector as omniscient and enigmatic and his surname is a homophone which is used symbolically. E.g. Goole to Ghoul. This makes him seem like ghostly spirit. J.B Priestley wrote this play as a message/moral to show the world that everyone is equal through terms of money and power. He saw more clearly the effects of both wars that some higher/upper class had no problems with rebuilding businesses, housing and even their lives as they had the money to do so. An element used to make ’An Inspector Calls’ successful on stage would be the ‘whodunnit’ genre. This differs from a detective genre as in a detective story there s a suspect that committed the crime but in ‘An Inspector Calls’ all of the characters in the same way helped to make Eva Smith/Daisy Renton commit suicide. Each member of the family had something to do with her whether it was physical contact or not; here is how each member was involved with her suicidal attack. Gerald and Eric both had sexual intercourse with Eva and Eric had left her pregnant, Sheila and Birling had no physical contact but both got her sacked from her job as a factory worker and working in a shop where Shelia shopped regularly, and last of all Mrs Birling pushed Eva to the limits when she would offer no help to Eva and her unborn foetus when she asked for help at the charity. Mrs Birling was the person who pushed Eva to the limit of committing suicide. The use of dramatic irony in ‘An Inspector Calls’ is used by most characters especially Mrs Birling who says to the inspector â€Å"I accept no blame for it at all†¦. Take some steps to find this young man and then make sure that he’s compelled to confess in public his responsibility†. The irony comes into this as she does not know that the father of the baby is Eric’s! Priestley presents all of the characters symbolising as the seven deadly sins. He presents the inspector as a mysterious, omniscient and enigmatic character : his name ‘Goole’, is a homophone for ‘Ghoul’ which we know is linked to the meaning ‘Ghost’; this makes you feel as if he is a kind of ghostly spirit; knowing some things before they happen. Priestley made Birling have mistaken predictions such as when Birling quoted, â€Å"‘the Titanic-she sails next week-absolutely unsinkable†, which makes the audience laugh with sarcasm as we all know that the

Sculptures in James Baldwins If Beale Street Could Talk Essay

In Narrative of the Life of Frederick Douglass, an American Slave, Written by Himself, Douglass describes his overseer as â€Å"a man of the most inflexible firmness and stone-like coolness† (Andrews 181). He adds that his mistress’s â€Å"tender heart became stone† (Andrews 188). When he first tries to free himself from such people, Douglass ends up â€Å"all alone, within the walls of a stone prison† (Andrews 208). Throughout these references, the image of stone is repeatedly linked with the stonehearted and dramatic Caucasian oppression of African-Americans. James Baldwin also includes images of stone and wood in his novel, If Beale Street Could Talk. Stone and wood are often mentioned together and are used for a joint purpose as Fonny, the protagonist, uses these materials to create sculptures. The novel’s three mentioned sculptures act as foreshadowing symbols that predict what ultimately happens to their subjects; they intricately detai l: the Caucasian oppression each subject faces, their subsequent imprisonment in stone, and their path to freedom. Fonny gives one of his first sculptures to his girlfriend’s mother; when describing the sculpture, his girlfriend, Tish, says, â€Å"It’s not very high, it’s done in black wood. It’s of a naked man with one hand at his forehead and the other half hiding his sex. The legs are†¦very wide apart, and one foot seems planted, unable to move, and the whole motion of the figure is torment† (Baldwin 38). This sculpture acts as a foreshadowing symbol in the novel because, like the sculpture, Fonny is a vulnerable black man who tries to avoid being raped, but he ends up being tormented and imprisoned in wood and stone. Also, like the sculpture, Fonny is ultimately left in the care and prote... ...g room† (Baldwin 38). It will likely become quite a conversation piece, encapsulating his life story more artistically and intricately than any family scrapbook or album. It will even link Fonny’s story to Frederick Douglass’s slave narrative, showing how both of these black men faced betrayal, isolation, and metaphorical death through unjust imprisonment in stone. It will also show how they both struggled to find freedom from Caucasian oppression, and how Fonny’s struggle occurred outside the context and time of slavery. Works Cited Andrews, William L., ed. The Literature of the American South: A Norton Anthology. New York: Norton & Company, 1998. Baldwin, James. If Beale Street Could Talk. New York: Dell Publishing, 1974. â€Å"Rape.† The American Heritage Dictionary of the English Language 2000 Fourth ed. Bartleby.com. 30 Sept. 2004

Use of Irony in Othello :: Othello essays

Use of Irony in Othello Shakespeare's plays rely largely on irony. There are three kinds of irony presented in this novel. They are: situational, verbal, and dramatic. Irony plays an important role in Othello. It creates suspense, and adds interest to the story. There are many examples of situational irony in this play. Cassio was the one Iago wanted dead or out of his position. At the end of the play, Cassio was the only one that did not die and Othello actually promoted him to a higher position. In the end Iago never accomplishes what he started to do-- to get back at Othello and take Cassio's place. Both Othello and Iago treat their wives horribly. Both killed their wives even through their innocence. Iago killed his wife because she was working against his plan. Othello killed his wife because he thought she cheated on him when she really didn't. Before he killed her, Iago used his wife in a way that helped him to betray Othello. She was a good friend of Desdemona's and she worked against her friend without knowing it. She took Desdemona's handkerchief because Iago said he wanted it. Iago then placed the handkerchief in Cassio's room to make him look guilty. Also, throughout the play, it seemed that Othello was the only one who didn't know the truth. Shakespeare uses situational irony well to make the story more interesting. The verbal irony in this novel can sometimes be humorous because of how ironic it is. Othello often said things that were actually the opposite of Iago: "O, thou art wise! 'Tis certain"(IV.I.87), "Honest Iago . . . "(V.II.88), (II.III.179) & (I.III.319), "I know, Iago, Thy honesty and love doth mince this matter"(II.III.251-52). These lines are just a few of the ironic that Othello says to Iago. They show the trust that Othello mistakenly puts in his "best friend." Most things Iago says are ironic and he's always lying. Othello still considered him his best friend but Iago was the only one Othello trusted although he was constantly lying. He says, "My lord, you know I love you"(III.III.136). This is a blatant lie - Iago does

Psychology the Nervous System

Assignment 3 Written Essay Questions 1. a) We are able to experience different types of sensations because our nervous system encodes messages. German physiologist Johannes Muller in his doctrine of specific nerve energies described a kind of code which is anatomical. In his doctrine, Muller explains that different sensory modalities exist because signals received by the sense organs stimulate different nerve pathways that lead to different areas of the brain. For example, when the ear receives signals, these signals cause impulses to travel along the auditory nerve to the auditory cortex.And signals from the eye cause impulses to travel along the optic nerve to the visual cortex. Because of these anatomical differences, light and sound produce different sensations. b) The code in the nervous system that helps explain why a pinprick and kiss feel different is known as functional. These codes rely on the fact that sensory receptors and neurons fire or are inhibited from firing, only i n the presence of specific kinds of stimuli. Functional encoding may occur all along a sensory route, starting in the sense organs and ending in the brain. 2.The lens of an eye operates differently from a camera, that just like a camera, the eye registers spots of light and dark, but neurons in the visual system build up a picture of the world by detecting meaningful features. The eye doesn’t passively record the external world, like a camera, ganglion cells and neurons in the thalamus of the brain respond to simple features in the environment, such as spots of light and dark. The existence of a specialized face module in the brain, explains why a person with brain damage may continue to recognize faces, after losing the ability to recognize other objects. . These units which were named after Alexander Graham Bell were called decibels (dB). Each decibel is 1/10 of a bel. Using decibels, they can be used to determine sound intensity, intensity of a wave’s pressure. Huma ns have an average absolute threshold of hearing of zero decibels and all decibels are not equally distant. For example, in my own environment, in my living room there is a 40decibel sound, my refrigerator and the light traffic from my window has about 50 decibels of sound.Everyday noises that may be hazardous to hearing could be rock concerts, deafening bars, stereos that are often played on full blast. In addition to that, noisy home appliances, lawn mowers and heavy city traffic also are hazardous to our ears. 4. If you were to inhale vapour from a rose, your receptors for smell have specialized neurons embedded in a tiny patch of mucous membrane in the upper part of the nasal passage. Millions of receptors in each nasal cavity respond to chemical molecules in the air.So when you inhale vapour from a rose, you’re pulling these molecules into the nasal cavity and can also enter from the mouth. These molecules then trigger responses in the receptors that produce that of fres h roses. From there, signals from the receptors are carried to the brain’s olfactory bulb by the olfactory nerve. And from the olfactory bulb, they travel to a higher region of the brain. 5. The basic concept of the gate- control theory, states the experience of pain depends on when pain impulses can get past a ‘’gate’’ in the spinal cord.The gate is a pattern of neural activity that blocks pain messages coming from the skin, muscles and internal organs or lets those signals through. Most of the time this gate is kept shut by impulses coming into the spinal cord from large fibres that respond to pressure or by signals coming down from the brain itself. However, when body tissue is injured, the large fibres are damaged and the smaller fibres open the gate. Once the gate is open, pain messages reach the brain unchecked. However, the theory doesn’t explain phantom pain, the pain from an amputated limb or organ that a person continues to feel aft er surgery.Melzack explains, even though there are no nerve impulses for the spinal cord gate to block or let through, the brain not only responds to incoming signals from sensory nerves but is also capable of generating pain entirely on its own. An extensive matrix of neurons in the brain gives us the sense of our own bodies and body parts. Pain results when this matrix produces an abnormal pattern of activity, as a result of memories, emotions, expectations or signals from various brain centres and not just from signals from peripheral nerves.Because of the lack of sensory stimulation or a person’s efforts to move a nonexistent limb, abnormal patterns may arise, resulting in phantom pain. 6. a) The role stimulus generalization plays in this problem is where mental images of the sights and smells of the clinic can become conditioned stimuli for nausea, aside from the nurse’s uniform, smell of rubbing alcohol or the waiting room. b) High order conditioning can be illus trated in this problem of vomiting and nausea where a patient who drank lemon –lime Kool-Aid before their therapy sessions developed anxiety disorders.They continued to feel anxious even when the drink was offered in their homes rather than at the clinic. c) Classical conditioning could help patients reduce pain and anxiety through the use of placebos. For example the use of pills and injections that have no active ingredients or treatments that have no direct physical effect on the problem. The bigger and more impressive the placebos are, the stronger their psychological effects are. 7. The evidence shows that punishments are effective when they are carried out immediately.As shown in the studies of criminal records of Danish men, punishments were effective in deterring young criminals from repeating their offences. After examining repeat arrests through the age of 26, punishment reduced rates of subsequent arrests for both minors and serious crimes. However, recidivism stil l remained fairly high. Other studies have indicated that the severity of punishment made no difference, in that fines and probation were just as effective as jail time. The consistency of the punishment is what matters most.For example, when law breakers get away with their crimes, their behaviour is intermittently reinforced and becomes resistant to extinction. Speeding tickets are another example of when you receive punishments. Even though the use of photo radar systems is useful for catching all speeders or reduces speeding, it doesn’t eliminate speeding entirely. As mentioned before, punishments are most effective in the period immediately following its delivery. This would explain when police officers supervise the speed traps; they are more effective since the punishment is given out immediately.However, when photo radars catch you, you have to wait for several weeks to receive the ticket. Laboratory and field studies find that punishments fail in everyday life, in sc hools, families and workplaces because of six drawbacks. The first is that people often administer the punishment inappropriately or mindlessly. People swing in a blind rage or shout things they don’t mean and when people aren’t angry, they misunderstand the proper application of punishment. Secondly, the recipient of punishment often responds with anxiety, fear or rage. Negative emotional reactions can create more problems than the punishment solves.For example, a teenager who has been severely punished may strike back or run away. Children, who have been punished physically in childhood, risk at being in depression, having low self-esteem, violent behaviour and many other problems. Third, depending on the presence of the punishing person or circumstances, the effectiveness of the punishment is often temporary. When a police officer is around at a park, you wouldn’t dare littering but if the police officer isn’t around then you wouldn’t be as afra id of littering. Forth, most behaviour is hard to punish immediately.For example, while you’re at work, your children eat all the deserts that were for tonight’s party, but you don’t punish them till after work, the punishment is no good. You children’s behaviour would have been reinforced by all those deserts. Fifth, punishments express little information, in that punishments may tell the recipient what not to do, but doesn’t communicate what the person should do. For example yelling at a student who learns slowly, won’t teach him/her to learn faster. Sixth, an action intended to punish may instead be reinforcing because it brings attention.For example, in the classroom, students enjoy when teachers yell at them in front of their classmates, putting them in the limelight. Often rewarding the student’s misbehaviour they are trying to remove. 8. a) Fixed Interval b) Variable Interval c) Variable Ratio d) Fixed Ratio Take a Long look 1. What is meant by the term â€Å"form perception†? Form perception means when an infant can or can’t respond to stimuli as shape, pattern , size or solidity. Thus they can see or can’t perceive form. 2. Why is the â€Å"preferential-looking† method of studying infants likened to a biologist’s use of a microscope?This method is similar to that of a biologist’s use of a microscope because this method is one of the first tools researchers turn to when they want to study how babies think. The method literally opened the doors to understanding the minds of infants. 3. What patterns were the babies in Fantz’s studies least interested in looking at? The patterns the babies were least interested in were the shapes that were just plain with no complexity. The least interesting shape for the infants was the square with no designs or complexity inside the square. 4.A preference for looking at faces is said to â€Å"set the stage for an infantâ €™s future survival and growth† (p. 41). Suggest two areas of learning that an infant’s attention to faces might facilitate. Two areas of learning that an infant’s attention to faces might facilitate are innate and primitive knowledge. The innate knowledge of the environment is shown by the infant’s interest in the kinds of forms that will later aid in object recognition, social responsiveness and spatial orientation. The primitive knowledge help provide an accumulation of knowledge through experience. 5.The early psychologist William James thought that the world for babies was a â€Å"blooming buzzing confusion† (see page 211 of the course text). Do Fantz’s findings support this statement? Explain. Fantz’s findings pointed out infants, regardless of age, can demonstrate that basic form perception is present at birth and ruling out a learning or developmental factor. Meaning that, babies have some kind of understanding of the diffe rent patterns and forms that are presented to them. This is how they are able to differentiate between faces, their mothers face or a stranger’s face. 6.Imagine you have been hired by a toymaker. Using Fantz’s findings describe your design for an infant toy or crib mobile. Using Fantz’s findings, I would create a toy that would have detailed patterns and include pictures or objects of faces of people or similar to those of people. Thus, I would create a toy with a face similar to that of humans and cover their body with items of great complexity, for example, a bull’s eye or a checkers board type of pattern. You would be able to place this toy over the infant in the crib, which should keep the infant entertained for many hours.Watch out for the Visual Cliff 1. What is meant by the statement that Gibson and Walk take a nativist position on the topic of depth perception? Both Gibson and Walk believed that depth perception and the avoidance of a drop-off app ear automatically as part of our original biological equipment and has nothing to do with experience. On the other hand, empiricists argue that these abilities are learned and aren’t biologically hard wired in us. 2. Write a one-paragraph summary of what Gibson and Walk discovered from their visual cliff studies with infants.Gibson and Walk had 36 infants for this study between ages 6 and 14 months with their mothers participating in the study. Nine of infants refused to move at all off the center of the board, which wasn’t explained by the researchers, but perhaps infant stubbornness. However, the other 27 infants crawled off the board and crossed the glass when called by their mothers on the shallow side of the table. Only 3 of the infants crept with hesitation off the brink of the visual cliff when called by their mothers from the deep side.When the infants were called from the cliff side by their mothers, most of the infants either crawled away from their mother on the shallow side or cried in frustration at being unable to reach their mothers without ‘’ falling off the cliff’’. The infants would often peer down through the class of the deep side and then back away or pat the glass with their hands, but would refuse to cross. After these results, it was difficult to prove that human’s ability to perceive depth is innate rather than learned because all the infants had at least 6 months of life experience to learn about depth through trial and error. . What did Gibson and Walk discover about depth perception in young animals? Gibson and Walk discovered that the ability of various animals to perceive depth developed in relation to when the species need such a skill for their survival. For example, within 24 hours of age, baby chickens never made the mistake stepping off into the deep side while looking for food. Kids and lambs response was the same as the baby chickens, which indicted the visual sense was in com plete control and the animals ability to feel the solidity of the glass on the deep side had no effect on the response.The rats were different from the others, as they didn’t show any preference for the shallow or deep side of the table. This could be explained by the fact that rats locate food by smell and doesn’t depend very much on its vision, but moves around using cues from the stiff whiskers on its nose. 4. Describe how Gibson and Walk use evolutionary theory to explain their infant and animal findings on depth perception. Gibson and Walk used evolutionary theory to explain that all animals that are to survive need to develop the ability to perceive depth by the time they able to move independently.For humans, this doesn’t occur until about 6 months of age and for chickens and goats it’s immediately. For dogs, rats and cats it’s about 4 weeks. Thus, this ability is inborn because to learn through trial and error would cause many potential fat al accidents. 5. Give one example of a finding that suggests depth perception has a learned component. A later study placed younger infants, ages 2 to 5 months, on the glass over the deep side of the visual cliff. The infants showed a decrease in heart rate, a sign of interest and not fear.This had indicated that the younger infants had not yet learned to fear the drop off and would learn the avoidance behaviour later on in life. 6. How has social referencing been found to impact youngsters' behaviour when faced with a visual cliff? In the Gibson and Walk study, when the mother had been instructed to maintain an expression of fear on her face, the infants refused to crawl any further on the table. However, when the infants saw their mothers looking happy, they checked the deep side again and crawled across.But when the drop-off was made flat, the infants did not check with their mothers before crawling across. Knock Wood 1. Why is Skinner referred to as a radical behaviourist? Skinn er is referred to as a radical behaviourist because he believed that all behaviours are ultimately learned, are controlled by the relationships between the situation that immediately precedes the behaviour and the consequences that directly follow it. This includes behaviours that are public or external, private and events such as feelings and thoughts.He believed that private behaviours are difficult to study, but acknowledged we all have our own subjective experience of these behaviours. However, he didn’t view internal events, such as thoughts and emotions, as causes of behaviour but rather as a part of the mix of the environment. 2. What is a Skinner box? How was the food dispenser set up for the pigeons in this study? Refer back to your text. What type of reinforcement schedule is this? The Skinner box consists of a box or cage that is empty except for a tray or dish into which food may be dispensed.This allows the researcher to have control over when the animal receives reinforcement, such pallets of food. The earlier boxes contained a lever that when pressed, would cause some food to be dispensed; rats were most commonly used in these boxes. For pigeons, the conditioning chambers were designed with disks to be pecked instead of bars to be pressed on. This study is an example of fixed – interval schedules, as the dispensers were rigged to drop food pellets into the tray at intervals of 15 seconds, regardless of what the pigeon was doing. 4.What were the pigeons conditioned to do as a result? One of the birds was conditioned to turn counter clockwise, making two or three turns between reinforcements. Another bird was repeatedly thrusting its head into one of the upper corners of the cage. Two of the birds developed pendulum motion of the head and body in which the head was extended forward and swung from right to left with a sharp movement followed by a somewhat slower return. One of the other birds was conditioned to make incomplete pecking or brushing movements directed toward but not touching the floor. . How did the pigeons’ behaviour change when the delay period for reinforcement was extended to a minute? With one of the head bobbing and hopping birds, the bird’s movements become more energetic until finally the bobbing and hopping become so intense, that it appeared that the pigeon was doing some kind of dance during the intervals. When the reinforcement in the cage was discounted, the birds’ behaviour was considered extinct. This resulted in the superstitious behaviour disappearing gradually.In the case of the dancing pigeon, there were over 10,000 responses that were recorded before extinction occurred. 5. Was extinction of this behaviour possible? This type of behaviour can persist a lifetime because any behaviour that is reinforced once in a while in a given situation, becomes very difficult to extinguish. This is because the expectation stays high that the superstitious behaviour might w ork to produce reinforcing consequences. In real life, instances of accidental reinforcement usually occur at irregular intervals which make extinction of this behaviour almost impossible. . What explanation does Skinner give for the resiliency to extinction of human superstitions? Skinner states that any behavior that is reinforced once in a while in a given situation, partial reinforcement, it becomes very difficult to extinguish. This is due to the expectation that stays high that the superstitious behaviour might work to produce the reinforcing consequences. In real life, accidental reinforcement usually occurs periodically, so you could imagine why superstitious behaviour may persist for a lifetime. 7.Use Skinner’s operant conditioning principles to explain the development of a superstition that you hold or once held, or one you have observed in someone else. Using Skinner’s operant conditioning principles, I noticed my friend who enjoys roulette had a superstitio n that when he bought himself and the person on his right a drink and place the bet on black he believed he would win. Of course he wouldn’t always win, only the person to his right side won with a free drink, but he always thought this would bring him good luck when he needed it.

How Television Has Impacted Technology Essay

Television was introduced in 1949 but very few people had it because it was extremely expensive. The only channels people could watch were NBC and CBS. Television became increasingly popular because it was entertainment without going and sitting in the movie theaters. As TV became more popular, it became more affordable. People would hear about television through word of mouth, news, radio and newspaper. Everybody liked the idea of being entertained and staying at home. By the 1960s most families has TV sets in their living rooms, depending on if they liked being entertained at home. Television in the United States has grown year after year and has made a big impact on American culture in many ways. TV has taken a big part in violence in society, the news, how people are stereotyped, childhood obesity, family values, social interaction, and so much more. In my opinion one of the biggest impacts that television has had on American culture is childhood obesity. Obesity is considered a form of malnutrition in which food energy is stored as fat due to being unused. Child obesity is bred within the home and the television is a major contributor to it. The energy we consume from food needs to be used up by the body on a daily basis through physical exertion. An overweight child devoting a major portion of time to watching television is at risk to becoming obese. Television is certainly a contributor to that obesity. Kids these days are getting bigger and bigger, while television shows are growing and growing. To me, that is a big issue and television affects it a lot. Back in the day children enjoyed going outside to play, getting involved in sports or just anything outdoors. I feel like as of today there are now only about a quarter of the kids that enjoy doing outdoors stuff like that. The other 75% of kids choose to stay inside because most likely there favorite TV show is on or there is a movie that they just have to watch. Those kids are losing their time to play outside and mainly burn and lose calories because they are just sitting there watching TV for hours and hours. Obesity is known to be one of the major health concerns among both children and adults in the United States today. It is suggested by certain groups that children should not watch more than two hours of television a day. This in my opinion is already too much because that is where childhood obesity all gets started. The average child n the United States regularly watches between 2-3 hours of television a day and many children now days have their own television set in their bedroom. Not only are children inactive while they are watching television, they often snack on unhealthy food choices. And like I said, establishing unhealthy food habits as a child can often continue into adulthood. Investi gators have hypothesized that television viewing cause’s obesity by one or more of three mechanisms: (1) displacement of physical activity, (2) increased calorie consumption while watching or caused by the effects of advertising, and (3) reduced resting metabolism. The relationship between television viewing and obesity has been examined in a relatively large number of cross-sectional epidemiologic studies but few longitudinal studies. Many of these studies have found relatively weak, positive associations, but others have found no associations or mixed results; however, the weak and variable associations found in these studies may be the result of limitations in measurement. Even studies for reducing the amount of television intake have been completed. They do not test â€Å"reducing television time† directly, but the results that they get may help to reduce the amount of risk for obesity or help promote weight loss in obese children. â€Å"An experimental study was designed specifically to test directly the causal relationship between television viewing behaviors and body fatness. The results of this randomized, controlled trial provide evidence that television viewing is a cause of increased body fatness and that reducing television viewing is a promising strategy for preventing childhood obesity. † I really think parents need to take a stand to their children by limiting the amount of time they spend in front of the television, before it gets too late and they have an obese child. Removing televisions from children’s bedrooms and putting time limits on the TV may be a good way for parents to reduce the risk of obesity in children. Parents must serve as role models because their television viewing habits influence their children’s. Parents should also limit the frequency of television viewing. Overweight and obese children need to be encouraged to do more physical activity such as walking, playing and limiting their television time. Children may also need structured physical activity times to divert them away from television. â€Å"Although the increase in childhood obesity is not caused solely by television watching, Dr. Reginald Washington points out in the editorial that accompanies the articles, â€Å"Society, as a whole, must realize that to effectively control and prevent this obesity epidemic, all risk factors must simultaneously be reduced. † A study by the University of Liverpool psychologists has shown that it is to be true that obese and overweight children increase their food intake by more than 100% after watching food advertisements on television. Children all over the world are exposed to a huge number of TV advertisements, primarily for fast foods and sweets. Some say that it is not the amount of TV; it is the number of junk food commercials that advertise unhealthy foods and constantly play over and over. It is miserable that people blame television as a result to childhood obesity but the United States is starting to get very lazy when it comes to situations like this, therefore I truly believe TV is one of the dominate reasons of why children are becoming obese. I feel like this impact has been mainly negative on American culture. Television advertisers get talked down to by research groups, wanting them to take away all the unhealthy food commercials. Childhood obesity coming from television watchers makes American culture look very bad. When you find out that all it takes is television sets in a kids bedroom and high-quality shows that make children sit, stare and snack to become obese. It really puts a depressing look on America. In my opinion it is a very negative result because it used to not be this way at all. The parents and children put themselves in the situation to becoming obese and television just is an excuse for whenever they actually are obese. I know I will never let my children or close friends get this way due to excess amount of television watching. I have time to watch all my shows I like during the day and still get a good exercise in. I believe that all people can watch their weight and not become obese if they really try. So I really hope the culture changes and fix its look on television with obesity. I do believe that the internet will be used more wisely than television as a medium for delivering content. Television is an older and dull way of showing and sharing shows, movies and advertisements, while now days the nternet can do the same plus a whole lot more. Internet is a lot easier to get to because so many people have smart phones or laptops to be able to quickly access it. I feel like even now I start to see more and more people of all ages on their laptop/computer/smart phone rather than sitting down and watching television shows. Internet is a new (compared to TV) and entertaining way to access World Wide Web. News and broadcast stations are all starting to put their information and ideas on the internet even before they send them to television. While putting the internet into question about my topic, as much as I hate seeing younger kids run around with their own smart phone and/or laptop, it would really help society. Internet will help a lot more in this situation because children that do have smart phones will be able to play outside and exercise with their phone in hand. If the kids do go outside while on their phone it will stop them from sitting in front of a television set, sitting, staring and snacking. Therefore, it will lower the childhood obesity rate in the United States. Childhood obesity is a very heartbreaking yet occurring thing that television influenced and started in the U. S. It has been a very big impact on television and American Culture. After all, we are all hoping and praying that parents help their children get back to how it was back in the day. Have the children exercising, playing outside, and getting involved in sports that way they only spend approximately one hour watching television. We have to lower the childhood obesity rate and will continue to try and stop every way that is involved in it.

Effect of Maternal Employment on Child Hood Education Essay

Abstract The study aims to examine in detail the effects of maternal employment as a doctor on child’s academic achievement at school level, with the help of using samples taken from working doctor and non working mothers and the schools grades of their respective children. The results predicted show that mothers as a doctor does exert negative impact on the academic achievement of their children. Further findings highlight that mothers education and the quantity of time spend with the child incase when the mother is working are the important tools for better school performance. The effect of maternal employment (doctor) on child development and academic achievement Introduction As we all know Pakistan being a developing nation gives great importance to two main sectors namely health and education. Therefore a lot of funds and resources have been contributed to these sectors over two decades on the principals of making Pakistan a healthy and literate community. Over the years Pakistan has witnessed a great deal of changes in its social, cultures and norms one of which has great relevance to our research such as female employment. The number of female employees has greatly increased. However female employment in profession cannot take place alone until and unless it blends with sound education. Therefore an increase employment in female sectors has led to a simultaneously increase in schooling or education as well, both of which are primary focus of our discussion. Since females are now opting medical as their profession and female doctors are increasing day by day, it was for this reason why we opted for this topic to study the impact of maternal employment as a doctor on their children’s primary education. Our aim is to make people aware of the fact whether maternal employment effects children’s education or not. In Lahore preschools and primary education schools are opening up at every location. This increase in demand for more schools is mainly due to more and more mothers going out for work. To become a doctor and serve the community can although be seen as positive aspect individually and socially however it can also have serious or negative implications on the child.To draw conclusions whether the working mothers as doctor have a positive or negative influence on child’s development we would need to consider several aspects of this development  that is how it affects the child’s academic performance and achievements, his personal character development and mental and emotional well being. All of the factors mentioned above would help us in determine whether it is feasible for the mother to work as a doctor or stay at home giving attention to their children. To study in depth we have taken into account the effect of working doctor mothers on children who are mainly enrolled in preschool and primary school. Children when are between the age of 3-12 years are most demanding in time and it is these early years of a child in which a strong bond between mother and child is created followed by the character development. Mother as doctors will tend to leave their children at day care or pre schools which might end up with negative effects on the children. On the other hand preschools and primary schools may also have positive impact on the child’s growth such as learning of new activities and work in groups which will help them build up confidence and lastly make them independent at a very young age. Despite these positive aspects of the schooling, a child might not perform well in his education performance. To carry out the survey and research a lot of variables were considered and used in finding. Variables such as the number of years after the mother started practicing medical profession after the child’s birth, the monthly income of the female doctors, the fraction of the to tal monthly salary spent on children. Last but not the least the amount of items available in the house that contribute in time saving techniques resulting in ample time available for the mother to be spent with the child, these equipment would mainly include washing machines, dryers dish washers and the number of helpers present in the house. Our main objective is to also study and compare previous generations to today’s generations in Pakistan. In past very less women were doctors and mostly were housewives who believed in not to work but to spend quality time at home and give in their best efforts to bring up their children. However nowadays females are becoming doctors. Thus a question arises whether women can still manage to give quality timer to their children with medical as their profession or children have to suffer because of their mother as doctor. Which option is better, to become a doctor and raise children or become a house wife and raise children. These questions will be addressed and answered in our research. Questions that will be asked from the doctors and non working women that will help us formulate general results  are in the form of two questionnaires. To gain more primary data which is still not answered by the questionnaires; there will also be direct interviews from the doctors. Thus our population will be few female doctors in Lahore that have children. However we have further narrowed the female doctors to a few hospitals at Lahore. The sample would be taken from surgimed hospital/ Services hospital.To sum up, research paper mainly focuses on the effect of mothers being doctors on their childhood’s development with special importance given to education development. To summarize in one line, the research helps in studying the development of child when their mothers are doctors (maternal employment sector) or when their mothers are housewives (nonemployee). Literature Review This paper involves number of studies that involve the relationship between maternal employment and children’s cognitive development. Maternal employment can be taken as an economic factor which eventually can affect and influence a lot of environmental conditions, thus it also affects the children’s cognitive abilities. We cannot deny the fact that economic conditions initially play a vital role in child’s development but on the other hand psychological aspects can also not be denied and need to be taken into account. To define and state them more clearly some of the factors affecting the child outcomes may include maternal employment, education levels of parent’s socio economic standing and other demographic standings. It is widely believed that mothers as doctors have less time available to spend with their children therefore one could say mothers as doctors have negative effects on the cognitive development of children. Some of the problems that can come across are slow language development process, unable to solve mathematical problems and deficits in reading abilities. Ruhm (2000) found out that during the early years such as 3 and 4 years old, children had detrimental effect on language learning and children with the age of 5 and 6 years had to face the problems mathematical inabilities. Lack of interaction and bonding with the mother at this stage in life may lead to cognitive difficulties in the child .Maternal employment results in separation of mother and child therefore providing a gateway to cognitive problems. An interesting finding that we found out while going through the  literature was that unlike maternal employment, unemployed fathers have negative effects. Harvey (1999) found out some significant results though they were more or less confined to high income versus low income families. Harvey (1999) conducted different surveys and techniques and studied the effects of maternal employment on cognitive development. Harvey (1999) found out that maternal employment is favorable and has positive impact to children that belong to low income families. This is perhaps because children from poor families receive more education in their pre schooling compared to if they stayed at home. This view point can also be supported with the fact that mothers from poor families are less educated and thus have less motherly skills. However children from richer families mostly lose out when their mothers are not at work. Income effects: David Blau (1999) conducted a study which focused on income effects. Blau (1999) found out that only permanent income that is from permanent career can affect the relationship which also is to a limited extent. Blau (1999) agreed that different economic classes do affect the cognitive levels. Family variables are important which mainly include mother’s educational level, marital status and race. Education Status: With respect to Blau, Loury(1988) examined that the educational level of the parents is the main cause of cognitive problems. To conclude about the literature review Investigation into the influences on children’s development shows the fundamental factor is the nature of children’s experiences in their primary life contexts, including the relationships between those contexts and wider socio-cultural contexts. The most influential factor is the nature of interactions with parents and, in the early childhood education setting, with early childhood educators. With regard to the impact of maternal employment, the direction of international research suggests maternal employment in itself has no significant negative or positive effects on children, although small negative cognitive and behavioral effects of extensive maternal employment may occur in the child’s first year. These possible negative effects are linked to the quality of the early childhood education, so high quality generally removes the negative effects and may increase positive effects in that first year. Any negative effects of maternal employment are negligible beyond the child’s first year  and must be seen in relation to the numerous influences in the different contexts of a child’s life. Methodology The purpose of the study is to look at how mothers working as doctors have an effect on their children’s performance in the field of education at preschool and primary level. To carry out research, female doctors who have children were selected as population from hospitals of Lahore mainly constituting Services and Surgimed hospital . To carry out data collection the population was sampled and fifteen female doctors who have children from each hospital were given a questionnaire and similarly two interviews from each hospital were conducted. We have used quota sampling based on convenient and non probability sampling. Semi structured questionnaire which consists of both structured and unstructured questions have been used. The questionnaire designed focused on general questions in the beginning and then focused more towards specific questions, the approach known as general to specific was used.. Since there are large numbers of female doctors who have children working in these two hospitals; it was easy for us to collect data with the help of questionnaires by distributing them once and collecting the questionnaires back next time. Unstructured interviews were also conducted, two from each hospital to collect data.The aim of the interviews was to find out any additional information that could not be generated or left out in questionnaires. This additional information was generated with help of probe questions. We tried our best to create an atmosphere which is suitable and comfortable for the respondents to conduct the interview Questions used in questionnaires are mostly measured in numerical frequency. The effect of maternal employment (doctor) on child development and academic achievement Questionnaire results and discussion: Q1: Most of the mothers (working and non working) were married, thus majority of them belonged to a stable family meaning by they were not disturbed due to family domestic affairs.(See Appendix for charts) Q2: An interesting finding from the questionnaires was that mothers who worked as  doctors had less children. On an average female doctors had two children. Whereas mothers who were not working had a majority of three children. Thus clearly highlighting the fact that mothers can give more time to their children if they are not working. (See Appendix for charts) Q3: Mostly mothers who had children of below the age of five years took leave from their profession to up bring their children. (See Appendix for charts) Q4: Both mothers who are working as doctors and mothers who are nonworking had majority of their life partners (husbands) as working and earning. (See Appendix for charts) Q5: Income was enough for them to buy things for children. (See Appendix for charts) Q6: Though when this question was put in a different way in terms of spending time with their children. Women who were not working, mostly spent 6 hours a day with their children whereas working women only spent 4 hours a day due to their staying away from home unlike nonworking women who worked while staying home thus could give more time to children. (See Appendix for charts) Q7: Mothers who worked in hospitals had hired maids for their children to look after them whereas non working mothers who hired maids were 9 out of 30 mothers who answered questionnaire. Out of 30 working mothers who were given questionnaire 16 had The effect of maternal employment (doctor) on child development and academic achievement hired maid’s .Therefore mothers who don’t work can look after their children much better unlike maids hired by working mothers for their children. (See Appendix for charts) Q8: Though there is a slight difference as most of the nonworking mothers visit 6 times years while working mothers visit 4 times a year. (See Appendix for charts) Q9: Mothers who work are supported and to great extent in bring up their children up to their academic expectations. Majority working mothers stated that their husband contribute more than 50% in children’s education responsibility. Whereas mothers who did not work took most of the children’s education responsibilities and husband contributed very less. Therefore a valid conclusion drawn is that mothers who do not work can give more time to their children’s education and can produce better results. (See Appendix for  charts) Q10: Mothers who worked provide their children with recreational activities such as taking them out to restaurants etc. Whereas mothers who stayed at home emphasized more on providing recreational activities such as sports for healthier routine and health. (See Appendix for charts) The effect of maternal employment (doctor) on child development and academic achievement Q11: Now talking about the main research question. Results drawn showed that mothers who did not work their children showed a better academic performance when compared to mothers who work. Out of 30 working mothers only 9 termed their children with excellent academic performance whereas in case of nonworking women out of 30, 18 termed their children as excellent in academics. Therefore clearly indicating that mothers who do not work are able produce better results out of their children unlike working mothers. (See Appendix for charts) Q12: Mothers who were working wanted their children to get the highest degree of education to become successful in life. Majority of the working mothers wanted their children to do masters. (See Appendix for charts) Q13: Some working women agreed that bringing up child is possible with job whereas almost an equal amount of women did not agreed that bringing up child is easily possible with job and thus affects overall performance especially academic performance. (See Appendix for charts) Q14: When working and non working mothers were asked about their opinion as mothers. Non working mothers termed themselves in majority (25 out of30) as excellent mothers whereas mothers as doctors only 12 out of 30 termed themselves excellent mothers. (See Appendix for charts) Q15: Lastly mothers were to give reasons of why they were working. Most of them mothers stated that they worked either for advancement in career or for monetary reasons. (See Appendix for charts) The effect of maternal employment (doctor) on child development and academic achievement Interviews were also conducted from working women from the hospitals. The unstructured interviews followed by probe questions helped us  to find more useful information about their impact of job on their children’s education performance. The findings from the interviews were finding out how much interest they showed in their children’s education and whether they had ever thought of the impact of their profession on their children’s education performance. Most of the female doctors were interested in their children’s education performance and were concerned but they also agreed that at times they lack in keeping their child’s performance up to date due to their performance. Thought it was found out that they tried to give equal time to their profession and their children to maintain balance however doctor as profession did not allow them to work on this idea freely and thus female doctors as mothers were more towards the view that doctor as a profession is too demanding, therefore some cost in the form of children’s upbringing has to be paid. To find more details doctors were asked what they thought of this profession whether it is friendlier towards family. Most of the doctors abruptly answered in a negative manner and demanded that working hours too long and should be cut short so that more time can be spent with families. Though in monetary terms they were happy since most of the female doctors quoted a handsome amount of salary and were able to meet their children’s requirement and their schooling (education). Lastly questions were asked from doctors whether they would like their children to be a doctor as well keeping in view the costs associated and children’s education impact. Most of the mothers were not in favor of making their children’s doctors stating that there is no social and family life in this profession. The effect of maternal employment (doctor) on child development and academic achievement Conclusions Findings from the research we suggest that doctor as a profession is not friendly and does not goes in favor side by side in bringing children’s education performance to the peak. Mothers working as doctors no doubt work hard in up bringing their child to their best however nowadays doctor as a profession is becoming demanding day by day and the number of hours to work have increased. Simultaneously education competitions have also increase and have become very demanding. Therefore looking at the results mothers who works as doctors, their children suffer more than mothers who do not work and spend time with their children. The other two sectors like bankers etc  had less or negligible effects on children’s education. Thus doctor’s children have a negative impact on their children education unlike mothers who are government servants or bankers. Recommendations The research is very helpful and will provide a good rationale for female mothers who work as doctors to take a decision whether to take up job or bring up their child as nonworking mothers. Looking at the results and findings the researcher suggests that in Pakistan, doctor as a profession is very demanding and has negative effect on children’s performance. Therefore it is recommended that women instead of taking up doctor as their profession should look for other job alternatives such as banking or other government jobs which are less demanding and have less working hours. The main advantage of considering other professions would be to give time simultaneously to their children along with their jobs. The effect of maternal employment (doctor) on child development and academic achievement Limitations: The one and only limitation faced in the project was to get the questionnaires filled out from the doctors. Since most of the time doctors were busy and getting hold of doctors to take their interviews and filling out questionnaires was difficult. The effect of maternal employment (doctor) on child development and academic achievement References Blau, F. D., & Grossberg, A. J. (1992). Maternal labor supply and children’s cognitive development. Review of Economics and Statistics Achenbach, T. M., Edelbrock, C., & Howell, C. T. (1987). Empirically based assessment of behavioral/emotional problems of 2- and 3-year-old children. Journal of Abnormal Child Psychology, Baydar, N., & Brooks-Gunn, J. (1991). Effects of maternal employment and child care arrangements on preschoolers’ cognitive and behavioral outcomes: Evidence from the National Longitudinal Survey of Youth. Developmental Psychology Brooks-Gunn, J., Han, W., & Waldfogel, J. (2002). Maternal employment and child cognitive outcomes in the first three years of life: The NICHD Study of Early Child Care. Child Development,