The Hunters: Phantom Chapter 13

â€Å"I'm so sorry. I'm so sorry,† Meredith said for the tenth time. Her usual y composed face was flushed, and her eyes were bright with unshed tears. Matt didn't remember ever seeing her so upset about something, especial y something that had ended up not being a big deal. Sure, Celia could have been hurt, but the car hadn't touched her. â€Å"I'm fine, real y I am, Meredith,† Celia assured her again. â€Å"I just didn't see you. I don't know how, but I didn't. Thank God for Alaric,† Meredith said, throwing a grateful glance at Alaric, who was sitting close beside her and rubbing her back. â€Å"It's okay, Meredith,† he said. â€Å"It's al okay.† Alaric seemed more concerned for Meredith than for Celia, and Matt didn't blame him. Babbling was pretty out of character for Meredith. Alaric wrapped his arms tightly around Meredith, and she visibly relaxed. Celia, on the other hand, tensed noticeably as Meredith leaned into Alaric's embrace. Matt traded a rueful glance with Bonnie. Then Stefan reached out and stroked Elena's shoulder absently, and Matt was surprised to feel a jealous pang of his own. Wasn't he ever going to get over Elena Gilbert? It had been more than a year since they dated, and about a century in experience. Bonnie was stil watching him, now with a speculative gleam in her eyes, and Matt shot her a bland smile. He'd just as soon not know what Bonnie saw in his face when he looked at Elena and Stefan. â€Å"Around this bend and up the slope is the Plunge,† he said to Celia, ushering her forward along the trail. â€Å"It's a little bit of a hike, but it's the best place around here for a picnic.† â€Å"Absolutely the best,† said Bonnie cheerily. â€Å"We can jump down the waterfal .† She fel in on Celia's other side, helping him to herd her away from the two couples, who were murmuring to one another softly as they fol owed behind. â€Å"Is that safe?† asked Celia dubiously. â€Å"Total y,† said Bonnie. â€Å"Everybody jumps the waterfal here, and nobody's ever gotten hurt.† â€Å"Usual y it's safe,† said Matt, more cautiously. â€Å"You and Meredith might want to think about not swimming, Celia.† â€Å"I hate this,† Bonnie said. â€Å"I hate having to be extracareful because of some dark thing that we don't know anything about. Everything should be normal.† Normal or not, it was a magnificent picnic. They spread their blankets on the rocks near the top of the waterfal . The smal fal s plummeted down the side of the cliff and ended in a deep pool of effervescent water, making a sort of natural fountain that spil ed into a clear bronze-green pool. Mrs. Flowers had packed salads and breads and desserts for them, as wel as meat and corn to gril on a hibachi Stefan had brought from the boardinghouse. They had more than enough food for a couple days of camping, let alone one lunch. Elena had stowed cold drinks in a cooler, and, after hiking up the trail in the Virginia summer heat, everyone was happy to crack open a lemonade or soda. Even Stefan took a water bottle and drank as he started heating the gril , although it was automatical y understood by everyone that he would not be eating. Matt had always found the fact that he never saw Stefan eating a little creepy, even before Matt knew he was a vampire. The girls squirmed out of jeans and tops to display their bathing suits, like caterpil ars transforming into butterflies. Meredith was tan and lean in a black one-piece. Bonnie was wearing a petite mermaid-green bikini. Elena wore a soft gold bandeau that went with her hair. Matt watched Stefan watching her appreciatively, and felt that little twist of jealousy again. Both Elena and Bonnie pul ed their T-shirts back on over their bathing suits almost immediately. They always did: Their pale skin burned instead of tanned. Celia lounged on a towel, looking spectacular in a casual yet daringly cut white swimsuit. The effect of the pure white against Celia's coffee-colored skin was amazing. Matt noticed Meredith's eyes passing over her and then glancing sharply at Alaric. But Alaric was too busy shucking down to a pair of red trunks. Stefan stayed out of the direct sunlight, remaining in his dark jeans and black T-shirt. Wasn't that a little creepy, too? Matt thought. Stefan's ring protected him from the sun's rays, didn't it? Did he stil have to stick to the shadows? And what was with the black clothing? Was he pretending to be Damon now? Matt frowned at the thought: One Damon had been more than enough. Matt shook his head, stretched his arms and legs, turned his face toward the sun, and tried to get rid of his thoughts. He liked Stefan. He always had. Stefan was a good guy. A vampire, a dry voice in the back of his mind noted, even a harmless one, can rarely be described as a good guy. Matt ignored the voice. â€Å"Let's jump!† he said, and headed toward the waterfal . â€Å"Not Meredith,† said Stefan flatly. â€Å"Not Meredith, and not Celia. You two stay here.† There was a little silence, and he glanced up from the gril to see his friends staring at him. He kept his face neutral as he returned their gazes. This was a life-or-death situation. It was Stefan's responsibility now to keep them safe, whether they liked it or not. He looked at them each in turn, holding their eyes. He was not going to back down. Meredith had risen to her feet to fol ow Matt to the fal s' edge, and she hesitated for a moment, clearly unsure how to react. Then her face hardened, and Stefan saw that she had chosen to take a stand. She stepped toward him. â€Å"I'm sorry, Stefan,† she said, her voice level. â€Å"I know you're worried, but I'm going to do what I decide I want to do. I can look after myself.† She moved to join Matt, who was standing at the edge of the cliff, but Stefan's hand whipped out to grab her wrist, his fingers as strong as steel. â€Å"No, Meredith,† he said firmly. Out of the corner of his eye, he saw Bonnie's mouth drop open. Everyone was looking at him with puzzled, anxious faces, and Stefan tried to soften his tone. â€Å"I'm just trying to do what's best for you.† Meredith sighed, a long, gusty sound, and seemed to be making an effort to let go of some of her anger. â€Å"I know that, Stefan,† she said reasonably, â€Å"and I appreciate it. But I can't go through the world not doing the things I usual y do, just waiting for whatever this is to come get me.† She tried to move around him, but he sidestepped to block her way again. Meredith glanced at Celia, who threw up her hands and shook her head. â€Å"Don't look at me,† Celia said. â€Å"I have no urge to jump off a cliff. I'm just going to lie in the sunshine and let you al work this out yourselves.† She leaned back on her hands and turned her face toward the sun. Meredith's eyes narrowed and she whirled back to Stefan. As she was opening her mouth, Elena broke in. â€Å"What if the rest of us go first?† she suggested placatingly to Stefan. â€Å"We can make sure there's nothing clearly dangerous down there. And we'l be near her at the bottom. Nobody's ever been hurt jumping here, not that I've heard of. Right, guys?† Matt and Bonnie nodded in agreement. Stefan felt himself softening. Whenever Elena used her logical voice and her wide, appealing eyes, he found himself agreeing to plans that, in his heart of hearts, he thought were foolhardy. Elena pressed her advantage. â€Å"You could stand right by the water below, too,† she said. â€Å"Then, if there's any problem, you could dive in right away. You're so fast, you'd get there before anything bad could happen.† Stefan knew this was wrong. He hadn't forgotten that sick swoop of despair, of realizing he was too slow to save someone. Once again, he saw Damon's long, graceful leap toward Bonnie that had ended with Damon fal ing to earth, a wooden branch driven through his heart. Damon had died because Stefan was too slow to save him, too slow to realize the danger and save Bonnie himself. He'd also been too late to save Elena when she had driven off the bridge and drowned. The fact that she now lived again didn't mean he hadn't failed her then. He remembered her pale hair floating like seaweed in the chil y water of Wickery Creek, her hands stil resting on the steering wheel, her eyes closed, and shuddered. He had dived repeatedly before he found her. She had been so cold and white when he carried her to shore. Stil , he found himself nodding. What Elena wanted, Elena got. He would stand by and protect Meredith as best as he could, and he prayed, as far as a vampire could pray, that it would be enough. The rest of the friends stayed at the top while, down at the bottom of the fal s, Stefan surveyed the pool at his feet. The water sprayed up exuberantly from where the fal s hit the surface. Warm, pale sand encircled the pool's edges, making a tiny beach, and the center of the pool seemed dark and deep. Matt jumped first, with a long, wavering whoop as he plummeted. The splash as he hit the water was huge, and he seemed to stay submerged for a long time. Stefan leaned forward to watch the water. He couldn't see through the foam thrown up by the fal s, and an anxious quiver shot through his stomach. He was just thinking of diving in after him when Matt's sleek wet head broke the surface. â€Å"I touched the bottom!† he announced, grinning, and shook his head like a dog, throwing glittering drops of water everywhere. He swam toward Stefan, strong tan limbs moving powerful y, and Stefan thought how easy everything seemed for Matt. He was a creature of sunlight and simplicity, while Stefan was stuck in the shadows, living a long half-life of secrets and loneliness. Sure, his sapphire ring let him walk in the sun, but being exposed to the sunlight for a long time, like today, was uncomfortable, as if there were some kind of itch deep inside him. It was worse now that he was readjusting to a diet of animal blood again. His unease was yet another reminder that he didn't real y belong here. Not the way Matt did. He shrugged off his sour feelings, surprised at their emergence in the first place. Matt was a good friend. He always had been. The daylight must be getting to him. Bonnie jumped next, and surfaced more quickly, coughing and snorting. â€Å"Oof!† she said. â€Å"I got water up my nose! Ugh!† She pul ed herself out of the water and perched on a rock near Stefan's feet. â€Å"You don't swim?† she asked him. Stefan was struck with a flash of memory. Damon, tanned and strong, splashing him and laughing in one of his rare fits of good humor. It was hundreds of years ago now. Back when the Salvatore brothers had lived in the sunlight, back before even the great-grandparents of his friends had been born. â€Å"Not for a long time,† he answered. Elena jumped with the same casual grace as she did everything else, straight as an arrow toward the bottom of the fal s, her gold bathing suit and her golden hair gleaming in the sunshine. She was underwater for longer than Bonnie had been, and again Stefan tensed, watching the pool. When she broke the surface, she gave them a rueful grin. â€Å"I couldn't quite reach the bottom,† she said. â€Å"I was stretching and stretching down. I could see the sand, but the water pushed me back up.† â€Å"I didn't even try,† Bonnie said. â€Å"I've accepted that I'm too short.† Elena swam away from the bottom of the fal s and climbed onto the sand, settling next to Bonnie at Stefan's feet. Matt climbed out of the water, too, and stood near the fal s, gazing up critical y. â€Å"Just jump feetfirst, Meredith,† he cal ed teasingly. â€Å"You're such a show-off.† Meredith was poised at the edge of the fal s. She saluted them and then leaped into a perfect swan dive, arching swiftly toward the pool, disappearing smoothly beneath the water with barely a splash. â€Å"She was on the swim team,† Bonnie said conversational y to Stefan. â€Å"She has a row of ribbons and trophies on a shelf at home.† Stefan nodded absently, his eyes scanning the water. Surely Meredith's head would break the surface in a second. The others had taken about this long to reemerge. â€Å"Can I jump yet?† Alaric cal ed from above. â€Å"No!† Elena shouted. She rose to her feet and she and Stefan exchanged a worried glance. Meredith had been down there too long. Meredith surfaced, sputtering and pushing her wet hair out of her eyes. Stefan relaxed. â€Å"I did it!† she cal ed. â€Å"I – â€Å" Her eyes widened and she began to shriek, but her scream was cut off as she was abruptly yanked under the water by something they couldn't see. In the space of a breath, she was gone. For a moment, Stefan just stared at where Meredith had been, unable to move. Too slow, too slow, an internal voice taunted him, and he pictured Damon's face, laughing cruel y and saying again, So fragile, Stefan. He couldn't see Meredith anywhere under the clear, effervescent water. It was as if she had been taken suddenly away. Al of this flew through Stefan's head in only a heartbeat, and then he dived into the water after her. Underwater, he couldn't see anything. The white water from the fal s bubbled up, throwing foam and golden sand in front of him. Stefan urgently channeled his Power to his eyes, sharpening his vision, but mostly that just meant that now he could see the individual bubbles of the white water and the grains of sand in sharp relief. Where was Meredith? The bubbling water was trying to push him up to the surface, too. He had to struggle to move forward through the murky water, reaching out. Something brushed his fingers and he grabbed at it, but it was only a handful of slippery pondweed. Where was she? Time was running out. Humans could go without oxygen for only a few minutes before brain damage set in. A few minutes after that, there would be no recovery at al . He remembered Elena's drowning once more, the frail white shape that he had pul ed from Matt's wrecked car, ice crystals in her hair. The water here was warm, but would kil Meredith just as surely. He swal owed a sob and reached out frantical y again into the shadowed depths. His fingers found skin, and it moved against his hand. Stefan grasped whatever limb it was, tight enough to bruise, and surged forward. In less than a second more, he could see that it was Meredith's arm. She was conscious, her mouth tight with fear, her hair streaming around her in the water. At first he couldn't see why she hadn't come to the surface. Then Meredith gestured emphatical y, reaching to fumble at long tendrils of pondweed that had somehow become entangled with her legs. Stefan swam down, pushing against the white water from the fal s, and tried to work his hand under the pondweed to pul it off her. It was wrapped so tightly around Meredith's legs that he couldn't get his fingers beneath it. Her skin was pressed white by the strands. Stefan struggled for a moment, then swam closer and let Power surge into him, sharpening and lengthening his canines. He bit, careful not to scratch Meredith's legs, and pul ed at the pondweed, but it resisted him. A little late, he realized that the resilience of the plants must be supernatural: His Power-enhanced strength was enough to break bones, tear through metal, and should have had no problem with a bit of pondweed. And final y – so slow, he reprimanded himself, always just so damn slow – he realized what he was looking at. Stefan felt his eyes widen in horror. The tight strands of pondweed against Meredith's long legs spel ed out a name.

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Music Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Pedagogy refers to the art and science which aims to fully equip human beings with skills. In this education strategy, the instructor’s philosophical principles of instruction are embraced by the pupil’s upbringing knowledge and experience, environment and situation as well as the studying objectives and goals set by both the teacher and the pupil. Johann Heinrich Pestalozzi, a Swiss pedagogue introduced his revolutionary modern principles of education. In the early 19th century, his principles Pestalozzi principles and philosophy started to influence the education system in America. His approach of â€Å"educating the entire man† man was incorporated in the music education.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In 1830s, Lowell Mason-a teacher, began to use Pestalozzi’s principles and philosophy in his methods of teaching and later came up with a new tactic to the music education. Lowell Mason later championed for inclusion of music curriculums in normal education. (Branscome, 2005; Mark & Gary, 1990, p.76; Sturm, 1998; Tellstrom, 1971). In schools for people with special needs in the United States, music was already incorporated in their syllabus in early 1930s. Such schools where music was taught include New England Asylum for Blind that is also referred to as Perkins School for Blind. Julia Ward Howe offered singing lessons and instructions to the blind and the people with mental disorders using a curriculum that was developed for the purpose of training students in singing and marching lessons.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   From 1900 music education was incorporated in the public school educations system. From 1960 to 1970 the music education, music education was fully encompassed in the special education syllabus whereby the music classes were taught by the special needs education teacher.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   More music teachers were delegated to teach students with special needs as from 1970. During the lessons, the teachers were required to visit the schools for two or three times in a month. The lessons were meant for listening to recordings, singing or movement engagement exercises. According Graham (1975 & 1980) and Mark & Gary (1990, there is enough evidence to show that music education was not mainly considered for secondary education but elementary level. The enactment of the law that ensured education was compulsory for all children with disabilities -EHA ensured participation of students with disabilities in the regular music program. References Raumer, K.,et al.(1885) . The Life and System of Pestalozzi. London: Longmans press. Pestalozzi,J.,Banard,H.(1859). Pestalozzi and Pestalozzianism: Life, Educational Principles, and Methods of Johann Heinrich Pestalozzi. New York: F.C. Brownell press. Mortimore, P.( 1999). Understanding pedagogy and its impact on learning. London: Paul Chapman Publishing. Source document

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Supply Chain Management in Saudia Airlines - Research Paper Example The low cost airlines have impacted the local sales of the leading airlines by a large margin. This is so because customers while traveling locally may prefer a low cost airline as the distance is less and they may not require any extra facilities or entertainment. However, these new entrants still lag behind in the development of an effective Supply Chain Management (SCM) system which is the source of competitive edge for the leading players of the industry. In the last few years, the organization structures of many airline companies have undergone drastic transformations to incorporate the challenges encountered during the tough economic times that have been prevailing since 2008. Since the aviation industry has become dynamic and competitive, every player in the market has to ensure that it meets the demands of its target market effectively (Bolstorff and Robert, 40). Innovation, design, quality of products and services are important areas of consideration for all organizations. In the airline industry, only those companies can survive that have a competitive edge in their SCM process and those which will ensure that they are providing premium quality services at competitive rates to their customers. Supply chain management strategies need to be effective and timely as any delays at any point of the supply chain would affect the performance and the quality level of the airlines to a large extent. Emirates Airline is among those companies that entered the market with the aim of becoming the leader in the aviation industry worldwide. It is among the top-ranked airlines available in the market which has been providing an excellent range of services to its customers ranging from leisure to business traveling packages. Emirates airlines are considered as one of the best airlines of the world and the entire management strives towards maintaining this image. Emirates Airline was the pioneer in introducing the

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Chipotle Mexican Grill Financial Position - Case Study Example This shows an improvement in the company’s performance, as it is indicates an increase in the rate of return on the shareholders equity that is going up steadily over the years. More than often, the return on assets ratio gives a measure of effective and efficient utilization of assets in order to produce net profit. It therefore, allows the management an opportunity to enhance the utilization of resources around the company. Chipotle Mexican Grill return on assets in the year 2008 indicates a ratio of 0.3788 and thereafter an increase in the 2009 as the return on assets ratio rose to 0.4987 and a further increase in 2010 to 0.5094, indicating that there was an increase in the returns on the net profit from the assets, as they were effectively utilized (Grant, 2009). As a restaurant that offers Mexican food, Chipotle Mexican Grill is considered to be the leading among its competitors in the United States market. This attributes are related to its ability to offer services that have got high level of integrity. More so, the services of Chipotle Mexican Grill is accredited as one that is of high quality and has outstanding reputation as a result, the company outshines the rest of its competitors who offer Mexican dishes as it is followed by Baja fresh Mexican grill (Allen, 2011). On the other hand, Taco Bell remains low in its operations because it offers lower food quality as compared to its competitors even though its menu remains favorable. The liquidity ratio of Chipotle Mexican Grill indicates the profitability measure concerning how effectively and efficiently the firm’s performance is accredited in terms of the current ratio (Grant, 2009). A good liquidity ratio gives creditors more interest in transacting with the company, as it determines the overall liquidity of a company in terms of business short-term solvency thus, its ability to pay back its debts as it runs its business

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Communication Etiquette within a Franchised Business - Essay Example I decide to discuss business etiquette in business particularly in franchised business since communication is very crucial in any form of business. Additionally, the way that communication is done is even more important and it determines how well the employees and the clients relate to each other. This paper focuses on the different communication etiquettes used in the business field particularly in franchised business spread across different nations. While doing business it is critical that the persons involved be in a position to communicate appropriately irrespective of their differences in culture and language. Being from different culture results in differences in mannerisms thus the need to have specific etiquettes to govern how business is conducted. Over the recent past, there has been great demand for development of communications skill particularly in the franchised businesses. This is due to the need to optimize business operations. Business franchising has become a common phenomenon over the recent past. However, most franchise business end up collapsing as soon as they are formed, which is mainly due to lack of or poor communication. Etiquette entails making other people feel good and appreciated, which is crucial in business set up (Chaney & Martin, 2007). Communication in business settings takes different forms. The forms include written documents such as letters and memos. Additionally, communication may involve phone calls, video conferencing, or through emails. Moreover, social media has become a means of communication that franchised business are increasingly adopting (Martin & Chaney, 2012; Chaney & Martin, 2007) Communication using emails and letter is governed by some basic rules, which are considered the etiquette. Letter writing is quite a common communication strategy between businesspersons. The way a letter is structured and the language used demonstrates ones communication skills. Errors such as undated letters as well as spelling mi stakes portray negative aspects about one’s communication skills. The letters should also be clear and specific without any jargon. Letters and emails should also be standard. This can be made possible by designing a specific template. The template can be modified to suit different purposes (Brookins, 2012; Thompson, 2011). Communication and Etiquette Communication is the process of encrypting and conveying a message to an individual or group of people. There are different ways of communicating in business setup, which may include body language, verbal or written means. The etiquettes may vary in different parts of the world and is mainly determined by the culture of the people doing business. However, there are certain conducts that are considered common in the business field and are crucial for the success of any business. Communication etiquette is very crucial in franchise business since this kind of business is often spread worldwide across different cultures (Fox, 2008) . Since communication is one of them most crucial aspect of doing business, it is important to practice good communication for effective business transactions. Good business etiquettes entails respecting and adhering to other people’s cultures in addition to being courteous to colleagues and other stakeholders. Good business e

Black Exodus of 1879 Research Paper Example | Topics and Well Written Essays - 3250 words

Black Exodus of 1879 - Research Paper Example † The Black Exodus of 1879, often referred to as the Exoduster Movement, took place in late nineteenth century US, where there was a large-scale migration of the black Americans from southern states (primarily from regions adjoining the Mississippi River) to Kansas. This was the first movement of the black Americans (in large numbers) away from South, after end of the US Civil War. At this time, there were increasing instances of racial strife that led to widespread violence and brutal murders (of both black and white community members) in the southern states. The protection accorded to the black slaves by the Reconstruction era under Federal Bureau, disappeared with the end of Reconstruction, and with the start of the next phase known as Redemption, the former slaves became more vulnerable and were again at the mercy of their former owners. After the 1876 election, many of the former slaves felt unsafe and decided to migrate to other regions that were deemed safer. While some migrate d towards the abolitionists states in the north-eastern regions, there were large-scale movements towards Kansas (held under Republicans and the famous John Brown). The black Americans that moved to Kansas in 1879 came to be known as the Exodusters, and their movement created a great deal of worry for the southerners and led to significant debate amongst the southern and northern states. In the black exodus of 1879,  Benjamin "Pap" Singleton played a prominent role.5  During this movement, nearly forty thousand Exodusters  migrated from the  South  and went to live in Colorado Oklahoma,  and Kansas.6   The  term Kansas Fever Exodus  refers to the immigration of nearly six thousand former slaves to Kansas, from  the southern states of Texas, Louisiana and Mississippi.7 Benjamin Singleton, at the time of the exodus, was residing in Kansas (Morris country), and he had started the demand for rights to black immigration immediately after the end of the civil war, and owing to his deep involvement in the movement he is also known as the â€Å"Father of Exodus.† There are various speculations as regards the actual cause for this sudden exodus of the black Americans from the Mississippi region towards Kansas in such large numbers. Some authors contend that this movement was primarily owing to the feeling of insecurity arising from the sudden fall i n political ascendancy of the black community, after the Reconstruction era ended. Other writers feel that some of the crafty northern politicians lured these former slaves in order to garner support in the forthcoming elections. Some authors also claim that agricultural failure in 1878, a subsequent fall in labor prices, and various other external causes led to discontent amongst the black population, which ultimately made them move northwards, and search for a better and a more stable livelihood.8 Another strong influence that made many of the black Americans move to Kansas or to other parts in the north and western regions, were the news and letters detailing the prosperous conditions of some of the former slaves who had already migrated and settled in these regions, right after the civil war. In this context, the paper will now discuss the Black Exodus of 1879, and will examine the reasons and causes behind the movement. It will explore the effects of this movement, as in change of black population demographics. The paper will include notable figures that were involved in the movement while examine the opinions of various African Americans of that era about this movement. Discussion The era of reconstruction After the end of the US Civil War in 1865, the period of Reconstruction started which lasted until around 1877, when there were large-scale efforts to rebuild South on new lines and

Job Satisfaction in Hospitality Industry Essay Example for Free

Job Satisfaction in Hospitality Industry Essay Turnover intention The purpose of this study is to investigate the antecedents (i. e. , role ambiguity and con? ct, burnout, socialization, and work autonomy) and consequences (i. e. , affective and continuance commitment, absenteeism, and employee turnover intention) of employee job satisfaction. Data obtained from a sample of 671 respondents drawn from 11 international tourist hotels in Taiwan were analyzed with the LISREL program. According to the results, role con? ict, burnout, socialization, and work autonomy, but not role ambiguity, signi? cantly predicted job satisfaction. In addition, job satisfaction signi? cantly contributed to psychological outcomes in terms of organizational effectiveness (i. . , greater affective and continuance commitment and lower employee turnover intentions). ? 2009 Elsevier Ltd. All rights reserved. 1. Introduction 1. 1. Background In the competitive and people-oriented business environment characterizing the modern hospitality industry, frontline employee performance represents a crucial component of service. Better employee performance yields greater guest satisfaction and loyalty. Moreover, frontline employees in the hospitality industry seem to be underpaid and to suffer job-related stress (Weatherly and Tansik, 1993; Karatepe and Sokmen, 2006). An appropriate quality of service includes employee attitudes and behaviors that meet customer expectations. Consequently, employee job satisfaction is a necessary contributor to meeting such expectations (Rust et al. , 1996; Kim et al. , 2005; Karatepe and Sokmen, 2006). The literature on job satisfaction covers an enormous territory with ambiguous boundaries, apparently as a result of the growing interest of academic researchers and managers in three perspectives on this domain. The ? rst views job satisfaction as an antecedent of organizational outcomes, e. g. business performance (Iffaldano and Muchinski, 1985; Schyns and Croon, 2006), employee turnover (Williams and Hazer, 1986; Griffeth et al. , 2000; Lam et al. , 2001a,b; Martin, 2004; Silva, 2006; Schyns and Croon, 2006), and organizational commitment (Chatman, 1989, 1991; Chatman and Barsade, 1995; Harris and Mossholder, 1996; Lowry et al. , 2002; Lam and Zhang, 2003; Martin, 2004; Taris et al. , 2005; Li, 2006; Silva, 2006) . The second treats job satisfaction as an outcome of organizational conditions, e. g. , leadership (Williams and Hazer, 1986; Schriesheim et al. 1992; Podsakoff et al. , 1996; Sparks and Schenk, 2001; Schyns and Croon, 2006), social support (Frone, 2000; Liden et al. , 2000; Schirmer and Lopez, 2001; Schyns and Croon, 2006), and task characteristics (Seers and Graen, 1984; Williams and Hazer, 1986; Stepina et al. , 1991; Dodd and Ganster, 1996; Schyns and Croon, 2006). The third examines job satisfaction in terms of the temperament of employees, which is affected by individual traits (Judge et al. , 1998, 2000; Dormann and Zapf, 2001; Judge and Bono, 2001; Schyns and Croon, 2006). 1. 2. Previous studies of job satisfaction in hospitality Previous studies on the antecedents and consequences of job satisfaction in the hotel industry have examined antecedents in terms of individual, organizational, and job-related factors. Much of the literature regarding individual factors in the hospitality industry has identi? ed salary, bene? ts, and marital status as contributors to employee turnover (Iverson and Deery, 1997; Pizam and Thornburg, 2000). For Chinese managers, job satisfaction was affected by the work environment, the nature of the job itself, and the rewards associated ith the job, but not by manager characteristics (Lam et al. , 2001a,b). Rewards, particularly those related to job security, emerged as an in? uential factor relating to job satisfaction. This study also indicated that high levels of job satisfaction resulted in low levels of turnover intentions among managers. Aziz et al. (2007) studied fast food restaurants and found that satisfaction with ? nancia l rewards minimized absenteeism and hence turnover rates. Martin (2004) and Silva (2006) applied a psychological perspective to a sample drawn from the hotel industry, using a correlation analysis to identify signi? ant relationships among job satisfaction, organizational commitment, employee turnover, and personality traits. Carbery et al. (2003) applied a hierarchical regression analysis to a sample of 89 hoteliers and showed that individual affective * Tel. : +886 935 927 138; fax: +886 7 238 3553. E-mail address: [emailprotected] Nkhc. Edu. Tw. 0278-4319/$ – see front matter ? 2009 Elsevier Ltd. All rights reserved. doi:10. 1016/j. ijhm. 2009. 11. 002 610 J. -T. Yang / International Journal of Hospitality Management 29 (2010) 609–619 commitment accounted for a signi? ant amount of variance in turnover intentions, that job satisfaction did not explain managers’ levels of commitment to a signi? cant extent, and that job satisfaction and affective, but not cont inuance, commitment were important factors in predicting the turnover intentions of employees. These ? ndings were also echoed by Iverson and Deery (1997). Second, at the organizational level, organizational support and socialization have been identi? ed as crucial factors in? uencing individual behavior. Cho et al. (2009) empirical study demonstrated that perceived organizational support and commitment negatively in? enced individual intentions to leave, but only the former positively affected intentions to stay. Young and Lundberg (1996) proposed that organizational socialization signi? cantly contributed to newcomers’ job performance, job satisfaction, and organizational commitment and hence to their intentions about leaving the organization. The study indicated that role ambiguity, role con? ict, and job burnout could be minimized by wellorganized orientation and training programs during the early stage of employment, and that this approach would increase the level of job satisfaction. A similar study also showed that socialization dif? culties negatively affected the organizational culture with respect to employee turnover (Iverson and Deery, 1997). Tepeci and Bartlett’s (2002) empirical study went one step further, implying that organizational socialization resulted in increased job satisfaction and intentions to remain in an organization. Subramaniam et al. (2002) empirically showed direct and positive relationships between variables measuring decentralized structures and organizational commitment among managers. Lam and Zhang (2003) surveyed 203 employees in the Hong Kong fast-food industry about their jobs. A multiple regression model showed that organizational commitment was correlated with and predicted by variables re? ecting training and development, job characteristics (including the extent to which a job is challenging, the sense of accomplishment associated with the job, the meaningfulness of the work, the friendliness of co-workers, and job security) and compensation and fairness. Job satisfaction was correlated with the ? st two factors. Subramaniam et al. (2002) found a direct and positive relationship between variables measuring managers’ needs for achievement and their organizational commitment to and use of a participatory budgeting process. Lowry et al. (2002), drawing on a sample of 454 employees working in registered clubs in Australia, show that job satisfaction signi? cantly affected organizational commitment and that formal training plans as well as empowerment and ? exible work hours were dominant factors in? uencing job satisfaction. Iverson and Deery (1997) and Silva (2006) presented empirical results showing that organizational commitment was connected with employee turnover, as mediated by job satisfaction. Kim et al. (2005) re? ned the aforementioned statistical relationship by applying structural equation modeling. Manageable levels of job stress should have a certain number of positive effects on individual and/or organizational behaviors. The most signi? cant empirical studies in this regard were conducted by Faulkner and Patiar (1997) and Iverson and Deery (1997). Zohar (1994) and Brymer et al. (1991) claimed that stress included three aspects of role con? ict and ambiguity: workload, decision latitude, and psychological stress. Faulkner and Patiar (1997) identi? ed ? ve sources of the job stress suffered by front-of? ce employees: ‘‘coping with of? ce politics, dealing with ambiguous situations, inadequate guidance from superiors, under-promotion, and staff shortages’’ (p. 110). This empirical study implied that these ? ve stressors should be eliminated to stimulate individual adaptive behaviors. Recent research conducted by Karatepe and Uludag (2007) with employees of Northern Cyprus hotels found that work–family con? ict did not signi? cantly contribute to job satisfaction or intentions to leave an organization. Karatepe et al. (2006a,b) and Kim et al. (2009) found that role con? ict and ambiguity were signi? cantly associated with job satisfaction, given sex as a mediating variable. The study conducted by Kim et al. (2007) implied that job burnout might increase rates of employee turnover. Employee turnover constitutes a critical issue for many hoteliers and academics. Some hoteliers view turnover as a part of the culture of the hospitality industry as a whole (i. e. , a so-called turnover culture). Hotel operations in Taiwan are also characterized by this sort of culture (Yang, 2008). Recent studies of the hotel industry in Taiwan conducted by Yang (2008) demonstrated that organizational socialization contributed to job satisfaction and commitment and minimized newcomer turnover intention. This study, applying a multiple regression analysis, showed that job satisfaction affected affective commitment and hence in? enced turnover intentions. Yang (2009) indicated that newcomers enjoyed observing and reading job-related information to learn how to perform tasks, implying that organizational socialization and job stress were correlated with job satisfaction. 1. 3. Justi? cation for and contribution of the study Although many empirical studies have focused on issues related to job satisfaction, organizational commitment, and employee turnover, many una nswered questions about the nature of job satisfaction seem to remain. One such unanswered question concerns the importance of different job factors, such as role stress and job burnout, in determining satisfaction. This empirical study attempts to explore the relationships among several components of the antecedents and consequences of job satisfaction. The main impetus for conducting this comprehensive and holistic study derived from the need to narrow three theoretical gaps. First, although prior studies have revealed the relationship between antecedents (i. e. , role stress, socialization, and burnout) and consequences (i. e. organizational commitment and employee intentions to leave an organization) and job satisfaction, few studies have investigated the interactive effects of these variables within the context of a more inclusive model. Second, a great deal of the literature in the hospitality and tourism ? eld shows a strong relationship between job satisfaction and organizational commitment, but few studies have examined this relationship by dis tinguishing affective from continuance commitment. Third, no empirical evidence about whether absenteeism mediates between organizational commitment and intention to leave has been presented. This study will contribute to a growing body of research on job satisfaction that illustrates the need to adopt a multi-faceted approach to the study of employee turnover intentions. It will also demonstrate the importance of considering not only the effects of job characteristics on job satisfaction, but also the effects of job satisfaction on organizational commitment, absenteeism, and turnover intention. 1. 4. Purpose of the study The study focuses on interactions among employees in hotels in Taiwan and empirically examines the effectiveness of an integrated understanding of applied psychology that includes organizational socialization. The purpose of this research is to explore (1) the effect of role stress, burnout, socialization, and work autonomy on job satisfaction; and (2) the situational relationships among job satisfaction, individual commitment to organizations, absenteeism, and employee turnover intentions. 2. Hypotheses development This study aims to recast our perspective on job satisfaction by applying organizational theories pertaining to job stress, burnout, J. -T. Yang / International Journal of Hospitality Management 29 (2010) 609–619 611 socialization, and work autonomy. These factors contribute to job satisfaction, and hence to organizational effectiveness, in terms of organizational commitment, absenteeism, and employee turnover intentions. 2. 1. Job satisfaction Job satisfaction can be viewed as ‘‘the pleasurable emotional state resulting from the appraisal of one’s job as achieving or facilitating the achievement of one’s job values’’ (Locke, 1969, p. 316). Early comprehensive empirical research conducted by Porter and Steers (1973) and Muchinsky and Tuttle (1979) showed a negative relationship between job satisfaction and employee turnover intentions. Some studies (e. g. , Steers, 1977; Wanous et al. 1984; Lo and Lam, 2002) have found a signi? cant relationship between job satisfaction and organizational commitment. Williams and Hazer (1986) demonstrated that job satisfaction could be predicted by pre-employment expectations, perceived job characteristics, leadership considerations, and age. Job satisfacti on signi? cantly and positively contributed to the outcomes of organizational commitment, which reduced employees’ intentions to leave and subsequently resulted in decreased turnover. Recent research on the restaurant industry conducted by Lam et al. (2001a,b) reported that the relationship between job satisfaction and job tenure ? a U-shaped model. When people entered an organization and/or job, job satisfaction decreased when job expectations were not met. At times, ‘‘reality shock’’ (Hughes, 1958) occurred. After such an experience, employees adjusted their expectations according to the reality of the job. During the course of this transition, job satisfaction increased when jobrelated expectations were reached. Rayton’s (2006) empirical research revealed that perceived levels of job reutilization and higher levels of work involvement, pay satisfaction, managerial support, and career opportunities were signi? ant determinants of employee jo b satisfaction. 2. 2. Role stress All employees, from senior managers to frontline personnel, can suffer from job stress (Ross, 1997). Human resources managers face a great challenge in attempting to ameliorate employee job stressors (Ngo et al. , 2005). Ngo et al. (2005) characterized role stressors in terms of role ambiguity, role con? ict, role overload, and work–family con? ict. These stressors can lead to such personal reactions as employee burnout, job dissatisfaction, and intentions to leave an organization. According to Karatepe and Sokmen (2006), role con? ict refers to situations characterized by incompatible demands in which employees feel obliged to attend to different individuals (e. g. , managers, colleagues, and customers) simultaneously; on the other hand, role ambiguity also refers to the experience of not having (or receiving) the information necessary for pursuing jobrelated tasks in the workplace. Much relevant research (e. g. , Brown and Peterson, 1993; Almer and Kaplan, 2002; Perrewe et al. , 2002; Siu et al. , 2002; Firth et al. , 2004; Ngo et al. 2005; Karatepe and Sokmen, 2006) has empirically con? rmed the association of a variety of work stressors, including role ambiguity and role con? ict, with lower job satisfaction, increased job-associated tension and anxiety, less affective commitment, lower work involvement, and poor job performance (Sohi, 1996; Karatepe and Sokmen, 2006), leading to intentions to resign. Accordingly, the following hypotheses are proposed: Hypo thesis 1. Role ambiguity negatively affects job satisfaction. Hypothesis 2. Role con? ict negatively affects job satisfaction. 2. 3. Burnout Gill et al. (2006) de? ed burnout as ‘‘a syndrome or state of physical, emotional, and mental exhaustion, as well as cynicism towards one’s work in response to chronic organizational stressors’’ (p. 471). Pienaar and Willemse (2008) demonstrated that burnout might be caused by unfair pay systems, imbalance between pay and work-related effort, and lack of organizational support, career advancement, and recognition by superiors. In addition, frontline hospitality employees sometimes encounter dif? cult interactions with demanding customers, and such experiences can also lead to emotional exhaustion and/or psychological burnout. Many empirical studies (e. . , Leiter and Maslach, 1988; Firth and Britton, 1989; Cordes and Dougherty, 1993; Turnipseed, 1994; Wright and Bonett, 1997; Etzion et al. , 1998; Maslach and Go ldberg, 1998; Van Dierendonck et al. , 1998; Gillespie et al. , 2001; Hsieh and Chao, 2004; Gill et al. , 2006; Pienaar and Willemse, 2008) have reported that burnout results in additional negative effects on individuals, including reduced satisfaction and lower levels of productivity. Burnout also impacts the organization and management by eliciting employee mistrust and discouraging teamwork. Thus, the following hypothesis is proposed: Hypothesis 3. Burnout negatively affects job satisfaction. 2. 4. Socialization Louis (1980) de? ned socialization as ‘‘a process by which an individual comes to appreciate the values, abilities, expected behaviors, and social knowledge essential for assuming an organizational role and for participating as an organizational member’’ (pp. 229–230). Socialization aims to alleviate the feeling of emotional vulnerability (e. g. , job uncertainty, ambiguity, anxiety, and stress) by strengthening the social interactions between newcomers and colleagues to accelerate newcomers’ learning and adjustment to a new environment (Kennedy and Berger, 1994).

Central Giant Cell Granuloma (CGCG) Case Study

Central Giant Cell Granuloma (CGCG) Case Study ABSTRACT: Central giant cell granuloma (CGCG) is an intraosseous lesion which occurs as an uncommon benign condition in jaws. WHO defines this intraosseous lesions as â€Å"a lesion that contains multiple foci of haemorrhage, consisting of cellular fibrous tissue and there is trabeculae of woven bone. It may become aggressive leading to expansion and perforation of the cortex. Mobility and displacement of the involved teeth and root resorption are often observed. Here is a case report of an 18 year old female patient who is diagnosed with an aggressive type of CGCG. KEYWORDS: Central giant cell granuloma, granuloma, giant cell granuloma, giant cell lesions. Introduction Central giant cell granuloma (CGCG) is a benign proliferation of fibroblasts and multinucleated giants cells that almost exclusively occurs within the jaw. It commonly occurs in young adults showing a female predilection.1 CGCG rarely occurs in areas elsewhere other than the jaws, like maxillary sinus, temporal bone, cranial vault and other bones of the craniofacial complex.2 It was thought that CGCG is a reparative lesion as it develops in response to intrabony hemorrhage and inflammation secondary to trauma. However, it can be considered as an aggressive lesion because of its aggressive behaviour as seen in the present case. Case report A 18 year old female patient, presented with a painful swelling over the lower border of mandible of 3 months duration. The patient had a history of trauma 6 months back with fractured 31. On extra oral examination, gross asymmetry of face was seen with a diffuse swelling of approximately 34 cm size on chin. Lymph nodes were not palpable. Local examination revealed a diffuse swelling extending mentolabial sulcus, inferiorly below the lower border of mandible and antero-posteriorly extending from the midline to the level of corner of mouth both side extending 1.5cm size. Colour over the surface appeared normal; no ulceration or discharge from the swelling was seen. Surface of the swelling was smooth, consistency was hard. The swelling was non – fluctuant; No rise in temperature, no pulsations were felt. The swelling was tender on palpation. On intraoral examination, tenderness on palpation was evident in relation to left mandibular canine and first premolar. No lingual expansio n. Based on the history given by the patient and the clinical examination, a provisional diagnosis of traumatic bone cyst in relation to anterior lower border of mandible was given. However, radiographic examination was suggested to confirm the provisional diagnosis. Orthopantomographs demonstrated normal anatomic hard tissue structures with a diffuse radiolucency seen in the mandibular anterior region crossing the midline , measuring approximately 3 cm x 3.5 cm, extending medio-laterally from 34 to 44 and supero-inferiorly from the apex of mandibular anterior extending to 1.5 cm below the level of inferior border of mandible suggestive of expansion of inferior border of mandible with sclerotic border on superior aspect and no sclerotic border inferiorly. Based on the clinical and the radiographic examination, differential diagnosis of odontogenic keratocyst, ameloblastoma, osteosarcoma and central giant cell granuloma were considered. Histopathological evaluation of the excisional biopsy specimen showed the presence of connective stroma containing numerous young fibroblasts as well as multinucleated giant cells. Trabeculae of osteoid and woven bone were also seen in the periphery. Numerous extravasated RBCs were present within the connective tissue stoma. These findings are suggestive of CGCG, but in order to differentiate this from brown tumor of hyperparathyroidism, we carried out blood investigation, to find the serum calcium, serum phosphorus and alkaline phosphatase levels, which are found within normal limits. Based on the above histological and investigational findings, a diagnosis of CGCG was given. Discussion Central giant cell granuloma is a benign intraosseous lesion of the jaws. Jaffe in the year 1953, described this intraosseous lesion as â€Å"central giant cell reparative granuloma†.1 Since there is not reparative process, the name â€Å"reparative giant cell granuloma† was denominated. The etiology and pathogenesis of CGCG is unknown, but the granulomatous process is induced by an exacerbated reparative process due to trauma and haemorrhage.3 Giant cell granuloma is considered as a benign proliferation of fibroblasts and multinucleated giant cells that occurs almost exclusively within the jaws. It is seen in all age groups ranging from 2 to 80 years, but more than 60% of the cases occurs under the age of 30 years.5 Although Sex distribution varies in different reviews, CGCG show female predilection with a prevalence of almost twice that of males.4 It commonly occurs in mandible ,anterior to the first molar ,often crossing the midline. It occurs in the short tubular b ones of hands and feet and also in the other bones of facial skeleton and cranial vault but rarely occurs in craniofacial bones. 6 It may be peripheral or central. The peripheral lesions occur as pedunculated or sessile lesions where the central lesion is endosteal. Females, children and young adults have more predilection since the female male ratio is 2:1.7, 8 The main etiological factor for this lesion is trauma. The lesion progresses by accumulation of tissue which due to slow and continuous haemorrhage of multicentric nature as a result of trauma and defect in the capillaries. 9 Though the CGCG is a benign lesion, it occurs as aggressive and non-aggressive types. The aggressive type shows painful and rapid growth occurs in younger patients and often involves cortical perforation and root resorption and may recur. The non-aggressive type is of slow growing, asymptomatic, without any resorption or perforation of the involved teeth and it never recurs.10 The signs of CGCG are a painless swelling, which causes facial asymmetry, where the radiological investigations reveals that there is unilocular or multilocular radiolucency, which is well or ill-defined with variable expansion along with destruction of cortical plate. Since the radiological appearance of this lesion is not pathognomonic, it is usually confused with the other lesions of the jaws. But the final diagnosis is based on its histopathology, though the clinical and radiological features are not specific.11 Histopathological features reveal that it is comprised of dense proliferation of oval or spindle shaped cells with varying number of multinucleated giant cells containing 20 nuclei. There is a deposition of hemosiderin, extravasted RBC’s, foci of osteoid material dystrophic calcification around the periphery of the lesion.12 Though multinucleated giant cells are in more in number, they cannot be considered as proliferative cells, since the macrophages, mesenchymal cells and fibroblasts are accountable for the growth of the lesion. Hence these cells release cytokines that stimulate the proliferation and recruitment of blood monocytes to become osteoclast like cells.13 The multinucleated giant cells may be large or small in number and they may be irregular or round cells that contains more than twenty nuclei which are responsible for bone resorption and local progression of lesion.14 The giant cells containing more nuclei and dese cellular stroma are found to be more aggressive and may relapse after surgical treatment.13 Some studies reveal a significant difference in the number of giant cells in aggressive and non-aggressive lesions where other studies reveal only few differences in the cell size in histomorphic analysis. Some of them found that the aggressive lesions show the higher number of giant cells with more irregular shape, where the giant cells are larger. There is a an increase in the mitotic activity along with a difference in histomorphic analysis which indicates increase in the fusion of resident macrophages and recruitment of monocytes and also there is higher metabolic activity of multinucleated giant cells that shows an aggressive clinical behavior.15 According to the differential diagnosis of the central giant cell granuloma , based on radiological investigation, being a small unilocular lesions it may be confused with granulomas and periapical cyst and the large multilocular lesions it may be ameloblastoma or lesions the resemble PGCL ,aneurysmal bone cyst, central odontogenic fibr oma, brown tumor of hyperthyroidism, giant cell tumor. The CGCG and brown tumor of hyperparathyroidism resembles each other histologically, in having an intense endogenous brownish pigmentation of hemosiderin. The additional test that help in diagnosis are serum calcium, phosphate, parathyroid hormone and alkaline phosphatase levels which are normal in CGCG, but increased in brown tumor of hyperparathyroidism. The CGCG usually occurs in both maxilla and mandible but the giant cell tumour more commonly occurs in the epiphyses of long bones. But both the lesions appear as osteolytic defects radiographically but can be differentiated histologically. Evidence reveals that the giant cells are larger, numerous and more round in giant cell tumor in CGCG, with a higher number of nuclei and eventually dispersed. There is fewer foci of osteoid material, areas of haemorrhage and there is deposition of hemosiderin and fibrosis and the stroma contains large and oval cells. The aneurysmal bone cyst can be differentiated from CGCG in having a network of multiple cystic cavities fill with blood within thin walls. Depending on the clinical and radiographic findings, if there is a well-defined lesion, curettage can be done where there is low recurrence, but if it is extensive lesion with perforated cortex, the radical excision is mandatory. Sometimes even partial maxillectomy or mandibulectomy and jaw reconstruction plates or placement of bone grafts can be done. Conclusion Based on the clinical, radiological, histopathological features, it is considered as an aggressive variant of CGCG, which is rare in occurrence. More clarification is needed regarding the pathogenesis and nature of giant cell lesions.

Life Experiences Are What Makes a Persons Personality Essay -- essays

Life Experiences Are What Makes a Persons Personality An individuals experiences, past and present provide a significant basis for the type of person they will become. Relationships that are established during childhood and adolescence are important for the shaping of someone's personality, as most personality development occurs in the early stages of life. Experiences that someone must deal with in the present sense also contributes to their personality. Dominick Birdsey in Wally Lambs novel I Know This Much Is True, suffered his entire life experiencing every emotion humanly possible in his current stretch of forty five years. The sad and stressful episodes of his life began to take their toll sending Dominick began to grow into a depression and question his reason for living. Dominick Birdsey, his twin brother Thomas, his mother Connie, and stepfather Ray, "Ray is not our real father. We don't know who our real father is. I don't even know if Ma knows." (91) live in Connecticut. Dominick and Thomas had to form an alliance to stand up to Ray, as he had a tendency to use his belt rather than words to punish. He was extremely strict, clearly in charge of the house, and showed little or no emotion, not even towards his wife. As a child of about eight years old, Ray has Dominick and his brother believing that part of being a man is not showing emotion, so the two grow up as little boys feeling very lonely, resulting in a lonely adulthood. The way Dominick remembers his childhood is feeling obligated to frequently rescue his brother from Ray's abuse. Ray was always much harder on Thomas as he felt he was a mamma's boy and had to be toughened up. "These days they called Ray's kind of 'toughening up' child abuse." (63) D... ...realize that all they have is each other. Ray regrets not expressing love towards both his wife and his sons and vows to grow old with Dominick and be the best father he knows how to be for the remainder of his life. Dominick Birdsey was clearly the stronger twin. All his life, from a child to a middle aged man, he had to take care of someone, namely his brother Thomas. It is very difficult to be constantly giving and getting nothing in return as such was the case with Dominick. Finally, to be showed love by Ray, (the one man who Dominick thought was incapable of love) Dominick accomplished a sense of rest and settlement. Perhaps the reason why Dominick was so strong was because he had to be, as people were dependent on him. His childhood and his everyday battles made him the person that he thought he would never become. He was finally in control of his life.

Prozac (Selective Serotonin Reuptake Inhibitors) :: Health Medicine Research Essays

Prozac (Selective Serotonin Reuptake Inhibitors) Selective Serotonin Reuptake Inhibitors have been approved for use in the treatment of a wide area of psychological disorders, including major depression, obsessive-compulsive disorder, bulimia nervosa, panic disorder, social phobia, post traumatic stress disorder, and premenstrual dysphoric disorder. They are also said to be effective in treating dysthymia and chronic depression. (Tollefson and Rosenbaum, 2001) The manufacturer of Prozac, Eli Lilly advertises that this drug is particularly effective in treating clinical depression, obsessive compulsive disorder, bulimia and panic disorder. The manufacturer argues that, "While Prozac cannot be said to 'cure' depression, it does help control symptoms of depression, allowing many people with depression to feel better and return to normal functioning." (Eli Lilly, www.prozac.com) The diminished side effects of Prozac and its overall effectiveness in treating depression, OCD, bulimia and panic disorder has made it the drug of choice for over two decades. More than this, many psychiatrists have attributed to the drug some amazing transformative properties above and beyond that of just diminishing the negative symptoms associated with depression. As one physician put it, "Prozac seemed to give social confidence to the habitually timid, to make the sensitive brash, to lend the introvert the social skills of a salesman." (Kramer, Peter, D., p. xvii, 1993) Indeed, he argued that Prozac made patients 'better than well' and actually served to transform personality. "The transformative powers of the medicine went beyond treating illness to changing personality, it entered into our struggle to understand the self." (Kramer, Peter, D., p. xviii, 1993) Prozac's approval for use for patients under the age of 18 has also been a particular selling point for Eli Lilly. As recently as summer 2004, NPR reported that the Journal of the American Medical Association showed that "Prozac, in combination with cognitive behavioral therapy, is highly effective for treating depression in teens. But the study also showed a small increase in 'harm-related behaviors,' including suicide attempts, among teens on Prozac." (Baron, National Public Radio, 2004, www.npr.org) Other doctors have been more cautious about the behavioral change benefits of Prozac. They warn that Prozac has produced some very serious side effects leading to several lawsuits against Eli Lilly. "These side effects include akathisia (a condition in which a person feels compelled to move about), permanent neurological damage, and suicidal obsession and acts of violence." (Null

The Descriptiveness of Conrads Heart of Darkness Essay -- Literary Ana

Heart of Darkness was written by Joseph Conrad in 1902. Before it was published it appeared in a 3-part series in Blackwood’s magazine. The story tells of a detailed incident when Marlow who takes over the assignment of the captain of a ferry-boat travels into the darkness. He was employed by the Belgian Trading company. Marlow is employed to transport ivory downriver; however while doing his job, he comes across a person called Kurtz to whom he has to give the ivories after he have collected them. Kurtz is a very reputed man throughout the region and is known by everyone. The novella starts as the main character Marlow at the Thames River in the evening with several other people and starts telling the story about how he entered into the Dark Continent. The novel is a critique to the manifest destiny which is a norm believed that Europeans were chosen by god to rule over the world and make colonies all over Asia and Africa. The Europeans behaved and acted like the kings of the world. They considered Africans as objects and not people. In the novel, Africans were merely used as a backdrop where Marlow—the main character can lay out his philosophical and existential struggles. The dehumanization is harder to identify then open racism or violence. Also, Conrad, through the book hypocrites his own country and blames them for dehumanization. When it comes to analyzing the novella—symbolic interpretations, character development and language are the three main topics to discuss. The novella is written in such precision and high detail that almost every paragraph has a very significant role to play in the overall plot. The story is created to illustrate ideas and themes, rather than just a simple narrative. The ideas and themes are consta... ...ughout the Heart of Darkness. One of them starts when the unnamed reader describes the ship Nellie, himself, his fellow mates on the ship and particularly Marlow. At first, the unnamed narrator is not sure to be a character in aboard on the ship until a few paragraphs until we realise that he has been observing others—â€Å"between us there was, as I have already said†. Marlow gradually takes over the narration beginning â€Å"and this also has been one of the darkest places on earth†. Later on in the novel, Conrad has Marlow take over the entire second monologue narrative. No matter how descriptive the book is, the basic facts still remain that Kurtz was the man who jumps off the edge of insanity and plunges into the dark of insanity. Whereas, Marlow is the man who goes to the edge of insanity, looks over the edge, and had enough strength to not go over to the other side.

Care and love Essay

However, this is when we contradict our first impression of him being a caring father, because no commendable father or even guardian will wait until morning to find out what is wrong with a child. Especially if previous events might have been the key to the survival of the child. We first see how he treats his daughter, Betty now we see the other responsibility he neglects, his niece; she is an orphan and should be treated with care and love. Instead he questions her commitment to the church and notes she was â€Å"dancing like heathen in the forest†; this testifies that he really does not care about his own flesh and blood, being an outcast of the church in this time was very dangerous: it was the centre of the community. Hale’s main interrogation method is to ask leading questions; therefore his victory of the debate whether Tituba was a witch or not. In the same way Parris asks leading questions to Abigail â€Å"What did you do with her in the forest?†. There is one thing about Parris though when dealing with minors he always is completely sure of who should take charge of the conversation.  Parris is quite selfish on numerous occasions he talks about himself more than Betty, by â€Å"my enemies† and the fact that â€Å"they will ruin me† does show some sort of over reaction. Getting frustrated over position and forgetting the main cause of the conversation driven to the point of believing a â€Å"faction swore to drive me out of my pulpit† we see definite troubles in Parris. The employment of a teenager nearing womanhood was very important it showed that you were respected if you became a servant in those days, Abigail had not been employed for a â€Å"seven month† but until this conversation he had always over-looked the matter and never inquired why as to she was sacked.  The Crucible reveals to us the modern day â€Å"tooth for a tooth†, Parris uses emotional blackmail, when he demands for an issue to be revealed in his favour he declares that he has â€Å"put clothes upon you back† this implies the use of emotional blackmail for getting something he wants; but putting clothes on your nieces back should not be a chore. Goody Putnam is the husband of a wealthy land owner, when she intervenes he shows a certain â€Å"deference† towards her for she is on the winning side of the community her husband is a rich land owner. Parris shows greed and hunger for money and status, he is easily â€Å"swayed† into agreeing with the Putnam’s that witches were among them in Salem we get the feeling of neglecting one self he is a man who thinks he is prosecuted everywhere, unpopular and mistrusted in the community.  Finally Parris makes a decision and indeed leaves in kin over money and power, he cleverly leaves Abigail in a complicated situation by stating â€Å"then you were conjuring spirits last night† he gives away his own kin for power and respect. Millers concern is that many in power are led astray by greed. Miller wants to have these people not in control of the public and it is people like Parris whom are dangerous and selfish  Goody Putnam and Parris have similar status she is a women she is married to a powerful landlord. Parris looks up to her and will believe anything, like her. In order to keep status.  Goody Putnam is directly portrayed as a â€Å"twisted soul† Miller makes us keep a open mind. We already get the gist of this. It means that a person who not trustworthy and has been through so much that they have become bended to one side of an argument. She has been described as â€Å"Death ridden† because she had lost all her â€Å"seven babies†. Later on we will learn how and why she acts in such a irresponsible and insane manner. When she first appears with play she is â€Å"shiny eyed† this gives us the opinion that she had just heard extraordinary news that Parris daughter had just flown over a barn. â€Å"How high did she fly† as a question shows clear stupidity for then or now anyone could have worked out for themselves they cannot. She indicates to Parris that the â€Å"devil† was right under his nose and in his household for there was a â€Å"stroke of hell† upon him and the â€Å"devil† was directly attacking him. Goody Putnam’s only daughter is â€Å"sick† as well and has the same sort of sickness as Betty, before thinking of a medical explanation she forces a recognition of witchcraft for the â€Å"devils touch† was on the children and was no natural cause for this illness.  This superstitious ignorance was terribly dangerous then: There could be a false accusation and someone’s life would pay the price these are Millers concerns. She does in some reference act like Hale. She is completely zealous in terms of supernatural causes but her reasons are not intellectual but ignorant. In depth we must look why, she believes she gave birth to seven â€Å"hearty babies† which suggest they were healthy. But â€Å"withered† in her arms. Now we could have a reason maybe a rare type blood disease for instance. At the time, a lack of science helped to sustain superstitious ideas  She is so immersed in her beliefs to the point that she sends her own daughter, Ruth to dance with the girls and try and â€Å"get closer† to her previous dead kids. This is entirely a kind of taboo. Since there is no other resource or explanation for these things at these times, the supernatural good and evil were heeded: the local doctor was â€Å"baffled† because the science was not advanced, not because the devil had intervened.

A study of anatomy and physiology of movement of upper limb

The procedure in lifting the hand to drink water is a complex one which involves a huge amount of technology inter-transfer between the brain and the eventual skeletal muscle.There is initiation of the movement at the brain which is transmitted via specialized white fibre tracts to the hip flexors via the intermediate spinal cord, involving a very complex mechanism at the cellular levelThe initiation of the   process is at the motor cortex (Ms I) of the brain. The primary motor area is located at the precentral gyrus of the frontal lobe. The area controlling the motion of the lower limbs lies towards the superior surface of the brain. Within this area lies the cell body of the primary neuron. These neurons are known as upper motor neurons (UMN).These UMNs receive modulating impulse from the inputs from the cerebellum and the basal ganglia via the extrapyramidal pathways. These tracts modulate the gross movement initiated at the frontal cortex. In turn these areas are modulated by a fferent signals from ascending spino cerebellar, and spino-thalamic pathways.   The signal initiated at the nucleus of the cell body is transmitted electronically via the axon of the myelinated neuron via the mode of salutatory conduction.The myelin sheath which surrounds the axon of nerves that involve fast transport, breaks at intermediate regions known as Nodes of Ranvier. The electrical impulse moves in   a jumping manner at these nodes nerve transmission as a neural impulse, generated by the formation of a nerve action potential. Like all excitable tissue, nerves maintain a resting membrane potential that is the difference of voltage across the membrane of the neuron. In neurons this value is   – 70 mV.This voltage difference is maintained by the Na/K pump on the membranes. This impulse generated at the axon hillock is transmitted via the depolarizing phase which allows sodium ions ingress into cells via opening of the Na channels. This entry of Na in one portion a llows activation of other Na channels, causing depolarization of the adjacent region of the neuron. Subsequently repolarization occurs via the opening of K channels, which restores the membrane potential.Thus this process continues which allows the transmission of impulse. Many such nerves together descend as the descending cortico spinal tract in the pyramidal system, which travels through the midbrain into the spinal cord, decussating at the level of midbrain( 90% of the fibres decussating and forming the lateral spinothalamic tract) and again at the level of spinal cord ( the other 10%, forming the anterior spinothalamic tract) .It is the former which is responsible for the upper limb movements. The cortico-spinal tract travels in the anterior horn cell of the spinal cord till the brachial plexus where they synapse with the spinal ventral root neuron (lower motor neuron). A single post-synaptic neuron receives signals from many neurons. At the axon terminal, the propagation of im pulses leads to release of neurotransmitters, which are stored in specialized vesicles.The released Ach diffuses into the synaptic cleft and binds with receptors on the post synaptic membrane to produce excitatory post synaptic potentials. This leads to generation and propagation of impulse in nerves which are destined to innervate the neuro-muscular junction. At the neuro-muscular junction, Ach is released, which diffuses into the synovial cleft and binds to receptors in the motor end plate, and triggers a muscle action potential.The released Ach is destroyed by the acetylcholinestrase. At the level of the sarcolemma of the muscles, the muscle AP travels along T-tubules, opening Ca release channels in the sarcoplasmic reticulum. Ca binds to troponin-tropomysin complex, which releases the myosin heads, these then bind to the actin thin filaments, and draws them closer to the M line. Meanwhile bringing the Z disc closer.This leads to muscle fibre contraction. This is a self propagati ng sequence eventually leading to the contraction muscles involved in the movement. Each nerve fibre innervates many musle fibres ( about 150). This is the motor unit.The greater the number of motor units recruited by the nerve action potential, the greater the force of contraction of the muscles. In the spinal cord, nerve impulse travels along the brachial plexus (C5 – T1) to innervate the Pectoralis major (Arm adduction and flexion – reaching out to hold the glass), Flexor digitorum superficialis and profundii of all fingers, the interossei and the lumbricals of all digits, opponens pollicis, flexor pollicis brevis , adducor pollicis and abductor pollicis brevis ( gripping of the glass by the fingers flexion at metacarpophalangeal.Proximal interphalangeal and the distal interphalangeal joint of the fingers; the carpometqcarpal joint, metacarpophalangeal and the interphalangeal joint of the thumb); then contraction of the biceps brachii ( elbow flexion) and the supina tor ( supination at the elbow joint); finally the contraction of the triceps muscle ( elbow extension, to put the glass back).This excitatory impulse is also associated with the production of inhibitory action potential ( hyperpolarizing impulse) in the antagonists (eg triceps during elbow flexion, and biceps during elbow extension)   

America’s Foundation

The United States Declaration of Independence written by Thomas Jefferson was a statement that was used on July 4, 1776 by the Continental Congress to declare the independence of thirteen American colonies from Britain. It entailed in part the following; political independence of every person as provided by natural law, right of revolution. By this, it implied that all Americans were entitled to equal rights and in cases where these rights were breached, anyone was entitled to revolt against the aggressor.Another part of the declaration was a list of charges against king George who was seen as having dishonored the rights of colonialist therefore was seen as unfit to govern. Lastly, the declaration stipulated conditions under which people could change their government and Britain situation offered a perfect example. Hence it called on to all colonies to throw off British Crown and claim their independence (Library of Congress, 1861, 865). The article of Confederation The article of C onfederation was the first governing constitution of America.The article sought to unite several States in America that were initially sovereign under the British regime. It was made in drafts with the last draft made in 1977 and adopted by Continental Congress on November 15, 1977. The article stipulated the rules and regulation to govern the new found United States confederation. Hence with the Article, United States was capable of making wars and settling interstates dispute diplomatically. Furthermore, United States was able to resolve issues concerning western territories.The articles were created with a view of providing freedom, Sovereignty and independence of America. With time, it was found that these articles were unable to provide sufficient provisions that would govern the country effectively hence a need for a detailed constitution that would replace the Confederation with the Federal. This paved way for the formation of a constitution in 1788 (Jensen, 1970, p 109). The constitution The constitution is the current governing body of law in United States of America.It is the supreme law of United States and is the source of legal authority fundamental to the existence of America and all its administrative and judicial bodies within it. It defines three arms of the government; the legislative led by Congress, an executive branch led by the President and judicial branch led by Supreme Court. In its description, it stipulates each branch powers that helps eliminate conflict of power during implementation. In addition, it established the federal system of government that gave individual states various rights.It was adopted on September 17, 1789 and has so far undergone twenty seven amendments (Hickey, 1853, 483) Comparison and Contrast between Articles of Confederation, Constitution and Declaration of Independence. There are various similarities and differences in the Declaration, Articles of Confederation and the Constitution. In comparison, all the ab ove three documents sought to provide the sovereignty and independence of United States of America. They stipulated that US was a sovereign state that was capable of making laws, negotiating diplomatic relations and setting up its own army.America, therefore, was free to trade and govern itself under its own laws without any external interference. All three document emphasized on basic human right. This was stipulated through the provision for freedom of movement and expression in the constitution and the Article of Confederation. Equality and sovereignty of each state was also equally stipulated in three documents. Above all, the document stipulated the rules and regulation that would hence fourth govern United States of America.Breach of which would lead to prosecution and there after a punishment. Similarity among the documents can also be seen in their way of formation where by; representatives from various states were chosen to draft them and later sign on the document to authe nticate them. In this sense, all the above three document are similar. Contrasts Among the notable differences are in levying taxes. In Articles of Confederation, Congress could only request various states to pay taxes but looking into the constitution, Congress has the right to levy taxes on individuals.On the Executive side, the Constitution provides the president with powers to choose cabinet members and has power to check on the powers of judiciary and legislature, however, the article provided the president with no executive powers and his role was only to preside over the Congress. On amending the constitution, two thirds of both houses of congress and three quarter of senate legislature are needed to amend the constitution under the provision of the current constitution compared to thirteen out of thirteen as provided by the Article.With the Article, it recommended that sovereignty remained within States however; the constitution states that it is the supreme law of the land hence sovereignty applies within the range of constitution. Regarding trade, Article provided no control of trade within states and no regulation what so ever was done between interstate trades. This implied that there was free movement of goods and services within states without government interference. However, constitution provides for regulation of trades between states and the power is bestowed to the Congress which oversees all these regulations.In formation of an army to provide military support, Article of Confederation awarded no right to the congress to draft troops that would participate in war. Hence, they had to rely on military contribution by various states. In the Constitution, Congress has the power to raise an army that would deal with any military emergency in the country. In conclusion, it can be asserted that without these three documents in US history, the legality of United States of America could be at stake and therefore, it would have become difficult to go vern all the states under one government.References Faber H. , Faber, Doris. (1987). We the People: The Story of the United States Constitution since 1787. New York: Scribner's. Hickey, W. (1853). The Constitution of the United States of America: With an Alphabetical Analysis; the Declaration of Independence †¦ Electoral Votes for All the Presidents and Vice-presidents: the High Authorities and Civil Officers of Government from March 4, 1789, to March 3. T. K. & P. G. Collins . pp 483. Jensen M. (1970).The Articles of Confederation: An Interpretation of the Social-constitutional History of the American Revolution 1774-1781. University of Wisconsin Press. Library of Congress (1861). Catalogue of the Library of Congress. Oxford University. Pp 865. Suksi M. (1993). Bringing in the People: A Comparison of Constitutional Forms and Practices of the Referendum. Martinus Nijhoff Publishers. US History. Articles of Confederation Vs the Constitution. http://home. earthlink. net/~gfeldmet h/chart. art Accessed on February 26, 2009.

Health information exchange Essay

The Health information exchange or also known as HIE is the sending of healthcare-related data electronically to facilities, health information organizations and government agencies according to national standards. The goal is to be able to access and retrieve data more efficient, safer, and to improve the quality of care and patient safety and reduce healthcare costs. The Health Information Exchange has existed for over two decades. In the 1990s there were attempts to organize networks. It began in 2006 by Governor Sonny Perdue. The U.S. Department of Health & Human Services is responsible for setting the standards for national health information exchange. The Health information exchange was created so that health care providers could use it to improve health care. Health care professionals are able to access your information, such as in an emergency situation, this way they can make informed decisions about your emergency faster. Also, your files are stored safely just in case your area is hit by national disaster. There are several benefits of the system. It helps to assist patients from receiving prescription medications to which they may be allergic. The HIE helps reduce medical errors. Health care providers are able to give you the care you need and it won’t interact with your other treatments. Because health care providers can see what tests you have had and the results, they don’t always have to repeat them. When your health information is shared electronically, information about access to your record is stored electronically. This helps to know who accesses your information, when, what and why. This helps the medical staff to check your records faster. Having faster access to your records helps healthcare providers find the information needed to diagnose health problems earlier, which gives them a more complete picture of your overall health. This leaves less room for error, more time with the patient. Not only are there the good benefits of the HIE, but there are the risks that come with it. Let’s start one a well-known problem, Identity theft. More people are also able to break into records and steal information, for example hackers. There are more known errors to occur. If your health care  provider does not enter the correct information, the information remains in the health record until it is corrected. Then there are also the concerns of privacy issues. This is when HIPPA comes into effect. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulates the privacy of health information exchange. The HIPPA reduces health care fraud and abuse. It protects the privacy of all individual’s health information. The HIE has privacy and security concerns. There is a privacy rule that all employees and health care providers should abide by. If you see a medical record in view where patients or others can see it, cover the file, or turn it over. When speaking about patients, try to prevent others from overhearing the conversation. Conversations about patients should be held in a private area. Do not discuss patients while you are in public areas. When medical records are not in use, they should be put away. Never remove the patient’s official medical record from your office. You should not leave records out where your family members or others may see it. If an y copies are made and not used they should be shredded. Privacy policies can be particularly hard for an HIE to deal with .There are efforts such as the government’s Connect project that provide guidelines for securing HIEs. Privacy laws vary from state to state giving complications for cross-state HIEs. The HITECH Act, part of the American Recovery and Reinvestment Act of 2009, has increased the penalties healthcare providers face if their systems are breached. There is a HIPAA privacy rule that provides federal floor of protection. One of the main challenges that HIE face is getting data to doctors and other clinicians. It is normally delivered directly to a providers’ EMR system, however with limited EMR use across the country, HIEs have had to provide alternative delivery methods. If an EMR isn’t compatible or if doctors don’t have systems, they can use a Web portal to see data. The problem with portals is that they force doctors to take an extra step to view data. Due to this doctors often end up using the HIE less as a result, and some provider groups decide the exchange isn’t worth the investment if their clinicians aren’t using it. With all the concerns about HIE, there are still more pros then cons. It benefits healthcare providers by reducing their operational costs. The system supports the retrieval of and access to clinical data. HIEs can improve payers’ ability to manage outcomes and reduce medical costs and increases accuracy of the information. www.himss.org/hieforums/ www.health.ny.gov/†¦health_information†¦/health_information_exch www.informationweek.com/healthcare/†¦/health-information-exchan www.myphr.com/healthliteracy/health_information_exchange.aspx www.himss.org/Asp/topics_News_item.asp?cid=67543&tid=33

Culture, Social Status and Identity in Viramontes' The Months and Essay

Culture, Social Status and Identity in Viramontes' The Months and Tan's Rules of the Game - Essay Example These stories are the same because they depict the cultural and social status of their characters, and the main protagonists want to mold identities that conflict with their society’s beliefs about womanhood, but they are different, because they discover dissimilar sanctuaries, where they can be, who they are, without being judged. These short stories are the same, because they portray the cultural and social status of the characters. The beliefs and practices of the protagonist in â€Å"The Moths† demonstrate that she comes from a conservative and patriarchal society. This society demands their women to be submissive and skilled in feminine tasks and values, such as crocheting. Her father, who she calls Apa, often gets angry with her, because she dislikes going to church. As part of their conservative and religious culture, they are expected to go to mass every Sundays, especially decent girls and women. But she does not does not like the church, because its â€Å"vas tness† makes her feel alone (Viramontes). Likewise, in â€Å"Rules of the Game,† Waverly’s Chinese is culture is very conservative, where hierarchies exist. On top of the family hierarchy are parents, who children will and should never disobey. When Waverly’s mother says this, she embodies the â€Å"strong wind† in her daughter’s life: â€Å"Strongest wind cannot be seen† (Tan). She cannot see her mother, who is always at her back, watching and commenting on her every move, not only in chess, but in real life. The social status of the characters is also evident in the settings of the story. The protagonist in â€Å"The Moths† lives in a place where superstitions are respected. Her grandmother mixes dried moth wings with Vicks to soothe her â€Å"bull hands† and shrink them back to normal size (Viramontes). Her grandmother also has stomach cancer, but they do not have money to pay for expensive therapies. Similarly, Waverl y lives in a poor community, although she is not aware that she is poor. They live on a â€Å"†¦two-bedroom flat that sat above a small Chinese bakery† (Tan). It signifies living in a cramped and controlled space, where Waverly cannot expect to express her freedoms. These stories are also the same, because the female protagonists challenge their cultures, in order to form their identities. The protagonist in â€Å"The Moths† does not believe in following cultural norms about womanhood. Instead of learning how to crochet, she learns how to plant with her grandmother. Her â€Å"bull hand† signifies that she does not fit with her society, because her personality, preferences, and beliefs oppose female stereotypes and Christian norms. When she smells the chile, she cries not only because of the chile’s spice on her eyes, but also because of herself. She is like a chile that hurts the feelings of her family, who wants her to be someone she is not. She is also compared to the â€Å"defiant† sun, because they both resist changing for others (Tan). When the sun meets the land during sunset, the union depicts that â€Å"endings† are windows to â€Å"rebirths† (Tan). But if she will be reborn, she will be the same pertinent and critical daughter that makes Apa angry and disappointed. Also, Waverly defies her culture, by becoming a great chess player and toppling every other man or boy she plays with. Moreover,